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    Radiology of Gastrointestinal Tract: (GIT) Bachtiar Murtala

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    Michael Husain
    This document provides an overview of radiology techniques used to examine the gastrointestinal tract. It discusses examinations of the pharynx, salivary glands, esophagus, stomach, duodenum, small intestine, and colon. Both techniques without contrast media like plain radiography and with contrast media like barium swallows, sialography, and barium enemas are covered. Normal anatomy and findings are reviewed along with common abnormalities that can be identified on imaging like tumors, ulcers, inflammations, obstructions, and more.

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    Radiology of Gastrointestinal Tract: (GIT) Bachtiar Murtala

    Uploaded by

    Michael Husain
    74 views53 pages
    This document provides an overview of radiology techniques used to examine the gastrointestinal tract. It discusses examinations of the pharynx, salivary glands, esophagus, stomach, duodenum, small intestine, and colon. Both techniques without contrast media like plain radiography and with contrast media like barium swallows, sialography, and barium enemas are covered. Normal anatomy and findings are reviewed along with common abnormalities that can be identified on imaging like tumors, ulcers, inflammations, obstructions, and more.

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    radiology geh

    Original Title

    Gastrointestinal Tract

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    This document provides an overview of radiology techniques used to examine the gastrointestinal tract. It discusses examinations of the pharynx, salivary glands, esophagus, stomach, duodenum, small intestine, and colon. Both techniques without contrast media like plain radiography and with contrast media like barium swallows, sialography, and barium enemas are covered. Normal anatomy and findings are reviewed along with common abnormalities that can be identified on imaging like tumors, ulcers, inflammations, obstructions, and more.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    74 views53 pages

    Radiology of Gastrointestinal Tract: (GIT) Bachtiar Murtala

    Uploaded by

    Michael Husain
    This document provides an overview of radiology techniques used to examine the gastrointestinal tract. It discusses examinations of the pharynx, salivary glands, esophagus, stomach, duodenum, small intestine, and colon. Both techniques without contrast media like plain radiography and with contrast media like barium swallows, sialography, and barium enemas are covered. Normal anatomy and findings are reviewed along with common abnormalities that can be identified on imaging like tumors, ulcers, inflammations, obstructions, and more.

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    You are on page 1of 53
    At a glance
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    The key takeaways are that radiology plays an important role in diagnosing abnormalities in the gastrointestinal tract and there are two main techniques - with and without contrast media. Modalities include conventional X-rays, imaging, CT and MRI.

    The different techniques used for examining the gastrointestinal tract include examinations without contrast media like plain abdominal radiography and examinations with contrast media like barium enema for visualizing the colon.

    Some indications for examining the salivary glands include stones, inflammation, and neoplasms. Techniques include plain radiography, sialography, CT and MRI.

    RADIOLOGY OF

    GASTROINTESTINAL TRACT
    (GIT)

    Bachtiar Murtala
    1. This topic covers :
    - Introduction
    - GIT examination with contrast media
    - Plain abdominal radiography & hepatobiliary
    system (taken over by another topic).
    2. Introduction
    - Radiology has an important role in diagnosing
    abnormalities in GIT
    - Basically categorized into two technique :
    • without contrast media
    • with contrast media
    - Modalities : • Conventional X – ray
    • Imaging
    - This lecture will be focused to :
    • Indication
    • Procedure of examination
    • The appearance of organs/abnormarlities
    3. Pharynx/Salivary glands :
    Pharynx : - Plain AP/Lateral
    - Contrast with urografin
    - Fluoroscopy
    Indication : - Disturbances of swallowing
    - Tumors of the base of the tongue
    & epiglottis
    4. Salivary glands :
    Consist of : - Parotic glands
    - Submandibular glands
    Indications : Stones; inflamation; neoplasm
    Technique : - Plain Foto
    - Sialography
    - CT
    - MRI
    Sialography :
    – Duct orifice. is located & intubated by a blunt needle/abbocath
    – 0,5 – 1,5 ml contrast medium (water soluble/lipiodol) injected
    slowly & then taking a series pictures
    – Give a few drops of lemon juice  make an “after lemon” film
    10’ later to evaluate the remaining contrast

    Abnormalities :
    – Chronic obstructive Sialectasis
    - stone
    - strictures
    – Chronic non-obstructive Sialectasis (chronic inflamation)
    – Tumours (mostly mixed salivary type)
    5. Esophagus
    It should be visualized with contrast media
    (Barium Sulfat)  Esophagography
    Indications : - Dysphagia
    - Dyspepsia
    - Haematemesis/melena
    - Congenital anomalies ?
    6. Technique of Examination
    • The patient is asked to swallow a thick Barium
    Sulfat (1:1) and followed by fluoroscopy &
    taking radiography
    • Radiography positions : - AP
    - Right Anterior Oblique
    projection (RAO)
    - Left Anterior Oblique
    projection (LAO)
    - Spot Film (optional)
    7. Radiological Signs :
    A. Normal Indentations : - Knob aorta
    - Left main bronchus
    - Left atrium
    - Hiatus hernia
    B. Abnormalities :
    Congenital malformation
    - Esophageal atresia
    - Short esophagus with a thoracic stomach
    (Brachy-esophagus)
    - Duplication
    Traumatic Disorders  rupture
    Abnormalities in density  foreign bodies
    Abnormalities in Size (length & diameter)
    Abnormalities in architecture
    Esophagitis : - Narrowing of the lumen
    - Irregularitis of mucosa
    - Proximal dilatation
    Tumours :
    - Benign : • Filling defect with smooth
    border
    • Forked stream appearance
    (Fluoroscopy)
    - Malignant : • Filling defect with irregular
    border
    • Spasticity
    3 Types : - Papillary
    - Ulcerating
    - Infiltrating
    Abnormalities in neuromuscular function
    - Spasm
    - Chalasia (dilatation of the distal part)
    - Achalasia/Cardiospasm/Megaesophagus :
    sigmoidal type & fusiform type
    Rö : narrowing of the distal end of esopha-
    gus with proximal dilatation,elongation
    Smooth contour,
    “Mouse Tail Appearance”.
    Others :
    • Varices : - “Honey-Comb Appearance”
    - “Cobble-Stone Appearance”
    • Ulcer : Additional Shadow
    GASTRODUODENOGRAPHY
    (= Maag Duodenum/MD Foto)
    Is a radiographic evaluation of the stomach &
    duodenum by introducing contrast media inside
    [Barium sulfat (+) & air/gas (-)]
    Indication : - Dyspepsia
    - Epigastric pain
    - Vomiting
    - Haematemesis/melaena
    Procedure Of Examination
    1. Preparation : fasting ± 4-6 hours
    2. The patient swallows contrast Barium Sulfat (&
    air) followed by fluoroscopy and taking
    radiography in various position
    3. Usually in Supine, Prone, Prone oblique, Erect.
    Spot-Film Compression (recommended)
    Normal Anatomic Radiography
    Radiographic Abnormalities of Gastroduodenal
    Disease.
    It can be classified as changes in :
    – Position
    – Size (redundancy, enrlargement/widening,
    narrowing/shrinkage)
    – Contour
    – Rugae abnormalities
    – Filling defect
    – Function
    Change in Position
    – Abnormalities due to extragastric structures
    - Abnormalities of Size
    - Change in Contour of Gastroduodenum
    • Diverticula
    • Ulcer
    – Abnormalities of the Rugae Pattern
    • Filling Defect
    Duodenum
    Ulcer
    Carcinoma
    Inflamation : Duodenitis
    SMALL INTESTINE (JEJENUM & ILEUM)
    • Normal size: - ± 20 feets (length)
    - 2,5 cm (jejenum); 1,75 cm (ileum)
    in diameter
    • Indications:
    Anemia (unclear origin)
    Persistent diarrhoe
    Abdominal pain
    Palpable mass
    Excessive protein loss
    Malabsorbtion
    • Contraindication:
    Obstruction signs
    Perforation
    Paralytic ileus
    Peritonitis
    • Technique of Examination
    1. Plain abdominal radiography
    2. Follow Through
    Patient is asked to swallow 200-300 cc Barium
    sulfat (1:2-3 water),followed by taking pictures
    30-60 minutes interval until contrast seen in
    caecum
    • Abnormalities
    Crohn’s Disease = Regional ileitis
    Adhesion
    Fistula
    COLON
    Indication : • Haemochesia
    • Persistent diarrhea
    • Abdominal mass
    • Obstructive symptoms
    • Congenital abnormalities

    Contraindication : • Ileum (Paralytic)


    • Suspect Bowel Perforation
    • Peritonitis
    Technique of Examination : • Barium enema
    (colon inloop)
    • Mostly Double-
    Contrast method
    Preparation is the most important to remove
    faecal material from the colon
    Colon inloop : - Using a thin Barium sulfat
    (1:3-6) aprox. 2 L
    - Contrast should fill colon entirely
    (rectum-caecum)
    - Picture taken in many positions/
    views.
    Normal Radiographic Appereance

    Abnormalities
    Carcinoma of Colon
    3 types : • Fungating type
    • Polypoid type
    • Annular type
    Fungating type :
    - usually medullary Ca.
    - Sites: Caecum, Ascending Colon, Rectum
    - Complication: Bleeding, fistula

    Polypoid type :
    - Sites: usually Descending Colon
    - Complications: Intussusception
    Annular type :
    - Sites: Sigmoid, Descending Colon, flexures
    - Complication: Fistula, obstruction
    Pathology : - 50 – 75% adeno Ca.
    - 20% fibro Ca.
    - 10% mucoid adeno Ca.
    Metastasis : Liver or regional nodes
    Radiographically :
    Filling defect with
    Obstruction signs
    2. Obstruction
    Obstruction to the flow of Barium can be caused by :
    • Spasme
    • Annular Carcinoma
    • Intusussception
    • Volvulus
    • Diverticulitis
    3. Displacement of the Colon
    causes : - Enlarge Liver - large abdominal mass
    - Enlarged Spleen - Pelvic mass or tumor
    - Stomach mass of Spine
    4. Dilatation/Distension
    - Idiopathic symptomatic megacolon (older age)
    - Hirschsprung’s disease (megacolon congenital)
    • Disease of childhood, mostly males
    • Abscent of ganglion cells in the mesenteric
    plexus in the narrowing segment (mostly
    sigmoid colon, ± 40%)
    • Marked dilatation above the area of agangliono-
    sis.
    Radiographically :
    - Plain abdominal films  veriable degrees of
    distension of GIT above the obstruction
    - Colon in loop :
    • Narrowing along the site of aganglionosis
    • Dilatation above the narrowing, might be associated
    with irregularity/sawtoothing/ulcerative Colitis
    5. Narrowing of the Colonic Lumen
    • Congenital stricture or atresia Ani
    varies from an imperforate anal membrane to com-
    plete atresia of the entire anus
    • Ulcerative Colitis
    - Loss of haustra
    - Contracted,shortened & small calibre
    - Saw-toothing/ulceration
    - “Stringiness/String sign”
    Radiographically :
    Technique of examination :
    • Inverted or Wangesteen position
    • Knee-chest position
    Aim : to identify the lowest end of air in colorectal
    6. Intussusception = Invaginasi

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