Radiology of The Abdomen PDF

Radiology of The Abdomen DR. Mohammed Ayesh, DR. Noura Molla COLOR INDEX: EDITING FILE MAIN TEXT MALE’S SLIDES FEMALE’S SLIDES IMPORTANT DOCTOR’S NOTES EXTRA INFO Objective To know radiology modalities used in abdomen imaging mainly GI tract. To know advantages and disadvantages of each modali...

Radiology of The Abdomen DR. Mohammed Ayesh, DR. Noura Molla COLOR INDEX: EDITING FILE MAIN TEXT MALE’S SLIDES FEMALE’S SLIDES IMPORTANT DOCTOR’S NOTES EXTRA INFO Objective To know radiology modalities used in abdomen imaging mainly GI tract. To know advantages and disadvantages of each modality. To know indications and contraindications of each modality. Overview on normal abdomen appearance and common pathologies including: - Pneumoperitoneum - Peptic ulcer - Bowel obstruction - Inflammatory bowel disease - Large bowel masses / malignancies X-Ray Definition ◦ X-ray is a form of radiation, that are focused into a beam ◦ They can pass through most object including the human body ◦ When X-rays strike a piece of photographic film, they make a picture ◦ Widely available ◦ Cheap ◦ Excellent in diagnosing free air in the abdomen ◦ Good in diagnosing bowel obstruction & stones/calcification (e.g. renal stone) Advantage Disadvantage Indications C.I ◦ Abdominal pain ◦ Bowel (Intestinal) obstructions ◦ Others: foreign body, Supportines lines, etc ◦ Masses ◦ Trauma ◦ Stones Pregnancy, Even though the radiation very minimal Interpretation (2) ◦ Radiation ◦ Poor soft tissue details (1) ◦ White → Bone and calcification ◦ Grey → Soft tissue ◦ Black → Air When is the presence of air in X-rays considered normal? ◎ Stomach: almost always air in stomach ◎ Small bowel: usually small amount of air in 2 or 3 loops ◎ Large bowel: almost always air in rectum and sigmoid, varying amount of gas in rest of large bowel 3, 6, 9 Rule Maximum Normal Diameter of bowel: Small bowel → 3cm Large bowel → 6cm Caecum → 9cm X-Ray Always keep in mind the image in the opposite side of you Normal abdominal X-Ray Stomach Liver Spleen Kidneys Psoas muscles Small bowel Large bowel (4) Rectum Standing position (3) Supine position (3) 14 Spleen 15 Kidney Liver Psoas muscles 16 1. 11th rib 2. T12 3. Gas in stomach 4. Splenic flexure 5. Transverse colon 6. Gas in sigmoid 7. Sacrum 8. SI joint (sacroiliac joint) 9. Femoral head 10. Gas in caecum 11. Iliac crest 12. Hepatic flexure 13. Psoas margin 14. Liver 15. Left kidney 16. Bladder Abnormal abdominal X-Ray Dilated bowel loops Air fluid levels (5) Bowel obstruction Air in the diaphrma, outside the bowel loops (pneumoperitonium) (6) Fluoroscopy (X-ray + Oral contrast) Definition It is the same as X-rays, but the difference between them is that X-rays take snapshots of internal tissues in a single moment, whereas fluoroscopy can provide continuous (dynamic), real-time moving video of your internal tissues. Advantage Disadvantage Indications ◦ Available ◦ Relatively cheap ◦ Excellent in evaluation the bowel lumen and mucosa ◦ Radiation ◦ Poor in evaluating extra luminoal pathologies ◦ Masses ◦ Inflammatory bowel diseases ◦ Post surgical, leak. ◦ Assessing the mucosal outline ◦ Abdominal pain ◦ Gastroesophageal reflux ◦ Pregnancy ◦ Bowel obstruction -it will worse the patient symptoms because bowel is already C.I maximally dilated, if you adding some barium (which is thick) → extra fluid- ◦ Bowel perforation (with barium type of contrast). The best modality to assess each part of the GI system (7) Barium swallow Barium meal Barium follow through Barium enema ↓ ↓ ↓ ↓ esophagus Stomach small bowel large bowel Normal abdomen Abnormal abdomen Type of study: Barium enema 1. Rectum 2. Sigmoid colon 3. Descending colon 4. Splenic flexure 5. Transverse colon 6. Hepatic flexure 7. Ascending colon 8. cecum Peptic ulcer disease Dye mixed with air Type of study: Barium enema Diagnosis: Colon mass/malignancy (Apple core appearance) CT scan Multiple X-ray Advantage Disadvantage Indications C.I ◦ Available ◦ Short scan time ◦ Much more soft tissue and bone details ◦ Excellent in diagnosing extra-luminal lesions ◦ Excellent in diagnosing the cause of bowel obstruction ◦ Radiation ◦ Sometimes need intravenous contrast (renal disease) ◦ Relatively expensive ◦ To look for bowel obstruction cause ◦ To diagnose intra-abdominal masses ◦ Abdominal pain ◦ Trauma ◦ Pregnancy ◦ No IV contrast in renal failure ◦ Unstable patients (severe trauma/ICU) Normal abdomen Abnormal abdomen Mass outside the bowel causing mass effect Pictures MRI Advantage Disadvantage Indications C.I Dr: True or false: MRI uses large number of x-ray? False. False. ◦ Relatively safe in pregnancy (no radiation) ◦ Give much more soft tissue details ◦ Excellent in diagnosing abdominal solid organ lesion: liver, spleen, kidneys ◦ Expensive ◦ Long scanning time ◦ Abdominal solid organ masses ◦ Sensitive to motion ◦ Inflammatory bowel disease ◦ Uncooperative patients ◦ Early pregnancy (relative contraindication) ◦ No IV contrast renal failure (relative contraindication) Normal abdomen Pictures The oral contrast will reveal the specific characteristics of the small bowel to you. And this is a much better view of the liver. ‫اﻟﺠﺪار ﻛﺄﻧﮫ‬ ‫ﻣﺮﺳﻮم ﺑﻘﻠﻢ‬ ‫ﺣﺎد‬ Abnormal abdomen Diagnosis: Inflammatory bowel disease Signs: Bowel wall thickening ‫اﻟﺠﺪار ﻛﺄﻧﮫ ﻣﺮﺳﻮم ﺑﻤﺤﺪد‬ Extra Dr Notes 1. Wide of things appears as gray, all of this is soft tissue. but you can’t see (distinguish) which soft Tissue is this. 2. Gas allows for much greater penetration than bone, which permits very little. The picture depends on how much x-ray energy reaches the film behind the patient or behind the item.. 3. why is the air distribution in the stomach here different than the air distribution here? It's the gravity 4. We are looking at all of these shadows because sometimes we're not gonna be able to see the boundaries of the psoas muscle. That means probably the patient has a large intra-abdominal mass that is obscuring the psoas muscle. So, we were going to ask for a CT scan to assess for more details. 5. There's no mixing of the air and fluid and the content when they stop flowing, either due to obstruction or paralytic ileus, the paralysis of the small intestine. Where will the air disappear to? Above. This is known as the air fluid level, or numerous air fluid levels, and it is related to the suggestion of intestinal blockage. 6. always we have to check underneath the diaphragm, if there is any amount of free air in here as well. 7. There are two different kinds of dieting. Dasrographon is one of them, and barium is the other. Therefore, we do not recommend using barium if you suspect a leak or a preparation because it is very powerful for the proteinal cavity and can irritate it. We can utilize the dasrographon for bowel preparation, although barium is not recommended. Summary Test X-ray Fluoroscopy CT scan MRI Indications Contraindications ◦ Abdominal pain ◦ Bowel (Intestinal) obstructions ◦ Foreign body, Supportines lines, etc ◦ Masses ◦ Trauma ◦ Stones Pregnancy ◦ Assessing the mucosal outline ◦ Abdominal pain ◦ Gastroesophageal reflux ◦ Masses ◦ Inflammatory bowel diseases ◦ Post surgical, leak. ◦ Pregnancy ◦ Bowel obstruction ◦ Bowel perforation (with barium type of contrast) ◦ To look for bowel obstruction cause ◦ To diagnose intra-abdominal masses ◦ Abdominal pain ◦ Trauma ◦ Pregnancy ◦ No IV contrast in renal failure ◦ Unstable patients (severe trauma/ICU) ◦ Abdominal solid organ masses ◦ Inflammatory bowel disease ◦ Uncooperative patients ◦ Early pregnancy (relative contraindication) ◦ No IV contrast renal failure (relative C.I) MCQ Q1. According to the 3, 6, 9 rule that indicates the maximum normal diameter of bowel, which of the following is the measurement of the small bowel ? A. 3cm B. 6cm C. 9cm D. 12cm Q2. What is the type of fluoroscopy contrast for evaluating the small bowel mucosa ? A. Barium swallow B. Barium meal C. Barium follow through D. Barium enema Q3. What is the best radiological modality for evaluating the cause of bowel obstruction? A. X-ray B. Fluoroscopy C. CT scan D. MRI Q4. A 59-year-old man complains of progressive weakness. He reports that his stools are very dark. Physical examination demonstrates fullness in the right lower quadrant. Colon cancer is suspected. Which of the following radiological findings is specific to the diagnosis? A. Air under diaphragm B. Dilated bowel loops Answers: 1. A 2. C 3. C 4. D C. Air fluid levels D. Apple core appearance TEAM LEADRS Danah Almuhaisen Abdurahman Alshahwan TEAM MEMBERS Aroub Almahmoud Norah Almania Reuf Alahmari