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

2. 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

3. 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.

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

5. Plain X-ray Abdomen and Pelvis AP view

6. 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

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

8. 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)

9. 1-stomach
2-duodenum
اسم ورقم المقرر – Course Name and No.
4/27/2019

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

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

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

13. Rectum Sigmoid colon Descending colon Splenic flexure Transverse colon4 5 6
Rectum
Sigmoid colon
Descending colon
Splenic flexure
Transverse colon
Hepatic flexure
Ascending colon
cecum 3 7 2 8 1

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

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

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

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

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

19. 5 2 1 6 4 3
1- Rectum 2-Sigmoid colon 3-Descending colon 4-Ascending colon 5-Transverse colon 6-Cecum

20. 3 2 4 1 5 6
Descending colon
Splenic flexure
Hepatic flexure
Ascending colon
cecum
Sigmoid colon

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

22. Common plain x-ray abdomen radiograph findings

23. 57 year old male presents with abdominal distension and vomiting:
اسم ورقم المقرر – Course Name and No.
4/27/2019

24. 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

25. 50 year old male with known Crohn’s presents with an acute abdominal pain.
اسم ورقم المقرر – Course Name and No.
4/27/2019

26. 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

27. 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.

28. Coffee Bean Sign Sigmoid volvulus
Massively dilated sigmoid loop

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

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