ICL 4.4: Radiology of the Upper GI Tract

Question 1

what imagining can be done on the GI tract?

Answer 1

1. X-ray
2. fluoroscopy with contrast
3. computed tomography (CT)
4. ultrasound
5. MRI
6. nuclear medicine

Question 2

what 2 contrast agents do we use in the GI tract?

Answer 2

1. barium sulfate

2. water soluble iodine

Question 3

what are the 4 layers of the GI tract lumen?

Answer 3

1. muucsa
2. submucosa
3. muscularis propria
4. adventitia (serosa)

Question 4

what is the response o the GI tract to disease?

Answer 4

1. dilation

2 strictures

3. ulceration
4. changes in mucosal folds
5. diverticula
6. polyps or plaques
7. changes in peristalsis

Question 5

what is the peristalsis of the esophagus?

Answer 5

1. primary wave = food from mouth to stomach
2. secondary wave = gets the left overs that the primary wave didn’t catch
3. tertiary wave = non-peristaltic contraction, they’re just random peristalsis

Question 6

what are diffuse esophageal spasm?

Answer 6

esophagus contracts in an uncoordinated way that doesn’t help with movement of the bolus

patient will have substernal chest pain or a sensation that the bolus is stuck in the esophagus usually at the level of the manubrium

Question 7

what is achalasia?

Answer 7

a lack of peristalsis in the esophagus and lack of relaxation of LES

so all the food you eat stays in the esophagus until there’s enough food build up to push open the LES

Question 8

what is the x-ray hallmark of achalasia?

Answer 8

bird beak with dilated esophagus

inflation can cause ulceration or squamous cell carcinoma due to prolonged damage to the esophagus from food buildup

Question 9

what is the hallmark of hiatal hernias?

Answer 9

schatzki’s ring

Question 10

what is the hallmark of zener’s lateral?

Answer 10

a huge pouch right behind the mouth

Question 11

what is odontophagia?

Answer 11

painful swallowing

usually associated with esophagus infections

Question 12

what is a common esophageal infection?

Answer 12

1. candida

you’ll see streaky plaques in the esophagus

2. CMV ulcer that almost always occurs with AIDS and you need to make sure you differentiate it from primary HIV esophagitis

Question 13

what is the most common benign esophageal tumor?

Answer 13

leiomyoma = smooth muscle tumor

they frequently calcify and cause a mass in the esophagus

Question 14

what are the common causes of stomach ulcers?

Answer 14

1. H. pylori
2. NSAIDs
3. corticosteroids
4. tobacco, alcohol, coffee
5. stress
6. GERD

Question 15

what are the complications of ulcers?

Answer 15

1. bleeding
2. obstruction
3. perforation

Question 16

what are the 2 types of gastric polyps?

Answer 16

1. hyperplastic (non-malignant; tend to be multiple)

2. adenomatous (pre-malignant, bigger, in the antrum often)

Question 17

what are the causes of gastric cancer?

Answer 17

1. H. pylori
2. diet
3. atrophic gastritis/pernicious anemia
4. gastric polyps
5. partial gastrectomy
6. Menetrier’s disease
7. hereditary

Question 18

what part of the GI does Crohn’s effect?

Answer 18

small intestine and colon

Question 19

what CT findings do you see with intestinal ischemia?

Answer 19

1. wall tichkening
2. intramural hemorrhage
3. changes in wall enhacement
4. pneumatosis
5. portal veinous gas
6. clot in SMA or SMV