19- GI Flashcards
What is Organomegaly? slide 4 usually involves what organs? How would you assess it? What is the name of it when either of these organs are enlarged? What are some causes of organomegaly?
- Enlargement of organs beyond normal limits
- Usually involves the liver and/or spleen
- Relationship of these organs to the 12th ribs is the starting point for assessment
- Liver can extend downward (ptosis)
- Hepatomegaly = rounded inferior angle, liver extends over psoas muscle/spine, absence of bowel gas in right abdomen
- Splenomegaly = spleen extends below 12th rib, gastric air bubble displaced anteromedially
- Some causes include: neoplasm, leukemia, abscess, hepatitis, hematologic disorders
View slide 5 nd 6, 7, 8 to see abnormal and normal
Abnormal Air patterns.
What is normal of air in the bowel lumen?
-normal to see air in the large bowel and stomach
-shouldnt see more than a few cm of small bowel gas or 2-3 air-fluid levels
-the small bowel shouldn’t measure no more than 3cm in diameter
-functional and mechanical causes are most likely to give these findings.
View slide 10 and 11
In Bowel Lumen: abnormal location’ normal pattern
12
Commonly see with what?
What are the signs?
- occasionally a portion of the GI tract is locates in the wrong place
- commonly seen with hiatal hernias
- Chilaiditis’s sign/ Syndrome:
- interposition of large bowel between the liver and diaphragm
- usually asymptomatic
- can be associated with abdominal pain, consipation, vomiting, respiratory distress
View slide 13
Outside the bowel lumen -abnormal air patterns.
Were can air localise?
-its not normal to see air in the abdominal cavity outside of the GI tract
Air can localise:
-In the wall of the bowel (pneumotosis intestinalis)
-In the peritoneal cavity
-in the abdominal vasculature(hepatic, portal)
Air in these locations should be followed up, as this may indicate serious bowel disease
note: If patient has had recent surgery, pneumo-peritoneum and portal vein gas are common residuals.
slide 15-17
What are the 4 basic categories of Calcifications?
19
- concretion = within a lumen (well marginated, laminated, faceted, solid, moveable)
- conduit wall = within the wall of a tube (linear, parallel lines, may be continuous or discontinuous)
cyst wall = within the wall of a - cyst or cyst-like structure (oval to round, thin walled calcification)
- solid = within the substance of a mass (irregular, fragmented, solid, lobulated [mulberry, popcorn])
View slide 20
Gallstones
What do they conaine?
slide 21
Types? 22
-only about 10-15% will calcify- concretion
-most require contrast study or ultrasound
-most often contain varying combinations of cholesterol, bile pigments, and/or calcium carbonate
View slide 22
Renal stones?
How much will turn to concretion?
Type?
whats the name of a stone filling a calyx and/or the pelvis
-up to 85% will calcify- concretions
-most common type is calcium oxalate
-usually asympt. unless they move into the ureter
-staghorn Calculus
Slide 24-26
What is an aneurysm?
-assosiated with?
-may be which shapes?
Diamter means what?
- weakness in the vessel wall allows for dilation
- often associates hypertensive disease
- approx 50% of abdominal aortic aneurysms will calcify
- may be saccular or fusiform
- diameter over 3cm= aneurysm, over 5cm= requires surgery
slide 28-29
Vas Deferens Calcification
- conduit wall calcification
- appears as a “V” shaped opacity in the pelvus
- high association with diabetes mellitus
What are Fibroids?
31 and 32
- solid calcification of a benign smooth muscle tumor- leiomyoma-usually of the uterus
- may be single or multiple or large
Upper GI Tract Achalasia. What is it? Results in what? -Usually seen in who? -presents as what on X-ray?
Achalasia
- Failure of relaxation of the gastrooesophageal sphincter due to a decrease or absence of the myenteric plexus - Results in dilatation of the esophagus, with secondary clinical manifestations (dysphagia, halitosis, vomiting of undigested food particles). - As food mainly empties into the stomach via gravity, there may be malnutrition issues and failure to thrive. - Usually seen between 30-50 years of age, and rarely presents before the age of six. - On plain chest x-rays, the dilated esophagus may present as a widened mediastinum. A fluid level may be seen on the lateral view. There is absence of the gastric air bubble. -Barium swallow demonstrates a dilated esophagus, which can vary in size depending on how long it has been present. It can be alarmingly large. -The contrast may appear irregular from undigested food in the distal esophagus. -The very distal end of the esophagus appears narrowed or tapered, and there is failure of relaxation of the distal sphincter as viewed under fluoroscopic exam. view slides 37, 38
Upper GI tract- Stomach
Hiatal Hernia
2 main types
2 main types: Slideing (99%) and paraesophageal
-with a sliding hernia, the cardia of the stomach passes above the diaphragm due to laxity of the phreno-esophageal membrane
- the oesophagus should still be seen above the herniated portion of the stomach
- may be signs of GERD due to lack of proper sphincter function- but not inevitable and most cases are asymptomatic.
Hiatal Hernia
-With a paraesophageal hernia, the cardia of the stomach stays below the diaphragm and a portion of the body or fundus passes through a defect in the phreno-esophageal membrane.
-The esophagus will extend below the herniated portion of the stomach.
Clinically, there is a potential for volvulus to occur, so these must be surgically repaired.
slide 41 and 42
Upper GI Tract- Stomach & Duodenum
Peptic Ulcers what are they? Clinical presentation? Mainly occur in who? Some radiographic signs that suggest the ulcer is benign include?
Peptic Ulcers
- a tear in the mucosal layer greater than 3mm in diameter
- classicaly manifest with epigastric pain within 2 hrs of eating
- gastric Ulcers occur in adults >40 yrs, while duodenal ulcers can occur in adults of any age.
- typical appearance of ulcer crater is round to oval collection of barium which extends beyond the normal confines of the lumen
- ulcers less than 5mm are easily missed using contrast studies.
- 5% are ulcerating carcinomas so all must be checked closely to determine aggressive potential.
Some radiographic signs that suggest a benign ulcer include:
- less curvature location
- ulcer craer extends beyond edge of lumen profile
- crater margins are smooth and well-defined
- mucosal folds are smooth and extend to edge of ulcerative crater
- Malignancy is suggested when these findings are not present, or opposite findings are seen.
Slides 47-49
Upper GI Tract- Stomach
Gastric Carcinoma
What are the 3 types identified on contrast studies?
3 main types of contrast studies:
- Polypoid (fungating, mass-like)
- large, irregular mass extends into the lumen
- may contain ulcerations - Infiltrative (scirrhous, linitus plastica)
- causes narrowing of long segment of the stomach, stiffening of the wall, and shrinking of the stomach - Ulcerating
- demonstrates characteristics of aggressive ulceration
Carcinomas are distributed fairly evenly throughout the stomach
View Slide 53 and 54
Small and Large Intestine Inflammatory Bowel Disease what is it? What are the 2 main types? 55 and 56
-an idiopathic disease, probably involving an immune reaction of the body to its own intestinal tract
2 main types: ulcerative colitis and Crohns Disease
Ulcerative Colitis is limited to the colon; Crohn disease can involve any segment of the GI tract
Small and Large Intestines
Ulcerative Colitis
Ulcerative Colitis
-typically starts at the rectum and progresses to varying amounts in a retrograde manner towards the ileum
Imaging findings include:
-smal, surface ulcers
-continuous, circumferential involvement of the bowel wall
-loss od haustration and shortening of the bowel (lead-pipe or stove pipe colon)
-toxic megacolon
57
Small and Large Intestines
Chron’s Disease
what is i?
Were does it happen?
Imaging findings?
Chron’s disease
- can manifest in any part of the GI tract, but typically involves the intestines. - When the colon is involved there is usually small bowel involvement, - Findings in the colon start at the ileocecal region and progress to varying amounts towards the rectum. - It is unusual for the rectum to be involved.
Imaging findings include:
- deep ulcers with or without a ‘cobblestone” muscosal pattern
- discontinuous, non-circumferential involvement of the intestinal wall (skip lesions)
- fistulas, strictures
View images on slide 60-64
Small and Large Intestines
Polyps/ Adenomas
-localized proliferations of dysplastic epithelium which are initially flat, but with increased growth project from the mucosa forming polyps
-adenomas are classified by their gross appearance as either sessile (flat or broad-based) or pedunculated (having a stalk)
-on contrast x-rays they appear as areas of absence of contrast
-adenomas are benign lesions, but they can degenerate into adenocarcinoma
-adenomas are generally asymptomatic
slide 68 and 69
Small and Large Intestine
Carcinoma
- colorectal carcinoma is disease of the older population or people with chronic inflammatory bowel disease
- Often undetected until late in their life cycle, reducing survival rates
- 5yr survival rate
- appearance dependant on stage of timor
- early invasive carcinoma may maintain the appearance of the original adenoma
- Over time lesion spreads circumferentially through circular lymphatics to produce a constricting annular (apple-core) lesion in the mucosa.
- Because of the large volume of space in which they can grow before symptoms show, cecal carcinomas often cover late areas of the cecum.
Slide 73-75
Large Intestines
Diverticulosis/ Diverticulitis
Diverticulosis / Diverticulitis:
-Chronic or recurrent increase in intraluminal colonic pressure causes herniation of the mucosa through the colon wall in an area of potential weakness where the penetrating nutrient arteries enter the muscularis propria.
-Diverticuli are most common in the sigmoid colon, but may be found along the entire length of the colon.
- The mucosa is usually studded with small(<2mm) openings leading to numerous diverticuli.
- When inflamed (diverticulitis), they can result in abscess formation.
- Most people with diverticulosis are asymptomatic or have mild disease and only 20% of afflicted people are ever symptomatic.
Accompanied by left lower pain, fever and often tenderness
-presence of palpable mass indicates abscess formation
Present as out pouching along the wall of the colon, which fill with contrast. their smooth, rounded contours usually distinguished them from ulcers.
-Diverticuli, may be seen as thinned, irregular diverticuli, possibly in the presence of colon stricture an for fistulas.
Slides 81 and 82
