GIT II (stomach) Flashcards
Clinical signs and symptoms that may come to patients with stomach and duodenal problems
Epigastric pain
Vomiting
Hematemesis
Some conditions for doing barium study
Fasting patient for at least 6 hours
IV injection of a short acting smooth muscle relaxant
Causes of filling defect in the stomach
Carcinoma
Leiomyoma
Polyps
Intraluminal defects
Radiology pattern of carcinoma of stomach
Irregular filling defect with alternation of mucosal pettern
Radiological description of leiomyoma of stomach
Smooth, round filling defect arising from the wall of the stomach
May has an ulcer on its surface
Causes of intraluminal defects in stomach
Food or blood
Hair forming ball or bezoar
Filling defects of the gastric polyps
Single or multiple
Sessile or have a stalk
Investigation of choice to visualize mucosal disease
Endoscopic ultrasonography
Investigation of choice to visualize mucosal disease
Endoscopic ultrasonography
Uses of endoscopy with combination of high-frequency US
Visualization of the bowel wall with high spatial resolution
Perform targeted endoscopic biopsy
Uses of CT with oral contrast in stomach
Dx and staging of tumors of the stomach and duodenum
Multidetector CT : multiplanar reconstrictions allowing early detection of various disease, (subtle mural abnormalities)
Features of congenital hypertrophic pyloric stenosis
Age : usually at 2-8 weeks
Non-bilious projectile vomiting
Palpable olive-shaped mass
Positive family hx
Visible peristalsis
Nasogastric aspirate > 10ml
Radiological findings of pyloric stenosis
(measurements)
Pyloric muslce wall thickness > 3mm
Pyloric transverse diameter > 14 mm with pyloric channel closed
Elongated pyloric canal > 17 mm in length
(special signs)
Cervix sign
Antral nippel sign
Target sign
(real time)
Exaggerated peristalsis waves
What are the three uss signs of pyloric stenosis
Target sign :transverse uss
Cervix sign: longitudinal
Antral nipple sign : longitudinal
Signs of pyloric stenosis on barium meal study
Mushroom sign
Shoulder sign
String sign
Mucosal nipple sign
Duodenal atresia
Atresia usually just **distal to ampulla of vater
Main C/F Bilious vomiting in first several hours
Prenatal ultrasounds in case of duodenal atresia
Double bubble sign
Plain abdominal x-ray in case of duodenal atresia
Larger bubble is air in dilated stomach
Smaller bubblenis air in a dilated duodenum
There is usullay little or no air in the bowel distal to the obstruction
Do we need a contrast study to dx duodenal atresia?
No
Malrotation with a midgut volvulus
Torsion of entire gut around superior mesenteric artery (SMA) due to a short mesenteric attachment of small intestine
Malrotation and midgut vovulus usually occurs which age:
Neonate or young infant
occasionally older child and adult
Clinical signs and symptoms of midgut volvulus
Projectile bile-stained vomiting
Intermittent, postprandial abdominal distension
Intermittent obstructive symptoms in older child, recurring attacks of nausea, vomiting, abdominal pain
Failure to thrive
Radiological findings in case of midgut volvulus
Plain X-ray: double bubble sign
Barium meal: corkscrew sign (spiral appearance of the distal duodenum and proximal jejunum)
Uss midgut volvulus
Whirlpool sign: swirling of the bowel and mesenteric vein around the superior mesenteric artery (SMA)
Hiatus hernia
results from the extension of the the stomach into the chest throughout the wide esophagus hiatus
some features of hiatus hernia
Acquired
often associated with obesity or pregnancy
frequently are asymptomatic and incidental findings on chest radiographs and CT
usually associated with gastroesophageal reflux
examination of choice to hiatus hernia
barium swallow
common types of hiatus hernia
sliding : GE junction and gastric cardia
paraesophageal (rolling) hernia: fundus +/- other parts of the stomach
how to describe hiatus hernia on CXR
round retrocardiac masses, usually containing air or an air-fluid level
CT scan chest for hiatus hernia
Extension of a portion of the proximal stomach into the lower mediastinum
diagnosis of hiatus hernia is confirmed by:
barium swallow or CT
types of peptic ulcer
gastric ulcer : are open sores on the lining of the stomach
duodenal ulcers: occur in part of the intestine just beyond the stomach
common symptoms of peptic ulcer
ingestion
heartburn
nausea
gastric ulcer caused by:
an infection with Helicobacter pylori (H. pylori) bacteria
taking NSAIDs
complications of peptic ulcer
hint : POB
perforation
gastric obstruction
bleeding
90-95% of gastric ulcers are located on:
lesser curvature and posterior stomach wall in the gastric body and antrum
uncommonly seen on the greater curvature
