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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)

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Presentation on theme: "GI Radiology. Imaging modalities in GI Plain X-rays (Supine, Erect, Decubitus) Barium studies (Ba Swallow, Meal, Follow through, Enteroclysis, Enema)"— 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

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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: Dysphagia Pain Reflux Anemia Tracheo-esophageal fistula Perforation Contraindications: Aspiration

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14 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

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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)

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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

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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

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

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

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