The problem of upper abdominal pain
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The problem of upper abdominal pain

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The lecture is dedicated to family physicians ,focusing on radiological approach to the clinical problem of upper abdominal pain.

The lecture is dedicated to family physicians ,focusing on radiological approach to the clinical problem of upper abdominal pain.

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The problem of upper abdominal pain The problem of upper abdominal pain Presentation Transcript

  • The problem ofUpper Abdominal pain Dr/Ahmed a. Bahnassy Consultant Radiologist RMH MBCHB-MSc-FRCR
  • Anatomical orientation
  • Aetiology: Pancreatic: Acute or chronic Pancreatitis. Hepatic: hepatitis, hepatic abscess. Gastric:gastritis Duodenal :Duodenal ulcer,duodenitis. Biliary :Cholecystitis,choledocholithiasis. Renal : stones,pyelonephritis. Aortic :Dissecting aortic aneurysm. Splenic: Infarction (Sickle cell crisis) Large bowel: Colitis. Referred pain :e.g.pneumonia,spondylosis.
  • Methods of Examination Plain x-ray Barium studies. Ultrasonography Computed tomography. Isotopic scan (e.g.: Cholecystitis) MRI :MRCP Arteriography.
  • Rationale of imaging Clinical data of the patient. ERCP/MRCP  Biliary colic Ultrasound  Epigastric pain with high serum amylase CT  Flank pain with haematuria US NECT/IVP  jaundice US Focal hepatic lesion No biliary duct dilatation Biliary dilatation Triphasic CT/MRI Pre/hepatic haundice ERCP/MRCP
  • Plain abdominal films Stones detection. Calcifications. Air under diaphragm.
  • Gall Stones and chronicPancreatitis
  • Gall stones
  • Pneumoperitoneum -Free air
  • Subphrenic Abscess
  • Contrast studies Evaluation of gastroesophageal junction abnormalities. Gastric ulcers and masses. Duodenal pathology.
  • Hiatal Hernia.
  • Giant Gastric ulcer
  • Duodenal ulcer
  • Ultrasonography. Gall bladder disease. Biliary radicle dilatation. Renal problems.
  • Acute Calcular Cholecystitis
  • Biliary dilatation
  • Hydronephrosis
  • Computed Tomography Pancreatitis evaluation. Focal hepatic lesions. Renal diseases. Aortic lesions. Bony lesions Trauma evaluation.
  • Acute Pancreatitis .
  • CT severity index
  • Acute pseudocyst
  • Pancreatic necrosis
  • The Focal Hepatic Lesion: Radiologic Assessment
  • Triple Phase Helical CT Axial C+ CT Axial C+ CT Axial C+ CT Arterial Phase Portal Venous Hepatic Venous Phase Phase Contrast Injection Arterial Portal Venous Hepatic Venous 0 15 30 45 60 75 Time (sec)
  • Liver Metastasis. Axial C+ CT Film Findings: Multiple hypoenhancingheterogenous lesions
  • Liver Abscess Axial C+ CT Film Findings: Well demaracatedhypoenhancing lesion Rim of increasedenhancement relative tocentral region
  • Complicated Hydatid cyst .water lilly sign
  • NECT  Left Right renal chronic stones pyelo- nephritis
  • Renal Abscess
  • Aortic Dissection Type B
  • Bony lesions :Lytic lesion in upperlumbar vertebra .
  • Abdominal trauma On evaluation, urgent life-threatening injuries, such as a large hemoperitoneum, a large or tension pneumothorax, or active arterial extravasation, should be sought out first. This should be followed by a thorough interrogation for injury of the abdomen and pelvis: liver and right paracolic gutter; spleen and left paracolic gutter; upper abdominal organs, arterial tree; retroperitoneum; small bowel, colon, and mesentery.
  • liver trauma 4-cm-thick subcapsular hematoma associated with parenchymal hematoma
  • Renal injury Subcapsular and perinephric haematoma.
  • Splenic trauma Splenic lacerations with perisplenic haematoma
  •  Clinical evaluation of the patient is the first step in the diagnosis. Choose the appropriate imaging modality.