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BIOS5092 > GASTROINTESTINAL 1 > Flashcards

GASTROINTESTINAL 1 Flashcards

1
Q

what are the imaging modalities used to image GI tract?

A

ultrasound, endoscopy, plain radiographs (intestinal obstruction), CT, MRI

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2
Q

what is MRI T1 weighting used to identify?

A

normal anatomy- shows fat as white, water as black

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3
Q

what is MRI T2 weigthing used to identify?

A

pathology- fluid appears white (pathology adds water to tissue)- CSF appears white

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4
Q

how does MRI identify perfusions?

A

gadolinium

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5
Q

what do you normally find in an ab radiograph?

A

gas, solid organ outlines, air fluid levels, extra luminal air, calcifications, organ size

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6
Q

where does gas in bowel come from?

A

from swallowed air- always gas in stomach, som air in small intestine, no air in rectum & sigmoid colon

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7
Q

what are loops of bowel called when they’re filled with gas and beyond their normal size?

A

distended & dilated

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8
Q

what is the normal diameter of intestinal loops?

A

SI (3cm), LI (6cm), caecum (9cm)

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9
Q

what are the characteristics for small intestine?

A

centrally located in abdomen, more tightly curved loops than large intestine, has valvulae conniventes which are close together & cross the width of the bowel

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10
Q

what are the characteristics for large intestine?

A

peripherally located, has haustra which do not cross entire width of bowel & further apart than valvulae, contains solid faeces

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11
Q

what areas have air-fluid levels?

A

always air-fluid level in stomach on upright abdominal image, small amount of fluid is normal in small intestine, no air fluid levels in colon

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12
Q

where is extra-luminal air in GI tract?

A

always abnormal (indicating rupted organs- viscus), upright image allows intra-abdominal gas to form a crescent beneath diaphragm, gas may accumulate in intestinal wall or gallbladder

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13
Q

are radiographs good at indicating organ size?

A

limited value in evaluating size of soft tissue, edges may be directly visualised, enlarged organ may displace gas-filled intestinal loops

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14
Q

does the stomach normally contain gas and air-fluid levels?

A

yes

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15
Q

does small intestine normally contain gas & air-fluid levels?

A

yes (2-3 loops) & yes

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16
Q

does the large intestine normally contain gas & air-fluid levels?

A

yes (especially sigmoid colon & rectum) & no

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17
Q

what can pneumonia at lung base mimic?

A

symptoms of an acute condition in abdomen

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18
Q

what can pleural effusion be secondary to?

A

intraabdominal process

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19
Q

what can pancreastitis be associated with?

A

left pleural effusion

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20
Q

what can some ovarian tumours be associated with?

A

associated with right-sided or bilateral pleural effusions

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21
Q

what is the function of the oesophagus?

A

transport of fluid/solids from pharynx to stomach by paristalis

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22
Q

what are common pathologies of the oesophagus?

A

swallowing disorders & excessive gastroesophageal reflux

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23
Q

what is the most common test for evlauting the GI tract?

A

endoscopy - also barium radiography

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24
Q

what can contrast radiography demonstrate about the oesophagus?

A

reflux of contrast media, histal hernia, mucosal erosions, ulcerations & strictures

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25
Q

what is the cervical (upper 1/3) & thoracic (lower 2/3)oesophagus composed of?

A

mainly composed of striated muscle the smooth muscle

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26
Q

what regulates the bolus transport in thoracic oesophagus?

A

true peristalsis regulated by autonomic nervous system

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27
Q

what are the 2 parts of peristaltic wave?

A

initial relaxation that accomodates the bolus & contraction that propels it- gravity also assist peristalsis in upright position

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28
Q

what is the function of lower oesophageal sphincter?

A

it is tensioned at rest to prevent regurgitation from the stomach

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29
Q

what is dysphagia?

A

abnormal swallowing - leads to dehydration, malnutrition, pneumonia

30
Q

what causes dysphagia?

A

neurological disorder & stroke, structural lesions, psychiatric disorder, CT disease, surgical resection, radiation fibrosis, medication

31
Q

what does GORD result in?

A

troublesome symptoms and/or oesophageal & oesophageal & oextraesophageal manifestattion including adenocarcinoma

32
Q

what is oesophagitis?

A

most common- refluxed gastric acid & pepsin acid & pepsin cause necrosis of the oesophageal mucosa & possible oesophageal stricture- due to histal hernia

33
Q

what are symptoms of GORD mistaken for?

A

myocardial infarction (vice versa)

34
Q

what is oesophageal stricture caused by?

A

intrinsic disease that narrows lumen through inflammation, fibrosis or neoplasia- extrinsic disease that invade directly or cause lymph node enlargement and diseases that disrupt peristalsis and/or lower sphincter function- 80% caused by GORD

35
Q

what can CT be used to investigate in oesophagus?

A

neoplasia

36
Q

what is a histal hernia?

A

part of stomach prolapses through diaphragmatic oesophageal hiatus- mostly asymptomatic & discovered incidentally

37
Q

what is the function of the stomach?

A

storage of food, initial digestion by acid & pepsin also mixing

38
Q

what are the common pathologies of the stomach?

A

peptic ulcer disease & gastric carcinoma (diagnosed by endoscopy & CT to visualise spread)

39
Q

what can CT and barium sow in the stomach?

A

CT shows wall thickening due to diffuse tumour or infection/inflammation- barium show ulcer pits or scar

40
Q

what are secondary stomach cancers?

A

breast or melanoma

41
Q

what is the function of the small intestine?

A

important site of digestion by enzymes from pancreas or mucosal brush border- significant absorption of digestion of nutrient and fluid- sites of neutralisation of gastric acid- site of solubilisation of lipids by bile salts

42
Q

what are common pathologies of the small intestine?

A

obstruction/dilation, inflammation, tumour

43
Q

what does small intestine obstruction result in?

A

distended loops of intestine with air/fluid levels (viral enteritis may increase small intestinal gas), absence of colonic gas

44
Q

what is small intestine obstruction fatality rate?

A

high due to ischaemia (aka strangulation)

45
Q

where can obstruction be located?

A

bowel lumen (intraluminal), bowel wall (intramural), outside bowel wall (extraluminal), SBO (postsurgical obstructions)

46
Q

what can cause obstruction in bowel lumen?

A

foreign bodies + gallstones

47
Q

what can cause obstruction in bowel wall?

A

crohns disease, neoplasia, structures/anastomoses

48
Q

what can cause obstruction outside bowel wall?

A

adhesions (post-surgical), hernia, neoplasia

49
Q

what can small intestinal obstruction cause?

A

abdominal pain, nausa & vomiting, abdominal distention, diarrhea or constipation, bowel sounds are hyperactive in early stages or hypoactive in late stages

50
Q

how does small intestinal destruction cause proximal dilation?

A

due to accumulation of GI secretions & air

51
Q

how are small bowel loops suspended & how does strangulation occur?

A

suspended by mesentery in which blood vessels are located- strangulation occurs when mesentary twists including blood flow

52
Q

how are small bowel obstructions seen?

A

plain radiographs but CT is imaging modality of choice

53
Q

what is the normal small intestinal gas pattern?

A

no gas or small amounts of gas within up to 4 variably shaped, nondistended loops with normal large intestinal gas & faeces

54
Q

what is small intestine obstruction indicated by?

A

multiple gas or fluid filled loops of dilated small intestine, moderate amount of colonic gas, increased distance between valvulae conniventes, gas trapped between valvulae conniventes

55
Q

what is an absolute confirmation of small intestine obstruction?

A

absence of colonic gas

56
Q

how big is a dilated proximal bowel loop & collapsed distal loop?

A

more than 2.5cm & less than 1cm

57
Q

what indicates a partial obstruction?

A

passage of contrast agent into collapsed segment

58
Q

what indicates mechanical obstruction?

A

accumulation of feces & gas proximal to obstruction (feces sign)

59
Q

what does MRI of small bowel require?

A

distention using an oral contrast agent

60
Q

what is a intussusception?

A

a segment of intestine telescopes into an adjoining section causing obstruction

61
Q

what is the most reliable diagnoses of intussusception?

A

contrast enema- radiographs & CT are relatively unreliable

62
Q

what is crohns disease?

A

inflammatory bowel disease- idiopathic- transmural process

63
Q

what can crohns disease affect?

A

any part of GIT from mouth to anus- segmental & can skip areas in midst of diseased intestine

64
Q

what is irritable bowel syndrome?

A

an inappropriate immune response to microbiota

65
Q

how many people have small intestinal disease only?

A

30-40%

66
Q

how many people have disease in small & large intestines?

A

40-55%- small % have coltis only - terminal ileum is involved in 90% of patients with small intestinal disease

67
Q

how does crohns disease appear in plain radiograph?

A

non-specific but may show thickening of wall & intestinal dilation; abnormal faecal distribution

68
Q

what is recommended to diagnose crohns disease?

A

contrast radiologic studies are recommended to determine disease extent, disease severity and complications & treatment strategy

69
Q

how does barium enema show crohns disease?

A

allows identification of structural changes - not used in patients with known perforations

70
Q

what is CT used for in crohns disease?

A

assessing extramural complications

71
Q

what type of tumours develop in small intestine?

A

carcinoid tumour

72
Q

what are carcinoid tumours?

A

arises from endocrine cells & small intestine - causes intestinal obstruction- CT is used as tumours are highly vascular making them easily visible with contrast

BIOS5092 (17 decks)

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