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Rad Patho > Pathophysiology 2 > Flashcards

Pathophysiology 2 Flashcards

1
Q

inflammation of the mucosal lining of the stomach and small bowel

A

gastroenteritis

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2
Q

[pathophysiology] gastroenteritis

A
  1. Gastritis due to NSAIDS, alcohol, steroids, stress, trauma, viral/fungal infections, smoking, H. pylori
  2. Salmonella enteritis - contaminated poultry, meat, egg, dairy - diarrhea from mild mucosal ulcerations
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3
Q

[s/s] gastroenteritis

A

mild feverr
vomiting
watery diarrhea

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4
Q

[Dx] gastroenteritis

A

UGIS/ SIS
DC - slit-like collection of Ba surrounded by radiolucent halos; thickened mucosal folds

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5
Q

[Tx] gastroenteritis

A

antibiotics
fluid management
remove causative agent

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6
Q

chronic condition where parts of the digestive system become inflamed.
a type of a condition called inflammatory bowel disease (IBD).

A

Crohn’s Disease

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7
Q

Crohn’s Disease occurs in [..]

A

GI tract (lower ileum and cecum)

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8
Q

Crohn’s Disease [poi occurrence percentage]

A

SB 30%
Colon 30%
Combination 40-50%

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9
Q

Crohn’s Disease [bimodal distrib]

A

14-24 and 50-60 yrs old

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10
Q

[pathophysiology] Crohn’s Disease

A

-involves all bowel layers which may lead to fistulas and abscess
-rectal sparring 50%
-may affect mouth to anus
-NOD2/CARD15 gene increases susceptibility
-unreg intestinal immune response to envi factors
-crypt cells inflammation and abcess
-small ulcers-thickened bowel wall

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11
Q

[s/s] Crohn’s Disease

A

-similar to appendicitis or acute bowel
obstruction
-periods of exacerbation and inactivity
-abdo pain and cramping , blood in stool, diarrhea, fever, fatigue, mouth sores, reduced appetite and wt loss

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12
Q

[s/s] Crohn’s Disease

A

-similar to appendicitis or acute bowel
obstruction
-periods of exacerbation and inactivity

-abdo pain and cramping , blood in stool, diarrhea, fever, fatigue, mouth sores, reduced appetite and wt loss

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13
Q

[Dx] Crohn’s Disease

A

UGIS/SIS
SBFT
Endoscopy
BaE
CT/MR Enterography
Sonography
HMPAO Leukoscintigraphy

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14
Q

[Dx] Crohn’s Disease - useful for characterizing length of involvement

A

SBFT

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15
Q

[Dx] Crohn’s Disease - SBFT Characteristic Findings: (5)

A

abscess/fistula
mucosal nodularity
narrowed lumen
string sign
ulceration

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16
Q

[Dx] Crohn’s Disease -SBFT sign

A

“String sign” - appears w/ small ulcers and thickened bowel wall, narrowing of lumen, reversible
-caused by incomplete filling as a result of irritability/spasms assoc. w/ ulceration

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17
Q

[Dx] Crohn’s Disease - preferred initial examination, when ulceration is severe
[appearance]

A

Endoscopy
Cobble Stone appearance

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18
Q

[Dx] Crohn’s Disease - for unsuccessful colonoscopies

A

BaE

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19
Q

[Dx] Crohn’s Disease -shows promise for initial dx

A

CT/MR Enterography

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20
Q

[Dx] Crohn’s Disease - CT/MR Enterography -sign

A

“comb sign” - increased no of visible vessels on mesenteric side of affected segments of SB
-found in CD or LUPUS ENTERITIS (SLE MESENTERIC VASCULITIS)

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21
Q

[Dx] Crohn’s Disease - Sonography signs

A

bowel wall thickening (4-5mm)
“target sign”

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22
Q

[Dx] Crohn’s Disease - monitor and assess disease activity

A

HMPAO Leukoscintigraphy

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23
Q

[Cx] Crohn’s Disease

A

Mechanical bowel obstruction – fibrotic
scarring
Increased risk for bowel carcinoma

abscess, cancer, fistula, obstruction, perianal disease

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24
Q

[Tx] Crohn’s Disease

A

drug therapy, surgery 70%
recurrence is common
rarely cured but rarely fatal

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25
Q

long term condition where colon and rectum become inflamed

A

ulcerative colitis

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26
Q

[incidence] Ulcerative Colitis

A

15-25 yr olds; 4x more common in whites

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27
Q

[pathology] Ulcerative Colitis

A

-inflammation of mucosa only (exudate of pus, blood and mucus from the “crypt abscess”)
-always start in rectum (up to 1/3 dont progress)
-limited to colon and rectum

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28
Q

[s/s] Ulcerative Colitis

A

diarrhea w/ blood or pus, mucus, rectal bleeding, abdo pain and cramping, urgency by inability to defacate. wt loss and fatigue

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29
Q

[dx] Ulcerative Colitis

A

colonoscopy
BaE

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30
Q

[dx] Ulcerative Colitis - primary means

A

colonoscopy

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31
Q

[dx] Ulcerative Colitis - support dx, assess progression

A

BaE

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32
Q

[dx] Ulcerative Colitis BaE sign

A

LEAD PIPE SIGN - loss of haustrations + mucosal edema
PSEUDOPOLYPS
(islands of normal mucosa surrounded by affected mucosa

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33
Q

[diagnosis] Ulcerative Colitis

A

-continuous lesions
-rare
-lead pipe app due to chronic scarring and subsequent retraction and loss of haustra

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34
Q

[Cx] Ulcerative Colitis

A

cancer
megacolon
perforation
stricture

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34
Q

[Cx] Ulcerative Colitis

A

cancer
megacolon
perforation
stricture

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35
Q

[Tx] Ulcerative Colitis

A

dietary restrictions, steroids
Surgery – for obstruction or neoplasm
Resection – ileorectal/anal anastomosis

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36
Q

Inflammation of the vermiform appendix due to obstruction by a fecalith or neoplasm (rare)

A

appendicitis

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37
Q

[incidence] Appendicitis

A

late teens and 20s
M=F

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38
Q

[pathophysiology] Appendicitis

A

Obstruction – inflammation + distention –
compromised blood flow – increased
susceptibility to infection (E. coli bacteria) –
gangrene, perforation, rupture

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39
Q

[s/s] Appendicitis

A

Persistent RLQ pain
Nausea and vomiting – reflex symptom (stomach and appendix innervated by Vagus nerve)
Low grade fever, elevated WBC

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40
Q

[dx] Appendicitis

A

CT
Radiography + Contrast (BaE)
Sonography

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41
Q

[dx] Appendicitis - golden standard, most accurate for pts who do not have a clear clinical dx

A

CT

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42
Q

[dx] Appendicitis - follow-up to investigate other RLQ pain causes

A

Radiography + contrast (BaE)

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43
Q

[dx] Appendicitis - effective as CT if done by experienced […]

A

Sonography

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44
Q

[Cx] Appendicitis

A

Gangrenous/perforated appendicitis
because of delayed dx – rupture –
generalized peritonitis – death

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45
Q

[Tx] Appendicitis

A

Surgical removal of the appendix

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46
Q

Varicose veins
Abnormally lengthened and dilated
superficial veins

A

Esophageal Varices

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47
Q

Varicose veins
Abnormally lengthened and dilated
superficial veins

A

Esophageal Varices

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48
Q

[pathophysiology] Esophageal Varices

A

Portal hypertension – conditions that cause
resistance to the normal blood flow thru the
liver (ex. Cirrhosis) – increased blood flow
to the collateral veins (esophageal and
gastric) – dilatation

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49
Q

[s/s] Esophageal Varices

A

vomiting blood, black/blood stools, lighthead, loss of consciousness, jaundice, easy bleeding, ascites

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50
Q

[dx] Esophageal Varices

A

Thin Ba Swallow - rec pos’n, serpentine/wormlike filling defects

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51
Q

[Cx] Esophageal Varices

A

rupture and hemorrhage - massive often fatal

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52
Q

[Tx] Esophageal Varices

A

Endoscopic Sclerotherapy
Banding Ligation
Vasopressin
Balloon Tamponade
“Transjugular intrahepatic portosystemic shunt” (TIPPS)

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53
Q

[Tx] Esophageal Varices - redirect blood flow, assessed by Doppler

A

“Transjugular intrahepatic portosystemic shunt” (TIPPS)

54
Q

protrusion of bowel loops (usually in the abdominal wall)

A

Hernia

55
Q

[patho] Hernia

A

due to anatomic weakness - bowel loop herniates (along with peritoneum)

56
Q

[types] hernia

A

inguinal - m only
femoral
umbilical

57
Q

weakness of the esophageal hiatus causing portions of stomach to herniate into the thoracic cavity

A

hiatal hernia

58
Q

[incidence] Hiatal Hernia

A

occur in half the popu over the age 50

59
Q

[patho] Hiatal Hernia

A

early stages - reducible
chronic herniation - assoc. w/ GERD

60
Q

[types] Hiatal Hernia

A

direct/sliding - eso and top of stomach slides w/in diaphragm, GEJ and stomach portions above diaphragm

rolling/paraesophageal - portion of stomach herniates above diaphragm, GEJ remains below diaphragm may result in intrathoracic stomach

61
Q

[s/s] Hiatal Hernia

A

mostly asymptomatic
reflux

62
Q

[dx] Hiatal Hernia

A

UGIS - Schatski Ring (luminal ring related to reflux) -direct/sliding

63
Q

[tx] Hiatal Hernia

A

conservative management (minimize discomfort)

64
Q

interruption of normal peristalsis of SB and LB due to lesions

A

Bowel Obstruction

65
Q

[types] Bowel Obstruction

A

mechanical/physical -physical blockage

paralytic/non-mechanical/adynamic/ functional - ab peristalsis

66
Q

[patho] Small BO

A

adhesive secondary to prev abdo surgeries: 50-70%
hernia: 20-25%
tumors: 10%
mesenteric ischemia: 3-5%

67
Q

[patho] Large BO

A

colon/rectal CA: 90%
volvulus: 4-5%
diverticular d.: 3%

68
Q

luminal occlusion by physical means - hernia, tumor, volvulus, intussusception, post op adhesion (most common)

A

mechanical bo

69
Q

[types] Mechanical BO

A

Simple Obstruction - does not involve blood supply

Strangulating Obstruction- impairment of blood flow resulting to bowel edema then necrosis

69
Q

[types] Mechanical BO

A

Simple Obstruction - does not involve blood supply

Strangulating Obstruction- impairment of blood flow resulting to bowel edema then necrosis

70
Q

volvulus is usually in [..]

A

sigmoid or ileocecal area

70
Q

volvulus is usually in [..]

A

sigmoid or ileocecal area

71
Q

[dx] volvulus

A

rad’phy - collection of air in the dilated bowel

71
Q

[dx] volvulus

A

rad’phy - collection of air in the dilated bowel

71
Q

[dx] volvulus

A

rad’phy - collection of air in the dilated bowel

72
Q

[dx] volvulus

A

rad’phy - collection of air in the dilated bowel

73
Q

[patho] intussusception

A

imbalance b/w longit and radial smooth muscle forces of intestine that maintain normal struc

74
Q

**[s/s] intussusception

A

stool w/ blood and mucus, vomiting, lump in belly, weakness, diarrhea

75
Q

[dx] intussusception

A

BaE - spring-like app

76
Q

a gallstone erodes the gb and creates a fistula w/ SB

A

gallstone ileus

77
Q

[patho] Gallstone Ileus

A

obstruction occurs when gs reaches ileocecal valve

78
Q

[dx] Gallstone Ileus

A

Clinical Radiograph (supine and erect)
CT - 90% accuracy for high grade SBO w/o cont (limited for low grade, needs multiformat recon)
CT enterography - detecting lumen obliterating ab
MRI- for low grade SBO

79
Q

neuromuscular ab
failure of the lower esophageal sphincter to relax leading to dysphagia

A

achalasia

80
Q

[incidence] achalasia

A

m=f
20-40 yrs old

81
Q

[patho] achalasia

A

motility disorder, absence of esophageal peristalsis

82
Q

[s/s] achalasia

A

slow progressive dysphagia, regurgitation, wt loss, chest pain

83
Q

[dx] achalasia

A

barium swalllow -upper dilater, lower constricted w/ little/absent peristalsis

84
Q

[tx] achalasia

A

nitrates, calcium channel blockers, botulinum toxin, esophageal dilation, myotomy

85
Q

variable sized sac/pouch occurring normally or created by herniation of the mucosal membrane thru the muscle wall

A

diverticulum

86
Q

herniation of the mucosa due to motility disorders of the eso frequent in the upper and lower thirds

A

pulsion diverticulum

87
Q

[types] pulsion diverticulum

A

zenker
killian-jamieson
epiphrenic

87
Q

pulsion diverticulum - zenker

A

posterior, upper eso (pharyngoesophageal junction)

87
Q

pulsion diverticulum - killian-jamieson

A

lateral, upper eso

87
Q

pulsion diverticulum - killian-jamieson

A

lateral, upper eso

88
Q

pulsion diverticulum- epiphrenic

A

lower eso, above diaphragm

89
Q

[dx] pulsion diverticulum

A

Ba swallow - rounded w/ narrow neck

90
Q

involves all layers of eso
from pulling off adjacent scar tissue

A

traction diverticulum

91
Q

traction diverticulum frequently in [..]

A

middle third carina

92
Q

[s/s] traction diverticulum

A

asymptomatic if small
causes obstruction, aspiration pneumonia if large (food retention)

93
Q

[dx] traction diverticulum

A

Ba Swallow -triangle

94
Q

presence of 2 or more diverticula w/o inflammation

A

diverticulosis

95
Q

diverticulosis is frequently in the [..]

A

sigmoid colon 95%

96
Q

[incidence] diverticulosis

A

adults over 40 yrs

97
Q

[patho] diverticulosis

A

-assoc. w/ hypertrophy of muscle layer
-occur where mesenteric vessel branches pierce bowel wall
-pressure gradient b/w lumen and serosa
-sigmoid narrowest

98
Q

occurs in 10-20% of pts w/ diverticulosis, exacerbated by lodged feces

A

diverticulitis

99
Q

[s/s] diverticulitis

A

LLQ pain and tenderness
fever
increased WBC

100
Q

[dx] diverticulitis

A

CT -gs
BaE
Sonography
Endovaginal Sonography

101
Q

[dx] diverticulitis - CT

A

80-90% sensitivity, ability to detect extraluminal patho (detect other diseases that mimic diverticulitis)
-pericolonic adenopathy adjacent -thickened colonic wall seg

102
Q

[dx] diverticulitis- BaE

A

poor extraluminal imaging

103
Q

[dx] diverticulitis -sonography

A

high sensi and speci but dep on skill and pt habitus

104
Q

[dx] diverticulitis - endovaginal sono

A

rule out ectopic pregnancy or PID

105
Q

[cx] diverticulitis

A

abscesses, fistulas, obstructions, perforations

106
Q

[tx] diverticulitis

A

antibiotics/anti-inflammatory drugs
CT/UTS guided percutaneous drainage of abscess
surgical resection

107
Q

benign tumors are almost always [..]

A

leiomyomas (smooth muscle usually incidental findings)

108
Q

[dx] benign tumors

A

Ba Swallow -intramural defects
CT-gs - exact location of homo st mass

109
Q

[stats] malignant tumor

A

7% GI cancers - poor prognosis
<10% 5 yr survival rate

110
Q

[dx] malignant tumors

A

endoscopic biopsy
CT for TNM staging
Endoscopic UTS

111
Q

forms in thin, flat cells lining in esophagus

A

squamous cell carcinoma

112
Q

[s/s] squamous cell carcinoma

A

chronic irritation (smoking, alcohol, reflux)
dysphagia (50-75% circum reduced)
metastatic spread to LN and mediastinal strucs

113
Q

[dx] squamous cell carcinoma

A

mucosal destruction, ulceration, narrowing, sharp demarcation b/w normal and malignant tissue

114
Q

[tx] squamous cell carcinoma

A

excision, chemo/rad’n

115
Q

cancers that start in gland cells or bottom of eso lower portion
95%mucosal

A

adenocarcinoma

116
Q

[s/s] adenocarcinoma

A

Barrett Esophagus

117
Q

[dx] adenocarcinoma

A

plaquelike or sessile polyps, infiltrating lesions w/ irregular luminal narrowing (abrupt, asymmetric)

118
Q

[localization of ulcers] gastric adenocarcinoma

A

lesser curvature, pyloric and antral regions

119
Q

[stats] gastric adenocarcinoma

A

5x more in Japan
5 yr survival rate - 71% localized
<4% metastatic

120
Q

[patho] gastric adenocarcinoma

A

alter in p53 tumor suppressor gene, cell cycle regulators, cell adhesion mole, DNA repair genes
H. pylori -3-6x increased risk

121
Q

[s/s] gastric adenocarcinoma

A

non specific symp at early stages, diagnosed late

persistent GI pain, bleeding, vomiting, loss of appetite, wt. loss, early satiety

122
Q

[dx] gastric adenocarcinoma

A

UGIS
upper gi endoscopy w/ biopsy
CT

123
Q

gastric adenocarcinoma - UGIS

A

rigid peristalsis and filling defects

124
Q

gastric adenocarcinoma-CT

A

polypoid tumors, staging

125
Q

[tx] gastric adenocarcinoma

A

subtotal gastrectomy + gastrojejunostomy
rad’n/chemo-less effective

Rad Patho (8 decks)

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