Archive for ‘Gastrointestinal’

August 4, 2014

We Love… Get Your Rear In Gear!

Katie Couric VF 2012 Shankbone 2 by via david_shankbone Flickr Copright Creative Commons Attribution 2.0 Generic (CC BY 2.0)To end this series on GI imaging, we thought we’d shine a light of hope and health by talking about an organization we love… Colon Cancer Coalition!

 

This is an amazing group of people dedicated to the knowledge that early detection of colon cancer saves lives! Their mission?

 

“Empower local communities to promote prevention and early detection of colon cancer and to provide support to those affected.”

 

Katie Couric, through her own personal loss and resilience, has helped make colorectal cancer a nationally known and talked about  issue (and for this we are grateful). The Colon Cancer Coalition reminds us to Get Your Rear In Gear! This program in cities across the US funnels money back into the participating cities, supporting local education and screening efforts. Check for events in your community here.

 

Early detection is the key to saving lives from colon cancer which is a largely preventable disease – in most cases, colon cancer starts from small growths called polyps. If these are found early, no colon cancer will develop! From a healthy diet and exercise to regular check-ups and knowing the signs of colon cancer, we can all make a difference. Regular screening with colonoscopy at age 50 for folks of average risk can and will make a difference.

 

Catch up with the Coalition on Twitter. (We follow them too.)

 

Time to celebrate life – and kick cancer’s butt!

 

 

(Image credit: Katie Couric VF 2012 Shankbone 2 by david_shankbone via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 30, 2014

MR Enterography

MR enterographyWhen investigating issues of the abdomen and intestines, there are multiple options, including small bowel series, small bowel enteroclysis and CT or MR enterography (entero- meaning intestine, our linguistic lesson for the day!).

 

Why would you need MR enterography?

 

MR enterography is performed for many of the same reasons as CT enterography. As with each imaging modality, there are nuances and benefits from the different techniques.

 

One of the reasons a patient may come in for MR enterography is due to an iodine allergy (iodine is the IV contrast agent for CT). MR technology uses a different IV contrast agent, one containing gadolinium.

 

Additionally, MR technology uses no radiation. This can be beneficial when the patient is pregnant (although only done in pregnancy after the first trimester). It is an ideal means for assessing younger patients with inflammatory bowel disease who may face the need for frequent, repeated imaging of the intestine.

 

How does a patient prepare for MR enterography?

 

Preparation for MR enterography is done similar to the CT version – fasting for up to 4 hours before the examination.

 

What can be expected when you have MR enterography?

 

As always, remember your basic MRI safety – no metal can enter the MR suite – this means all clothing with metal must be removed.

 

MR enterography relies on adequate distention of the small bowel, usually using the same oral contrast agent containing iodine as for CT enterography. Images of the abdomen and pelvis will be obtained while IV contrast containing gadolinium is injected. The imaging time is longer for MRI than for CT, usually close to 30 minutes total for MR. Holding still is important as any motion will cause loss of detail.

 

What can we find with MR enterography?

 

This can show vascular lesions of the wall of the GI tract, masses and mucosal lesions as can be seen with inflammatory bowel disease. It also allows us to see detail in the bowel wall and in the adjacent soft tissues. Fistulas (abnormal communications from bowel loops), strictures and blockages, and abscesses can be seen in patients, often in those with inflammatory bowel disease. Problems with the blood vessels going to the bowel will be shown, such as narrowings or aneurysms.

 

And after the exam?

 

To flush the excess contrast from your system – drink lots of water!

 

MR enterography is one more tool in the arsenal for imaging the small intestines able to produce beautiful images helping us keep you on the path to your best health.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 23, 2014

CT Ent-enter-entero-enterography! Whew!

Screen Shot 2014-07-23 at 2.52.56 PMWhen investigating issues of the abdomen and intestines, your doctor may order a small bowel series or enteroclysis. However, CT technology is also an excellent noninvasive way of looking at internal organs. It also allows us to better see the tissues adjacent to the small bowel. If a dedicated view of the bowel and adjacent soft tissues is needed there is a special procedure called CT enterography which may be used.

 

Why would you need CT enterography?

 

There are many potential reasons why a patient may come in for CT enterography, with the goal of precisely defining anatomy and potential causes of symptoms. Symptoms can include:

 

  • Abdominal pain (especially in the left or right lower quadrant)
  • Blood in stool
  • Possible bowel obstruction, usually partial blockages of the small bowel which can be difficult to diagnose and difficult to find the cause of
  • Inflammatory bowel disease – with CT enterography we can see not just the disease of the bowel, but any complications in adjacent tissues which are frequent
  • Hernias
  • Masses
  • Narrowings or strictures
  • Infections
  • Masses in the mesentery or adjacent organs that can affect the GI tract

 

How does a patient prepare for CT enterography?

 

Patient prep for this type of imaging is fairly basic: fasting (no food or drink) for 4 hours before the CT may be requested. At times the study may be done without preliminary fasting.

 

What can be expected when you have CT enterography?

 

Typically, CT enterography uses fairly large volumes of oral contrast agents which are iodine-based and iodine-based IV contrast. The oral contrast material helps distend the bowel, so that the wall is well seen. The blood vessels and any inflammatory changes are best seen with the IV contrast highlighting the vessels.  If you have allergies, let us know so we can plan ahead. CT uses radiation, so this exam in general is not done in those that are pregnant or who may be pregnant.

 

What might we see with CT enterography?

  • Inflammatory bowel disease – bowel wall thickening, abnormal enhancement of the wall of the bowel, strictures, fistulas (abnormal communication between bowel loops), adjacent abscesses all may be signs of inflammatory bowel disease and imaging with CT enterography can help assess its degree of activity
  • Masses – benign polyps and cancers
  • Vascular problems to the small or large bowel, including narrowings of vessels or aneurysms (small saccular outpouchings)
  • Blockages – we can not only see the site of obstruction but many times can find the cause of the blockage
  • Infections

 

 

CT enterography is a fusion of the best of CT technology, allowing us to see the soft tissues in the abdomen, and enterography which distends the small bowel, allowing us to best see the wall. With this technique, small bowel diseases are beautifully demonstrated.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 21, 2014

Intestinally Yours

small bowelIn our continuing series on gastrointestinal imaging, today we’re talking about the small bowel or small intestine. The small intestine is key in absorbing nutrients in our food.

 

Why would you need an imaging study of the small bowel?

 

The small bowel is a coiled tube in the abdomen up to 23 feet in length connecting the stomach and the colon.  In contrast to the stomach and colon which are easy to evaluate by endoscopy, much of the small bowel is beyond the reach of endoscopes.

 

Symptoms which might prompt a small bowel evaluation include:

 

  • diarrhea
  • blood in stools
  • abdominal pain
  • malabsorption
  • suspected partial small bowel obstruction
  • inflammatory bowel disease
  • anemia

 

There are two types of fluoroscopy exams a patient can have to evaluate the small bowel: a small bowel series or a small bowel enteroclysis.

 

How does a patient prepare for small bowel imaging?

 

The prep for these studies is simple: no food or drink by mouth for 4 hours. Clothing with metal will need to be removed. Radiation is used, so these studies are not performed in pregnant women. If you have an allergy or sensitivity to oral barium please advise the radiologist.

 

What can be expected of a small bowel imaging procedure?

 

Both exams will start with a preliminary film which is used to assess the gas in the intestine. Signs of obstruction or bowel perforation may lead to the exam being cancelled or modified.

 

1. Small bowel series

For this procedure, the patient will be given barium to drink. Sufficient barium is necessary in order to fill up the small bowel in order to image it. Next, we will take a series of x-rays to follow the barium through the entire small bowel all the way to the cecum (first part of colon). Additionally, we will take images with gentle compression of the small intestine including the  terminal ileum which is the point at which small bowel ends and joins the colon. Please note it can take up to 4 hours for the contrast to travel all the way through!

2. Small bowel enteroclysis

This procedure uses a tube placed through the mouth or nose until the tip is in the first part of the small bowel. This tube is used to instill a solution of barium at a rate which distends the small intestine and limits normal peristalsis (those normal contractions which move food along). Images are then taken in the same method as above. The entire study can take up to 3-4 hours to complete.

 

So, what are radiologists looking for? What can we expect to find?

 

Images from either method will allow a beautiful depiction of your small bowel anatomy and a little about how it is functioning. Imaging can find:

  • tumors – benign polyps and cancers
  • inflammatory bowel disease IBD (inflammatory bowel disease)
  • infections
  • strictures or narrowings which might partially block small bowel – frequent in patients with IBD
  • fistulas or abnormal communication between bowel loops – frequently found in patients with IBD
  • celiac disease

 

After a small bowel exam, drink lots of fluids! This will help flush out the contrast that was introduced for the exam.

 

The small bowel series and small bowel enteroclysis are methods of viewing the elusive small intestine. The resulting images can be phenomenal. We love being able to see into the human body to get you on the road to your best possible health!

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 16, 2014

Upper GI Pain and Imaging

UGI imagingEver wondered what happens when you swallow or what your stomach looks like? Upper GI (gastrointestinal) and esophagrams are tests used to assess  the first part of the gastrointestinal system and can be used to answer these questions and much more.

 

Why would you need one of these tests?

These exams may be used for a variety of symptoms including but not limited to:

  • Abdominal pain
  • Epigastric pain
  • Heartburn or other symptoms of reflux disease including chest pain or discomfort, a burning sensation, or excessive burping; more unusual symptoms of reflux can include sinusitis, anosmia (loss of smell), aspiration, and chronic cough.
  • Trouble swallowing
  • Choking
  • Vomiting
  • Blood in stools
  • Ulcers

 

Prior to the study:

It is very important that a patient coming in for an upper GI imaging procedure not eat or drink anything after midnight the day before the exam. In order to look at the structures and anatomy, the stomach and esophagus must be empty. Even a small amount of water can keep the contrast material from coating and sticking to the lining of the structures which would limit what the radiologist can see. Due to radiation exposure UGI imaging is not used in women who are or may be pregnant.

 

It is okay to eat and drink before an esophagram.

 

You will change into a gown, removing all clothing that has metal. We don’t want metal buttons, zippers or underwires hiding any of your lovely GI structures!

How are the tests done?

For an UGI we start with a preliminary x-ray or image of the abdomen- this makes sure there is no blockage before we begin the test. In order to optimally see your GI tract on x-ray using fluoroscopy, we have to give you a contrast material by mouth. General GI imaging can be done with contrast material such as barium and crystals of gas – the barium lines the esophagus (the connection from the mouth to the stomach) and the stomach; the crystals create gas which expands the organs, allowing radiologists to beautifully see the mucosal lining.

 

The contrast travels thru the pharynx, esophagus, stomach and duodenum; observing real-time with fluoroscopy allows us to see function as well as anatomy.

 

Images are obtained of all parts of the upper GI tract, usually starting with you positioned upright and then horizontal. fluoroscopy allows a real time look at what is happening.  X-ray images are also recorded for better detail.

 

For an esophagram, we focus on the pharynx and esophagus only, using oral contrast agents, gas and sometimes foods like crackers coated with barium paste.

 

What can be found using these tests?

  • masses- anywhere along the upper GI tract; these can be benign like polyps or cancerous;
  • ulcers (gastric or duodenal);
  • hiatal hernia (a condition where the stomach is positioned above the diaphragm predisposing to reflux disease and it’s complications like Barrett’s esophagus which is a pre-cancerous condition; this is one of the reasons to not ignore your reflux symptoms!);
  • reflux -we can see the barium going from the stomach back up into the esophagus- we will try different positions and maneuvers to try to elicit reflux;
  • esophagitis or gastritis-conditions of inflammation from many different causes;
  • congenital abnormalities-sometimes the upper GI tract is not connected normally or there may be congenital cysts or masses along the upper GI tract;
  • motility disorders- most often of the esophagus; imaging real-time allows us to see how your upper GI tract is functioning
  • swallowing disorders

What happens after the test?

The radiologist may be able to discuss some of your results at the end of the test. A final report will be made by your radiologist after reviewing all of the images, with the official report going to your doctor.

 

We will ask that you drink lots of fluids to help flush the barium out of the system! (Besides, drinking water is good for you no matter what!). You can resume your normal diet immediately.

 

Upper GI exams can result in amazing images and can be a key to diagnosis of a wide variety of conditions. Seeing your body in action helps us keep you on the road to your best possible health!

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

July 14, 2014

What Is Fluoroscopy?

IFFluoroscopy is a way of imaging the body using x-rays that allows a radiologist to view the body in motion. A special machine uses low-dose x-rays that are sent through the body while the radiologist is observing the area of interest. Images project on a screen in the room.  Most commonly, this technology is used for imaging the gastrointestinal tract, the genitourinary tract, joints, and for guiding interventional procedures of many types.

 

For studies using fluoroscopy, you will be placed on a table. The table can be positioned in upright and horizontal positions, depending on what part of the body is being examined. For gastrointestinal studies, the table may be moved during the procedure, and you will be asked to change positions as well so that all of the area of interest is seen optimally.

 

For many procedures using fluoroscopy, some type of contrast material will be used to let us see the area of interest – including barium for the gastrointestinal tract and iodine for the genitourinary system among others.

 

In addition to the images on the screen in the room, additional images will be recorded, again using x-rays to give better detail of the areas of interest. These are similar to other x-rays obtained of the body.

 

Fluoroscopy is an amazing way of seeing the body and its parts in real-time. We will be further discussing this technique in viewing the gastrointestinal system in upcoming posts.

(Image credit: Fluoroscope by Zereshk via Wikimedia Commons Copyright Public Domain)

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 9, 2014

Barium: Great for Imaging, and Okay for Puns

Bariumsulfaat by Dr.T via Wikimedia Commons Copyright Creative Commons Attribution-Share Alike 3.0 UnportedImaging of the gastrointestinal system can be done many ways, using scopes, fluoroscopy/x-rays, ultrasound, CT and MRI studies. The gastrointestinal (GI) system includes everything from the mouth or oral cavity and esophagus down to the rectum and anus. The GI tract can be thought of as one long hollow tube, and filling the tube with fluid to image it with xrays was one of the earliest techniques developed when radiology was in its infancy.

 

This technique is still used today with barium sulfate the most commonly used contrast agent. Barium blocks the xrays from travelling through the body resulting in a white appearance on the image. Since its first development, many different forms of barium are now available allowing us to see different parts of the GI tract in detail.

 

Barium studies include UGIs (upper gastrointestinal exam to evaluate the esophagus, stomach and the first part of the small bowel), esophagrams (to image the esophagus), small bowel series (to image the small intestine) and barium enemas (to evaluate the colon or large intestine). Barium or other oral contrast agents may be used for CT examinations of the abdomen and pelvis, allowing better visualization of the GI tract. Over the next few posts we’ll be covering these imaging tests in detail.

 

Barium has been used for years and is inert, traveling through your system without being absorbed. It is well tolerated in almost all patients. After a study using barium, patients are advised to drink extra fluids in order to flush the barium out of their system.

 

Oh, and we promised a groaner of a pun too. What do you do with a chemist who has passed on? Barium!

(Image credit: Bariumsulfaat by Dr.T via Wikimedia Commons Copyright Creative CommonsAttribution-Share Alike 3.0 Unported)

 

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!