 Yeah, now it's full screen man. Yeah, thank you and thank you Mithusha and thank you the team and I'm sorry for all the technical glitches. Should I start Mithusha? Yes, yes ma'am. Yeah, today I'm going to talk on variant studies and exam spotters. Each of my case is a spotter from a exam. I'll be talking on Instagram, Modify UCC program, Appajaya TV, SmallBower TV, SmallBower Infoclices and Radiant Enema. So I have made a table of all the indications, contraindications and patient preparation. Patient preparation is more or less common for all. UCC most common indication is dysphagia, contraindications, population, pregnancy and we need to title it according to the indication. In a modified UCC, the frame rate of the acquiring image is changed to 15 points per second. So it's like a video of the pharynx and the UCC. Appajaya series is dysphagia, epigastric frame, or Appajaya series is replaced with CT and SmallBower Infoclices and SmallBower Enema. SmallBower Enema, SmallBower TV and Radiant Enema is almost now replaced with CT. So in Appajaya series also, we require ONEC fasting. We need to tell the patient to stop activities like snuffing and chewing tobacco as it hinders the disposal of autism. Variant is the contrast medium of choice for variant studies. It has a high atomic number, it's highly radiated, non-absorbable, non-toxic, inert, insoluble in water and inert tissues. It can be safely used for double contrast. So for each epigogram, a 50-100% weight-by-volume is used for full-column service and a medium-substantial phase of 250% weight-by-volume for neocosin resistance. For upper GI theories, it's 50-100 and SmallBower examination, 50-100 of variant suspension. Suspension is usually used to look for detention and a phase is usually used for neocosin relief and for coating. For lower contrast enteroclysis, it's 15-20% weight-by-volume. Variant enema uses 15-20% weight-by-volume of variant suspension. A single contrast enema is usually preferred if needed in elderly patients. They are not able to retain the inner strength of the tone. So low viscosity, 10% to 25% weight-by-volume variant suspensions are used. And for a double contrast enema, high viscosity, variant sulphate, 100% weight-by-volume along with air is administered for a double contrast enema. Coming to esophageal, the length is 20-24 cm, much thinner too. Also longitudinal and inner-thirteenth muscle. It's lined with stratified spamous epithelium. The upper esophagus has a striatum muscle, lower half or lower 2-3 esophagus and smooth muscle with a transition at the iotaic arch. This transition needs to be remembered as all connective tissue disorders usually start at this level. It crosses from the unit F to the LES. There are deviations initially at the clavicle pharyngeal, it's in the center and then slowly deviates to the left. And again at the level of the diaphragmatic hygen, it's in the midline. The normal constrictions at the UEL, at the iota, at the left main bronchage, at the diaphragmatic hygen. Distensibility is a little distance only on administration of a bonus or when there is food passing through it. As in a normal testing state, it is hardly 1 cm in diameter. Pelistals will need to see peristalsis. There are primary, secondary and tertiary. Primary is initiated when the bonus passes through the esophagus. Second is at the distension of the esophagus and tertiary or non-terostatic contraction. They usually have a sort of appearance and they are discontinuous. The shrinkers at the UES, we have the clavicle pharyngeal muscle and at the diaphragmatic hygen, there is a shrink rising from the diaphragm. This image shows the anatomical divisions of the esophagus, whereas this shows the radiological divisions. I'll be coming to it later. Not the iota impression and the left main bronchage impression. Coming to the esophageal gram. First, a pharyngeal esophageal gram is performed followed by the esophageal gram. Patient is usually given an appointment and the patient is asked for overnight fasting. An APN lateral vertebrate of the neck is taken first. Patient is admitted, administered, a mouth full of varium. Patient is asked to swallow and screening of the esophagus is performed from the UES to the G-junction. Look for peristalsis, look for obstruction, either partial or complete. APN lateral full column use of the hycopherins, lateral full column, AP full column are obtained. Varium paste is administered to support the hycopherin peristalsis. DC radiograph of the hycopherins and esophagus is obtained in APN lateral use. A lot of cooperation from the patients is needed for this study, especially because they may be vertical, horizontal. They need to follow instructions very carefully. Then the tables, this need horizontal. An APN lateral of paracetamethasis is obtained in full column and in oblique, especially in the left posterior oblique position to offset the esophagus against the vertebral body. Patient is administered and a perversant agent and double contrasted minutes of the esophagus are obtained in APN lateral position. Patient is made for own headlock with balsala manoeuvres, look for gliar and hycophernia. Again the table is made vertical and a bolus of basiom and a full stomach are obtained in L2O position. It is very important to explain to the patient that he will be having a roller coaster ride and his cooperation is very much needed. The radiological parts of the esophagus, we have a supra-iotic esophagus and an intra-iotic esophagus. Supra-iotic esophagus is divided into sub-wide full and a supra-iotic proper. Infra-iotic esophagus is a specific iotic segment, the inter-iotic or bronchial segment which has a pseudo-divertical appearance. Retro-bronchial segment, the retrocardiac which shows the subtle left atrial impression and the atyphoenic segment. This is the table showing esophageal impressions, they can be normal or abnormal. Normally there is a iotic arch left atrium and left main bronchial impression. Abnormal impressions are either lateral or aty. Seen on the lateral or aty, on the lateral it can be anterior or posterior. Anterior is usually due to enlarged left atrium and lymph nodes. Oscea is due to this, osteophyte, right-sided aortic arch. Aburain's right subclavian arch is three vertebral abscess and an unfolded aorta. On the aty, it can be either involving the right lateral wall or the left lateral wall. On the right lateral wall, it could be either lymph nodes or right-sided aortic arch. On the left, it is enlarged left atrium and the aburain's right subclavian arch. We need to know because we are going to do screening of the chest with the first bolus. So this is the posterior junction line. This is the right and the left para-tracheal stripe. This is the anterior junction line and this is the azygoincipital recess. This is the para-vertible stripe, again the para-vertible stripe. The para-iodical line. We need to know that the para-iodical line and the left para-vertible stripe join at the level of the medial end of the dole f-domic acid. It is very important to note this. If this is widened, then you may suspect a lesion there or it could be just a plain and simple solution. This is the concept of pulled-and-pushed esophageal. This is the case with unfolded aorta. This means that the aorta is pushed to the right and is elevated anteriorly. This is the case of tuberculosis involving the right upper zone. We have seen that the eccentric wall, the right wall of esophageal is pulled to the right. Usually in caeum, we try barium topatheum or barium red for sacrifice structure. Frame rates are increased in modified barium swallow. In case of perforation, when water was filled with contrast, swallow is negative. We may use a thin layer. How to demonstrate the class? We usually use the lateral position forward bending to the valsalva maneuver. The regensin, the right anterior oblique or lateral u is very important. The lateral view shows the cardiac rosette. If the cardiac rosette is distorted, you need to look at a ceiling. What a radiologist should look for or what a resident should look for? Spinning of the chest and use a spinning bowler. Flow looks more smooth or obstructed. Distensibility equal column views. Look for contour abnormality and structure. And in mucosal relief, look for mucosal irregularity. In double contrast study, look for subtle mucosal lesions. Mucosal lesions are nearly single, continuous, lack like or shiny. Extrinsic compressions or impressions, normal or abnormal, intrinsic masses. See whether any masses are etched in white. D-junctions, look at the rosette. Whether we should use water soluble or radium. In acute perforations, water soluble contrast is safer. If no perforation is demonstrated, use radium. Any suspected perforation below the dome of the diaphragm, only water soluble contrast is given use. As radium baritonitis is affected. The central radiograph of the chest shows a widening in the posterior media syndrome along the right side of the stride and along the left. There is a fluid level, air fluid level. There is a lucency. This side is the apnea. There is an accent of the stomach bubble. This is the case of acnesia caria. This is another case. It shows a bird beak appearance. Again, a bird beak appearance. So, this is another case. Again, a fluid level. There is a large posterior media center widening on both sides. The sigmoid insipidus. There is mnemonitins in both lower loads. Now, this lateral cervical spine image shows presence of air posterior to the criteria. Normally, there should be no air posterior to the criteria, as the insipidus is always in a collapse case. So, if this is such kind of a leaching, a steam, then you may suspect something in the insipidus because it is very much contained or it could be a contained perforation. So, why do you do a variance follow in a case of acnesia for diagnosis and differentiation? To look at computations of candidate psoriasis, postoperative management to look for perforations and to assess the postoperative state. Again, a large dilative. There is a modeled appearance. We see a modeled appearance in the psoriasis. We think of acnesia cardia. Now, this patient, the HHS, is totally normal. Whereas, in this patient, there is a high grade narrowing at the g-junction. So, variance of acnesia early or rigorous when depending upon diameter of the dilated psoriasis. It should be early, that is up to 4 centimeter, moderate, that is 4 to 6. Severe is more than 6. Based on nanometry, it can be either type 1, type 2, or type. So, in this, there is a bird beak appearance. But this bird beak has an irregular beak. There is shouldering or a shelving in the proximal segment of the g-junction. There is a large soft tissue density along the medial extent of the gastric bubble. As though the gastric bubble is distorted at this level. So, this is, CT shows a large mass along the greater curvature and acnesia cardia. So, this is a case of secondary acnesia. We need to know that in secondary acnesia, there is no smooth narrowing. Whereas, in primary acnesia, it is a smooth narrowing. It is very important to note this. Regimens confuse a bacterial appearance with secondary or primary acnesia. In acnesia, the narrowing is always below the domobank. If the narrowing is above the domobank, it could be a fixed picture, but not acnesia. So, in secondary acnesia, and due to tumors of g-junction of cardia, there is a reason on set of this stage, the duration is less than 6 months. Note, this is your weight loss. The narrow segment is more than 3.5 centimeters in length. There is necrosis irregularity and nodular contour. There is always a proximal shape, but no distortion. This is a very important point. Another case of ca-cardia, note the large soft tissue density in the stomach bubble. The stomach bubble is not seen. There is a large defect in the stomach. So, differences between primary and secondary. There is quantity of ganglances of the other clutches in this case. Secondary tumors of g-junction, chagas disease, post-surgical states like post-pandoplication and gastric banding, infectious disorders. Usually seen in the middle age is the older age. There is a long, the issue of long standing in this stage. There is a reason on this, on this stage. Narrow segment is usually 1 centimeter or 2-3 centimeters. Narrow segment is greater than 3.5 centimeters. There is marked luminal dilution. The luminal dilution is less. There is a smooth, universal contour and an irregular, nodular and ulcerated bleak area. These are full columns of radiographs of an intracalogram. It shows new cultural irregularity in the retrocardic segment along the left lateral wall. On the AT, on the left lateral wall and on the lateral on both the anterior and posterior wall. In this stage, the intracalculus is tipping. It's turned out to be adenosia. So, this is the case of early as an individual CA. They are usually seen as preceded black, black-like nations, non-sci-polis. It's smooth on slightly-lobulated contour. There may be focal irregularity or ulceration of the region. So, usually we need to know this. CA can be either early or there. It can be advanced. In the advanced form, it's the infiltrated form. Polypoidal, ulcerative or varicoid. Usually, ulcerative cancers have mixed morphological features. The stitches may be normal. There may be widening of the azygoisodistrite. There's thickening and convexity to the right. Tracheal deviation with widening of the retrocuticles. So, this is a polypolytide. There's a lobilator of fungating intraluminal mass, more than 3.5 centimeters in length. Areas of ulceration and secondary tumor necrosis is C. This is a ulcerative site. You can see that there are cremations within the mass. This is the convex azygoisocisodistrite, which is thickened up to 1.5 centimeters. This is the shelf. This is the right and lateral shelf. There is a hyacinth hernia in this patient. This is a varicoid site. With some necrosis of tumor leading to pain, there is a subcutaneous longitudinal killing defect. They're making acetylvaricis. This is an infiltrative site. Note the extreme narrowing, irregular narrowing of the lumen. There is a proclamation shelf and a recital shelf. So, this varicoid site, ADD is varicis. So, there can be either up, note that on the wall of the esophagus is smooth. On distinctions of the lumen, the varicis are flattened. On no distinctions, the varicis can be seen as nodular, subcutaneous longitudinal filling defects. The filling defects show a smooth wall, whereas here the wall is irregular. There are two types, up-hill and down-hill. Up-hill varicis is from protein activation. Down-hill varicis is from SLC obstruction, malignancy, lymphoma, media cyanetism. Media cyanetism usually seen in upper or mid-field. So, these are fine, mucosal shelf-like defects in the esophagus and in the hypoferrine. So, this is the case of web. There are here are two types. Note that there is no narrowing. The wall of the esophagus is smooth. There is no mucosal irregularity at all. There are two types, down-hill and esophage. They are usually described as shelf-like defects. They are a primary requirement to demonstrate web is a large bolus and a full column. They are usually associated with Plummer-Winstein syndrome, but we have seen patients not being associated with Plummer-Winstein syndrome and still having web, a graft-versus-host disease of prolonged antibiotic usage can be anterior or circumferential, but never only posterior. Jet phenomenon is demonstrated only on complete research. There is a large filling defect in the hypoferrine along the right lateral wall. You can see that there is a large polypidermath on C3. This is the case of CVA hypoferrine. Now, this is a full column view. Now, this patient was, since we had severe dysphagia, we just created 20 ml of varium. You can see that there is a large mark in the cervical esophagus, which is causing a more extensive impression on the trachea. Note the smooth wall, posterior wall of the trachea. It is indented into the hypoferrine. Note the shallow impression on a normal hypoferrine. Note the deep impression on the ingestation. The piriform forza are usually shallow. Whereas here, they have become narrowed and thinned out. So, this is a case of post-curcuit CVA with oscillation into the trachea. Post-curcuit CVA is part of hypoferrine CVA. Can account for 30 percent. Piriform sinus masses is 60 percent. And posterior angular wall is 10 percent. Usually, they are squamous in CVA. You may be asked in the exam what is the mode of treatment. The mode of treatment is usually the first treatment. Now, this is a case of CVA. We are seeing a large polypidermath along the right lateral wall of the trachea. There is widening of the trachea. The trachea is spiked. It is hardly 2 millimeters. It may be up to 4 millimeters, especially in older patients. The ingestation is widened. There is widening of the right lateral trachea. Now, in this patient, there is a large mass, polypidermath. So, this is a case of milk dissipation. Just to note, the close approximation of the trachea with the esophageal. This is the aortic impression. This is the left wing bronchial impression. And this is the pseudo-diverticular appearance of the intervening esophageal. You can see that the esophageal wall, the wall mucosa is ulcerating. And there is a large widening of the trachea. This is the trachea bronchial stride, which is normal in all patients unless it is affected by the infagnopathy or mass. This shows a large smooth feeling defect in the esophageal, which is etched in white. There is a nominal widening at this level compared to a mass of trachea in which there is irregular, luminous narrowing. The mass is etched in white. So, this is the case of myoma. So, if we look at the myoma, sub-nucleosal masses. So, they usually cause a smooth esophageal impression. And luminous widening instead at this level. So, this is a steroid sign. So, if I extrapolate the circle at this level, the center of the circle lies beyond the wall of the esophageal and that's why it's extra luminous on sub-nucleosal mass. So, this is another patient we will show you. The lumen is normal on AP and narrowed on lateral. There is this appears like a shelf but there is no lucrative irregularity. Now, I'm subject to this in another patient. There is irregular, there is luminous widening but the mucosa of the esophageal is irregular. The mass is etched in white but it is irregular. So, this is the myoma sarcoma. Usually located in the distal two-thirds of the esophageal lying by smooth muscles. Typically appear in various large muscles containing areas of alteration or classification. We usually have bulky esophageal These are full-column esophageal brands of the retrocardiac and esophageal segment of esophageal which shows narrowing and in the epipylic segment the stomach is contracted. There is a narrowing in the mid-body of the stomach. You can see the narrowing. So, differential diagnosis of the esophageal. But in view of the narrowing we have to think of a corrosive structure of the esophageal. So, this is a corrosive narrowing of the esophageal. Not the widening of the asido esophageal strike. So, this is another patient. There is a round segment narrowing. Not the abnormal contour of the hypofibring. So, this patient will be unable to follow a large volant. It is very important for corrosive structures to ask them whether they are able to follow their own saliva and if they are able to follow their saliva then we can give them at least 15 or 30 ml of agate. We should not give a large volus. If a large volus is given, it will actuate into the trachea. So, it is very important to evaluate esophageal brands with a dedicated stomach measure graph to rule out gastric outlet obstruction. This is a case of gastric outlet obstruction in another patient. You see the air fluid and a fluid barium barium. Coming to the next topology these are full column radiographs. Chose a irregular shaggy appearance of the esophageal along the intra-aerotic esophageal. There is mesopharyngeal reflux of contract as the patient is unable to follow a large volus. So, in this patient we are having a double barrel appearance of the esophageal due to severe cannular esophageal. Maybe due to many varieties of canada. There may be discrete plaques. There is usually a normal intervening esophageal, granular appearance, a snake skin pattern. These are the double barrel esophageal. In severe cannidialism, usually shaggy, volusal plaques into the membrane formation. There is herpes esophageal, whereas they are discrete ulcers with no plaques. Another DD is reflux esophageal, but the reflux esophageal usually involves the epiflinic segment of the esophageal and not more cranial. So, there is a large protrusion arising in the vital esophageal seen on the lateral posterior. These are lateralaryngeal pouches. When the lateral perigal process do not collapse, along with collapse of vitro phagos, then it is termed diverticulum. This is a Zengsler's diverticulum. You can see that it is going posteriorly. This is the Phelan Jameson diverticulum and this is the Zengsler's diverticulum. This is a diverticulum due to what is diverticulum seen in aphelizia failure. So, diverticulum can be either have an anatomical or an ecologically facilitation. An anatomical offers a Zengsler's diverticulum and a Phelan Jameson diverticulum in mid esophageal destruction and in the lower with epiflinic or a traction diverticulum according to etiology. These are the few differences but right now many patients of traction diverticulum usually has fulcrum. So this traction and fulcrum diverticulum doesn't work anymore. This we will discuss later is it gastric optic obstruction because the stomach is large, usually dilated. Is it post-coctin failure? Is there carcinoma of the gastric junction? Is it of course mastectomy failure? This is the carcinoma of the G junction. We are seeing a large mass causing a controlled effect of the stomach problem. Now these are full and because of the difference of an histogram shows a large diverticulum with a communication this is the case of esophageal bronchial crystalline in the case of esophageal. So these are images full and because of the difference we see that the esophageal has not collapsed. It remains dilated. There are no certain diversified contractions seen in the esophageal. This is the carcinoma. You can see that there is there is there is still osteoporosis. It is a there is a patchless G junction. It is important to perform radiograph on the swallow in supine position to eliminate the effect of gravity on the mechanism of following. It performs in standing position. We miss all scleroderma. It is very important history wise to ask the patient whether there is solid or equal dysphagia in all these pictures. You can see that it still has to lysis again. So this is you can see multiple diverticules along the esophageal. This is the case of diffused esophageal stasm. There is involvement of smooth muscle protection of the esophageal. We usually present with substance pain in dysphagia. In this case of mid-term and middle age with more than 10 percent weight followers. The large electrocardiac shadow is seen. On a penetrated view of the spine, you can see that there is multiple pair. So this is the case of high edged hernia. This is the case of pharaesophageal hernia. This is the case of pharaesophageal This is the sum of hermetic into the thorac and at a position at a para-isocisional location. In this sliding hernia, the G-junction migrates into the thorac. Similarly, in this patient, the G-junction is here and this is the hernia. This is the para-isocisional hernia. This is the combined hernia. There are four types. Either one to four, one is sliding, two is rolling, three is mixed, and four is large defect from the phrenosythesial membrane causing hermination of kidney, spleen, and labors along with interchinaocytitis. These are full column radiographs. It shows a smooth, deep-like impression about the heriotic segment of the insulator. So this is an aberrant right subclavian artery. How an extrusive impression looks? This is a web. So we can see the comeral diverticulum here. The impression may be smooth. Normally, the impression of the aorta is a shallow sea. You can see the impression here. This is the comeral diverticulum. This is the phase of aberrant right subclavian artery. Again, you can see a similar deep-like appearance, deep-like impression, but this is due to a right-sided aortic artery. In this patient, you can see that the phrenosythesial membrane is deviated to the right. There's a large left-row double density seen here. So this is due to a enlarged left aortic artery. A large enlarged left aortic artery on the left aortic artery. So this is the combined effect of osteophyte and a factor-primary. Just to revise this again. Now in this, you can see a smooth extrinsic band-like impression at the level of the at the level of the UVS. You can see that it's affected. Usually it's seen because of reflux. So there's the narrowing at the G-junction. So it's a peptid stricter along with the highest phrenia. So this is the case of a tracheopharyngeal, a chalesia or a tracheopharyngeal bar. So this is to show a high-test phrenia. The stomach is located above the dome of the diaphragm. There is a subtle narrowing in the retrocardiac and epicanic segment of the inserted area. So this is the case of a peptid stricter. Coming to the stomach and doorknob, we can either have a single contract, double contract, mucosal relief and compression relief. So this is also another section itself on the radial. So this is the microbar. This is how the bottom looks. There is effervescence in this leg. So ideal varium preparation should have high density, stable suspension, should not fluctuate, should have a good coating. It's very important to shake the bottle and then give the bolus to the patient. It is non-absorbable, so preferable for double contracts and allows the introduction of second or negative contrast agent without regulation. So this is normal anatomy. This is the fundus. Fundus will draw a line from the g-junction up to the lateral margin of the stomach. This is the body. We need to know that even this is almost parallel to each other. This is the incisors angularity, angularity. So from here, still the pyloresis is the anterum of the stomach. The anterum has got a tetrasidal shape. Of course, the curvy tetrasidal shape. This is the second part of... The g-cap is the vertical donor. This is the third part of the donor. And this is the fourth part of the donor. So for contrast media, single contrast, load empathy, 50 to 100 percent gauge by volume. So we can do the water solubility contrast with pressure gas or a gas propagation contrast. So usually in these patients, the patient is administered varium in the supine position and examined the insta-fazers. You can examine the insta-fazers either in the supine or in the LPO. It's very difficult to examine the insta-fazers in these supines. So a preferred is standing LPO. Immediately the patient is made supine. The table is made supine. And in the LPO, we examine the insta-fazers. A supine followed by LPO is left posterior oblique and right posterior oblique projection. A double contrast of gastric anterum and body or a single contrast of the fundus is approved. They are complementary. Right left side down. Double contrast of gastric cardia and fundus and single contrast of gastric anterum and body. So RPO, double contrast of the recta-curvator and fundus, supine LPO. They examine the wooden bulk and sweep. Recommend with Valsava minima. It's very important to ask the patient to take a deep breath first so that the diaphragm moves down. So the intraderminal pressure is increased and then to do the Valsava minima. So these are images from a somat dornum. This is a double contrast of the somat. Double contrast of the anterum. This is the dornal sweep. The decaf and the dornum in double contrast. This is with extrinsic impressions of the column. So these are images of the G-junction. This is the cardiac rosette. You can see that there are five holes originating from here. So this is very important because it is distorted in gastritis and a total hypertension or due to a cardiac mark, G-junction mark. This is a placement of a cardiac tube. This is also a hole. This is the hole around the G-junction. So these are fine area gastric aches and they are distorted in a total gastritis. So this is a cascade stomach. These are impressions of the anterior end of this. This is a G-v mark. This is G-v, gamma G-v impressions. This is of the G-v. This is of the liver and the spleen. This is the brain of the G-v. And this is of the sugo cyst. So this is the case of gastritis. You can see that the mucosal folds are widened. They are more than 1 centimeter. There is a bullseye appearance of the... of in the summer. So this is the case of gastritis. So usually you can get pyrrhosis gastritis. This is the case of pyrrhosis gastritis. Bullseye lesions types are there. So this is the case of large ulcer craters filled with varium. There are mucosal folds relating to the ulcer mount. This is along the greater... lesser curvature. So it is a benign lesion. This is in the body. This is also benign. You can see that there is a large discosction of mucosal folds and there is a large mass along the greater curvature. This is a malignant lesion in the distal body. So this is the difference between benign and malignant ulcers. So differences between gastric ulcer and bone malus. So we finished with the mucosal lesion. Now some mucosal lesions are concentrated on this and this. So now this is a large lobulated mass along the greater curvature. You can see that it is etched in white. There is no compromise of the lumen of the stomach. So this is the case of the distal stomach. So this is the mesenchymal tumor. Those are the esophytic mass. There is no obstruction. There may be ulceration, cavitation or calcification and presently DIB. On double contrast it causes extrinsic impression on the stomach bubble without obliterating it. So this is extrinsic impression on the stomach bubble without obliterating it. This is a large neomyome. This is the same patient with the another patient which is showing ulceration and contrast between the eyes. So this is the case of the neomyome. Similar another patient showing contrast whatever the contrast this can be a large mass. Coming to the next stage these are smooth rounded film defects in the fundus and body of the stomach. These are called gastric polyps. So these are all the differences between hyperplastic adenomatis and fundus polyps and associations. So coming to the aluminum lesion it could be a large mass because the gastric adenomatis is based on location whether it's cardiac or g-junction and non-cardiac tumor based on invasion whether it's early or advanced in the volume stratification early gastric stratenoma is a three types type 1, type 2, type 3 and advanced in the volume. There's a mottled appearance due to regent fold particles between the stomach with a large qualifier mass you can see the thickness of the stomach has become almost 2 cm here. So this is the deep part deformity of the adenomatis of the diminished extension of the stomach. So this is of the anterum of the stomach with another case there's a narrowing of the anterum with a proximal and a distribution so this patient complained of pain in the abdomen and hence was asked for a small bubble narrowing of the anterum with a shell so this is a case of anterum CA presently without obstruction and without the without obstruction this is a case of not the diminished distensibility of the stomach in double contrast and full columns there is no obstruction to the chest usually missed in ogedyscopy it is very important to note it in CT or in double contrast also in contrast so causes of the chest so this is another case you can see that there is a diminished dispensibility of the stomach there's a large mass along the greater and the descubretion to the stomach and the lung to the stomach and tube so this is the lung of the lung and the lung is the lung is a lung of It is very important to differentiate gastric lymphoma and adenocasinoma. So in lymphoma, adenocasinoma will have diminished distensibility whereas in lymphoma the distensibility will not be affected. On CV, the stomach is homogeneously enhancing, thick voids, it is homogeneously enlarged lymphoma. Same patient showing thickening of the stomach. There is no gastric outlet obstruction in all the users of lymphoma. So this is a small bubble CV that shows a filling defect in the stomach. This is persistent, same persistent filling defect. This is a FITSAR film. You see that the ideal junction is open so there is no obstruction. There remained in the 24 hours film all these. We thought that it was the ascending colon and the system. However, it is not the ascending colon and system. It is mass taking the shape of the bowel. So now in this patient, there is a large mottled appearance in the stomach. So this was the case of a gastric tricobasor. So it is a case of Raffensel syndrome. You can see that the mass, the bazar goes, takes the shape of the organ and it is born up to the terminal height. So we can have a tricobasor, a phytobasor, a lactobasor or a pharmacogen. So this case shows a 2 hour film, a 2 hour radiograph shows a large mass, a ground glass, a ground glass capacity in the center of the abdomen. There is no obstruction. There is a smooth extrinsic impression on the stomach. This shows heterogeneity shows heterogeneity in the stomach. So this is a Leo-Mio-Sarcoma. So enlarged nodes are uncommon and when present, it can help with the lactic adenosia and leochema from Leo-Mio-Sarcoma. Now here in this patient, the stomach is usually dilated. There are no fluid levels except for the large level here. Fluid density. In this patient, the stomach is usually dilated. So there is a fluid barium and a barium fluid relish. So this is the case of gastric obstructive obstruction. You can see lateral density or retain food in the stomach. You can see a large ground glass density. I am sure it is not present too well. But this is a large ground glass density due to a dilated stomach. Now other causes. So this is of course engine insertion. We are showing chronic pancreatitis. And there is a ground glass capacity here. So this is the tuberculosis. So a corrosive injection is causing gastric obstructive obstruction. So in the same patient, there is a large tuberculosis causing incursion on the entrance of the stomach. These are the causes of gastric obstructive obstruction. So this is the case of... This is the D-cap and the stomach. More than the full stomach is given the thorax. So this is the case with the distortion of the normal outline of the architecture of the stomach. This is the case of molybillus of the stomach, organo-actual molybillus, more common in others. So this is paracetamide hernia. You can have sudden gastric pain in every part of the tissue. They engage in coiling in the thorax. There is intractable retching or without vomiting. So this is the mirror image of normal anatomy, reverse loss, greater and less accurate. So this is the greater curvature and this is the less accurate. You can see that the D-cap is higher. The thoranum is stretched. So this is the mechanism along a line organo-actual molybillus. And this is along a plane for perpendicular to the abdominal axis. So this is a case of mesentro-actual molybillus. It can be controlled with a cascade tumor. So cascade tumor is a normal region. The anterum is at the level of the G-junction on the back. You can see the anterum is at the level of the G-junction on the back. It is usually present to the hematoma. So this is coming to the duodenum. You can see a large double contrast of the duodenum. This is going to be for both. So now in this, this is the stomach. You can see that the duodenum is not following its normal course. It is not crossing over to the left side. It is crossing over to the right side. So this is the case of duodenum inverse. It is a normal region. So now in this, you can see that this is the pyloric canal. This is the D-cap. It has the effects under the base and pharmacist and blood. Now in this patient, you can see a no normal pyramidal anatomy of the duodenum cap. There is a diverticulum here. There is a trifoliary deformity of the D-cap. So it is chronic bruise. Again the diverticulum compare the two sides. This patient has a normal duodenum. A somewhat irregular duodenum bulge. However, there is a narrowing as in the post-bulbar region. So this is the case of post-bulbar narrowing of the stomach of the duodenum, which I can do to accept the duodenum. So types, bulbar ulcer, post-bulbar ulcer and giant duodenum. So this may make muscles. So again this is the case of post-bulbar narrowing. You can see that it is irregular. There is a smooth in this, there is a smooth extrinsic impression on the distal body and pyloric and pyloric answer of the stomach and on the duodenum. So this is the case of extrinsic impression and widening of the C-loop of the duodenum. So these are the two causes of sneezing. So now in this patient we have a colorectal duodenum chistula, the causes of colorectal chistula, the chronic duodenum ulcer or the colorectal disceases or perforation or FDRCV and phylloctomy. So this should not be confused with total venous gas on a film. Total venous gas is usually in the painful. Normally we need the duodenum in the stomach. We need the duodenum to trot over to the left. If there is anything, if you see continuity between the duodenum and a loop, usually we must think of a duodenum colorectal chistula. In this patient it was a duodenum colorectal chistula. The causes is diverticulitis, Crohn's, postoperative and post-traumatic and hypogemy. So this is a normal appearance. Jejunum is 4 to 7 volts per inch. Ilium is 2 to 4. The lumen width of the Jejunum is 2.5 centimeters and of the Ilium is featureless and 2 centimeters. This has a feathery appearance. In the Jejunum the villi are tall and thin and short and broad in the Ilium. So this is the 15, 30, 1 hour, 2 hours, 3 hours and 4 hours. Usually radiographs are taken after 15 minutes, after 30 minutes and 15 minutes is so fine. The rest all patients are taken prone so that the patient's own abdomen acts as a separator between the bowel movements. So now this is after this, after this film the IC junction has been seen. So an IC spot is taken. Usually the patient is rotated to the left. The left leg is folded and kept within the below the right leg. And the patient's right hand is taken over to the left side. This is a oral mnemocolon. You can see that there is air in the vector. This is a oral mnemocolon in routinely in all cases of IC film, post-IC film. If there is a narrowing in the region of the cecum or in the ascending column, or if you have spastic, then by a third oral mnemocolon they usually expand and without this object. So now this is a case of there is narrowing of the cecum. There is narrowing at the IC junction. There is a narrowing at the terminal ilum. There is a irregularity of the terminal ilum and narrowing of ascending column. So this is the case of IC cough. These are different manifestations of abdominal cough. IC junction is the most common type for abdominal tuberculosis and it's the most common overall type of cough. There are three morphological patterns. Ulcerative, hypertrophic, and ulcerative, hypertrophic. So here again the cecum is spastic. There is narrowing at the IC junction and terminal ilum. There are dilated barbell loops, there's an ornament of the ascending colon in this patient. This is a patient with amalgamation, so the cecum is on the left. It's narrowed, there is ulcerated narrowing in the terminal ilu. Similar picture, you can see the ulcerations. The ulcerations are within the wall, so we can see projections of contrast going into the wall. These are all cases of ic carc, similar where the cecum is pulled up, contracted. There's a narrowing at the level of involving the ascending colon, cecum and terminal ilu. However, there is no obstruction. In this patient, you can see pictures. In this patient, this was the ic junction. The terminal ilu is not clearly pacified along with the compression device. We can see that there is ulcerated narrowing at the ic junction and the terminal ilu. The cecum was not involved, but in view of vomiting and loss of weight and loss of appetite and fever, we decided to do it as an ic carc and on the similar expertise of the ic carc. There is regular narrowing in the terminal ilu. The whole ascending colon is involved, so these are cases of ic carc. In this patient, all the bowel lobes they show are fighting. They are all fixed to the abdomen that is passive of the large bowel. These are the cases of peritoneal carc. There are three types, bedstripe, hydrotic type and tri-type. Normally, the distance between two bowel lobes is hardly one or two millimeters. Now, you can see multiple islands in the bowel lobes. I really call this spellable sign. You see this sign, it is due to ascites. This patient, there is ground-large density along the flanks and all the bowel lobes are in the center. We need to look at signs of ascites on the heliograd, obliteration of the inferior edge of the liver, widening of the distance between the flank stripe and the ascending colon, medial displacement of the lateral edge of the liver or the heliograd sign, fluid accumulation in the pelvis, pseudo displacement of bowel lobes and a centrally located bowel lobes bulging of flanks and a ground-large appearance. This is the ground-large appearance, obliteration of the properitoneal carc. In this patient, again, we have seen that these bowel lobes are minimally dilated. However, there is no obstruction. So, on CB, you can see that the peritoneum is between antithesis and cancer. So, this is the case of carc, peritoneal carc. We have also included in peritoneal carc. In this patient, in a two-hour film, there was a suit exchanging impression on the bowel lobes. So, we answer the patient's empty bladder and we see that all the bowel lobes have gone into effect. In peritoneal carc with addition, that's the city of bowel lobes, there is spiking of the changes. This is the dry cat. You can see that along the center point, there is variation of bowel lobes. Now, in this patient, we are seeing extensive impression on the, this is the prone liver, extensive impression on the stomach. There is IC carc. This is, you can see that extensive impression is due to the horseshoe kidney. You can see that the kidney shadow is not normal. It is like a horseshoe. Same, there is brown glass spiking in the case of cancer. So, this is a pre-DKT FD. It shows spiking, toxicity. The spiking is contracted, pulled up, there is narrowing of the terminal isle and there is dilution of the terminal isle. I can see that the post-contact is the same as the last one. Now, in this patient, on a 30-minute film, there is a feeling defect in the disc, in the functional period. So, this is the case of intrusive perception. These are the causes, intrusive and in other. Again, in this patient, again, there is another patient, there is a feeling defect in these terminal isle. This is also the case of intrusive perception. However, the cause of intrusive perception was, a viewpoint was a mask in the secret. You can see the intrusive perception and is also what an example could be in the case. So, now this is a classic thumb-printing picture involving the vaginal and the proximal dilution. So, these are a colony of worms, the roundworms, which can be smaller. So, this is a single worm for feeling a feeling defect in the terminal, in the isle. In stronger resist, the degenerative loses all the, turns from feathery to featureless and patients usually present late with similar failures that can be done. Next case, this is a feeling defect in the, in the case in the isle. There are polyps within the thumb. There are polyps in the large worm with intrusive perception. So, you may be asked, what are all the associations, familial abnormalities, polyphosphor syndrome, thumb abnormalities, polyphosphor syndrome, principal syndrome, caudal syndrome, ulterior and polyphosphor syndrome. Now, in this case, in 30 minutes, the feeling is so much, the lower numb, all the bowel loops are in the right number region. We should not see any bowel loops in the right number region if we see them suspect an agitation. So, there are, the various types of non-rotation, incomplete rotation and reverse rotation. So, they all can present with obstruction. So, in non-rotation, small bowel loops are seen in the right and large bowel loops are on the left. The different sections is on the right of the human life. So, on cv, there is altered SM and SMV relation and accent of it from its residential door. So, on this, there are bowel loops in the right number region. Again, non-rotation. There is a large bowel in the, on the left. Similar. Now, in this patient, the large bowel, the sequence is not descended down up to the left Piazza. It is in the Piazza or in the left hyperchondrium, overlying the B3 segment of the woman. So, this is the most common critical condition of male rotation. So, this is reverse rotation. There is a block-wide rotation of the intestine. DJ loop is anterior to SMA and SM and transverse salon and for three years. So, this is the cockscrew appearance of the mid-grit volume. So, this is a large impression on the cheekum and in the terminal ideal. So, this is a very special kind of appendical alarms, abscess, masses, transplants in the estrophic kidney. Now, coming to enema. This is the Rebao dotted clue. This is the major diagonal catheter. So, a small bowel, sorry, a small bowel enema. So, these are the maneuvers for the enteroclysis phase name. Initially, in the pre-obtuctionacy, we give a talk to the clue and the clue is turned to the right of the patient. We maneuver into the d-cat and then into the, into the changement. It has to be placed in the loop. If it is placed anywhere here, patients will have one. So, these are pictures from three small bowel enteroclysis. First, one enterocyte suspension, that is the suspension of valium is instilled to the nasal genital catheter and pictures and it is followed. So, basically, there are images obtained in the left hypovondrium, left, wherever the genital moves, we need to take overhead pictures. And then once the terminal valium is reached, the methyl cellulose solution in one liter, a pinch of methyl cellulose is dissolved in one liter of warm water and the inclusion is started and the plane double contact cellulose is hydroscopic. So, it absorbs water, so you can see the pattern of the mucosa of the genium and the oo. So, this is our approach to interpretation of the enteroclysis. Now, in this patient, we have a narrowing at the IC junction. The cecum is contracted, the cecum is contracted, the narrowing of the enteroclysis and the terminal ilium. This is the case of I2POP. So, in this, there is focal structure in the proctomirilium, this vindication of the ibian segmented structure in the, in the guvenum in a different patient. This is the subtle structure in the guvenum. Now, this is huge dilatation. So, this is the specific structure of the small bubble, but short term. This, note that in this, in these structures, you can see that the edges of the structure are moving towards the midline, whereas in this, it is rounded off. So, this is the band. Next, coming to the idiom enema, either what is available or single contrast or double contrast, is advisable to use single, to document single contrast structure because sometimes patients are unable to retain air and we will not be able to do a fluid diagnosis in those structures. So, this is enema tip catheter. This is a ponies catheter, rubber catheter. We usually use rubber ganglion patients. This is a ponies catheter patient who cannot hold the inner tone in lakhs. So, this is a varium enema in a single contrast and a double contrast, which are the vindication, contraindication, concentration and transmission of patients. So, spotless regress are taken in the, the scan is kept at three feet above the table and it is very important to secure the inner tapes, otherwise the whole table will get flooded with varium. So, we need to be very careful and we need to instruct the patient to tell us whenever he experiences a case. So, the first radiograph is a proven radiograph for the rectum, the left posterior oblique, the left lacquer and supine upright and supine and supine oblique and overhead radiograph and rectum radiograph. These are APN lateral for the rectum. This is for the extracellular junction and sigmoid cologne. This is the descending cologne. This is the sine flexure, the transverse cologne, the hepatic flexure and the IC junction and cologne. So, these are overhead radiographs, bone and supine. And these are rectus, the right rectus and the left rectus. So, this is the anatomy. So, the normal mucosa is smooth and featureless. So, there can be a rectangular pattern just like area gaskete. There can be granularities in ulcerative colitis. There can be nodularity, cobblestone. Nodularity is between lymphoma or lymphomatter in butchers or as it can be cobblestone. So, there can be technical problems, poor preparation. Diabetic ulcers may mimic polyps on double contrast. So, it is required to use single contrast. Incontinence. So, it is preferable to use a polyps catheter. Non-filling of the right cologne in spite of maneuvering. So, there are minimal effects. We need to really maneuver the patient and give right instructions. There can be computation, gaskete, perforation of the valve and fecal darium perichonitrile. Allergy reaction to darium, transient bacteria and gas in the fecal range leading to fecal conflict. So, this is a passive segment of the cologne which has opened up on distention. This is the cologic shrinker. It mimics malignancy. So, it is very important. This can be seen even on CPS. So, it is very important to remember this. So, this does not allow backwash of fecal material upstream. These are the normal cologic shrinkers. There are many of them. So, they are all had right from the rectum to the cp. So, this is the next case. You can see that the rectum is devoid of this possibility of air receiving in the rectal region. There is a variation of the smart valve. So, there is absent air in the rectum. So, in the case of perichonitrile, you can see that the rectum is narrow. You can see that there is no gradient anymore. Usually, watercolour is nowadays. Watercolour contrast is different. They are in view of large fecalomide. So, electrocicmoid ratio is less than 1. Normally, the rectum diameter is more than the sigmoid. A transition zone is seen. So, this is the transition zone. There are three types. Short, botides, ultra-short, short, long-segment, and triple-colonics, again. So, this is the approach to a megacolons type. So, it can be organic, idiopathic, or sentinine. It can be sentinine. It can be long, short, ultra-short, and total-colonics, again. So, long is from scenic pectidicycle. Short is in the rectum or the entire rectum. It could be rectum and sigmoid. So, this is the range of agranicism in rectum and sigmoid colon. Ultra-short is in the internal strength. The internal strength is involved. So, the small rectum has been evaluated. Total-colonics agranicism is the micro-colon. So, this is the range of agranicism. You can see that the narrow segment is in the sigmoid colon. In the patient, this is in the function of the sigmoid colon. This is the case of ultra-short. You can see that the range of agranicism is by bioxygen. This is the case of total-colonics agranicism. So, this is a distant hologram, which shows that the rectum is upturned, which is what is called the contrast medium. The rectum is upturned. There is a rectum due to rectum cystida. So, this is the case of high ARM. So, this is upturned rectum with upturned anal canal. Marker is in place at the inner venus and a recto-virtual tissue. This is a recto-perineal tissue. Recto-bicycle tissue. The next case, this is total-colonics diabetical locus. This is the short-tooth appearance in rediabetical changes in the sigmoid colon. So, why is diabetical locus common in the sigmoid colon? Because it's the narrow portion of the colon with high pressures within. Tooth is very hard and dehydrated. There are increasing segmentations in motor activity. There is myososis. There is thickening of the circular muscle brain. So, this is the case of diabetical locus, which is a C-A of the rectum. Retain to varium within the diabetical locus. This is the case of the thinia coli and chronic diabetical locus. These are the thinia coli. So, it's usually called as a left-sided appendicycle. Pneumotoristrope is contraindicated in a tooth diabetical locus. So, these are the complications that will be hemorrhage, perforation, muscular hypertrophy and obstruction, and the acycolic abscesses, the psychopholis, or the colorecycline. So, this is the case of diabetical lysis with an earth colostomy with a four-conincipation. So, this is a different hologram which shows the diabetical eye. And there is a tissueless communication with the JG. And there is a narrowing within the rectum in the sigmoid or coli. And sigmoid is depending on the charge. You can see that there is a narrowing. And there is a sigmoid or Jejunal tissue. I can give you this narrowing, that there is inflammation. There is a sigmoid or baby tissue. So, this is a follow acyclic tissue of any diabetical lysis followed by sigmoid or vaginal tissue. So, next case, this overhead trim of a varium enema shows glass of acyclic narrowing of the entire polon with pseudo polyps within multiple pilling depicts in the rectum thus a faster pattern. So, this is the case of ulcerative coli. So, a few changes. There is a granularity, stippling, colobatom ulcers, austral cuponine, conframe, contiguous, circumferential disease, and chronic pain loss of acyclic, luminal narrowing, glass of rectal valve, widening of the three stages and backwash allelesis and post-inflammatory polona. So, we can see that there is a hospital descending polon. It may be a normal variant. We need to be very careful. Of course, necrosis surface, necrosis granularity is commonly. We can see, necrosis irregularity, granularity. So, on CT, there is necrosis thickening, necrosis hyper-enhancing, pseudo polyps, increase very regular and three-stakeable fat, sub-necrosis edema, and sub-necrosis creaking of fat. So, these are the pseudo polyps. Next case, there are multiple polyps within the large colin. There is a large colin under the case which is because of lipoma in the descending polon. You can see that it is HKNY. A diverticulum is protrude outside. It is very important to differentiate between diverticula and polyps. So, polyps can be adenomatous, hematomatous, hyperplastic, inflammatory. So, this is solorectal polyps proliferation. So, this is the case of a child, 10-year-old, and mother gave history that he passes multiple well-defined clots when passing schools. So, these are multiple filling defects in the rectum or carpeted throughout the large colin. So, this is the case of familial adenomatosis, polyps tissue. So, this is again the case of, this is Jager-Sundler, I showed earlier. So, coming to the next, there is the Afrochor's narrowing within the rectum. There is widening of this three-stakeable stage, loss of fat length between the rectum and the base of the bladder and the clots. Now, this is involving Afrochor in the ignite colin, long segment narrowing, or both, ignite colin. So, differentiation between diverticulitis and carcinoma is the gradual donor transition, hubbub transition. It protrudes outside the lumen. It is luminous. The lumen is narrowed. Neucoza is preserved. There is a destruction of neucoza with the Afrochor dependency. Now, you can see a short segment, Afrochor narrowing in the descending colin. Now, you can see that there is an environment of the real bridge in this case. Again, another widening of the three-stakeable stage at the level of S2, it should be hardly 5 million times. So, this was already shown by Dr. Anubhash. I am not showing. This is a phase of fistula in anal. This is cologram, very important assessment in case of colostomy patients. So, you are seeing a complexity of bowel movements. This is the ilioptonis, which was catheterized with a porous catheter and contrast of injectors. There is a narrowing of the IC junction. There is a dilution of the terminal ilium. The sequence is contracted. There is a narrowing of the entire ascending colin. So, this is a phase of fistula. Sorry, ma'am. I just wanted to remind. Yeah. Over. Over. Thank you for the minutes. You can take, ma'am. No, I have finished. So, this is a phase of colovaginus fistula. You can see that it's anterior place. It's a vaginus fistula. It's a phase of colovaginus fistula. So, this is the mnemonic for the insipidus. Whenever you ask patients symptom dodgy, please remember this. So, you will go in the right side. So, fix up identifying gallium squatters. Identify the study, the right and the left. There are many things. We as radiologists, you must look at the periphery first. Follow each and every labelling. This is there on the film. Follow the identification pattern. According to various diaries. Look at contrast use, whether it's water soluble or gallium. Look for clues. Look for side markers. And if still blank, look for diagnosis beyond life. Something like the, like the harsha film. And thank you. Thank you, Nityusha. Thank you, Masterclass. And thanks to money. And to all my students. And best of luck to all of you. You are best. Forget the rest. Thank you. Thank you, ma'am. This was really an extensive talk. And the residents were waiting since morning for this particular talk. Because, and all these things are something which we don't learn these days during our residency. And but definitely are asked.