Radiology of the Upper GI Tract Flashcards
What does a normal esophagus look like?
Smooth, radiolucent in the middle.
What can transverse striations on the esophagus be indicative of?
Reflux
could also be eosinophilic esophagitis “ringed esophagus”, depending on how they look
What do esophageal ulcers from reflux look like? (relatively mild disease)
Tiny punctate collections of contrast starting at the GE junction.
If you see ulcers high on the esophagus, but not near the GE junction, what do you think?
Cause other than reflux.
Most common organism in infectious esophagitis? What does this look like?
Candida
Multiple discreet plaques (radiolucent) in longitudinal orientations.
What does florid, fulminant candidaisis of the esophagus look like? In whom is this seen? Treatment?
“Shaggy esophagus”
This is mainly seen in AIDS.
Treatment = fluconazole.
What does herpes esophagitis look like? Treatment?
Multiple tiny ulcers (surrounded by radiolucent mounds of mucus)
Treatment = acyclovir
What does CMV esophagitis look like? Treatment?
One or more giant flat ulcers (in pt with AIDS)
Treatment = ganciclovir (which is pretty toxic)
Why is it important to really confirm your diagnosis of CMV esophagitis? What can present in a very similar way (giant ulcers)?
The drugs for CMV are very toxic.
HIV itself can cause giant ulcers on the esophagus (and these respond well to steroids).
What do you think if you see small discreet ulcers in mid esophagus in a patient who is not immunocompromised?
Think drug-induced, such as by tetracycline.
What is usually happening in medication induced esophagitis?
Pills are actually locally caustic, and cause problems when they get stuck.
How can eosinophilic esophagitis look on radiograph?
Ringed esophagus.
Diffusely narrowed esophagus.
Ugly, irregular esophagus?
More likely to be cancer
How do benign ulcers appear differently from malignant ulcers?
Benign: Round or ovoid crater with symmetric radiating folds.
Malignant: Irregular crater, nodular/ clubbed radiating folds. Projects inside lumen.
Take home point about the sensitivity/specificity radiological Dx of gastric ulcers as benign vs. malignant?
There’s very high negative predictive power: if the thing is said to be benign, it’s benign.
(avoids unnecessary endoscopy)
Equivocal or malignant looking should get endoscopy.
Can erosions be malignant?
No.
Most important cause of erosions? Pattern on film?
NSAIDs - linear erosions from falling NSAID pills.
If you see a giant ulcer on the greater curvature of the stomach…
It’s an older women with bad arthritis taking high doses of NSAIDs.
(greater curvature ulcers are pretty much always caused by NSAIDs)
How can NSAIDs make you vomit feces?
If an ulcer burrows from the stomach to the transverse colon…
How often are duodenal ulcers (DUs) malignant?
“never”
If you see 4 DUs in the 4th segment of the duodenum, you should think…
ZES
What can H. pylori gastritis look like?
Hypetrophic gastritis from H. pylori can look like thickened rugae.
Percentage of gastric ulcers caused by H. pylori?
DUs?
80% of gastric ulcers (rest are from NSAIDs, basically)
95-99% of DUs
3 non-invasive tests for H. pylori?
Serum abs
Urea breath test
Fecal tests
What’s the best way to follow-up a benign appearing gastric ulcer on a double contrast upper GI film?
(Treat, probs with PPIs) and repeat barium study in 8 weeks.
benign appear gastric ulcers really are benign
