imaging of gi system
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This document provides an overview of imaging techniques for evaluating the gastrointestinal system, including plain abdominal x-rays, barium enema, and small bowel follow through. It describes the anatomy visualized, procedures for performing the exams, normal findings, and examples of common pathological findings. Key points covered include differences between single and double contrast barium enema, indications and contraindications for the exams, and examples of how various gastrointestinal diseases appear on imaging.
imaging of gi system
- 1. 1 Imaging of Gastrointestinal System 義大醫院 影像醫學科 李浩銘醫師
- 2. Plain Photo EUS Fluoros copy Nuclear Medicine Ultrasound CT Scan MRI
- 3. Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas
- 4. • • • • Plain abdominal x-ray Technique : AP – Supine AP – Erect • • LLD Semi recumbent CXR Indication : Acute abdomen
- 5. What to Examine ?? - Air (bowel gas) - Bone density - Calcification (stone / foreign body) - Soft tissue mass
- 6. Air Sub diaphragm free air Bowel perforation
- 7. Bowel obstruction AP-semi recumbent LLD, horizontal AP-supine -dilated bowel loops -thickening of bowel wall -multiple air-fluid levels
- 8. Ileo-cecal valve incompetent small and large bowel distention Bowel obstruction
- 9. Mechanical large bowel obstruction Colon dilatation obstruction. Barium enema
- 10. volvulus of sigmoid colon
- 11. Bone density - Osteoporosis - Compression fracture
- 12. Calcifications, stones Soft tissue mass
- 14. Barium Enema (BE) Plastic irigator : 1. enema tip 2. enema tube 3. enema reservoir bag 4. balloon with it inflator. 1 4 4 2 1 3 4 4 2
- 16. Technique & positioning A. Left lateral position : contrast filling rectum and rectosigmoid B. Left posterior oblique: contrast filling sigmoid
- 17. C. Left lateral with 15o Trendelenberg position : contrast flow to descendent colon and splenic flexure D. Clockwise to prone position: contrast filling transversal colon
- 18. E. Clockwise to right lateral with 15o Trendelenberg position : contrast filling the hepatic flexure F. From E, turn left to supine position : contrast filling hepatic flexure and ascendant colon
- 19. Contrast Single Double Barium Barium + air
- 20. Contrast Single Double Motility study Mucosa study Simple & relative safe More difficult
- 21. Indication Double contrast BE Melena / bloody stool Cancer Suspected colonic polyp Family hx of colon ca / polyp Chronic diarrhea / bowel habit change IBD (inflamatory bowel disease) Pain & abdominal discomfort Diverticulosis
- 22. Intussusceptions Hirschprungs disease Fatique / very old patient / serious illness Suspected pelvic metastasis Indication Single contrast BE
- 23. Contraindicati on Suspect bowel perforation Toxic megacolon After colonic biopsy Pregnant Patient
- 24. Complicati on Gas pain Colonic perforation/rupture Intramural barium Stool impaction Bacterial contamination Allergy / hypersensitivity
- 25. Patient preparation Low residue diet Increased fluid intake Rectal or oral laxative Antispasmodic agent (if needed) 1. Glucagon: iv 0.5 – 1 mg 2. Buscopan: iv or im 1 amp (20 mg/mL)
- 26. Record / filming Plain abdominal photo Spot photo Overhead whole abdomen Plain abdominal photo
- 30. Spot film : Single contrast Rectum (left lateral) Hepatic flexure Sigmoid Splenic flexure Cecum
- 31. Whole abdomen : single contrast Whole colon : overhead film
- 33. Spot film : double contrast Rectum & sigmoid : Lateral position Supine position Prone position
- 34. Spot film : double contrast Sigmoid : posterior oblique Distal descendant colon Proximal descendant colon
- 35. Spot film : double contrast Splenic flexure (RPO) Transverse colon Erect position
- 36. Spot film : double contrast Ascendant colon Hepatic flexure Erect position Erect position, LPO
- 37. Spot film : double contrast Cecum & appendix Cecum & terminal ileum
- 38. Overhead film : whole colon
- 40. Hirschsprung disease Dilatation of proximal bowel with caliber change at rectum Transitional zone
- 43. Pedunculated Polyp Sessile Polyp Mexican hat sign
- 44. Malignant polyp : villous type
- 45. Apple core sign Colon cancer : annular type
- 47. Ulcerative colitis Continuous lesion, lead pipe sign Segmental colitis Pancolitis
- 48. Crohn’s disease Discontinuous skip lesion Fistula formation
- 49. Colitis TB Rectal carcinoma Overhanging edges / shouldering Annular constriction Irregularity border
- 50. Colonic polyp Filling defect on single contrast Soft tissue mass on double contrast
- 51. Extraluminal tumor ileocecal intussusceptions (Coiled spring appearance)
- 52. Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas
- 53. Diffuse esophageal spasm: corkscrew esophagus 15
- 54. Foreign body Mimicking tumor Intraluminal filling defect 16
- 55. 17 Gastric wall filling defect Gastric carcinoma
- 58. 3. Small Intestines Barium follow through (Single Contrast) Enteroclysis (Double Contrast) 20
- 59. Barium Follow Through • Patient fasting • Single contrast : 200 – 500 cc of barium suspension is given to drink • Followed by fluoroscopic or conventional x- ray. • Taken serial photo : 5‘ , 10’, 20’ etc. • Examination must be stop when barium filling the cecum. 21
- 60. Enteroclysis = small bowel enema • Inserted the NG Tube (12F 135 cm long) • Maneuver catheter tip to the antrum passing pylorus placed and fixation catheter tip in duodenal 3rd parts. • Contrast irrigation (+ methylcellulose) or air insufflating • Filming 22
- 61. Normal follow through Enteroclysis - normal small bowel mucosa 23
- 62. ascariasis in small intestine 24
- 63. Take home message • ABCS in KUB • Single v.s Double contrast • Indication / Contraindication / Complication of barium enema
- 64. Learn to be better !