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Abdomen II

Objectives. Be able to identify the musculature of the anterior and lateral abdominal wall. Refresh your knowledge of the musculature about the pelvis.Be able to identify the regions of the gastrointestinal tract and their appearance on contrast studies as well as in planar images.Be able to ident

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Abdomen II

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    1. Abdomen II Chris Sistrom, MD, MPH Diagnostic Radiology University of Florida College of Medicine

    2. Objectives Be able to identify the musculature of the anterior and lateral abdominal wall. Refresh your knowledge of the musculature about the pelvis. Be able to identify the regions of the gastrointestinal tract and their appearance on contrast studies as well as in planar images. Be able to identify the biliary system and its appearance in contrast studies. Be able to identify the intraperitoneal organs of the abdomen as they appear in plain radiographs and on axial, sagittal and coronal images.

    3. Objectives Be familiar with which structures of the gastrointestinal tract are retroperitoneal in location. Understand the portal vascular system as unique within the overall circulatory system. Be able to identify the modalities used in imaging the abdomen. Be able to identify the vascular anatomy of the abdomen including all major branches.

    4. Organs Liver Gallbladder Pancreas Spleen Adrenal glands Kidneys Stomach Small Intestine Large Intestine

    5. Organs Liver Gallbladder / Bile Ducts Pancreas Spleen Adrenal glands Kidneys

    7. Cross Sectional Imaging CT MRI Ultrasound

    8. Contrast? Oral dilute iodine dilute barium Intravenous iodine (non-ionic)

    9. Organs Liver Gallbladder / Bile Ducts Pancreas Spleen Adrenal glands Kidneys

    10. Liver

    11. Liver triple blood supply Like the lungs Portal vein Inflow of blood needing metabolic processing Hepatic veins Outflow to the right atrium Hepatic artery Some call it the ‘biliary’ artery Supplies the bile ducts Gives about 15% of flow to liver tissue

    12. Liver – arterial supply

    13. Liver - portal supply

    14. Liver – hepatic vein

    16. Liver MRI

    17. Liver Ultrasound

    18. Organs Liver Gallbladder / Bile Ducts Pancreas Spleen Adrenal glands Kidneys

    19. Gallbladder

    20. Gallbladder

    21. Gallbladder

    22. Gallbladder - CT

    23. Gallbladder - US

    24. ERCP Endoscopic Retrograde Cholangio-Pancreaticogram

    25. Endoscopy

    26. ERCP - Procedure

    27. ERCP - Image Usually pull out endoscope and shoot again for the $ shot

    28. Biliary System - ERCP

    29. MRCP MRI Cholangiopancreatogram

    32. Organs Liver Gallbladder / Bile Ducts Pancreas Spleen Adrenal glands Kidneys

    33. Pancreas

    34. Pancreas

    35. Pancreas

    36. Pancreas

    37. Pancreas

    40. Organs Liver Gallbladder / Bile Ducts Pancreas Spleen Adrenal glands Kidneys

    41. Splenic Artery

    42. Splenic Vein

    43. Spleen – CT (axial)

    44. Spleen - CT (coronal)

    45. Spleen After Trauma This scan taken within the ‘golden hour’

    46. Spleen After Trauma This scan taken 7 hours later

    47. Organs Liver Gallbladder / Bile Ducts Pancreas Spleen Adrenal glands Kidneys

    48. Adrenal Glands - CT

    50. Right Kidney Ultrasound

    51. Urography Classically done with XRAY Called ‘IVP’ or ‘IVU’ Intravenous contrast (iodine) Excreted by the kidneys in 5-10 minutes Can evaluate Collecting systems Ureters Bladder

    52. ‘Old School’ IVP

    53. 3D CT Urogram

    54. Vasculature

    55. Aorta

    56. IVC

    61. Celiac Art – Catheter Angio

    62. Celiac Art – Catheter Angio

    63. Vessels – Celiac (portal phase)

    64. Vessels – Celiac CT

    65. SMA – Catheter Angio

    66. SMA - Portal Phase

    67. Portal Veins - Ultrasound

    68. Portal Veins – Direct Injection

    69. IMA – Catheter/CT Angio

    70. IVC – Catheter Venogram

    71. A Cruise Through the Abdomen on a CT Scan In the past, patients with abdominal problems would first have a plain radiograph Then perhaps an upper GI series (UGI) and/or barium enema (BE) Today, it is very common to obtain a CT Shows more anatomic detail than XRAYS Much of the same information as UGI Therefore, you will be looking at CT scans of the abdomen

    72. Details of the Scan Patient had no food for 12 hours before the scan, no other preparation Drank 2-3 cups of dilute barium mixture starting 1.5 hours before scan Had an intravenous line inserted Lies supine on the CT scan couch 100 cc of iodinated contrast injected into the IV line at ~ 2 cc / second Scan started about 45 seconds after injection Scan from lower chest through mid pelvis Scan took about 30 seconds to complete

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