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GI > GI Radiology > Flashcards

GI Radiology Flashcards

1
Q

Pathogenesis of GERD: What increases the frequency of GER? (2)

A

Decreased LES tone

Multiple transient LES relaxations

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2
Q

What are the two main factors in pathogenesis of GERD?

A

Increased frequency of GER
Increased duration of GER
Increased acidity of refluxate
Resistance of mucosa

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3
Q

What can increase the duration of GER?

A

Abnormal motility (i.e from scleroderma)

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4
Q

What can increase the acidity of refluxate?

A 
ZES (increased acid)
Billroth II (bile)
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5
Q

What increases the resistance of mucosa?

A

Age

Debilitation

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6
Q

What are the clinical findings of GERD? (4)

A

Heartburn/regurg
Epigastric/RUQ pain
Upper GI bleeding
Dysphagia

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7
Q

How do esophageal ulcers from GERD present on imaging?

A

Tiny stellate/punctate lit up areas

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8
Q

What are two the most common causes of infectious esophagitis?

A

1st: Candida
2nd: Herpes

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9
Q

What are symptoms of candida esophagitis? What is the treatment of choice?

A

Dysphagia or odynophagia

Treat with fluconazole (an antifungal)

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10
Q

How does esophageal candidiasis present on contrast imaging?

A

Multiple plaque-like lesions

If severe, fulminate “shaggy” looking

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11
Q

How does herpes esophagitis present? What’s the recommended treatment?

A

Dysphagia or odynophagia

Treat with acyclovir

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12
Q

How does herpes esophagitis present on imaging?

A

Multiple tiny punctate ulcers filled with barium

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13
Q

How does CMV esophagitis present on imaging? How do you treat it?

A

Giant barium ulcers with thin adenomatous ring

Gancyclovir

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14
Q

Should follow up be done with suspected CMV esophagitis?

A

Yes, do endoscopy– treatment is toxic to BM, and esophagitis can be caused by HIV

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15
Q

How does HIV esophagitis present?

What is recommended treatment?

A

Odynophagia, giant ulcers with presence of palatal ulcers, maculopapular rash

Treat with steroids

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16
Q

What drugs are associated with contact esophagitis?

A

Oral meds such as tetracycline/doxycyclince, NSIADs, KCl, Fosomax

17
Q

What is the clinical presentation of drug-induced esophagitis? How does it appear on contrast imaging?

A

Presents as severe odynophagia with rapid clinical improvement

Appears as discrete superficial ulcers at level of aortic arch or left main bronchus

18
Q

Eosinophilic esophagitis: What is epidemiology?

A

young men with history of allergies/asthma

19
Q

How does eosinophilic esophagitis present?

A 
Young man with longstanding dysphagia and food impactions-- can have esophageal stricture, ringed esophagus or small caliber esophagus
Peripheral eosinophilia (differentiates it from GERD)
20
Q

How do you treat idiopathic eosinophilic esophagitis?

A

Inhaled steroids

21
Q

Squamous Cell Carcinoma of esophagus: Where does it present and what is prognosis

A

Accounts for 50% of esophageal cancers

Usually in upper or mid esophagus and has dismal prognosis

22
Q

Adenocarcinoma of esophageal cancer: Pathogenesis

A

Arises in Barrett’s esophagus, often in distal esophagus

Usually invades stomach

23
Q

Where do most gastric ulcers arise?

How many are benign

A

Gastric ulcers are usually located in the antrum or fundus

95% are benign ulcers, but they must be differentiated from cancer

24
Q

How do benign gastric ulcers appear on barium contrast imaging?

A

Ovoid or button

25
Q

How do malignant gastric ulcers appear on imaging?

A

Irregular crater in tumor mass
Nodularity/clubbing
Projects inside lumen

26
Q

Which gastric ulcers require endoscopy follow up? What do you do for the ones that don’t require endoscopy?

A

Only malignant or equivocal appearing ulcers require endoscopy. For benign ulcers, repeat Ba study in 8 weeks

27
Q

What are causes of erosive gastritis? (6)

A 
Peptic ulcer disease
Alcohol
Trauma
Stress
Crohn's disease
NSAIDs
28
Q

Where do most NSAID-related ulcers appear?

A

The greater curvature of the stomach (due to effect of gravity)

29
Q

How do most duodenal ulcers present?

Location, symptoms, benign/malignant

A

Most occur in the bulb
Present with pain or upper GI bleeding
Deodenal ulcers are always benign– no need for endoscopy

30
Q

How do duodenal ulcers appear on imaging?

A

Ovoid barium dots on duodenum

31
Q

How many ulcers are associated with H Pylori infection? Answer for both gastric and duodenal ulcers

A

80% gastric ulcers

95-99% duodenal ulcers

GI (41 decks)

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