The problem of upper abdominal pain

The problem of Upper Abdominal

painDr/Ahmed a. Bahnassy

Consultant Radiologist RMH

MBCHB-MSc-FRCR

Anatomical orientation

Aetiology: Pancreatic: Acute or chronic Pancreatitis. Hepatic: hepatitis, hepatic abscess. Gastric:gastritis Duodenal :Duodenal ulcer,duodenitis. Biliary :Cholecystitis,choledocholithiasis. Renal : stones,pyelonephritis. Aortic :Dissecting aortic aneurysm. Splenic: Infarction (Sickle cell crisis) Large bowel: Colitis. Referred pain :e.g.pneumonia,spondylosis.

Methods of Examination Plain x-ray Barium studies. Ultrasonography Computed tomography. Isotopic scan (e.g.: Cholecystitis) MRI :MRCP Arteriography.

Rationale of imaging Clinical data of the patient.

Biliary colic Epigastric pain with high serum amylase Flank pain with haematuria jaundice

Ultrasound

CT

US NECT/IVP

ERCP/MRCP

US Focal hepatic lesion

Triphasic CT/MRIBiliary dilatation

ERCP/MRCP

No biliary duct dilatation

Pre/hepatic haundice

Plain abdominal films Stones detection. Calcifications. Air under diaphragm.

Gall Stones and chronic Pancreatitis

Gall stones

Pneumoperitoneum -Free air

Subphrenic Abscess

Contrast studies Evaluation of gastroesophageal junction

abnormalities. Gastric ulcers and masses. Duodenal pathology.

Hiatal Hernia.

Giant Gastric ulcer

Duodenal ulcer

Ultrasonography. Gall bladder disease. Biliary radicle dilatation. Renal problems.

Acute Calcular Cholecystitis

Biliary dilatation

Hydronephrosis

Computed Tomography Pancreatitis evaluation. Focal hepatic lesions. Renal diseases. Aortic lesions. Bony lesions Trauma evaluation.

Acute Pancreatitis .

CT severity index

Acute pseudocyst

Pancreatic necrosis

The Focal Hepatic Lesion:Radiologic Assessment

Hepatic VenousPortal Venous

Triple Phase Helical CT

Axial C+ CT Arterial Phase

Axial C+ CT Portal Venous

Phase

Axial C+ CT Hepatic Venous

Phase

Contrast Injection

Arterial

0 15 30 45 60 75Time (sec)

Liver Metastasis.Axial C+ CT

Film Findings:

Multiple hypoenhancing heterogenous lesions

Liver AbscessAxial C+ CT

Film Findings:

Well demaracated hypoenhancing lesion

Rim of increased Rim of increased enhancement relative to enhancement relative to central regioncentral region

Complicated Hydatid cyst .water lilly sign

NECT

Right chronic pyelo-nephritis

Left renal stones

Renal Abscess

Aortic Dissection Type B

Bony lesions :Lytic lesion in upper lumbar vertebra .

Abdominal trauma On evaluation, urgent life-threatening injuries,

such as a large hemoperitoneum, a large or tension pneumothorax, or active arterial extravasation, should be sought out first.

This should be followed by a thorough interrogation for injury of the abdomen and pelvis: liver and right paracolic gutter; spleen and left paracolic gutter; upper abdominal organs, arterial tree; retroperitoneum; small bowel, colon, and mesentery.

liver trauma 4-cm-thick

subcapsular hematoma associated with parenchymal hematoma

Renal injury

Subcapsular and perinephric haematoma.

Splenic trauma

Splenic lacerations with perisplenic haematoma

Clinical evaluation of the patient is the first step in the diagnosis.

Choose the appropriate imaging modality.