4) Oesophagus and stomach

Question 1

Imaging modalities - oesophagus

Answer 1

CT
- oral or IV C+
- good for pathology, physiology, staging diseases, great for tumours
Plain radiography
- AP
- OBL & OBR (30 or 45). Obliques solve superimposition problems
Endoscopy
- can see inside oesophagus in real time. Often combined with US
MRI
- not that common due to cost and availability

Question 2

Anatomy issues

Answer 2

• Due to close proximity of oesophagus and trachea, a pathology in one can effect the other
• Common problems arise when the lower oesophageal sphincter isn’t working properly and stomach acid frequently comes up the oesophagus

Question 3

Oesophagitis (cause, signs: M, I, U, A, S, B)

Answer 3

Cause: usually GERD
Signs
- mucosal folds
- irregular thickened mucosa
- ulcers and erosions
- adenocarcinoma
- strictures (hiatal hernia in >95% of pt's with stricture)
- Barrett's oesophagus: heterogeneous CM spread. Erosions at distal oesoph may be present. Reticular mucosa is a characteristic

Question 4

Candida oesophagus (double C+ oesophagram…), achalasia, schatzki ring (occurs where)

Answer 4

Candida oesop
- Double C+ oesophagram: discrete plaques with longitudinal orientation. “Cobblestone” or “snakeskin” appearance

Achalasia
- motility disorder characterised by the absence of peristalsis in oesoph and impaired relaxation of lower oesophageal sphincter in response to swallowing. Bird beak sign

Schatzki ring

• Occurs near oesoph sphincter (LES)
• causes dysphagia with solid food

Question 5

Hiatus hernia. Happens to… Types… Detected by…

Answer 5

• can happen in pt’s with reflux BUT there are pt’s with reflux without hernia
  Can be
• sliding hernia: distal end enlarged
• paraoesophaeal hernia: sac
• mixed
• detected by seeing air under diaphragm in CXR

Question 6

Corkscrew oesophagus (what, findings, sphincter), diverticula, pseudodiverticulosis

Answer 6

Corkscrew oesophagus

• motility disorder of oesophagus
• classical but uncommon finding is corkscrew appearance, especially of distal oesophagus
• Lower oesophageal sphincter will relax normally, unlike achalasia

Diverticula
- a diverticula is a pouch arising from a tubular organ

Pseudodiverticulosis
- oesophageal intramural pseudodiverticula are dilated excretory ducts of the deep mucosal glands in the oesophagus

Question 7

Tumours (W, T, O, S, U)

Answer 7

• walls of oesophagus may be thickened
• Tumours grow and cause strictures
• oedema associated walls become larger
• search for tumours near stomach (caused by acid)
• US + endoscope technique to see if lymphnodes associated

Question 8

Imaging modalities - stomach

Answer 8

CT
- solves superimposition issues
- water is better than Ba for C+ as Ba is too bright, covering anatomical detail
Plain x-ray/fluoro --> obliques
MRI
Endoscopy

Question 9

Gastric studies by plain x-ray (S, W, I)

Answer 9

• shape, size and position are important to radiologists
• water shows better results than Ba to promote contrast
• IV C+ is essential for evaluating neoplastic and inflammatory diseases of stomach

Question 10

Gastritis and ulcers (look for…)

Answer 10

• look for change of folds

- look for ulcer signs, C+ concentrated around ulcers

Question 11

Gastric varices (CT, Radiographic findings)

Answer 11

CT
- appear as well defined clusters of tubular soft tissue attenuation in posterior wall of stomach
Radiographic findings
- Thick, tortuous folds in cardia or fundus
- folds change in shape and size with compression and luminal distension
- May see extrinsic pressure defect on greater curvature if there is associated splenomegaly