lecture in GI tract radiology showing some important points to help medical students and doctors

1. GIT Radiology
Prepared By
Haiat Shaban ben Hasan
4th Year med student

2. MODALITI E S FOR GI TRACT IMAGING
1) Plain Abdominal X-ray film .
2) Ultrasound .
3) Intraluminal contrast studies .
4) CT scan .
5) MRI .
6) CT angiogram .
7) CT enterograph .
8) Endoscopic studies .
9) Nuclear imaging .
10) Percutaneous imaging procedure .

3. Plain Abdominal X-ray film
Often the first preliminary test
INDICATIONS
1- Acute abdomen
2- Bowel obstruction
3-Viscus perforation
4- Foreign body ingestion
ADVANTAGES
1- Easy availability
2- Low cost
1-Screening modality ; usually need another imaging test to confirm
diagnosis .
2- Lack of anatomic detail .
LIMITATIONS

4. Plain Abdominal X-ray film
NOT Indicated for
1- Trauma .
2- Solid organ assessment .
Contra-Indications
pregnancy

5. Basic Principles
Five Radiologic Densities
1- Gas / Air .
2- Fat .
3- Soft tissue / Water .
4- Bone / calcifications .
5- Metals .
Normal VS Abnormal gas shadow
Normal Abnormal
1- Stomach .
2- Colon .
3- Small bowel .
1-Within the lumen :
Dilated Bowel ? Obstruction.
2- Outside the lumen :
a) Free ? Perforation .
b) In a cavity ? Abscess .

6. (A) Top half with domes of the diaphragm
(B) Lower half of the abdomen.
psoas
shadows
urinary
bladder
bowel gas

7. Intra-Luminal Contrast Study
Contrast Media for GI
Water Soluble
:# Ionic ( gastrografin )
Can lead to pulmonary edema if
aspirated .
# Non-Ionic ( Low Osmolar ) :
Relatively safer if aspirated .
## Gadolinium ( MRI )
NON-Water Soluble
#Barium
Can cause sever peritonitis and
fibrosis in perforation or leakage

8. Contrast Swallow
Indications
Dysphagia .
Pain .
Reflux .
Anemia .
Tracheo-esophageal fistula .
Perforation .
Contra-Indication
Aspiration

10. Barium Meal
Indications
Dysphagia .
Upper abdominal mass .
Weight loos .
GI Hemorrhage .
Parial Obstruction .
Assessment for
perforation .
Contra-indications
Complete large bowel
obstruction
Patient preparation
NPO …. 6 hrs
No smoking …increases GI
motility

12. Small Bowel Follow through /
Small bowel Enema ( Enteroclysis )
Indications
Pain – Diarrhea – Anemia /
GI bleeding – Partial
obstruction – Malabsorption
– Abdominal mass .
Contra-indications
Complete Obstruction
Patient Preparation
Low residue diet
Bowel prepare ( Dulcolax – 2-4 tab )

14. Barium Enema
Indications
Change in Bowel habits – Pain
– Mass – Melena / Anemia
Single Contrast
Obstruction .
Intussusception .
Contra-Indications
1- Rectal biopsy 5 days .
2- Toxic megacolon .
3- Pseudomembranous
colitis .
Preparation (2 days )
Low residue diet .
Bowel prep ( Dulcolax ) .

17. Ultrasound Abdomen
Advantage
1-Cost effective .
2- Adequate visceral visualization .
3- Best for GB .
4- No radiation .
Indications
Acute Abdomen , Obstructive
jaundice , Abdominal masses ,
Collections , Free fluid ,
Follow-up tumors .
Disadvantage
1- Operator dependent .
2- Poor in obesity .
3- Bowel gases .
4- Bone / Calcifications .

22. CT Scan Abdomen
Advantages
1) Accurate & Quick .
2) Bowel / Gases / Bones .
3) Reformation and Angio
Indications
Acute abdomen , Abdominal
masses , Tumor staging ,
Follow-up , Appendicitis /
Abscesses , Post op
complications .
Disadvantages
1) Radiation .
2) Renal failure .
3) Contrast reaction .

28. MRI Abdomen
Advantages
1- Multiplaner .
2- Renal Failure .
3- MRCP .
4- Liver specific contrast .
Dis-Advantages
1- Bowel motion / contrast .
2- Calcification .
3- Metallic implant .
4- Relative long procedure time .
5- Claustrophobia .

30. THANK U