1. Diagnostic Imaging of the Gastrointestinal Tract

2. Plain Radiographs Contrast Studies Ultrasound

3. Plain Radiographs Demonstrate distribution of fluid and gas within the tract

4. Plain Radiographs In normal abdomen dependant on radiographic contrast

5. Plain Radiographs Ascites significantly impairs diagnostic utility

6. Loss of serosal detail due to hydroperitoneum

7. Plain Radiographs Cannot resolve soft tissue opacities as separate structures

8. Ultrasound Resolves soft tissue opacities

9. Tumour within wall of small intestine

10. Ultrasound can see the wall lesion within the fluid filled loop of bowel, plain radiographs cannot

11. Ultrasound Cannot image through gas

12. Plain Radiographs and Ultrasound are complementary

13. Contrast Radiography Allows visualization of the mucosal surface and indicates status of bowel lumen

14. Contrast Radiography Provides data regarding GI function

15. Esophagus

16. Megaesophagus Esophageal Foreign Body

17. Megaesophagus Retention of air or food material within the esophagus

18. Megaesophagus

20. Contrast study required only if do NOT see distended esophagus on plain radiographs

21. Megaesophagus Retention of barium within the esophagus

22. Normal Barium Swallow

23. Megaesophagus

24. Esophageal Foreign Body

25. Usually easy to identify Good contrast with aerated lung

26. Esophageal Foreign body

27. Aspiration pneumonia is a common complication

28. Esophageal foreign body with aspiration pneumonia

30. Stomach

31. Gastric Dilation with Volvulus GDV

33. Right lateral projection

35. Gastric Ileus

36. Gastric Ileus Normal Stomach

37. Normal Stomach

38. Foreign Bodies

39. Radiopaque Foreign Body

40. Semi radiopaque foreign body

42. Hair Ball

44. Hairball v Food Material?

45. Hairball has smooth margins and may not contact stomach wall Do not disappear following fasting

46. Food material has irregular margins usually in contact with stomach wall Disappears following fasting

47. Fibres e.g. carpet, socks are difficult to identify on plain radiographs and ultrasound and frequently require contrast radiography

48. Double Contrast Gastrogram

49. Naso-gastric intubation

50. 1-2 mls/kg undiluted barium 20ml/kg room air

51. Left lateral Right lateral Ventrodorsal Dorsoventral

52. Normal Double Contrast Gastrogram

53. Carpet Foreign Body

54. Gastric Foreign Body

57. Gastric Tumours

58. Uncommon

59. Filling defect on contrast study

60. May identify on ultrasound

61. But easily missed if stomach is gas filled

62. Gastric Tumour

63. Pyloric Dysfunction

64. Obstruction of pyloric outflow

65. Congenital

66. Obstruction of pyloric outflow Congenital Acquired Neoplasia

67. Obstruction of pyloric outflow Congenital Acquired Neoplasia Fibrosis

68. Plain Radiographs Enlarged Pylorus

71. Contrast Study Hyperperistalsis

73. The hourglass appearance must be present on several radiographs

74. Narrowing of pyloric canal

75. String or bird’s beak appearance

76. Narrowing of pyloric canal

79. Small Intestine

80. Obstruction is commonest abnormality identified

81. Foreign Body Intussuception Tumour

82. Foreign body most common

83. Complete obstruction v Partial obstruction

84. Normal width of small intestine 2-3 X width of a rib Width of a vertebral body

85. Obstruction results in fluid or gas distension or a combination of both

86. Foreign body may be Radiopaque Semi-radiopaque Radiolucent

87. Radiopaque small intestinal foreign body

88. Semi radiopaque small intestinal foreign body

92. Radiolucent small intestinal foreign body

93. Occasionally early enteritis, especially parvo virus infection will present with intestinal distension

94. Parvo virus enteritis

95. Cases with clear plain radiographic evidence of obstruction require surgery

96. They do not require an upper gastrointestinal series

97. The decision to perform an upper gastrointestinal study or a laparotomy is influenced by experience in interpreting the plain radiographs

98. Clear evidence of rupture of the gastrointestinal tract is a contraindication to an upper gastrointestinal series

99. Long standing cases of obstruction will also have hydroperitoneum

100. Pneumoperitoneum secondary to intestinal rupture

102. Fibres e.g. carpet or socks have a characteristic appearance on contrast studies

103. Look for a linear or reticular fibre pattern

104. Sock foreign body

106. Linear Foreign Body

107. Contrast column has acute angles with contrast accumulation at the angles

108. Linear Foreign Body

111. Partial obstruction of the small intestine

112. More challenging on plain radiographs

113. Partial obstruction of small intestine

116. Small Intestinal Tumours

117. Ultrasound most useful imaging modality

118. Normal small intestine 5 layers

119. Mucosal surface – white Mucosa – black Submucosa – white Muscularis – black Serosa – white

120. Normal small intestine

122. Normal single wall thickness <5mm

123. Intestinal Tumour Focal lesion

124. Intestinal tumour

125. Diffuse Thickening of Small Intestine

126. Gastro Intestinal Lymphoma Inflammatory Bowel Disease

127. Gastro Intestinal Lymphoma

128. Tumours of colon Uncommon

129. Normal colon

130. Tumour of the colon

131. Intussuception Rarely diagnosed definitively on plain radiographs

132. Intussuception Presents as non specific obstruction of small intestine

133. Ultrasound Target appearance Or Too many layers

134. Intussuception Requires a contrast study or ultrasound evaluation for confirmation

135. Intussuception

136. Contrast Radiographs Coiled spring appearance

137. Intussuception

138. Mega Colon