• Plain X-rays
(Supine, Erect, Decubitus)
• Barium studies
(Ba Swallow, Meal, Follow through, Enteroclysis,
Enema)
• Ultrasound Abdomen
• CT Scan/MRI Abdomen
• ERCP, Cholangiography.
• Angiography and Nuclear Medicine

• Erect Chest
• Supine Abdomen
• Erect / Decubitus Abdomen ( 10 min )
• Radiation Dose ( 1 Abd = 75 CXR)
• Contraindicated – pregnancy

• “Acute Abdomen”
• Abdominal Pain.
• ?Obstruction.
• Not Indicated for:
– Trauma.
– Solid organ assessment .

• Five radiographic densities:
– Gas/Air
– Fat.
– Soft Tissue/Water
– Bone/Calcium
– Metals
• Interface/line only visible when two of these densities interface with each other.

• Technical Assessment.
• Projection.
• Bowel/Gas Shadows.
• Normal/Abnormal Calcifications.
• Solid Organs.
• Look at lung bases and at the skeleton.

• Stomach.
• Colon.
• Small Bowel.
• Within the Lumen:
– Dilated bowel
?Obstruction
• Outside the Lumen:
– Free ?perforation
– In a cavity ?abscess

Water Soluble
• Ionic (gastrografin)
Can lead to pulmonary edema if aspirated.
• Non- Ionic ( Low
Osmolar)
Relatively safer if aspirated.
•
Gadolinium (MRI)
• Barium
( Non-water soluble)
•
Can cause sever peritonitis and fibrosis in perforation or leakage.

• Indications:
•
Dysphagia
•
Pain
•
Reflux
•
Anemia
•
Tracheo-esophageal fistula
• Perforation
• Contraindications:
•
Aspiration

• Indications:
•
Dyspepsia
•
Upper abdominal mass
•
Weight Loss
•
Gastrointestinal Hemorrhage.
•
Partial Obstruction
• Assessment for perforation
• Contraindications
•
Complete large bowel obstruction
• Pateint preparation:
• NPO ---6 hrs
•
No smoking– increases GI motility

• Indications:
•
Pain
•
Diarrhoea
•
Anemia/GI bleed
•
Partial Obstruction
•
Malabsorption
• Abdominal mass
• Contraindications
•
Complete obstruction
• Patient Preparation:
• Low residue diet
• Bowel Prep (Dulcolax -2-4 Tab)

Small Bowel follow through VS Small bowel enema

• Indications:
•
Change in bowel habits
•
Pain
•
Mass
•
Melaena / Anemia
• Single contrast –
Obstruction & Intussusception
.
• Contraindications:
•
Rectal biopsy—5 days
•
Toxic megacolon
•
Pseudomembranous colitis
• Preparation:
(Two days)
•
Low residue diet
•
Bowel prep (Dulcolax – 4 Tab)

• Cost effective
• Adequate visceral visualization
• Best for GB
• No radiation
Acute
Abdomen, Obstructive jaundice, abdominal masses, collections, Free fluid, follow up- tumors.
• Disadvantage
•
Operator dependent
•
Poor in Obesity
•
Bowel gasses
•
Bones / Calcifications

• Advantages
•
Accurate & quick
•
Bowel/ gasses/ bones
•
Reformation and angio
• Indications:
Acute abdomen,
Abdominal mass, tumor staging/follow up,
Appendicitis/abscesses, Post op complications
• Disadvantages :
•
Radiation (250 CXR)
•
Renal failure
•
Contrast reaction

• Advantages
•
Multiplaner
•
Renal failure
•
MRCP
•
Liver specific contrasts
• Disadvantages
•
Bowel motion/ contrast
•
Calcifications
•
Metallic implant
•
Relatively long procedure time
•
Claustrophobia

•
Endoscopic Retrograde
Cholangiopancreatography (ERCP)
• MR Cholangiopancreatography
(MRCP)
•
T-tube Cholangiography.
• Percutaneous Transhepatic
Cholangiography (PTC).