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Abdominal > Quiz 5 (GI tract) > Flashcards

Quiz 5 (GI tract) Flashcards

1
Q

what are functions of the GI tract?

A
  • ingest food
  • digest food
  • secrete mucus and digestive enzymes
  • absorb and breakdown food
  • reabsorb fluid to prevent dehydration
  • form solid feces
  • expel fecal waste
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2
Q

what enzymes are secreted by the stomch?

A

hydrochloric acid

pepsin

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3
Q

what enzymes are secreted from the small intestines?

A
  • secretes mucus

- receives digestive enzymes

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4
Q

what enzymes are secreted from the duodenum?

A

large quantities of mucous (protects small intestine from acidic chyme)

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5
Q

what enzymes are secreted from the colon?

A

large quantities of mucous-bacteria in colon

-produces vit K and some B-complex vitamins

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6
Q

what is the stomach wall thickness?

A

less than 5mm when distended

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7
Q

what is the normal bowel wall measurment?

A

less than 4mm thickness

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8
Q

where does the small intestine decrease in size?

A

pylorus to ileocecal valve

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9
Q

where is the colon the largest?

A

cecum and gradually decreases in size toward the rectum

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10
Q

what is seen on ultrasound with the stomach?

A
  • GEJ in SAG LL indent

- walls of pylorus in TRV view of pancreas

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11
Q

where does much of the digestion and absorption of food take place?

A

valves of Kerckring (valvulae conniventes)

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12
Q

how long is the small intestine?

A

6 meters

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13
Q

what are the functions of the colon?

A
  • absorbs water

- passes useless waste form body

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14
Q

how long is the colon?

A

2 meters

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15
Q

Teniae coli

A

Longitudinal ribbons of smooth muscle on the outside of the colon
-contract lengthwise

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16
Q

Produce haustra

A

-Bulges in the colon
-Caused by contractions
of the teniae coli

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17
Q

what are the 4 concentric layers of the gut?

A
  • mucosa
  • submucosa
  • muscularis propria
  • serosa or adventita
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18
Q

what is the sonographic appearance of gut signiture?

A 
echogenic
hypoechoic
echogenic
hypoechoic
........(up to 5 layers)
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19
Q

what are indications for scanning the stomach?

A
  • abdominal or RLQ pain
  • leukocytosis
  • vomiting
  • weight loss
  • fever
  • e.t.c
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20
Q

what are steps to assess GI tract?

A
  • wall thickness
  • doppler evaluation
  • peristalsis
  • inflammed fat surrounding bowel
  • lymphadenopathy
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21
Q

how do you measure gut wall?

A

measure from outer wall (adventitia) to wall of lumen

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22
Q

vascularity of normal gut

A

minimal doppler seen

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23
Q

vascularity of inflammation and neoplasia

A

increased vascularity

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24
Q

vascularity of ischemia and edematous gut

A

hypovascular

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25
Q

where is peristalsis normally seen?

A

in small bowel and stomach

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26
Q

what is the most striking and detectable abnormality on sonography?

A

mesenteric edema and fibrosis

-uniform echogenic halo around gut

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27
Q

what is a sign of imflammation

A

Lymphadenopathy

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28
Q

why might thickening of the bowel wall occur?

A
  • infiltration
  • inflammation
  • edema
  • neoplastic invasion
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29
Q

causes of congenital bowel wall inflammtion?

A
  • meckels Diverticulum
  • Malrotation of the bowel
  • enteric duplication cysts
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30
Q

causes of non congenital or IBD?

A
  • neoplasms (adenocarcinoma most common)
  • intussesception
  • IBD
  • Appendicitis
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31
Q

Meckels diverticulum

A
  • remnant of prenatal yolk stalk vitelline duct

- projects from side of the ileum

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32
Q

malrotation of bowel

A

associated with malposition of SMA and SMV

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33
Q

what helps with evaluating malrotation of bowel?

A

assessed with doppler

  • varices may be detected
  • ischemia
  • necrosis
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34
Q

enteric duplication cysts

A

rare congenital malformations that frequently occur in the small intestine especially the hilum

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35
Q

what are the symptoms to enteric duplication cysts?

A
  • abdominal pain
  • vomiting
  • palpable mass
  • hemorrhage
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36
Q

what is the most common cancer of the colon?

A

adenocarcinoma

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37
Q

how are esophageal and gastric lesions assessed?

A

endoscopy

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38
Q

is adenocarcinoma of stomach more common in females or males?

A

males

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39
Q

what are differential diagnosis of gastric lesions/neoplasms?

A 
adenocarcinoma
lymphoma
leukemia
crohn's disease
intussusception
metastases
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40
Q

intussusception

A

a proximal segement invaginates into a distal segement and stragulation of vascular supply occurs

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41
Q

who is intussusception more commonly seen in?

A

children

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42
Q

what may cause intussusception?

A
  • malignant lesions in adults

- benign lipomas or polyps

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43
Q

examples of IBD

A
  • crohn’s

- colitis

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44
Q

what is ulceration of bowel caused by?

A

inflammation

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45
Q

thickened walls of ulceration of bowel look like what?

A
  • pseudo kidney

- doughnut sign

46
Q

what are bowel problems?

A
  • illeus

- bowel obstructions

47
Q

ilieus

A

temporary absence of peristalsis

48
Q

what causes ilieus?

A
  • common after abdominal or pelvic surgery

- can happen to any part of the bowel

49
Q

bowel obstruction

A

interference of normal passage of luminal contents

50
Q

what causes bowel obstruction?

A

-intrinsic or extrinsic factors

mass, fecal matter

51
Q

what does mechanical bowel obstruction cause?

A
  • adhesions (scar tissue)
  • foreign bodies
  • gallstones
  • hernias
  • impacted stool
  • intussesception
  • tumors-blocking the lumen
  • volvulus
52
Q

how does ileus dilate bowel?

A
  • causes paralysis of bowel loops
  • peristalsis is absent
  • gas accumulates in these loops
  • localized ileus may occur near inflammatory process
53
Q

how does obstruced bowel dilate bowel?

A
  • prevent gas from passing through the GI tract
  • builds up proximal to obstructed loop
  • portion distal to the obstruction becomes decompressed
54
Q

Pneumoperitoneum

A

presence of air or gas in the abdominal cavity

55
Q

what is the most common cause-perforated peptic ulcer?

A

Pneumoperitoneum

56
Q

Peritonitis

A

inflammation of the peritoneum

57
Q

what are signs of peritonitis?

A
  • abdominal pain
  • tenderness
  • fever
58
Q

Miscellaneous

A

worm causing thickened bowel seen when we covered Liver/Biliary tree parasites

59
Q

what are signs and symptoms of miscellaneous?

A

diffuse pain

vommiting

60
Q

Ascaris

A

tube within a tube within bowel worm can be seen moving

61
Q

other GI diagnostic tests

A
  • abdominal x-ray plain film
  • barium swallow (upper GI)
  • barium enema
  • CT
62
Q

what is CT good at diagnosing?

A

gastric carcinoma

63
Q

sonographic appearance of neoplasms

A
  • potential causes of bowel thickening

- may demonstrate decreased to intermediate echogenicity

64
Q

what are sonographic guidelines for benignancy of appendix??

A

-long segment
-concentric thickening
-wall preservation
(crohn’s disease)

65
Q

what are the sonographic guidelines for malignancy of apendix??

A

-short segment
-eccentric thickening
-wall layer destruction
(adenocarcinoma)

66
Q

is gut wall thickening malignant or bengin?

A

malignant and benign

67
Q

gut wall masses location

A
  • intraluminal
  • mural
  • exophytic
  • with or without ulceration
68
Q

neoplasia

A
  • adenocarcinoma
  • stromal tumors
  • lymphoma
  • metastases
69
Q

what is the most common malignant tumor of the GI tract?

A

adenocarcinoma

70
Q

where does adenocarcinoma occur?

A

less frequently in the small bowel than in the stomach and large bowel

71
Q

adenocarcinoma appearance

A
  • thicken gut wall in concentric symmetrical or asymmetrical
  • target or pseudo kidney may be created
  • tumors are usually hypoechoic
  • may be lymph node enlargment
  • liver mets
72
Q

what are the most common stromal tumors?

A

smooth muscle origin

73
Q

where are stromal tumors most often seen?

A

stomach

small bowel

74
Q

where do colonic tumors occur most often?

A

in rectum

75
Q

colonic tumors sonographic appearance

A
  • round mass lesions of varying echogenicity
  • necrosis or hemorrhage
  • air within ulceration
76
Q

lymphoma sonogrpahic appearance

A
  • nodular or polypoid
  • carcinoma-like ulcerations
  • infiltrating tumor masses
  • frequently invade adjacent mesentary and lymph nodes
77
Q

what is the most common IBD?

A

crohn’s disease

78
Q

crohn’s disease

A
  • chronic transmural granulomatous inflammatory process
  • affects all layers of gut wall
  • has skip lesions
79
Q

ulcerative colitis

A
  • mucousal inflammation of the colon
  • minimal sonographic change
  • begins in anal region and moves upward
80
Q

crohn’s disease acute or chronic?

A

chronic

81
Q

where does crohn’s disease most often affect?

A

terminal ileum
colon
(gut very thick and rigid)

82
Q

what are complications of chronic crohn’s disease?

A
  • inflammatory masses
  • obstruction
  • strictures
  • perforation
  • appendicitis
83
Q

what are classic sonographic findings for crohn’s disease?

A
  • gut wall thickening
  • creeping fat
  • hyperemia
  • mesenteric lymphandenopathy
  • strictures
  • mucosal abnormalities
  • skip lesion
84
Q

strictures

A

rigid narrowing of gut lumen

85
Q

what do structures look like?

A

lumen appears as a linear echogenic central area within a thickened gut loop
(US is accurate technique for detecting small bowel)

86
Q

fistula formation

A

characteristic complication at the proximal end of a thickened segment of Crohn’s loop

87
Q

SUMMARY chron’s classic features

A
  • gut wall thickening greater than 4mm
  • creeping fat
  • hyperemia
  • strictures
  • lymphadenopathy
  • mucosal abnormalities
88
Q

SUMMARY chron’s complications

A
  • inflammatory masses
  • fistula
  • obstruction
  • perforation
  • appendicitis
89
Q

what is the treatment for crohn’s?

A

no cure

medication

  • anti-inflam.
  • corticosteroids
  • antibiotics

surgery

  • removal of colon or sm intes.
  • ileostomy-small bowel
  • colostomy-large bowel
90
Q

sonographic features of ulcerative colitis

A
  • minimal sonographic change even with acute or long standing disease
  • starts in anus and proceeds up
  • no skip lesion
91
Q

RLQ pain

A
  • appendicitis

- diverticulitis

92
Q

LLQ pain

A

-acute diverticulitis

93
Q

other abdomen abnormalities

A
  • mechanical bowel obstruction
  • ileus
  • colitis
94
Q

appendicitis

A

inflammatory process of the appendix that may indent or displace the cecum

95
Q

what may be see with appensicitis?

A
  • will not exhibit peristalsis
  • will not compress
  • appendicoliths and periappendiceal abscess
96
Q

what is the most common cause of RLQ pain?

A

acute appendicitis

97
Q

what is the triad of symptoms for acute appendicitis?

A

-RLQ pain
-tenderness
-leukocytosis
(mass could also be palpable)

98
Q

what further symptoms could occur with acute appendicitis?

A
  • transient visceral or referrer crampy pain in periumbilical area
  • nausea and vomiting
  • pain shifts to RLQ-peritoneal irritation
99
Q

who does acute appendicitis most occur in?

A
  • younger patients
  • 10-30
  • but can affect all ages
100
Q

what is the graded compression technique in appendicitis?

A

-used to assess for non-compressible bowel
-use a linear, broad, footprint, high frequency transducer (7MHz)
-displace the bowel loops while applying moderate compression
REBOUND PAIN will occur as probe is lifted off quickly

101
Q

what are good indications of appendicitis?

A
  • non compression

- rebound pain

102
Q

what helps to locate origin of appendix?

A

ileocecal

103
Q

what are the sonographic appearances of the appendix?

A
  • blind ended
  • non compressible
  • aperistaltic tube
  • gut signature
  • arising from base of cecum
  • AP diameter greater than 6mm
104
Q

what are supportive features of appendix?

A
  • inflammed perienteric fat
  • pericecal collections
  • appendicoltih
105
Q

what are complications of appendicitis?

A
  • perforation
  • abscess
  • gangrene
106
Q

where is the appendix located?

A

behind the cecum which makes visualization difficult

107
Q

diverticulitis “LLQ pain”

A
  • cause in an overwhelming number of cases

- pouches within the bowel wall become inflammed

108
Q

what are diverticuli?

A

acquired deformities of large bowel

-muscular dysfunction and hypertrophy

109
Q

where is diverticuli often seen?

A
  • western urban population

- sigmoid and left colon

110
Q

what is the classic triad of symptoms for acute diverticulitis?

A
  • LLQ pain
  • Fever
  • Leukocytosis
111
Q

sonographic features of acute diverticulitis?

A
  • segmental thickened gut
  • inflammed diverticula
  • inflammed perienteric fat
112
Q

what is the treatment to diverticulitis?

A
  • simple uncomplicated diverticulitis responds well to antibiotics
  • recurring acute attacks or complications such as peritonitis, abscess or fistula require surgery
  • low fiber diet rests bowel-heals

Abdominal (11 decks)

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