Radiology of the abdomen Prepared by Dr Sarah Kamal Radiology lecturer اسم ورقم المقرر – Course Name and No. 4/27/2019

Learning objectives By the end of this lecture the student should be able to: Identify various radiological investigations used for GIT Formulate step wise approach in requesting GIT radiology investigations Define radiological appearance(anatomy)seen in various imaging modalities. Interpret plain x-ray radiograph of abdomen with common pathologies. Diagnose the common GIT pathologies presentation. اسم ورقم المقرر – Course Name and No. 4/27/2019

IMAGING MODALITIES: X-RAY. FLUOROSCOPY ( CONTRAST STUDY). ULTRASOUND. CT. MRI. NUCLEAR MEDICINE. ANGIOGRAPHY. Indications for MRI in abdominal pathology are malignancy, liver lesions, and MRCP. Nuclear Imaging: Patient injected with a small amount of radioactive drug. The drug is localized to a part of the body according to metabolic properties. Once there it decays emitting gamma radiation. This gamma radiation is picked up by a gamma camera.

Antero- posterior direction Commonly taken in supine position Antero- posterior direction اسم ورقم المقرر – Course Name and No. 4/27/2019

Plain X-ray Abdomen and Pelvis AP view

Normal Abdominal X ray AP view Gas in stomach Liver Splenic flexure 11th rib T12 Psoas margin Left kidney Hepatic flexure Transverse colon Iliac crest Gas in sigmoid Sacrum Gas in caecum SI joint Femoral head

Plain Abdominal X ray AP view Transverse colon stomach Small bowel cecum Descending colon Plain Abdominal X ray AP view

Fluoroscopy (contrast study) Can be used as first imaging modality. Cheap. Use of contrast. Recently replaced by CT and MRI Useful for intraluminal pathology. Can give clue about the motility (function)

1-stomach 2-duodenum اسم ورقم المقرر – Course Name and No. 4/27/2019

اسم ورقم المقرر – Course Name and No. 4/27/2019

Barium study (barium meal+ follow through) اسم ورقم المقرر – Course Name and No. 4/27/2019

اسم ورقم المقرر – Course Name and No. 4/27/2019

Rectum Sigmoid colon Descending colon Splenic flexure Transverse colon 4 5 6 Rectum Sigmoid colon Descending colon Splenic flexure Transverse colon Hepatic flexure Ascending colon cecum 3 7 2 8 1

Ultrasound Relatively cheap. No radiation. Limited uses (gas filled structures). Used in pediatrics and pregnant ladies Abdominal ultrasound

اسم ورقم المقرر – Course Name and No. 4/27/2019

CT ( computer tomography) Expensive. More radiation. Fast. Contrast (iv, oral &rectal) usually used. Used as an advanced imaging modality and in case of emergency.

اسم ورقم المقرر – Course Name and No. 4/27/2019

اسم ورقم المقرر – Course Name and No. 4/27/2019

5 2 1 6 4 3 1- Rectum 2-Sigmoid colon 3-Descending colon 4-Ascending colon 5-Transverse colon 6-Cecum

3 2 4 1 5 6 Descending colon Splenic flexure Hepatic flexure Ascending colon cecum Sigmoid colon

MRI ( Magnetic resonance imaging) More expensive than CT. No radiation. Slow and affected by artifacts.

Common plain x-ray abdomen radiograph findings

57 year old male presents with abdominal distension and vomiting: اسم ورقم المقرر – Course Name and No. 4/27/2019

This is a plain AP radiograph Bowel gas pattern: Multiple dilated loops of small bowel. No gas seen in large bowel. Conclusion- Findings are consistent with small bowel obstruction اسم ورقم المقرر – Course Name and No. 4/27/2019

50 year old male with known Crohn’s presents with an acute abdominal pain. اسم ورقم المقرر – Course Name and No. 4/27/2019

This is a plain PA radiograph Bowel gas pattern: crescenteric appearance on the underside of diaphragm otherwise normal Conclusion: Findings are consistent with extra-luminal gas (pneumoperitoneum) Best demonstrated on upright chest x rays or left lat decub اسم ورقم المقرر – Course Name and No. 4/27/2019

Apple core sign Radiologic manifestation of a focal stricture of the bowel usually at contrast material enema examination. The stricture demonstrates shouldered margins and resembles the core of an apple that has been partially eaten. The most common cause is an annular carcinoma of the colon.

Coffee Bean Sign Sigmoid volvulus Massively dilated sigmoid loop

Football Sign Seen with massive pneumoperitoneum Most often in children with necrotising enterocolitis In supine position air collects anterior to abdominal viscera

Thank you اسم ورقم المقرر – Course Name and No. 4/27/2019