![RadiologyGASTROINTESTINAL SYSTEMBy: Dr. KawaTyped by:Bnar J. AhmedPaywand M. AliRako AbdulqadirRanko B. MajeedSuren Y. Hama BaqiDesign: Rzgartmi.CONTENTSCONTENTS TOC quot;
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CONTENTS PAGEREF _Toc295592494 2ESOPHAGUS PAGEREF _Toc295592496 3Normal barium swallow PAGEREF _Toc295592497 3Abnormal barium swallow: PAGEREF _Toc295592498 3Stricture: PAGEREF _Toc295592499 3Filling defect PAGEREF _Toc295592500 4Dilatation of esophagus PAGEREF _Toc295592501 5Varices PAGEREF _Toc295592502 5Esophagus web PAGEREF _Toc295592503 5Diverticula PAGEREF _Toc295592504 5Esophageal atresia PAGEREF _Toc295592505 5Candidiasis PAGEREF _Toc295592506 5STOMACH AND DUODENUM PAGEREF _Toc295592507 6Normal barium meal: PAGEREF _Toc295592508 6Gastroscopy: PAGEREF _Toc295592509 6Indications: PAGEREF _Toc295592510 6Abnormal barium meal findings PAGEREF _Toc295592511 6Filling defects (intarluminal, intramural, extramural) PAGEREF _Toc295592512 7GU PAGEREF _Toc295592513 7narrowing PAGEREF _Toc295592514 8Thick gastric mucosal folds PAGEREF _Toc295592515 8Gastric outlet obstruction PAGEREF _Toc295592516 8Gastritis PAGEREF _Toc295592517 9Hiatus hernia PAGEREF _Toc295592518 9DU PAGEREF _Toc295592519 9Upper GI bleeding: PAGEREF _Toc295592520 9SMALL INTESTINE PAGEREF _Toc295592521 9Normal Ba follow through: PAGEREF _Toc295592522 10Enteroclysis: PAGEREF _Toc295592523 10Abnormal Ba follow through: PAGEREF _Toc295592524 10Crohn’s disease: PAGEREF _Toc295592525 10Tb: PAGEREF _Toc295592526 11Lymphoma: PAGEREF _Toc295592527 11Malabsorption: PAGEREF _Toc295592528 11Definite Dx PAGEREF _Toc295592529 11Signs: PAGEREF _Toc295592530 11Disaccharidase deficiency: PAGEREF _Toc295592531 11Acute SI obstruction: PAGEREF _Toc295592532 12LARGE INTESTINE PAGEREF _Toc295592533 12Indications for colonoscopy: PAGEREF _Toc295592534 12Normal Ba enema: PAGEREF _Toc295592535 12Abnormal Ba enema: PAGEREF _Toc295592536 12Narrowing of the lumen: PAGEREF _Toc295592537 12Dilatation of colon: PAGEREF _Toc295592538 13Filling defects in the colon: PAGEREF _Toc295592539 13Ulceration of colon: PAGEREF _Toc295592540 13Tumors of the colon: PAGEREF _Toc295592541 14Polyp PAGEREF _Toc295592542 14Carcinoma PAGEREF _Toc295592543 14Hirschsprung’s disease PAGEREF _Toc295592544 15Idiopathic megacolon PAGEREF _Toc295592545 15Acute Bleeding (S and L bowel) PAGEREF _Toc295592546 15HEPATOBILIARY SYSTEM PAGEREF _Toc295592547 15Methods of imaging: PAGEREF _Toc295592548 15Normal liver: PAGEREF _Toc295592549 15Liver masses: PAGEREF _Toc295592550 16Masses include the following: PAGEREF _Toc295592551 16Liver trauma: PAGEREF _Toc295592552 17Liver cirrhosis and portal hypertension: PAGEREF _Toc295592553 17Fatty degeneration of the liver: PAGEREF _Toc295592554 18Biliary system PAGEREF _Toc295592555 18Ultrasound PAGEREF _Toc295592556 18CT PAGEREF _Toc295592557 18Radionuclide scan: PAGEREF _Toc295592558 18ERCP: PAGEREF _Toc295592559 19Others PAGEREF _Toc295592560 19Gall stones and chronic cholecystitis PAGEREF _Toc295592561 19Plain film: PAGEREF _Toc295592562 19U/S: PAGEREF _Toc295592563 19Acute cholecysitis PAGEREF _Toc295592564 20U/S: PAGEREF _Toc295592565 20Jaundice: PAGEREF _Toc295592566 20US shows: PAGEREF _Toc295592567 20CT-scan: PAGEREF _Toc295592568 20Others PAGEREF _Toc295592569 21SPLEEN AND PANCREAS PAGEREF _Toc295592570 21Spleen: PAGEREF _Toc295592571 21Pancreas: PAGEREF _Toc295592572 21Pancreatic masses: PAGEREF _Toc295592573 21Adenocarcinoma of pancreas PAGEREF _Toc295592574 21Acute pancreatitis PAGEREF _Toc295592575 22Chronic Pancreatitis PAGEREF _Toc295592576 22Pancreatic trauma PAGEREF _Toc295592577 22PERITONEAL CAVITY AND RETROPERITONEUM PAGEREF _Toc295592578 23Peritoneal cavity PAGEREF _Toc295592579 23Ascites PAGEREF _Toc295592580 23Peritoneal tumors PAGEREF _Toc295592581 23Intra peritoneal abscess PAGEREF _Toc295592582 23Retroperitoneum PAGEREF _Toc295592583 24Retroperitoneal organs: PAGEREF _Toc295592584 25Retroperitoneal Lymphadenopathy PAGEREF _Toc295592585 25Adrenal glands PAGEREF _Toc295592586 25Retroperitoneal tumor PAGEREF _Toc295592587 27Aortic aneurism PAGEREF _Toc295592588 27Retroperitoneal hematoma PAGEREF _Toc295592589 27Retroperitoneal abscess and psoas abscess PAGEREF _Toc295592590 27<br />ESOPHAGUS<br />Plain film very dilated- opaque FB<br />Barium swallow is the contrast examination to visualize the esophagus <br />Oblique view to project the esophagus clear of the spine. <br />Take films under fluoroscopy ... full of barium to show outline. <br />Empty of barium to show the mucosal pattern. <br />Normal barium swallow <br />,[object Object]](https://image.slidesharecdn.com/dr-kawabilateral-110802201651-phpapp02/85/dr-kawa-radiologygit-1-320.jpg)
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Dr. kawa (Radiology-GIT)
- 2. Empty of barium folds of mucosa( three or four long straight parallel lines)
- 9. Several CMs in length
- 11. Almost invariably associated with hiatus hernia and GERD
- 13. Smooth outlines
- 14. Tapering ends
- 17. pressure effect
- 19. The outline of lesser curve of stomach is smooth with no filling defects or projection
- 20. Greater curve is nearly always irregular due to prominent mucosal folds
- 21. The Duodenal cap or bulb is nearly triangular in shape + short pyloric canal
- 22. The duodenum forms a loop around the head of pancreas to reach the duodenojejunal flexture
- 24. Histological Ex
- 26. Follow up of ulcer
- 27. Ex of the patient after gastric surgery
- 29. GU
- 30. Narrowing
- 31. Thick gastric mucosal folds
- 33. Gastritis
- 34. Hiatus hernia
- 36. Altered normal mucosal pattern
- 38. CA of the fundus may obstruct the esophagus
- 39. CA of the antrum gastric outlet obstruction
- 43. Projecting beyond the lumen
- 45. Thick rigid tube
- 46. No peristalsis
- 47. Obliteration of the mucosal folds
- 50. Gastritis due to H. pylori
- 52. CA antrum
- 54. Lucent zone around it due to edema
- 55. Mucosal folds are often seen radiating toward the ulcer
- 57. Mucosal abnormality, mucosal folds thicken in malabsorption, oedema, hemorrhage in the bowel wall, and when inflamed or infiltrated.
- 58. Narrowing, normal narrowing is caused by peristalsis, they are smooth, concentric, transient with normal mucosal folds. When there is stricture, it’s caused by crohn’s disease, TB, lymphoma, they don’t contain normal mucosal folds and bowel dilates proximally.
- 59. Ulceration, may appear shallow or deep. Ulceration is seen in Crohn’s disease, TB, lymphoma... Cobble stone appearance may be seen due to ulceration and mucosal oedema.
- 61. Nearly always affects the terminal ileum.
- 62. Skin lesions involve several different parts of SI and LI, leaving normal remaining bowel.
- 63. Stricture.
- 65. String sign, severe narrowing of a loop of bowel from spasm in the ulcerated part or from oedema and fibrosis and proximal dilatation.
- 67. Thickened bowel wall and mucosal folds.
- 68. Inflammatory mass which displace the loops.
- 69. Fistulae to other loops of bowel, bladder and vagina.
- 71. Displacement of the loops by enlarged LN.
- 77. Tropical sprue
- 78. Deficiency of absorptive factors e.g bile or pancreatic enzymes.
- 80. Lymphoma
- 82. Decreased length of the bowel
- 84. Small bowel becomes dilated
- 87. Patient with persistent symptoms with a normal Ba enema.
- 88. Screening of a patient with a strong family Hx of colonic Ca.
- 92. Benign strictures have tapered ends, smooth outline of any length.
- 93. Ulceration maybe seen in strictures due to crohn’s dis.
- 94. Stricture due to diverticular disease is accompanied by other signs.
- 95. The site of the stricture can help, e.g.:
- 96. Diverticular disease is almost always confined to sigmoid colon
- 97. Ischemic strictures located between splenic flexure and sigmoid colon
- 98. Crohn’s dis and TB at caecum
- 100. Paralytic ileus (Dx is clinical)
- 101. Valvulus
- 102. Ulcerative colitis with toxic dilatation
- 105. TB (rare).
- 108. Short thick stalk
- 109. Irregular surface
- 111. Villous polyps: benign, sessile tumors, having sponge-like appearance, frequently mistaken for feces, mostly found in the rectum and cecum, having high incidence to change to Carcinoma.
- 113. Juvenile polyps: almost all isolated polyps in children.
- 114. Inflammatory polyps (pseudopolyps), seen in ulcerative colitis.
- 116. Show carcinoma.
- 117. Show spread and invasion.
- 118. Show metastasis.
- 121. Low and medium amplitude echoes.
- 123. Liver cysts:
- 124. Congenital: This could be single or multiple.
- 125. Infection.
- 127. Hydatid cyst.
- 129. No echoes within the cyst.
- 130. Intensive echoes from the front and back of the cyst.
- 138. Splenomgaly.
- 139. At ultrasound the texture of liver is diffusely abnormal.
- 143. Best for showing gall stones.
- 144. Best for diseases of GB.
- 147. Unexplained abdominal pain thought to be biliary in origin when other investigations have been equivocal.
- 149. Vary in size and shape.
- 150. Dense outer rim with central lucency.
- 153. Inflammatory debris.
- 154. GB wall thickening.
- 155. Oedema adjacent to the wall of GB (is very important sign in distinguishing between chronic & acute cholecystitis).
- 157. CA of head of pancreas.
- 159. CBD lies just infront of the portal vein and is dilated when more than 7 mm in diameter.
- 162. Portal hypertension.
- 164. Hemolytic anemias.
- 167. Neoplasm of adjacent LN.
- 168. Focal pancreatitis.
- 169. Pancreatic abscess.
- 171. Irregular obliteration of the fat around the pancreas.
- 173. Irregular outline.
- 174. low density areas at CT.
- 175. Echo-poor area at U/S.
- 176. In very sever cases large fluid, filled area abscess.
- 178. The calcification in panceatitis is mainly due to small calculi within the pancreas, so often recognizable on plain film U/S and particularly CT.
- 179. Pseudocyst, just like acute type.
- 180. Enlargement… Either focal (rare and mistaken with CA) or general enlargement.
- 181. Atrophy: is non specific sign as it occurs in elderly and distal to CA... Maybe focal or general.
- 183. If large amount of fluid are present, fluid will be seen throughout the peritoneal cavity and stomach or ………… may be seen floating in the ascites.
- 184. At CT scan, ascites is of lower density than liver, spleen and kidney.
- 185. One of the easiest site to see ascites is near the liver, a uniform band of low density can identify with liver and diaphragm
- 186. Ascites cannot collect posterior to the upper part of liver because of the peritoneal reflection forming the so called bare area.
- 187. When loculated ascites is seen as discrete collection of fluid. Loculated lesion may not be distinguishable from fluid in abscess because the density of infected and uninfected fluid can be identical.
- 189. Either sub hepatic, Subphrenic, Para colic and pelvic.
- 190. Multiple abscesses are not uncommon.
- 191. Ascites frequently follow abdominal and pelvic abscess.
- 194. The abscess has slightly irregular walls and may contain internal echoes due to septation or debris. these internal echoes are not specific for infection.
- 196. Gas within the abscess seen in ½ of patients. It is very useful sign to distinguish infected and non infected fluid loculation.
- 197. The gas may take the form of multiple small streaks or bubbles, or may collect as one large bubble.
- 198. Air fluid level may be present within the larger collection.
- 199. The wall of the abscess show enhancement following IV contrast administration.
- 202. Calcification within the mass
- 203. Gas in the abscess
- 205. Lymphadenopathy
- 206. Aortic aneurism
- 208. Hematoma
- 210. There is usually fat containing space to left of aorta which is a good area to look for Lymphadenopathy. The only structure other than LN to be seen in this space is left renal vein.
- 211. The psoas muscles are seen as symmetrical rounded structures.
- 213. Size is the only criterion of abnormality normal, inflammatory and neoplastic nodes usually have the same features and texture at CT, US & MRI.
- 215. Calcification of adrenal gland may follow:
- 216. Old intra adrenal hemorrhage.
- 217. Old healed TB
- 218. Severe destruction or calcification may lead to Addison’s ∆
- 219. Enlargement may be due to
- 220. Neoplasm
- 221. Hyperplasia
- 222. Cyst
- 223. Abscess
- 224. Hemorrhage
- 225. Advantage of US and MRI over CT ;
- 226. Display retroperitoneum in any plane
- 228. Most hyper plastic gland in pituitary dependant Cushing ∆ are normal or only slightly enlarged at CT.
- 229. Aldosteronoma (Conn’s tumor) are usually < 1 cm and may be difficult to be identified.
- 231. Very large at CT or MRI
- 233. MRI is very helpful
- 234. Non functional adenoma larger than 3cm are rare, may be due to metastasis or primary adrenal carcinoma. The common malignant adrenal tumor is neuroblastoma.
- 237. At angiography the outline of aortic lumen seen this is due to thrombus and not the wall that form the outline.
- 238. Aortography is of limited use in assessing the diameter although it is a good technique for the aorta above the aneurism.
- 240. Diagnosis is readily made by CT, MRI or US.
- 241. Hematoma may have similar feature to non fatty retroperitoneal tumor on CT and US.
- 242. Recent hemorrhage may show area of high density, while older hematoma have often undergone liquefaction (area of low attenuation)
- 244. Retroperitoneal abscess have many similar features to tumors and hematoma at both CT and US. Usually there is evidence of fluid center and gas.
- 245. The wall of the abscess may enhance with contrast.
- 246. Psoas abscess occasionally seen as an isolated entity which show enlargement of psoas muscle.
- 247. For diagnosis you should compare both psoas muscles.
- 248. ‘’ All the best ‘’