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Digestive System Flashcards

1
Q

Read the following list of esophageal pathologies:

A
  1. Esophageal Atresia
  2. Tracheoesophageal Fistula
  3. Gastroesophageal Reflux
  4. Achalasia
  5. Esophageal Cancer
  6. Esophageal Varices
  7. Esophageal Diverticuli
    Zenker’s diverticulum
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2
Q

What is Esophageal Atresia? What is it often asosiated with?

A

-Congenital absence or closure of the esophagus
-Often associated with tracheoesophageal fistulas

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3
Q

What is the main risk of Esophageal Atresia?

A

Aspiration Risk

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4
Q

What treatment is needed for esophageal Atresia?

A

Immediate surgery required after birth

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5
Q

What does Atresia mean?

A

Hasn’t formed properly and ends in a pouch

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6
Q

What does Fistula mean?

A

Abnormal connection between two things

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7
Q

What pathology is shown here?

A

Esophageal Atresia

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8
Q

What is Tracheoesophageal Fistula? What is this often assosiated with?

A

-Abnormal connection between the trachea and esophagus
-Associated with Esophageal Atresia

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9
Q

What are the 2 causes of Tracheoesophageal Fistula?

A
  1. Congenital
  2. Acquired (malignancy, trauma, infectious process)
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10
Q

Which of these is most common?

A

Atresia with proximal fistula (B)

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11
Q

What pathology is shown here?

A

Tracheaoesophageal fistula

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12
Q

What are the white arrows pointing to?

A

The airway

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13
Q

What pathology is seen here?

A

Tracheoesophageal Fistula

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14
Q

What are the radiographic signs of a Tracheoesophageal Fistula?

A

-Connection of the fistula between airway and esophagus
-Large dilation of the esophagus

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15
Q

What is Gastroesophageal Reflux (GERD)

A

Stomach acid refluxes into esophagus

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16
Q

What are 3 possible complications of Gastroesophageal Reflux (GERD)?

A
  1. Esophagitis
  2. Strictures; narrowing of the lumen (thicker walls of esophagus)
  3. Barrett’s Esophagus (specific)
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17
Q

What is this describing?

Premalignant diagnosis in which the esophagus changes to become more like the stomach. The Squamous lining replaced by columnar epithelius.

A

Barrett’s Esophagus

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18
Q

What foods should a patient with GERD avoid? Why?

A

Avoid chocolate, caffeine, alcohol because that relaxes the sphincter

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19
Q

T/F

A Sliding hernia can cause GERD.

A

True

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20
Q

What imaging is done to diagnose GERD?

A

Barium Swallow
(Using Valsalva maneuver, Toe Touch and Compression Paddle)

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21
Q

What pathology is seen here?

A

GERD stricture

-Damage to the walls
-Inflammation

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22
Q

What pathology is seen here?

A

GERD; Barretts esophagus

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23
Q

What patholgy is seen here?

A

Gastroesophageal Reflux (GERD)

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24
Q

What is Achalasia?

A

Functional obstruction of distal esophagus and incomplete relaxation of lower esophageal sphincter

-Not enough nerve cells going to the distal part of the esophagus stopping it from relaxing causing a stricture
-Compared to normal structure, area proximal is very big

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25
Q

What physical symptom is seen with Achalasia?

A

Dysphagia (Difficulty swallowing)

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26
Q

What are the radiographic signs of Achalasia?

A
  1. Acute tapering of the distal esophagus-“Bird’s Beak” or “Rat’s Tail”

. Proximal to the diseased area is dilated

. Proximal to the diseased area is dilated
3. Tortuous, structure pushed out to the side

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27
Q

What pathology is seen here?

A

Achalasia

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28
Q

What pathology is seen here?

A

Achalasia

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29
Q

What pathology is seen here?

A

Achalasia

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30
Q

What pathology is seen here?

A

Achalasia

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31
Q

What is the most common site for Esophageal Cancer?

A

GE junction

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32
Q

What are the 2 types of Esophageal Cancer?

A
  1. Squamous Cell Carcinoma
  2. Adenocarcinoma
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33
Q

What is the cause of Squamous Cell Carcinoma of the esophagus?

A

Excessive alcohol or smoking

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34
Q

What is the cause of Adenocarcinoma of the esophagus?

A

Long-term acid reflux

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35
Q

What are the four physical signs of Esophageal Cancer?

A
  1. Progressive dysphagia (over time it gets harder to swallow)
  2. Hematemesis (vomiting of blood)
  3. Hoarseness (esophagus makes it harder to talk)
  4. Weight loss
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36
Q

What imaging is the best to evaluate esophageal cancer?

A

Endoscopy is the best to evaluate

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37
Q

What modality is best to evaluate esophageal cancer metastases?

A

CT and PET (Double-contrast barium swallow)

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38
Q

What are the 3 radiographic signs of esophageal cancer?

A
  1. Irregular stricture with over-hanging shoulders
  2. Pre-stricture dilation (cancer is ussually very irregular, overhanging shoulders-like rat bite lesion)
  3. Tracheal wall thickening (walls thicker)
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39
Q

What are the early signs of esophageal cancer?

A

Minimal reduction in lumen caliber, plaque-like lesion

Filling defect seen

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40
Q

What pathology is seen?

A

Esophageal Cancer

Early-plaque like lesion
Filling defect seen

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41
Q

What pathology is seen here?

A

Esophageal Cancer

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42
Q

What pathology is seen here?

A

Esophageal Cancer

arrow pointing to the lumen (the rest of the area around that is wall thickness), cancer starting to evade the wall

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43
Q

What is Esophageal Varices caused by?

A

Caused by portal hypertension in portal vein

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44
Q

What are Esophageal Varices?

A

Dilated veins in the walls of the esophagus

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45
Q

Where do Esophageal Varices ussually appear?

A

Usually in the distal esophagus

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46
Q

What is the risk assosicated with esophageal varices?

A

Risk of rupture

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47
Q

What treatments are offered for esophageal Varices?

A
  1. Blakemore tube inflated inside the stomach and esophagus
  2. TIPS (Transjugular Intrahepatic Portosystemic Shunt)
    -Shunt or bypass around portal vein
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48
Q

T/F

Patient has end stage liver disease, and they notice esophageal varacies, prognosis is not good

A

True

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49
Q

What imaging is done for esophageal varicies?

A
  1. Endoscopy
  2. Double contrast barium swallow (Valsalva maneuver, supine imaging)
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50
Q

What radiographic sign indicates esophageal varices?

A

Round, filling defects (“Rosary beads”)

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51
Q

What pathology is seen here?

A

Esophageal Varices

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52
Q

What pathology is seen here?

A

Esophageal Varices
(severe)

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53
Q

What is Esophageal Diverticuli?

A

Outpouching of the esophageal wall (part of the wall pushing outwards)

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54
Q

What 3 things can Esophageal Diverticuli
lead to?

A
  1. Dysphagia (trouble swallowing),
  2. halitosis (bad breath),
  3. aspiration pneumonia (food pushed out and goes into trach)
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55
Q

What are the 2 types of Esophageal Diverticuli?

A

True and False

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56
Q

What is true Esophageal Diverticuli?

A

all layers of the wall out pouch

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57
Q

What is false Esophageal Diverticuli?

A

mucosa and submucosa out pouch

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58
Q

What is Zenker’s Diverticula? What type of Esophageal Diverticula is it?

A

-Type of Esophageal Diverticula on the posterior wall of upper esophagus
-False diverticula

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59
Q

What pathology is seen here?

A

Zenker’s Diverticula

-Large impact on swallowing

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60
Q

What are the four pathologies of the stomach?

A
  1. Hiatal Hernia
  2. Hypertrophic Pyloric Stenosis
  3. Peptic Ulcer Disease
  4. Cancer of the Stomach
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61
Q

What is a Hiatal Hernia?

A

Protrusion of a portion of the stomach into thoracic cavity through the esophageal hiatus

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62
Q

What are the 2 types of Hiatal Hernias?

A

Large and sliding

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63
Q

T/F

50% of the population gets a hernia at some point

A

True

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64
Q

What is the risk of a large Hiatal Hernia?

A

Risk of volvulus

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65
Q

Where is a large hiatal hernia located?

A

Portion of stomach in thoracic cavity

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66
Q

What type of hernia is more common?

A

Sliding

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67
Q

When does a sliding hernia appear?

A

Emerges with pressure differences

Not permently there

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68
Q

What sign indicated a hiatus hernia?

A

3 gastric folds above the hiatus indicates hiatal hernia

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69
Q

What pathology is shown here?

A

Hiatal Hernia

Air bubble and enlarged heart shadow

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70
Q

What pathology is shown here?

A

Hiatal Hernia

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71
Q

What pathology is shown here?

A

Hiatal Hernia

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72
Q

What pathology is shown here?

A

Hiatal Hernia

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73
Q

What age is Hypertrophic Pyloric Stenosis most common in?

A

Pediatrics

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74
Q

What pathology is this describing?

Hypertrophy and hyperplasia of the muscular layers of the pylorus

A

Hypertrophic Pyloric Stenosis

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75
Q

What is the cause of Hypertrophic Pyloric Stenosis?

A

Congenital cause

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76
Q

What are the two (non radiographic) signs/symptoms of Hypertrophic Pyloric Stenosis?

A
  1. Projectile vomiting: Causes the milk to come out
  2. Palpable olive (can feel the muscular area)
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77
Q

What is the modailty of choice for Hypertrophic Pyloric Stenosis? Why? What other modailty is used?

A

Ultrasound is the modality of choice (because it is non-ionizing and good at showing soft tissue structures of the abdomen)
-Fluroscopy is also used

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78
Q

What are the ultrasound signs of Hypertrophic Pyloric Stenosis?

A

Doughnut” or “target” on transverse image (thick wall around pylorus)

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79
Q

What are the fluoroscopic radiographic signs of Hypertrophic Pyloric Stenosis?

A

Elongated pylorus with a thickened wall

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80
Q

What pathology is shown here?

A

Hypertrophic Pyloric Stenosis

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81
Q

What pathology is shown here?

A

Hypertrophic Pyloric Stenosis

Lumen almost completely blocked off

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82
Q

Hypertrophic Pyloric Stenosis treated?

A

Fixes surgically once they find it

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83
Q

What is an ulcer?

A

Ulcer: Breakdown of the skin causing an open sore that won’t heal well

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84
Q

What are the 2 types of ulcers seen with Peptic Ulcer Disease?

A
  1. Gastric Ulcer
  2. Duodenal Ulcer
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85
Q

What is the most common type of ulcer with Peptic Ulcer Disease?

A

Duodenal Ulcer

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86
Q

Where are the majority of gastric ulcers?

A

Majority are along the lesser curvature

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87
Q

Where are the majority of duodenal ulcers? What percentage is in this location?

A

95% occur in the first part of the duodenum (duodenal bulb)

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88
Q

T/F

Duodenal ulcers are almost always malignant

A

False; Duodenal ulcers are almost always benign

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89
Q

T/F

Gastric ulcers can only be benign.

A

False; Can be benign or malignant

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90
Q

What are the 3 causes of Peptic Ulcer Disease?

A
  1. Acid and pepsin
  2. Bacteria Helicobacter pylori (H pylori)
  3. NSAID’s (aspirin, ibuprofen and naproxen)
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91
Q

T/F

The radiographic appearance of Peptic Ulcer Disease varies from superficial erosion to pit that perforate through the entire wall

A

True

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92
Q

What is the risk of Peptic Ulcer Disease?

A

Complications from perforation

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93
Q

What are the complications from perforations that occur with Peptic Ulcer Disease?

A
  1. Pneumoperitoneum (“free air”)
  2. GI bleed (hematemesis or melena)
  3. Gastric Outlet Obstruction-Blocks the flow of food
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94
Q

What imaging is best to diagnose Peptic Ulcer Disease?

A

Endoscopy

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95
Q

What imaging is best if there is a perforation or bleed assosiated with Peptic Ulcer Disease?

A

CT

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96
Q

What pathology is shown here?

A

Peptic Ulcer Disease

Pit filled with Barium (notice mucosal folds around it-filling defect)

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97
Q

What pathology is shown here?

A

Peptic Ulcer Disease

Flower like appearance-end on view, pit filled with barium, swollen folds of barium around it

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98
Q

What pathology is shown here?

A

Peptic Ulcer Disease

-Images to the right=ulcer that has perforated
-D=Located in the duodenal bulb
-White arrow=Blood
-Circled: Free air in the abdomen

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99
Q

T/F

The prognosis is fairly good for the cancer of the stomach.

A

False; Poor prognosis

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100
Q

What is the most common type of cancer of the stomach?

A

Adenocarcinoma

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101
Q

What bacteria is cancer of the stomach assosiated with?

A

Associated with H Pylori Bacteria

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102
Q

What type of imaging is best for the diagnosis of cancer of the Stomach?

A

Endoscopy (+ biopsy)

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103
Q

What imaging is best to determine if there is metastases with Cancer of the Stomach?

A

CT

CT good for staging and showing the thick wall

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104
Q

What contrast is given in a CT scan for Cancer of the stomach?

A

Double contrast barium meal

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105
Q

What are the two radiographic signs of cancer of the stomach?

A
  1. Fibrotic wall with thickened, narrowed, fixated stomach
  2. Polyp-like mass with ulceration (mass coming inward into the lumen)
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106
Q

What pathology is shown here?

A

Cancer of the Stomach

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107
Q

What pathology is shown here?

A

Cancer of the Stomach

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108
Q

What pathology is shown here?

A

Cancer of the Stomach

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109
Q

What are the four pathologies of the small bowel?

A
  1. Crohn’s Disease-Can affect entire GI tract, most common in SB
  2. Small Bowel Obstruction
  3. Adynamic Ileus
  4. Intussusception
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110
Q

What is another name for Chron’s disease?

A

Regional Enteritis

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111
Q

Where does Crohn’s Disease affect the body?

A

Can affect any part of the GI tract but mostly affects the terminal ileum

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112
Q

What type of disorder is Chron’s disease?

A

Idiopathic inflammatory autoimmune disorder

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113
Q

What layers of the small bowel does inflammation and edma from Chron’s disease affect?

A

Diffuse inflammation and edema affecting all layers of the wall

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114
Q

T/F

With Chron’s disease, Ulcerations are common

A

True

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115
Q

What can flare ups from Chron’s disease be caused by?

A

Can be triggered with high amounts of stress

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116
Q

What can Chron’s disease lead to?

A

Can lead to small Bowel Obstructions or fistulas

(1/2 of patients with Crohn’s experience this)

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117
Q

What are 3 symptoms of Chron’s disease?

A
  1. Severe abdominal pain
  2. Diarrhea
  3. Blood in stool
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118
Q

What are 3 radiographic x-ray signs of Chron’s disease?

A
  1. String Sign”-From inflammation (barium looks like string)
  2. “Skip Lesions”-Area that is affected, skips a part of the bowel and will see it again (not big continuous region)
  3. “Cobblestone” appearance-Ulcerations appear longitudinal and transverse creating a ribbing pattern
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119
Q

What are the CT signs of Chron’s disease?

A

Comb sign in CT-More blood vessels, looks like string

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120
Q

What pathology is shown here?

A

Chron’s disease

String sign with skip lesions

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121
Q

What pathology is shown here?

A

Chron’s diseaes

Cobblestone appearance

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122
Q

What pathology is shown here?

A

Chron’s disease

A: Inflammation at the area of the terminal ileum
B: Can appreciate the thickened walls, narrow lumen, looks string like

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123
Q

T/F

Small bowel obstructions are more common than large bowel obstructions

A

True

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124
Q

What are the 3 causes of small bowel obstructions?

A
  1. Fibrous Adhesions (surgeries and inflammation)
  2. Hernias
  3. Neoplasms, Inflammatory lesions, Intussusception
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125
Q

What is the 3,6,9 rule?

A

3-6-9 Rule: Referring to the diameter of the bowels (anything greeter than 3 is SI and 6 in the large intestine, and greater than 9 in cecum we are seeing obstruction

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126
Q

What pathology is this describing?

Dilated loops of bowel proximal to obstruction as they fill up with air

A

Small bowel obstruction

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127
Q

How do small bowel obstructions appear radiographically?

A

-Air/fluid levels on erect or decubitus abdominal images
-“Step Ladder” appearance

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128
Q

T/F

Small bowel obstructions are more centrally located

A

True

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129
Q

What pathology is seen here?

A

Small Bowel Obstruction

130
Q

What pathology is shown here?

A

Small Bowel Obstruction

131
Q

What pathology is shown here?

A

Small Bowel Obstruction

132
Q

What pathology is shown here?

A

Small Bowel Obstruction

133
Q

What is the most abdominal wall herniation?

A

Inguinal Hernias

134
Q

T/F

Inguinal hernias are more common in males

135
Q

What are the 2 types of inguinal hernias and where are they located?

A

Indirect: Lateral
Direct: Medial

136
Q

What can inguinal hernias lead to?

A

Can cause obstruction and ischemia

137
Q

What 3 types of imaging is done for inguinal hernias? What is the 1st choice?

A
  1. Ultrasound-1st choice
  2. CT
  3. MRI
138
Q

How are inguinal hernias treated?

A

Treated surgically

139
Q

What pathology is shown here?

A

Inguinal hernia

140
Q

What pathology is shown here?

A

Inguinal hernia

141
Q

What pathology is shown here?

A

Inguinal hernia

-Seeing large amount of bowel loops hanging out of inguinal canal

142
Q

What pathology is shown here?

A

Inguinal hernia

Seeing stricture=could cause ischemia and bowel loop prior to stricture very dialted

143
Q

What are the four causes of Adynamic Ileus?

A
  1. Post-op abdominal surgery (36-48 hours)
  2. Drugs (Opioids)
  3. Peritonitis
  4. Sepsis
144
Q

What is the radiographic appearance of Adynamic Ileus?

A

Distention of both large and small bowel

145
Q

What is the auditory sign of Adynamic Ileus?

A

Decreased bowel sounds

146
Q

What is Adynamic Ileus?

A

Paralysis of intestinal motility causing functional obstruction of the GI tract.
The bowel loops get dilated

147
Q

What pathology is shown here?

A

Adynamic Ileus

-All throughout the abdomen and pelvis; everything dilated
Ignore arrow

148
Q

What is Intussusception?

A

“Telescoping” of proximal bowel into distal

“Pushing one sleeve into the other”
-Something catches and doesn’t come back, tangles up on itself

149
Q

Where is the most common place for Intussusception to occur?

A

More common in small bowel (ileocecal valve)

150
Q

What does Intussusception result in?

A

Results in small bowel obstruction or ischemic necrosis of bowel wall

151
Q

What age group is Intussusception most common in?

A

More common in children

152
Q

Why is it better for children to have Intussusception than adults?

A

It can be reversed easier

153
Q

How can intussusception be reversed in children?

A

Reduction can be achieved with a barium enema (barium pops it back open)

154
Q

What non radiographic sign is seen with intussusception in children?

A

“Currant jelly” stool

155
Q

What is the cause of intussusception in adults

A

Usually a complication of a polyp (bowel moves into it and gets tangled up on it)

156
Q

T/F

Barium enemas cannot resolve intussusception in adults

A

True

Affected bowel is often resected

157
Q

How does intussusception appear in both children and adults in Fluoroscopy?

A

“Coiled Spring” appearance

158
Q

How does intussusception appear in both children and adults in ultrasound?

A

“Target” or “Doughnut” sign

159
Q

What pathology is shown here?

A

Intussusception

160
Q

What pathology is shown here?

A

Intussusception

161
Q

What pathology is shown here?

A

Intussusception
-Pushing into itself, getting tangled

162
Q

What pathology is shown here?

A

Intussusception
-Bowel loops way wider than they should be, bowel caught on cancer

163
Q

Read over the list of the following pathologies of the colon:

A

Diverticulitis
Volvulus
Ulcerative Colitis
Toxic Megacolon
Primary Colon Carcinoma
Large Bowel Obstruction
Imperforate Anus

164
Q

What is Diverticulosis?

A

Outpouching of the mucosa and submucosa through the muscular layer

165
Q

Where does Diverticulosis appear?

A

Sigmoid colon

166
Q

What is the appearance of Diverticulosis?

A

“Saw tooth” appearance

167
Q

What is Diverticulitis?

A

Inflammation in the diverticula and retained trapped fecal material

168
Q

What are the four radiographic appearances of Diverticulitis?

A
  1. Mimics an intramural mass (narrowed lumen)
  2. Abscesses/Perforations-GI bleeding
  3. Develops fistulas-abnormal connection btwn two structures
  4. GI bleeding
169
Q

What pathology is shown here?

A

Diverticulosis

170
Q

What pathology is shown here?

A

Diverticulosis

Large structure, narrowing the lumen, looks like a mass (not actually colon cancer)

171
Q

What pathology is shown here?

A

Diverticulosis
-Seeing pouches

172
Q

What pathology is shown here?

A

Diverticulosis
-Seeing a case with perforations and free air, see lots of fluid surrounding the walls (lots of inflammation=lots of fluid)

173
Q

What is Volvulus?

A

Twisting of the bowel on itself-Like a balloon animal

174
Q

Where are the two places where Volvulus appear?

A
  1. Sigmoid colon
  2. Cecum
175
Q

What is the radiographic appearance of Volvulus in the cecum?

A

“Kidney” shaped cecum

176
Q

What is the radiographic appearance of Volvulus in the sigmoid colon

A

Bird’s beak” appearance (with contrast)

177
Q

Where is the most common location for Volvulus?

A

Sigmoid colon

178
Q

Where does the lumen taper with Volvulus in the sigmoid colon?

A

Lumen tapers to the site of the twist

179
Q

T/F

With Volvulus, everything distal becomes dialted

A

False; Everything proximal becomes dialted

180
Q

Where do sigmoid colon volvulus arise from and what do they appear as?

A

Inverted U arising from the pelvis (distended)

181
Q

What CT sign is seen with Volvulus?

A

CT shows whirlpool sign

182
Q

What pathology is shown here?

183
Q

What pathology is shown here?

184
Q

What pathology is shown here?

185
Q

What pathology is shown here?

186
Q

What age is Ulcerative Colitis ussually seen in?

A

Typical in young adults (15-40)

187
Q

What is Ulcerative Colitis linked to?

A

Linked to autoimmune or psychogenic factor

188
Q

What is Ulcerative Colitis?

A

Idiopathic inflammatory disease of the bowel

189
Q

What layers of the colon does Ulcerative Colitis affect?

A

Usually only the mucosal layer

Alternating bouts of remission and relapse

190
Q

What is the risk assosiated with Ulcerative Colitis?

A

Risk of developing into carcinoma

191
Q

Where does Ulcerative Colitis ussually begin in the colon?

A

Often begins in rectosigmoid region

192
Q

What is the earliest radiographic sign of Ulcerative Colitis?

A

Earliest radiographic sign is fine granulations

193
Q

What are the 3 radiographic appearances of Ulcerative Colitis?

A
  1. Large nodular protrusions of mucosa
  2. Deep ulcers outlined by intraluminal gas
  3. Produces “lead pipe” appearance (loss of haustra-no muscular layers)
194
Q

What pathology is seen here?

A

Ulcerative Colitis

195
Q

What pathology is seen here?

A

Ulcerative Colitis
-Later stage, seeing complete loss of the haustra (very smooth-lead pipe appearance)
-With barium enema, it is usually double contrast

196
Q

What pathology is shown here?

A

Toxic Megacolon

197
Q

What is toxic megacolon?

A

Potentially fatal complication of colonic inflammation
Usually ulcerative colitis

198
Q

What number from the 369 rule indicates toxic megacolon?

A

Dilation > 6cm

199
Q

T/F

Toxic megacolon can come from any type of inflection

200
Q

What imaging is done for toxic megacolon?

A

Plain radiograph or CT

201
Q

How does toxic megacolon appear radiographically?

A

-Loss of haustral markings (not going in as deep as they would)
-May include pseudopolyps (not ulcerations)

202
Q

What pathology is shown here?

A

Toxic Megacolon
Circled: Protrusion coming in wards

203
Q

What pathology is shown here?

A

Toxic Megacolon

204
Q

What age range does Primary Colon Carcinoma
ussually affect?

A

Peak incidence is 50 to 70 years of age

205
Q

What cancer is the largest cause of cancer deaths

A

Primary Colon Carcinoma

206
Q

Where does Primary Colon Carcinoma appear?

A

50% in rectum and sigmoid

207
Q

What are the predisposing factors to Primary Colon Carcinoma?

A

-Long-term ulcerative colitis
-Familial polyposis (genetic mutation)

208
Q

What are the two types of familial polyps assosiated with primary colon carcinoma? What are thier differences?

A
  1. Sessile Polyps (have no stalk)
    Malignant, just bulge out
  2. Pedunculated Polyps (have a stalk)
    Benign-stalk and larger part
209
Q

What is the most typical form of primary colon carcinoma?

A

Annular Carcinoma

210
Q

What are the radiographic appearances of Primary colon carcinoma?

A
  1. “Apple Core” lesion
  2. CT demonstrates a thickened wall
211
Q

What pathology is shown here?

A

Primary Colon Carcinoma
-Small stricture with over hanging shoulder, outer part irregular

212
Q

What pathology is shown here?

A

Primary Colon Carcinoma
-Apple core lesion
-Circle: Compression paddle artifact

213
Q

What pathology is shown here?

A

Primary Colon Carcinoma
Arrow: Wall thickened, irregular, coming inwards

214
Q

What are the 3 causes of Large Bowel Obstructions

A
  1. 70% by primary colon cancer
  2. Diverticulitis
  3. Volvulus
215
Q

What are the 2 radiographic appearances of Large Bowel Obstructions?

A
  1. Peripherally distended bowel proximal to obstruction (may perforate)
  2. Collapse of the colon distal to obstruction
216
Q

T/F

Large Bowel Obstruction
are less acute and less common than SBO

A

True

Fewer fluid and electrolyte disturbances

217
Q

What pathology is shown here?

A

Large Bowel Obstruction
-Bowel loop coming from the side
-Clear obstruction causing the dealation

218
Q

What is Imperforate Anus (Anal Atresia)?

A

Colon ends in a blind pouch
No connection to the outer world for the intestinal tract

219
Q

T/F

Imperforate Anus (Anal Atresia) may include fistulas to urethra or vagina

220
Q

How does Imperforate Anus (Anal Atresia) appear radiographically?

A

Either plain abdomen or invertogram will show dilated bowel loops

221
Q

What is an Invertogram?

A

Invertogram=Holding the patient upside down (seeing air with no where to go)

222
Q

How is Imperforate Anus (Anal Atresia) treated?

A

Treated surgically

223
Q

T/F

Imperforate Anus (Anal Atresia) is seen more in children

224
Q

What pathology is shown here?

A

Imperforate Anus (Anal Atresia)
Invertogram

225
Q

What pathology is shown here?

A

Imperforate Anus (Anal Atresia)
Invertogram

226
Q

What are the two types of gall bladder diseases?

A

Cholelithiasis (Gallstones)
(Lith-Stones)
Acute Cholecystitis

227
Q

What are the two types of Cholelithiasis (Gallstones)?

A
  1. Cholesterol based
  2. Pigment (formed from bilirubin)
228
Q

T/F

Cholelithiasis (Gallstones) is more seen in the tropics or Asian countries

229
Q

What are the four predispositions to Cholelithiasis (Gallstones)?

A
  1. Family history
  2. 40+
  3. Overweight
  4. Female
230
Q

Where do gall stones develop?

A

Develop in ducts (choledocholithiasis) or gall bladder (cholecystolithiasis)

231
Q

What is the modility of choice for gall stones?

A

Ultrasound

232
Q

What is used to clear out gall stones?

A

ERCP used to clear the stones from the common bile duct

233
Q

What percentage of gall stones have enough calcium to appear without contrast?

A

20% contain enough calcium to be seen radiographically

234
Q

T/F

We can use CT with contrast to look at gallstones

235
Q

What pathology is shown here?

A

Cholelithiasis (Gallstones)
-Hyperechoic (whiter)

236
Q

What pathology is shown here?

A

Cholelithiasis (Gallstones)
-Hyperechoic (whiter)

237
Q

What pathology is shown here?

A

Cholelithiasis (Gallstones)
-Seeing filling defects and huge blockage in the bile duct

238
Q

What pathology is shown here?

A

Cholelithiasis (Gallstones)
-Seeing filling defects and huge blockage in the bile duct

239
Q

What pathology is shown here?

A

Acute Cholecystitis

240
Q

What pathology is shown here?

A

Cirrhosis of the Liver

-Not filled arrow: Atrophy of liver
-White arrow: Collateral blood flow (blood vessels larger and shunted off to a collateral flow-blood becomes more visible)
-Surrounding the abdomen: Ascites

241
Q

What patholgy is shown here?

A

Fatty liver disease

-Tissue not attenuating as well
-Tissue very dark, and seeing blood vessels very white (with no contrast in image)
-Early stage

242
Q

What pathology is seen here?

A

Hepatocellular Carcinoma (HPC)

Arrow: Border between the tumour and the rest of the liver
White arrow: Cyst

243
Q

What pathology is seen here?

A

Hepatocellular Carcinoma (HPC)

244
Q

What pathology is seen here? Label A-D

A

Hepatocellular Carcinoma (HPC)
-Multiphase study
A: Non contrast: Mass is hypodense
B: Arterial phase: Aorta bright, tumour enhanced, non uniform enhancement (mish mash)
C: Portal venous phase
D: Delayed phase

245
Q

What pathology is seen here?

A

Hepatic Metastasis

246
Q

What pathology is seen here?

A

Hemangioma
-Fairly uniform

247
Q

What pathology is seen here?

A

Pancreatitis

Acute: Larger and inflamed and around the pancreas
White arrows-inflammation moving into the mesocolon (inflammatory process)

248
Q

What pathology is seen here?

A

Pancreatitis

Chronic: Calcifications, appear smaller

249
Q

What pathology is seen here?

A

Pancreatic Cancer

-In the head of the pancreas
-Hypodense (dark compared to the rest of the pancreas)
-Contrast image shown here (always look for contrast when identifying)
-Gallbladder appearing larger (blocked duct causing things to back up)

250
Q

What pathology is shown here?

A

Foreign Body

251
Q

What pathology is shown here?

A

Foreign Body

252
Q

What pathology is shown here?

A

Pneumoperitoneum

-Seeing on the right and left side under the diaphragm
-Easier to see on the right side

253
Q

What pathology is shown here?

A

Pneumoperitoneum

Patient prone, anterior air shown

254
Q

What pathology is shown here?

A

Situs Inversus

255
Q

What pathlogy is shown here?

A

Situs Inversus

256
Q

What is Acute Cholecystitis?

A

Inflammation of the gall bladder

257
Q

What is acute cholecystitis caused by?

A

Mostly caused by cystic duct blockage

258
Q

What is one non radiographic sign of acute cholecystitis?

A

Acute RUQ pain

259
Q

What is the best modailty to look at Acute Cholecystitis?

A

Ultrasound

260
Q

How does the gallbladder appear with acute cholecystitis?

A

Distended gallbladder
Edema of gallbladder wall

261
Q

What are the 5 types of liver diseases?

A

Hepatitis
Cirrhosis of the Liver
Hepatocellular Carcinoma
Hepatic Metastasis
Hemangioma

262
Q

What is the common inflammatory disease of the liver

263
Q

T/F

Hepatitis may be asymptomatic or may cause jaundice and pain

264
Q

What are the two causes of hepatitits?

A
  1. Viruses
  2. Reaction to Drugs and Toxins (alcohol, acetaminiphin)
265
Q

What is the first screening device used for hepatitis? What other modailities are used to image?

A

-Ultrasound (1st screening device)
-MRI, CT imaging modalities

266
Q

What are the four types of hepatitis?

A

A, E, B, C

267
Q

How is Hepatitis A virus (HAV) and Hepatitis E virus (HEV) transmitted?

A

Transmitted through oral or fecal contact

Usually warned when going to other countries

268
Q

T/F

Hepatitis A and E are self contained

269
Q

How is hepatitis B spread?

A
  1. Exposure to contaminated blood products or body fluids
  2. Sexual contact
270
Q

T/F

Hepatitis B has a poor prognosis

A

False; Has a better prognosis

271
Q

How is hepatitis C transmitted?

A

Blood transfusion
Sexual contact

272
Q

What type of hepatitis is a common cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma?

A

Hepatitis C

273
Q

T/F

The prognosis is not as good for hepatitis C

274
Q

What is Cirrhosis of the liver?

A

Chronic deterioration of the liver

275
Q

T/F

Cirrhosis of the Liver is end stage liver disease

276
Q

What are the causes of Cirrhosis of the Liver?

A

Alcoholism
Hepatitis C
Hepatotoxic drugs

277
Q

How is cirrhosis of the liver treated?

A

Liver transplant

278
Q

What 3 modailties are used to image cirrhosis of the liver?

A

Ultrasound, CT, MRI

279
Q

How does cirrhosis of the liver appear in images?

A

Enlarges at first, then becomes smaller and more nodular

280
Q

What are the 3 clinical symptoms of cirrhosis of the liver?

A
  1. Ascites-Abnormal amount of intraperitoneal fluid
  2. Portal hypertension (liver becomes more fibrotic which puts more pressure and causes liquid to seep out-ascites)
  3. Jaundice
281
Q

What is the modailty of choice for Hepatocellular Carcinoma (HPC)?

282
Q

What are 3 physical signs/symptoms of Hepatocellular Carcinoma (HPC)?

A

More mild UQ pain, jaundice, weight loss

283
Q

What is the primary liver cell cancer?

A

Hepatocellular Carcinoma (HPC)

Seen most commonly with cirrhosis-which is caused by alcohol abuse; ect.

284
Q

What are the radiographic signs of Hepatocellular Carcinoma (HPC)

A
  1. arge mass outside normal border (not always)
  2. Dense, diffuse non uniform enhancement with c+
  3. Small lesions creating multinodular mass
285
Q

What is the most common liver malignancy?

A

Hepatic Metastasis

286
Q

What imaging modailites are used to image hepatic metastasis? What are the best modailties?

A

CT
MRI
Ultrasound
NM
-CT and MRI best to look at

287
Q

What is the treatment for Hepatic Metastasis?

A

Palliative treatment only

288
Q

In order to to look at the cells with Hepatic Metastasis, what process is required?

A

Fine needle aspiration biopsy required

289
Q

How do Hepatic Metastasis appear radiographically without contrast?

A

-Well marginated
-Less dense compared to normal parenchyma

290
Q

How do Hepatic Metastasis appear with contrast?

A

-Can show increased density compared to surrounding parenchyma
-Are hypodense in reality

CAMRT: (ignore for this test)
WILL show increased density compared to surrounding parenchyma
Hyperdense with contrast

291
Q

What is a Common benign liver tumour?

A

Hemangioma

Abnormal collection of blood vessels

292
Q

T/F

Hemangioma can be other places in the body but most commonly seen in the liver

293
Q

What is the cause of Hemangioma?

A

Belived to be congenital

294
Q

How does Hemangioma appear radiographically?

A

Peripheral enhancement with contrast initially
Uniform filling
Later stages the entire lesion fills

295
Q

T/F

Hemangioma can be an asymptomatic/incidental finding

296
Q

What rae the four pathologies of the pancreas?

A

Pancreatitis
Pancreatic Cancer
Diabetes Mellitus
Hypoglycemia

297
Q

What is Pancreatitis? What are the two types?

A

-Inflammation of the pancreas
where pancreatic enzymes activate within the pancreas
-Acute and Chronic

298
Q

What are the causes of pancreatitis? What are the physical symtoms?

A

-Alcohol abuse
-Gall stone blocking hepatopancreatic ampulla
-Sudden abdominal pain; tends to radiate around to the back

299
Q

What percentage of pancreatic cancers are adenocarcinomas

300
Q

T/F

Pancreatic cancer has a poor prognosis

A

True

Metastasizes before it is diagnosed

301
Q

What percentage of pancreatic cancers arise from the head of the pancreas?

302
Q

What modaility is used to image lesions in the head of pancreas? What modailty is best for imaging pancreatic cancer?

A

-Ultrasound for lesions in the head of pancreas
-CT is best for imaging

303
Q

How does pancreatic cancer appear radiographically in CT?

A

Hypodense lesion that is poorly marginated

304
Q

What are the 3 causes of diabetes mellitus?

A
  1. Insufficient production of insulin (Islets of Langerhans – pancreas)
  2. Inadequate utilization of insulin by cells of the body
  3. Autoimmune disease
305
Q

What are the non radiographic signs of diabetes mellitus?

A
  1. Excess sugar in blood = hyperglycemia
  2. Polyuria (excessive urination),
  3. polydipsia (excessive thirst),
  4. polyphagia (excessive hunger)
306
Q

What percentage of diabetes does Type one make up out off all diabetes? What is the cause?

A

-Makes up 5% of all diabetes
-Cause unknown

307
Q

What age does type one ussually affect?

A

-Typically affects children
-However, can affect persons up to 30 years of age (age of onset)

308
Q

What is type one diabetes? What is the treatment?

A

-Body doesn’t know how to produce insulin
-Insulin injections needed to control blood sugar levels

309
Q

What population does type 2 diabetes affect?

A

-Persons older than 40 with a gradual onset
-Patients are often very obese

310
Q

What is type 2 diabetes caused by?

A

-Genetic predisposition (familial risk factors)
-Caused by impaired sensitivity to insulin or decreased production of insulin

311
Q

What is the treatment for type 2 diabetes?

A

-Exercise, diet, and weight loss are important to manage the hyperglycemia
-Otherwise, may need insulin therapy or diabetic medication (metformin)

312
Q

What is Hypoglycemia?

A

-Patient has taken insulin but no food (DI test)
-Can cause them to go into hypoglycemic shock

low blood sugar

313
Q

What are the symptoms of hypoglycemia?

A

-Sudden onset of weakness, sweating, tremors, confusion
-Eventually loss of consciousness

314
Q

What is the treatment for hypoglycemia if the patient is alert/non alert?

A

-If alert, patient can be given fruit juice, candy, squeeze tubes (doses of glucose)
-Not alert, parenteral injection of glucagon or dextrose through an IV

315
Q

What type of imaging is done for foreign bodies?

A

-2 Images are required at 90° to each other
-Follow up images to make sure foreign body is passed

Radiolucent versus radiopaque
Contrast may be required for radiolucent

316
Q

What is the first line of treatment for foreign bodies?

A

Medication is first line of treatment to relax anatomy

Surgical emergency

317
Q

What is a Pneumoperitoneum?

A

“Free Air” in the peritoneal cavity causing perforation of the wall of part of the digestive tract

318
Q

What are the causes of a Pneumoperitoneum?

A

Ulcer, ruptured diverticulum, bowel perforation during endoscopy

319
Q

What positions are done to image a Pneumoperitoneum?

A

Erect Abdomen
Left Lateral Decubitus

320
Q

What is the cause of Situs Inversus?

A

Congenital condition

321
Q

What are the symptoms of sinus invertus?

A

Usually asymptomatic

322
Q

What is Situs Inversus? What are the two types?

A

-Thoracic and Abdominal organs are mirrored on opposite side of body
-Dextrocardia-Heart on the right side
-Levocardia-All abdominal flipped but heart is still normal position

Pathology (15 decks)

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