第六章 消化系统
一、目的与要求
1．了解消化系统的检查方法（普通检查、造影检查、CT、MRI），熟悉各种检查的优劣势；
2．了解胃肠道、肝、胆、胰、脾正常影像；熟悉胃肠道异常造影表现，了解肝、胆、胰、脾CT和MRI的异常表现；
3．掌握食管癌、溃疡病、胃癌、肝海绵状血管瘤、肝细胞癌、肝转移瘤、肝硬化、胆囊炎症和结石、胰腺癌、胰腺炎、肠梗阻、胃肠道穿孔的影像学表现。熟悉食管静脉曲张、结肠癌、肝脓肿、肝囊肿、胆道梗阻、脾外伤的影像学表现。
二、教学内容
第一节 检查方法
1．胃肠道检查方法：侧重讲解钡剂造影；简单介绍普通检查及血管造影。
2．肝胆胰脾检查方法：侧重讲解CT和MRI动态增强，介绍各种检查技术优劣势。
第二节 胃肠道正常影像和异常表现
1．胃肠道正常影像：了解食道、胃、十二指肠、小肠、结肠的造影表现；
2．胃肠道异常影像表现：熟悉轮廓、粘膜及粘膜皱襞、管腔、位置和可动性的改变年，了解功能性改变。
第三节 肝胆胰脾正常影像和异常表现
1．肝脏：了解肝脏CT和MRI平扫、动态增强扫描的正常影像和异常表现。
2．胆囊：了解胆系CT、MRI及MRCP正常影像和异常表现；简单介绍X线影像。
3．胰腺：了解胰腺CT、MRI正常影像和异常表现；简单介绍X线造影表现。
4．脾脏：简单介绍脾脏CT、MRI正常影像和异常表现。
第四节 食管疾病
1．食管静脉曲张：熟悉食管静脉曲张的X线造影表现，了解MRI表现。
2．食管癌：着重讲述食管癌各病理分型的X线造影表现，了解食管癌的CT表现与食管静脉曲张的鉴别。
其他疾病：自学。
第五节 胃肠疾病
1．溃疡病：掌握胃溃疡和十二指肠溃疡X线造影直接征象，了解其间接征象。
2．胃癌：着重中晚期胃癌的X线造影表现、良恶性溃疡的鉴别诊断，熟悉胃癌的CT、MRI诊断和优势，介绍早期胃癌的诊断。
3．结肠癌：熟悉各病理分型的X线造影表现，介绍CT诊断的优势和进展。
其他疾病：自学。
第六节 肝脏疾病
1．肝海绵状血管瘤：掌握CT、MRI平扫和动态增强扫描表现，重点掌握其“快进慢出”的增强特点。
2．肝细胞癌：掌握肝癌的CT、MRI平扫和动态增强扫描表现，重点掌握其“快进快出”的增强特点；熟悉肝癌的分型和与血管瘤的鉴别。
3．肝转移癌：掌握肝转移癌的CT、MRI表现。
4．肝脓肿：熟悉肝脓肿的CT、MRI表现。
5．肝囊肿：熟悉肝囊肿的CT、MRI表现。
6．肝硬化：掌握肝硬化的CT、MRI表现。
第七节 胆道疾病
1．胆囊炎症、结石：掌握急性胆囊炎的CT、MRI表现，熟悉慢性胆囊炎和胆囊结石的CT、MRI表现。
2．胆道梗阻：熟悉胆管结石、胆管癌、胆囊癌的影像学表现，熟悉各种胆道梗阻的特点和鉴别。
其他疾病：自学。
第八节 胰腺疾病
1．胰腺癌：掌握胰腺癌的CT、MRI表现，了解其X线造影表现。
2．胰腺炎：掌握急性胰腺炎的CT表现，了解慢性胰腺炎的影像学表现。
第九节 脾脏疾病
脾外伤：熟悉脾外伤的CT表现。
其他疾病：自学。
第十节 急腹症
1．肠梗阻：重点掌握单纯性和绞窄性小肠梗阻的X线特征，了解其CT表现；了解麻痹性肠梗阻和结肠梗阻的X线表现。
2．急性肠套叠：了解X线造影和CT表现。
3．胃肠道穿孔：结合临床与病理，重点讲述平片表现，介绍CT表现。
4．肠扭转：了解小肠扭转、乙状结肠扭转的典型X线征象。
5．腹部外伤：了解实质脏器、空腔脏器破裂的CT表现。
思考题
1．胃肠道在X线造影上有哪些轮廓和粘膜皱襞的异常表现？
2．单纯性小肠梗阻在X线平片上有何特点？
3．如何在X线造影上鉴别胃的良恶性溃疡？
4．肝海绵状血管瘤在CT、MRI平扫和动态增强扫描上有何特点？
Chapter Six Digestive System
一、Learning Objectives
1. Understanding imaging methods and being familiar with the roles and limitations of various imaging modalities;
2. Understanding the normal imaging manifestations of gastrointestinal tract, liver, biliary system, pancreas and spleen. Being familiar with the basic abnormal finding of gastrointestinal tract on contrast examination. Understanding the basic abnormal appearances of liver, biliary system, pancreas and spleen on CT and MRI.
3. Mastering the imaging findings of esophageal carcinoma, digestive ulcer, gastric carcinoma, cavernous hemangioma of liver, hepatocellular carcinoma, hepatic metastases, cirrhosis of liver, cholecystitis and calculus, intestinal obstruction, and gastrointestinal perforation. Being familiar with esophageal varices , carcinoma of colon, hepatic abscess, obstruction of biliary tract , spleen trauma.
二、Teaching Contents
Section One Imaging Methods
1. Imaging methods of gastrointestinal tract: To emphasis on contrast examination. Briefly introduce plain film and angiography.
2. Imaging methods of liver, biliary system, pancreas and spleen: To emphasis on dynamic contrast-enhanced scans of CT and MRI. To introduce the roles and limitations of various imaging modalities.
Section Two Normal Imaging Anatomy and Abnormal Appearance
1. Normal Imaging Anatomy of gastrointestinal tract: To introduce manifestations of esophagus, stomach, duodenum, small intestine, and colon on contrast examinations
2. Abnormal Imaging manifestation: Being familiar with the changes in contour, mucosa and mucosal rugae, lumen, position and mobility. Understanding function changes.
Section Three Normal and Abnormal Images of the Liver, Biliary System, Pancreas and Spleen.
1. Liver: To Know the normal and abnormal images on plain and dynamic contrast-enhanced CT and MRI.
2. Biliary system: To know the normal and abnormal images on CT, MRI and MRCP. To briefly introduce X-ray images.
3. Pancreas: To know the normal and abnormal images on CT and MRI. To briefly introduce X-ray contrast images.
4. Spleen: To briefly introduce the normal and abnormal images on CT and MRI.
Section Four Disease of Esophagus
1.Esophageal varices: To be familiar with the manifestations on X-ray contrast examination. To introduce MRI images.
2.Esophageal carcinoma: To stress the manifestations of each pathologic type on X-ray contrast examination. To introduce the CT images of the disease and the differentiations between esophageal carcinoma and varices.
Section Five Disease of Stomach and Intestines
1. Digestive ulcer: To stress the direct signs on contrast examination. To know the indirect manifestations.
2. Gastric carcinoma: To emphasize contrast manifestations of advanced carcinoma, and radiographic characteristic associated with benign and malignant ulcers. To be familiar with manifestations on CT and MRI．To introduce progressed CT techniques and advantages of CT and MRI. To introduce earlier carcinoma.
3. Carcinoma of colon: To be familiar with Contrast manifestations. To introduce the advantages and progress of CT techniques.
4. Other diseases: self-study.
Section Six Diseases of the Liver
1. Cavernous hemangioma of liver: Mastering the findings on plain and dynamic contrast-enhanced CT and MRI. Paying attention to the feature of “quick enhance, slow wash-out”.
2. Hepatocellular carcinoma: Mastering the findings on plain and dynamic contrast-enhanced CT and MRI. Paying attention to the feature of “quick enhance, quick wash-out”. To be familiar with pathologic patterns and differentiations between HCC and hemangioma.
3. Hepatic metastases: Mastering the manifestations on CT and MRI.
4. Hepatic abscess: To be familiar with CT and MR findings.
5. Hepatic cyst: To be familiar with the CT and MR findings.
6. Cirrhosis of liver: Mastering the manifestations on CT and MRI.
Section Seven Disease of Biliary Tract
1. Cholecystitis and calculus: Mastering the manifestations of Acute cholecystitis on CT and MRI. To be familiar with the CT and MR findings of chronic cholecystitis and calculus.
2. Obstruction of biliary tract: To be familiar with the CT and MR findings of calculus of bile duct, cholangiocarcinoma, and carcinoma of gallbladder. To introduce the characteristics and differentiations of different obstructions.
Section Eight Disease of Pancreas
1. Pancreatic carcinoma: Mastering the manifestations on CT and MRI. Knowing the X-ray contrast findings.
2. Pancreatitis: Mastering the CT manifestations of acute pancreatitis. Knowing the imaging manifestations of chronic pancreatitis.
Section Nine Disease of Spleen
To be familiar with the CT and MR findings of spleen trauma.
Self-study other diseases.
Section Ten Acute Abdomen
1. Intestinal obstruction: To emphasize the X-ray characteristics of simple and strangulated intestinal obstruction. To introduce CT manifestations of obstruction. To introduce obstruction of colon and paralytic ileus.
2. Intussusception: To introduce X-ray contrast and CT manifestations.
3. Gastrointestinal perforation: To pay attention to the X-ray findings as well as clinical and pathologic features. To introduce CT manifestations.
4. Volvulus: To describe the typical manifestations of intestinal volvulus and sigmoid torsion.
5. Abdominal trauma: To list CT findings of solid viscera and bowel.
Questions
1.What are the abnormal X-ray manifestation of changes in contour and mucosal rugae of gastrointestinal tract?
2. How to describe the X-ray characteristics of simple intestinal obstruction?
3. How to differentiate benign gastric ulcer from malignant one on barium meal radiogram?
4. What can we find about cavernous hemangioma of liver on plain and dynamic contrast-enhanced CT and MRI?