RADIOLOGY OF

GASTROINTESTINAL TRACT
(GIT)

Bachtiar Murtala
1. This topic covers :
- Introduction
- GIT examination with contrast media
- Plain abdominal radiography & hepatobiliary
system (taken over by another topic).
2. Introduction
- Radiology has an important role in diagnosing
abnormalities in GIT
- Basically categorized into two technique :
• without contrast media
• with contrast media
 - Modalities : • Conventional X – ray
• Imaging
- This lecture will be focused to :
• Indication
• Procedure of examination
• The appearance of organs/abnormarlities
3. Pharynx/Salivary glands :
Pharynx : - Plain AP/Lateral
- Contrast with urografin
- Fluoroscopy
 Indication : - Disturbances of swallowing
- Tumors of the base of the tongue
& epiglottis
4. Salivary glands :
Consist of : - Parotic glands
- Submandibular glands
Indications : Stones; inflamation; neoplasm
Technique : - Plain Foto
- Sialography
- CT
- MRI
Sialography :
– Duct orifice. is located & intubated by a blunt needle/abbocath
– 0,5 – 1,5 ml contrast medium (water soluble/lipiodol) injected
slowly & then taking a series pictures
– Give a few drops of lemon juice  make an “after lemon” film
10’ later to evaluate the remaining contrast

Abnormalities :
– Chronic obstructive Sialectasis
- stone
- strictures
– Chronic non-obstructive Sialectasis (chronic inflamation)
– Tumours (mostly mixed salivary type)
5. Esophagus
It should be visualized with contrast media
(Barium Sulfat)  Esophagography
Indications : - Dysphagia
- Dyspepsia
- Haematemesis/melena
- Congenital anomalies ?
6. Technique of Examination
• The patient is asked to swallow a thick Barium
Sulfat (1:1) and followed by fluoroscopy &
taking radiography
 • Radiography positions : - AP
- Right Anterior Oblique
projection (RAO)
- Left Anterior Oblique
projection (LAO)
- Spot Film (optional)
7. Radiological Signs :
A. Normal Indentations : - Knob aorta
- Left main bronchus
- Left atrium
- Hiatus hernia
B. Abnormalities :
Congenital malformation
- Esophageal atresia
- Short esophagus with a thoracic stomach
(Brachy-esophagus)
- Duplication
Traumatic Disorders  rupture
Abnormalities in density  foreign bodies
Abnormalities in Size (length & diameter)
Abnormalities in architecture
Esophagitis : - Narrowing of the lumen
- Irregularitis of mucosa
- Proximal dilatation
Tumours :
- Benign : • Filling defect with smooth
border
• Forked stream appearance
(Fluoroscopy)
- Malignant : • Filling defect with irregular
border
• Spasticity
3 Types : - Papillary
- Ulcerating
- Infiltrating
Abnormalities in neuromuscular function
- Spasm
- Chalasia (dilatation of the distal part)
- Achalasia/Cardiospasm/Megaesophagus :
sigmoidal type & fusiform type
Rö : narrowing of the distal end of esopha-
gus with proximal dilatation,elongation
Smooth contour,
“Mouse Tail Appearance”.
Others :
• Varices : - “Honey-Comb Appearance”
- “Cobble-Stone Appearance”
• Ulcer : Additional Shadow
GASTRODUODENOGRAPHY
(= Maag Duodenum/MD Foto)
Is a radiographic evaluation of the stomach &
duodenum by introducing contrast media inside
[Barium sulfat (+) & air/gas (-)]
Indication : - Dyspepsia
- Epigastric pain
- Vomiting
- Haematemesis/melaena
Procedure Of Examination
1. Preparation : fasting ± 4-6 hours
2. The patient swallows contrast Barium Sulfat (&
air) followed by fluoroscopy and taking
radiography in various position
3. Usually in Supine, Prone, Prone oblique, Erect.
Spot-Film Compression (recommended)
Normal Anatomic Radiography
Radiographic Abnormalities of Gastroduodenal
Disease.
It can be classified as changes in :
– Position
– Size (redundancy, enrlargement/widening,
narrowing/shrinkage)
– Contour
– Rugae abnormalities
– Filling defect
– Function
Change in Position
– Abnormalities due to extragastric structures
- Abnormalities of Size
- Change in Contour of Gastroduodenum
• Diverticula
• Ulcer
– Abnormalities of the Rugae Pattern
• Filling Defect
Duodenum
Ulcer
Carcinoma
Inflamation : Duodenitis
SMALL INTESTINE (JEJENUM & ILEUM)
• Normal size: - ± 20 feets (length)
- 2,5 cm (jejenum); 1,75 cm (ileum)
in diameter
• Indications:
Anemia (unclear origin)
Persistent diarrhoe
Abdominal pain
Palpable mass
Excessive protein loss
Malabsorbtion
• Contraindication:
Obstruction signs
Perforation
Paralytic ileus
Peritonitis
• Technique of Examination
1. Plain abdominal radiography
2. Follow Through
Patient is asked to swallow 200-300 cc Barium
sulfat (1:2-3 water),followed by taking pictures
30-60 minutes interval until contrast seen in
caecum
• Abnormalities
Crohn’s Disease = Regional ileitis
Adhesion
Fistula
COLON
Indication : • Haemochesia
• Persistent diarrhea
• Abdominal mass
• Obstructive symptoms
• Congenital abnormalities

Contraindication : • Ileum (Paralytic)

• Suspect Bowel Perforation
• Peritonitis
Technique of Examination : • Barium enema
(colon inloop)
• Mostly Double-
Contrast method
Preparation is the most important to remove
faecal material from the colon
Colon inloop : - Using a thin Barium sulfat
(1:3-6) aprox. 2 L
- Contrast should fill colon entirely
(rectum-caecum)
- Picture taken in many positions/
views.
Normal Radiographic Appereance

Abnormalities
Carcinoma of Colon
3 types : • Fungating type
• Polypoid type
• Annular type
Fungating type :
- usually medullary Ca.
- Sites: Caecum, Ascending Colon, Rectum
- Complication: Bleeding, fistula

Polypoid type :
- Sites: usually Descending Colon
- Complications: Intussusception
 Annular type :
- Sites: Sigmoid, Descending Colon, flexures
- Complication: Fistula, obstruction
Pathology : - 50 – 75% adeno Ca.
- 20% fibro Ca.
- 10% mucoid adeno Ca.
Metastasis : Liver or regional nodes
Radiographically :
Filling defect with
Obstruction signs
2. Obstruction
Obstruction to the flow of Barium can be caused by :
• Spasme
• Annular Carcinoma
• Intusussception
• Volvulus
• Diverticulitis
3. Displacement of the Colon
causes : - Enlarge Liver - large abdominal mass
- Enlarged Spleen - Pelvic mass or tumor
- Stomach mass of Spine
4. Dilatation/Distension
- Idiopathic symptomatic megacolon (older age)
- Hirschsprung’s disease (megacolon congenital)
• Disease of childhood, mostly males
• Abscent of ganglion cells in the mesenteric
plexus in the narrowing segment (mostly
sigmoid colon, ± 40%)
• Marked dilatation above the area of agangliono-
sis.
Radiographically :
- Plain abdominal films  veriable degrees of
distension of GIT above the obstruction
 - Colon in loop :
• Narrowing along the site of aganglionosis
• Dilatation above the narrowing, might be associated
with irregularity/sawtoothing/ulcerative Colitis
5. Narrowing of the Colonic Lumen
• Congenital stricture or atresia Ani
varies from an imperforate anal membrane to com-
plete atresia of the entire anus
• Ulcerative Colitis
- Loss of haustra
- Contracted,shortened & small calibre
- Saw-toothing/ulceration
- “Stringiness/String sign”
 Radiographically :
Technique of examination :
• Inverted or Wangesteen position
• Knee-chest position
Aim : to identify the lowest end of air in colorectal
6. Intussusception = Invaginasi