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Introduction To Gastrointestinal Radiology: Piyaporn Apisarnthanarak, M.D. Faculty of Medicine Siriraj Hospital

This document provides an overview of gastrointestinal radiology modalities including plain films, fluoroscopy, ultrasound, CT, and MRI. It focuses on plain films which are the cheapest option but have limitations. Examples are provided of using plain films to detect pneumoperitoneum, bowel obstruction, and gallstones. Fluoroscopy with barium is described as the standard for visualizing the gastrointestinal tract but exposes patients to radiation. Common fluoroscopy studies discussed are esophagography, upper GI series, small bowel follow through, and barium enema.

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159 views

Introduction To Gastrointestinal Radiology: Piyaporn Apisarnthanarak, M.D. Faculty of Medicine Siriraj Hospital

This document provides an overview of gastrointestinal radiology modalities including plain films, fluoroscopy, ultrasound, CT, and MRI. It focuses on plain films which are the cheapest option but have limitations. Examples are provided of using plain films to detect pneumoperitoneum, bowel obstruction, and gallstones. Fluoroscopy with barium is described as the standard for visualizing the gastrointestinal tract but exposes patients to radiation. Common fluoroscopy studies discussed are esophagography, upper GI series, small bowel follow through, and barium enema.

Uploaded by

Silp Satjawattanavimol
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Introduction to

Gastrointestinal Radiology

Piyaporn Apisarnthanarak, M.D.


Faculty of Medicine Siriraj Hospital
GI Radiology

• Plain Film
• Fluoroscopy (barium studies)
• Ultrasound (US)
• Computed Tomographic (CT) scan
• Magnetic Resonance Imaging
(MRI)
Plain Film
• Pro:
– Cheapest and more available
– Good for screening of
• Abnormal air
• Abnormal calcification
• Abnormal bowel gas dilatation

• Cons:
– Radiation
– DDx only 5 density: air, fat, soft tissue, bone,
and metallic
Density in Plain Films
3
4

2
3 1
1 = air

4
2 = fat
3 = soft tissue
5
4 = bone
5 = metallic
Plain Film
• Plain abdomen
– Supine
– Upright

• Acute abdominal series


– Abdomen: supine, upright
– CXR: upright
Plain Abdomen

Supine Upright
Plain Film
• Plain abdomen
– Supine
– Upright

• Acute abdominal series


– Abdomen: supine, upright
– CXR: upright
Plain Abdomen

• Abnormal air
– Pneumoperitoneum
• Abnormal bowel gas dilatation
– Gut obstruction
– Paralytic ileus
• Abnormal calcification
– Gallstone
Abnormal Air:
Pneumoperitoneum

• Perforation of hollow viscus

• Signs in plain films


– Free air beneath diaphragm (upright)
Pneumoperitoneum

CXR: upright
Abnormal Bowel Gas Dilatation

• Gut obstruction
• Paralytic ileus
Gut Obstruction vs Ileus

• Proportion of prox. and distal bowels


• Upright view: air- fluid level
• Bowel sound
• Follow up film
Gut Obstruction

supine upright
Paralytic Ileus

supine upright
Abnormal Calcification:
Gallstones

AP Lateral
Fluoroscopy
• Pro:
– See mucosal / intraluminal lesion
– Real time
– Dynamic study [anatomy and movement
(peristalsis)]

• Cons:
– Radiation
– Contrast use: barium sulfate (single vs double
contrast)
Single vs Double Contrast
Mucosal Details

Stomach

Small bowels

Colon
Fluoroscopy

• Normally use barium sulfate


• Use water soluble contrast when suspect
of leakage (prevent granulomatous infection)
Fluoroscopy

– Esophagography
– Upper GI series (UGIS)
– GI follow through (GIFT)
– Barium Enema
Esophagography

– Terminate at EG junction
• Except see lesion in gastric fundus
Esophagography

EG
junction
Spot Films
Esophagography

Overhead
Films
UGIS or GISM

• Evaluate stomach and duodenum


• Terminate at DJ junction
• NPO at least 6 hours
• Prefer double contrast technique: for mucosal
fold details
• In case of gastric outlet obstruction: lavage
before study
Anatomy of Stomach
Anatomy of Duodenum
• 4 parts
– 1st part or duodenal bulb (cap)
• Triangular shape
• Intraperitoneal: free movement
• Smooth mucosa
– 2nd, 3rd and 4th part duodenum
• C-loop or duodenal loop: encircle pancreatic
head
• Retroperitoneal structures: fixed
• Mucosa: feathery appearance
UGIS: Spot Views
UGIS: Overhead Films
GI Follow Through

• NPO at least 6 hrs


• Terminate when barium reach colon
• Indication: suspected small bowel lesions
GI Follow Through

• Folds: feathery appearance


– jejunum > ileum
• Jejunum: LUQ, ileum: RLQ
GI Follow Through
GI Follow Through
Barium Enema

• Evaluate colonic pathology


• Preparations
– Laxatives the night before BE
– Soft and liquid diet at least 2 days
– Warm water enema before study
• Terminate when
– Barium reach cecum
– Filled appendix
– Reflux to terminal ileum
Colonic Anatomy
Barium Enema: Overhead
Barium Enema: Spot

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