GI Radiology Flashcards
Pathogenesis of GERD: What increases the frequency of GER? (2)
Decreased LES tone
Multiple transient LES relaxations
What are the two main factors in pathogenesis of GERD?
Increased frequency of GER
Increased duration of GER
Increased acidity of refluxate
Resistance of mucosa
What can increase the duration of GER?
Abnormal motility (i.e from scleroderma)
What can increase the acidity of refluxate?
ZES (increased acid) Billroth II (bile)
What increases the resistance of mucosa?
Age
Debilitation
What are the clinical findings of GERD? (4)
Heartburn/regurg
Epigastric/RUQ pain
Upper GI bleeding
Dysphagia
How do esophageal ulcers from GERD present on imaging?
Tiny stellate/punctate lit up areas
What are two the most common causes of infectious esophagitis?
1st: Candida
2nd: Herpes
What are symptoms of candida esophagitis? What is the treatment of choice?
Dysphagia or odynophagia
Treat with fluconazole (an antifungal)
How does esophageal candidiasis present on contrast imaging?
Multiple plaque-like lesions
If severe, fulminate “shaggy” looking
How does herpes esophagitis present? What’s the recommended treatment?
Dysphagia or odynophagia
Treat with acyclovir
How does herpes esophagitis present on imaging?
Multiple tiny punctate ulcers filled with barium
How does CMV esophagitis present on imaging? How do you treat it?
Giant barium ulcers with thin adenomatous ring
Gancyclovir
Should follow up be done with suspected CMV esophagitis?
Yes, do endoscopy– treatment is toxic to BM, and esophagitis can be caused by HIV
How does HIV esophagitis present?
What is recommended treatment?
Odynophagia, giant ulcers with presence of palatal ulcers, maculopapular rash
Treat with steroids
What drugs are associated with contact esophagitis?
Oral meds such as tetracycline/doxycyclince, NSIADs, KCl, Fosomax
What is the clinical presentation of drug-induced esophagitis? How does it appear on contrast imaging?
Presents as severe odynophagia with rapid clinical improvement
Appears as discrete superficial ulcers at level of aortic arch or left main bronchus
Eosinophilic esophagitis: What is epidemiology?
young men with history of allergies/asthma
How does eosinophilic esophagitis present?
Young man with longstanding dysphagia and food impactions-- can have esophageal stricture, ringed esophagus or small caliber esophagus Peripheral eosinophilia (differentiates it from GERD)
How do you treat idiopathic eosinophilic esophagitis?
Inhaled steroids
Squamous Cell Carcinoma of esophagus: Where does it present and what is prognosis
Accounts for 50% of esophageal cancers
Usually in upper or mid esophagus and has dismal prognosis
Adenocarcinoma of esophageal cancer: Pathogenesis
Arises in Barrett’s esophagus, often in distal esophagus
Usually invades stomach
Where do most gastric ulcers arise?
How many are benign
Gastric ulcers are usually located in the antrum or fundus
95% are benign ulcers, but they must be differentiated from cancer
How do benign gastric ulcers appear on barium contrast imaging?
Ovoid or button
How do malignant gastric ulcers appear on imaging?
Irregular crater in tumor mass
Nodularity/clubbing
Projects inside lumen
Which gastric ulcers require endoscopy follow up? What do you do for the ones that don’t require endoscopy?
Only malignant or equivocal appearing ulcers require endoscopy. For benign ulcers, repeat Ba study in 8 weeks
What are causes of erosive gastritis? (6)
Peptic ulcer disease Alcohol Trauma Stress Crohn's disease NSAIDs
Where do most NSAID-related ulcers appear?
The greater curvature of the stomach (due to effect of gravity)
How do most duodenal ulcers present?
Location, symptoms, benign/malignant
Most occur in the bulb
Present with pain or upper GI bleeding
Deodenal ulcers are always benign– no need for endoscopy
How do duodenal ulcers appear on imaging?
Ovoid barium dots on duodenum
How many ulcers are associated with H Pylori infection? Answer for both gastric and duodenal ulcers
80% gastric ulcers
95-99% duodenal ulcers
