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Radiology > GIT I (Esophagus) > Flashcards

GIT I (Esophagus) Flashcards

1
Q

Clinical manifestations of GIT

A

Loss of appetite
Heartburn
Abdominal pain
Indigestion
Nausea and vomiting
Swollen belly

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2
Q

The esophagus has been subdivided into 3 portions

A

The cervical portion
The thoracic portion
The abdominal portion

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3
Q

Esophagus formed from:

A

Outer longitudinal layer and inner circular layer of smooth muscle
Between them, there is Auerbach’s plexus that responsible for **peristalsis

In the submucosa, there is Meissner’s plexus that is responsible for sensation

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4
Q

The esophagus has four normal constrictions:

A

1st: at level of C6 (15cm from incisor teeth)
2nd: where the arch of aorta crosses it, at T3 (22.5 cm)
3rd: where the left bronchus crosses it, at T6 (27.5 cm)
4th: where it passes through the diaphragm, at T10 (40 com)

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5
Q

The narrowest part of the esophagus

A

1st constriction

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6
Q

The normal indentations of the esophagus

A

Aortic arch (22.5cm)
Left bronchus (27.5cm)

Enlarged left atrium (Abnormal)

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7
Q

What is cardio-esophageal syndrome:

A

It happens when the left atrium is enlarged, it may compress in the esophagus and cause dysphagia.

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8
Q

Symptoms of esophageal disorders

A

Dysphagia
Odynophagia
Regurgitations (esophangitis or esophageal ulcer)
Vomiting

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9
Q

Related to the age, Achalasia most common in:

A

Young

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10
Q

Related to age: Cancer most common in:

A

Elderly

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11
Q

During reflux, some food regurge into the pulmonary system and causes aspiration pneumonia
Particularly in which age?

A

Pediatrics age

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12
Q

Patients with esophageal anomaly that are susceptible to recurrent infections:

A

Tracheoesophageal fistula (TOF)

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13
Q

Imaging modalities of esophagus:

A

Plain X-ray
Fluoroscopy (by Barium swallow)
Ultrasound
CT scan
MRI
Nuclear medicine

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14
Q

Using of X-ray in esophagus

A

Dilated esophagus (achalasia)
Foreign bodies
Air fluid level
Mass

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15
Q

What is the type of contrast used in barium swallow

A

Barium sulfate (45% weight/volume)

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16
Q

Double vs single contrast:

A

Single: esophagus is full of barium and has a smooth outline
Double: Then emptying esophagus and barium lies b/w mucosal folds, it appears as three or four long, striaght parallel lines

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17
Q

The normal indentations of the opacified esophagus are seen in which view during barium swallow?

A

Right anterior oblique

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18
Q

The barium sulfate is the preferable contrast media using fluoroscopy because:

A

It provides a good coating of the internal part of lumen

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19
Q

Barium sulfate is conisder as positive (bright) or negative (dark) contrast media:

A

Positive

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20
Q

Stricture is the main cause of dysphagia:
It caused by:

A

Peptic (GERD)
Carcinoma
Achalasia
Corrosives
Surgery

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21
Q

The stricture can be:

A

Tapering ends with smooth outline =benign
Overhanging edges or shouldering with irregular outline = malignant

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22
Q

Peptic stricture:

A

• Found at lower end of the esophagus
• associated with hiatus hernia/GERD(reflux esophangitis)

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23
Q

Signs of peptic stricture

A

Short
Smooth outline
Tapering ends
Ulcer may be seen close to the stricture

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24
Q

What is Achalasia

A

Rare swallowing disorder, which affects the esophagus
Primary: functional dt neuromascular abnormality (defect on **myenteric (Auerbach’s) plexus)
2ry: non-functional, may cause by malignancy

25
Q

Features of achalasia:

A

Failure of organized esophageal peristalsis
Impaired relaxation of LES
Food stasis (marked dilation)
Occurs at middle and late adulthood

26
Q

Patients with achalasia may comes with

A

Dysphagia
Chest pain
Regurgitation

27
Q

Complications of achalasia

A

Pneumonia and brochiectasis due to aspiration
Esophageal carcinoma
Candida esophangitis

28
Q

Radiological findings of achalasia:

A

Markedly dilated esophagus
Tapering in inferior esophagus
Rat tail (bird beak)

29
Q

Rat tail and bird beak sign raises the possibility of esophageal carcinoma

A

Involves more than distal esophagus or had irregular contours

30
Q

CT rule in achalasia

A

It has little role in directly assessing patients with achalasia, but it is useful in assessing commin complications
Used to identify any focal regions of thickenning (malignancy)
Inspection of lungs for evidence of aspiration

31
Q

A number of entities may mimic achalsia

A

Scleroderma
Esophageal or gastric malignancy
Esophageal stricture
Chagas disease
Anti-Hu antibodies from lung cancer (paraneoplastic syndrome)

32
Q

Corrsive stricture

A

Long stricture, which begins at the level of aortic arch

33
Q

Features of corrosive stricture

A

Smooth
Tapered ends
May be irregular

34
Q

Esophageal carcinoma

A

Usually involves the full circumference to form stricture for several centimeters in length.

35
Q

Features of malignant carcinoma stricture

A

Occur anywhere
Irregular outline
Shouldered edges
Deep ulceration
There is always dilatation before any stricture

36
Q

If you suggest that the stricture from esophageal carcinoma
What is the next step?

A

CT scan

37
Q

Types of filling defects on barium swallow

A

Intraluminal
Intramural: acute angle made with the wall
Extramural: There is a shallow obtuse angle with the wall of the bowel

38
Q

Ex of intramural filling defect

A

Leiomyoma
esophageal carcinoma

39
Q

Ex of extramural lesion

A

Carcinoma of the bronchus
Enlarged mediastinal lymph node
Aneurysm of aorta

40
Q

Intra-luminal filling defects

A

Foreign body like coin/lump food

41
Q

Esophageal varices:

A

Dilated submucosal veins dt ++ collateral blood flow from portal system to azygos system

Mainly caused by portal hypertension

42
Q

What is the next step if suggested on the esophageal varices

A

Endoscopy

43
Q

How to describe the finding in case of esophageal varices

A

Multiple tortuous worms like filling defects

Most likely esophageal varices

44
Q

Other findings may you get them with esophageal varices:

A

Liver cirrhosis and splenomegaly (CT)

45
Q

Esophageal web:

A

Thin, shelf-like projection arising from the anterior wall of cervical portion of the esophagus
not shouldering

46
Q

The combination of a web, dysphagia , and iron deficiency anemia that is usually found in middle-aged females is known as:

A

Plummer vinson syndrome

47
Q

How to describe the esophageal web in the barium x-ray

A

Thin non circumferential defect arising from the anterior wall of the cervical esophagus

48
Q

Esophageal diverticula

A

A pouch or sac that protrudes from the gastrointestinal wall and can derive from any tubular organ in the gastrointestinal wall

49
Q

True vs. False esophageal diverticula

A

False: consists of mucosa, submucosa, and strands of muscle fibers
True: contains all layers of the gastrointestinal wall

50
Q

Which level of the esophagus can diverticula occur at?

A

At any level

51
Q

Clinical features of diverticula

A

It is often Asymptomatic, may cause dysphagia, aspiration…

52
Q

Diverticula more common in:

A

Older male

53
Q

Common types of esophageal diverticula

A

Pharyngo-esophageal (Zenker’s diverticulum) : most common
Mid-esophageal (para-bronchial)
Epinephric

54
Q

Esophageal atresia

A

It is an absence in the continuity of the esophagus due to an inappropriate division of the primitive foregut into the trachea and esophagus.

55
Q

Most common congenital anomaly of the esophagus

A

Atresia

56
Q

Esophageal atresia may associated with :

A

Duodenal atresia
Pyloric stenosis

57
Q

Types of esophageal atresia :

A
  1. Proximal atresia with distal fistula (85%)
  2. Isolated esophageal atresia (8%)
  3. Double fistula with esophageal atresia (1%)
  4. Proximal fistula with distal atresia (1%)
58
Q

X-ray finding of the proximal esophageal atresia with distal tracheoesophageal fistula

A

Non progression of an orogastric catheter in the blind esophagus pouch and the presence of air ij the stomach

59
Q

The non-progression radiopaque tube in the esophageal pouch with no air in the stomach

A

Esophageal atresia without tracheoesophageal fistula

Radiology (16 decks)

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