Gastrointestinal Imaging
Gastrointestinal Imaging
Presentation by:Rajneesh Mathur D.O.
Basic Imaging Techniques
* Plain Film Radiography
o Quick, Easy, Inexpensive
o “Snapshot” of a dynamic system
o Technique
+ Bones
+ Upper quadrants
+ Flanks
+ Mid-Abdomen
+ Lower Abdomen
Plain Film Radiography Continued
* Acute Abdominal Series
o Supine
+ Detects fluid/blood in peritonuem
+ Detects gas in bowel
o Upright
+ Air Fluid Levels
o Left Lateral Decubitus
o Upright CXR
+ Best for free air
Contrast Radiography
* Barium Sulfate
o Standard for contrast GI studies
o Insoluble, High viscosity
o Not absorbed by the GI tract
* Gastrograffin
o Soluble, Low viscosity
o Not absorbed by the GI tract
o Laxative Effect
+ Not recommended in Peds
Computed Tomography
* Imaging of SOLID organs
* View of RETROPERITONEUM
* Oral Contrast
o Identify bowel
* IV Contrast
o Blood Vessels
* 2 Phases
Radionuclide Scanning
* Replaced by Ultrasound in ED secondary to time
Ultrasonography
* Inexpensive
* Non-Invasive
* Air is a poor conductor
* Solid structures conduct well
Specific Gastrointestinal Conditions
* Plain Film Radiography
* Abdominal CT
* Ultrasound
* Air Contrast or Barium Enema
* Angiography
* Radionuclide Scanning
* MRI
Plain Film Radiography
* In past, every belly pain got plain films
o 10 to 40% of the time it does not change clinical management
o Get it for
+ SBO
+ Free Air
+ Ileus
+ Bowel Ischemia
+ Foreign Bodies
Abdominal Computed Tomography
* Diagnostic Tool of Choice for:
o Diverticulitis
o Pancreatitis
o Pancreatic Pseudocysts
o Aortic Aneurysm
o Blunt Trauma
o Appendicitis
* Can pinpoint a diagnosis in 95% of cases where clinical judgment fails to narrow a wide range of potential diagnoses
Ultrasonography
* Initial study for patients with
o RUQ pain
o Pelvic Pain
o Acute Appendicitis
Air Contrast or Barium Enema
* Used for
o Intussusception
o Has been replaced by CT for suspected abdominal aortic aneurysm
o May be helpful in evaluation of patients with lower GI bleed
Angiography
Radionuclide Scanning
* Can be useful as an adjunct to Ultrasound when suspicion of
o Cholecystitis
o Cystic Duct obstruction
o No Role in the imaging of the GI tract in the ED
MRI
Gastrointestinal Imaging.ppt
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