Diseases of the esophagus Flashcards
Esophagus imaging
Absorbable Iodine based swallow fluorscopy
Barium swallow fluroscopy
Gastroscopy
What is achalasia and how does it present
Hypercontractility of the Lower Esophageal Sphincter,
and decreased esophageal peristalsis.
Most often idiopathic, primary achalasia no clear cause.
Can occur secondary to esophageal cancer or Chagas disease.
difficulty swallowing
regurgitation of food
chest pain
Incurable, prolonged course
Presents as a huge dilation of the esophagus on X-Ray.
Often with a shrunken stomach
Pseudodiverticulosos
Barsony-Tessendorf syndrome
Rare disease,
Presents with may strictures of the esophagus, looking like beads on a string with contrast swallow.
Dysphagia, but no other major symptoms except for rare cases of rupture
Esophageal stenosis
Causes
Esophageal inflammation
Cancer
Reflux disease
Esophageal diverticula
how are the classified
By location or by mechanism,
Locations:
- Pharnyo-esophageal Zenker diverticulum.
Can cause severe dysphagia or completely halt swallowing and often cause regurgitation. Regurgitation without feeling sick is a strong sign for LES dysfunction or esophageal diverticles.
- Epibronchial
- Epiphrenic
- Epicardial
Mechanism
Traction diverticulum: due to inflmmation in sites adjacent to the esophagus and adhesions pulling the esophagus outward.
These are usually asymptomatic and food passes easily into and out of them.
Pulsion diverticulum: Due to increased intraesophageal pressure, from a hyperactive LES.
When is an X Ray performed specifically to examine the stomach?
After the patient has fasted for at least 12 hours, and the X ray is done in the morning, when the fasting gastric secretion level is the lowest.
How are functional studies of the stomach performed?
Motility studies are with single contrast, and followed by fluoroscopy/Xray series
Used to examine gastric filling and emptying times.
How is the stomach wall visualized
with double contrast
Causes of emptying disorder
Pancreas head tumors
Post operative stenosis
Hiatal hernias
Paralytic illeus
- peritonitis
- postop
- poisoning
- bulemia
- severe diabetes
- medication side effects.
How do ulcers look on a double contrast image
The gastric folds are arranged radially around the ulcer rim, due to its fibrosis and contraction, and lack of peristalsis in the immediate area of the ulcer.
Forming a stellate ring of folds centered around the ulcer.
The rim of the ulcer often appears as a sharp translucent line, called the Hampton line.
Gastric polyps
become clearly detectable at about 5mm.
Gastric Hernia types
Type 1: aka Sliding hiatal hernia. The whole phrenico-esophageal opening is widened.
The whole upper part of the gastric cardia herniates upward. Always presents along with reflux as the cardia cannot function well.
Most common type, 95%.
Type 2: Only part of the phrenico-esophageal membrane has a defect
Part of the gastric fundus herniates, while the cardia remains in its position.
Type 1 and 2 are the vast majority of cases
Type 3: Combination of both types 1 and 2.
Tpye 4: Huge opening, Stomach as well as other organs herniate
Cancerous signs on GI imaging
polyps, ulcers, strictures, linitis plastica
polyps larger than 2cm are potentially malignant.
Enteroclysis
GI contrast follow through study basically. The contrast is delivered via a catheter placed into the duodenum.
Enteroclysis
GI contrast follow through study basically. The contrast is delivered via a catheter placed into the duodenum.
