Gi radiology
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GI Radiology. Imaging modalities in GI. Plain X-rays (Supine, Erect, Decubitus) Barium studies (Ba Swallow, Meal, Follow through, Enteroclysis, Enema) Ultrasound Abdomen CT Scan/MRI Abdomen ERCP, Cholangiography. Angiography and Nuclear Medicine. Plain Abdominal X-rays. Erect Chest

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GI Radiology

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Gi radiology

GI Radiology


Imaging modalities in gi

Imaging modalities in GI

  • Plain X-rays (Supine, Erect, Decubitus)

  • Barium studies (Ba Swallow, Meal, Follow through, Enteroclysis, Enema)

  • Ultrasound Abdomen

  • CT Scan/MRI Abdomen

  • ERCP, Cholangiography.

  • Angiography and Nuclear Medicine


Plain abdominal x rays

Plain Abdominal X-rays

  • Erect Chest

  • Supine Abdomen

  • Erect / Decubitus Abdomen ( 10 min )

  • Radiation Dose ( 1 Abd = 75 CXR)

  • Contraindicated – pregnancy


Gi radiology

Indications.

  • “Acute Abdomen”

  • Abdominal Pain.

  • ?Obstruction.

  • Not Indicated for:

    • Trauma.

    • Solid organ assessment.


Gi radiology

Basic Principles

  • Five radiographic densities:

    • Gas/Air

    • Fat.

    • Soft Tissue/Water

    • Bone/Calcium

    • Metals

  • Interface/line only visible when two of these densities interface with each other.


Gi radiology

Approach to a AXR

  • Technical Assessment.

  • Projection.

  • Bowel/Gas Shadows.

  • Normal/Abnormal Calcifications.

  • Solid Organs.

  • Look at lung bases and at the skeleton.


Normal vs abnormal gas shadows

Stomach.

Colon.

Small Bowel.

Within the Lumen:

Dilated bowel ?Obstruction

Outside the Lumen:

Free ?perforation

In a cavity ?abscess

Normal Vs Abnormal Gas shadows


Contrast medium for gi

Water Soluble

Ionic (gastrografin) Can lead to pulmonary edema if aspirated.

Non- Ionic ( Low Osmolar) Relatively safer if aspirated.

Gadolinium (MRI)

Barium ( Non-water soluble)

Can cause sever peritonitis and fibrosis in perforation or leakage.

Contrast Medium for GI


Contrast swallow

Indications:

Dysphagia

Pain

Reflux

Anemia

Tracheo-esophageal fistula

Perforation

Contraindications:

Aspiration

Contrast Swallow


Barium meal

Indications:

Dyspepsia

Upper abdominal mass

Weight Loss

Gastrointestinal Hemorrhage.

Partial Obstruction

Assessment for perforation

Contraindications

Complete large bowel obstruction

Pateint preparation:

NPO ---6 hrs

No smoking– increases GI motility

Barium Meal


Small bowel follow through small bowel enema enteroclysis

Indications:

Pain

Diarrhoea

Anemia/GI bleed

Partial Obstruction

Malabsorption

Abdominal mass

Contraindications

Complete obstruction

Patient Preparation:

Low residue diet

Bowel Prep (Dulcolax -2-4 Tab)

Small Bowel Follow through/ Small bowel enema (Enteroclysis)


Gi radiology

Small Bowel follow through VS Small bowel enema


Barium enema

Indications:

Change in bowel habits

Pain

Mass

Melaena / Anemia

Single contrast – Obstruction & Intussusception.

Contraindications:

Rectal biopsy—5 days

Toxic megacolon

Pseudomembranous colitis

Preparation: (Two days)

Low residue diet

Bowel prep (Dulcolax – 4 Tab)

Barium Enema


Ultrasound abdomen

Advantage

Cost effective

Adequate visceral visualization

Best for GB

No radiation

Indications:Acute Abdomen, Obstructive jaundice, abdominal masses, collections, Free fluid, follow up- tumors.

Disadvantage

Operator dependent

Poor in Obesity

Bowel gasses

Bones / Calcifications

UltrasoundAbdomen


Ct scan abdomen

Advantages

Accurate & quick

Bowel/ gasses/ bones

Reformation and angio

Indications: Acute abdomen, Abdominal mass, tumor staging/follow up, Appendicitis/abscesses, Post op complications

Disadvantages:

Radiation (250 CXR)

Renal failure

Contrast reaction

CT Scan Abdomen


Mri abdomen

Advantages

Multiplaner

Renal failure

MRCP

Liver specific contrasts

Disadvantages

Bowel motion/ contrast

Calcifications

Metallic implant

Relatively long procedure time

Claustrophobia

MRIAbdomen


Cholangiography

EndoscopicRetrograde Cholangiopancreatography (ERCP)

MR Cholangiopancreatography (MRCP)

T-tubeCholangiography.

Percutaneous Transhepatic Cholangiography (PTC).

Cholangiography


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