Radiology (dra Bandong
GI Radiology
19 July 08
From doc Bandong\u2019s own words:
\ue000Ultrasound of the whole abdomen, there is
perforation, put in NPO for patients who have no
history of cholecystectomy. Because we want the
gallbladder to be distended in order to evaluate it.
\ue000The patient will not eat or have his breakfast, the
gallbladder will be contracted because of the bile
because you\u2019re bile contains those that will
breakdown the fat. Patient should be NPO atleast 4-6
hours.
\ue000Normal gallbladder: less than 5 cm in diameter
o
More than 5: hydrops
\ue000Normal wall of gallbladder: around 3 mm
o
Thickened wall with adjacent fluid in the GI wall:
cholecystitis
\ue000Ultrasound: stones will appear as white
\ue000X-ray: stones will also appear as white
\ue000Common radiographic finding for cholecystolithiasis
is: inter-luminal stones, wall would be thickened
\ue000Stones in common bile duct of gallbladder:
choledocholithiasis (please check kung tama, di ko
masyado maintindihan)
\ue000Stones in gallbladder: cholecystolithiasis
\ue000Stone in common bile duct: check intra-hepatic ducts,
particularly in region of area of the pancreatic duct
\ue000Liver is mainly supplied by portal vein.
\ue000Mass in liver: check portal vein if there is possibility of
metastasis or a visual____(may dumaldal, dko narinig
na haha) in CBD that would cause portal vein
thrombosis
\ue000Portal vein size: 1.2
\ue000CBD size: 0.7 cm
\ue000In patients with previous cholecystectomy, size of
CBD would be 1 cm.
\ue000In liver cirrhosis, the left lobe of the liver is enlarged,
right lobe would be smaller and the margin of the
conture of the liver would be nodular, epigenicity of
the liver parenchyma is coarsened (jassie on tape:
coarse? Coarse?) hahahaha\ue001.
\ue000Liver cirrhosis: Common feature: small liver with
nodular and coarsened pattern with ascites
\ue000Importance for requesting for MRI:
o
In patients who has acute renal failure, we
cannot give contrast materials because the
minimum contrast material to be given on CT
scan would be 16 ml, on MRI it\u2019s I think 5-10 cc.
\ue000Structure: barum enema or UGI series, but rule out
lower obstruction so barium enema first then UGI
series
\ue000Most common reason why (peste! Peste! Kahit sa
tape di sya maintindihan peste! Haha) emergency
request for UTZ for cholecystitis: because GB may be
distended more than 8-10 cm, surgical er may be
needed. Also to rule out stones in kidney or GB. And
to rule out if there is abdominal pain (WTF?!)
\ue000What are the common sonographic finding of acute
cholecystitis: thickened wall, possibly a stone, and
____shadowing
\ue000Acute pancreatitis: echomogenous (echomogenous?!
Wala na cranky na ko haha) enlarged pancreatitis or
possibility of pseudo-cyst, does not have severe
abdominal pain
\ue000Chronic pancreatitis and pancreatic CA have both
calcification on the pancreas. So rule out pancreatic CA first. But in some cases, there are different types of (tpos nawala na lang sya hahahaha)
\ue000Normal GB wall: less than 3mm
\ue000Status post cholecystectomy
\ue000Liver CA: rule out if there is PV thrombosis, the normal
size of the spleen is 11x5 cm. more than that: Ddx:
lymphoma or leukemia
\ue000Calcification in the liver and spleen: first impression
would be kidney (sobrang di cguro eto yung snabi
nya) if patient is Filipino
**natapos din! Churi churi I tried my best, but I guess my
best was not good enough. Haha. Natorture yung tenga
ko dun a. happy aral! Panimula palang yan kala nyo
haha!
\u2013isay-
ANATOMY
ESOPHAGUS
\ue000muscular tube
between
6th
vertebral
body (cricopharyngeus) and 10th - 12th thoracic vertebra (just below the diaphragm).
\ue000It measures 25-30cms in adults.
\ue000Esophagus is divided into 3 parts:
i)
cervical (5cm) - lies behind the trachea ,
ii)
thoracic (20cms) - extends from the
thoracic inlet into the posterior mediatinum;
and
iii)
abdominal
(1-3cms)
-
starts
where esophagus passes through the diaphramatic hernia.
3 esophageal constrictions
\ue000Uppermost - caused by cricopharyngeal muscle
\ue000Middle - where esophagus is crossed by aortic arch at
tracheal bifurcation
\ue000Lowermost - caused by gastroesophageal sphincter
at the esophageal hiatus of the diaphragm
STOMACH
shar
1 of 20
Radiology \u2013 GI Radiology by Dra Bandong
Page2 of 20
1. Body of stomach
2.Fu n d u s
3. Anterior wall
4. Greater curvature
5. Lesser Curvature
6.Cardi a
9. Pyloric sphincter
10. Pyloric antrum
11. Pyloric canal
12. Angular notch
13. Gastric canal
14. Rugal folds
Small Intestine
\ue000The is a tube measuring about 2.5 cm in diameter.
\ue000The complete small intestine is approximately 600 cm
(20 feet) long and coiled in loops, which fill most of
the abdominal cavity.
\ue000It extends from the pyloric sphincter to the ileocecal
valve
\ue000Duodenum -- approximately 25 cm long; proximal
end of small intestine; joined to stomach by the
pyloric sphincter.
\ue000Jejunum -- approximately 200 cm long.
\ue000Ileum -- approximately 300 cm long; joins the cecum
at the ileocecal valve
PLAIN FILM
*Top: Gas in the stomach
*Left: Free Gas in the small bowel
*Right: gas in the rectum/sigmoid
*Right: Always air-fluid level in the stomach
*Left: Few air-fluid levels in the small bowel
Radiology \u2013 GI Radiology by Dra Bandong
Page3 of 20
LARGE VS SMALL BOWEL
\ue000LARGE BOWEL
o
Peripheral
o
Haustral markings do not extend from wall to
wall
\ue000SMALL BOWEL
o
Central
o
Valvula extend across the lumen
o
Maximum diameter of 2\u201d
Abnormal gas patterns
\ue000Functional ileus
o
Localized (sentinel loops)
o
Generalized adynamic ileus
\ue000Mechanical obstruction
o
Small bowel obstruction (SBO)
o
Large bowel obstruction (LBO)
Air in
Rectum or
Sigmoid
Air in
Small
Bowel
Air in
Large
Bowel
Localized
Ileus
Yes
2-3
distended
loops
Air in
rectum
or
sigmoid
Generalize
d Ileus
Yes
Multiple
distended
loops
Yes-
distend
ed
SBO
No
Multiple
dilated loops
No
LBO
No
None \u2013
unless
ileocecal
valve
incompetent
Yes -
dilated
LOCALIZED ILEUS
\ue000May resemble early mechanical SBO
o
Clinical course
o
Follow up
GENERALIZED ILEUS
\ue000Gas in dilated small and large bowel down to the
rectum
\ue000Long air fluid levels
\ue000Only post-op patients have generalized ileus
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GI Radiology
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| Upload Date: | 02/20/2009 |
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