Abdomen and Gastrointestin Al (Git) Imaging: Prof. Qurashi M. Ali

1
NUSU-ME-RAD-414-UNIT-5-GIT-Qurashi M Ali
ABDOMEN AND
GASTROINTESTIN
AL (GIT) IMAGING
PROF. QURASHI M. ALI
2
OBJECTIVES OF UNIT-5
 Review the techniques used in abdomen and GIT imaging.
 Review the normal imaging appearance and parts of abdominal viscera and
vessels.
 Identify abnormal developmental features of GIT components
 Diagnose hepatosplenomegaly, ascites, esophageal varices, strictures, achalasia
and carcinoma, gastric and duodenal ulcers and tumors, perforations, small and
large intestinal obstruction, volvulus, colonic cancer, diverticulitis, gallstones,
 Suggest a diagnosis in esophagitis, gastritis, pancreatitis, Crohn’s disease,
ulcerative colitis,
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IMAGING TECHNIQUES
RADIOLOGICAL USE OR INDICATION
TECHNIQUE
Plain radiography (neck, chest, Distribution of gases , calcifications and calculi
abdomen, pelvis, bones & radio-opaque foreign material
Contrast radiography Abnormal locations and size of viscera, ulcers,

Barium swallow, meal, follow-through, narrowing, (obstruction), perforations, masses,
enema
dirverticula, fistulas, etc
“Oral cholecystography”, Function, dilatation, obstruction, patency (pre-
Cholangiography (tranhepatic, t-tube), and post-operative), stones or masses
ERCP
Angiography Detect vascularity of organs and suspected
masses, effect of pathology on the size and
course of vessels
Sialography Salivary glands and ducts
Sinography External discharging sinuses
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IMAGING TECHNIQUES
 Ultrasonography
 Real time visualization of organs (liver, GB, pancreas, spleen), vessels, lymph nodes,
peritoneal spaces etc
 Measurements and localization for interventions
 Computed tomography (CT)
 Cross sectional anatomic display of organs and lesions
 Measurement and localization for interventions
 Magnetic resonance imaging (MRI)
 All-planes’ anatomic display of organs and lesions
 Functional display of tissues
 Measurement and localizations for interventions
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IMAGING TECHNIQUES
TAKE HOME ADVICE:

Start with ultrasound because it is:
quick, cheap, non-invasive and very
informative.
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IDENTIFY: 1,2,3,4,5,6
1
4
3 5
G 6
7
PLAIN ABDOMEN: Note psoas shadow (1), abdominal
viscera (2) and foreign body (3)
L
S
K
K
1 2 3
8
HEPATOSPLENOMEGALLY
L S
L S
S s
L
2 ABNORMAL
3
ABNORMAL
1
NORMAL
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ABDOMINAL EMERGENCIES
These include:
 Intestinal obstruction
 Intestinal perforation
 Gastrointestinal bleeding
 Acute abdomen: appendicitis, pancreatitis, stones, infarcted
bowel or visceral trauma.
 Rupture of urinary bladder into peritoneal space: occurs in
trauma when bladder is full.
ASCITES 10
3
PANCREATITIS 11
1 2 ABNORMAL SUPINE
NORMAL SUPINE
PERFORATION: Free air under diaphragm 12
2
1
13
INTESTINAL OBSTRUCTION
MULTIPLE FLUID LEVELS
1 2
14
PLAIN ABDOMEN [Localized
Ileus]
1 2
15
PLAIN ABDOMEN [Generalized Ileus]
1 2
DIAGNOSE 16
1 2
SUPINE VIEW UPRIGHT VIEW
PLAIN ABDOMEN [SUPINE] Small
Bowel Obstruction
1 2
NORMAL
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DILATED SMALL BOWEL
QUIZ-3 18
NUSU-ME-RAD-414-UNIT-5-GIT-Qurashi M Ali SUPINE VIEW

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PLAIN ABDOMENT [SUPINE + DECUBITUS] Free Air and SBO
1 2
UPRIGHT VIEW DECUBITUS VIEW
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PLAIN ABDOMEN [Large Bowel]
1 2 3
Constipation Fecal Impaction
PLAIN ABDOMEN [Small Bowel 21
Obstruction]
1 2
SUPINE VIEW UPRIGHT VIEW
PLAIN ABDOMEN [Large Bowel 22
Obstruction]
2
1
SUPINE VIEW
NUSU-ME-RAD-414-UNIT-5-GIT-Qurashi M Ali UPRIGHT VIEW
PLAIN & CONTRAST ABDOMEN 23
[Sigmoid volvulus]
2
1
24
PLAIN ABDOMEN [Sigmoid Volvulus]
UPRIGHT VIEW DECUBITUS VIEW

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CONTRAST AGENTS
 Water Soluble
 Gastrografin
 Low-osmolality
 Inert
 Barium sulfate
2
26
FlUOROSCOPY
 Real-time x-ray video

 Multiple sequential record images
 Spot films
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BARIUM SWALLOW
1
2
28
GASTRO-ESOPHAGEAL REFLUX DISEASE
[GERD]
HiatalHernia (HH)
Cricopharyngeus muscle
spasm
Reflux esophagitis
Benign stricture
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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
1 2
30
CRICOPHARYNGEUS MUSCLE
and Zenker’s Diverticulum
 Posterior wall of
pharyngoesophageal junction
 Normally relaxes with
swallowing to allow passage of
food
 Incomplete relaxation can be
seen as protective mechanism
in GERD patients
 Smooth impression at C5-6
level
1 2 3
COMMON ESOPHAGEAL 31
PATHOLOGIES
Reflux (1), benign stricture (2), achalasia (3), carcinoma (4,5)
3 5
1 2 4
Begins distally. Thickened [? Diffusely decreased or absent peristalsis,
Confluent] Distal or mid-esophagus, lower esophageal sphincter fails to relax,
smooth walls, may be smooth, tapered distal esophageal Barium studies are not as sensitive as endoscopy, but more
Folds. May have associated readily available
linear ulcers partially distensible narrowing, allows some passage of food
in upright position Suspect cases referred on to endoscopy
CT, MRI not suitable for screening
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ESOPHAGEAL VARICES
BARIUM MEAL-GASRIC 33
ULCER AND CANCER
1 2
CROHN’S DISEASE AND ULCERATIVE 34
COLLITIS
1 2
35
DIVERTICULOSIS
COLON CANCER- ANNULAR 36
CONSTRICTION [APPLE CORE], FOCAL
[MOTH-EATEN]
33
1 2
4
37
NORMAL GB ULTRASOUND
1 2
ULTRASOUND OF GALLBLADDER 38
DISEASE
1 2 3
Acute cholecystitis
Large and small gallstone with acoustic shadowing
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ABDOMINAL AORTIC
ANEURYSM
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ANATOMIC CROSS SECTIONS
1 2
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IDENTIFY: 1,2,3,4,5,6,7,8,9,10,16
IDENTIFY: 1,2,3,4,5,6,7,8,9,11,12, 42
13,15
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IDENTIFY: 1,2,3,4,6,7,8,9,10,11,12,13,14,15
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IDENTIFY: 1,2,3,7,8,10,13,16,17,19
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46
IDENTIFY: 1,2,3,4,5,6,7,8,9,10,16
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SUMMARY –UNIT-5
 The technique for Abdomen and GIT imaging have

been named and described.
 The basic imaging anatomic features of GIT
system, particularly in CT cuts of the abdomen.
 The imaging appearance of the following entities
have been outlined: esophageal lesions, hiatal
hernia, gastric ulcer, intestinal obstruction,
perforation, ulcerative colitus, colonic tumors.

Abdomen and Gastrointestin Al (Git) Imaging: Prof. Qurashi M. Ali

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1

Contrast radiography Abnormal locations and size of viscera, ulcers,

Sinography External discharging sinuses

TAKE HOME ADVICE:

SUPINE VIEW UPRIGHT VIEW

NUSU-ME-RAD-414-UNIT-5-GIT-Qurashi M Ali SUPINE VIEW

UPRIGHT VIEW DECUBITUS VIEW

 Real-time x-ray video

 The technique for Abdomen and GIT imaging have

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