Download Free Medical IMAGING OF THE ABDOMEN and THE GIT PowerPoint Presentation

IMAGING OF THE ABDOMEN and THE GIT PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Radiology and Imaging, which is titled "IMAGING OF THE ABDOMEN & THE GIT", to know about imaging of the abdomen and the git.

Tags : Radiology, Imaging, abdomen, git

Published on : Jul 28, 2021 | Views : 2671 | Downloads : 10

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

IMAGING OF THE ABDOMEN & THE GIT YEAR 4, MBBS Dr Azlin bt Sa’at @ Yusof Kulliyah of Medicine IIUM.
Slide 2-

CONTENTS  Imaging modalities: Plain XR Contrast studies Ultrasound Computed Tomography Magnetic Resonance Imaging Angiogram and interventional Others: ERCP,  PTC, intra-op & T-tube cholangiogram,  Radionuclide imaging – IDA, Meckel’s and GIT bleed.  Quiz and summary.
Slide 3-

PLAIN ABD XRAY
Slide 4-

Radiographic anatomy know where solid organs lie: intraperitoneal retroperitoneal – kidneys, adrenals, pancreas, psoas, IVC, Ao, lymph node. pro-peritoneal fat GIT Interpretation quality views: supine, erect, decubitus (usu lt side down) bowel gas pattern: normal gas : stomach and colon normal air-fluid level : stomach and proximal duodenum stomach – rugae; jejunum – feathery; small bowel – valvulae conniventes; colon – haustrations. PLAIN ABD XRAY (1)
Slide 5-

* Dilated? jejunum > 3.5 cm mid small bowel > 3 cm ileum > 2.5 cm tranverse colon > 5.5 cm caecum > 8 cm Psoas outline: symmetrical and slightly concave lateral borders. Renal outline : 10-12cm / 3.5 vertebral height. Bladder outline. Liver and splenic outline. Intraperitoneal fluid / collections. Calculi / calcifications : GB, kidneys, pancreas, lymph nodes, vacsular, phleboliths, tumoral. Soft tissue masses. Extra-luminal gasses. PLAIN ABD XRAY (2)
Slide 6-

(3) Various conditions * Bowel obstruction: Mechanical obstruction of the small bowel: small bowel dilatation with normal / reduced calibre of colon. Large bowel obstruction: dilatation of large bowel +/- small bowel dilatation. Paralytic ileus: large + small bowel dilatation +/- gas in sigmoid to rectum. Local peritonitis: dilatation of loops adjacent to inflammatory process  ‘sentinel loops’ PLAIN ABD XRAY (3)
Slide 7-

PLAIN ABD XRAY (4) * Bowel obstruction (cont.): Gasteroenteritis: normal / excess fluid levels / ~ paralytic ileus / ~small bowel obstruction. Small bowel infarction: obs of small or large bowel Closed loop obstruction: caecal/sigmoid volvulus – filled with air + char shape. obstructed hernias – fluid-filled, usu not visible. Toxic dilatation of the colon: maximal dilatation usu at transverse colon, lost/abnormal haustra +/- polypoid shadows.
Slide 8-

SUPINE ERECT Small bowel obstruction PLAIN ABD XRAY
Slide 9-

Large bowel obstruction Small + large bowel Toxic dilatation due to ulcerative colitis PLAIN ABD XRAY
Slide 10-

VOLVULUS
Slide 11-

Various conditions * Extra-luminal gas: Free intraperitoneal gas: causes – post-laparotomy (up to 7 days) perforated peptic ulcer IBD / infarction ERECT FILM! – air under diaphragm or lateral decubitus supine – gas outlining the falciform lig. gas on both sides of the bowel (Rigler’s sign) PLAIN ABD XRAY (5)
Slide 12-

PLAIN CXR Air under hemidiaphragm
Slide 13-

Free intraperitoneal air PLAIN ABD XRAY
Slide 14-

* Extra-luminal gas (cont.) - Intramural gas pattern: spherical – pneumatosis coli linear – infarction neonatal period – NEC PLAIN ABD XRAY (6) NEC PNEUMATOSIS COLI
Slide 15-

* Extra-luminal gas (cont.) - Gas elsewhere: * biliary system – following sphincterotomy / fistula (stone) / duodenal ulceration. * GB * kidneys *abscess *subphrenic PLAIN ABD XRAY (7) Kidneys Biliary tree Galbladder
Slide 16-

Subphrenic ???? PLAIN ABD XRAY
Slide 17-

*Ascites *Calcifications - phleboliths - vascular solid organs: liver, spleen, pancreas, adrenals, kidneys. tumours: fibroids, ovarian masses. soft tissue faecoliths. PLAIN ABD XRAY (8)
Slide 18-

Pancreatic Gallstones Appendicolith Uterine fibroid
Slide 19-

* Abdominal / pelvic masses PLAIN ABD XRAY
Slide 20-

CONTRAST STUDIES (1) General * Contrast material: - BARIUM vs GASTROGRAFFIN vs LOCM * Single contrast vs Double contrast Good opacification and coating BUT peritoneal leak  peritonitis Safe if ?peritoneal leak BUT hypertonic, lung irritant if aspirated and less opaque Safe if aspirated or leak BUT expensive and poor opacification and coating Oesophagus, small bowel and TRO Hirschprungs and obstruction only. (no need bowel prep) Ideal for stomach, and colon. Excellent mucosal detail.
Slide 21-

Basic terms: wall of the bowel -> not seen. mucosal folds: contracted -> folded distended -> valv conniventes / haustra abnormal -> ? smoothing / ? Irregular filling defect: Intra-luminal Intra-mural Extra-luminal CONTRAST STUDIES (1)
Slide 22-

Tapering ends vs. overhanging edges (shouldering) - Ulceration: - Stricture: persistent narrowing In profile En face CONTRAST STUDIES (2)
Slide 23-

Description: site of the abnormality what is its shape? how long? is there a soft tissue mass? CONTRAST STUDIES (3)
Slide 24-

(2) Barium swallow Barium swallow vs OGDS Method: - CONTROL FILM !!!! swallow while flouro, oblique position, films taken in full, collapsed +/- air-filled state. Normal: full  smooth outline collapsed  3-4 long straight parallel lines indentation  left: aorta and left bronchus  anterior: (L) atrium and ventricle peristalsis  smooth  elderly: pronounced and prolonged (3o contractions) CONTRAST STUDIES (4)
Slide 25-

Full Collapsed 3o contractions CONTRAST STUDIES (5) – Barium Swallow
Slide 26-

* Pathology: - Carcinoma (a) (b) CONTRAST STUDIES (6) – Barium Swallow
Slide 27-

Benign peptic stricture Achalasia Candidiasis CONTRAST STUDIES (7) – Barium Swallow
Slide 28-

Oesophageal web CONTRAST STUDIES (8) – Barium Swallow Leiomyoma Varices Ca bronchus
Slide 29-

(3) Barium meal * Method: - swallow barium then gas-producing agent, iv smooth muscle relaxant. various positions. Normal: - lesser curvature -> smooth, - greater curvature -> irregular, rugae duodenal cap -> triangular. CONTRAST STUDIES (9) – Barium Meal
Slide 30-

OGDS vs barium meal Pathology: - Hiatus hernia (b) Rolling CONTRAST STUDIES (10) – Barium Meal (a) Sliding
Slide 31-

- Linnitus plastica: adenoca, lymphoma, breast mets, battery acid ingestion, TB, Crohn’s and eusinophilic gastroenteritis. CONTRAST STUDIES (11) – Barium Meal
Slide 32-

Ulcers Benign Malignant Duodenal ulcer CONTRAST STUDIES (12) – Barium Meal
Slide 33-

Erosive gastritis CONTRAST STUDIES (13) – Barium Meal Polyps
Slide 34-

Carcinoma CONTRAST STUDIES (14) – Barium Meal
Slide 35-

Normal barium follow-through and SBE: continuous column < 2.5cm diam. transverse folds appear as filling defect 2-3mm width. If filled  transverse lines If collapsed  feathery folds are most in the jejunum, least in the ileum. CONTRAST STUDIES (15) – Barium follow-thru’ & Small bowel enema (4) Barium follow through and small bowel enema * Differences in method: - Barium follow through vs. SBE / enteroclysis - time-consuming procedure (2-3 hrs) require nasoduodenal intubation shorter time - excellent mucosal detail - view terminal ileum!
Slide 36-

Normal barium follow through SBE / Enteroclysis CONTRAST STUDIES (16) – Barium follow-thru’ & Small bowel enema
Slide 37-

Malabsorption SMALL BOWEL LYMPHOMA CONTRAST STUDIES (17) – Barium follow-thru’ & Small bowel enema
Slide 38-

Malrotation Crohn’s CONTRAST STUDIES (18) – Barium follow-thru’
Slide 39-

Lymphoma Worm infestation CONTRAST STUDIES (19) – Barium follow-thru’
Slide 40-

Barium enema barium enema vs. colonoscopy (vs. CT colonoscopy) Method: - Bowel prep! Control film! Double contrast: Rectal tube, infuse barium, drain, pump air. Normal: - Length variable +/- redundant loops. calibre decreases from caecum to sigmoid colon. ileocaecal valve may cause filling defect. haustra may be absent in descending and sigmoid regions. CONTRAST STUDIES (20) - Barium Enema
Slide 41-

Normal barium enema CONTRAST STUDIES (21) - Barium Enema
Slide 42-

Diverticulosis CONTRAST STUDIES (22) - Barium Enema
Slide 43-

Polyposis coli CONTRAST STUDIES (23) - Barium Enema
Slide 44-

Carcinoma ‘Apple core’ appearance CONTRAST STUDIES (24) - Barium Enema
Slide 45-

TUBERCULOSIS INVOLVING BOWEL
Slide 46-

Strictures: # ca, diverticular ds, Crohn’s, ischaemic colitis, TB, lymphogranuloma venereum, amoebiasis, radiation. ‘THUMBPRINTING’ (amoebiasis) Diverticular disease CONTRAST STUDIES (25) - Barium Enema
Slide 47-

Crohn’s dz: # most freq inv lower ileum and colon # early: - loss of haustration, narrowing and shallow ulceration. # ulcer + mucosal oedema  ‘cobblestone’ # later: deeper ulcer  ‘rose-thorn’ or fissures. # cx: - intra or extra-mural abscesses. fistulae. strictures: smooth and tapered ends. when caecum inv  markedly contracted. CONTRAST STUDIES (26)
Slide 48-

Ulcerative colitis: - similar to Crohn’s dz BUT (see below) CONTRAST STUDIES (27)
Slide 49-

CROHN’S DS (aphtous) Deep ulcer with tracking in the submucosa Shallow ulcers Skip lesions CONTRAST STUDIES (28)
Slide 50-

ULCERATIVE COLITIS Loss of haustra CROHN’S Recto-vaginal fistula CONTRAST STUDIES (29)
Slide 51-

Hirschsprung’s ds Intussusception CONTRAST STUDIES (30)
Slide 52-

ULTRASOUND General considerations preparation normal anatomy: solid organs + biliary tree + vessels + lymph nodes. echogenicity: pancreas, liver, spleen, kidney. hyper hypo appearances of various tissues: fat = hyper; fluid = hypo with posterior acoustic enhancement; calculi/ bone = hyper with post ac shadowing; gas = shadowing.
Slide 53-

NORMAL: Liver Pancreas Spleen Kidney
Slide 54-

Gallbladder Aorta & IVC Lymph nodes NORMAL:
Slide 55-

Oesophagus Stomach Small bowel Gas in bowel NORMAL:
Slide 56-

Cirrhosis PATHOLOGY: Abscesses Metastases Lymphoma
Slide 57-

Cyst PATHOLOGY: Ascites PV thrombosis Cholecystitis with calculi
Slide 58-

COMPUTED TOMOGRAPHY & MAGNETIC RESONANCE IMAGING (1) General considerations Differences between CT and MRI. Windowing in CT, and sequences in MRI. Various densities in CT and intensities in MRI. CT MRI T2W T1W
Slide 59-

COMPUTED TOMOGRAPHY & MAGNETIC RESONANCE IMAGING (2) Pathology Hepatic cysts CT MRI T1W T2W
Slide 60-

NECT Contrasted CT T2W MRI COMPUTED TOMOGRAPHY & MAGNETIC RESONANCE IMAGING (3) Haemangioma Pancreatic Ca 6 months later Post-op 3 months later
Slide 61-

ANGIOGRAPHY & INTERVENTIONAL RADIOLOGY (1) Types: Flush aortogram Inferior vena cavogram / SVCgram Selective: (according to vessels) hepatic artery, renal, spleen, pancreas, coeliac axis, SMA, IMA, uterine artery. may include intervention:  chemoembolization, coil/glue embolization, stenting. Indications: tumour / haemangioma, bleeding, pre-op … etc
Slide 62-

ANGIOGRAPHY & INTERVENTIONAL RADIOLOGY (2) Late phase MULTIFOCAL HEPATOMA ANGIOMA Post-embolisation Arterial phase
Slide 63-

OTHER IMAGING METHODS (1) (1) Endoscopic retrograde cholangio-pancreatogram Stone Stone (2) Percutaneous transhepatic cholangiogram
Slide 64-

OTHER IMAGING METHODS (2) (3) T-tube cholangiogram (4) Radionuclide imaging (I) GIT bleed (II) IDA scan
Slide 65-

MECKEL’S DIVERTICULUM
Slide 66-

THE END !