imaging of gi system

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  • 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
  • imaging of gi system

    1. 1. 1 Imaging of Gastrointestinal System 義大醫院 影像醫學科 李浩銘醫師
    2. 2. Plain Photo EUS Fluoros copy Nuclear Medicine Ultrasound CT Scan MRI
    3. 3. Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas
    4. 4. • • • • Plain abdominal x-ray Technique : AP – Supine AP – Erect • • LLD Semi recumbent CXR Indication : Acute abdomen
    5. 5. What to Examine ?? - Air (bowel gas) - Bone density - Calcification (stone / foreign body) - Soft tissue mass
    6. 6. Air Sub diaphragm free air Bowel perforation
    7. 7. Bowel obstruction AP-semi recumbent  LLD, horizontal AP-supine -dilated bowel loops -thickening of bowel wall -multiple air-fluid levels
    8. 8. Ileo-cecal valve incompetent small and large bowel distention Bowel obstruction
    9. 9. Mechanical large bowel obstruction Colon dilatation obstruction. Barium enema
    10. 10. volvulus of sigmoid colon
    11. 11. Bone density - Osteoporosis - Compression fracture
    12. 12. Calcifications, stones Soft tissue mass
    13. 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. 14. Colon Radiology Anatomy
    15. 15. Technique & positioning A. Left lateral position : contrast filling rectum and rectosigmoid B. Left posterior oblique: contrast filling sigmoid
    16. 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. 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. 18. Contrast Single Double Barium Barium + air
    19. 19. Contrast Single Double Motility study Mucosa study Simple & relative safe More difficult
    20. 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. 21. Intussusceptions Hirschprungs disease Fatique / very old patient / serious illness Suspected pelvic metastasis Indication Single contrast BE
    22. 22. Contraindicati on Suspect bowel perforation Toxic megacolon After colonic biopsy Pregnant Patient
    23. 23. Complicati on Gas pain Colonic perforation/rupture Intramural barium Stool impaction Bacterial contamination Allergy / hypersensitivity
    24. 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. 25. Record / filming Plain abdominal photo Spot photo Overhead whole abdomen Plain abdominal photo
    26. 26. Barium Enema Single Contrast
    27. 27. Spot film : Single contrast Rectum (left lateral) Hepatic flexure Sigmoid Splenic flexure Cecum
    28. 28. Whole abdomen : single contrast Whole colon : overhead film
    29. 29. Barium Enema Double Contrast
    30. 30. Spot film : double contrast Rectum & sigmoid : Lateral position Supine position Prone position
    31. 31. Spot film : double contrast Sigmoid : posterior oblique Distal descendant colon Proximal descendant colon
    32. 32. Spot film : double contrast Splenic flexure (RPO) Transverse colon Erect position
    33. 33. Spot film : double contrast Ascendant colon Hepatic flexure Erect position Erect position, LPO
    34. 34. Spot film : double contrast Cecum & appendix Cecum & terminal ileum
    35. 35. Overhead film : whole colon
    36. 36. Hirschsprung disease Dilatation of proximal bowel with caliber change at rectum Transitional zone
    37. 37. Intussusception Doughnut Sign
    38. 38. Polyp Bubble  Filling defect
    39. 39. Pedunculated Polyp Sessile Polyp Mexican hat sign
    40. 40. Malignant polyp : villous type
    41. 41. Apple core sign Colon cancer : annular type
    42. 42. Colonic diverticulitis Colonic diverticulosis
    43. 43. Ulcerative colitis Continuous lesion, lead pipe sign Segmental colitis Pancolitis
    44. 44. Crohn’s disease Discontinuous skip lesion Fistula formation
    45. 45. Colitis TB Rectal carcinoma Overhanging edges / shouldering Annular constriction Irregularity border
    46. 46. Colonic polyp Filling defect on single contrast Soft tissue mass on double contrast
    47. 47. Extraluminal tumor ileocecal intussusceptions (Coiled spring appearance)
    48. 48. Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas
    49. 49. Diffuse esophageal spasm: corkscrew esophagus 15
    50. 50. Foreign body Mimicking tumor Intraluminal filling defect 16
    51. 51. 17 Gastric wall filling defect Gastric carcinoma
    52. 52. Linitis plastica 18
    53. 53. 19 Additional shadow Duodenum diverticulosis
    54. 54. 3. Small Intestines Barium follow through (Single Contrast) Enteroclysis (Double Contrast) 20
    55. 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. 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. 57. Normal follow through Enteroclysis - normal small bowel mucosa 23
    58. 58. ascariasis in small intestine 24
    59. 59. Take home message • ABCS in KUB • Single v.s Double contrast • Indication / Contraindication / Complication of barium enema
    60. 60. Learn to be better !

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