Chapter 29 - Stomach and Duodenum (CHERI NOTES) Flashcards
__ technique entail using small amounts of barium to coat the mucosa without distending the bowel to demonstrate abnormalities such as varices. (p.752)
MUCOSAL RELIEF VIEWS
____ technique;using high-density barium suspensions
to coat the mucosa and ingestible effervescent granules
to distend the stomach and duodenum. (p.752)
DOUBLE-CONTRAST TECHNIQUE
- this is optimal for the demonstration
of subtle features of the mucosal
surface
____ infection has been identified as the major cause
of chronic gastritis; duodenitis; benign gastric and
duodenal ulcers; gastric adenoCA and MALT lymphoma.
(p.753)
H.pylori infection
- a gram-negative spiral bacillus that colonizes
the stomachs in as many as 80% of individuals
in some populations.
H.pylori infection will only infect ____ epithelium
and is usually localized to the gastric ___
living on the surface epithelial cells
beneath the mucous coat. (p.753)
GASTRIC-LIKE epithelium;
gastric ANTRUM
- it survives in gastric acid by using a powerful urease enzyme to break down urea into ammonia and bicarbonate; creating a more alkaline environment for itself.
TRUE OR FALSE.
The prevalence of H.pylori infection increases with
age (>50% of Americans older than 60 years) and is high
in lower socioeconomic populations and in
developing countries. (p.753)
TRUE
TRUE OR FALSE.
Double-contrast technique
demonstrates enlarged areae gastricae in 50% of
patients with H.pylori infection.
TRUE
_____ is the third most common GI malignancy;
folliwing colon and pancreatic CA. (p.753)
GASTRIC CARCINOMA
- most 95% are ADENOCARCINOMAS; the
remainder are diffuse anaplastic (signet-ring)
carcinoma; squamous cell carcinoma; or
rare cell types. - incidence of gastric CA is as much as five
times higher in Japan; Finland; Chile and Iceland
than in the United States. - mortality is high with a 5-year survival rate
of 10% to 20%
4 predisposing factors of Gastric CA. (p.753)
- smoking
- pernicious anemia
- atrophic gastritis
- Gastrojejunostomy
- H.pylori infection increases the risk of gastric CA sixfold and is the cause of approximately half of gastric adenoCA cases. - peak age is from 50 to 70 years; with males predominating 2:1.
4 common morphologic growth
growth patterns of Gastric CA. (p.754)
- POLYPOID masses
- ULCERATIVE masses
- INFILTRATING
tumors;
FOCAL PLAQUE-like
lesions with central
ulcer or diffusely
infiltrating (15%);
DIFFUSELY INFILTRATING
(15%) with poorly
differentiated
carcinomatous cells
producing bizarre
thickened folds and
thickened rigid stomach
wall; the so-called
scirrhous carcinomas
The terms “____” and “____” may be applied
to describe the resulting stiff narrowed
stomach.
LINITIS PLASTICA;
WATER-BOTTLE
STOMACH
The GASTRIC CA tumor spreads by \_\_\_\_\_\_ through the gastric wall to involve the perigastric fat and adjacent organs; or it may seed the peritoneal cavity. (p.754)
DIRECT INVASION
lymphatic spread is to the regional
lymph nodes including perigastric
nodes along the lesser curvature;
celiac axis; and hepatoduodenal
Lymphatic spread of Gastric CA is to the
regional lymph nodes including perigastric
nodes along the _____. (p.754)
- LESSER CURVATURE
- CELIAC AXIS
- HEPATODUODENAL
- RETROPANCREATIC
- MESENTERIC
- PARAAORTIC NODES
Hematogenous metastases involve the
___; ____; ____and rarely ____ and ___.
(p.754)
- ADRENAL GLANDS
- OVARIES
- LIVER;
rarely BONE and LUNG
Intraperitoneal seeding of Gastric CA
presents as _____ or ____ tumors. (p.754)
CARCINOMATOSIS;
KRUKENBERG OVARIAN
TUMORS
- PET-CT is most effective in the
demonstration of metastatic
lymph nodes and distant spread
of tumor
Early gastric cancers appear on barium
studies as ___; ____ and ___. (p.754)
- Gastric polyps with risk of malignancy
increased for lesions larger than 1 cm - Superficial plaque-like lesions or nodular
mucosa - Shallow irregular ulcers with nodular
adjacent mucosa
- these lesions are most sensitively detected
on double-contrast studies.
CT and MR findings of gastric CA;
give 8. (p.754)
1. Focal;often irregular; wall thickening (>1 cm) 2. Diffuse wall thickening due to tumor infiltration (LINITIS PLASTICA) (contrast enhancement is common) 3. Intraluminal soft tissue mass 4. Bulky mass with ulceration 5. rare; large; exophytic tumor resembling leiomyosarcoma 6. extenstion of tumor into perigastric fat 7. regional lympadenopathy 8. metastases in the liver; adrenal and peritoneal cavity
TRUE OR FALSE.
Mucinous adenoCAs frequently
contain stippled calcifications.
(p.754)
TRUE
____ account for 2% of gastric neoplasms.
p.754
LYMPHOMA
The ____ is the most common site of
involvement of primary GI lymphoma;
accounting for approximately 50% of
cases. (p.754)
STOMACH
- most (80%) gastric lymphoma is Non-Hodgkin; B-cell type. -chronic infection of the gastric epithelium with H.pylori is associated with the risk of developing MALT gastric lymphomas; which are more indolent and have a better prognosis than B-cell lymphomas.
TRUE OR FALSE.
Gastric Lymphomas has a better prognosis
than carcinoma with a 5-year survival
rate of 62% to 90%. (p.754)
TRUE
- because lymphoma remains confined
to the bowel wall for long periods of time.
4 morphologic patterns of gastric
lymphoma. (p.755)
- POLYPOID SOLITARY MASS
- ULCERATIVE MASS
- MULTIPLE SUBMUCOSAL
NODULES - DIFFUSE INFILTRATION
DIAGNOSIS?
UGI FINDINGS OF:
1. Polypoid lesions
2. irregular ulcers with nodular thickened
folds
3. bulky tumors with large cavities
4. multiple submucosal nodules that
commonly ulcerate and create a target or
“bull’s eye” appearance
5. diffuse but pliable wall and fold thickening
6. rarely; linitis plastica appearance of diffuse;
stiff narrowing. (p.755)
GASTRIC LYMPHOMA
___ is the primary imaging modality used to
stage lymphoma. (p.755)
CT
5 CT findings that are helpful in differentiating
gastric lymphoma from carcinoma include
_____. (p.755)
- More marked thickening of the wall
(may exceed 3 cm) - Involvement of additional areas of
the GI tract (transpyloric spread of
lymphoma to the duodenum in 30% - Absence of invasion of perigastric fat
- Absence of luminal narrowing and
obstruction despite extensive involvement - More widespread and bulkier adenopathy.
____ are the most common mesenchymal
tumors to arise from the GI tract. (p.755)
GI STROMAL TUMORS (GISTs)
Most; but not all; tumors previously
classified as leiomyomas; leiomyosarcomas;
and leiomyoblastomas are now classified
as ___. (p.755-756)
GISTs
- approximately 60% to 70% of GISTs arise in the stomach; and 10% to 30% of these are malignant - true leiomyomas and leiomyosarcomas are very rare in the stomach - long-term silent growth to a large size is characteristic - the overlying mucosa is commonly ulcerated
TRUE OR FALSE.
Dystrophic calcifications are relatively
common in both benign and malignant tumors
(GISTs) and helps differentiate these lesions
from other gastric tumors.
TRUE
- on UGI series; GISTs appear as submucosal nodules and masses - ulceration causes a bull's eye- appearance and may be responsible for significant bleeding
CT is useful in characterizing GISTs because
they are predominantly ____. (p.756)
EXTRALUMINAL
- Benign tumors are smaller (4 to 5 cm; average size); are homogenous in density; and show uniform diffuse enhance- ment. - Malignant tumors tend to be larger (>10 cm) with central zones of low density caused by hemorrhage and necrosis and show irregular patterns of enhancement.
____ cancer metastases cause linitis
plastica. (p.756)
BREAST CANCER metastases
TRUE OR FALSE.
GASTRIC METASTASES may present as
submucosal nodules or ulcerated masses.
Most are hematogenous metastases. (p.756)
TRUE
- rich blood supply results in common
involvement of the stomach and small
bowel
3 common primary tumors with gastric
metastasis. (p.756)
- MELANOMA
- BREAST CA
- LUNG CA
TRUE OR FALSE.
KAPOSI SARCOMA; when disseminated in
patients with AIDS involves the GI tract in
50% of patients. (p.756)
TRUE
- double-contrast study demonstrate flat masses with or without ulceration; polypoid masses; irregularly thickened folds; multiple submucosal masses and linitis plastica. - CT demonstrates enhancing adenopathy in the porta hepatis; mesentery and retroperitoneum - bleeding is a common symptom and may require embolization
___ tumors are adenomatous polypoid
masses that produce multiple frond-like
projections.
- most are solitary and of 3 to 9 cm in size;
although giant tumors may be as large as
15 cm.
VILLOUS TUMORS
- malignant potential is high and varies with size of the lesion (50% for 2 to 4 cm lesions;80% for lesions >4 cm). (p.756)
DIAGNOSIS?
Barium trapped in the clefts between fronds
produces a characteristic soap-bubble
appearance. (p.756)
VILLOUS TUMORS
- the tumors are mobile and deform with
compression - all should be treated as malignant lesions.
___ are lesions that protrude into the lumen
as sessile or pedunculated masses. (p.756)
POLYPS
- Their appearance on double- contrast UGI series depends on whether they are on the dependent nondependent surface.
A polyp on the ___ surface appears
as a radiolucent filling defect in the barium
pool. (p.756)
DEPENDENT
A polyp on the ____ surface is covered with
a thin coat of barium. (p.756)
NON-DEPENDENT
The ____ sign is produced by the acute angle
of attachment of the polyp to the mucosa.
(p.756)
BOWLER HAT sign
The ___ sign consists of two concentric rings
and is produced by visualizing a
pedunculated polyp end-on.
MEXICAN HAT sign
- polyps are commonly
multiple
____ polyps account for 80% of gastric
polyps. (p.756)
HYPERPLASTIC polyps
- most are less than 15 mm in
diameter. - they are not neoplasms;
but rather hyperplastic
responses to mucosal
injury especially gastritis - they may be located
anywhere in stomach; - are frequently multiple;
have no malignant potential;
but are indicative of chronic
gastritis.
____ polyps account for 15% of gastric polyps
and are true neoplasms with malignant
potential. (p.757)
ADENOMATOUS polyps
- most are solitary; located in the ANTRUM; and are larger than 2 cm in diameter - polyps that are larger than 1 cm; lobulated or pedunculated should have biopsies taken of them because of the risk of malignancy
____ polyps occur in Peutz-Jeghers syndrome.
They have no malignant potential. (p.757)
HAMARTOMATOUS POLYPS
____ are submucosal neoplasms composed
of mature benign fatty. (p.757)
LIPOMAS
- UGI series reveals a smooth well-defined submucosal lesion that occasionally ulcerates. - CT provides a definitive diagnosis by the demonstration of sharply circumscribed wall mass with uniform fat attenuation
ECTOPIC PANCREAS is common intramural
lesion; usually found in the _____. (p.757)
ANTRUM
- lobules of heterotropic pancreatic tissue;
up to 5 cm in size; are covered by gastric
mucosa. - most are nipple shaped or cone shaped
with small central orifices
The term ____ refers to an intraluminal
gastric mass consisting of accumulated
ingested material. (p.757)
BEZOAR
- may be composed of a wide variety of substances - stones may be ingested or form with bezoar - any ingested foreign body may produce an intraluminal filling defect.
_____ are bezoars are composed of hair.
p.757
TRICHOBEZOARS
_____ are bezoars composed of fruit or
vegetable products. (p.757)
PHYTOBEZOARS
_____ are bezoars consist of tablets and
semi-solid masses of drugs. (p.757)
PHARMACOBEZOARS
TRUE OR FALSE.
EXTRINSIC MASSES on the dependent
surface produce ill-defined radiolucencies.
(p.757)
TRUE
-the mucosa may be impressed upon by an extrinsic mass and be seen in profile as a white line - pancreatic; splenic; hepatic and retroperitoneal masses may impress upon stomach - CT is excellent for demonstrating the nature of an extrinsic mass impression
Normal gastric folds are thicker and more
undulated in the ___ stomach and along
the ____ curvature. (p.758)
PROXIMAL stomach and along
the GREATER curvature
- they have smooth contour and taper distally - gastric distention causes the folds to become thinner; straighter and less prominent - normal rugal folds consist of both mucosa and submucosa and may become thickened by disease processes that infiltrate these layers
TRUE OR FALSE.
GASTRITIS is much more common than
gastric ulcers. (p.758)
TRUE
The hallmarks of gastritis are ______ and
_______. (p.758)
THICKENED FOLDS and
SUPERFICIAL MUCOSAL
ULCERATIONS (EROSIONS)
- the thickened folds are
usually caused by mucosal
edema and superficial
inflammatory infiltrate
____ are defined as defects in the mucosa
that do not penetrate beyond the
muscularis mucosae. (p.758)
EROSIONS
___ ulcers (also called ___) are complete
erosions that appear as tiny central flecks
of barium surrounded by a radiolucent halo
of edema. (p.758)
APTHOUS ULCERS
(also called VARIOLIFORM
EROSIONS)
____ erosions appear as linear streaks and
dots of barium. (p.758)
INCOMPLETE EROSIONS
- erosions heal without scarring
- barium precipitates may
mimic erosions; appearing
as distinct punctate barium
spots but without the
distinctive radiolucent halo
of a radiolucent halo of a true
erosion
_____ gastritis is the most common form
of gastritis and is the most common cause
of gastric folds. (p.758)
HELICOBACTER PYLORI
GASTRITIS
- almost all patients with
benign gastric and duodenal
ulcers have H.pylori gastritis.
DIAGNOSIS? \_\_\_\_\_\_ GASTRITIS UGI findings of: 1. thickening (<5 mm) of gastric folds 2. nodular folds; 3. erosions 4. antral narrowing 5. inflammatory polyps 6. enlarged gastric gastricae (p.758)
HELICOBACTER PYLORI
GASTRITIS
DIAGNOSIS? \_\_\_\_\_ GASTRITIS is most often caused by alcohol; aspirin and other NSAID agents or steroids Double-contrast UGI findings include: 1. erosions (aphthous ulcers) 2. thickened nodular folds in the antrum 3. limited distensibility of the antrum 4. wall stiffness and limited peristalsis (p.758)
EROSIVE Gastritis
DIAGNOSIS? \_\_\_\_\_ GASTRITIS
is a chronic autoimmune disease that
destroys the fundic mucosa but spares the
antral mucosa. (p. 758)
Characteristic UGI findings:
1. decreased of absent folds in the fundus
and body ("BALD FUNDUS")
2. narrowed; tube-shaped stomach
(fundal diameter < 8cm)
3. small (1 to 2mm) or absent areae
gastricae. (p.758)ATROPHIC Gastritis
- destruction of parietal cells results in decreased acid and intrinsic factor production that leads to Vit.B12 def. and pernicious anemia - antibodies to the parietal cells and intrinsic factors are found in peripheral blood samples.
