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GI Radiology.

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Presentation on theme: "GI Radiology."— Presentation transcript:

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).



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