Imaging of the Gastrointestinal Tract and Retroperitoneum PDF

Imaging of the Gastrointestinal Tract and Retroperitoneum Bi-Hung Peng, PhD Department of Neurobiology The University of Texas Medical Branch  Types of barium tests Barium test: Barium sulfate, white liquid, to outline of the upper parts of the gut...

Imaging of the Gastrointestinal Tract and Retroperitoneum Bi-Hung Peng, PhD Department of Neurobiology The University of Texas Medical Branch  Types of barium tests Barium test: Barium sulfate, white liquid, to outline of the upper parts of the gut (esophagus, stomach and small intestines) shows up clearly on X-ray pictures. Barium swallow Barium meal Barium follow through Barium enema Barium Tests (Barium Meal, Swallow, Follow Through) Barium swallow In this test you drink some barium liquid. The barium liquid is often fruit-flavoured so it is pleasant to drink. You stand in front of an X-ray machine whilst X-ray pictures are taken as you swallow. This test aims to look for problems in the gullet. These include a narrowing (stricture), hiatus hernias, tumours, reflux from the stomach, disorders of swallowing, etc. Not to eat or drink for a few hours before this test. A barium swallow test takes about 10 minutes. Barium meal This is similar to a barium swallow. However, it aims to look for problems in the stomach and the first part of the gut (small intestine), known as the duodenum. These problems may include ulcers, small fleshy lumps (polyps), tumours, etc. You drink some barium liquid but you then lie on a couch whilst X-ray pictures are taken over your tummy. It may take a little longer to do than a barium Barium meal stomach X-ray swallow. Take bicarbonate power & citric acid to generate gas Different positions Barium follow through This test is similar to a barium meal but aims to look for problems in the small intestine. Therefore, you drink the barium liquid but then need to wait 10- 15 minutes before any X-rays are taken. This allows time for the barium to reach the small intestine. You may then have an X-ray every 30 minutes or so until the barium is seen to have gone through all the small intestine and reached the large intestine (colon). This test will last longer than the previous ones. The overall time taken will depend Barium follow through showing on how quickly your gut moves small bowel Barium enema This is a test to take X-ray pictures of the colon. The barium it is placed in your colon (a tube through anus). So that the barium coats all of the lining of the colon, the doctor doing the test may be do some of the following: Ask you to change position on the couch, for example on your side or back. Give you an injection of a drug that makes the muscles in the walls of the colon relax. Pass some air down the enema tube into the colon. It helps makes the x-ray pictures much clearer. When the barium liquid has spread throughout the colon, several x- ray pictures are taken so that all parts of the colon can be seen. The tube is then removed and you can go to the toilet. This test takes around 15-20 minutes. Barium swallow Barium swallow Barium swallow Barium swallow  Barium swallow Take bicarbonate power & citric acid to generate gas Barium swallow Barium swallow Barium swallow Barium swallow  Jejunum vs. ileum Jejunum: Ileum: Larger diameter Smaller diameter More densely packed and higher plica Fewer and shorter plica Feathery appearance on X-ray Sausage appearance on X-ray More vascular supply (pink color) Less vascular supply (brown color) Simpler vascular supply: More complex vascular supply: - Only one arcade, from which vasa - Multiple arcades recta emerge More encroaching mesenteric fat Less encroaching mesenteric fat Presence of Peyer’s patches. Meckel’s diverticulum Barium enema Barium enema with air insufflation Barium enema with air insufflation Barium enema with air insufflation Barium enema with air insufflation “Apple core” lesion CT showing tumor in colon Fetal cecum  CT of abdomen C: caudate lobe  CT of abdomen D:diaphragm Ad: adrenal g CT of abdomen CT of abdomen CT of abdomen  Hepatopancreatic ducts A fiberoptic endoscope is passed through the mouth down into the duodenum. A cannula is inserted through the ampulla of Vater (arrow) into the pancreatic duct and contrast is injected. Celiac trunk Translumbar needle injection  Superior mesenteric artery upper small arrows : anastomosis between the inferior& superior pancreatico- duodenal arteries Large red arrow: ileocolic artery. Arrowhead: middle colic artery. Stars: intestinal arteries Contrast material was injected directly into the orifice of the superior mesenteric artery (SMA) following femoral artery catheterization Inferior mesenteric artery translumbar inferior mesenteric arteriogram Renal arteriogram: arterial phase selective renal arteriogram Renal arteriogram: glomerular phase Renal arteriogram: venous phase Urinary collecting system excretory urogram in a child, with the stomach deliberately distended with gas The End