RADIOLOGY OF GASTRO- INTESTINAL TRACT

Dr Rekha Khare MD Radiology

GASTRO-INTESTINAL SYSTEM

HOW TO IMAGE GASTROINTESTINAL TRACT?

Plain X-ray Contrast study : Barium study Ultrasound CT scan MRI

PLAIN –X RAY ABDOMEN

Indication: Intestinal obstruction Intestinal perforation Imperforate anus Routine views: Erect abdomen AP Supine abdomen AP (Include part from diaphragm to pubic

symphysis)

Lateral upside down– Invertogram only for imperforate anus

INTESTINAL OBSTRUCTIONDILATED BOWELS, HORIZONTAL AIR FLUID LEVEL, NO AIR IN THE RECTUM

INTESTINAL OBSTRUCTION

INTESTINAL OBSTRUCTION ON CT & U/S

INTESTINAL PERFORATIONAIR UNDER RT DIAPHARGM

INVERTOGRAM: IMPERFORATE ANUS

BARIUM STUDY FOR GIT

What is Barium? Barium sulphate

It is contrast agent inert material when reaches to gastrointestinal tract whether oral or per rectal route, it opacifies the tract ( seen white on x ray)

BARIUM SWALLOW--OESOPHAGUS

Common problem: Dysphagia difficulty in swallowing

Ask for Barium swallow:

Paste like Barium Ask the patient to swallow X-ray under fluoroscopy in

different views

BENIGN STRICTURESMOOTH LONG NARROW SEGMENT NEEDS DILATATION

CAUSES OF SIMPLE STRICTURE

MALIGNANT STRICTUREIRREGULAR SHORT NARROW SEGMENT WITH PROXIMAL HOLD UP AND SHOULDER SIGN

ACHLASIA CARDIAFAILURE OF ORGANISED PERISTALSIS WITH IMPAIRED RELAXATATION OF LOWER OESOPHAGEAL SPHINCTER

BIRD BEAK APPEARANCE CHRONIC SMOOTH DILATATION OF PROXIMAL OESOPHAGUS

DIVERTICULUMSAC OR PROJECTIONS ARISING FROM SIDES OF OESOPHAGUS

MOTILITY DISORDER NEUROMUSCULAR DISORDER ---CORK SCREW OESOPHAGUS

OESOPHAGEAL ATRESIA

BARIUM SWALLOW IN NEONATEOESOPHAGEAL ATRESIA

CAUTION

If in doubt of tracheo-oesophageal fistula never be tempted to give liquid Iodine contrast, might cause Pulmonary oedma

OESOPHAGEAL VARICESSERPIGINIOUS DEFECT DUE TO EXTREMELY DILATED SUB MUCOSAL VEINS IN LOWER THIRD OF OESOPHAGUS AS IN PORTAL HYPERTENSION

BARIUM MEAL FOR STOMACH & DUODENUM

Common gastric problem: Acid peptic disease Peptic ulcer Mass epigastrium- after ultrasound Gastric outlet obstruction

Barium like thick milk, ask pt to drink, films in different projection

GIT ON BARIUM STUDY

ANATOMY OF STOMACH

GASTRIC ULCER

DUODENAL ULCER

MASS STOMACH

GASTRIC OUTLET OBSTRUCTION

PYLORIC STENOSIS

BARIUM MEAL FOLLOW THROUGH( FOR SMALL BOWEL)

Common problem: Any symptom causing subacute intestinal obstruction Right iliac fossa mass or TB ileocaecal

region

BARIUM MEAL FOLLOW THROUGH

BARIUM MEAL FOLLOW THROUGH

DEFORMED CECUM, DILATED TERMINAL ILEUM AND OBTUSE ILEOCECAL ANGLE

MULTIPLE STRICTURES _STRING SIGN

SPASTIC CECUMTRANSIT TIME _ 10 HRS

TB ILEOCAECAL REGIONCONTRACTED CECUM, NARROW IRREGULAR TERMINAL ILEUM & DISTORTED ILEOCAECAL ANGLE

ILEOCECAL T.B. STRICTURE IN TRANSVERSE COLONASCITIC FLUID CYTOLOGY_ T.B. NATURE

BARIUM ENEMA FOR LARGE BOWEL

INDICATION FOR BARIUM ENEMA

Bleeding per rectum not for the haemorrhoids Difficulty in daefecation Altered bowel habit Chronic constipation

BARIUM ENEMA

MICROCOLON DOLICHOCOLON

ULCERATIVE COLITIS DIVERTICULUMPIPE STEM COLON POUCH OR SAC

POLYPOSISSINGLE CONTRAST & DOUBLE CONTRAST BARIUM ENEMA

MALIGNANCY COLONSTRICTURE/ NARROWING, APPLE CORE DEFECT, FILLING DEFECT

HIRSCHSPRUNG DISEASEAGANGLIONIC DISTAL COLON , NO PERISTALSIS, PROXIMAL DILATATION

HIRSCHSPRUNG DISEASE

ANAL ATRESIA- INVERTOGRAM

CROHNS VERSUS ULCERATIVE COLITIS

CROHNS VERSUS ULCERATIVE COLITIS

COLITIS – PIPE STEM COLON

COLLAR STUD ULCER- TOTAL COLITIS

EXTENSIVE MUCOSAL ULCERATION

HEPATOBILIARY SYSTEM

Ultrasound is the first choice then depending on CT scan or MRI could be the complementary investigation

Indication: Acute pain Rt hypochondrium Jaundice

HEPATOBILIARY SYSTEMCASE WITH JAUNDICE

GB CALCULUS ACUTE CHOLELITHIASIS

PANCREAS ON ULTRASOUND NORMAL CHRONIC PANCREATITIS

CHRONIC PANCREATITIS CALCIFICATION ON PLAIN X-RAY ON ULTRASOUND

AC.CHOLECYSTITIS AC. PANCREATITIS

T-TUBE CHOLANGIOGRAPHY CBD DILATATION

HEPATIC MASS MRI ULTRASOUND

THANK YOU Have a nice day