Professional Documents
Culture Documents
OUTLINE
I. Imaging Modalities
II. Plain Abdomen
III. Contrast Study
IV. Ultrasound
V. Nuclear Scantigraphy
VI. CT scan
VII. Clinical Cases
I. IMAGING MODALITY
X-ray (tomography)
CT scan
Nuclear Scintigraphy
o Requires injection of radioisotope to the patient and the
machine detects where the isotope concentrates
Ultrasound
MRI
o Ultrasound and MRI are the most used for imaging the
abdominal cavity, as compared to thoracic cavity wherein the
X-ray is most used.
STRENGTH OF MODALITIES
Survey or preliminary study of the abdomen
o Plain X-Ray
SOLID structures/organs
o Ultrasound first choice
Cheap
does not use ionizing radiation
o CT
o MRI (open-type)
Alimentary Tract
o X-Ray (Contrast study)
But now it has been replaced by endoscopy
CLINICAL CORRELATION
Densities on Plain Radiograph (x-ray)
Substances with higher atomic number are more white,
therefore, plain calcium is more white than bone
Why is contrast important?
-It is used for seeing the border or boundaries of the structures,
thus, it enlargement or atrophy can be detected
Significance
o If you have a severely malnourished patient without
body fat, you might not be able to see these
structures.
o Clearly seen in obese because of the abundant fat
present in the fascia
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INTESTINAL PATTERNS
Presence of gas
o swallowed air
o from bacterial fermentation in colon
In pediatrics, gas would be absent in the alimentary tract
because it is filled with fluid. There would only be gas once
the baby starts to cry. The gas would stay there in 24 hours
before it reaches the rectum.
In normal adults, gas seen in the stomach and colon only
but not in the small intestine (SI) because peristalsis is
faster in the SI.
o If you see gas in the SI, it could mean that
peristalsis has stopped
there is blockage that prevents the passage of air to
the colon
Duodenal C-Loop
o Inside the C-loop, youll find the Pancreatic Head
Figure 4. Stomach
Lesser curvature
o straight
o Magenstrasse (German: main street)
directs the flow of gastric acids gastric acids would be at
the lesser curvature, at the area of pyloric antrum
Peptic ulcer (rapture): Pyloric antrum (lesser curvature
aspect raptures air in the stomach escapes air goes to
the lesser peritoneal cavity since the lesser sac is posterior to
the stomach
Greater curvature
o Mucosal pattern: whirl pattern (?)
RG, Sopie, Keifer, Tasie, Fille, Jana
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Celiac trunk
o Only vascular structure that forms the letter T
Superior mesenteric artery 1 cm below Celiac trunk
o anterior: pancreas
o curves downwards
Inferior mesenteric artery
Splenic vein
o With inferior mesenteric vein forms the portal vein
o The only vein that moves from R to L
Portal vein part of the portal triad
o Anterior: common bile duct or main bile duct (in
ultrasound)
Portal triad (extrahepatic)
o Portal vein
o Hepatic artery
o Common bile duct
Duodenum
st
o duodenal bulb 1 part
o Descending
rd
o Horizontal/transverse 3 part
passes between aorta and superior mesenteric
artery
passes between IVC and Superior mesenteric vein
o Ascending
LANDMARKS
Useful in identifying different structures of the abdomen
Vascular structures are the most reliable ones (know them by
heart!)
In US or CT
To identify the common hepatic duct:
Look for portal vein (big structure)
o Anterior: main bile duct it is called as such
because you cant differentiate the common
hepatic duct and common bile duct
o Cystic duct is the boundary of common bile duct
and common hepatic duct
o To identify cystic duct: look for spiral valves of
Heister
Pancreas anterior to splenic vein (?)
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IV. ULTRASOUND
ABDOMINAL AORTA
There are watershed regions in the peritoneal cavity that are areas of
fluid stasis:
Ileocolic region
Root of the sigmoid mesentery
Pouch of Douglas
CLINICAL CORRELATION
When you are staging a patient for gastrointestinal malignancy
you have to look for disease in these areas of stasis.
Clearly the surgeons do better in finding subtle disease in these
areas.
Peritoneal metastasis usually occurs in the RLQ because of the
normal circulation of the peritoneal fluid from left to right side
of the abdomen.
V. NUCLEAR SCINTIGRAPHY
Differs because here, you inject the radioactive isotope into the
patient.
The machine records the location where the isotopes would
concentrate (BLACK SPOTS)
GAMMA Camera
PERITONEAL CAVITY
3 Important Structures:
Transverse Mesocolon
Sigmoid Mesocolon
Root of Mesentery
Peritoneal circulation
Compartments enable the peritoneal cavity to have a
normal circulation for peritoneal fluid.
The normal abdomen without intraperitoneal disease, a
small amount of peritoneal fluid continuously circulates.
Fluid in the peritoneal cavity is normal, it is not static and
circulates in the cavity.
Movement of fluid in this circulatory pathway is produced
by the movement of the diaphragm and peristalsis of
bowel.
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Densities in X-ray
Depends on how black or how white the image is
What is responsible in making the image black or white?
o ATOMIC NUMBER
High Z atoms would appear white.
Bone can be seen in the x-ray since it contains Ca.
However it is not as white as barium sulfate, since the
bone is composed of Ca (not purely made) in proteinrich matrix.
Black substances that allow x-ray to pass through and
interact with the film
VI. CT SCAN
Figure 15. Diaphragmatic Hernia
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