The gastrointestinal tract

 
Theme:   “The imaging investigations of the main pathological conditions of the
gastro-intestinal tract.”
The plain films can be very informative in patients with an acute abdomen, but for most other intestinal disorders
some form of endoscopy or imaging examination is necessary. 
Endoscopy is often the first investigation, because it shows mucosal lesions directly and also allows biopsy material
to be obtained. Imaging is pivotal for showing processes that cannot be diagnosed or assessed endoscopically, e.g. to
visualize the bowel beyond a stricture that cannot be traversed by an endoscope. The indications for barium examinations are
more numerous in centres where endoscopy services are either unavailable or restricted.
Barium sulphate is the best contrast medium for the gastrointestinal tract. It produces excellent opacification, good
coating of the mucosa and when completely inert. It’s only major disadvantage is that when water is reabsorbed in the colon
the barium may solidify and proximal to a colonic or rectal stricture. The other available contrast agents are the water-
soluble media, of which Gastrografin is the most widely used.
Most barium and Gastrografin examinations are carried out under fluoroscopic control so that the passage of contrast
can be observed on a television monitor. By watching the television monitor the radiologist is able to position the patient so
that any abnormality is shown clearly. Films are taken to shown fine detail and to serve as a permanent record. One of the
values of fluoroscopy is to ensure that an abnormality has a constant appearance. Peristaltic waves are transitory and so can
be easily distinguished from a true narrowing, which is constant.
Double-contrast examination of the stomach and colon (and in selected cases of the small bowel) is now the standard
technique for barium examinations. In double-contrast examinations the mucosa is coated with barium and the lumen is
distended by introducing air or some other gas, often in combination with an injection of a short-acting smooth muscle
relaxant.
               Aims and tasks             
     The aim of the lesson:
Studying radiological signs of the gastrointestinal tract disease:
Achalasia; Oesophageal diverticula; Gastritis; Gastric ulcers; Duodenal ulcer; Tumours
           Didactic aims
            The students have to know:
1. The principle and the technique of barium meal examination of the oesophagus, stomach, colon.
2. The principle and the technique of double-contrast examination of the oesophagus, stomach, colon.
3. Radiological signs of gastrointestinal tract pathological conditions (filling defect, stricture, and ulceration).
4. Radiological signs of gastrointestinal tract disease (achalasia, oesophageal diverticula, gastritis,
5. gastric ulcer, duodenal ulcer, tumours).
The plan of the lesson
№ Step lesson Time (min.)                  Equipment
1 Organizational moment   5  Educational magazine
  questioning of students   50 Educational magazine, tables, X-ray films.
3  Analysis of X-ray films. Sketch. 45  Tables, X-ray films.
  control of knowledge   60 Situational tasks, methodical works                                       
5 Analysis of situational tasks   15 Collection situational tasks, methodical works            
6 Home work    5 Text book, lectures.

Substantial module 4      Complex clinical imaging of the GIT.

 Topic 7. Gastrointestinal imaging. Normal anatomy and function of the oesophagus, stomach, small
intestine, large intestine.
Algorithm of clinical imaging of the GIT. Indications and contraindications methods visualization of
the GIT. Methods visualization of the salivary glands: plain films, sialography, ultrasound, CT scan, MRI.
Salivary gland lesions (radiological features).
Methods visualization of the GIT: plain radiography, barium studies, double contrast technique,
barium follow - through, barium enema, extrinsic impressions,endoscopy, computed tomography,
endoscopic ultrasound, radionuclide radiology including positron emission tomography, magnetic
resonance imaging. Contrast agentsand radiopharmaceuticals Technique of examination. Advances in
gastric imaging. The normal swallow, peristalsis, gas patterns, organ shapes and sizes, gastric
emptying,abdominal  calcification Abnormal motility. Patient preparation.