Radiographic anatomy of

Gastrointestinal Tract
DR. KIKOMEKO SHARIF
DEPARTMENT OF RADIOLOGY
IUIU-HABIB MEDICAL SCHOOL
IMAGING MODALITIES
 Plain X ray abdomen
 Barium study
 Ultrasound abdomen
 CT abdomen
 ERCP/PTHC/MRCP
 MRI
 Nuclear medicine
 Sialography
 Plain X ray
Common Abdomen Films (Views)
 Antero-posterior – supine
 Antero-posterior –erect
 Left lateral decubitus/ chest radiograph.

many structures are not clearly

defined on a radiograph of the
abdomen, and therefore cannot be
fully assessed.
Indications:
 Acute abdomen
 Bowel obstruction
 Perforation
 Abnormal gas collection
 Renal pathology
 Detection of calcification
 As a preliminary film before contrast studies
 Toxic megacolon
 Foreign body localization
Normal supine abdominal radiograph
Recognizing the normal abdomen
 what to look for
◦ Intraluminal gas pattern
◦ Extra-luminal air
◦ Calcifications
◦ Organs and soft tissues masses
 Normal bowel gas pattern
◦ Stomach – almost always present
◦ Small intestines – in 2-3 loops which are non-
dilated
◦ Large intestine – almost always present in the
sigmoid and rectum, but variable in the other
segments
 Faecal mottling
 Normal air-fluid
levels/normal fluid
levels
 Only visible on chest x-

ray, upright or and

decubitus films of the
abdomen
◦ Stomach – almost always
present
◦ Small intestine – 2-3
levels
◦ Large colon – very few or
no air-fluid levels
Look for the bowel gas pattern

 Where are the bowel loops located (central vs.

peripheral)?
 Is there too much intraluminal gas?
 What is the distribution of the gas in the
abdomen?
 What is the intraluminal caliber of the small and
large bowel?
◦ Are there any dilatations of the small and/or large
bowel?
 identify any air-fluid levels?
Small bowel Identified by:
 Central position in the abdomen

 Valvulae conniventes - mucosal folds that cross the

full width of the bowel

Large bowel normal large bowel may be identified by:

 Peripheral position in the abdomen (the transverse

and sigmoid colon occupy very variable positions)

 Haustra

 Contains faeces
Large vs. Small Bowel

 Small
Bowel
◦ Central
◦ Valvulae
extend
across
lumen
Large Bowel
• Peripheral
• Haustral markings don't extend from wall
to wall
Haustra Faecal mottling
Radiographic Approach: Normal stomach
 If the stomach contains air it may be visible in
the left upper quadrant of the abdomen. The
lowest part of the stomach crosses the
midline.
Look at the diaphragms

 Are they raised or flattened?

 Are the costophrenic angles clear?
 Is there any free intra-abdominal air? (better

to be judged if erect or decubitus)

 Lateral decubitus view of an abdominal X-ray exhibiting
free intra-abdominal air between the liver, right
hemidiaphragm and lateral abdominal wall
Look at the liver
The liver lies in the right upper quadrant (RUQ)
and is seen as a bland area of grey on an
abdominal X-ray.
 Is it enlarged?
 Is it shrunk?
 Is it displaced?
 Are there any signs for a Chilaiditi's

syndrome (interposition of the colon between

the right hemidiaphragm and the colon)?
 Are there any calcifications?
 Abdominal X-ray
showing an enlarged
liver (*) displacing the
ascending and
transverse colon
downward. Note the
metallic artefact
(arrowhead) consistent
with a zipper.
Look at the spleen
The spleen lies in the left upper quadrant
(LUQ)immediately superior to the left kidney.
 Is it enlarged?
 Is it shrunk?
 Has it been removed?
 Are there any calcifications?
Kidneys on abdominal X-ray

Often visible on an X-ray of the abdomen.

 They lie at the level of T12-L3 and lateral to

the psoas muscles. The right kidney is usually

slightly lower than the left due to the position
of the liver.
 Look at the kidneys, ureter and bladder
 Is their position normal?
 Are they enlarged or shrunk?
 Are there any calcifications?
 Is there a variant?
Abdominal x-ray showing oval white density to left of spine--
stone in left ureter.
Psoas muscles
Psoas edges on abdominal X-ray
 The psoas muscles arise from the transverse

processes of the lumbar vertebrae and

combine with the iliacus muscles attaches to
the lesser trochanter of the femur.
 An abdominal X-ray often demonstrates the

lateral edge of the psoas muscles as a near

straight line or blurred.
2.Barium Study
 Barium swallow
 Barium meal
 Barium follow-through
 Barium enema
Fluoroscopy is an imaging technique that uses X-rays
to obtain real-time moving images of the internal
structures of a patient through the use of a
fluoroscope
 UPPER GI--(GASTRO INTESTINAL)
STOMACH
ORAL BARIUM CONTRAST

WITHOUT CONTRAST-plain or
scout film

COLON

BARIUM ENEMA
RECTAL BARIUM CONTRAST
28
BARIUM SWALLOW
 It is a medical imaging procedure used to
examine upper gastrointestinal tract, which
include the esophagus and to a lesser extent
the stomach.

 The contrast used is barium sulfate.

Barium swallow: Indications
 Dysphagia
 Carcinoma of oesophagus
 Oesophageal diverticulum
 Oesophageal varices
 Achalasia
 Gastroesophageal reflux
 Congenital anomalies of oesophagus:
 Oesophageal atresia with TEF

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ESOPHAGEAL CONSTRICTION

Superiorly: level of Cricoid

cartilage, juncture with pharynx

• Middle: crossed by aorta and

left main bronchi

• Inferiorly: diaphragmatic
sphincter

normal sites of narrowing of Esophagus

 Cervical esophagus bordered anteriorly by trachea,
posteriorly by vertebral column and laterally by carotid
sheath and thyroid gland.

 Thoracic esophagus anteriorly lies the trachea, right

pulmonary artery, left main bronchus diaphragm.
Posteriorly it rest on vertebral column and closely related
to thoracic duct, azygus & hemiazygus vein.

 Abdominal eshophagus its right border is continuous with

lesser curvature & left border is demarcated from fundus
by esophagogastric angle of implantation(angle of His)
Barium meal
 In a barium meal test, X-ray images are taken
of the stomach and the beginning of
duodenum.
Barium meal: Indications
 Dyspepsia
 Peptic ulcer disease
 Gastroesophageal reflux disease
 Hiatus hernia
 Gastric neoplasm (benign & malignant)
 Infantile pyloric stenosis
 Gastric volvulus
 Gastric outlet obstruction

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Barium follow through
Barium enema
SINGLE CONTRAST STUDY
 The colon is filled with barium, which outlines the

intestine and reveals large bowel abnormalities.

DOUBLE CONTRAST with AIR

 The colon is first filled with barium
 then the barium is drained out, leaving only a thin

layer of barium on the wall of the colon.

 The colon is then filled with air. This provides a

detailed view of the inner surface of the colon, making

it easier to see narrowed areas (strictures), diverticula,
or inflammation.
Barium enema: Indications
 Abdominal pain & altered bowel habit
 Lower GIT bleeding
 Colorectal neoplasm:benign/malignant
 Inflammatory bowel disease:
 Ulcerative collitis
 Crohn’s disease
 Colonic diverticular disease
 Hirschsprung’s disease

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3. CT scan:
 Indications
◦ Tumours
◦ Staging of tumours
◦ Acute abdomen – e.g. acute appendicitis
◦ Trauma

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CT of abdomen without contrast. Note
the lack of distinction between
abdominal organs.
CT scan of abdomen with intravenous contrast. Notice how
much better you can see the kidneys and blood vessels.
Abdominal ultrasound: Indications
 Intestinal obstruction:
 Dilated bowel loops
 Increased peristalsis
 Intussusception mass
 Perforated gut:

 Free peritoneal fluid

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Abdominal ultrasound: Indications
cont.
 Infantile hypertrophic pyloric stenosis
 Duodenal atresia
 Appendicitis
 Peritonitis
 Pancreatitis
 Biliary obstruction/obstructive jaundice
 Cholecystitis & cholelithiasis
 Tumours/neoplasm

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Abdominal ultrasound:
liver & gallbladder

 Gallbladd
er

 Liver

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Abdominal ultrasound:
cholelithiasis

 Gallbl
adder

 Gall
stones

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Abdominal ultrasound:
pancreas

 Pancrea
s

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ERCP/PTHC/MRCP: Indications
 Obstructive jaundice

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Sialography: Indications
 Salivary gland duct stones
 Salivary gland duct strictures
 Chronic inflammation of salivary glands with

sialectasis
 Tumours

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 Parotid sialogram

Parotid duct

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Thank You