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GI Imaging PowerPoint Presentation

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Description : Check out this medical presentation on Digestive System, which is titled "GI Imaging", to know about Gastrointestinal Radiology.

Tags : Digestive System, GI Imaging, Gastrointestinal Radiology

Published on : Jul 10, 2021 | Views : 2828 | Downloads : 4

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GI Imaging
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Densities X-ray allows visualization of different densities -Air -Fat -Water -Metal
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Visualization of the Esophagus Different density required for visualization i.e.: contrast
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Contrast Agents Water Soluble Gastrografin Low-osmolality Inert Barium sulfate
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Single vs. Double Contrast Improved mucosal visualization
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Fluoroscope Real-time x-ray video Multiple sequential images Spot films
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Barium Studies (Video) Esophogram Barium Swallow UGI series Modified Barium Swallow
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Gastroesophageal Reflux
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GERD & Barium Visualization of refluxing barium Patient position Valsalva Usefulness is arguable
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GERD Secondary Signs Hiatal Hernia (HH) Cricopharyngeus muscle spasm Reflux esophagitis Benign stricture Barrett’s esophagus Aspiration pneumonia
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Hiatal Hernia Extension of stomach into chest through esophageal hiatus 2 types: Sliding 95% Para-esophageal 5% Not associated with GERD May be more prominent when supine
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Cricopharyngeous Muscle Posterior wall of pharyngoesophageal junction Normally relaxes with swallowing to allow passage of food Incomplete relaxation can be seen as protective mechanism in GER patients Smooth impression at C5-6 level
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Cricopharyngeous Muscle Spasm
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Reflux Esophagitis Begins distally Thickened folds May have associated linear ulcers
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Benign Stricture Distal or mid-esophagus Smooth walls May be partially distensible
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Barrett’s Esophagus In approx. 10% of untreated reflux patients Metaplasia of normal squamous epithelium to a gastric columnar epithelium Nodular or granular mucosa Look for focal ulceration, stricture, and cancer (15% or 30x increase)
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Barrett’s Esophagus
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Aspiration Pneumonia Appearance will vary with amount of aspirate, patient position, reaction to aspiration Often bilateral, associated atalectasis Posterior and basal areas more common
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Aspiration Pneumonia
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Aspiration
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Esophageal Cancer
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Detection Barium studies are not as sensitive as endoscopy, but more readily available Suspect cases referred on to endoscopy CT, MRI not suitable for screening
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Barium Swallow Patterns Annular constricting Most common Many variations Polypoid mass Infiltrative In submucosa, may simulate benign stricture Ulcerated mass
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Esophageal Cancer
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Esophago-bronchial fistula
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Tumor Staging CT most commonly used Endoscopic ultrasound in some centers
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Computed Axial Tomography
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Computed Axial Tomography
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CT Staging Wall thickness Infiltration of paraesophageal fat planes Regional invasion (trachea, pleura, pericardium, vertebrae etc…) Lymphadenopathy Distant Metastases
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Normal CT
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Invasive Cancer
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Endoscopic Ultrasound Smaller lesions Assess wall involvement
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Esophageal Motility
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Normal Motility Best seen prone 3 phases: Oral, pharyngeal, esophageal
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Esophageal Phase Primary wave: Initiated by swallowing reflex Secondary Wave: As response to esophageal distension
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Normal Swallow
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Abnormal Motility Non-specific finding Seen in reflux esophagitis, radiation injury, caustic ingestion, myxedema, diabetes mellitus…
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Corkscrew esophagus Tertiary esophageal waves Non-propulsive Corkscrew or beaded appearance
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Scleroderma Fibrosis of smooth muscle Dilated esophagus with widely patent GEJ Resultant reflux Reflux esophagitis => ulceration => stricture (mild) => Barrett’s => neoplasm
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Scleroderma
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Achalasia Diffusely decreased or absent peristalsis Lower esophageal sphincter fails to relax Smooth, tapered distal esophageal narrowing Some passage of food in upright position
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Achalasia
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Neuromuscular Disorders Most common => stroke Parkinsonism, Alzheimer’s, multiple sclerosis, CNS neoplasms, traumatic injury Modified barium swallow
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Zenker’s Diverticulum
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Zenker’s Herniation at posterior midline above UES Horizontal & oblique fibers of inferior constrictor muscles => Killian’s dehiscence Associated incomplete cricopharyngeus muscle relaxation Neck at superior aspect of sac Midline, but lateral extension with growth
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Zenker’s Diverticulum
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Zenker’s Diverticulum