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The radiological
methods of the
gastrointestinal system
examination
The main methods of
examination
- Fluoroscopy
-Radiography
-CT
-MRI
-Ultrasound
-Radionuclide methods (PET, SPECT)
The special contrast methods
- Double contrasting
- Pneumoparietography of the stomach
The X-ray anatomy and
examination of esophagus
- Width – 1,5-2 см ;
- Length – 25-26 см;
- The parts of esophagus:
А) cerv...
Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice
- Three physiologic narrowings:
А) at the level of cricoid cartilage;
Б) at the level of aortic arc;
В) at the level of ca...
peristalsis
narrowing (arc)
cardia
parallel
The folds of mucosa – parallel, longitudinal;
longitudinal
The X-ray anatomy and
examination of the stomach
1. The survey fluoroscopy.
2. The first stage of examination – the
patien...
4. The stomach peristalsis:
- Superficial;
- Medium depth;
- Deep;
- Segmental;
- The velocity of peristaltic wave is 21 s...
trendelenburg
Double-contrast gastrography
5. Parts of the stomach:
- Fundus;
- Cardiac part;
- Body;
- Sinus (or angle);
- Antrum;
- Pyloric part;
- Minor and major...
Ultrasound and MRI of the stomach is assigned
fairly rare, due to the fact that the procedure is
less effective for cavity...
Ultrasound of the stomach
 Ultrasound of the stomach is not included in the number of
studies performed during a standard...
 Computed tomography of the stomach is used
mainly for the detection of neoplastic diseases of
the stomach. .
 During th...
. normal
Stomach wall thickening . Endoscopy was suggested
for biopsy.Biopsy - Carcinoma
The x-ray anatomy and examination
of duodenum and small intestine
1. The duodenum comes after stomach
and it has three par...
2. Small intestine:
- duodenum;
- jejunum;
- ileum;
- Kerckring's folds of the mucosal layer.
N
The X-ray anatomy and
examination of large intestine
1. The methods of examination:
- Per os;
- Irrigoscopy – contrast ene...
2. X-ray anatomy and parts of the large
intestine:
- Caecum;
- C. ascendens;
- C. transversum;
- C. descendens;
- C. sygmo...
3. Irrigoscopy:
- The first stage of examination – tight
filling of the bowel.
А) shape;
Б) size;
В) localization.
- The s...
N
Double-contrast irrigoscopy
MRI of the internal organs - a method of
medical research , which is to apply a
magnetic field to produce images and three...
MRI
Sometimes, during a bowel MRI uses a special ingredient - a contrast that
promotes visualization of certain structures...
The pathology of the
gastrointestinal tract
1. Esophagus:
- Esophageal diverticuli:
А) pulsational;
Б) tractional;
В) func...
 Causes of esophageal diverticula may vary. Of congenital esophageal
diverticulum is usually associated with the primary ...
 Radiographs of the esophagus with
achalasia cardia: visible sharply
narrowed terminal esophagus, supra-
stenotic extensi...
Balon dilatation
Achalasia before
after
Radiographs of esophageal
perforation: taken by mouth
radiopaque substance is
distributed in the posterior
mediastinum in ...
- Cancer of esophagus:
А) scirrhous;
Б) bowl-shaped ;
В) medullar shape.
The symptoms of cancer:
- Stenosis of esophagus;
- Filling defect;
- Irregular borders;
- The delay of contrast media abov...
filling defect
cancerfilling defect
cancer
filling defect
Computed tomography (CT)
of the esophagus to determine the
boundaries of lesions of the
esophagus, to identify the affecte...
Positron Emission Tomography (PET ) study, which allows you to
simultaneously identify all the malignant tumor in the body...
PET CT (esophageal cancer)
- Burn of esophagus:
The first examination is possible after 2-3
weeks.
Symptoms:
• Circular stenosis;
• Flat contours;
• ...
burn
Рентгенпозитивні сторонні тілаРентгенпозитивні сторонні тіла
2. Stomach:
- Gastritis:
А) acute;
Б) chronic;
В) chronic hyperthrophic gastritis;
Г) rigid antral gastritis.
- The ulcer of stomach and duodenum:
Symptoms:
• “niche”;
• inflammative elevation of mucosa;
• folds convergention;
• the...
Chronic ulcer
niche
niche
niche
ulcer
ulcer
niche
ulcer
niche
ulcer
niche
- Cancer of stomach:
• polypous;
• bowl-shape;
• ulcerative cancer;
• diffuse;
• cancerous ulcer;
• cancer from polyp.
Symptoms:
• filling defect;
• the absence of the folds of mucosa;
• the absence of peristalsis at the defect
localization;...
Cancer of stomach:
filling defect
Cancer of stomach:
filling defect
Cancer of stomach:
filling defect
cancer
• filling defect
polyposis
filling defect
Malignant polyps of stomach
filling defect
Computed tomography
tumor formation
 Radiographs: an extensive filling defect with
clear smooth rounded contours in the upper
third of the stomach - submucos...
3. Large intestine:
- Inflammations:
А) colitis;
Б) chronic colitis;
В) chronic spastic colitis;
Г) unspecific ulcerative ...
colitis
smoothness of haustrum
Colorectal polyp
Clinical presentation: Usually colon polyps are
asymptomatic and constitute an accidental finding.
They c...
Diverticula of the colon
protrusion wall filled with contrast
foreign bodie
Plain abdominal x-ray showing multiple foreign
bodies.
- Cancer of the large intestine
Symptoms:
• filling defect;
• irregular contours;
• circular stenosis;
• the absence of th...
Cancer of the large intestine
filling defect
Cancer of the large intestine
filling defect
Cancer of the large intestine
filling defect
 
 
Transvaginal ultrasound
 In the pelvic cavity , posterior to the stump of the 
uterus, is determined  the area of the ...
 ПриПри биопсии биопсииПри биопсии
Conclusion MRI. Suspected mass lesion distal sigmoid colon (the spread
on the proximal...
The x-ray picture of the acute
abdomen
1. Bowel obstruction.
- high;
- low.
Symptoms:
- Kloyberg cups(at the background of...
Symptoms obstruction the small
intestine:
 Kloyberg cups located in the central
parts of the image;
 -Height is greater ...
Symptoms obstruction in the large
intestine:
 Kloyberg cups located in peripheral parts
of the image;
 Their width is gr...
Kloyberg cups
Kloyberg cups
Bowel obstruction Kloyerg cups
2. Perforate ulcer.
- Symptom of sickle (the presence of air
under the right cupola of the diaphragm).
Symptom of sickle
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
Radiological diagnostics of Gastro-Intestinal System
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Radiological diagnostics of Gastro-Intestinal System

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Radiological diagnostics of Gastro-Intestinal System

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Radiological diagnostics of Gastro-Intestinal System

  1. 1. The radiological methods of the gastrointestinal system examination
  2. 2. The main methods of examination - Fluoroscopy -Radiography -CT -MRI -Ultrasound -Radionuclide methods (PET, SPECT)
  3. 3. The special contrast methods - Double contrasting - Pneumoparietography of the stomach
  4. 4. The X-ray anatomy and examination of esophagus - Width – 1,5-2 см ; - Length – 25-26 см; - The parts of esophagus: А) cervical; Б) thoracic; В) abdominal.
  5. 5. Sponsored Medical Lecture Notes – All Subjects USMLE Exam (America) – Practice
  6. 6. - Three physiologic narrowings: А) at the level of cricoid cartilage; Б) at the level of aortic arc; В) at the level of cardia. The velocity of contrast movement is 4-6 sec.
  7. 7. peristalsis narrowing (arc) cardia
  8. 8. parallel The folds of mucosa – parallel, longitudinal; longitudinal
  9. 9. The X-ray anatomy and examination of the stomach 1. The survey fluoroscopy. 2. The first stage of examination – the patient drinks 1-2 swallows of contrast barium sulfate (we can evaluate the folds of mucosa of the stomach). 3. The second stage of examination – tight filling. We can determine the shape, size and position of stomach.
  10. 10. 4. The stomach peristalsis: - Superficial; - Medium depth; - Deep; - Segmental; - The velocity of peristaltic wave is 21 sec.
  11. 11. trendelenburg
  12. 12. Double-contrast gastrography
  13. 13. 5. Parts of the stomach: - Fundus; - Cardiac part; - Body; - Sinus (or angle); - Antrum; - Pyloric part; - Minor and major curvature.
  14. 14. Ultrasound and MRI of the stomach is assigned fairly rare, due to the fact that the procedure is less effective for cavity organs than other methods of investigation. Assign to detect metastases gastric cancer to other organs
  15. 15. Ultrasound of the stomach  Ultrasound of the stomach is not included in the number of studies performed during a standard ultrasound examination of the abdomen. Typically, this is due to the fact that the visualization of the stomach significantly impeded due to its anatomical location , content, and the presence of a gas bubble in the stomach. What parts are available at ultrasound of the stomach :  When conducting ultrasound examination of the stomach well visualized terminal , the output sections . This part of the body of the stomach , large and small curvature of the stomach , the antrum , the pyloric sphincter ( the place of transition into the duodenum ) , an ampoule of the duodenum. Visualization of other structures in the stomach ultrasound can not in all cases. Since the majority of lesions of the stomach is concentrated just in the output section , holding ultrasound of the stomach is quite appropriate.
  16. 16.  Computed tomography of the stomach is used mainly for the detection of neoplastic diseases of the stomach. .  During the CT scan of the stomach help to produce image slice wall of the stomach, which allow the detection of the thickness and elasticity of the gastric wall in the lesion. This sensitivity allows you to determine the nature of the growth of the tumor, lesion volume, distribution, germination of neighboring organs involved in the regional lymph nodes.  Also, the benefits of CT scan of the stomach is no need for oral contrast agent (necessary to conduct X- ray). Before the computer scanning is smoothing the stomach wall by introducing into its cavity of an inert gas (air scan).
  17. 17. . normal Stomach wall thickening . Endoscopy was suggested for biopsy.Biopsy - Carcinoma
  18. 18. The x-ray anatomy and examination of duodenum and small intestine 1. The duodenum comes after stomach and it has three parts: - Superior (bulb of triangular shape); - Descending (covers the head of pancreas); - Inferior.
  19. 19. 2. Small intestine: - duodenum; - jejunum; - ileum; - Kerckring's folds of the mucosal layer.
  20. 20. N
  21. 21. The X-ray anatomy and examination of large intestine 1. The methods of examination: - Per os; - Irrigoscopy – contrast enema.
  22. 22. 2. X-ray anatomy and parts of the large intestine: - Caecum; - C. ascendens; - C. transversum; - C. descendens; - C. sygmoideum; - Rectum.
  23. 23. 3. Irrigoscopy: - The first stage of examination – tight filling of the bowel. А) shape; Б) size; В) localization. - The second stage of examination– the evaluation of the mucosa folds (after depletion of patient); - The third stage of examination– double contrasting (inflation of large intestine with barium sulfate by Bobrov device). The elasticity of the walls is determined.
  24. 24. N
  25. 25. Double-contrast irrigoscopy
  26. 26. MRI of the internal organs - a method of medical research , which is to apply a magnetic field to produce images and three- dimensional images of the examined organ and tissue . The patient is placed in a magnetic field such that its abdomen was at the center of radiation. Then, the doctor performs a complete scan of the selected region receives digital images and three- dimensional model on a computer screen. One advantage of MRI bowel that does not require long preparation. Thus , the preparation for bowel MRI includes a conversation with the patient to identify the information about the presence of iron-bearing elements in the body ( body piercing , implants , pins , tattoos of special materials) , which is a contraindication for the procedure .
  27. 27. MRI Sometimes, during a bowel MRI uses a special ingredient - a contrast that promotes visualization of certain structures. Contrasts help to check the blood flow and to identify certain types of cancer and detect areas of inflammation or infection. MRI with contrast is most often used in the diagnosis of small bowel . MRI of the intestine , usually assigned in the following cases: - To detect tumors or problematic points in the tissues. Contrast allows you to determine the nature of the tumor (malignant or benign) . - Body checking for the presence of congenital anomalies , as well as bleeding. - The so-called hydro- MRI is able to identify problems that can not be diagnosed by x-ray or by ultrasound. For MRI hydro intestines filled with water, which facilitates unfolding of the walls. Diagnosis of diseases of the intestine with MRI recognized most effective and informative among other research body ( such as X-rays , ultrasound , etc.). MRI is capable of early detection of the presence of malignant tumors.
  28. 28. The pathology of the gastrointestinal tract 1. Esophagus: - Esophageal diverticuli: А) pulsational; Б) tractional; В) functional. -Achalasia of esophagus ( subdiaphragmatic segment narrowing of the esophagus and the delay in its contrast mass )
  29. 29.  Causes of esophageal diverticula may vary. Of congenital esophageal diverticulum is usually associated with the primary weakness of the muscular layer of the esophagus wall in a particular area.  In the development of acquired diverticula of the esophagus significant role played by inflammation of the upper gastrointestinal tract and mediastinum. Often the formation of esophageal diverticulum preceded by a long course of esophagitis and gastroesophageal reflux disease mediastinit , tuberculosis of intrathoracic lymph nodes, fungal infection of the esophagus ( oesophageal candidiasis ). Also, the development of oesophageal diverticulum can cause esophageal injury , ezofahospazm , achalasia cardia, esophageal stricture.  Formation of pulsation diverticulum caused by of the esophagus violation esophageal motility, leading to spastic contractions of muscles, the internal pressure and bulging walls of the weaknesses (often above functional or organic narrowing).  Development traction diverticulum of the esophagus promote fusion of connective tissue wall of the esophagus with inflammatory mediastinal lymph nodes that cause tension and displacement esophageal wall toward the mediastinum to form abnormal protrusion.
  30. 30.  Radiographs of the esophagus with achalasia cardia: visible sharply narrowed terminal esophagus, supra- stenotic extension of the esophagus, stomach gas bubble is not defined.
  31. 31. Balon dilatation Achalasia before after
  32. 32. Radiographs of esophageal perforation: taken by mouth radiopaque substance is distributed in the posterior mediastinum in the form of a large streaks. ма пищевода при перфорации: принятое через рот рентгеноконтрастное вещество распространяется в заднем средостении в ви
  33. 33. - Cancer of esophagus: А) scirrhous; Б) bowl-shaped ; В) medullar shape.
  34. 34. The symptoms of cancer: - Stenosis of esophagus; - Filling defect; - Irregular borders; - The delay of contrast media above the level of stenosis; - Deformation and absence of the folds; - The absence of peristalsis at the level of defect.
  35. 35. filling defect cancerfilling defect cancer
  36. 36. filling defect
  37. 37. Computed tomography (CT) of the esophagus to determine the boundaries of lesions of the esophagus, to identify the affected organs and metastatic lymph nodes, as well as the suspected growing into adjacent organs.  At a cancer, esophageal ultrasound is used to detect metastases in abdominal organs and remote lymph nodes.
  38. 38. Positron Emission Tomography (PET ) study, which allows you to simultaneously identify all the malignant tumor in the body lesions larger than 5 -10mm . Before examining a patient is injected into the vein of a small amount of radioactive glucose ( sugar). After that rotates around the body scanner that detects areas of increased accumulation of radioactive glucose in the body. Malignant tumor cells rapidly accumulate glucose they need for active growth Therefore , the images obtained from a scanner , malignant tumor foci appear much brighter than the surrounding tissue. PET value in treating cancer of the esophagus , now constantly increases
  39. 39. PET CT (esophageal cancer)
  40. 40. - Burn of esophagus: The first examination is possible after 2-3 weeks. Symptoms: • Circular stenosis; • Flat contours; • Deformation – cone-, funnel-, ampullar. -Foreign substances Method by Ivanova : after 1-2 sips of barium sulfate patient takes one sip of water, balances contrast are above the foreign body.
  41. 41. burn
  42. 42. Рентгенпозитивні сторонні тілаРентгенпозитивні сторонні тіла
  43. 43. 2. Stomach: - Gastritis: А) acute; Б) chronic; В) chronic hyperthrophic gastritis; Г) rigid antral gastritis.
  44. 44. - The ulcer of stomach and duodenum: Symptoms: • “niche”; • inflammative elevation of mucosa; • folds convergention; • the symptom of “pointing finger”. Complications: • hemorrhage; • perforation; • penetration; • malignisation (transformation into cancer).
  45. 45. Chronic ulcer niche
  46. 46. niche
  47. 47. niche ulcer
  48. 48. ulcer niche
  49. 49. ulcer niche ulcer niche
  50. 50. - Cancer of stomach: • polypous; • bowl-shape; • ulcerative cancer; • diffuse; • cancerous ulcer; • cancer from polyp.
  51. 51. Symptoms: • filling defect; • the absence of the folds of mucosa; • the absence of peristalsis at the defect localization; • stenosis of the lumen.
  52. 52. Cancer of stomach: filling defect
  53. 53. Cancer of stomach: filling defect
  54. 54. Cancer of stomach: filling defect
  55. 55. cancer
  56. 56. • filling defect
  57. 57. polyposis filling defect
  58. 58. Malignant polyps of stomach filling defect
  59. 59. Computed tomography tumor formation
  60. 60.  Radiographs: an extensive filling defect with clear smooth rounded contours in the upper third of the stomach - submucosal tumor (leiomyoma)  Computed tomography before intravenous contrast: between the small curvature of the stomach and the left lobe of the liver detected tumor formation  Computed tomography after intravenous contrast: a significant increase in the radiopacity of the tumor with clear smooth contours
  61. 61. 3. Large intestine: - Inflammations: А) colitis; Б) chronic colitis; В) chronic spastic colitis; Г) unspecific ulcerative colitis. Symptoms: • spasm of intestine; • smoothness of haustrum; • smoothness of the folds of mucosa.
  62. 62. colitis smoothness of haustrum
  63. 63. Colorectal polyp Clinical presentation: Usually colon polyps are asymptomatic and constitute an accidental finding. They can bleed, thus a positive fecal blood test can draw attention to their existence. They are also considered precancerous lesions. Polyps larger than 2 cm are potentially malignant. A round lesion with sharp edges protrudes into the intestinal lumen.
  64. 64. Diverticula of the colon protrusion wall filled with contrast
  65. 65. foreign bodie
  66. 66. Plain abdominal x-ray showing multiple foreign bodies.
  67. 67. - Cancer of the large intestine Symptoms: • filling defect; • irregular contours; • circular stenosis; • the absence of the folds of mucosa; • evacuation disorders.
  68. 68. Cancer of the large intestine filling defect
  69. 69. Cancer of the large intestine filling defect
  70. 70. Cancer of the large intestine filling defect
  71. 71.     Transvaginal ultrasound  In the pelvic cavity , posterior to the stump of the  uterus, is determined  the area of the intestine  ( the size 6.8 x2, 9x7,4 cm, thick up to 0.5-0.6 cm  wall decreased echogenicity . Peristalsis in this  projection is absent, the inner lumen is  differentiated clearly. The contents of the intestine  practically defined .     In   Doppler mode  with ultrasonic angiography  in the wall is determined by the presence of  pronounced vascularisation vessels with blood type  spectrum (Vmax 14,4 cm / s , RI 0 , 74) . Conclusion. Condition after supravaginal hysterectomy . . Ultrasonic signs of tumors of the rectum, pelvic formation
  72. 72.  ПриПри биопсии биопсииПри биопсии Conclusion MRI. Suspected mass lesion distal sigmoid colon (the spread on the proximal colon; manifestations of moderate lymphadenopathy). Suspected secondary changes in bone structure at the studied levels. Condition after supravaginal amputation. Uterine cysts . Suspected cervical polyp. Cystiform formation of the right ovary Histological report - Rectosigmoid tumor .
  73. 73. The x-ray picture of the acute abdomen 1. Bowel obstruction. - high; - low. Symptoms: - Kloyberg cups(at the background of swallen bowel there is the presence of horisontal level of fluid).
  74. 74. Symptoms obstruction the small intestine:  Kloyberg cups located in the central parts of the image;  -Height is greater than their width;  -Not see haustres.
  75. 75. Symptoms obstruction in the large intestine:  Kloyberg cups located in peripheral parts of the image;  Their width is greater than height;  Haustres - see.
  76. 76. Kloyberg cups
  77. 77. Kloyberg cups
  78. 78. Bowel obstruction Kloyerg cups
  79. 79. 2. Perforate ulcer. - Symptom of sickle (the presence of air under the right cupola of the diaphragm). Symptom of sickle

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