Professional Documents
Culture Documents
Imaging of The Abdomen & The Git: Year 4, Mbbs
Imaging of The Abdomen & The Git: Year 4, Mbbs
(2) 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 (2)
* Dilated? - jejunum > 3.5 cm
- mid small bowel > 3 cm
- ileum > 2.5 cm
- tranverse colon > 5.5 cm
- caecum > 8 cm
* Bowel obstruction:
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 (4)
* Bowel obstruction (cont.):
Gasteroenteritis:
- normal / excess fluid levels / ~ paralytic ileus / ~small
bowel obstruction.
SUPINE ERECT
* Extra-luminal gas:
- Free intraperitoneal gas:
Subphrenic
????
PLAIN ABD XRAY (8)
*Ascites *Calcifications
- phleboliths - vascular
- solid organs: liver, spleen,
pancreas, adrenals, kidneys.
- tumours: fibroids, ovarian
masses.
- soft tissue
- faecoliths.
Pancreatic
* Contrast material:
- Ulceration:
In profile En face
CONTRAST STUDIES (3)
Description:
- site of the abnormality
- what is its shape?
- how long?
- is there a soft tissue mass?
CONTRAST STUDIES (4)
(2) Barium swallow
(a) (b)
CONTRAST STUDIES (7) – Barium Swallow
Candidiasis
CONTRAST STUDIES (8) – Barium Swallow
Ca bronchus
Leiomyoma
Benign
Malignant
CONTRAST STUDIES (13) – Barium Meal
* Differences in method:
- Barium follow through vs. SBE / enteroclysis
- time-consuming - require nasoduodenal
intubation procedure (2-3 hrs) - shorter time
- excellent mucosal detail
- view terminal ileum!
SBE / Enteroclysis
CONTRAST STUDIES (17)
– Barium follow-thru’ & Small bowel enema
SMALL BOWEL
Malabsorption LYMPHOMA
CONTRAST STUDIES (18)
– Barium follow-thru’
Crohn’s
Malrotation
CONTRAST STUDIES (19)
– Barium follow-thru’
Diverticulosis
CONTRAST STUDIES (23) - Barium Enema
Polyposis coli
CONTRAST STUDIES (24) - Barium Enema
Carcinoma
‘Apple core’
appearance
TUBERCULOSIS
INVOLVING
BOWEL
CONTRAST STUDIES (25) - Barium Enema
Strictures: # ca, diverticular ds, Crohn’s, ischaemic colitis, TB,
lymphogranuloma venereum, amoebiasis, radiation.
‘THUMBPRINTING’
(amoebiasis)
D
i
CONTRAST STUDIES (26)
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 (27)
Ulcerative colitis:
Shallow ulcers
(aphtous)
Skip lesions
CONTRAST STUDIES (29)
CROHN’S
Recto-vaginal fistula
ULCERATIVE COLITIS
CONTRAST STUDIES (30)
Hirschsprung’s ds
Intussusception
ULTRASOUND
(1) General considerations
- preparation
Pancreas
Liver
Spleen
Kidney
NORMAL:
Gallbladder
Aorta
&
IVC
Lymph nodes
NORMAL:
Oesophagus
Stomach
Small bowel
Gas in bowel
PATHOLOGY:
Cirrhosis
Abscesses
Metastases
Lymphoma
PATHOLOGY:
Cyst
Ascites
PV thrombosis
Cholecystiti
s with
calculi
COMPUTED TOMOGRAPHY &
MAGNETIC RESONANCE IMAGING (1)
(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
COMPUTED TOMOGRAPHY &
MAGNETIC RESONANCE IMAGING (2)
Pathology
Hepatic cysts
T1W
CT
MRI
T2W
COMPUTED TOMOGRAPHY &
MAGNETIC RESONANCE IMAGING (3)
Haemangioma
Pancreatic Ca
ANGIOMA
OTHER IMAGING METHODS (1)
(1) Endoscopic retrograde cholangio-pancreatogram
Stone
Stone
OTHER IMAGING METHODS (2)