imaging of gi system

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Information about imaging of gi system
Health & Medicine

Published on March 18, 2014

Author: haomingli1


1 Imaging of Gastrointestinal System 義大醫院 影像醫學科 李浩銘醫師

Plain Photo EUS Fluoros copy Nuclear Medicine Ultrasound CT Scan MRI

Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas

• • • • Plain abdominal x-ray Technique : AP – Supine AP – Erect • • LLD Semi recumbent CXR Indication : Acute abdomen

What to Examine ?? - Air (bowel gas) - Bone density - Calcification (stone / foreign body) - Soft tissue mass

Air Sub diaphragm free air Bowel perforation

Bowel obstruction AP-semi recumbent  LLD, horizontal AP-supine -dilated bowel loops -thickening of bowel wall -multiple air-fluid levels

Ileo-cecal valve incompetent small and large bowel distention Bowel obstruction

Mechanical large bowel obstruction Colon dilatation obstruction. Barium enema

volvulus of sigmoid colon

Bone density - Osteoporosis - Compression fracture

Calcifications, stones Soft tissue mass

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

Colon Radiology Anatomy

Technique & positioning A. Left lateral position : contrast filling rectum and rectosigmoid B. Left posterior oblique: contrast filling sigmoid

C. Left lateral with 15o Trendelenberg position : contrast flow to descendent colon and splenic flexure D. Clockwise to prone position: contrast filling transversal colon

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

Contrast Single Double Barium Barium + air

Contrast Single Double Motility study Mucosa study Simple & relative safe More difficult

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

Intussusceptions Hirschprungs disease Fatique / very old patient / serious illness Suspected pelvic metastasis Indication Single contrast BE

Contraindicati on Suspect bowel perforation Toxic megacolon After colonic biopsy Pregnant Patient

Complicati on Gas pain Colonic perforation/rupture Intramural barium Stool impaction Bacterial contamination Allergy / hypersensitivity

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)

Record / filming Plain abdominal photo Spot photo Overhead whole abdomen Plain abdominal photo

Barium Enema Single Contrast

Spot film : Single contrast Rectum (left lateral) Hepatic flexure Sigmoid Splenic flexure Cecum

Whole abdomen : single contrast Whole colon : overhead film

Barium Enema Double Contrast

Spot film : double contrast Rectum & sigmoid : Lateral position Supine position Prone position

Spot film : double contrast Sigmoid : posterior oblique Distal descendant colon Proximal descendant colon

Spot film : double contrast Splenic flexure (RPO) Transverse colon Erect position

Spot film : double contrast Ascendant colon Hepatic flexure Erect position Erect position, LPO

Spot film : double contrast Cecum & appendix Cecum & terminal ileum

Overhead film : whole colon

Hirschsprung disease Dilatation of proximal bowel with caliber change at rectum Transitional zone

Intussusception Doughnut Sign

Polyp Bubble  Filling defect

Pedunculated Polyp Sessile Polyp Mexican hat sign

Malignant polyp : villous type

Apple core sign Colon cancer : annular type

Colonic diverticulitis Colonic diverticulosis

Ulcerative colitis Continuous lesion, lead pipe sign Segmental colitis Pancolitis

Crohn’s disease Discontinuous skip lesion Fistula formation

Colitis TB Rectal carcinoma Overhanging edges / shouldering Annular constriction Irregularity border

Colonic polyp Filling defect on single contrast Soft tissue mass on double contrast

Extraluminal tumor ileocecal intussusceptions (Coiled spring appearance)

Digestive system: Digestive tracts: - Oral cavity - Pharynx - Esophagus - Stomach - Small bowel - Large bowel (Colon) - Rectum Accessories organs: - Parotids - Liver - Billiary - Pancreas

Diffuse esophageal spasm: corkscrew esophagus 15

Foreign body Mimicking tumor Intraluminal filling defect 16

17 Gastric wall filling defect Gastric carcinoma

Linitis plastica 18

19 Additional shadow Duodenum diverticulosis

3. Small Intestines Barium follow through (Single Contrast) Enteroclysis (Double Contrast) 20

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

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

Normal follow through Enteroclysis - normal small bowel mucosa 23

ascariasis in small intestine 24

Take home message • ABCS in KUB • Single v.s Double contrast • Indication / Contraindication / Complication of barium enema

Learn to be better !

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