ABDOMINAL & PELVIC PATHOLOGY Flashcards
Order of the GL tract
Mouth & Pharynx
Oesophagus
Stomach
Duodenum
Jejunum
Ileum
Caecum
Ascending Colon
Transverse Colon
Descending Colon
Sigmoid Colon
Rectum
What is Aspiration?
accidental breathing in of food or fluid into the lungs.
Types of barium studies
Studies include:
Barium Swallow
Barium Meal
Barium Follow Through
Barium Enema
What is BARIUM PERITONITIS?
Inflammation of the peritoneum due to barium contact.
Occurs when there is a leak of barium into the peritoneal cavity
Serious complication of barium study.
If a leak or perforation is suspected barium should NOT be used
Water soluble contrast should be utilised instead
another word for Oesophagogram
barium sallow
What is a Stricture
(apple core sign) Caused by a mass invading from the wall inwards, reducing the size of the lumen. Constriction of the lumen as a result of tumour/cancer.
Not usually within the lumen but surrounding or within the wall of the lumen.
What are Polyps?
Polyps are found in many areas of the human body, but mostly uterine or colon.
They are small flat bumps or often described as mushroom like due to the stalks.
Most are small and less than half an inch wide.
What is Cholangiocarcinoma?
Symptoms?
Modality?
Treatments?
Cancer of the biliary system
Can cause jaundice, itching, fatigue, adbo pain, fever, night sweats
Modality of choice- MRCP
Also CT with contrast/US
Radiological Treatments
ERCP- Endoscopic retrograde cholangiopancreatography
PTC- Percutaneous Transhepatic Cholangiography
Surgical Resection
Accessory structures
Three pairs of salivary glands
Pancreas
Liver & Biliary tree
Lymph System
Peristalsis
Peristalsis is a series of wave-like muscle contractions that move food through the digestive tract
HEPATOCELLULAR CARCINOMA
Cancer of the liver, 5th most common in the world
Often linked to Hepatitis infection
Linked to cirrhosis so has common risk factors
Jaundice most common symptom
Assessed with US/CT/MRI
Aside from surgical resection/transplant various image guided procedures to treat or manage symptoms are available such as:
- TACE – Trans-Arterial Chemo-Embolisation
- PTC – Percutaneous Transhepatic Cholangiogram (+/- drain)
- SIRT – Selective Internal Radiation Therapy
- Radiofrequency or Microwave Ablation
Types of hepatitis
Hepatitis A: highly contagious, mild illness, many infected may not know, usually resolves with no treatment and does not cause long-term damage to the liver. Spread though ingested of unclean water orfood that has been in contact with infected person.
Hepatitis B: Bloodborne. Can e transmitted sexually or via dirty needles as an example.
Hepatitis C: Bloodborne also – common transmission via unsterile needles such as through IV drug use.
Hepatitis D: Only affects those with Hepatitis B
Hepatitis E: Also spreads via contaminated food/water as with Hepatitis A.
CIRRHOSIS
Risk factors for liver disease and cirrhosis include excess alcohol consumption and repeated infections such as hepatitis.
Cirrhosis may not have any early symptoms. Later symptoms can include feeling sick and tired, yellowing of the skin, itchy skin and a swollen tummy.
There are 4 Stages of liver failure
Inflammation. In this early stage, the liver is enlarged or inflamed.
Fibrosis. Scar tissue begins to replace healthy tissue in the inflamed liver.
Cirrhosis. Severe scarring has built up, making it difficult for the liver to function properly.
End-stage liver disease (ESLD). …
HAEMANGIOMA
The most common benign liver tumour
Can vary in size
60% of cases have more than one present
Imaging used every 6-12 months to monitor
If small and stable no treatment necessary
Surgery used to remove if rapid growth or significant discomfort
Usually picked up on U/S with CT/MRI to confirm diagnosis.
What is ACUTE PANCREATITIS?
How is it diagnosed?
Severe inflammation and infection of the pancreas
Diagnosed clinically usually with physical examinations and blood tests.
Imaging can help but changes may not be seen immediately.
CT can be used to rule out other causes for symptoms such as perforation.
PANCREAS ADENOCARCINOMA
About 95% of cancers of the exocrine pancreas are adenocarcinomas.
These cancers usually start in the ducts of the pancreas.
About 10%, if caught early, are disease free after treatment
The most aggressive of all cancers, 53% of patients at diagnosis also have metastatic spread
Best imaging tool for large bowel
Optical Colonoscopy
However some patients cannot tolerate and has risk of perforation
What is a BARIUM ENEMA? and indications to do one
A dedicated study used to assess the large bowel
Sharp decline in use due to other ‘gold standard’ imaging (endoscopy/colonoscopy)
Indications:
?Ca
Tenesmus
Colitis
Stricture
Diverticular
Endometriosis
Volvulus
CT COLONOGRAPHY
Prep- Laxatives and low residue diet
Tube inserted into rectum and CO2 gases pumped in to dilate bowel
IV Contrast also given
Often scanned in supine + Prone positions
Able to to ‘fly through’ bowel in 3d much like colonoscopy
2 types of polyps
Sessile polyp - flat
Pedunculated polyp - mushroom shaped
Polyps information and risk factors
Small growths on the inner lining of the large intestine or rectum commonly.
Common (1 in 4 people affected)
Slightly more common in men than women
Age 60+
Some polyps can develop into cancer
Risk factors – family history, colitis, Crohn’s, overweight, smoking
Gastric polyps
Gastric polyps are abnormal growths on the inner lining of your stomach. Most are harmless and don’t cause symptoms. But some of them turn into cancer over time (many years). The chance of a polyp turning cancerous depends on the type of polyp that it is.
Diverticular Disease
Small pockets that develop in the bowel lining – the process of this formation is called diverticulosis
Can become inflamed
Food/waste can become lodged in them leading to infection.
Infection is known as diverticulitis
Can be asymptomatic.
If present, symptoms can include abdominal pain, altered bowel habit, diarrhoea, constipation and haematochezia.
Diverticulosis
Small pockets in the bowel
Diverticulitis
Infection of the small pockets in the bowel
Crohn’s
Can affect any part of the GI tract
Affects the full thickness of tract lining
Narrows the lumen of GI tract
Cause still unknown
Thought to be linked to genetics, immune status, previous pathology
Imaging can help with some symptoms, rule out SBO.
Ulcerative Colitis
Affects the colon and rectum
Ulcers form along the inner lining (mucosa)
Associated with other inflammatory conditions such as arthritis
Cause also not 100% known
Thought to be autoimmune
Body attacks normal bacteria in gut, causing ulcers.
Crohns on imaging
The bowel will have a part that is extremely small, which means that stool cant go through, this can cause an obstructive appearance to the rest of the bowel.
Ulcerative colitis on imaging
On imaging the bowel has lost its folds and the walls appear smooth.
Foreign bodies
May be ingested, or go down the trachea, or may be in the rectum
Scleroderma
In systemic scleroderma, there can be damage to the muscles of the small bowel (small intestine). The weakened muscles do not work effectively to push food through the bowel. Simply put, things sit rather than move well. One consequence can be an overgrowth of bacteria, leading to diarrhoea.
This leads to obstructive appearance on imagining
What does Scleroderma look like on imaging
Obstructive appearance on imagining, the bowel looks very large
