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Abdominal Imaging Dr Catherine GriersonConsultant Abdominal Radiologist University Hospital Southampton
Abdominal Imaging Specific presentations Imaging strategiesGastrointestinal bleeding Inflammatory bowel disease Sepsis Imaging strategies
Gastrointestinal BleedingPresentations Gastrointestinal Bleeding
Gastrointestinal bleedingAcute Haematemesis Melaena ‘Bright rectal bleeding’ Collapse Chronic Anaemia
Acute gastrointestinal bleedingENDOSCOPY IMAGING CT angiography Conventional angiography CT
CT angiography Detects acute bleedingPatient needs to be actively bleeding (0.3ml/min) Requires rapid injection of large bolus of IV contrast (120 mls at 5 mls/sec) Consider: Renal function IV access
CT angiography Detects focus of bleeding in a blood-filled colonIdentifies small bowel source Clarifies upper GI or colonic origin Guides selective catheterisation for interventional radiologists
Conventional angiographyAdvantages over CT angiography View of vessels over longer time-period Bleeding may be evident as inject contrast into individual vessels THERAPEUTIC Inject coils, glue, embolic particles Place covered stents
Abdominal CT May be useful outside the context of active bleeding to find cause Particularly relevant in patients who cannot tolerate endoscopy Relatively insensitive
Causes of acute GI bleedingColorectal adenocarcinoma
Causes of acute GI bleedingVarices
Causes of acute GI bleedingLinitis plastica Ulcerated gastric tumour
Causes of acute GI bleedingSmall bowel adenocarcinoma
Causes of acute GI bleedingSplenic artery pseudoaneurysm
Chronic gastrointestinal bleedingLooking for underlying malignancy Predominantly Colon Small bowel Patients in whom optical colonoscopy not possible
CT colonography ‘Virtual fly-through’Sensitivity rates approaching those of colonoscopy for tumour and polyps > 6 mm
CT colonography Requires bowel preparation and ‘faecal tagging’Picolax + Omnipaque Gastrografin Carbon dioxide insufflation Buscopan IV
CT colonography Prone acquisition (low dose)Supine acquisition (+ IV contrast) Prone acquisition (low dose)
CT colonography 2D review
CT colonography 2D review 3D ‘fly through’ (x4)
CT colonography Current utilisation in UHS:Needs request by gastroenterologist or colorectal surgeon Indications: Failed colonoscopy (immediately or electively) Warfarin Patient request Frailer patients
CT colon ‘Minimal preparation’ CT colon5 x 25 mls gastrografin over 3 days Faecal tagging
CT colon (Extraluminal findings)Groin lymph nodes Abdominal aortic aneurysm Gallstones and GIST
Small bowel CT Oral mannitol IV contrast (Buscopan) ‘Negative’1500 mls Osmotic IV contrast Portal venous phase +/- Arterial phase (Buscopan)
Acute inflammatory bowel diseasePresentations Acute inflammatory bowel disease
Inflammatory bowel diseaseKnown IBD Complications Extent New diagnosis Make diagnosis Type Distribution
Diagnosing colitis Acute colitis on AXR
Diagnosing colitis Chronic colitis on AXR
Diagnosing colitis Colitis on CT: Type?
Diagnosing colitis Colitis on MR
Diagnosing Crohns diseaseTerminal ileitis on ultrasound
Diagnosing Crohns diseaseCrohns disease on fluoroscopy
Diagnosing Crohns diseaseDistal ileitis on CT
Diagnosing Crohns diseaseSmall bowel involvement on MR
Complications of IBD Terminal ileitis and abscess
Complications of IBD Perforated Crohns disease on CT
Complications of IBD Inflammatory mass on CT
Biliary sepsis Cholecystitis on ultrasound
Biliary sepsis Biliary obstruction
Biliary sepsis Portal venous occlusion on ultrasound
Biliary sepsis Gallbladder empyema
Biliary sepsis Liver abscess and biliary dilatation
Biliary sepsis MRCP
Urinary sepsis Hydronephrosis on ultrasound
Urinary sepsis Renal calculi on US Ureteric calculi on CT
Sepsis of unknown originDiverticulitis Psoas abscess
Conclusions Diverse uses for abdominal imaging in acute medical presentations Needs precise matching of modality to clinical question for maximum benefit
Imaging of IBD and Other Colitides
Inflammatory Bowel Disease Crohn’s Disease And Ulcerative Colitis.
GI Bleeding Scan รศ. พญ. มลฤดี เอกมหาชัย หน่วยเวชศาสตร์นิวเคลียร์ ภาควิชารังสีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่
Dr. Cynthia Walsh Department of Radiology. To learn the imaging modality best to SCREEN for Colon Cancer To learn the imaging modality best to SCREEN.
LOWER GASTROINTESTIRAL BLEEDING Asoc. Prof. Dr.Orhan Yalçın Ministry of Health, Okmeydanı Education and Research Hospital, Turkey.
CROHN’S DISEASE Alison Cunliffe. What is Crohn’s Disease? Chronic inflammatory disease of the intestines Causes ulcerations, breaks in the lining,
Abdomen and gastro - intestinal tract imaging Abdomen and gastro - intestinal tract imaging Dr. Jehad Fataftah Interventional Radiology Hashemite University.
NEW IMAGING TECHNIQUES IN THE EVALUATION OF CROHNS DISEASE Barry Daly, M.D. Department of Radiology University of Maryland School of Medicine.
Inflammatory Bowel Disease
Biliary Disease In this segment we are going to be talking about the identification and diagnosis of biliary disease using various image techniques.
VASCULAR & INTERVENTIONAL RADIOLOGY. INTERVENTIONAL RADIOLOGY Interventional radiology also known as Image-Guided Surgery or Surgical Radiology, is a.
Slides last updated: June 2015 CRC: CLINICAL FEATURES.
Lower Gastrointestinal Bleeding
BROOKLYN 3 MRI USER GROUP Cate HOLLINSHEAD Sat 31 st Aug 2013 Session 4 / Talk 1 15:25 – 15:45 ABSTRACT Magnetic Resonance (MR) Enterography has become.
ULCERATIVE COLITIS. Ulcerative colitis is an idiopathic chronic inflammatory disease of the colon that follows a course of relapse and remission. In a.
Managing Crohn’s Disease through Nutritional Intervention
Maryam Treifi Dr. Mircea Muresan Faculty of Medicine, UMPh Targu Mureș Department of Surgery Targu Mures County Hospital.
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas NICE CG March 2011.
CLINICAL AND ENDOSCOPIC CORRELATION OF INFLAMMATORY BOWEL DISEASE Coordinator: Prof. Univ. Dr. Simona Băţagă Students: Andra Oltean Stoica Ioan Adrian.
Iron deficiency anaemia Christian Selinger Consultant Gastroenterologist.
PR BLEEDING BY HELEN BERMINGHAM. MESENTERIC BLOOD VESSELS Coeliac trunk T12 foregut left gastric common heptic splenic SMA L1 midgut inferiorpancreaticoduodenal.
Flexible Sigmoidoscopy And Whole Colon Imaging In The Diagnosis Of Cancer In Patients With Colorectal Symptoms Peter O’Leary Journal Club 13/10/08.
Bile ducts Caroli disease Congenital Dysplasia with focal dialatations.
Imaging of the Small Bowel Carmen Meier, MD March 24, 2012.
COLORECTAL BLEEDING: A MULTIDISCIPLINARY APPROACH PATIENTS EVALUATION AND DIAGNOSIS: COLONSCOPY Stefania Caronna MD Dept. of Gastroenterology Molinette.
Radiology course Abdomen Clinical cases GASTROINTESTINAL.
Gastro Intestinal Bleeding By: Abdulrahman Sindi ED Resident.
Mechanical vascular and neoplastic abnormalities of the gut.
Finding Sources of Obscure Lower GI Bleeding William Kwan.
O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH.
Dr David Scott Gastroenterologist Tamworth Base Hospital
Dr. Angus Lee SET 1 General Surgery. Burrill Crohn, an American Gastroenterologist, with his 2 other colleagues first described “Terminal ileitis” in.
From Hemobilia to Hematochezia A 49-year-old woman transferred from an outside hospital because of severe hematochezia with a drop in hemoglobin from 14.
Ischemic Colitis Ri 陳宏彰.
A site specific approach to radiologic diagnosis
Computed Tomography II – RAD 473
Clinical Manifestations of Gastrointestinal Disorders Awni Taleb Abu sneineh.
Obscure GIT Bleeding By Dr. Mohamed Alsenbesy Assistan Prof. of Internal Medicine.
Review on enterocutaneous fistula
BASIC GI RADIOLOGY THE “FLAT” PLATE
Doreen Benary 3rd Year Medical Student NY Medical Programme, TAU Sheba MC, Internal Medicine 6 Head: Prof Avi Livne.
Virtual Colonoscopy to Screen for Colorectal Cancer Lawrence Fleming, M.D. June 23, 2004.
Interventional angiography Initial success rates for patients with acute peptic ulcer bleeding are between %, with recurrent bleeding rates of 10.
DIFFERENTIAL DIAGNOSIS 1.Colon Cancer 2.Colonic obstruction 3.Crohn’s Disease.
بسم الله الرحمن الرحيم Bowel Fistula ــــــــــــــــــــــــــــــــــ Dr.Saad Al-Qahtani Department of surgery College of medicine, King Saud University.
Introduction to Gastrointestinal System Dr.Yasir M Khayyat Assistant Professor, Consultant Gastroenterologist.
Faffing or fixing? (Part 2). Straight to theatre? Time to laparotomy Trauma centre127 mins NCEPOD200 mins –NO CT110 mins –CT499 mins NO CT group unstable.
Implementing NICE guidance
Indeterminate colitis Karel Geboes. Case History Male patient, ° : Hyperthyroidism 1996 : PSC 2003 : Ulcerative colitis –2006 : surveillance.
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