The document discusses the acute abdomen and various imaging modalities used to evaluate it. It covers:
1) The causes of acute abdomen including perforation, obstruction, inflammation and others.
2) The imaging modalities used including plain films, ultrasound, CT and their roles in evaluating specific causes.
3) How different conditions present on imaging including bowel obstruction, perforation, appendicitis and others.
Hepatobiliary system radiology revision notesTONY SCARIA
hepatobiliary system
hepatic segments
image based questions
last minute revision
radiology radiodiagnosis
hepatic investigations
based image based questions f
Purpose of this presentation is to educate non radiologist about basic CT anatomy of abdominal viscera and basic interpretation of very common diseases
Hepatobiliary system radiology revision notesTONY SCARIA
hepatobiliary system
hepatic segments
image based questions
last minute revision
radiology radiodiagnosis
hepatic investigations
based image based questions f
Purpose of this presentation is to educate non radiologist about basic CT anatomy of abdominal viscera and basic interpretation of very common diseases
Syncope is a sudden, complete loss of consciousness commonly described as fainting or passing out. https://www.okheart.com/about-us/ohh-news/what-is-syncope
Acute abdomen in children
1/Why acute abdomen in children want to present ??!!!
2/Areal case discussion in dibba hospital .
3/Evaluation of acute abdominal pain clinically .
4/Intussusception
5/Cases .
6/Something missed in my topic . ?????
Neonatal bilious vomiting is due to congenital obstruction in GI tract. This will present in early neonatal life. Exact diagnosis should be made quickly and appropriate surgical intervention should be done immediately to save these unfortunate children.
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
Abdominal xray - imaging and interpretation ArushiGupta119
everythng about abdominal radiograph is discussed from views to obstruction to foreign body.
definetly u r not going to get bored
read and share with your peers.
Rapid review of radiology text book, abdominal imaging, contrast imaging, CT , plain x ray, IVU , power point of abdominal pathological cases and description of diagnosis , differential diagnosis of diagnosis
The lecture overviews the different situations where cholecystitis can be fatal,if not accurately diagnosed.Different types of dangerous cholecystitis are illustrated with their imaging findings.
Intestinal obstruction is the mechanical impairment which is partial or complete blockage of the bowel that results in the failure of the passage of intestinal content through the intestine.
various congenital gastrointestinal diseases manifesting in childhood or even in adults, their radiographic findings on various imaging modalities such as radiograph, barium, ultrasound etc.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
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ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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2. • The 'acute abdomen' is a clinical condition characterized by severe abdominal
pain, requiring the clinician to make an urgent therapeutic decision.
Role of imaging
• To help surgeon decide whether or not a patient with acute abdomen needs to
have a surgery
• Whether operation needs to be done immediately or time can be spent on
further investigations
• To support the clinical findings.
5. Plain abdominal film
Erect Chest Supine abdomen Erect abdomen Left lateral decubitus
Demonstrates-
-Small pneumoperitoneum
-Chest abnormalities
-Acute abdomen complicated
by chest pathology
-Acts as a baseline
Shows-
-Distribution of gas
-Caliber of bowel
-Displacement of bowel
-Obliteration of fat lines
Shows air-fluid level If patient cannot sit or stand
-Free gas between liver and
lateral abdominal wall
-Gas filled duodenal loop
-Calcification in aortic
aneurysm
6.
7. Role of USG in acute abdomen
• Real time USG allows confirmation of palpable masses and focal point of tenderness
• Evaluation of visible gas and fluid
• Perienteric soft tissue
• Evaluation of peristalsis
• Acute appendicitis
• Acute cholecystitis
8. Focused assessment with sonography for trauma ( FAST)
• Rapid bedside ultrasound examination performed by surgeons, emergency
physicians as a screening test for blood around the heart (pericardial
effusion) or abdominal organs (hemoperitoneum) after trauma.
• The four classic areas (4P) that are examined for free fluid are -
Perihepatic space (also called Morison's pouch or the hepatorenal recess)
Perisplenic space
Pericardium
Pelvis
• With this technique it is possible to identify the presence of intraperitoneal
or pericardial free fluid.
• In the context of traumatic injury, this fluid will usually be due to bleeding.
9. Role of CT scan
• Most sensitive method for the detection of peritoneal free gas
• Confirm the diagnosis of intestinal obstruction
• H/O previous abdominal malignancy
• Extra luminal disease
• In acute pancreatitis, renal colic, leaking abdominal aneurysm, Intra abdominal
abscess
10. Bowel perforation
• The radiological hall mark of hollow viscus perforation is the presence of air and
fluid in the peritoneal cavity.
Causes
• Peptic ulcer disease
• Inflammatory bowel disease
• Blunt or penetrating trauma
• Foreign body
• Neoplasm
• Obstruction
• Pancreatitis
11. Supine abdominal radiograph
• Oval/linear collection of gas
- Subhepatic space
- Morrison’s pouch
• Beneath the diaphragm(the cupola sign)
• In the center of the abdomen over a fluid collection(the football sign)
• Visualization of the outer as well as the inner wall of loop of bowel
(Rigler’s sign)
• Visualization of falciform ligament, medial and lateral umbilical ligament
and the urachus.
• In the fissure of ligamentum teres
11
15. CT scan
• Most sensitive method for detecting peritoneal gas
• Gas tends to collect over the liver anteriorly, mid abdomen and peritoneal recess.
18. Goals of imaging in a patient with suspected intestinal obstruction
• To confirm that it is a true obstruction and to differentiate it from an ileus
• To determine the level of obstruction
• To determine the cause of the obstruction
• To look for findings of strangulation
• To allow good management either medically or surgically by laparotomy or laparoscopy
19. On Plain films
• Dilated gas filled loops of small bowel.
• Multiple fluid level
• Dilated small bowel almost completely filled with fluid with small bubbles of gas
trapped in rows between the valvulae conniventes-”string of beads” sign.
• Dilated fluid-filled loops of small bowel may be identified as oval or round soft
tissue densities.
• Absent or little air in large bowel
23. Role of USG in bowel obstruction
• Presence of abundant gas produces images of non diagnostic quality
USG evaluation of potential MBO
• GIT caliber
• Content of dilated loop
• Peristaltic activity
• Site of obstruction
• Gut wall morphology
• Extrinsic soft tissues
25. Role of CT scan
• CT can confirm the diagnosis of SBO, indicate the location of the obstruction
• Fluid filled levels clearly visible on CT
• Indicated with H/O –
- previous abdominal surgery
- extra luminal disease
• Effective at detective hernias
• A focal calibre change from dilated to collapsed bowel, the transition point,
indicates the level of obstruction.
• The small bowel is considered dilated when its diameter is greater than2.5 cm.
26. Simple bowel obstruction
• Dilated small bowel leads into a mass at the point of transition to collapsed
small bowel
27. Closed loop obstruction
• Two points in the segment of bowel is
obstructed
• When blood supply is compromised its
called strangulation
• CT is the imaging of choice
• A U-shaped loop of bowel is seen with a
transition point at either end.
• In severe cases, gas may be seen within the
bowel wall and within the portal venous
system
28. • U-Shaped or C-shaped loop
• Beak appearance at the point of obstruction
29. SBO due to hernia
External hernia Internal hernia
Inguinal
Femoral
Umbilical
Incisional
Spigelian
Paraduodenal
Transmesenteric
30. CT findings
• Free fluid collection within hernia sac
• Bowel wall thickening
• Abnormal bowel wall enhancement(hypo or hyper attenuating)
• Proximal bowel dilatation
• Herniated bowel segment and involved mesentery are shorter in length
32. SBO due to gall stone ileus
• Is mechanical bowel obstruction due to gall stone/s in the intestine
• 2% of SBO
Signs of gall stone ileus
• Gas within the bile ducts or the gall bladder
• Complete or incomplete SBO
• Abnormal location of gall stone
• Change in position of gall stone
35. Intussusception
Characteristics
Invagination or prolapse of a segment of intestinal
tract ( intussusceptum) into the lumen of the
adjacent intestine ( intussuscipiens).
90% are ileocolic and ileo-ileocolic.
Clinical features
• Severe colicky pain and vomiting.
• Initial stools passed at the start of symptoms
are unremarkable; blood and mucus
(‘redcurrant jelly’) stools are passed after 24
hours
36. Cont.
Adult intussusception
• The majority arise from a pathological lead point.
• Causes include lipomas, carcinomas, metastases and lymphoma.
Paediatric intussusception
• 90% of all paediatric intussusceptions have no pathological lead point and are
thought to be associated with lymphoid hyperplasia in Peyer’s patches of the
ileum.
• 10% have a lead point, which include a Meckel’s diverticulum, polyps and
duplication cysts.
• Intussusception usually occurs within the first 2 years.
37. Ultrasound
• A mass is usually demonstrated in the right upper quadrant adjacent to the
gallbladder, in ileocolic intussusceptions, which are the most common type in
paediatric patients.
• Transverse section through the mass reveals concentric alternating hyperechoic and
hypoechoic rings, representing compressed mucosal and serosal surfaces and
oedematous bowel wall respectively (target/doughnut sign).
• A longitudinal section through the mass demonstrates a hypoechoic mass with an
appearance very similar to a kidney (pseudo-kidney sign) .
Radiological features
38. Plain film
• There are multiple gas filled loops of dilated
small bowel
• Soft tissue mass in right iliac fossa
40. Mesenteric ischemia
• Due to thrombosis or embolism of SMA or vein.
Plain films
• Gas filled slightly dilated loops of bowel with multiple fluid levels
• Thumb printing sign(20-30 %)
• Occasionally air in the intestinal wall
• Thickened valvulae conniventes
41. CT Scan
• Low-density filling defects within an enhancing artery confirms the
presence of thrombus. Reduced or non-enhancement suggests
thrombosis or atherosclerotic narrowing.
• The bowel wall may demonstrate either low attenuation due to oedema
or high attenuation due to mural haemorrhage.
• Bowel-wall enhancement may be poor with a sharp cut-off between
normal and abnormal colon at the boundary of vascular territories.
• In complete occlusion there can be absent of enhancement of bowel wall.
42. • Dilated bowel loops with air fluid levels
• In severe cases gas may be seen within the bowel wall appearing as
intramural locules of low attenuation.
• Gas may also be seen in the portal venous system as branching
peripheral low attenuation usually in the left lobe of the liver .
• CT angiography allows the assessment of the coeliac axis, superior
and inferior mesenteric arteries
Contd.
46. Plain film signs of large bowel
• Depends on the state of competence of ileo caecal valve
• Few in number
• Large: above 5.0 cm diameter
• Tend to be peripheral
• Haustra : thick and widely separated and may or may not extend right
across the bowel
47.
48. CT-Scan
• CT confirms obstruction with a colonic diameter of >5.5 cm (9 cm in
the caecum) considered abnormal.
• Identification of a transition point indicates the level of obstruction.
• CT clearly demonstrates intramural gas, perforation and abscess
formation.
49. Colonic carcinoma
• Focal irregular bowel-wall thickening with proximal dilatation.
• There may be inflammatory stranding in the adjacent fat.
Axial and coronal images demonstrating large-bowel obstruction (asterix)
secondary to a colonic carcinoma in the distal descending colon (arrow).
50. Contrast enema maybe helpful:
• To differentiate pseudo-obstruction and may be indistinguishable on
plain film from mechanical of obstruction
• To localize the point of obstruction
• To diagnose the cause of obstruction e.g. tumour, inflammatory mass
51. Large bowel volvulus
• Prerequisite :Long and freely mobile mesentery must be present
Sigmoid volvulus
• Common in old , mentally ill and instituionalised people
• Twisting occurs around the mesenteric axis
52. Identification of loop in sigmoid volvulus
• Ahaustral margin
• Left flank overlap sign
• Apex at or above T10 level
• Apex under the left hemidiaphragm
• Inferior convergence on the left
• Liver overlap sign
54. Caecal volvulus
• Associated with degree of malrotation
• Accounts for less than 2% of adult intestinal obstruction
• Age -30-60 years
Diagnosis
• Pole of the caecum and the appendix lie in LUQ(50%)
• Caecum twists in axial plane and lies in the RLQ(50%)
• One or two haustral markings can usually be identified
• Seen as large gas filled or fluid filled viscus
• Identification of adjacent gas filled appendix confirms the diagnosis
• Left half of colon is usually collapsed
59. Intra-abdominal abscesses
• Abscess are mass lesions of soft tissue density
• Displacement of bowel or organ from their usual position
• Effacement of fat lines
• May contain gas
60. • Subphrenic space
• Subhepatic
• Omental bursa
• Pericolic
• Pelvic
• Posterior pararenal
• Anterior pararenal
• Liver abscess
Specific anatomic sites of abscess formation
61. Sub-phrenic and Subhepatic abscess
On Chest X-ray
-raised hemidiaphragm(80%)
-Basal consolidation(70%)
-Pleural effusion(60%)
Other signs
• Decreased diaphragmatic movement
• Generalized or localized paralytic ileus
• Scoliosis toward the lesion
• Decreased organ mobility
62. USG
• an effective test for abdominal collections, being sensitive for fluid collections or
gas–fluid collections.
• It can also be used for guided percutaneous drainage.
• Occasionally deep collections may be obscured by overlying bowel gas
63. CT Scan
• Subphrenic abscess containing fluid and air
• A mass (15-35 HU)
• Ring enhancement after I.V contrast is
characteristic
65. Leucocyte scanning
• 111In-labelled leucocyte scans have been shown to have sensitivity ad specifity
greater than 90 % in the localization of intra abdominal sepsis
• Can identify sepsis at any site including prosthetic grafts and pre-exiting cysts.
66. Acute appendicitis
• Appendix calculus(.5-6.0 cm)
• Sentinel loop
• Dilated caecum
• Widening of the properitoneal fat
• Blurring of the properitoneal fat
• Right lower quadrant haze due to fluid and edema
• Right lower quadrant mass indenting the caecum
• Blurring of right psoas outline
• Gas in the appendix-rare
On plain films---Signs of acute appendicitis
67. USG signs
• Blind ending tubular structure at the point of tenderness
• Non-compressible
• Diameter 7mm or greater
• No peristalsis
• Appendicolith casting acoustic shadow
• High echogenicity non-compressible surrounding fat
• Surrounding fluid or abscess
• Edema of caecal pole
68. Ultrasound images showing an anechoic blind-ending tubular structure measuring 10mm in
diameter in the right iliac fossa (RIF): this was found to be non-peristaltic and non-
compressible.
An echogenic round body, with posterior acoustic shadowing seen within the tubular
structure, in keeping with an Appendicolith.
APP = dilated appendix, OMEN = surrounding echogenic inflamed omentum, BLD = bladder
69. CT findings of acute appendicitis
• 90% diagnostic accuracy to detect acute appendicitis
• Failure of appendix to fill with oral contrast
• Tubular structure 6 mm in diameter or greater with a thickened wall
• Appendicolith
• Surrounding inflammatory changes
70. Acute appendicitis. CT showing
an appendix which contains a
dense Appendicolith
Appendix inflammatory mass. CT shows soft-
tissue density in the right iliac fossa containing an
Appendicolith..
71. Acute cholecystitis
• Gallstones
• Duodenal ileus
• Ileus of hepatic flexure of colon
• Right hypochondrial mass due to
enlarged gallbladder
• Gas within the biliary system
Signs of acute cholecystitis
72. Ultrasound : The mainstay of imaging in cholecystitis
• Gallbladder wall thickening (>3 mm), which may be poorly defined.
• Impacted calculi in the gallbladder neck or cystic duct. Gallstones are visualized
as echogenic foci with posterior acoustic shadowing.
• Biliary sludge may be seen as echogenic debris layering in the gallbladder.
• Pericholecystic fluid.
• Positive ultrasound Murphy’s sign
74. CT is not routinely required but may be utilized as part of the investigation of
nonspecific abdominal pain or to assess for secondary complications of
cholecystitis.
• Gallbladder wall thickening (>3 mm).
• Biliary calculi may be visualized as foci of high attenuation within the gallbladder.
• Inflammatory stranding in the pericholecystic fat
• Pericholecystic fluid/focal enhancing collections will appear as a low-attenuation
collection surrounding the gallbladder.
• Locules of free gas adjacent to the gallbladder secondary to necrosis/perforation.
• Cholecystoenteric fistulae are rare.
75. Axial and coronal images showing a thick-walled distended gallbladder with
pericholecystic stranding in keeping with acute cholecystitis .
77. Role of USG
• To detect gallstones as a cause of acute pancreatitis
• Detect bile duct calculus and obstruction
• Diagnosis of unsuspected acute pancreatitis or confirm diagnosis
• Guide aspiration and drainage
• Enlargement of the gland
• Decreased gland echogenicity
• Peripancreatic inflammation
• Pancreatic duct dilatation
• Rarely echogenicity may increase due to hemorrhage
USG features
78. Acute pancreatitis . Transverse image shows
heterogeneous pancreas with focal hypoechoic area
Transverse image shows acute inflammation ventral
to the pancreas and ventral to the splenic vein–
superior mesenteric vein confluence . The pancreas
is enlarged and heterogeneous.
79. Role of CECT
• Necrosis cannot be definitely diagnosed by USG .CECT is the modality of choice.
• Detect complications
• Diagnose unsuspected or confirm acute pancreatitis
• Diagnose conditions mimicking acute pancreatitis
• Guide aspiration and drainage
80. CT findings
• Enlarged gland
• Low or heterogeneous glandular attenuation
• Peripancreatic fat-normal or hazy
• Focal areas of decreased or no enhancement represents areas of necrosis
81. CT grading-identifies subgroup of individuals at risk for morbidity and
mortality
Percentage
of necrosis
Severity
index
A. Normal pancreas 0 0 o
B. Focal or diffuse pancreatic enlargement 1 0 1
C. Inflammation of pancrease or
Peripancreatic fat
2 <30 %(2) 4
D. Single ill defined Peripancreatic fluid
collection
3 30-50%(4) 7
E. 2 or more Peripancreatic fluid collection 4 >50%(6) 10
Grade A –C: F/Up recommended only if clinical condition declines
Grade D and E: F/up scan needed at 7 to 10 days
:At the time of discharge
86. Plain film can assess
• the extent of the colitis
• the state of mucosa
State of colonic mucosa can be assessed from :
- the faecal residue
- the width of the bowel lumen
-the mucosal edge
-the haustral pattern
87. Toxic megacolon
• A fulminating form of colitis with transmural inflammation, extensive &
deep ulceration & neuromuscular degeneration.
• Most often involves the transverse colon
• Radiological Findings:
Mucosal islands (=pseudopolyps) & dilatation (>5.5 cm)
Haustra will be effaced or blunted
• Common complication:
Perforation in the sigmoid & peritonitis
93. CT scan
• Best diagnostic modality
• Mural thickening and peri-colonic stranding
• Thickening and mucosal hyper density
• Heterogeneous enhancement
• Loss of colonic Haustra
• Colon contour is shaggy
• Lumen dilated
• +/- gas in the bowel wall, portal vein and mesentery
94. Leaking abdominal aortic aneurysm
Etiology
• Atherosclerosis
• Mycotic
• inflammatory
Age: 65 yrs and older
Site: below the origin of renal arteries
C/F: prescence of pulsatile mass with sudden hypotension
: back pain
95. Imaging
Plain film
• Central soft tissue mass which may obscure psoas
outline on the left
• Frequently curvilinear calcification
• Obscured renal outline
97. CT scan
• Most common finding is retro peritoneal
hematoma(density>50 HU)
•Extension of blood into pararenal spaces and psoas
muscle
• On CECT active extravasation of the contrast
100. Ectopic pregnancy
• Occurs in 2% of pregnancies and accounts for 9% of all pregnancy-
related deaths secondarily to venous thromboembolism.
• Many factors increase the risk of ectopic pregnancy by affecting the
migration of the embryo to the endometrial cavity.
• Usually presents by 7th week of pregnancy.
• Missed or delayed diagnosis can be devastating with massive
haemorrhage and possibly death.
101. Risk factors
• pelvic inflammatory disease
• previous history of ectopic pregnancy
• prior tubal surgery
• assisted reproductive technology
• intra-uterine contraceptive devices,
• age >35 years and smoking.
102. Radiological features
• An extra-uterine sac containing a fetal pole or yolk sac with or without
cardiac motion is observed in <20% of cases and confirms an ectopic
pregnancy .
• A thick-walled cystic structure or a complex adnexal mass independent of
the ovary and uterus is also suggestive of ectopic pregnancy.
• Identification of a viable intra-uterine gestation sac virtually rules out an
ectopic pregnancy except in the rare circumstance of a heterotopic
pregnancy (incidence of 1 in 7,000 pregnancies)
Ultrasound : The imaging modality of choice
Features
103. Cont.
• Other supportive findings include absence of an intra-uterine pregnancy at
6 weeks gestation pelvic free fluid or hyperechoic clot within the uterus,
hydro- or haematosalpinx or a thickened endometrium.
• A pseudogestational sac may be seen consisting of endometrial thickening
with an anechoic centre composed of haemorrhage.
• In cases of rupture, extensive anechoic intra-abdominal and pelvic
haemorrhage may be seen.
105. Ovarian cyst torsion
• Commonest in women of childbearing age but can affect women of all ages.
• Caused by twisting of the vascular pedicle with associated venous or arterial
occlusion and subsequent infarction.
• Symptoms include lower abdominal pain, nausea , vomiting
• Risk factors include enlarged ovaries >6 cm, elongated ovarian ligaments
106. USG
• Free fluid seen within the abdomen is suggestive of cyst rupture. In the absence
of a visible cyst, a review of previous ultrasound studies may be useful.
• Torsion is characterized by an heterogeneous enlarged ovary with internal echoes
and reduced or absent Doppler signal.
108. Renal colic
• Pain caused by the passage of a renal calculus through the ureter.
Clinical features
Renal colic: severe, spasmodic flank pain radiating to groin.
Imaging
The role of imaging is to confirm urolithiasis, identify the location and degree of
obstruction and identify potential complications.
109. Plain films
• Low sensitivity and specificity (45% and 75%) for urolithiasis limits its role in the
acute setting. Can provide a baseline for follow-up.
Intravenous urography (IVU)
• Traditionally the first-line imaging modality. Not ideal if there is poor renal
function.
Findings
• Direct visualization of a ureteric calculus.
• A delayed nephrogram and filling of the collecting system with a standing column
of contrast in the ureter to the level of the calculus which persists post
micturition.
• The length of delay in the appearance of contrast in the collecting system gives an
idea of the degree of obstruction.
• Affected kidney is modestly enlarged.
Cupola sign- Large amount of gas beneath the diaphragm
Football sign- Large gas in the center of abdomen over a fluid collection
Erect chest film. Free intra-abdominal gas is clearly demonstrated under the right hemidiaphragm.
Under the left hemidiaphragm a small triangular collection of free gas can be identified between loops of gas-filled bowel (arrow).
Pneumoperitoneum. Abdomen, supine. A triangular collection of free gas is demonstrated in the subhepatic region (arrows). The falciform ligament is also outlined (arrowheads).
Pneumoperitoneum. Abdomen, supine. Visualisation of both sides of the bowel wall (Rigler's sign). Both the inside and outside wall of multiple loops of small bowel can be clearly identified
Free intraperitoneal gas. (A) On abdominal windows the free gas is not well seen anteriorly.
(B) On wide window settings, the free gas is much more obvious.
Abdomen, supine of A 38-year-old woman admitted in diabetic precoma. A case of Acute gastric dilatation.
Small-bowel obstruction: (A) supine
Multiple dilated loops of both gas-filled and fluid-filled small bowel loopsThere is little or no gas in the large bowel.
A 77-year-old woman with a past history of several abdominal operations. The small-bowel obstruction was due to adhesions
Multiple fluid levels are noted on erect film.
The dilated proximal bowel is predominantly gas filled with few long fluid levels.
More distally the small bowel is fluid filled and bubbles of gas are trapped between the valvulae conniventes producing chain of beads.
Shows long loops of dilated fluid-filled small bowel in mechanical bowel obstruction
Small-bowel obstruction due to a metastatic deposit. Very dilated small bowel leads into the mass at the point of transition to collapsed small bowel.
CT demonstrating the midline incisional hernia containing a bowel loop
Supine film of adomen. Multiple dilated loops of small bowel are seen. A band of gas is seen in the right hypochondrium (arrowhead) lies with the CBD.
Appendix abscess causing small-bowel obstruction. A small gas bubble which lies within the abscess (arrow) is seen in the right iliac fossa. Age 11 years, vomiting with some diarrhoea for 1 week
Intussesuception <3.5 cm is benign
The grossly dilated loop of jejunum contains oral contrast medium and leads into the intussusception, which contains the characteristic central mesenteric fat (arrow)
Type IA: Competent ileocaecal valve. Distended large bowel, particularly ascending colon and caecum. No distension of small bowel.
Type I B: Competentileocaecal valve. Caecal distension and small-bowel distension.
Type II: Incompetent ileocaecal valve. No distension of caecum and ascending colon but distension of small bowel.
Caecal perforation is much more likely to occur in type I large-bowel obstruction.
Large-bowel obstruction type IA (competent ileocaecal valve).Supine film. There is gaseous distension of the large bowel from the sigmoid backward including the ascending colon and caecum. The dilated caecum lies in the pelvis. There is no visible small-bowel distension.(Carcinoma of the sigmoid.)
Axial and coronal images demonstrating large-bowel obstruction (asterix) secondary to a colonic carcinoma in the distal descending colon (arrow).
Sigmoid volvulus. Supine film. The hugely dilated ahaustral loop of sigmoid can be seen rising out of the pelvis in the shape of an inverted U. Haustrated ascending and descending colon can be identified separate from the volved sigmoid loop.
Caecal volvulus. Supine. The considerably distended caecum with its haustral markings readily identified lying low in the central abdomen. There is no significant small-bowel distension.
Paralytic ileus. Supine film. There is generalised dilatation of both small and large bowel. An 84-year-old woman with generalised peritonitis following perforation of a gastric ulcer
Retroperitoneal abscess in the anterior and posterior pararenal spaces. Fat is seen within the renal fascia bounded anteriorly by the fascia of Gerota and posteriorly by the Zuckerkandl fascia. The superior most extent of this retroperitoneal abscess continues in the bare area behind the liver.
Acute appendicitis. CT showing an appendix which contains a dense appendicolith, with surrounding inflammatory changes.
Appendix inflammatory mass. CT shows soft-tissue density in the right iliac fossa containing an appendicolith.
Abscess formation was seen on adjacent images.
Positive ultrasound Murphy’s sign – focal tenderness and inspiratory arrest upon direct pressure with the ultrasound probe in the RUQ, which is not elicited with pressure in the left upper quadrant (LUQ) – is present in 85% of cases
Inflammatory adhesions form between the gallbladder and adjacent small-bowel wall, enabling a calculus to erode through the gallbladder wall
into the bowel lumen. This in turn can lead to a rare cause of small-bowel obstruction
secondary to calculus impaction, classically in the terminal ileum rather than the ileocaecal
valve. Review images for air within the biliary tree secondary to fistulation
Axial and coronal images showing a thick-walled distended gallbladder with pericholecystic stranding in keeping with acute cholecystitis .
A: Acute pancreatitis . Transverse image shows heterogeneous pancreas with focal hypoechoic area
B: Transverse image shows acute inflammation ventral to the pancreas and ventral to the splenic vein–superior mesenteric vein confluence . The pancreas is enlarged and heterogeneous.
Axial CECT reveals a diffusely enlarged enhancing pancreas with an acute inflammatory fluid collection in the peri pancreatic regions. Follow-up CT after conservative management shows improvement in the pancreatic swelling with organization of the peri pancreatic inflammation.
Severe pancreatitis. Axial CECT reveals a swollen pancreas that is replaced by inflammatory exudate in the region of the head and body .
The fragility of the pseudoaneurysm wall increases risk of rupture and life threatening haemorrhage. The inflammatory process results in increased risk of thrombosis in adjacent veins, including the splenic and renal veins.
Supine film. Loss of haustration and irregular mucosa in the transverse colon. Acute IBD
In left-sided disease, the proximal limit of faecal residue will indicate the extent
Mucosal line is irregular because of adjacent mucosal ulceration and sloughing-mucosal islandsAbdominal film showing more than 4 loops of gas filled small bowel failed medical therapy
The wall of splenic flexure & descending colon is greatly thickened→ thumb printing
Wall thickening due to submucosal haemrrhage and odema
Soft tissue mass outside the calcified wall…..bowel gas displaced anteriorly……obscured
The faintly calcified rim of an aortic aneurysm is identified (arrowheads). In addition, there is a large soft-tissue mass outside the aneurysm, indicating a retroperitoneal haematoma. The outlines of the psoas and renal margins on the left are lost.
shows an abdominal aortic aneurysm with hyper attenuating crescent sign which represents an acute hematoma within the left aneurysm wall.
demonstrating an aneurysmal abdominal aorta with crescentic low-attenuation thrombus adherent to its posterior wall.
In the next figure : An extra-uterine gestation sac within the right adnexa .
showing an enlarged appearance of the ovary with small peripheral cysts
Which shows delay in appearance of contrast in the left collecting system. Contrast outlines a mildly dilated ureter down to stricture/calculus at left vesicoureteric junction