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GI Radiology

GI Radiology. Imaging modalities in GI. Plain X-rays (Supine, Erect, Decubitus) Barium studies (Ba Swallow, Meal, Follow through, Enteroclysis, Enema) Ultrasound Abdomen CT Scan/MRI Abdomen ERCP, Cholangiography. Angiography and Nuclear Medicine. Plain Abdominal X-rays. Erect Chest

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GI Radiology

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  1. GI Radiology

  2. Imaging modalities in GI • Plain X-rays (Supine, Erect, Decubitus) • Barium studies (Ba Swallow, Meal, Follow through, Enteroclysis, Enema) • Ultrasound Abdomen • CT Scan/MRI Abdomen • ERCP, Cholangiography. • Angiography and Nuclear Medicine

  3. Plain Abdominal X-rays • Erect Chest • Supine Abdomen • Erect / Decubitus Abdomen ( 10 min ) • Radiation Dose ( 1 Abd = 75 CXR) • Contraindicated – pregnancy

  4. Indications. • “Acute Abdomen” • Abdominal Pain. • ?Obstruction. • Not Indicated for: • Trauma. • Solid organ assessment.

  5. Basic Principles • Five radiographic densities: • Gas/Air • Fat. • Soft Tissue/Water • Bone/Calcium • Metals • Interface/line only visible when two of these densities interface with each other.

  6. Approach to a AXR • Technical Assessment. • Projection. • Bowel/Gas Shadows. • Normal/Abnormal Calcifications. • Solid Organs. • Look at lung bases and at the skeleton.

  7. Stomach. Colon. Small Bowel. Within the Lumen: Dilated bowel ?Obstruction Outside the Lumen: Free ?perforation In a cavity ?abscess Normal Vs Abnormal Gas shadows

  8. Water Soluble Ionic (gastrografin) Can lead to pulmonary edema if aspirated. Non- Ionic ( Low Osmolar) Relatively safer if aspirated. Gadolinium (MRI) Barium ( Non-water soluble) Can cause sever peritonitis and fibrosis in perforation or leakage. Contrast Medium for GI

  9. Indications: Dysphagia Pain Reflux Anemia Tracheo-esophageal fistula Perforation Contraindications: Aspiration Contrast Swallow

  10. Indications: Dyspepsia Upper abdominal mass Weight Loss Gastrointestinal Hemorrhage. Partial Obstruction Assessment for perforation Contraindications Complete large bowel obstruction Pateint preparation: NPO ---6 hrs No smoking– increases GI motility Barium Meal

  11. Indications: Pain Diarrhoea Anemia/GI bleed Partial Obstruction Malabsorption Abdominal mass Contraindications Complete obstruction Patient Preparation: Low residue diet Bowel Prep (Dulcolax -2-4 Tab) Small Bowel Follow through/ Small bowel enema (Enteroclysis)

  12. Small Bowel follow through VS Small bowel enema

  13. Indications: Change in bowel habits Pain Mass Melaena / Anemia Single contrast – Obstruction & Intussusception. Contraindications: Rectal biopsy—5 days Toxic megacolon Pseudomembranous colitis Preparation: (Two days) Low residue diet Bowel prep (Dulcolax – 4 Tab) Barium Enema

  14. Advantage Cost effective Adequate visceral visualization Best for GB No radiation Indications:Acute Abdomen, Obstructive jaundice, abdominal masses, collections, Free fluid, follow up- tumors. Disadvantage Operator dependent Poor in Obesity Bowel gasses Bones / Calcifications UltrasoundAbdomen

  15. Advantages Accurate & quick Bowel/ gasses/ bones Reformation and angio Indications: Acute abdomen, Abdominal mass, tumor staging/follow up, Appendicitis/abscesses, Post op complications Disadvantages: Radiation (250 CXR) Renal failure Contrast reaction CT Scan Abdomen

  16. Advantages Multiplaner Renal failure MRCP Liver specific contrasts Disadvantages Bowel motion/ contrast Calcifications Metallic implant Relatively long procedure time Claustrophobia MRIAbdomen

  17. EndoscopicRetrograde Cholangiopancreatography (ERCP) MR Cholangiopancreatography (MRCP) T-tubeCholangiography. Percutaneous Transhepatic Cholangiography (PTC). Cholangiography

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