X-RAYS TOUTRIALthis a summation of the toutrial of our group and the previous group

you have to read every things of the diseases included here or in the slide

Best whishesABODI2010

SPECIAL THANKS FOR:ABDUL , REDHA , OBIDAN AND ASALI

Dx: air under diaphragm ( pneumoperitonium)

-desc: x-ray of the chest and upper abdomen showing subphrenic air

-DDX: perforating peptic (vescous) ulcer and most commonly post operative (laproscopic surgery ,histosalpingiography) and subphrenic abscess

* if doctor said young and smoker pt. mostly it is due to duednal

ulcer

To be continue,,

Continue,,, -management: admission, NPO, bed rest, IV fluid ,nasogastric tube ,

analgesia , lapartomy and antibiotics. - definitive treatment :

1-closure of perforation by omental patch

2-wash the peritonium -complications :

- peritonitis- subphrenic abscess

- pelvic abscess

*residual air is N2. *the post operative pneumoperitonium takes minimum 2weeks to be

absorbed

plane x-ray showing multiple air fluid level

Dx :small bowel obstruction bcs: 1-the position is central

2-small size

3-absence of the air in the pelvis

the obstruction is in the ileum bcs: no appearance of Vulvus convanantes

DX: acute small bowel obstruction (jejunum due to appearance of vulvulus convanantes)

-complete opacity in the lower of the abdomen with complete vulvulas convanantes.

-there are multiple fluid level and dilatation of the intestine -read abt. The causes of intestinal obstruction

-management :N.G. tube, NPO….ETCSubjective (analgesics and relief the symptoms)Objectives (measurement of the girth of the abdomen, the volume of the N.G aspiration and urine output)

Vulvus convanantes

Small bowel obstruction

Dx: mostly it is lymphoma due to bizzar appearance

DDx:- adenocarcinoma

- lymphoma

Desc.: barium meal showing shouldering in the stomach

Common causes: TB , irradiation and gastrobaresis

Shouldering

Dx: diabetic foot (amputated big toe)

-x-ray of the foot showing chewed toe (calcified dorsalis pedis and post. Tibia)

It can indicates:

1-osteomylitis

2-gas necrosis

3-calcification of blood vessels

Read more about diabetic foot

Facated stone in the C.B.D

-Dx: intraoperative cholangiogram (due the instruments (clips and swabs))

-Structure outlines : extrahepatic billiary tree (lt. and rt. Hepatic ducts,

common hepatic duct , and twisted cystic duct , Common Bile Duct (SUPRA , INFRA AND RETRO DUEDNAL)) and duedonum .

- pathology : filling defects( stones ,air or both) in the infra duednal C.B.D -indication :

- assure the stones are extracted well by the ERCP- when the anatomy of extra hepatic tree is not clear

T-tube cholangiogram is used for drainage to inhibit the peritonitis (POST OP.).

Here there are dilated C.B.D ,multiple filling defect ,minimal leakage defect around the T-tube and the contrast reach

the duodenum .

Extra hepatic billiary tree

BARIUAM ENWMA (1) BARIUM ENEMA – MIDDLE PROCEDURE(2)

Apple CORE LESION + SHULDERING (3)

Apple CORE LESION + SHULDERING(4)

-the contrast of barium enema here are middle procedure this is due to :

- whole of the intestine are out lined- rectal tube is out lined also

) the beginning contrast the halve of the intestine is outlined and the end

contrast has no tube( -DX: colon carcinoma

-DDx: malig, T.B. ,ameaboma…..etc

-the lower x-rays show cecum with neoplasma : - apple core lesion

- shouldering - minimal dilatation

#N.B :.- the rt. Colonic lesion lead to anemia

- the lt. colonic lesion lead to obstruction-investigations :

1-biopsy 2-colonscopy

N.B.: TYPES OF THE BIOPSY:

1-fine needle aspiration (cytology)(1)

2-incisional (cut spec. for histology)(4)

3-excisional(remove whole for

histology)(5)

4-punch (3)

5-trucat valve(2)

In case of : 1 -the lesion in the right side of the colon involve ascending colon ,hepaticus

flexure and 1\2 of the transverse colon: do: 1- hemicoloectomy ( terminal ilium, cecum and 1\2 of transverse colon)

2 -then do iliocolic anastamosis

2- the lesion involves left side with out rectum :

do: 1-lt hemicoloectomy 2-then colocolic anastmosis

3-if the lesion involves the rectum only :(THIS IS FOR THE LOWER X-RAY

TREATMENT IN SLIDE NO.9)

do: 1-epiresection ( abdominoperineal excision of the rectum and anal canal

2-then followed by terminal colostomy

ERCP

Appearance of dilatation of the C.B.D. and multiple filling defect

-anatomy -gallbladder -cystic duct (twisted) ,infra-,supra- and duodenal C.B.D

also, the ampulla of vat.

- indications : 1-obst. Jaundice

2-C.B.D. stones

3-stricure in the common bile duct

- benign (inflammation in peritoneum)

- malignant as in cholangicarcinoma and pressure on the ampulla by the head of the pancreas(

Treatment of filling duct: 1- papilotomy + extraction of the stone by dormia basket.

2- elective laproscopic cholecystectomy.

Other investigations help it:- L F T

- CARCINOEMBRYOnic ANTIGEN - ULTRA SOUND

- PTC

COMPLICATIONS OF CHOLANGIOGRAM : -PANCREATITS

- ASCENDIC CHOLANGITIS- BLEEDING

- PERFORATION

PREPRATIONS:- CORRECT THE COAGULATION

- ANTIBODIES PROPHYLAXIS

Not explained by the doctor

NOT EXPLAINED BY THE DOCTOR

Complicated pneuomothorax with loculated hemothorax( not explained )

Dx : rt. Simple pneumothorax (lt. side showing air in gastric of fundus and splenic curvature)

- rib cage are intact here(ribs ,clavicle,sternum and scapula(

- soft tissue( white appearance) no evidense of emphysema - here you have to know the investigations and treatment and the

causes (see note no. 7 or chapter 9 in lecture’s note)

In case of tension pneumothorax :(slide no.21)- there will be :

1-shifting of the trachea and mediastinum into

opposite side 2-depressed diaphragm

3-total collapse of the lung 4-widening of the intercostal

space- treatment:

- chest tube and fix it to water- or needle decompression

There are 2 x-rays I didn’t get them: 1-plane x-ray showing foreign body (nails)

when you mention the Dx mention the foreign body.

treatment of GI foreign body: 1-if small it will pass spontanously

) the abdomen will be w\out tenderness ) but you have

to take x-ray every 24hours to see the progression

2-if stock in one of the narrow spaces (as, gastric pylorus , esophageal narrowings ,ileocecal junction…etc )

do the endoscopic removal

2-barium swallow:

صورة فيه واحد كل اعمدة ثالثة الليال اكيد (:esophagusعن عرفتوها

-Dx: pharyngeal pouch

N.B:.-YOU HAVE TO MENTION THE TYPE OF THE

RADIOGRAPH IF IT IS CONTRAST OR PLANE X-RAY -IF IT IS PLANE X-RAY YOU HAVE TO MENTION THE

SITE OF THE X-RAY IF IT IS ABDOMINAL OR CHEST -BARIUM CONTRAST:

1-barium swallow: found in the esophagus. 2-barium meal: found in the stomach and

jejinum 3-folow through :take the x-ray after 2hours of

swallowing. -the appearance of large and small bowel obstruction :