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GI Radiology


Radiography common uses Bowel Obstruction (adhesions, Hernias, Volvulus, intussusception); Adynamic Ileus; Free air (upright & LLD)
SBO on xray dilated bowel (SB > 3 cm, LB > 6 cm, cecum > 9 cm); poss free air; may also be post-op ileus
US uses Cholecystitis; Liver cirrhosis; Patency of hepatic vessels; Intussusception (kids); Appendicitis (kids)
Normal GB on US dark (anechoic); bright tissue interfaces (GB wall)
US: Cholecystitis findings Wall thickening, pericholecystic fluid, sonographic Murphy’s sign
Fluoroscopy uses: Esophagus motility disorders, structure abnormalities (hiatal hernia)
Fluoroscopy uses: Small bowel Celiac sprue, Crohn disease, Midgut volvulus (children)
Fluoroscopy uses: Colon cancer screening in setting of failed colonoscopy, sigmoid or cecal volvulus
Fluoroscopy uses: Congenital structural abnormalities microcolon, anorectal malformation, Hirschsprung disease
Fluoro Esophagus single contrast (barium alone) or double (barium & air)
CT uses: Abdominal pain Appendicitis, diverticulitis, bowel obstruction, cholecystitis, biliary tract obstruction
CT other uses: Trauma; Malignancy (Detect / stage tumors)
CT uses: Complications of cirrhosis HCC, varicosities, portal hypertension
CT uses: Complications of pancreatitis abscess, pseudocyst, necrosis, hemorrhage
MRI uses: Liver lesion characterization Focal nodular hyperplasia, hepatic adenoma, HCC, hemochromatosis, hemosiderosis
MRI uses: Pancreatic cystic lesion characterization Pseudocyst, mucinous or serous neoplasms, intraductal papillary mucinous neoplasms
MRI uses: Biliary tract pathology Obstructing stones, cholangiocarcinoma
Nuclear med: uses: Biliary imaging Obstructed cystic duct (ie, cholecystitis); Bile leak
Nuclear med: uses: Lower GI bleeding Diverticulosis, malignancy, anticoagulation
HIDA If cystic duct is patent: GB accumulates radioactivity; if CBD is patent: sm bowel will accumulate radioactivity
Tc-99 tagged RBC scan tagged RBCs accumulate in area of hemorrhage
Diverticulosis/diverticulitis: sx of inflammation: fat or tissue stranding
Appendix: normal size s/b no bigger than 6 mm diameter
Pancreatic cancer diagnostic studies Abd US (shows biliary duct dilatation). CT (TOC: mass & ductal dilatation). ERCP if CT neg (double duct sx of CBD & panc duct). Lap for staging.
For resectable pancreatic tumors, aspiration bx is: contraindicated (risk of spreading tumor)
Acute pancreatitis on KUB/CXR Atelectasis. Effusion. Sentinel loop air in small bowel/LUQ
If suspect pancreatic necrosis (in pancreatitis), choose this test Abd CT with contrast on day 3
Acute panc: Abd US (purpose) to r/o or establish GB/GS/BD dilatation; enlarged hypoechoic pancreas; poss pseudocyst, edema, calcification
MRI/MRCP in pancreatitis (purpose) to detect necrosis, stones/ductal disruption
Role of endoscopic US in pancreatitis Limited role acutely. Useful in occult biliary disease (microlithiasis)
Created by: Abarnard