The lecture is dedicated to family physicians ,focusing on radiological approach to the clinical problem of upper abdominal pain.

1. The problem of
Upper Abdominal
pain
Dr/Ahmed a. Bahnassy
Consultant Radiologist RMH
MBCHB-MSc-FRCR

2. Anatomical orientation

3. 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.

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

5. Rationale of imaging
 Clinical data of the patient.
ERCP/MRCP
 Biliary colic Ultrasound
 Epigastric pain with high serum amylase CT
 Flank pain with haematuria US NECT/IVP
 jaundice US Focal hepatic lesion
No biliary duct dilatation Biliary dilatation Triphasic CT/MRI
Pre/hepatic haundice ERCP/MRCP

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

7. Gall Stones and chronic
Pancreatitis

8. Gall stones

9. Pneumoperitoneum -Free air

10. Subphrenic Abscess

11. Contrast studies
 Evaluation of gastroesophageal junction
abnormalities.
 Gastric ulcers and masses.
 Duodenal pathology.

12. Hiatal Hernia.

13. Giant Gastric ulcer

14. Duodenal ulcer

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

16. Acute Calcular Cholecystitis

17. Biliary dilatation

18. Hydronephrosis

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

20. Acute Pancreatitis .

21. CT severity index

22. Acute pseudocyst

23. Pancreatic necrosis

24. The Focal Hepatic Lesion:
Radiologic Assessment

25. Triple Phase Helical CT
Axial C+ CT Axial C+ CT Axial C+ CT
Arterial Phase Portal Venous Hepatic Venous
Phase Phase
Contrast Injection
Arterial Portal Venous Hepatic Venous
0 15 30 45 60 75
Time (sec)

26. Liver Metastasis.
Axial C+ CT
Film Findings:
 Multiple hypoenhancing
heterogenous lesions

27. Liver Abscess
Axial C+ CT
Film Findings:
 Well demaracated
hypoenhancing lesion
 Rim of increased
enhancement relative to
central region

28. Complicated Hydatid cyst .
water lilly sign

29. NECT
 Left
 Right renal
chronic stones
pyelo-
nephritis

30. Renal Abscess

31. Aortic Dissection Type B

32. Bony lesions :Lytic lesion in upper
lumbar vertebra .

33. 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.

34. liver trauma
 4-cm-thick
subcapsular
hematoma
associated
with
parenchymal
hematoma

35. Renal injury
 Subcapsular and
perinephric
haematoma.

36. Splenic trauma
 Splenic
lacerations
with
perisplenic
haematoma

37.  Clinical evaluation of the patient is the first
step in the diagnosis.
 Choose the appropriate imaging modality.