Академический Документы
Профессиональный Документы
Культура Документы
IMAGING
dr. Christina Andica
DEPARTMENT OF RADIOLOGY
FACULTY OF MEDICINE, UNIVERSITY OF PADJADJARAN /
HASAN SADIKIN HOSPITAL
BANDUNG
Anatomy
- Plain
Without
Contrast
GI
Imagin
g
photo
- 3 way
abdomen
series
-
Esophagograhy
-MaagWith
Contrast
Duodenography
- Barium Follow
Through
- Colon in Loop
First thing to do
Establish the name, sex, age and clinical
diagnosis of the patient
Establish the projection of the film
See the marker : Right / Left
Mechanical Ileus
Localized / Generalized Ileus
Peritonitis
Ulcerative Colitis
Diverculitis
Colonic Carcinoma
Abdominal Images
What to Examine
Gas pattern
Extraluminal air
Soft tissue masses
Calcifications
Always
air/fluid level
in stomach
A few
air/fluid
levels in
small bowel
Erect Abdomen
Small Bowel
Central
Valvulae extend across
lumen
Maximum diameter of 2"
Supine
Prone or lateral rectum
Erect or left decubitus
Chest - erect or supine
Supine
Looking for
Scout film for gas
pattern
Calcifications
Soft tissue
masses
Substitute none
Prone
Looking for
Gas in rectum/sigmoid
Gas in ascending and
descending colon
Substitute lateral
rectum
Erect
Looking for
Free air
Air-fluid levels
Erect Chest
Looking for
Free air
Pneumonia at bases
Pleural effusions
Substitute supine
chest
Localized ileus
Generalized ileus
Mechanical SBO
Mechanical LBO
Important Points
Look for air in the rectum/sigmoid first
Identify the most dilated loops-are they large bowel or
small bowel?
Sentinel loops are 1-2 dilated loops of small bowel
Generalized adynamic ileus almost always occurs in
immediate post-op patients
Always correlate the clinical findings with imaging
findings
Localized Ileus
One or two persistently dilated loops of
large or small bowel
Gas in rectum or sigmoid
Supine
Sentinel Loops
Prone
Sentinel Loops
Cholecystitis
Pancreatitis
Ulcer
Appendicitis
Diverticulitis
Ulcer
Ureteral calculus
Generalized Ileus
Gas in dilated small bowel and large
bowel to rectum
Long air-fluid levels
Only post-op patients have generalized
ileus
Supine
Erect
Mechanical SBO
Mechanical SBO
Causes
Adhesions
Hernia*
Volvulus
Gallstone ileus*
Intussusception
SBO
Mechanical SBO
Pitfalls
Mechanical LBO
Dilated colon to point of obstruction
Little or no air in rectum/sigmoid
Little or no gas in small bowel, if
Ileocecal valve remains competent
Mechanical LBO
Causes
Tumor
Volvulus
Hernia
Diverticulitis
Intussusception
Supine
Prone
Haustra
Valvula conniventes
Number of loops
Distribution of loops
Radius of curvature of loop
Diameter of loop
Solid faeces
Small bowel
Large bowel
Absent
Present
Present in
jejenum
Absent
Many
Central
Small
30-50 mm
Few
Peripheral
Large
50 mm+
May be present
absent
PERITONITIS
Radiological findings :
Generalized ileus
Ascites
Pneumoperitoneum
No pre-peritoneal fat
COLON IN LOOP
Indikasi :
Kelainan motilitas
Kelainan pada mukosa (ulkus), divertikel, inflamasi)
Keganasan
Degeneratif
Kelainan kongenital
Kelainan obstruktif
Kontraindikasi
Perforasi dari saluran cerna, ulkus yang mengalami
perforasi
Alergi bahan kontras media
Obstruksi total dari saluran cerna
SINGLE
CONTRAST STUDY
DOUBLE
CONTRAST
STUDY
Ulcerative Colitis
Ulcerative Colitis
Chrons Diseases
Crohn's disease is a disorder of unknown
aetiology that is characterised pathologically by
involvement of all bowel wall layers in a chronic
inflammatory
process
with non-caseating
granulomas. The granulomatous inflammation
most frequently affects the terminal ileum but it
may affect any part of the gastrointestinal tract
and frequently affected areas are in discontinuity.
There is a tendency to form fistulae.
Chrons Diseases
skip lesions - discontinuous sites of pathology along
the gastrointestinal tract
cobblestone ulceration; a result of apthous
ulceration progressing to oedema and nodular
thickening
lead pipe thickening - thickened, stiff bowel
narrowed lumen
strictures
'rose-thorn' narrow-mouthed ulcers which lead to
fistulae
Skip lessions
This lower abdominal X-ray shows narrowing (stenosis) of the end of the small
intestine (ileum)with loss of mucosal pattern and bowel wall thickening. Crohn's
disease typically affects the small intestine. A solution containing a dye (barium), was
swallowed by the patient. When it passed into the small intestines, this X-ray was
taken (lower GI series).
Colonic
Diverticulitis
COLONIC CARCINOMA
Focal Ileus
Generalized Ileus
SBO
LBO
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back
Correct
There are multiple aircontaining and dilated loops
of small bowel with little or no
gas in the colon. The findings
are those of a mechanical
small bowel obstruction. The
patient had undergone prior
surgery and the cause of this
obstruction was adhesions
form the prior surgery.
Go Back
Go ahead
Correct
There is a dilated colon to
the splenic flexure/ Little
or no gas is seen in the
rectum or in the small
bowel. The findings are
those of a mechanical
large bowel obstruction.
The cause was an annular
constricting carcinoma at
the splenic flexure.
Go Back
Go ahead
Correct
There are several air-containing
and slightly dilated loops of
small bowel in the LLQ. These
were persistent. The findings
are those of a localized ileus
(sentinel loops) and their
location would suggest
diverticulitis. The patient had
appendicitis. The sentinel loops
do not always correspond to the
area of inflammation.
Go Back
Go ahead
Correct
All of the bowel is dilated.
There is air in the rectum. The
patient was post-op
abdominal surgery and the
bowel sounds were absent.
This is a generalized adynamic
ileus as is seen sometimes
after abdominal surgery.
Go Back
Go ahead
Wrong
Look Again
Go Back