Imaging in GIT

1. Plain X-ray

2. Contrast studies 3. US 4. CT 5. MRI

Plain X ray
Indications: 1. Acute abdomen (obst or non obst). 2. Abdominal colics. 3. Pre contrast study. Positions: 1. Abdomen erect & supine. 2. Abdominal lateral decubitus. 3. Chest (why?).

Causes:
A. GIT
1-Gut
Acute appendicitis Intestinal obstruction Perforated peptic ulcer Diverticulitis Inflammatory bowel disease Acute exacerbation of peptic ulcer Gastroenteritis Mesensteric adenitis Meckels diverticulitis
2-Liver and biliary tract

cholecystitis
cholangitis Hepatitis biliary colic

3-Pancreas 4-Spleen

Acute pancreatitis
Splenic infarct and spontaneous rupture

Causes:
B. Urinary tract
Cystitis Acute pyelonephritis Ureteric colic Acute retention

D. Abdominal wall conditions

Rectus sheath haematoma

E. Peritoneum

C. Vascular

Primary peritonitis Secondary peritonitis

Ruptured aortic aneurysm Mesenteric embolus Mesenteric venous thrombosis Ischemic colitis Acute aortic dissection

Causes:
F. Retroperitoneal
Hemorrhage e.g anticoagulants

H. Extra-abdominal causes
Lobar pneumonia Pleurisy MI Sickle cell crisis Uremia Hypercalcemia DKA Addisons disease Acute intermitent porphyria

G. Gynecological
Torsion of ovarian cyst Ruptured ovarian cyst Fibroid denegeration Ovarian infarction Salpingitis Pelvic endometriosis Severe dysmenorrhea Endometriosis

Plain X ray
Looking for
1. Gas pattern

2. Dilatation & air/fluid level.

3. Calcifications/stones 4. Soft tissue masses 5. Bones 6. Lung bases

Plain X ray I. Gas pattern

Distribution. Dilatation.

Air / Fluid Levels.

Normal Gas pattern

Stomach
Always

Small Bowel
Two or three loops of non-distended bowel Normal diameter = 2.5 cm

Large Bowel
In rectum or sigmoid almost always

Gas in stomach

Gas in a few loops of small bowel

Gas in rectum or sigmoid

Normal Gas Pattern

Plain X ray
Stomach

I. Gas pattern

Normal Fluid Levels

Always (except supine film)

Small Bowel
Two or three levels possible

Large Bowel
None normally

Plain X ray

I. Gas pattern

Intestinal obstruction
Clinical background. Diffuse of focal dilatation of the bowel. Multiple air/ fluid levels, > 5.

 Large Bowel
Peripheral

Large vs. Small Bowel

Haustra don't extend from wall to wall (incomplete rings) Diameter usually > 5
0

Small Bowel
Central

Valvulae extend across lumen (complete rings)

Diameter of 2

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

 Multiple

dilated SB.

No air/fluid levels.

Little or no gas in colon.

The findings are of mechanical SB Obst. The cause was adhesions of previous surgery.

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

Dilated colon splenic flexure.

No air/fluid level.

to

Little or no gas in rectum and SB. Findings are of mechanical LB Obst

The cause annular CA.

was

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

Multiple air-containing and slightly dilated loops of SB in the LLQ.

The findings are of localized ileus and their location suggest diverticulitis.

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

All the bowel (S & L) is dilated. Air is seen in rectum.

No air / fluid level.

This is generalized adynamic ileus as is seen sometimes after abdominal surgery.

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

All the bowel (S & L) is dilated.

Multiple air / fluid level.

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

 Multiple

dilated SB.

No air/fluid levels.

No gas in colon.
The findings are of mechanical SB Obst.

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

 Distended

sigmoid.

Air/fluid levels.

The findings are of mechanical LB Obst.

Sigmoid volvolus

1. Dilatation or no?

2. Distribution.
3. Air/fluid levels or no 4. SB or LB

 Multiple

dilated SB. air/fluid

Multiple levels.

No gas in colon. The findings are of mechanical SB Obst.

Mechanical small bowel obstruction

Duodenal atresia (double bubble sign)

DIAPHRAGM
Rupture of diaphragm scanogram) the left (CT

Plain X ray

II. Free Air

Perforated viscus:

Rupture of a hollow viscus Perforated ulcer Perforated diverticulitis Perforated carcinoma

Trauma (blunt or
iatrogenic)

Post-op 57 days

Plain X ray

II. Free Air

The Signs of Free Air Air under the diaphragm Air on both sides of bowel
wall

Chest erect: Air under the diaphragm in perforated viscous

Chest erect: Air under the diaphragm in perforated viscous

Air under the

diaphragm in perforated viscous

Does this patient have free air?

Plain X ray
Pattern

III. Calcifications

Rim-like

Linear or track-like
Lamellar Cloudlike

Rim like Ca

Wall of hollow viscus e.g GB Cyst e.g Renal cyst

Vascular: aneurysm

Rim like Ca

Gallbladder Wall

Renal Cyst

Linear or track like Ca

Wall of a tube:
o

Ureter.

Arterial wall

Linear or track like Ca

Atherosclerosis

Calcification Vas

Lamellar or laminar

Formed in lumen of a hollow viscus

Renal stones
Gallstones Bladder stones

Lamellar or laminar

UB stone

Renal staghorn stone

Cloud like, Amorphous, Popcorn

Formed in a solid organ or tumor

Leiomyomas of uterus

Ovarian cystadenomas
Pancreaic ca.

Cloud like, Amorphous, Popcorn

Nephrocalcinosis

Panc. calcificaion

Plain X ray

IV. Soft tissue masses

Look for

Bowel displacement Soft tissue tumefaction (shadow)

Edge of a soft tissue mass

The spleen projects well below the 12th rib and displaces the stomach to the right

Splenomegaly

Hours later

Bladder outlet obstruction-after catheterization, the dilated bladder returns to normal size. The bowel gas returns to pelvis.

Plain X ray
Looking for
1. Gas pattern

2. Dilatation & air/fluid level.

3. Calcifications/stones 4. Soft tissue masses

5. Bones 6. Lung bases

Thank You

Contrast studies
Barium : used in most studies , with
different composition according to part examined. : in suspected perforation or intestinal obstruction , in CT examination as barium will cause artifact .

Gastrographin

Lipidol in TOF .

Barium swallow
Indications:
Dysphagia Anaemia Pain Assessment of TOF Assessment of the site of perforation. Preoperative assessment of bronchial carcinoma Left atrial enlargement

Technique Technique

Cervical and dorsal esophagus. AP, Lateral, oblique. Gastro esophageal junction

Cervical esophagus

Mid & lower esophagus

Benign stricture
Smooth Zone of transition :
tapering Moderate to marked dilatation Causes: post corrosive ,peptic

Achalasia
Narrowing of the
lower end of the esophagus : parrot peak appearance . Dilated esophagus with air fluid level Absence of gas in the stomach

Achalasia

Dilated esophagus In plain film

Malignant stricture
Abrupt
Shouldering Mild to moderate dilatation above Irregular outline Mucosal destruction and intra luminal filling defects .

Ca of esophagus

Malignant stricture

Sliding hiatus hernia

Pouch of the
stomach more than 2 cm above the hiatus . Presence of 3 or more gastric folds +ve reflux .

Paraoesophageal hernia
Less frequent Gastro-esophageal

junction below the diaphragm Incarceration &bleeding

Varices

Worm like

serpigenous filling defects

Barium meal
AP View of the Stomach Left Posterior Oblique View of Gastric Antrum.

Supine View of the Entire Stomach & Duodenum.

Serial films for duodenum

Widened c shaped duodenal loop

Benign gastric ulcer

Ulcer niche
projecting outside the stomach ,mainly on lesser curvature Convergence of gastric folds towards ulcer edge

Benign gastric ulcer

Malignant ulcer
Non projecting ulcer . May formed within an intraluminal
mass Surrounded by excessive edema

Malignant ulcer

Linitis plastica

Barium meal follow through

Featheryappearance of jejunum

Smooth appearance of ileum

Crohns disease
Skip lesions Deep & shallow ulcers Can affect any part of the gut,

esp. terminal ileum. Causes mal absorption syndrome.

Barium Enema

carcinoma

Polyp
Rounded

filling defect Surrounded by barium

Colonic polyps

Colonic polyposis

Ulcerative colitis
Loss of haustra Superficial ulcers Wide prerectal
space Tubular colon of late ulcerative colitis .

Diverticular disease of colon

Acquired or congenital. Affect small or the large intestine. Acquired diverticula are more common

and consist of herniation of the mucosa and submucosa through the muscularis, usually at the site of a nutrient artery. Congenital diverticula are outpouchings of the entire thickness of the intestinal wall. Diverticula involve sigmoid colon in 95%.

Diverticular disease of colon

Diverticular disease of the colon

Thank You

Imaging in GIT

US
Screening for any
abnormality as bowel wall thickening or presence of mass related to the GUT .

Dilated renal pelvis, obstructing stone

Dilatation of the renal pelvis, calculous obstruction

Computed tomography CT
Indications:
Tumor: o To show exophytic component of the
mass. o Staging : presence of LN, direct infiltration. o Metastatic deposits :liver or lung Ischaemia (CTA). Inflammatory bowel disease. Intestinal obstruction.

CT abdomen

Occlusive stone in the renal pelvis, hydronephrosis

Computed tomography CT
Ischemic intestinal obst.

Computed tomography CT
Esophageal CA:
o To show exophytic
component of the mass. o Staging : presence of LN, direct infiltration. o Metastatic deposits :liver or lung

Computed tomography CT
Diverticular disease of the colon

Outpouches of colonic wall. Contain air, barium, or fecal material . Diagnosis of diverticulitis by using CT scans is based on the detection of colonic and paracolic inflammation in the presence of underlying diverticula .
.

Virtual Colonoscopy
It
is a recently developed technique uses a soft ware of the MSCT to look inside the body without having to insert a long tube (Conventional Colonoscopy) into the colon or without having to fill the colon with liquid barium (Barium Enema).

How to investigate abd case?!!

Plain X ray:
If If If If intest. Obst,: clinical correlation and CT. stones: IVP and US. Calcifications: CT negative------- CT

CT:

If bowel or stomach lesion:

CT

endoscopy, Barium,

Thank You