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.

Published in: Health & Medicine

The problem of upper abdominal pain

  1. 1. The problem ofUpper Abdominal pain Dr/Ahmed a. Bahnassy Consultant Radiologist RMH MBCHB-MSc-FRCR
  2. 2. Anatomical orientation
  3. 3. 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.
  4. 4. Methods of Examination Plain x-ray Barium studies. Ultrasonography Computed tomography. Isotopic scan (e.g.: Cholecystitis) MRI :MRCP Arteriography.
  5. 5. 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
  6. 6. Plain abdominal films Stones detection. Calcifications. Air under diaphragm.
  7. 7. Gall Stones and chronicPancreatitis
  8. 8. Gall stones
  9. 9. Pneumoperitoneum -Free air
  10. 10. Subphrenic Abscess
  11. 11. Contrast studies Evaluation of gastroesophageal junction abnormalities. Gastric ulcers and masses. Duodenal pathology.
  12. 12. Hiatal Hernia.
  13. 13. Giant Gastric ulcer
  14. 14. Duodenal ulcer
  15. 15. Ultrasonography. Gall bladder disease. Biliary radicle dilatation. Renal problems.
  16. 16. Acute Calcular Cholecystitis
  17. 17. Biliary dilatation
  18. 18. Hydronephrosis
  19. 19. Computed Tomography Pancreatitis evaluation. Focal hepatic lesions. Renal diseases. Aortic lesions. Bony lesions Trauma evaluation.
  20. 20. Acute Pancreatitis .
  21. 21. CT severity index
  22. 22. Acute pseudocyst
  23. 23. Pancreatic necrosis
  24. 24. The Focal Hepatic Lesion: Radiologic Assessment
  25. 25. 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)
  26. 26. Liver Metastasis. Axial C+ CT Film Findings: Multiple hypoenhancingheterogenous lesions
  27. 27. Liver Abscess Axial C+ CT Film Findings: Well demaracatedhypoenhancing lesion Rim of increasedenhancement relative tocentral region
  28. 28. Complicated Hydatid cyst .water lilly sign
  29. 29. NECT  Left Right renal chronic stones pyelo- nephritis
  30. 30. Renal Abscess
  31. 31. Aortic Dissection Type B
  32. 32. Bony lesions :Lytic lesion in upperlumbar vertebra .
  33. 33. 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.
  34. 34. liver trauma 4-cm-thick subcapsular hematoma associated with parenchymal hematoma
  35. 35. Renal injury Subcapsular and perinephric haematoma.
  36. 36. Splenic trauma Splenic lacerations with perisplenic haematoma
  37. 37.  Clinical evaluation of the patient is the first step in the diagnosis. Choose the appropriate imaging modality.