GI Radiology

Dr. Wangju Sumnyan MD

Professor & HOD,
Department of Radiology & Imaging
TRIHMS
 IMAGING MODALITIES IN GIT
• Plain X-rays (Supine, Erect, Decubitus)
• Barium studies (Ba Swallow, Meal, Follow through,
Enteroclysis, Enema)

• Ultrasound Abdomen
• CT Scan/MRI Abdomen
• ERCP, Cholangiography.
• Angiography and Nuclear Medicine
 Plain Abdominal X-rays
• Erect Chest
• Supine Abdomen
• Erect / Decubitus Abdomen ( 10
min )
• Radiation Dose ( 1 Abd = 75 CXR)
• Contraindicated – pregnancy
 Indications.
• “Acute
• Abdomen”
Abdominal Pain.
• ?Obstruction.

• Not Indicated for:

– Trauma.
– Solid organ assessment.
Basic principle: radiographic densities

• Air Black

• Fat
• Water/soft tissue
• Calcium
• Bone
• Metal White
 Approach to a AXR
• Technical Assessment.
• Projection.
• Bowel/Gas Shadows.
• Normal/Abnormal Calcifications.
• Solid Organs.
• Look at lung bases and at the
skeleton.
 Normal Vs Abnormal Gas shadows
• Stomach. • Within the Lumen:
• Colon. – Dilated bowel ?
Obstruction
• Small Bowel.
• Outside the
Lumen:
– Free ?perforation
– In a cavity ?abscess
 Small bowel obstruction: Supine and upright abdominal radiographs
show disproportionate dilatation of small bowel (SB) with a relatively small
amount of colonic gas (C). There are air-fluid levels (arrows) with different
height in the same small bowel loops. Small bowel obstruction due to
adhesion
 Contrast Medium for GI
Water Soluble
• Ionic (gastrografin) Can •
lead to pulmonary edema if
aspirated.
• Non- Ionic ( Low
Non-water soluble
Barium
Can cause sever peritonitis and
fibrosis in perforation or
leakage.

Osmolar) Relatively safer

aspirated. if
• Gadolinium (MRI)
 Contrast Swallow
• Indications: • Contraindications:
• Dysphagia • Aspiration
• Pain Reflux
• Tracheo-esophageal fistula
• Perforation
 Barium Meal
• Indications: • Contraindications
• Dyspepsia • Complete large bowel obstruction
• Upper abdominal
• mass Weight Loss
• Gastrointestinal Hemorrhage. • Patient preparation:
• Partial Obstruction
• NPO ---6 hrs
• Assessment for perforation
• No smoking– increases GI
motility
 Anatomy on
upper GI study
 Small Bowel Follow through/ Small
bowel enema (Enteroclysis)
• Indications: • Contraindications
• Pain • Complete obstruction
• Diarrhoea
• Anemia/GI bleed
• Patient Preparation:
• Partial Obstruction
• Low residue diet
• Malabsorption
• Bowel Prep (Dulcolax -2-4 Tab)
• Abdominal mass
Small Bowel follow through VS Small bowel enema
 Barium Enema
• Indications: • Contraindications:
• Change in bowel habits • Rectal biopsy—5 days
• Pain • Toxic megacolon
• Mass • Pseudomembranous colitis
• Melaena / Anemia
• Single contrast – • Preparation: (Two days)
Obstruction & • Low residue diet
Intussusception. • Bowel prep (Dulcolax – 4 Tab)
 Ultrasound Abdomen
• Advantage • Disadvantage
• Operator dependent
• Cost effective • Poor in Obesity
• Adequate visceral visualization • Bowel gasses
• Best for GB • Bones / Calcifications
• No radiation

• Indications:
Acute Abdomen, Obstructive jaundice,
abdominal masses, collections, Free fluid,
follow up- tumors.
 4
1 2

Diagram showing the areas included in FAST (focused abdominal

sonography for trauma). These four areas are 1) perihepatic and
hepato- renal space, 2) perisplenic, 3) pelvis, and 4) pericardium.
 hydronephrosis

hydroureter

Hydronephrosis due to obstructed upper ureteric stone: Sagittal

ultrasound image of the right kidney shows dilated renal collecting system
and proximal ureter in a 57-year-old man presenting with acute renal
failure.
He had bilateral hydronephrosis due to obstructing ureteric stones.
 CT Scan Abdomen
•
Advantages • Disadvantages:
•
Accurate & quick • Radiation (250 CXR) Renal
•
Bowel/ gasses/ bones • failure
•
Reformation and angio • Contrast reaction
•
Indications: Acute abdomen,
Abdominal mass, tumor staging/follow
up, Appendicitis/abscesses, Post op
complications
 MRI Abdomen
• Advantages • Disadvantages
• Multiplaner • Bowel motion/ contrast
• Renal failure • Calcifications
• MRCP • Metallic implant
• Liver specific • Relatively long procedure time
contrasts • Claustrophobia
 Cholangiography
•
Endoscopic Retrograde • T-tube Cholangiography.
Cholangiopancreatography (ERCP)
• Percutaneous Transhepatic
• Cholangiopancreatography
MR
Cholangiography (PTC).
(MRCP)
GI
Radiology

THANK YOU