Gastrointestinal System Pathologies

Question 1

Achalasia

Answer 1

Functional obstruction of the distal section of the esophagus with proximal dilation.
Imaging appearance: Dilated esophagus (CXR) or narrowing of distal esophageal segment (GI)
Treatment: Medication to relax sphincter, balloon dilation, surgical myotomy.

Question 2

Esophageal varices

Answer 2

Dilated veins in the wall of the esophagus.
Imaging appearance:
Treatment:

Question 3

Foreign body

Answer 3

*It is essential that any suspected foreign body be evaluated on two projections to be certain that the object projected over the esophagus truly lies within
Imaging appearance:
Treatment:

Question 4

Tracheoesophageal fistula

Answer 4

Failure of a satisfactory esophageal lumen to develop completely seperate from the trachea.
Imaging appearance:
Treatment:

Question 5

Esophageal carcinoma

Answer 5

Cancer of the esophagus.
Imaging appearance: Flat plaque like lesion, irregular wall, mass
Treatment: Surgical resection, palliative therapy (chemo/radiation therapy)

Question 6

Cholelithiasis

Answer 6

Gallstones. Gallstones can develop whenever bile contains insufficient bile salts and lecithin (fat) in proportion to cholesterol to maintain the cholesterol in solution.
Imaging appearance: Cholelithiasis evident if calcified
Treatment: Lithotripsy, chemical dissolution, ERCP for stone retrieval, laparoscopic cholecystectomy.

Question 7

Cirrhosis

Answer 7

Chronic destruction of liver cells and structure, it is an end stage liver disease.
Imaging appearance: Haziness in ascites
Treatment: Dietary modifications, cessation of alcohol consumption. *curable only by liver transplant.

Question 8

Hiatal hernia

Answer 8

The most common diaphragmatic hernia is a hiatal hernia; the stomach slips through the esophageal hiatus and in to the chest. An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal.
Imaging appearance: Numerous thicker folds of the stomach above the diaphragm
Treatment: no treatment in most cases, surgical intervention includes tightening the hiatus.

Question 9

Crohn’s disease

Answer 9

Chronic inflammatory disorder if unknown cause.
Imaging appearance: Irregular thickened mucosal folds, cobblestone appearance, string sign and skip lesions.
Treatment: Medication, surgery if complications occur.

Question 10

Peptic/Duodenal ulcers

Answer 10

Peptic ulcer disease is a group of inflammatory processes involving the stomach and duodenum. It is caused by the action of acid and the enzyme peptic secreted by the stomach. Duodenal ulcer is the most common, it occurs in the first portion of the duodenum (the duodenal bulb)
Imaging appearance: Small shallow erosions to perforations, rounded or linear collection of contrast.
Treatment: Avoid acidic foods. antibiotics for infection, histamine antagonist to reduce acidic secretions, proton pump inhibitors.

Question 11

Diverticulitis

Answer 11

Perforation of a diverticulum (abnormal sac/pouch) leads to the development of a peridiverticular abscess.
Imaging appearance: Diverticular perforation with possible abscess.
Treatment: Surgery for the perforated diverticula or antibiotics

Question 12

Intussusception

Answer 12

The telescoping of one part of the intestinal tract onto another because of peristalsis.
Imaging appearance: Coiled spring appearance on contrast enema
Treatment: Reduction of telescoping bowel (rectal insufflation)

Question 13

Ulcerative colitis

Answer 13

Inflammatory bowel disease that causes long-lasting inflammation and ulcers in the digestive track.
Imaging appearance: Deep ulcers with intraluminal gas or polypoid changes, loss of haustral markings.
Treatment: Nutritional supplements, dietary modifications, anti-inflammatory drugs, surgical resection.

Question 14

Volvolus

Answer 14

Twisting of the bowel on itself.
Imaging appearance: Distended cecum, displaced upward and to the left. Distended rectum, sausage or balloon shape.
Treatment: Surgical detorsion, water soluble enema may be therapeutic.

Question 15

Hepatitis

Answer 15

Inflammatory disease of the liver.
Imaging appearance: Macronodules, enlargement of the portal venous system.
Treatment: Prevention is most effective. Vaccines for hep A and B; immune globulin for short term immunization.

Question 16

Pneumoperitoneum

Answer 16

Free air in the peritoneal cavity.
Imaging appearance: Free intraperitoneal gas under the diaphragm (upright) or air collection between lateral margin of the liver and outer abdominal wall (left lat decubitus)
Treatment: Immediate surgery for visceral perforation, IV antibiotics.

Question 17

Anemia

Answer 17

A decrease in the amount of oxygen-carrying hemoglobin in the peripheral blood.
Imaging appearance: Other complication in the bones, cardiomegaly, renal papillary necrosis.
Treatment: Splenectomy, blood transfusion, bone marrow transplant.

Question 18

Ascites

Answer 18

Accumulation of fluid in the peritoneal cavity.
Imaging appearance: Increased density of the abdomen, poor definition of the soft tissue shadows, displacement of bowel, etc.
Treatment: modified diet, medications (diuretics), ascitic taps

Question 19

Bowel obstruction

Answer 19

Blockage in the small or large intestine.
Imaging appearance: Dilated bowel loops
Treatment: Surgical intervention

Question 20

Carcinoma of stomach

Answer 20

Malignant cancer cells form in the lining of the stomach.
Imaging appearance: mass, wall thickening, ulceration
Treatment: surgical intervention.

Question 21

Cholecystitis

Answer 21

Inflammation of the gallbladder.
Imaging appearance: Gas in gallbladder lumen, calcification in the muscular layers.
Treatment: Lithotripsy, chemical dissolution, ERCP for stone retrieval; laparoscopic cholecystectomy.

Question 22

Colorectal cancer

Answer 22

Cancer of the gastrointestinal tract.
Imaging appearance: Mass, bowel thickening, ulceration, complications (obstruction, fistula, etc)
Treatment: Surgery, chemotherapy, chemoradiation, radiationtherapy.

Question 23

Diabetes mellitus

Answer 23

Common endocrine disorder in which either beta cells inside the islets of Langerhans of the pancreas fail to secrete insulin or target cells throughout the body fail to respond to this hormone.
Imaging appearance: Peripheral vessel calcification, osteomyelitis, gas gangrene, emphysematous cholecystitis.
Treatment: Oral medication, insulin, proper diet, islet cell transplantation, insulin gene insertion.

Question 24

Dysphagia

Answer 24

Difficulty swallowing.

Treatment varies depending on what is causing the difficulty swallowing.

Question 25

Esophageal atresia

Answer 25

Congenital defect (occurs before birth). There are several types, in most cases, the upper esophagus ends and does not connect with the lower esophagus and stomach. 
Imaging appearance: dilated pharyngeal pouch, difficulty inserting feeding tube, presence of air. 
Treatment: Surgical intervention

Question 26

Hemangioma

Answer 26

Birthmark that most commonly appears as a rubbery, bright red nodule of extra blood vessels in the skin. A hemangioma grows during the first year of life, and then recedes over time.

Question 27

Hypertrophic pyloric stenosis

Answer 27

Occurs when two muscular layers of the pylorus become hyperplastic and hypertrophic.
Imaging appearance: Thickened pyloric muscle
Treatment: Pyloromyotomy (incision of the circular muscles of the pylorus)

Question 28

Hypoglycemia

Answer 28

Low blood sugar, when the blood decreases to below normal levels.

Question 29

Ileus

Answer 29

Medical term for lack of movement somewhere in the intestines which leads to a buildup and could cause a potential blockage.

Question 30

Liver cancer

Answer 30

Cancer of the liver.
Imaging appearance: Mass (or several) on the liver.
Treatment: Targetered therapy, immunotherapy, chemotherapy, radiation therapy, surgery.

Question 31

Pancreatic cancer

Answer 31

Cancer of the pancreas.
Imaging appearance: Mass, irregular contour
Treatment: *2% survival rate. Surgery, radiation therapy, chemotherapy, biologic therapy.

Question 32

Pancreatitis

Answer 32

Inflammatory process in which protein- and lipid-digesting enzymes become activated within the pancreas and begin to digest the organ.
Imaging appearance: Enlargement, calcification
Treatment: Supportive treatment, IV antibiotics, reduction of fat/protein intake, insulin, enzyme supplements

Question 33

Situs inversus

Answer 33

Congenital condition in which the major visceral organs are reversed or mirrored from their normal positions.

Question 34

Gastroesophageal reflux disease (GERD)

Answer 34

Occurs when the lower esophageal sphincter is weak or relaxes inappropriately, allowing the stomach’s contents to flow up into the esophagus.
Imaging appearance: Streaks or dots superimposed on flat mucosa
Treatment: medication, surgery.