Gastro Intetinal Tract 1

8/14/2019 Gastro Intetinal Tract 1

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GASTROINTESTINALGASTROINTESTINAL

TRACTTRACT


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2 Groups of Disorders.2 Groups of Disorders.

ACUTEACUTE: -: - Gut obstructionGut obstruction

Gut perforationGut perforation

InfectionInfection Trauma etcTrauma etc

CHRONICCHRONIC: -: - UlcersUlcers

MalabsorptionsMalabsorptions

Tumours etcTumours etc


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PLAIN FILM RADIOGRPHS:PLAIN FILM RADIOGRPHS:

Patients with an acute abdomen comprisePatients with an acute abdomen comprise

largest group of people presenting as alargest group of people presenting as a

general surgical emergency.general surgical emergency.

Following history and clinical examination,Following history and clinical examination,

plain abdominal radiograph is the first andplain abdominal radiograph is the first and

most useful method of furthermost useful method of further

investigations.investigations.


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PLAIN FILM RADIOGRPHS:PLAIN FILM RADIOGRPHS:

1-ABDOMEN SUPINE1-ABDOMEN SUPINE::

To assess distribution of Bowel Air,To assess distribution of Bowel Air,

Abdominal Viscera,Abdominal Viscera,

Fat Plains,Fat Plains,

Calcifications.Calcifications.


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2-ABDOMEN ERECT/2-ABDOMEN ERECT/

LATERAL DECUBITUS VIEWSLATERAL DECUBITUS VIEWS

To assess bowel gas fluid levels in theTo assess bowel gas fluid levels in the

bowel andbowel and

pneumoperitoneum.pneumoperitoneum.


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3-CHEST P/A IN ERECT:3-CHEST P/A IN ERECT:

To assess small pneumoperitoneum.To assess small pneumoperitoneum. A number of chest disease may mimic acute abdomenA number of chest disease may mimic acute abdomen

e.g.e.g.

*Lower lobar pneumonia*Lower lobar pneumonia*Myocardial infarction*Myocardial infarction

*Pericarditis*Pericarditis

*Dissecting thoracic aortic Aneurysm*Dissecting thoracic aortic Aneurysm Acute abdominal conditions may complicate chestAcute abdominal conditions may complicate chest

pathology e.g.pathology e.g.*Pleural effusion may accompany, liver abscess,*Pleural effusion may accompany, liver abscess,pancreatitispancreatitis

*Basal pneumonia in subdiaphragmatic abscess.*Basal pneumonia in subdiaphragmatic abscess.

*Raised right dome of diaphragm in liver abscess.*Raised right dome of diaphragm in liver abscess.


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INTERPRETATION OFINTERPRETATION OF

ABDOMINALABDOMINALRADIOGRAPHRADIOGRAPH


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BOWEL GAS PATTERNS:BOWEL GAS PATTERNS:

Organ identification on plain X-raysOrgan identification on plain X-rays

depends ondepends on

anatomical position,anatomical position,

helped by tissue fat interface andhelped by tissue fat interface and

presence of gas, fluid or food residue withpresence of gas, fluid or food residue within the bowel.in the bowel.


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STOMACH:STOMACH:

Anotomical location.Anotomical location.Relatively large amount of air shows an airRelatively large amount of air shows an air

fluid level in fundus on erect film.fluid level in fundus on erect film.


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SMALL BOWEL:SMALL BOWEL:

Usually small amount of gas is present.Usually small amount of gas is present. Sometimes with air Swallowing e.g.Sometimes with air Swallowing e.g.

during breathlessness and pain, more gasduring breathlessness and pain, more gascan be seen and valvulae cenniventescan be seen and valvulae cenniventescan be identified.can be identified.

Short air fluid levels are not uncommon.Short air fluid levels are not uncommon.Long air fluid levels are abnormal.Long air fluid levels are abnormal.A small bowel calibre exceeding 2.5 cmsA small bowel calibre exceeding 2.5 cms

is indicative of bowel dilatation.is indicative of bowel dilatation.


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COLON:COLON:

Can be identified by its position andCan be identified by its position and

haustra.haustra.

Old mentally retarded, institutionalizedOld mentally retarded, institutionalized

people may have enormous colonpeople may have enormous colon

measuring 10-15 cms in diameter with outmeasuring 10-15 cms in diameter with out

any symptoms.any symptoms.

Colonic fluid levels are common findingColonic fluid levels are common finding


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METEORISM:METEORISM:

Gas filled slightly dialted loops of bowelGas filled slightly dialted loops of bowel

produced due to excessive air swallowing.produced due to excessive air swallowing.


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INTESTINAL OBSTRUCTION:INTESTINAL OBSTRUCTION:

DynamicDynamicAdynamicAdynamic


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1-DYNAMIC OBSTRUCTION1-DYNAMIC OBSTRUCTION

Due to mechanical obstruction.Due to mechanical obstruction.Dilated loops of bowel proximally withDilated loops of bowel proximally with

non dilated or collapsed bowel distalnon dilated or collapsed bowel distal

to presumed point of obstruction.to presumed point of obstruction.


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CAUSES OF SMALL BOWELCAUSES OF SMALL BOWEL

OBSTRUCTION:OBSTRUCTION:

AdhesionsAdhesions Strangulated herniasStrangulated hernias

IntussusceptionsIntussusceptions VolvulusVolvulus Crohns diseaseCrohns disease

Ileocaecal T.BIleocaecal T.B Gall stone ileusGall stone ileus Mesenteric thrombusMesenteric thrombus


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CAUSES OF LARGE BOWELCAUSES OF LARGE BOWEL

OBSTRUCTION:OBSTRUCTION:

CarcinomasCarcinomasVolvulus of caecum and sigmoidVolvulus of caecum and sigmoid

Strangulated herniaStrangulated hernia


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2-ADYNAMIC ILEUS:2-ADYNAMIC ILEUS:

Paralytic ileus occurs when intestinalParalytic ileus occurs when intestinal

peristalsis ceases and as a result, fluid &peristalsis ceases and as a result, fluid &

gas accumulate in the dilated loops.gas accumulate in the dilated loops.

2 Types.2 Types.

Localized ileus.Localized ileus.

Generalized ileus.Generalized ileus.


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CAUSES OF LOCALISED ILEUS:CAUSES OF LOCALISED ILEUS:

AppendicitisAppendicitis

CholecystitisCholecystitisPancreatitisPancreatitis

AbscessAbscess

SalpingitisSalpingitis


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CAUSES OF GENERALISEDCAUSES OF GENERALISED

ILEUS:ILEUS:

PeritonitisPeritonitisPost operativePost operative

HypokalemiaHypokalemia

Pneumonia etc.Pneumonia etc.


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PNEUMOPERITONEUM:PNEUMOPERITONEUM:

Postoperative or post dialysis (Can take 3 weeks to absorb)Postoperative or post dialysis (Can take 3 weeks to absorb) Perforation of hallow viscus due to:Perforation of hallow viscus due to:

TraumaTrauma

UlcerUlcer

TumorTumorInfarctionInfarction

AppendicitisAppendicitis

DiverticulitisDiverticulitis Silent perforation of viscus e.g inSilent perforation of viscus e.g in

ElderlyElderly Steroid treatmentSteroid treatment Unconscious etc.Unconscious etc.


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2-SOFT TISSUE SHADOWS:2-SOFT TISSUE SHADOWS:

Liver.Liver.Kidneys.Kidneys.Urinary bladder.Urinary bladder.Psoas and obturator shadows.Psoas and obturator shadows.There size can be appreciatedThere size can be appreciatedAny soft tissue, space occupying massAny soft tissue, space occupying mass

can displace the viscera and bowel gas.can displace the viscera and bowel gas.


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3-CALCIFICATION AND CALCULI:3-CALCIFICATION AND CALCULI:

Urinary tract calculi/calcifications.Urinary tract calculi/calcifications. Biliary calculi.Biliary calculi. Lymph node calcification.Lymph node calcification. Vascular calcification.Vascular calcification.Worm calcification.Worm calcification. Peritoneal calcificationsfat calcification afterPeritoneal calcificationsfat calcification after

pancreatitis.pancreatitis. Phleboliths.Phleboliths. Prostatic.Prostatic.


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Gastro Intetinal Tract 1

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