Digestive System Flashcards
ACCESSORY GLANDS
Glands that secrete digestive enzymes into the alimentary canal
- Salivary glands
- Liver
- Gallbladder
- Pancreas
ALIMENTARY CANAL
A musculomembranous tube, extending from the mouth to the anus
ESOPHAGUS
Muscular tube that carries food and saliva from the laryngopharynx to the stomach.
- Approximately 24cm long 2 cm in diameter
- starts from C6
- passes through the diaphragm at the level of T10
- Terminal end at the cardiac atrium T11
- it has four layers fibrous-muscular - submucosal - Mucosal
STOMACH
Dilated sac like portion of the alimentary canal that secrete enzymes and mix them with food to break it down into chyme.
STOMACH DIVISIONS
- cardia- adjacent to the cardiac atrium
- Fundus- most superior Portion
- Body- central portion , with an innermost layer filled with ruggae
- Pyloric portion - distal portion that is connected to the duodenum
STOMACH BORDERS
- Lesser curvature- from oesophagus to the angular notch
- Greater curvature- from the cardiac notch to the pylorus
SMALL INTESTINE
Extends from the pyloric sphincter to he ileocecal valve
- About 6,5 m Long with a graduating diameter ranging from 4 cm to 2,5cm
- Has a four Layers same as the stomach
- Mucosa lined with ViLLi
= Dividende into three portions
- Duodenum- jejunum - ileum
SUSPENSORY LIGAMENT OF THE DUODENUM
Ligament of Treitz
LARGE INTESTINE
Abut 1,5 m Long . Lines the periphery of the abdomen, surrounds the small intestine and ends at the anus.
Divided into 4 parts+
- Cecum
- Colon- ascending , transverse, descending and sigmoid
- Rectum
- Anal canal
Main function is reabsorption of water and elimination of waste
HAUSTRA
Series of muscle tone which form a series of pouches
LIVER
Largest gland in the body,
Divisions =
- Right and left major lobes
- Two minor lobes- caudate and Quadrate lobes
- Liver hilum, or Porta hepatic
Function is to produce and secrete bile for fat emulsification
BILIARY SYSTEM
Consists of a series of ducts and the gallbladder =
- Right and left hepatic ducts
- Cystic duct
- Common hepatic
Common bile duct
Gallbladder
Pear shaped organ situated on the visceral surface of the liver.
it’s function is to store bile and secreteit when cholecystokinin is secreted. Y the duodenum
PANCREAS
Accessory digestive organ located along the posterior abdominal wall.
- Measures about 14 cm long and consists of four parts=
- Head- broadest portion
- Neck- curved portion between the head and body
- Body- passes posterior to the stomach.
- tail- passes behind the stomach
Has =
- Exocrine cells which produce pancreatic juice
- Endocrine cells which produce insulin and glucagon
SLPEEN
Bean shaped lymphatic organ that measures about 13x7,6x 3,8cm
It’s ruction is to produce lymphocytes and remove dead red blood cells
ERCP
Endoscopic Retrograde Cholangiopancreatography
- Used to diagnose biliary and pancreatic pathological conditions
- It is a diagnostic and therapeutic procedure
= Diagnostic- May identify stones and stenosis
= Therapeutic - Opening of stenosis with ballooning, stenting and removal of stones
ERCP PROJECTION PA OBLIQUE LAO
STRUCTURES DEMONSTRATED
Biliary tree moved away from the vertebral column
- Intrahepatic ducts
- Cystic duct
- Common bile duct
- Pancreatic ducts
ERCP PA PROJECTION
STRUCTURES DEMONSTRATED
- Common bile duct
- Cystic duct into gallbladder
- Gallbladder
- Common hepatic duct
- Intra hepatic duct within the liver
ESOPHAGEAL ATRESIA
Incomplete development of the esophagus
Clinical signs= New born will cough and experience respiratory distress and excessive drooling
IMAGING = Barium swallow
TRACHEOESOPHAGEAL FISTULA
Abnormal connection between the esophagus and the trachea
Clinical signs= New born will cough and experience respiratory distress and excessive drooling
IMAGING = Barium swallow
ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA
RADIOGRAPHIC APPEARANCE
- Positive contrast media ( Barium ) administered
- Esophagus ends as a blind pouch
- If TE is present , food , liquids and contrast, maybe aspirated
ZENKERS DIVERTICULUM
- Out pouching On the posterior wall of the upper esophagus
- The mucosa and submucosa of the esophagus protrudes through the muscular layer
= Clinical signs
- Dysphagia( difficulty in swallowing)
- Foul breath
= Imaging
- Barium swallow lateral view is best
ZENKERS DIVERTICULUM RADIOGRAPHIC APPEARANCE
- Positive contrast media is administered ( Barium)
- In the area of the diverticulum, the barium filled out pouching will extend out beyond the wall of the esophagus
SCHATZKIS RING
A smooth, benign, circumferential, and narrow ring of tissue in the lower end of the esophagus usually located just above the junction of the esophagus with the stomach
= Clinical signs
- Maybe asymptomatic and overtime the ring narrows the esophagus diameter
- Patient may experience dysphagia
= Imaging
- UGI
SCHATZKIS RING RADIOGRAPHIC APPEARANCE
A barium filled esophagus demonstrates a narrowing at the gastroesophageal junction, often associated with a hiatal hernia
ESOPHAGEAL VARICES
Enlarged veins in the wall of the esophagus
- Clinical signs are gastric bleeding
= Imaging- Double contrast Barium swallow
ESOPHAGEAL VARICES
RADIOGRAPHIC APPEARANCE
Wavy border, thickening of fold, which appear as round filling defects resembling the beads of a rosary
ACHALASIA
When the lower end of the esophagus fails to relax, the cardiac sphincter remains constricted. Food will accumulate proximal to the stricture
- Caused by loss of ganglion cells in the lower end of the esophagus, neurological abnormality.
= Clinical signs
- Dysphagia
- Chest pain
- Heartburn
= Imaging - Barium swallow
ACHALASIA RADIOGRAPHIC APPEARANCE
- Distal tapered end of the esophagus
- Ray tail or Beak Appearance
- Detailed esophagus proximal to the stricture
HIATAL HERNIA
- Incompetent Esophageal hiatus with in diaphragm, condition ranges from the Esophagogastric junction to parts of the stomach and small intestine lying with in the thoracic cavity
= Clinical signs
- Heartburn
- Chest pain
- Gastroesophageal Reflux Disease ( GERD) mayoccur
= Imaging
- Upper gastrointestinal series
HIATAL HERNIA
RADIOGRAPHIC APPEARANCE
- Barium filled lower end of esophagus and or stomach seen above the diaphragm
- Stomach is identified with in the thoracic cavity by its folds, rugae, outlined by the barium
ESOPHAGEAL CANCER
- Poor prognosis
- Incidence in >40 years of age
- Commonly occur at the esophagogastric junction
Clinical signs=
- Dysphagia
Imaging =
- Barium Swallow
- CT
ESOPHAGEAL CANCER
RADIOGRAPHIC APPEARANCE
- = Barium swallow =
- In early signs are flat plaque like lesions along the wall of the esophagus
- Later stages demonstrate luminal narrowing and an irregular wall
CT=
- Wall thickening
PEPTIC ULCER DISEASE
An inflammatory condition of the stomach and duodenum, primarily caused by an infection from bacteria known as Helicobacter pylori. Mostly found in the lesser curvature of the stomach
Clinical signs=
- Heart burn
- Burning pain in the addomen
Imaging =
Upper Gastrointestinal series
PEPTIC ULCER DISEASE
RADIOGRAPHIC APPEARANCE
A persistent collection of barium that extends outward from the lumen beyond the contours of the stomach. ( stick out lesion ).
Ulcer usually has radiating folds which typically extend to the ulcer margin and a surrounding margin of Edema that varies in size
DUODENAL ULCER
More common than stomach ulcers,
- mainly caused by Helocobacter pylori
- Found mostly in the duodenal bulb
Clinical signs =
- Heart burn
- Burning pain in the abdomen
- Complications May be hemorrhaging, perforation and obstruction
Imaging =
- UGI
DUODENAL ULCER
RADIOGRAPHIC APPEARANCE
- A persistent collection of contrast material
- I is unusual to see a duodenal ulcer as a stick out lesion
- A healing duodenal ulcer may resemble a cloverleaf deformity
HYPERTROPHIC PYLORIC STENOSIS
A congenital condition which is the narrowing of the pylorus causing partial or complete obstruction of the opening between the stomach and the duodenum
Clinical signs =
- Regurgitation and possibly aspiration of milk or formula
- Child will experience projectile vomiting immediately following feeding
- Vomitus will contain milk no bile
Imaging =
- Ultrasound
- Abdominal series
- UGI
HYPERTROPHIC PYLORIC STENOSIS
RADIOGRAPHIC APPEARANCE
Abdominal series-=
- Air filled stomach with little air in the small and large intestine
UGI=
- Delayed emptying of barium from the stomach to the duodenum.
- Baby maybe placed in RAO position to assist with peristalsis
- Delayed images maybe taken to confirm HPS
STOMACH VOLVULUS
A twisting or rotation of the stomach more than 180 deg, there are two types
1 Stomach rotates around an axis that connects the gastroesophageal junction and the pylorus
2 The axis bisects the lesser and greater curvatures
- Ofeten associated with paraesophageal hiatus hernias
- Produces an upside down stomach
Clinical signs =
- Epigastric pain
- LUQ pain
- Retching with no vomitus
Imaging =
- Abdominal series
- UGI
- CT
STOMACH VOLVULUS
RADIOGRAPHIC APPEARANCE
Abdominal series =
- Image May show a distended air filled stomach with one or two air fluid levels
UGI=
- Barium may not enter the stomach and or the duodenum due to obstruction
- Stomach May be seen herniating into the thoracic cavity
- Demonstration of displaced antrum of the stomach or inversion of greater and lesser curvature
STOMACH CANCER / ADENOCARCINOMA
Neoplasm in the distal third of the stomach on the lesser curvature
Imaging=
- Double contrast UGI
- CT
STOMACH CANCER / ADENOCARCINOMA
RADIOGRAPHIC APPEARANCE
UGI=
- Lesion protrudes into the lumen and produces a filling defect
- Thickened irregular wall
CT =
- Intra luminal mass
- Wall thickening
SMALL BOWEL OBSTRUCTION
- May be caused by intussusception , neoplasms, inflammatory disease
- Peristalsis will continue as compared to a functional obstruction
- Proximal of the obstruction the bowel loops will the dilated and filled with swallowed air and intestinal fluid
- Section Distal to obstruction and the large bowel will be empty
Clinical signs=
- Abdominal pain
- Constipation
Imaging =
- Abdominal series
SMALL BOWEL OBSTRUCTION
RADIOGRAPHIC APPEARANCE
- Small bowel loops stack up on one another forming a stepladder appearance beginning in the left upper quadrant proceeding to the right lower quadrant
- Bi air in the sigmoid and rectum
FUNCTIONAL OBSTRUCTION PARALYTIC ILEUS
Lack of peristalsis in the small and large bowel ,
- often seen in post op patients of abdominal and pelvic surgery
Clinical signs =
- Abdominal pain
- Abdominal distension
Imaging =
- Abdominal series
FUNCTIONAL OBSTRUCTION PARALYTIC ILEUS
RADIOGRAPHIC APPEARANCE
- Multiple dilated loops of small and large bowel -
- Air seen in the sigmoid and rectum
- Multiple air fluid levels
CROHNS DISEASE / REGIONAL ENTERITIS
Chronic inflammatory disease often involving the terminal ileum
- This disease can inflict any part of the GI system
- All layers of the internal wall are involved
- Common in young adults
Clinical signs =
- Sever diarrhoea
- Bloody stool-
- RLQ pain
- Weight loss
Imaging =
- Small Bowel Follow through
- CT abdomen and pelvis
CROHNS DISEASE / REGIONAL ENTERITIS
RADIOGRAPHIC APPEARANCE
Follow through =
- Cobblestone appearance produced by transverse and longitudinal ulcerations separating spaces of thick mucosa and submucosa
- String sign, narrowed ridged segments of small bowel, mucosal patterns is lost
- Skip lesions
- Fistula formations
- proud loops
INTUSSUSCEPTION
Telescoping of one part of the intestinal tract into another because of peristalsis, which forces the proximal bowel to move dismally,
Commonly seen in children
Common area is ileum into the cecum
Clinical signs=
- Abdominal pain
- Abdominal stools bloody and mucus
- Swollen abdomen, possibly palpable Masson the right side
Imaging =
- Abdominal series
- CT Abdomen and pelvis
- Barium Enema
INTUSSUSCEPTION
RADIOGRAPHIC APPEARANCE
CT
- Three concentric circles forming a soft tissue mass
Barium Enema
- Convex filling defect and a coiled spring sign
- BE May reduce the intussusception
VOLVULUS
A loop of bowel twisted on it’s mesntery
- The twisting may impede the flow of blood causing bowel ischemic necrosis
- Commonly affects the sigmoid colon in adults
- Commonly affects the small intestine in children
Clinical signs=
- Abdominal pain
- Nausea and vomiting
- Bloody stool
Imaging =
- AbdominalSeries
- Barium Enema
VOLVULUS
RADIOGRAPHIC APPEARANCE
Abdominal series
- Dilated air filled sigmoid colon projecting upwards from the pelvis
Barium Enema
- Advancing barium will demonstrate a narrowing with in the sigmoid colon
Beak Sign - BE May reduce the VOLVULUS
ULCERATIVE COLITIS
Inflammatory bowel disease of unknown cause
- Involves the mucosal layer of the colon
- Begins in the recto sigmoid area with continuous involvement throughout the colon
Clinical signs=
- Abdominal pain and weight loss
- Blood in stool
- Diarrhoea
- Periods of remission when no symptoms are experienced
imaging=
- Barium Enema
- CT
ULCERATIVE COLITIS
RADIOGRAPHIC APPEARANCE
- Collar- button- Intraluminal ulcers
- Lead pipe=
- Colon May appear as a rigid tubular structure
- Muscular spasm cause shortening and rigidity of the colon with loss of Haustral markings
DIVERTICULITIS
Inflammatory condition Out pouching representing a herniation of the mucosa and submucosa through a defect in the muscular layer. ( Stick out lesion )
- More prevalent in elderly patients
- Numerous diverticulum appear together
- Usually begin in the recto sigmoid area and May progress throughout the colon
Clinical signs=
- Maybe asymptomatic
- Abdominal pain
- Rectal bleeding
- Diarrhoea or constipation
Imaging=
- CT
- Barium Enema
DIVERTICULITIS
RADIOGRAPHIC APPEARANCE
CT
- Smooth collection of air or contrast
BE
- Round out pouching of barium and or air projected beyond the lumen
LARGE BOWEL OBSTRUCTION
Maybe caused by carcinoma, diverticulitis, VOLVULUS, intussusception and hernias
- Perforation of bowel is a concern
Clinical signs =
- Abdominal distension
- Abdominal pain
- Nausea and vomiting ( May vomit some feces )
Imaging =
- Abdominal Series
- Barium Enema
- CT Abdomen and Pelvis
LARGE BOWEL OBSTRUCTION
RADIOGRAPHIC APPEARANCE
Abdominal series =
- Bowel is dilated with air proximal to the obstruction, little air is seen in the small bowel if the ileocecal valve is competent
- If ileocecal valve is incompetent l there is distension of gas filled loops of both colon and small bowel
- Air fluid levels
BE and CT
- May display the cause of the obstruction e,g apple- core carcinoma
- large bowel is dilated to the point of the obstruction then normal in calibre distal to the obstructing lesion
POLYPS
Polyp is an abnormal growth on the mucosa of the colon
PEDUNCULATED POLYP
Polyp which are attached to the mucosa by an elongated stalk
Commonly benign
Clinical signs =
- Asymptomatic
- Occasionally rectal bleed ing , diarrhoea and or constipation
- Polyps may lead to intussusception
SESSILE POLYP
Polyps that do not project into the lumen of the colon, they are attached to the inner wall.
- Considered precancerous therefore removed during a colonoscopy
Clinical signs =
- Asymptomatic
- Occasionally rectal bleed ing , diarrhoea and or constipation
- Polyps may lead to intussusception
COLON CANCER / ADENOCARCINOMA
Commonly occurs in the rectum and the sigmoid area.
- Patients with ulcerative colitis and multiple polyps are susceptible to developing colon cancer
Clinical signs =
- Weight loss
- Fatigue
- Red or dark blood in stool
Imaging =
- Barium Enema
- CT
COLON CANCER / ADENOCARCINOMA
RADIOGRAPHIC APPEARANCE
Construction of the lumen producing the Apple-Core lesion or napkin ring
IMPERFORATE ANUS
A congenital abnormality , anal canal and or rectum fails to develop normally
Clinical signs =
- Baby does not pass stool within the first few hours of birth
- Missing or moved opening to anus
Imaging
- Prone decubitus image
Treatment =
- Anal stenosis: Treated by manual dilators
- Anal Reconstruction: Surgery
