GASTROINTESTINAL

TRACT
2 Groups of Disorders.

ACUTE: - CHRONIC: -
 Gut obstruction  Ulcers
 Gut perforation  Malabsorptions
 Infection  Tumours etc
 Trauma etc
IMAGING TECHNIQUES FOR GIT

 Plain film radiography

 Contrast studies
 Ultrasound
 Computed tomography
 Magnetic resonance imaging
 Nuclear medicine
 PLAIN FILM RADIOGRPHS:

 Patients with an acute abdomen comprise

largest group of people presenting as a
general surgical emergency.
 Following history and clinical examination,
plain abdominal radiograph is the first and
most useful method of further
investigations.
PLAIN FILM RADIOGRPHS:

1-ABDOMEN SUPINE:

To assess distribution of Bowel Air,

Abdominal Viscera,
Fat Plains,
Calcifications.
 2-ABDOMEN ERECT/
LATERAL DECUBITUS VIEWS

To assess bowel gas fluid levels in the

bowel and
pneumoperitoneum.
 3-CHEST P/A IN ERECT:
 To assess small pneumoperitoneum.
 A number of chest disease may mimic acute abdomen
e.g.
*Lower lobar pneumonia
*Myocardial infarction
*Pericarditis
*Dissecting thoracic aortic Aneurysm
 Acute abdominal conditions may complicate chest
pathology e.g.
*Pleural effusion may accompany, liver abscess,
pancreatitis
*Basal pneumonia in subdiaphragmatic abscess.
*Raised right dome of diaphragm in liver abscess.
INTERPRETATION OF
ABDOMINAL
RADIOGRAPH
 BOWEL GAS PATTERNS:

 Organ identification on plain X-rays

depends on
 anatomical position,
 helped by tissue fat interface and
 presence of gas, fluid or food residue with
in the bowel.
 STOMACH:

 Anotomical location.
 Relatively large amount of air shows an air
fluid level in fundus on erect film.
 SMALL BOWEL:
 Usually small amount of gas is present.
 Sometimes with air Swallowing e.g.
during breathlessness and pain, more gas
can be seen and valvulae cenniventes
can be identified.
 Short air fluid levels are not uncommon.
Long air fluid levels are abnormal.
 A small bowel calibre exceeding 2.5 cms
is indicative of bowel dilatation.
 COLON:

 Can be identified by its position and

haustra.
 Old mentally retarded, institutionalized
people may have enormous colon
measuring 10-15 cms in diameter with out
any symptoms.
 Colonic fluid levels are common finding
 METEORISM:

 Gasfilled slightly dialted loops of bowel

produced due to excessive air swallowing.
INTESTINAL OBSTRUCTION:

Dynamic
Adynamic
 1-DYNAMIC OBSTRUCTION

Due to mechanical obstruction.

Dilated loops of bowel proximally with
non dilated or collapsed bowel distal
to presumed point of obstruction.
 CAUSES OF SMALL BOWEL
OBSTRUCTION:
 Adhesions
 Strangulated hernias
 Intussusceptions
 Volvulus
 Crohn’s disease
 Ileocaecal T.B
 Gall stone ileus
 Mesenteric thrombus
 CAUSES OF LARGE BOWEL
OBSTRUCTION:

 Carcinomas
 Volvulus of caecum and sigmoid
 Strangulated hernia
 2-ADYNAMIC ILEUS:

 Paralytic ileus occurs when intestinal

peristalsis ceases and as a result, fluid &
gas accumulate in the dilated loops.
 2 Types.

Localized ileus.
Generalized ileus.
 CAUSES OF LOCALISED ILEUS:

 Appendicitis
 Cholecystitis
 Pancreatitis
 Abscess
 Salpingitis
 CAUSES OF GENERALISED
ILEUS:

 Peritonitis
 Postoperative
 Hypokalemia
 Pneumonia etc.
 PNEUMOPERITONEUM:
 Postoperative or post dialysis (Can take 3 weeks to absorb)
 Perforation of hallow viscus due to:
Trauma
Ulcer
Tumor
Infarction
Appendicitis
Diverticulitis
 Silent perforation of viscus e.g in
 Elderly
 Steroid treatment
 Unconscious etc.
 2-SOFT TISSUE SHADOWS:

 Liver.
 Kidneys.
 Urinary bladder.
 Psoas and obturator shadows.
 There size can be appreciated
 Any soft tissue, space occupying mass
can displace the viscera and bowel gas.
3-CALCIFICATION AND CALCULI:

 Urinary tract calculi/calcifications.

 Biliary calculi.
 Lymph node calcification.
 Vascular calcification.
 Worm calcification.
 Peritoneal calcifications—fat calcification after
pancreatitis.
 Phleboliths.
 Prostatic.