Your SlideShare is downloading. ×
0
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
imaging of gi system
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

imaging of gi system

2,576

Published on

Published in: Health & Medicine
0 Comments
9 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,576
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
311
Comments
0
Likes
9
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • R/o bowel obstruction
  • 腸子有傷口、會破的情形
  • 腸子有傷口、會破的情形
  • General: smooth wall, no defect
  • Transcript

    • 1. 1 Imaging of Gastrointestinal System 義大醫院 影像醫學科 李浩銘醫師
    • 2. Plain Photo EUS Fluoros copy Nuclear Medicine Ultrasound CT Scan MRI
    • 3. Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas
    • 4. • • • • Plain abdominal x-ray Technique : AP – Supine AP – Erect • • LLD Semi recumbent CXR Indication : Acute abdomen
    • 5. What to Examine ?? - Air (bowel gas) - Bone density - Calcification (stone / foreign body) - Soft tissue mass
    • 6. Air Sub diaphragm free air Bowel perforation
    • 7. Bowel obstruction AP-semi recumbent  LLD, horizontal AP-supine -dilated bowel loops -thickening of bowel wall -multiple air-fluid levels
    • 8. Ileo-cecal valve incompetent small and large bowel distention Bowel obstruction
    • 9. Mechanical large bowel obstruction Colon dilatation obstruction. Barium enema
    • 10. volvulus of sigmoid colon
    • 11. Bone density - Osteoporosis - Compression fracture
    • 12. Calcifications, stones Soft tissue mass
    • 13. Barium Enema (BE) Plastic irigator : 1. enema tip 2. enema tube 3. enema reservoir bag 4. balloon with it inflator. 1 4 4 2 1 3 4 4 2
    • 14. Colon Radiology Anatomy
    • 15. Technique & positioning A. Left lateral position : contrast filling rectum and rectosigmoid B. Left posterior oblique: contrast filling sigmoid
    • 16. C. Left lateral with 15o Trendelenberg position : contrast flow to descendent colon and splenic flexure D. Clockwise to prone position: contrast filling transversal colon
    • 17. E. Clockwise to right lateral with 15o Trendelenberg position : contrast filling the hepatic flexure F. From E, turn left to supine position : contrast filling hepatic flexure and ascendant colon
    • 18. Contrast Single Double Barium Barium + air
    • 19. Contrast Single Double Motility study Mucosa study Simple & relative safe More difficult
    • 20. Indication Double contrast BE Melena / bloody stool Cancer Suspected colonic polyp Family hx of colon ca / polyp Chronic diarrhea / bowel habit change IBD (inflamatory bowel disease) Pain & abdominal discomfort Diverticulosis
    • 21. Intussusceptions Hirschprungs disease Fatique / very old patient / serious illness Suspected pelvic metastasis Indication Single contrast BE
    • 22. Contraindicati on Suspect bowel perforation Toxic megacolon After colonic biopsy Pregnant Patient
    • 23. Complicati on Gas pain Colonic perforation/rupture Intramural barium Stool impaction Bacterial contamination Allergy / hypersensitivity
    • 24. Patient preparation Low residue diet Increased fluid intake Rectal or oral laxative Antispasmodic agent (if needed) 1. Glucagon: iv 0.5 – 1 mg 2. Buscopan: iv or im 1 amp (20 mg/mL)
    • 25. Record / filming Plain abdominal photo Spot photo Overhead whole abdomen Plain abdominal photo
    • 26. Barium Enema Single Contrast
    • 27. Spot film : Single contrast Rectum (left lateral) Hepatic flexure Sigmoid Splenic flexure Cecum
    • 28. Whole abdomen : single contrast Whole colon : overhead film
    • 29. Barium Enema Double Contrast
    • 30. Spot film : double contrast Rectum & sigmoid : Lateral position Supine position Prone position
    • 31. Spot film : double contrast Sigmoid : posterior oblique Distal descendant colon Proximal descendant colon
    • 32. Spot film : double contrast Splenic flexure (RPO) Transverse colon Erect position
    • 33. Spot film : double contrast Ascendant colon Hepatic flexure Erect position Erect position, LPO
    • 34. Spot film : double contrast Cecum & appendix Cecum & terminal ileum
    • 35. Overhead film : whole colon
    • 36. Hirschsprung disease Dilatation of proximal bowel with caliber change at rectum Transitional zone
    • 37. Intussusception Doughnut Sign
    • 38. Polyp Bubble  Filling defect
    • 39. Pedunculated Polyp Sessile Polyp Mexican hat sign
    • 40. Malignant polyp : villous type
    • 41. Apple core sign Colon cancer : annular type
    • 42. Colonic diverticulitis Colonic diverticulosis
    • 43. Ulcerative colitis Continuous lesion, lead pipe sign Segmental colitis Pancolitis
    • 44. Crohn’s disease Discontinuous skip lesion Fistula formation
    • 45. Colitis TB Rectal carcinoma Overhanging edges / shouldering Annular constriction Irregularity border
    • 46. Colonic polyp Filling defect on single contrast Soft tissue mass on double contrast
    • 47. Extraluminal tumor ileocecal intussusceptions (Coiled spring appearance)
    • 48. Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas
    • 49. Diffuse esophageal spasm: corkscrew esophagus 15
    • 50. Foreign body Mimicking tumor Intraluminal filling defect 16
    • 51. 17 Gastric wall filling defect Gastric carcinoma
    • 52. Linitis plastica 18
    • 53. 19 Additional shadow Duodenum diverticulosis
    • 54. 3. Small Intestines Barium follow through (Single Contrast) Enteroclysis (Double Contrast) 20
    • 55. Barium Follow Through • Patient fasting • Single contrast : 200 – 500 cc of barium suspension is given to drink • Followed by fluoroscopic or conventional x- ray. • Taken serial photo : 5‘ , 10’, 20’ etc. • Examination must be stop when barium filling the cecum. 21
    • 56. Enteroclysis = small bowel enema • Inserted the NG Tube (12F 135 cm long) • Maneuver catheter tip to the antrum  passing pylorus placed and fixation catheter tip in duodenal 3rd parts. • Contrast irrigation (+ methylcellulose) or air insufflating • Filming 22
    • 57. Normal follow through Enteroclysis - normal small bowel mucosa 23
    • 58. ascariasis in small intestine 24
    • 59. Take home message • ABCS in KUB • Single v.s Double contrast • Indication / Contraindication / Complication of barium enema
    • 60. Learn to be better !

    ×