1. GI Radiology

2. 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

3. Plain Abdominal X-rays
Erect Chest
Supine Abdomen
Erect / Decubitus Abdomen ( 10 min )
Radiation Dose ( 1 Abd = 75 CXR)
Contraindicated – pregnancy

4. Indications. “Acute Abdomen” Abdominal Pain. ?Obstruction.
Not Indicated for:
Trauma.
Solid organ assessment.

5. 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.

6. Approach to a AXR Technical Assessment. Projection. Bowel/Gas Shadows.
Normal/Abnormal Calcifications.
Solid Organs.
Look at lung bases and at the skeleton.

7. Normal Vs Abnormal Gas shadows
Stomach.
Colon.
Small Bowel.
Within the Lumen:
Dilated bowel ?Obstruction
Outside the Lumen:
Free ?perforation
In a cavity ?abscess

11. 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.

12. Contrast Swallow Indications: Contraindications: Dysphagia Pain Reflux
Anemia
Tracheo-esophageal fistula
Perforation
Contraindications:
Aspiration

14. Barium Meal Indications: Contraindications Pateint preparation:
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

17. 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)

18. Small Bowel follow through VS Small bowel enema

19. 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)

22. 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

27. 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

34. Multiple polyps

35. Apple core cancer on axial , volume randered (3D transparent image) and CT C images.

36. MRI Abdomen Advantages Disadvantages Multiplaner Renal failure MRCP
Liver specific contrasts
Disadvantages
Bowel motion/ contrast
Calcifications
Metallic implant
Relatively long procedure time
Claustrophobia

40. Cholangiography Endoscopic Retrograde Cholangiopancreatography (ERCP)
MR Cholangiopancreatography (MRCP)
T-tube Cholangiography.
Percutaneous Transhepatic Cholangiography (PTC).