pathology of digestive system Flashcards
Salivary gland calculi
Describes the formation of calculi inside the salivary glands, most commonly the submandibular ducts and glands
causes - may be no known cause, but dehydration, smoking and some autoimmune diseases are linked
symptoms - history of recurrent swelling and pain in the involved gland usually associated with eating and may also be infection
salivary gland calculi diagnosis and treatment
diagnosis = plain film, sialography, CT and MRI
complications = infection and pain
treatment = hydrationnand heat may need surgical removal
GORD
description = Reflux of gastric acid from the stomach into the lower oesophagus across the oesophageal sphincter
causes = hiatus hernia, smoking, alcohol, pregnancy, certain medications, certain asthma meds etc
symptoms = epigastric and retrosternal burning, acidic taste in mouth and chronic dry cough
diagnosis and treatment of GORD
diagnosis = barium swallow - will see reflux
complications = exposure of the oesophagus to acid causes inflammation that leads to Barretts oesophagus and then can result in cancer
treatment = drugs to inhibit gastric acid peoduction and surgery for severe cases
Barretts oesophagus
description = a change in the type of cells in the oesophagus (squamous epithelium to columnar epithelium)
causes = seen more in patients with oesophagtis, risk factors include being male and smoking
symptoms = asymptomatic and seen incidently when patients present with GORD
diagnosis and treatment of barretts oesophagus
diagnosis = endoscopy, may not be seen on imaging util it is advanced, barium swallow
treatment = patients will be monitored with endoscopy every 3,6 or 12 depending on severity
Oesophageal cancer
causes = alcohol and smoking, barrett oesaphagus, coeliac disease, radiation and HIV
symptoms = dysphagia, weight loss, reflux, hoarseness and cough
diagnosis and treatment of oesaphageal cancer
diagnosis = cxr, barium swallow, us, ct and pet ct
treatment = surgery - oesophagectomy
Gastric adenocarcinoma
description = Is a primary malignancy arising from the gastric epithelium. Most common gastric malignancy
causes = rare before 40, causes non specific anaemia, gastritis, smoking, reflux
symptoms = often non specific, weight loss and vague pain, nausea and vomitting in late stage
Gastric adenocarcinoma diagnosis and treatment
diagnosis = endoscopy is the gold standard
CT - can assess the tumour and look for local and distant spread
treatment = surgery, chemotherapy and radiotherapy
small bowel obstruction
Description
•Is a mechanical blockage of the transit of food through the small bowel.
•Can be complete or incomplete (high grade or partial)
causes and symptoms of small bowel obstruction
causes = adhesions, inflammatory bowel disease, cancer, hernias, foreign body
symptoms = depends on many factors but pain, no/few bowel movement and vomitting
diagnosis and treatment of small bowel obstruction
CT, oral contrast and MRI
treatment = non operative - bowel rest and NG tube, IV nutrition
operative - bowel resection
Small bowel follow through / Gastrografin
Often performed on inpatients with a suspected SBO
Are diagnostic and therapeutic
Patient drinks 100mls of water-soluble contrast orally or down the NG tube
AXR performed 6-12 hours later to see if the contrast has reached the large bowel.
If not contrast at 24 hours – indication for surge
large bowel obstruction
Description
• Less common than small bowel. Mechanical blockage again
large bowel obstruction causes and symptoms
Causes
• Most common cause is colonic cancer, then diverticulitis, volvulus, hernias, faecal / foreign
body impaction
Symptoms
• Again, can be complete or incomplete / partial. Same symptoms
diagnosis and treatment of large bowel obstruction
AXR and CT
treatemt depends on cause, surgery, colonic stent
volvulus
Description
•There is torsion of the bowel around its mesentery. This results in narrowing of the lumen at the point of rotation and compromise of the blood vessels that supply the bowel / stomach at that poin
causes and symptoms volvulus
causes = some medications for psychiatric conditions and neurological conditions like MS and parkisons, chronic constipation
symptoms = same as an onstruction. in the stomach - sudden epigastric pain, retching but no vomitting,
diagnosis and treatment of volvulus
gastric - AXR, CT
treatment = flatus tube at endoscopy, surgery if this does not work
Ulcerative colitis
Description
• Type of inflammatory bowel disease that primarily affects the large bowel
Ulcerative colitis causes and symptoms
causes = no known cause may be associated with stress poor immune system family history other environmental and genetic factors
symtpoms = chronic diarrhoea, pain fever
Ulcerative colitis diagnosis and treatment
diagnosis = axr, CT, MRI
treatment = drugs
may require surgery
Crohn’s disease
Description
•Inflammatory bowel disease that can affect anywhere in the GI tract. However, terminal ileum and proximal colon are most commonly affected
causes and symptoms of crohns disease
causes =no known cause. May be associated with stress, poor immune system, family history, other
environmental and genetic factors
symptoms = depend on location but pain fever blood diarrhoea
diagnosis and treatment of crohns disease
endoscopy, axr, ct and mei, us useful for looking at treatment response
treatment = corticosteroids, immunosuppression, surgery in severe cases
coeliac disease
Description
• Gluten intolerance characterised by loss of villi in the proximal small bowel and
GI malabsorption
• Is a chronic autoimmune disease
coeliac disease causes and symptoms
causes = less common in Asian and black population. Associated with inflammatory
bowel disease
Symptoms = Iron deficiency anaemia, abnormal bowel habit, malabsorption, weight loss
diagnosis and treatment of coeliac disease
diagnosis = ct/mri enterography
treatment = gluten free diet
acute appendicitis
Acute inflammation of the appendix
causes and symptoms of acute appendicitis
causes = Blockage of the opening of the appendix, family history, viral infections
Symptoms = Pain in the periumbilical area (T10) which moves to the right iliac fossa. Vomiting, raised
inflammatory markers
diagnosis and treatment of acute appendicitis
diagnosis = axr, us , ct , mri
treatmet = appendicectomy
toxic megacolon
Acute complication of IBD, and other forms of colitis. The colon loses its tone which results
in severe dilatation and high risk of perforation
causes and symptoms of toxic megacolon
causes = UC is the most common cause.
symptoms = Pain, no bowel movement. If perforated there may be signs of peritonitis
diagnosis and treatment of roxic megacolon
AXR – distended transverse colon, may see it increasing over time. Signs of perforation.
•CT – loss of haustral markings, distension and signs of ulceration
•DO NOT DO colonoscopy due to risk of perforation
treatment = may need bowel rest and surgery if it does not resolve
Colorectal cancer
Cancer of the colon and rectum. 3rd most common cancer worldwide. 98% are adenocarcinomas from preexisting polyps
causes and symtpoms of colorectal cancer
causes = Lifestyle factors, mainly individuals over 50
Symptoms
• Anaemia, rectal bleeding, change in bowel habit, pain, signs of obstruction
diagnosis and treatment of colorectal cancer
• Most common in the rectum and sigmoid.
• CTC for diagnosis
• CT for staging
• MRI is the best imaging for the rectum
treatment = surgery chemo radiotherapy
Diverticular disease
General term for any pathology involving diverticula. Can be diverticulosis, diverticulitis as well
causes and symptoms of diverticular disease
causes = A diverticulum is a small outpouching of the GI tract between the haustra. most common in signoid. lack of fibre in diet, increasing age, use of laxatives are all causes.
symptoms = Often asymptomatic. But in acute setting there will be pain, blood stools, vomiting, signs of obstruction
diagnosis and treatment of diverticular disease
often seen incidentally at CTC / CT scans. If acute, CT will show mucosal thickening and signs of perforation
treatment = bowel rest and diet change if severe surgery is often used
gallstones
Description
• Also called cholelithiasis. Is stone formation at any point along the biliary tree
causes and symptoms of gallstones
causes = Female, middle age, obesity, family history, recent rapid weight loss
Symptoms = Only symptomatic in approx. 25% of cases. Pain – RUQ, nausea, bloating, right scapula tip pain
diagnosis and treatment of gallstones
axr, ct, us
treatment = Laparoscopic cholecystectomy
Pancreatic calcifications
Description
Calcifications within the pancreas
Causes
• Mainly due to chronic pancreatitis
Symptoms
• Asymptomatic but the cause of them may be
causing symptoms
Diagnosis
• Generally seen incidentally on CT and AXR
Pancreatic cancer
There are many different cancers of the pancreas because of its endocrine and exocrine
functions. 99% are exocrine in origin
causes and symptoms of pancreatic cancer
Causes
• Smoking, chronic pancreatitis, obesity, diabetes, family history
Symptoms
• Pain, new onset diabetes
diagnosis and treatment of pancreatic cancer
ct and mri
treatment = surgery if possible
Liver cancer – hepatocellular carcinoma
80-90% of liver cancers. Most common primary cancer of the liver
causes ans symptoms of liver cancer
Causes
• Strongly associated with cirrhosis from alcohol and viral causes such as hepatitis B and C
Symptoms
• Jaundice, hepatomegaly, pain
diagnosis ans treatment of liver cancer
us, ct, pet ct
treatment = liver transplantation, resection, chemo, radiotherapy
liver cysts
• Simple hepatic cysts are common benign lesions with no malignant potential.
• Nearly always seen incidentally.
• Can be isolated or multiple
• On imaging they are typically round or ovoid in shape with well defined margins
