Ch 4-5 Flashcards
2 highly specialized connective tissues the skeletal system is composed primarily of
Bone
Cartilage
Consists of an organic matrix in which organic salts (primarily calcium and phosphate) are deposited
Bone
Fibrous membrane that covers the outer surfaces of bone, except at joint surfaces, where articular cartilage covers the bone and acts a protective cushion
Contains a network of blood vessels from which nutrient arteries penetrate into the underlying bone
Periosteum
Main shaftlike portion of bone
Diaphysis
Ends of the bone
Epiphysis
Hollow, tubelike structure within the diaphysis
Medullary cavity/marrow
Inner membrane that lines the medullary cavity
Endosteum
2 major types of bone
Compact
Cancellous
Outer layer of bone
Compact bone
Spongy inner layer of bone composed of a web-like arrangement of marrow-filled spaces
Cancellous (spongy) bone
Thin processes of bone that separate the spaces of cancellous bone
Trabeculae
Until the linear growth of bone is complete, the epiphysis remains separated from the diaphysis by a cartilaginous plate
Epiphyseal cartilage
Where the diaphysis meets the epiphyseal growth plate is a slight flaring
Metaphysis
2 special types of bone cells
Osteoblasts
Osteoclasts
Enlarge the diameter of the medullary cavity by removing bone from the diaphysis wall
Osteoclasts
Produce new bone around the outer circumference
Osteoblasts
Bone formation
Ossification
Bone destruction
Resorption
Connective tissue membrane bones can also develop within
Intramembranous ossification
Flat bones grow in size by the addition of osseous tissue to their outer surfaces
Appositional growth
Spinal canal defect caused from failure of the posterior elements to fuse properly
Spina bifida
Large defects of spina bifida have 2 complications of hernias
Meningocele
Myelomeningocele
Herniation of the meninges
Meningocele
Herniation of the meninges and a portion of the spinal cord or nerve roots
Myelomeningocele
3 malformations associated with a meningocele
Gait disturbances
Clubfoot
Bladder incontinence
Rare hereditary bone dysplasia in which failure of the resorptive mechanism of calcified cartilage interferes with the normal replacement by mature bone
Results in very brittle bones
Location: entire skeleton
Imaging appearance: generalized increased bone density
Osteopetrosis
“Marble bones”
An inherited generalized disorder of connective tissue characterized by multiple fractures and an unusual blue color of the normally white sclera of the eye
Osteogenesis imperfecta (OI) "Brittle bone disease"
Most common form of dwarfism
Results from diminished proliferation of cartilage in the growth plate (decreased enchondral bone formation)
Autosomal dominant condition
Characterized by short limbs with a normal axial skeleton
Thick bones
Location: vertebrae (short stature), long bones
Imaging appearance: progressive interpedicular distance from superior to inferior, and scalloping of posterior vertebral bodies; widened metaphysis (Erlenmeyer flask deformity)
Achondroplasia
Results from incomplete acetabulum formation caused by physiologic and mechanical factors
Congenital hip dysplasia/dislocation
Developmental hip dysplasia
9 inflammatory and infectious disorders
Rheumatoid arthritis Osteoarthritis (degenerative joint disease) Infectious arthritis Tuberculous arthritis Bursitis Rotator cuff tears Tears of the menisci of the knee Bacterial osteomyelitis Tuberculous osteomyelitis
Chronic systemic idiopathic disease that appears primarily as a noninfectious inflammatory arthritis of the small joints of the hands and feet
Location: small joints symmetrically
Imaging appearance: periarticular soft tissue swelling and symmetric joint destruction and deformity
Rheumatoid arthritis (RA)
3 rheumatoid arthritis (RA) variants
Ankylosing spondylitis
Reiter’s syndrome
Psoriatic arthritis
Very common generalized disorder characterized by loss of joint cartilage and reactive bone formation
Part of the wear and tear of the aging process
Affects the weight-bearing joints (spine, hip, knee, ankle) and the interphalangeal joints of the fingers
Imaging appearance: irregular narrowing of joint space with small bony spurs
Osteoarthritis (degenerative joint disease)
Chronic, indolent infection that has a gradual onset and a slowly progressive course
Most patients have pulmonary TB
Rare
Tuberculous arthritis
3 joints usually involved in tuberculous arthritis
Spine
Hips
Knees
An inflammation of the small fluid-filled sacs located near the joints that reduce the friction caused by movement
Location: shoulder most common
Imaging appearance: calcific tendinitis in 50%
Bursitis
The rotator cuff of the shoulder is a musculotedinous structure composed of the teres minor, infraspinatus, supraspinatus, and subscapularis muscles
Tears produce a communication between the shoulder joint and the subacromial bursa
MRI is the modality of choice, inject contrast (arthrogram) before
Rotator cuff tears
5 causes of bursitis
Repeated physical activity (most common) Trauma Rheumatoid arthritis Gout Infections
2 causes of tears of the menisci of the knee
Acute trauma
Degeneration due to chronic trauma
Common cause of knee pain, MRI is the modality of choice
Tears of the menisci of the knee
An inflammation of the bone and marrow caused by a variety of infectious organisms that reach bone by hematogenous spread, extension from an adjacent site of infection, or direct introduction of organisms (after trauma or surgery)
In infants and kids, the metaphysis of long bones (high in red marrow), especially the femur and tibia, are most often affected
In adults, acute hematogenous primarily occurs in the vertebrae, causing localized back pain and muscle spasms
Begins as an abscess of the bone; pus produced by the acute inflammation spreads down the medullary cavity and out to the surface
Imaging appearance: soft tissue swelling with periosteal elevation
Bacterial osteomyelitis
Rare osteomyelitis today that usually affects the T and L spine
Location: vertebra
Imaging appearance: lytic lesion without periosteal elevation and collapsed vertebra with kyphosis
Tuberculous osteomyelitis (Pott’s disease)
2 types of osteomyelitis
Bacterial osteomyelitis Tuberculous osteomyelitis (Pott's disease)
5 metabolic bone diseases
Osteoporosis
Osteomalacia
Rickets
Gout
A generalized or localized deficiency of bone matrix in which the mass of bone per unit volume is decreased in amount but normal in composition
Causes include aging and postmenopausal hormonal changes, more common in females
Location: loss of bone mass in entire skeleton (accelerated bone resorption)
Imaging appearance: cortical thinning appears as a relatively dense and prominent thin line
Osteoporosis
A ________ in kVp is required to obtain quality images of a patient with osteoporosis
Decrease
Insufficient mineralization of the adult skeleton
May be caused by inadequate intake or absorption of calcium, phosphorus, or vitamin D
Other nutritional causes are chronic kidney failure or kidney diseases that cause calcium secretion in the urine
Softening of the bone
Location: deossification of medullary bone
Imaging appearance: loss of bone density and cortex becomes thin and often indistinct
Osteomalacia
Systemic disease of infancy and childhood that is the equivalent of osteomalacia in adults
Calcification of growing skeletal elements is defective because of a deficiency of vitamin D in the diet or a lack of exposure to ultraviolet radiation (sunshine) which converts sterols in the skin into vitamin D
Soft bones
Location: insufficient mineralization of the immature skeleton
Imaging appearance: cupped and frayed metaphysis in long bone
Rickets
A disorder in the metabolism of purine (a component of nucleic acids)
Increases uric acid in the blood, which leads to the deposition of uric acid crystals in the joints, cartilage, and kidney
Manifests as very painful arthritis that initially attacks a single joint, primarily the first metatarsophalangeal joint
Additive and destructive
“Rate bite” erosions
If you have a mass forming, calcium will get into it and show up on x-rays
Location: 1st MTP joint but may attack any joint
Imaging appearance: joint inflammation (effusion) and destruction and/or uric crystals (tophi) in joint space
Gout
One of the most common chronic metabolic diseases of the skeleton
Associated increased risk of osteosarcoma
No known cure
Bone destroys itself, then comes back thicker; painful
Middle-age +
Most common in pelvis, seen well in skull
Can go into other areas of the bone
Location: destruction and reparative process in pelvis, weight-bearing bones, and skull
Imaging appearance: radiolucencies in destructive (lytic) phase and cotton-wool appearance in reparative phase
Paget’s disease
Osteitis deformans
Results from the ingestion of lead-containing materials (especially paint) or from the occupational inhalation of lead fumes
Environmental exposure occurs when drinking water (leaded pipes) and eating food that’s processed, preserved, or stored in containers made with lead
Currently lead is the number one major environmental pollutant worldwide
Chronic form may cause mental retardation, seizures, behavioral disorders, or delayed development
Children are more susceptible to lower doses (eat lead containing paint = pica)
In kids, because lead and calcium are used interchangeably by bone, high concentrations of lead are deposited in the most rapidly growing portions of the skeleton, especially the metaphysis at the distal ends of the femur
Lead poisoning
Characterized by the proliferation of fibrous tissue within the medullary cavity that causes loss of trabecular markings and widening of the bone
Fibrous dysplasia
Occurs due to a loss of blood supply with many different causes
Ischemic necrosis of bone
8 benign bone tumors
Osteochondroma Enchodroma Giant cell tumor (osteoclastoma) Osteoma Osteoid osteoma Simple bone cyst Aneurysmal bone cyst Bone island
5 malignant bone tumors
Osteogenic sarcoma Chondrosarcoma Ewing's sarcoma Multiple myeloma Bone metastases
Benign projection of bone with a cartilaginous cap that arises in childhood or teen years, commonly near the knee
Location: epiphyseal plate growing laterally in long bones
Imaging appearance: tumor runs parallel to long bone and points away from nearest joint
Osteochondroma
2 characteristics of osteochondromas
Long axis of tumor runs parallel to the bone shaft
Points away from the nearest joint
Slow-growing benign cartilaginous tumors arising in the medullary canal
Primarily in the small bones of the hands and feet
Often found when a fracture occurs with minimal force
Most frequent in kids and young adults and primarily involve the small bones of the hands and feet
Enchondroma
Typically arises at the end of the distal femur or proximal tibia of a young adult after epiphyseal closure (20-40 years old)
Does not affect the joint
Location: metaphysis extends into subarticular cortex
Imaging appearance: multiple large bubbles separated by strips of bone
Giant cell tumor (osteoclastoma)
Most often arise in the outer table of the skull, the paranasal sinuses (especially frontal and ethmoid) and the mandible
Cause pain
Appear radiographically as well-circumscribed, extremely dense, round lesions that are rarely larger than 2 cm in diameter
Osteoma
Typically imaged as a small, round or oval, lucent center (the nidus), less than 1 cm in diameter, that is surrounded by a large, dense sclerotic zone of cortical thickening
It is most common in teenagers or young adults.
Symptom is local pain, which increases at night and is easily relieved by aspirin
Location: femur and tibia, osteoblastic cells
Osteoid osteoma
A true fluid-filled cyst with a wall of fibrous tissue, which most often occurs in the proximal humerus or femur at the metaphysis
Asymptomatic and often discovered either incidentally or after pathologic fracture
Simple bone cyst
Not a true neoplasm or cyst
Consists of numerous blood-filled, arteriovenous communications thought to be caused by trauma
Aneurysmal bone cyst
Solitary, sharply demarcated areas of dense compact bone that occur most commonly in the pelvis and upper femur
Appear in every bone except the skull
Bone island
Generally occurs in the end of a long bone in the metaphysis (especially about the knee)
A malignant tumor of osteoblasts, which produce osteoid and spicules of calcified bone
Most common in persons between 10 and 25 years old
Smaller peak incidence is seen in older persons who have a preexisting bone disorder, particularly Paget’s disease
Metastases to the lungs
Mixed destructive and sclerotic lesion associated with a soft tissue mass
Imaging appearance: “sunburst” pattern or Codman’s triangle
Osteogenic sarcoma
A malignant tumor of cartilaginous origin that may originate anew or within a preexisting cartilaginous lesion, e.g., osteochondroma and enchondroma
Commonly occurs in long bones, but often originates in a rib, scapula, or vertebra
About half as common as osteogenic sarcoma
It develops at a later age (peak incidence in 35- to 60-year olds), grows more slowly, and metastasizes later
Chondrosarcoma
A primary malignant tumor arising in the bone marrow of long bones
Occurs in children and young adults and is rare over age 30
Destructive (takes away calcium) to whole area of bone
Major clinical complaint is local pain
Imaging appearance: medullary destruction with “onionskin” periosteal reaction
Ewing’s sarcoma
A widespread malignancy of plasma cells associated with bone destruction, bone marrow failure, hypercalcemia, renal failure, and recurrent infections
Affects primarily persons between 40 and 70 years of age
Eats away at the bone
Location: intramedullary canal of the diaphysis
Imaging appearance: multiple punched-out lesions
Multiple myeloma
The most common malignant bone tumors that are more common than primary neoplasms
They spread from primary tumors by means of the bloodstream or lymphatic vessels or by direct extension
The most common primary tumors are carcinomas of the breast, lung, prostate, kidney, and thyroid.
Favorite sites of spread are bones containing red marrow, such as the spine, pelvis, ribs, skull, and the upper ends of the humerus and femur
Location: entire skeleton
Imaging appearance: irregular, poorly defined lucent lesions or poorly defined increased densities depending on site of origin
Bone metastases
Metastases from carcinomas of the kidney and thyroid typically produce a single large metastaic focus that may appear as an expansive trabuculated lesion
“Blowout”
In the spine, bone metastases may produce a characteristic uniform density
“Ivory” vertebral body
Generally considered evidence of slow growth in a neoplasm that has allowed time for a proliferation of reactive bone (additive)
Osteoblastic metastases
A disruption of bone caused by mechanical forces applies either directly to the bone or transmitted along the shaft of a bone
Although often obvious, some are subtle and difficult to detect
Typically appears as a radiolucent line crossing the bone and disrupting the cortical margins
Fracture
4 ways fractures are defined and classified
Extent
Direction and position
Number of fracture lines
Integrity of the overlying skin
Fracture that results in discontinuity between two or more bone fragments
Complete fracture
Fracture that causes only partial discontinuity, with one side of bone cortex intact
Incomplete fracture
Fracture with overlying skin intact
Closed fracture
Fracture with associated skin wound, overlying skin is disrupted
Open/compound fracture
Fracture line is horizontal/runs at a right angle to long axis of bone
Most commonly results from a direct blow or is a fracture within pathologic bone
Transverse fracture
Fracture line extends at approximately a 45 degree angle to long axis of bone and is caused by angulation or by both angulation and compression forces
Oblique fracture
Fracture line encircles the shaft, is generally longer than an oblique fracture, and is caused by torsional forces
Spiral fracture
Small fragments torn from bony prominences by being pulled from bone by attached ligaments or tendons
Avulsion fractures
Fracture composed of more than two bone fragments
Comminuted fracture
Elongated triangular fragment of cortical bone separated from two larger fragments
Butterfly fragment
A piece/segment of the shaft is separated by proximal and distal fracture lines
Segmental fracture
Results from compression force that causes compaction the trabeculae and results in decreased length or width of a portion of a bone
Most commonly occur in the vertebral body as a result of flexion of the spine; they may also be seen as impacted fractures of the humeral or femoral
Compression fracture
Fragment driven inward, e.g., skull fragment pushed into brain; tibial plateau
Depressed fracture
The response of bone to repeated stresses, none of which is sufficient to cause a fracture
Stress/fatigue fracture
Occurs in bone at an area of weakness caused by a process such as tumor, infection, or metabolic bone disease
Usually not significant enough to cause a fracture in healthy bone
Weak bones
Frequently occurs in soldiers during basic training (“march” fracture)
Pathologic fracture
Occurs in immature bone (infant and children); incomplete fracture where one side of cortex remains intact
Greenstick fracture
Cortex is intact with buckling or compaction of one side of the cortex
Torus (buckle) fracture
Plastic deformity of bone caused by a stress that is too great to permit a complete recovery of normal shape but is less than the stress required to produce a fracture
Bowing fracture
A plane of cleavage exists in the bone without angulation or separation
Undisplaced fracture
Separation of bone fragments; the direction of displacement describes the relationship of the distal fragment with respect to the proximal fragment and is usually measured in terms of the thickness of the shaft
Displacement
Angular deformity of the axes of the major fracture fragments and also describes the position of the distal fragment with respect to the proximal one
Angulation
The displacement of a bone that is no longer in contact with its normal articulation
Most commonly shoulder joint anteriorly
Dislocation
Only partial loss of continuity of the joint surfaces
Subluxation
The healing of fracture fragments in a faulty position; leads to impairment of normal function or a cosmetic appearance that may require surgical correction
Malunion
An ill-defined term arbitrarily applied to any fracture that takes longer to heal than the average fracture at that anatomic location
May result from infection, inadequate immobilization, limited blood supply, or loss of bone at the fracture site
Delayed union
A condition in which the fracture healing process has completely stopped and the fragments remain ununited even with prolonged immobilization
Nonunion
Refers to multiple, repeated, physically induced injuries in young children caused by parents or guardians
Imaging professionals have a legal responsibility to report suspicious cases to their supervisors
The facility is legally obligated to notify authorities
Battered-child syndrome
Suspected nonaccidental trauma (SNAT)
Transverse fracture through the distal radius with dorsal (posterior) angulation
Common for ulnar styloid to fracture, too
Usually caused by a fall on the outstretched hand; most common fracture in wrist
Colles’ fracture
Transverse fracture of the neck of the 5th metacarpal with palmar angulation of the distal fragment
Often caused by hitting an object with a closed fist
Boxer’s fracture
Most common fracture involving the carpal bones
Navicular (scaphoid)
Ulnar shaft fracture associated with anterior dislocation of the radius at the elbow
Monteggia
Radial shaft fracture and a dorsal (posterior) dislocation of the ulna at the wrist
Galeazzi
Fracture of both malleoli with ankle dislocation
Pott’s
Fracture of both malleoli
One side is usually spiral or oblique and the other transverse
Bimalleolar
Fracture of both malleoli and the posterior lip of the tibia; usually represent fracture-dislocations
Trimalleolar
Transverse fracture of the 5th metatarsal base
Jones
2 classifications of fractures of the spine (result of direct trauma, hyperextension-flexion inuries [whiplash])
Stable
Unstable
Leave one of the two major columns of the spine intact
Stable fracture
Fractures that disrupt both major columns of the spine
Unstable fracture
Comminuted fracture of C1
Ring of atlas, involves both anterior and posterior arches and causes displacement of the fragments
Jefferson
Most occur at base of dens
Odontoid fractures
Fracture of C2 arch with subluxation of C2–C3
Patients who had been hanged
Hangman’s
Avulsion fracture of a spinous process in the lower cervical or upper thoracic spine
Clay shoveler’s fracture
Transverse fracture of a lumbar vertebra that is often associated with significant visceral injuries
Seat belt fracture
A twisting and curvature of the vertebral column in the lateral perspective
It is generally shaped somewhat like an “S”
Scoliosis
4 most common types of scoliosis
Idiopathic
Functional
Neuromuscular
Degenerative
Protrusion of a portion of the disk
Herniation of intervertebral disks
5 most common sites of herniation of intervertebral disks
L4–L5 L5–S1 C5–C6 C6–C7 T9–T12
A cleft in the pars interarticularis without displacement, usually bilateral
Most common site L5
Affects 5% of the population
Spondylolysis
Situated between the superior and inferior articular process
Lamina = neck of the scotty dog
Pars interarticularis
The forward displacement of one vertebra on another, causes chronic back pain
It may be caused by spondylolysis, a cleft in the pars interarticularis with displacement
Spondylolisthesis
Generally cause soft tissue swelling and cortisol bone erosion with a margin that is poorly defined
or absent
The neoplasm extends into soft tissue through spiculations (finger-like projections)
Plain radiographs may identify a single lesion
A radionuclide bone scan or PET scan can detect
silent lesions when minimal cellular destruction has occurred
CT and MRI can precisely define the location of a malignant bone tumor and its extension into the medullary cavity/surrounding
structures
Malignant bone lesions
What is the basic function of the digestive system and what does this process depend on?
To alter the chemical and physical composition of food so that it can be absorbed and used by body cells depends on secretions of the endocrine and exocrine glands and on the controlled movement of ingested food through the tract so the absorption can occur
The mechanical breakdown of food
Mastication/chewing
Where does digestion begin?
In the mouth with mastication/chewing
Secretion of saliva moistens the food in preparation for this complex process that requires coordination of many muscles in the head and neck and the precise opening and closing of esophageal sphincters
Deglutition/swallowing
Digestion continues in the stomach with the churning movement of gastric contents that have become mixed hydrochloric acid and the proteolytic enzyme pepsin; the resulting milky white substance is propelled through the pyloric sphincter into the duodenum by peristalsis
Chyme
Rhythmic smooth muscle contractions
Peristalsis
Where does the greatest amount of digestion occur?
Duodenum (first part of small bowel)
Controls the level of circulating blood glucose by secreting insulin and glucagon in the islets of Langerhans
Secretes enzymes for the digestion of proteins, fat, and carbohydrates and an alkaline solution to neutralize the acid carried into the small intestine from the stomach
Pancreas
An emulsifier secreted by the liver, stored in the gallbladder, and enters the duodenum through the common bile duct
Essential for the digestion and absorption of dietary fat and fat-soluble vitamins
Greenish liquid
Bile
A substance that acts like soap by dispersing the fat into very small droplets that permit it to mix with water
Emulsifier
Green pear-shaped sac that lies on the undersurface of the liver; function is to store bile
Gallbladder
Numerous finger-like projections that increase the inner surface area of the small bowel and proved the largest amount of surface area for possible for digestion and absorption
Villi
Material that has not been digested passes into the colon, where water and minerals are absorbed, and the remaining matter is excreted
Feces
If the contents of the lower colon and rectum move at a rate that is slower than normal, extra water is absorbed from the fecal mass to produce hardened stool
Constipation
Results from increased motility of the small bowel, which floods the colon with an excessive amount of water that cannot be completely absorbed
Diarrhea
Vermiform (worm-shaped) accessory digestive organ arises from the inferomedial aspect of the cecum approximately 3 cm below the ileocecal valve
No functional importance in digestion
Appendix
Largest gland in the body that is responsible for several vital functions
Cells detoxify a variety of poisonous substances that enter the blood from the intestines
Secrete approximately 1 pint of bile each day
Plays a vital role in the metabolism of proteins, fats, and carbohydrates
Major site of synthesis of the enzymes necessary for various cellular activities throughout the body
Liver
The liver plays an important role in maintaining the proper level of glucose in the blood by taking up excess glucose absorbed by the small intestine and storing it
Glycogen
Results from the failure of the esophageal lumen to develop completely separate from the trachea resulting in a blind pouch
Often associated with other congenital malformations involving the skeleton, cardiovascular system, and GI tract
Congenital tracheosophageal (TE) fistula
Tracheosophageal fistula caused by cancer, infection, trauma, instrumentation perforation
Acquired tracheosophageal (TE) fistula
Acute form is most commonly the result of reflux of stomach contents into distal esophagus
Chronic may result in strictures or Barrett’s esophagus
It may also be caused by infection: herpes virus or candida (fungal); usually occurs in patients with widespread malignancy who are receiving radiation or chemotherapy
Alcohol, chocolate, caffeine, and fatty foods tend to decrease the pressure of the esophageal sphincter, allowing reflux to occur
Esophagitis
Gastroesophageal reflux disease (GERD)
Produces acute inflammatory changes in the esophagus
Superficial penetration of the toxic agent results in only minimal ulceration
Deeper penetration of the submucosa and muscular layers causes sloughing of destroyed tissue and deep ulceration
Ingestion of corrosive agents
Most are squamous cell type
Most common site is esophagogastric junction
Associated with excessive alcohol intake and smoking
Dysphagia occurs late in the disease
Incidence far higher in men than women
CT is major method of staging patients with 90% accuracy
Esophageal cancer
Difficulty swallowing
Dysphagia
Outpouchings of the esophageal wall
Composed of only mucosa and submucosa herniating through the muscular layer
Esophageal diverticula
Outpouchings of the all the esophageal walls
True/traction esophageal diverticula
Outpouchings composed of only mucosa and submucosa herniating through the muscular layer of the esophageal wall
False/pulsion esophageal diverticula
Esophageal diverticula that arise from the posterior wall of the upper (cervical) esophagus
Zenker’s diverticula
Dilated veins in the distal esophagus
Caused by portal hypertension usually caused by cirrhosis
May hemorrhage
Esophageal varices
Protrusion of a portion of the stomach into the thoracic cavity through the esophageal hiatus in the diaphragm
Commonly causes GERD
Degree of herniation varies widely
Most common abnormality (50% of population) detected on upper GI
Range from large esophagogastric hernias to small hernias that emerge above the diaphragm
Prominent air fluid levels can be seen on chest x-rays
Hiatal hernia
Functional obstruction of the distal esophagus with proximal dilation
Caused by incomplete relaxation of the lower esophageal sphincter
Achalasia
May be radiopaque or radiolucent
Radiopaque is often seen without the aid of contrast
Radiolucent is best seen with the aid of barium swallow
Two projections 90 degrees from each other required to truly determine object is lodged in esophagus
Foreign bodies
6 causes of perforation of the esophagus
Esophagitis Peptic ulcer Neoplasm External trauma Instrumentation Severe vomiting (the most common cause) or coughing, often from dietary or alcoholic indiscretion
Inflammation of the stomach mucosa
Changes the normal surface pattern of the gastric mucosa
Gastritis
Alcohol
Corrosive agents
Infection (helicobacter pylori can cause chronic gastritis that may lead to peptic ulcer disease)
3 irritants that cause gastritis
Two muscular layers of the pylorus become hyperplastic and hypertrophic
Causes are thought to be a combination of environmental and hereditary factors
Demonstrates as: lengthening of the gastric antrum and pyloric canal or edematous and thickened mucosa
Causes obstruction (incomplete or complete), preventing food from entering into the duodenum.
Can be palpated and is often described as a mobile, hard “olive”
Pyloric stenosis
Infantile hypertrophic pyloric stenosis (IHPS)
A group of inflammatory processes involving the stomach and duodenum caused by the action of acid and the enzyme pepsin secreted by the stomach
Most common location is the lesser curvature
Disease spectrum varies from small and shallow superficial erosions to huge ulcers that may perforate
Most common cause of acute upper gastrointestinal bleeding
Duodenal is the most common manifestation
Majority occur in the duodenal bulb
Peptic ulcer disease
3 major complications of peptic ulcer disease
Hemorrhage (20%)
Gastric outlet obstruction (5-10%)
Perforation (<5%)
Rare in the United States; prevalent in Japan, Chile, and parts of Eastern Europe
Pain is not an early symptom, so diagnosis usually occurs late stage and prognosis is poor
Predisposing risk factors: atrophic gastric mucosa, as in pernicious anemia or 10 to 20 years after a partial gastrectomy for peptic ulcer disease
Cancer of the stomach
Malignancy of the lymphoreticular system
Gastric lymphoma often is seen as a large, bulky polypoid mass, usually irregular and ulcerated
It may be indistinguishable from a carcinoma
Lymphoma of the stomach
The lack of the development of the esophageal lumen resulting in a blind pouch
Esophageal atresia
An idiopathic, chronic, inflammatory disorder
Most often involves the terminal area of the ileum but can affect any part of the GI tract
Most common in young adults
Cause is unknown, but stress or emotional upsets are frequently related to the onset or relapse of the disease
Crohn’s disease
Most often caused by fibrous adhesions from previous surgery (75%)
Second most common cause is hernias
Other causes: luminal occlusion (gallstone, intussusception) or intrinsic lesions (neoplastic or inflammatory strictures, vascular insufficiency)
Small bowel obstruction
Occurs more often than mechanical bowel obstruction
A common disorder of intestinal motor activity
Fluid and gas do not progress normally through a nonobstructed small and large bowel
Neural, hormonal, and metabolic factors can trigger reflexes that impede intestinal motility
It occurs in almost every patient who undergoes abdominal surgery
Other causes: peritonitis, medications that decrease intestinal peristalsis (those with an atropine-like effect), electrolyte and metabolic disorders, or trauma
Adynamic ileus/paralytic ileus
The telescoping of one part of the intestinal tract into another because of peristalsis
It forces the proximal segment of bowel to move distally within the outer portion
A major cause of obstruction in children
Intussusception
This refers to a multitude of conditions in which there is defective absorption of carbohydrates, proteins, and fats from the small bowel that results in steatorrhea
Malabsorption disorders
The passage of bulky, foul-smelling, high-fat-content stools that float
Steatorrhea
The inflammation of the appendix
Causes: obstruction of fluid flow by fecalith or scarring
Complications: gangrene, abscess, or perforation
More common in children
Develops when the neck of the appendix becomes blocked
Appendicitis
Outpouchings that are acquired herniations of mucosa and submucosa through the muscular layers at points of weakness in the bowel wall
Incidence increases with age, can be demonstrated in half of persons older than 60
Occurs most commonly in the sigmoid portion
Can be cancerous
Diverticulosis
A complication of diverticulosis defined as necrosing inflammation in the diverticula
Complications: perforation, abscess, or fistulas to adjacent organs
Estimated 20% of patients with diverticulosis develop this
Diverticulitis
An idiopathic inflammatory disease of the bowel
May have an autoimmune or psychogenic factor (stress exacerbates condition)
A characteristic feature is alternating periods of remission and relapse
Increased risk of malignancy associated
Ulcerative colitis
The second major cause of inflammatory bowel disease
Identical to Crohn’s disease in the small bowel
Must be differentiated from ulcerative colitis
Most commonly affects the proximal colon
Most also have disease of the terminal ileum
Rarely affects the rectum
Crohn’s colitis
Characterized by the abrupt onset of lower abdominal pain and rectal bleeding
Diarrhea is common
Often accompanied by abdominal tenderness
Most common in those over 50 years old
Most have a history of cardiovascular disease
Ischemic colitis
Refers to several conditions that have an alteration in intestinal motility as the underlying pathophysiologic abnormality
Most common symptoms are alternating periods of constipation and diarrhea
Irritable bowel syndrome
The third leading cause of cancer death in the United States even though is can be easily diagnosed
Peak age incidence is 50 to 70 years old
Twice as common in men.
Predisposing factors: long-term ulcerative colitis and familial polyposis
Cancer of the colon
About 70% result from primary colonic carcinoma
Diverticulitis and volvulus account for most other cases
It is usually less acute than small bowel obstructions
Symptoms develop more slowly
Fewer fluid and electrolyte disturbances are produced
Large bowel obstructions
A twisting of the bowel on itself that may cause obstruction
Volvulus
2 most common sites of volvulus
Cecum Sigmoid (more commonly found in elderly, results from a low-fiber diet causing constipation)
Varicose veins of the distal rectum
Symptoms include pain, itching, and bleeding
Caused by increased venous pressure, such as with: constipation, pelvic tumor, or pregnancy
Hemorrhoids
2 major types of gallstones
Cholesterol (predominant type in the United States)
Pigment
Predispositions: family history, over age 40, overweight, female
Ultrasound is the imaging modality of choice to diagnosis
Oral cholecystography (OCG) was the traditional technique for diagnosis
Gallstones (cholelithiasis)
Acute inflammation of the gallbladder usually caused by cystic duct obstruction by a gallstone
Acute cholecystitis
Rare condition that occurs when stasis, ischemia, and cystic duct obstruction (stones) allow the growth of gas-forming organisms in the gallbladder that occurs most commonly in elderly men and in patients with poorly controlled diabetes mellitus
Emphysematous cholecystitis
Calcification of the gallbladder walls caused by chronic cholecystitis
Walls become fibrous, then calcified
Porcelain gallbladder
Most prevalent inflammatory disease of the liver
Hepatitis
Transmitted in the digestive tract from oral or fecal contact
Hepatitis A virus (HAV)
Contracted by exposure to contaminated blood or blood products and sexual contact
Healthcare workers are at risk of exposure
Vaccine is available and often required for employment
Hepatitis B virus (HBV)
The common cause of chronic hepatitis and cirrhosis
Contracted by blood transfusion or sexual contact
Hepatitis C virus (HCV)
Self-limited and acquired by the ingestion of food or water that has been contaminated by fecal matter
Hepatitis E virus (HEV)
The chronic destruction of liver cells and structure, with nodular regeneration of liver parenchyma and fibrosis
An end-stage liver disease
The major cause is chronic alcoholism (i.e., 10 to 20 years of alcohol abuse) in which damage to the liver is related either to the toxic effect of alcohol or to the malnutrition that frequently accompanies chronic alcoholism
Large amount of fat accumulates within the liver
Other causes: postnecrotic viral hepatitis, hepatotoxic drugs and chemicals, biliary cirrhosis, hemochromatosis
Most characteristic symptom: ascites
Incurable and irreversible
Cirrhosis
Fluid accumulation in the abdomen
Ascites
Primary liver cell cancer most common in those with cirrhosis or alcoholic
CT is modality of choice for diagnosis
Hepatocellular carcinoma
The most common malignancy of the liver
Diagnosed via: CT, US, MRI, or NM
Prognosis is very poor
Hepatic metastasis
Inflammatory process in which protein- and lipid-digesting enzymes become activated within the pancreas and begin to digest the organ itself
Most common cause: excessive alcohol consumption
Other causes: gallstones obstructing bile flow
US and CT
Acute pancreatitis
Results when frequent injury to the pancreas causes scar tissue
Recurring episodes usually result from chronic alcohol abuse
Causes the gland to lose its ability to produce digestive enzymes, insulin, and glucagon
Three symptoms: pain, malabsorption causing weight loss, and diabetes
Imaging appearance: pancreatic calcifications
Chronic pancreatitis
Walled-off fluid collections that occur due to inflammation, necrosis, or hemorrhage
Causes: acute pancreatitis or trauma
X-ray, CT, US
Pancreatic pseudocyst
Most common type of cancer of the pancreas
Usually advanced at time of diagnosis and prognosis is poor
Adenocarcinoma
Where is the most common site of cancer of the pancreas?
Head of the pancreas
3 other less common pancreatic tumors
Insulinoma
Gastrinoma
Diarrheogenic islet cell tumors
Pneumoperitoneum is defined as free air in the peritoneal cavity
Causes: perforation of a gas-containing viscus (surgical emergency), abdominal, gynecologic, intrathoracic, or iatrogenic causes (does not require operative intervention)
Imaging appearance: gas accumulates beneath the domes of the diaphragm
Pneumoperitoneum
Enlargement of the spleen associated with numerous conditions, including: infections (subacute bacterial endocarditis, tuberculosis, infectious mononucleosis, malaria), connective tissue disorders, neoplastic hematologic disorders (lymphoma, leukemia), hemolytic anemia, hemoglobinopathies, or portal hypertension (cirrhosis)
Splenomegaly
Most common cause is trauma
Rapid blood loss usually requires immediate surgery
May be a complication of the palpation of a spleen enlarged by infection (especially infectious mononucleosis) or leukemia
Splenic rupture
