Editing Gastrointestinal

Water loading: give 5 cups (about 800 ml) during the 15 minutes before getting on the CT scanner table. 3 of these cups should be given outside awaiting the scan and 2 cups of water in the scanner room. Do not give the water too early.


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! Indication
! Brief description
! Slice thickness and reconstruction kernel
!Further details of contrast timing/explanation of what the radiographers do
! Abbreviation

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Cancer of oesophagus, stomach, duodenum, gallbladder, pancreas and colon/rectum
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CT chest, abdomen &amp; pelvis (contrast)
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1.5 mm B30f, 1.2 mm increment.
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65 seconds post contrast + oral water as above
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CT CAP + c + oral water


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Anal cancer
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CT abdomen &amp; pelvis (contrast)
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1.5 mm B30f, 1.2 mm increment.
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65 seconds post contrast
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CT abdomen and pelvis + c


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Colorectal Ca? Including if failed or refused colonoscopy
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CT colonography
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1.5 mm B30f, 1.2 mm increment.
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See specific guidance
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CT colonography


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Active GI bleeding
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Pre/arterial/delayed abdomen and pelvis
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1.5 mm B30f, 1.2 mm increment.
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Pre, arterial and 90 sec bolus tracked as described below
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CT angio triple phase abdomen (90 second)

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Mesenteric ischaemia
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Pre/arterial/PV abdomen and pelvis
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1.5 mm B30f, 1.2 mm increment.
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Pre, arterial and 65 sec bolus tracked as described below
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CT angio triple phase abdomen (65 second)

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Acute abdominal pain (diverticulitis, appendicitis, perforation, obstruction, GB perforation, abdominal or pelvic collection, etc)
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PV abdomen and pelvis
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1.5 mm B30f, 1.2 mm increment.
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65 seconds
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CT abdomen and pelvis + c


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Neuroendocrine tumour including carcinoid
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CT Chest, abdomen and pelvis + arterial phase abdomen
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1.5 mm B30f, 1.2 mm increment.
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Arterial abdo + CAP in PV phase


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Anastamotic leak
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CT abdomen and pelvis with i.v. and oral contrast
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1.5 mm B30f, 1.2 mm increment.
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DEPRECATED SEE ROWS BELOW

<s>65 seconds + 1% gastrografin (10 ml gastrografin/L water) timing depending on site e.g. 15-30 mins stomach and duodenum, 60 mins for small bowel, 4 hours for large bowel. PR contrast if distal colonic anastomosis.</s>
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CT abdomen and pelvis + i.v. + oral contrast

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Oesophageal perforation
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CT thorax with i.v. and oral contrast
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1.5 mm B30f, 1.2 mm increment.
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65 seconds + 100 ml 4-6% water soluble contrast slowly over 3-5 minutes before scan
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CT thorax/oesophagus with i.v. and oral contrast (100 ml 4-6% water soluble contrast slowly over 3-5 minutes before scan)

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Oesophageal surgery (e.g. Ivo Lewis)
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CT thorax and abdomen with i.v. and oral contrast
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1.5 mm B30f, 1.2 mm increment.
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65 seconds + 200 ml 4-6% water soluble contrast slowly over 5-10 minutes before scan
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CT thorax/oesophagus with i.v. and oral contrast (200 ml 4-6% water soluble contrast slowly over 5-10 minutes before scan)

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Gastric surgery (e.g. gastrectomy)
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CT abdomen and pelvis with i.v. and oral contrast
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1.5 mm B30f, 1.2 mm increment.
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65 seconds + 300 ml 4-6% water soluble contrast slowly over 15 minutes before scan
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CT abdomen and pelvis with i.v. and oral contrast (300 ml water soluble contrast slowly over 15 minutes before scan)

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Small bowel with oral contrast
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CT abdomen and pelvis with i.v. and oral contrast
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1.5 mm B30f, 1.2 mm increment.
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65 seconds + 500 ml 4-6% water soluble contrast slowly over 30-60 minutes before scan
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CT abdomen and pelvis with i.v. and oral contrast (500 ml water soluble contrast slowly over 30-60 minutes before scan)

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Leak from roux-en-Y gastrectomy
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CT abdomen and pelvis with i.v. and oral contrast
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1.5 mm B30f, 1.2 mm increment.
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65 seconds + 300 ml 4-6% water soluble contrast slowly over 30-60 minutes before scan then 100 ml slowly over 10 minutes before scan
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CT abdomen and pelvis with i.v. and oral contrast (300 ml water soluble contrast slowly over 30-60 minutes before scan then 100 ml slowly over 10 minutes before scan)

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Scans requiring rectal contrast
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CT abdomen and pelvis with i.v. and rectal contrast
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1.5 mm B30f, 1.2 mm increment.
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65 seconds + 100 ml 4-6% water soluble contrast rectally before scan
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CT abdomen and pelvis with i.v. and rectal contrast (100 ml 4-6% water soluble contrast rectally before scan)

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Superior mesenteric artery (SMA) syndrome
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CT abdomen &amp; pelvis in arterial phase/angio
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1.5 mm B30f, 1.2 mm increment.
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CT angio abdomen or abdomen and pelvis (if more clinical questions)
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CT angiogram abdomen and pelvis 
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