This document provides an overview of special investigations for abdominal pathologies. It discusses common abdominal symptoms and conditions that may present with those symptoms. The document then covers various radiological investigations for the abdomen including abdominal x-rays, contrast medium x-rays like barium swallows and barium enemas, CT scans, MRIs, and USGs. It provides details on each imaging technique and their clinical indications.

1. Welcome…
1

2. Special investigations in
abdominal pathologies
By
Dr. Hari krishnan .S
2nd yr shalya pg
2

3.  1.Introduction
 2.Common abdominal pathologies
 3.Radiology and types
 4.Abdominal X ray
 5.Contrast medium X rays
 6.CT abdomen
 7.USG Abdomen
 8.MRI abdomen
 9.Invasive techniques
 10.Conclusion
3

4. Introduction
•‘Abdomen’ the major part of the body which a
layman refers as the belly or the tummy, is also a
mystery box, which is the abode of several vital
organs.
4

5. Introduction
• Data from hospitals indicate that more than 25% of
the population suffer from some type of abdominal
disorder, causing prolonged suffering, time off work and
poor quality of life.
•Disorders of the abdomen are very common and induce a
significant amount of morbidity and suffering in the
population.
5

6. Introduction
• As the na‘me suggest, the disorders of the abdomen are like
the mystery to be unraveled as some are trivial,
some are immediately life threatening, requiring
rapid diagnosis and surgery
• Therfore it requires a thorough and expeditions workup to
determine the need for the operative intervention and
initiate appropriate therapy
•. History and physical examination usually exclude all but a
few possible causes, with final diagnosis confirmed by
judicious use of laboratory and imaging tests.
6

7. Introduction
‘
•Therfore it is essential for a physician to have complete
understanding of the investigative procedures regarding
various abdominal disorders
• Here is a attempt to compile various investigations required
to unravel the mystery of the abdomen
7

8. Common symptoms
1.Constipation
2.Diarrhea
3.Flank pain
4.Lower abdominal pain
5.Stomach pain
6.Upper abdominal pain
7.Vomitting
8.Abdominal distention
9.Black stools
10.Blood in stools
11.Fatty stools
12.Groin pain
13.Vomitting blood
8

9. a. Low fiber diet
b. Medicines side reactions
c. Oral Fe suppliments
D. haemorrhoids
e. Bowel obstructions
f. Chronic renal faiure
g. Faecal impaction
h. Irritable bowel syndrome
i. Rectal cancer
j. Colonic diverticulitis
k. Hypothyroidism
l. Colon cancer
m. Paralytic ileus
n. hypokalemia
9

10. 2.Diarrhea
a. Gastroenteritis
b. celiac disease
c. Food poisoning
d. Irritable bowel syndrome
e. Lactose intolerance
f. Medication reaction
g. Bowel obstruction
h. Colon cancer
i. Chrons disease
j. Bacterial dysentry
k. Typhoid fever
l. Giardiasis
m. Pancreatitis
n. Shigellosis
o. Viral infections 10

11. Flank pain/lumbar pain
a.Nephrolithiasis
b.Uti
c.Muscle strain
d.Back trauma
e.Renal trauma
f.Pyelonephritis
g.Herpes zoster
h.Renal infarct
i.Renal vein thrombosis
j.Low back pain (lumbago)
k.Fibromyalgia
l.Spleen injury
m.Retro peritoneal
heamarrage
n.Kidney cancer/tumor
o.Poly cystic kidney disease
p.Ulcerative colitis
q.Myocardial infarction
r.Cholecystitis
s.Appendicitis
t.Cholelithiasis
u.Rib fracture
v.Pleuritis
w.Colonic diverticulitis
x.Pneumonia
11

12. Lower abdominal pain
12
Right lower quadrant
•Appendicitis
•Diverticulitis
•Salpingitis/Pelvic
inflammatory disease
•Endometritis
•Endometriosis
•Ectopic pregnancy
•Hemorrhage or rupture of
ovarian cyst
•Renal calculus
•Intussusception
•Pelvic/hypogastric region
•Cystitis
•Salpingitis/Pelvic
inflammatory disease
•Ectopic pregnancy
•Diverticulitis
•Strangulated hernia
•Endometriosis
•Appendicitis
•Ovarian cyst
•Ovarian torsion
•Testicular torsion
•Bladder distension
•Nephrolithiasis

13. epigastric pain
a.Gastritis
‘b.gastroentritis
c.Constipation
d.Gastro esophagal reflux (GERD)
e.Viral infections
f.Peptic ulcer
g.Appendicitis
h.Cholangitis (infected bile duct)
i.Cholecystitis
j.Inguinal hernia
k.Irritable bowel syndrome
l.Cholelithiasis
m.Uti
n.Celiac disease
13

14. Upper abdominal pain
14
Right upper quadrant pain
•Cholecystitis
•Fatty liver or NASH
•Congested liver (e.g., secondary
to heart failure)
•Cholangitis
•Hepatitis
•Gastritis or pancreatitis
•Pneumonia
Left upper quadrant pain
•Peptic ulcer disease
•Gastritis
•GERD
•Spleenic infarct
•Pulmonary embolism
•Pancreatitis
•Acute spleenomegaly
•Left lower lobepneumonia

15. Diffuse pain
15
•Gastro entritis
•Peritonitis
•Pancreatitis
•Early appendicitis
•Mesentric adenitis
•Intussusception
•Colitis
•Intestinal obstruction
•Inflamatory bowel disease
•Metabolic or bacterial cause

16. Vomiting
a.Gastro entritis
b.Viral infections
c.Medical reactions
d.Gerd
e.Food poisoning
f.Gastritis
g.Gastro intestinal bleeding
h.Bulimia nervosa
i.Post concussive syndrome
j.Appendicitis
K,alcoholism
l.Migraine
m.Carbon monoside poisoning
n. Bowel obstruction
o.Diabetic ketoacidosis
p.Head injury
q.Pancreaitis
16

17. Abdominal distension
a.Ascities
b.Constipation
c.Inguinal hernia
d.Irritable bowel syndrome
e.Lactose intolerance
f.Malabsorption syndrome
g.Paralytic ileus
h.Small bowel obstruction
i.Urine retention
j.Abdominal aortic aneurysm
k.Tumor
l.Cirrhosis of liver
k.Colon cancer
l.Congestive heart failure
m.Gastroperesis
n.Intestinal volvulus
o.Large bowel obstruction
p.Liver injury
q.Ovarian cancer
r.Pancreatic cancer
s.Spleenic injury
t.Toxic megacolon
u.Umblical hernia
17

18. groin pain
a.Muscle strain
b.Inguinal hernia
c.Epididymitis
d.Nephrolithiasis
e.Ligament sprain
f.Constipation
g.UTI
h.Testicular torsion
i.Contusion
k.Pyelo nephritis
l.Cellulitis
m.Bladder infection
n.Femoral hernia
o.lymphadenopathy
18

19. Black stools
a.Crohns disease
b.Gastritis
c.Fe suppliments
d.Mallory weiss syndrome
e.Pepto bismul /keopectate ingestion
f.Small bowel lymphoma (lymph cancer)
g.Gastro intestinal ulcers
h.Warfarin use
i.Intestinal ischemia
j.Intussusception
k.Meckels diverticulam
l.Volvulus
19

20. Blood in stools
a.Anal fissure
b.Constipation
c.Gastritis
d.Gastro entritis
e.Hemorrhoids
f.Ulcerative colitis
g.Peptic ulcer
h.Crohns disease
i.Intestinal volvulus
20

21. Bloody diarrhea
a.Colitis
b.Colonic diverticulitis
c.Crohns disease
d.Intestinal ischemia
e.Ulcerative colitis
f.Gastro intestianl ulcer
g.Intestinal volvulus
h.Intussusception
i.Hemolytic uremic syndrome
j.Amebiasis
21

22. Fatty stools
a.Bacterial over growth in
intestine
b.Celiac disease
c.Choledocholithiasis
d.Lactose intolerance
e.Pancreatitis
f.Ulcerative colitis
g.Cystic fibrosis
h.Primary scelorosing cholangitis
i.Whipples disease
22

23. 23
• Gastro entritis
• Esophagitis
• GERD
• Thrombocytopenia
• Intussuception
• Mallory weiss syndrome
• NSAID overdose
• Tonsilitis
• Intestinal volvolus
• Gastritis

24. INVESTIGATIONS
24

25.  Radiology is the branch of medicine that uses
radio active substances or electromagnetic
waves to create images of the body for the
purpose of diagnosis and treatment.
 Images can also show how effectively the body
and its internal organs and structures are
functioning
 It is used for both therapeutic and diagnostic
purposes
25

26. Types
1. Diagnostic radiology : type of radiology that uses
external radiation to produce images of body ,organs
and other internal structures for diagnostic purpose
2. Nuclear medicine : a type of diagnostic radiology that
uses a small amount of radio active substance to
create image of the body organ which helps to study
the structure and functions to make
diagnosis/treatment of them.
3. Theraputic radiology :that branch uses radiant energy
to study ,treats and manages cancer and other
diseases
4. Interventional radiology: that branch which uses various
imaging techniques to guide the insertion of small
instruments and tools through GIT to identify and treat
medical disorder .In this simultaneous diagnosis and
treatment with help of Xray imaging is carried out.
26

27.  Images produced by radiological procedures
can be grouped into
A.Transmission imaging
in this, a beam of high energy photons is produced
and passed through the body structure to be
examined.The beam passes through less dense types
of tissue such as watery secretions,blood and
fat,very quickly leaving a darkened area on the
film.muscle and connective tissue appear as grey
while bone appear as white er:Xrays,CT,
27

28.  B.Reflection imaging
Imaging produced by sending high frequency sounds
to the body part or organ being studied..These sound
waves bounce off various types of body tissue at varying
speeds, depending upon te density of the tissue
present.The bounced sound waves are sent to a computer
that analyse the sound wave and produce the visual image
of the body part or structure.
Eg :Ultrasound
C.Emission imaging
In this tiny nuclear particles or magnetic energy are
detected by a scanner and analysed by computer to
produce an image of body structure or organ being
examined.
Eg: MRI
28

29.  D. Contrast medium xray
• To visualise radio lucent structures like
stomach,intestines,blood vessels,etc a radio
opaque substance is passed or injected into
them and xray film is taken.In these indirect
viewing of the recquired part with help of
injecting a radio opaque substance is possible
• Eg:barium meal ,barium swallow,barium
enema,intravenous pyelography ,myelogram ,
intravenous urogram, cystogram,
urethrogram,cholesystogram,urethrogram,
cholangiogram, arteriogram,
venogram,lymphangiogram,sinusogram,etc
29

30. Abdominal xray
• X ray imaging is performed according to the x ray
penetrability of tissues under investigations.
•The formation of a radiographic image depends on the
structure & size of the organs within the abdomen
2 Common position in abdominal Xrays
•Anterio posterior (AP) supine
•Anterio posterior (AP) erect
If patient unable to sit or stand
• lateral decubitus

31.  In supine position – place support under knee to
relieve strain to abdominal muscles
 For upright position radiograph patients back
should be against the grid device ,legs slightly
spread,with body weight distributed equallly on
both feet.
 In both positions ,the mid sagittal plane of the
body should be centered to the mid line of the
grid device
31

32. •P-A (relation of x-ray beam to patient)
32

33. •Bone- High (white)
•Tissue- Middle (grey)
•Air- Low (black)
33

34. The big two densities are:
(1) WHITE - Bone
(2) BLACK - Air
The others are:
(3) DARK GREY- Fat
(4) GREY- Soft tissue/water
And if anything Man-made is on the
film, it is:
(5) BRIGHT WHITE - Man-made
34

35.  Abdominal landmark- illiac crest level of mid
abdomen
(L4.L5)
 For supine position ,the cassete of Image receptor
is centered into the illiac crest and lower abdomen is
generally included on lower margin of the cassete.
 For upright position, cassette is centered (5cm) above level
of illiac crest ,or high enough to include the diaphragm
 .Relaxation of musculature is acheieved by supporting and
slightly flexing patients knee.
 Ask the patient to take a deep breath,exhale completely
and hold the position while not inhaling.this moves the
diaphragm to a superior position that results in better
visualisation of abdominal muscles
35

36. Things to look for
 Name,date
 Position of the film and view
 Adequate area covered or not?
 Preperitoneal fat lines
 Visualised organs are normal in size
 Visualised bones and joints are normal
 Any radio opacity
 Any artifacts
 Any calcification
36

37. Indications for abdominal Xray
 Used for certain defined pathology such as abnormal
gas,masses,bones and stones
 Undifferentiated abdominal pain with provisional diagnosis of
a. toxic mega colon of IBD
b.bowel obstruction
c.bowel ischemia
d.perforation of a viscus with abdominal free air
e.KUB for renal tract calculi; 80 to 90% sensitivity if radio
lucent stone >3 mm
f.foreign body
 Radio dense tablets
eg.pottasium chloride tablet
 Metals eg: mercury
 Iatrogenic eg: barium
37

38. 38

39. 39

40. 1, 11th rib.
2, Vertebral body (TH 12).
3, Gas in stomach.
4, Gas in colon (spleenic
flexure).
5, Gas in transverse colon.
6, Gas in sigmoid.
7, Sacrum.
8, Sacroiliac joint.
9, Femoral head.
10, Gas in ceacum
11, Iliac crest.
12, Gas in colon (hepatic
flexure).
13, Psoas margin
40

41. 41

42. 42

43. Contrast medium x rays
 Barium x rays are used to diagnose abnormalities
of gastro intestinal tracts,such as tumour,
ulcer,polyps,hernia,strictures etc..
 With the use of barium sulphate , a metalic
chemical that x rays cannot pass through,x rays
are taken
 3 types
a.barium swallow
b.barium meal
c.barium enema
43

44. Indications in barium X ray
 Pain or difficulty in swallowing
 Blood in the vomit
 Abdominal pain
 Bowel moment changes
 Chronic diarrhea / constipation
 Unusual bloating
 Bleeding from the rectum
 Unexplained weight loss
44

45. Barium swallow
 A barium swallow is a radiographic (X-ray)
examination of the upper gastrointestinal (GI)
tract, specifically the pharynx (back of mouth and
throat) and the esophagus . The pharynx and
esophagus are made visible on X-ray film by a liquid
suspension called barium sulfate (barium)
 Barium is an X-ray absorber and appears white on
X-ray film. When swallowed, a barium drink coats
the inside walls of the pharynx and esophagus so
that the swallowing motion, inside wall lining, and
size and shape of these organs is visible on X-ray.
This process shows differences that might not be
seen on standard X-rays.
45

46. •Fluoroscopy is often used during a barium swallow. Fluoroscopy is a
study of moving body structures — similar to an X-ray "movie." A
continuous X-ray beam is passed through the body part being
examined, and is transmitted to a TV-like monitor so that the body
part and its motion can be seen in detail.
• In barium X-rays,fluoroscopy allows the radiologist to see the
movement of the barium through the pharynx and esophagus as a
person drinks
46

47. INDICATIONS
•Cancers of the neck, pharynx, and esophagus
•Tumors
•Hiatus hernia. Upward movement of the stomach,
either into or alongside the esophagus
•Structural problems. Such as diverticula, strictures, or polyps
•Esophageal varices (enlarged veins)
•Muscle disorders (pharyngeal or esophageal). Such as dysphagia
(difficulty swallowing) or spasms (pharyngeal or esophageal)
•Achalasia. A condition in which the lower esophageal sphincter
muscle doesn't relax and allow food to pass into the stomach
•Gastroesophageal reflux disease (GERD)
• Ulcers 47

48. Barium meal
•In a barium meal test, X-ray images are taken
of the stomach and the beginning of duodenum
•A barium meal usually takes less than an hour.
• The patient ingests gas pellets and citric acid
to expand the stomach. Then about 3 cups
(about 709 ml) of barium is ingested. The
patient may move or roll over to coat the
stomach and oesophagus in barium. Following
these preparations, an x-ray is taken.
48

49. •There are two varieties of barium meal: single
and double contrast meals.
•A single contrast meal uses only barium, a
radioopaque (or positive) contrast medium, to
image the upper gastrointestinal tract.
•A double contrast meal uses barium as well as a
radiolucent (or negative) contrast medium such
as air, nitrogen, or carbon dioxide.
•The double contrast meal is more useful as a
diagnostic test, demonstrating mucosal details
and allowing the detection of small mucosal
lesions such as diverticula or polyps. 49

50. Barium enema
•Lower gastrointestinal (GI) tract radiography,
also called a lower GI or barium enema, is an x-ray
examination of the large intestine, also
known as the colon.
•This examination evaluates the right or
ascending colon, the transverse colon, the left
or descending colon, the sigmoid colon and the
rectum.
•The appendix and a portion of the distal small
intestine may also be included
50

51. •After the instillation of barium into the rectum, the
radiologist may also fill the large intestine with air.
• Air will appear black on X-ray film, contrasting with
barium's white image.
•The use of the 2 substances, barium and air, is called
a double contrast study.
•The purpose of using 2 contrast substances is to
achieve an enhancement of the inside wall lining of
the large intestine.
51

52. •As the air expands the large intestine (like blowing up a balloon), a barium
coating is formed on the inner surface of the colon wall.
•This technique enhances visualization by sharpening the outline of the
inner surface layer of the large intestine.
•The benefit of this technique is to show smaller surface abnormalities in
the large intestine.
52

53. Indications
 Ulcerative colitis. Ulcerations and inflammation of the large
intestine.
 Crohn's disease. Ulcerations and inflammation occurring in any
part of the GI tract
 Obstructions and polyps (growths)
 Cancer
 Unusual bloating or lower abdominal pain
 Unexplained weight loss
 Irritable bowel syndrome
 Changes in bowel movements. Such as chronic diarrhea or
constipation, or passing of blood, mucus, and/or pus.
53

54. • Risks of barium enema may include, but are
not limited to:
 Colon perforation
 Constipation or fecal impaction
• Contraindications for a barium enema include,
but are not limited to:
 Suspected bowel perforation
 Severe ulcerative colitis
 Pregnancy
 Toxic megacolon
 Acute abdominal pain
54

55. Intra venous pyelogram (IVP)
 An intravenous pyelogram (IVP) is an x-ray examination of
the kidneys, ureters and urinary bladder that uses
iodinated contrast material injected into veins.
 When a contrast material is injected into a vein in the
patient's arm, it travels through the blood stream and
collects in the kidneys and urinary tract, turning these
areas bright white on the x-ray images
Indications
 kidney stones
 enlarged prostate
 tumors in the kidney, ureters or urinary bladder
 surgery on the urinary tract
 congenital anomalies of the urinary tract
55

56.  The equipment typically used for this examination
consists of a radiographic table, one or two x-ray tubes
and a television-like monitor that is located in the
examining room. Fluoroscopy, which converts x-rays into
video images, is used to watch and guide progress of the
procedure.
 In an IVP exam, an iodine-containing contrast material is
injected through a vein in the arm. The contrast material
then collects in the kidneys, ureters and bladder, sharply
defining their appearance in bright white on the x-ray
images.
 X-ray images may be maintained as hard film copy or as
digital images

56

57. •A CT or CAT scan is a diagnostic imaging procedure that
uses a combination of x rays and computer technology to
produce cross sectional images (slices) both horizontally
and vertically of the body.
•CT scan also minimize the exposure to radiation
• In CT ,the Xray beam moves in a circle around the
body.This allows many different views of the same organ
or structure , and provides much greater details.
•The xray information is sent to a computer that
interprets the xray data and displays it in 2 dimensional
form in monitor 57

58. •CT scans can be done with or without contrast
•Contrast refers to a substance taken by mouth or
injected into an intravenous line that causes the particular
tissue or organ under study to be seen more clearly
•Contrast procedure may require the patient to fast before
the procedure
•Usualy used in the diagnosis of tumors,internal bleeding
and also to check internal damage or injuries.
58

59. 59

60. •To assess the abdomen and its organs for tumors and
other lesions,
• injuries,
• intra-abdominal bleeding,
•Infections
• unexplained abdominal pain
• obstructions
• when another type of examination, such as X-rays or
physical examination, is not conclusive.
•A CT scan of the abdomen may also be used to
evaluate the effects of treatment on abdominal
tumors.
•Another use of abdominal CT is to provide guidance
for biopsies and/or aspiration of tissue from the
abdomen.
60

61. •Viewing a CT scan, an experienced radiologist
can diagnose many causes of abdominal pain or
injury from trauma with very high accuracy,
enabling faster treatment and often eliminating
the need for additional, more invasive diagnostic
procedures.
•When pain is caused by infection and
inflammation, the speed, ease and accuracy of a
CT examination can reduce the risk of serious
complications, such as those caused by a
burstappendix or an infected fluid collection and
the subsequent spread of infection.
61

62. •CT scanning is painless, noninvasive and accurate.
•A major advantage of CT is its ability to image bone,
soft tissue and blood vessels all at the same time.
•Unlike conventional x-rays, CT scanning provides
very detailed images of many types of tissue as well
as the lungs, bones, and blood vessels.
•CT examinations are fast and simple; in emergency
cases, they can reveal internal injuries and bleeding
quickly enough to help save lives
•CT has been shown to be a cost-effective imaging tool
for a wide range of clinical problems.
•CT is less sensitive to patient movement than MRI.
62

63. •CT can be performed if you have an implanted medical
device of any kind, unlike MRI.
•CT imaging provides real-time imaging, making it a good
tool for guiding minimally invasive procedures such
as needle biopsies and needle aspirations of many areas
of the body, particularly the lungs, abdomen, pelvis and
bones.
•A diagnosis determined by CT scanning may eliminate
the need for exploratory surgery and surgical biopsy.
•No radiation remains in a patient's body after a CT
examination.
•X-rays used in CT scans should have no immediate side
effects 63

64. •There is always a slight chance of cancer from
excessive exposure to radiation.
•The effective radiation dose for this procedure
varies.
•Women should always inform their physician and x-ray
or CT technologist if there is any possibility that they
are pregnant.
•CT scanning is, in general, not recommended for
pregnant women unless medically necessary because of
potential risk to the baby in the womb.
•. CT scans in children should always be done with
low-dose technique 64

65. .
65

66. .
66

67. •The sound waves bounce of the organs like an echo and
return to the transducer.
•The transducer picks up the reflected waves,
which are then converted into an electronic picture of the
organs.
.
•Different types of body tissues affect the speed at which
sound waves travel.
•Sound travels the fastest through bone tissue, and moves
most slowly through air.
67

68. •The speed at which the sound waves are
returned to the transducer, as well as how much of
the sound wave returns, is translated by the
transducer as different types of tissue
•By using an additional mode of ultrasound technology
during an ultrasound procedure, blood flow within the
abdomen can be assessed.
•An ultrasound transducer capable of assessing blood
flow contains a Doppler probe.
•The Doppler probe within the transducer evaluates
the velocity and direction of blood flow in the vessel
and makes the sound waves audible.
68

69. •Cysts
•Tumors
•Collection of pus
•Obstructions
•Fluid collection
•Blockage in blood vessels
•Infection
69

70. •
70

71. 71

72. 72
MAGNETIC RESONANCE IMAGING
•Non invasive technique
•MRI uses a powerful magnetic field, radio
frequency pulses and a computer to produce
detailed pictures of organs, soft tissues,
bone and virtually all other internal body
structures
•MRI does not use ionizing radiation (x-rays).
The images can then be examined on a
computer monitor, transmitted
electronically, printed or copied to a CD

73. 73
INDICATIONS
MR imaging of the body is performed to evaluate:
• organs of the chest and abdomen—including the
heart, liver,biliary tract, kidneys, spleen, bowel,
pancreas and adrenal glands.
• pelvic organs including the bladder and the
reproductive organs such as the uterus and
ovaries in females and the prostate gland in
males.
• blood vessels (including MR Angiography).
• Lymph nodes.

74. 74
Physicians use an MR examination to help diagnose
or monitor treatment for conditions such as:
• tumors of the chest, abdomen or pelvis.
• diseases of the liver, such as cirrhosis, and
abnormalities of the bile ducts and pancreas
• inflammatory bowel disease such as Crohn’s disease and
ulcerative colitis
• heart problems, such as congenital heart disease.
• malformations of the blood vessels and inflammation of
the vessels (vasculitis).
• a fetus in the womb of a pregnant woman
• It captures excellent images of fluid and swelling, as well
as active inflammation, bowel obstructions, abscesses, and
fistulas, or abnormal passageways between organs.

75. 75
Principle
• MRI does not depend on ionizing radiation.
• Instead, while in the magnet, radio waves redirect
alignment of hydrogen atoms that naturally exist
within the body without causing any chemical changes
in the tissues. As the hydrogen atoms return to their
usual alignment, they emit energy that varies
according to the type of body tissue in which they lie.

76. •. The MR scanner listens for this energy and
creates a picture of the tissues scanned.
•The magnetic field is produced by passing an
electric current through wire coils in most MRI
units. Other coils, located in the machine and in
some cases, placed around the part of the body
being imaged, send and receive radio waves,
producing signals that are detected by the
coils.
76

77. 77
• The traditional MRI unit is a large cylinder-shaped
tube surrounded by a circular magnet. Patient will lie on
a moveable examination table that slides into the
center of the magnet.
• The magnetic field is produced by passing an electric
current through wire coils in MRI units,placed around the
part of the body being imaged, send and receive radio
waves, producing signals that are detected by the coils.
A computer then processes the signals and generates a
series of image
• Duration : 30- 50 minutes

78. a.Colonoscopy
 With the help of a colonoscope, this procedure is used to examine
the colon,the last part of gastrointestinal tract.
 A colonoscope is a long, thin, flexible tube with a miniature video
camera and light at its end. The gastroenterologist will put a little
bit of air into the colon as he/she inserts the scope. The camera on
the end helps the physician both guide the colonoscope throughout
the length of the colon and take pictures of the colon.
 Colonoscopies are most commonly performed in colorectal cancer
screening and prevention
 Duration : 30 mins
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80. b.Endoscopic Retrograde CholangioPancreatography
(ERCP)
•During an endoscopic retrograde cholangio pancreatography, or ERCP,
the gastroenterologist uses an endoscope, a long, thin, flexible tube with
a light and camera at the end, through the esophagus, the stomach, and
the first part of the small intestine, called the duodenum.
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• Once the endoscope reaches the papilla, which is the opening of the
common bile duct, the physician injects dye through these ducts,
enabling x-rays to be taken

81. •Bile, a liquid that helps digest fat, is produced by the liver
and carried to the gallbladder, where it is stored, through a
series of tubes called ducts.
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•The main duct from the pancreas joins the common bile
duct and allows pancreatic juices to help with further
digestion in the duodenum.
•After eating, both bile and pancreatic juices flow through
the papilla and into the duodenum, where they mix with food
and play a major role in digestion.
•A physician may recommend an ERCP if the patient is
experiencing abdominal pain or develops jaundice .
• This procedure is helpful in identifying gallstones, tumors
or scar tissue obstructing the bile duct.

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C.Endoscopic Ultra Sonography (EUS)
To examine
Upper GI : esophagus,stomach and duodenum
Lower GI : colon,anus and rectum
•EUS involves the use of an endoscope or colonoscope, long, thin,
flexible tubes with a light and camera at the end, to help guide the
scope throughout the duration of the procedure.
•However, these scopes are different than those used in colonscopy
and ERCP: they emit sound waves that create visual images of the
digestive tract that a normal endoscope cannot detect.

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•It may also be used to assess the nature of a
tumor that may have been detected during a prior
endoscopic procedure
• In conjunction with examination of a tissue sample
obtained using a procedure called a "fine needle
aspiration," EUS can help diagnose diseases of the
pancreas, gallbladder and bile duct .
•Duration : 45 minutes

84. d.Upper GI Endoscopy
 An upper GI endoscopy looks at the upper part of the
gastrointestinal tract including the esophagus, the stomach and
the first part of the small intestine, called the duodenum.
 The gastroenterologist uses an endoscope, a long, thin, flexible
tube with a light and camera at the end to help guide the scope
throughout the duration of the procedure.
 The camera on the end helps the physician both guide the
endoscope throughout the length of the upper GI tract, and
take pictures.
Indications :chronic heartburn (acid reflux), difficulty
swallowing, stomach or abdominal pain, bleeding, ulcers and
tumors.
Duration : 10- 15 minutes
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85. e. Liver Biopsy
 A liver biopsy is used to determine the presence of
inflammation, fibrosis and to help diagnose various liver
diseases.
 During this procedure, the patient is fully conscious. A
physician numbs the area around the liver using a local
anesthetic (similar to that used by a dentist), and then
using a long, narrow needle obtains a tiny piece of liver
tissue.
 After the procedure, the patient is kept in recovery for
four hours for monitoring.
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86. F. Double Balloon Enteroscopy
 Double balloon enteroscopy is a new method of examining the small
intestine that previous techniques could not reach.
 Double balloon enteroscopy employs a high- resolution video endoscope
with latex balloons attached at the tips that can be inflated and
deflated with air from a pressure-controlled pump system.
 A sequence of inflation/deflation cycles allow the scope to be advanced
further into the small intestine. This technique can be performed using
either an oral or anal route.
Indications : obscure gastrointestinal bleeding, Crohn's disease,
unexplained diarrhea, pancreaticobiliary disease
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89.  SRB Manual of surgery
 Outline of shalya tantra
 Manipal surgery
 Webmd.com
 Radiopedia.com
 Medscape.com
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