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Pathology > Week 11: Gastrointestinal Pathologies Part 3 > Flashcards

Week 11: Gastrointestinal Pathologies Part 3 Flashcards

1
Q

Cholelithiasis

A
  • gallstones
  • most made out of cholesterol (radiolucent)
  • pigment stones contain calcium (radiopaque)
  • gallstones can leave gallbladder though bile duct and enter GI tracts (some get stuck on the way)
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2
Q

Cholelithiasis Radiographic Appearance

A
  • if contain calcium, may show up on plain radiographs
  • us is modality of choice for confirmation and diagnosis
  • CT with contrast can be used for confirmation/diagnosis
  • ERCP: treatment/removal
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3
Q

Cholecystitis

A
  • acute inflammation of the gallbladder
  • usually occurs after impacted gallstone obstructs the cystic duct
  • may require surgery
  • gallstones may injure the mucosal wall, allowing bacteria to enter
  • can become emphysematous cholecystitis: acute infection of gallbladder wall by gas forming organs = surgical emergency)
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3
Q

Cholecystitis Radiographic Appearance

A
  • us used for diagnosis
  • may see air around gallbladder and/or stones on ct/xray
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4
Q

Choledocholithiasis

A
  • the presence of at least one gallstone within the common bile duct
  • may block duct
  • radiographic appearance: may see stones themselves or filling defect for blocked duct
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4
Q

Cholangitis

A

inflammation of the entire bile duct system

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5
Q

Hepatitis

A
  • inflammation of the liver, usually from a viral infection
  • hepatitis A/E, B or C
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6
Q

Hepatitis A and E

A

transmitted from fecal oral route: consumption of food or water contaminated with fecal particles, often from poor hand hygiene

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6
Q

Hepatitis B

A

contracted by exposure to contaminated blood or blood products, or through sexual contact

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7
Q

Hepatitis C

A

common cause of chronic hepatitis , cirrhosis and hepatocellular carcinoma; contracted by blood transfusion or sexual contact

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8
Q

Hepatitis Radiographic Appearance

A
  • early hepatitis not seen on imaging
  • enlarged liver may be seen on plain radiography as a lifting of the right hemidiaphragm as the enlarged liver pushes on it
  • complications (cirrhosis and hepatocellular carcinoma/liver cancer) show up on us, ct and mri
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9
Q

Liver Cirrhosis

A
  • end stage liver disease, chronic destruction of liver cells and structures
  • major cause is alcoholism (10-20 yrs), viral hepatitis, or drugs/chemicals
  • fibrous connective tissue (scar tissue), which has no liver cell function, replaces the destroyed liver cells
  • liver initially enlarged due to regeneration but then shrivels as scarring contracts and become bumpy and nodular
  • decreed albumin production causes fluid to leak out of circulation (edema of lower limbs)
  • decreased albumin and increased venous pressure produces ascites
  • portal vein obstruction creates collateral circulation
  • jaundice occurs from destruction or blockage of bile ducts
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10
Q

Liver Cirrhosis Radiographic Appearance

A
  • fat may accumulate in the liver (liver darker than spleen)
  • portal veins may stand out more
  • spleen enlarges due to portal vein pressure form the liver
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11
Q

Ascites

A
  • accumulation of fluid in the peritoneal cavity, usually due to liver damage (hepatitis, cirrhosis, fatty liver)
  • causes abdominal distention
  • tight, hard abdomen
  • increase technical factors
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12
Q

Ascites Radiographic Appearance

A
  • plain radiographs show general haziness (ground glass appearance)
  • supine: fluid gravitates to lower portions of pelvis (posterior) and collects on both sides of the bladder (dog ear sign)
  • CT: extra visceral Lowe density fluid collection
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13
Q

Hepatocellular Carcinoma

A
  • liver cancer
  • most commonly occurs with underlying liver disease (alcoholic or post necrotic cirrhosis, HBV, HCV
14
Q

Hepatocellular Radiographic Appearance

A
  • CT: tumour appears as a large solitary mass or multi nodular (small number of lesions)
  • with contrast: dense, diffuse, non-uniform enhancement, may see tumours within hepatic portal venous systems
  • 3 phase liver study recommended
  • haptic mets show as well marginated lesions less dense than normal liver parenchyma
15
Q

Liver Hemangiomas - Benign Vascular Tumours

A
  • hepatic or cavernous hemangiomas, usually asymptomatic
  • if over 10cm = giant hemangioma
  • can cause edema and jaundice
16
Q

Liver Hemangiomas - Benign Vascular Tumours Radiographic Appearance

A
  • ct, mri or us used for diagnosis
  • hypotenuse lesions on unenhanced images
  • enhancement on contrats images
  • persistent enhancement during delayed phase
17
Q

Acute Pancreatitis

A
  • enzymes activates that cause pancreas to digest itself
  • common cause excessive alcohol consumption, less often from gallstones blocking ampulla or water causing inflammatory response as bile refluxes into pancreas
  • jaundice may occur if swollen pancreas blocks bile duct
18
Q

Chronic Pancreatitis

A
  • repeated injury causes formation of scar tissue
  • usually alcohol related
  • pancreas cannot produce digestive enzymes (insulin and glucagon)
19
Q

Acute Pancreatitis Radiographic Appearance

A
  • the most obvious thing on a plain radiograph might be a sentinel loop of bowel from an dynamic ileum and some loop distention but is most common not specified of plain x-rays
  • ct and us used
  • CT: diffuse enlargement of pancreas and obscured peri pancreatic soft tissue due to swelling
20
Q

Chronic Pancreatitis Radiographic Appearance

A
  • calcification of the pancreas are pathognomonic
  • ct and us used
  • CT: pancreatic enlargement or atrophy, ductal dilation, calcifications
21
Q

Pancreatic Carcinoma Radiographic Appearance

A
  • us: tumour 2cm or greater, irregular contour, semisolid pattern
  • ct: most effective for diagnosis ; tumour mass, ductal dilation and evasion of neighbouring structures (metastases) (staging) decreased attenuation compared to normal pancreatic tissue with contrast enhancement
  • BE may show distortion of mucosal pattern and duodenal configuration
21
Q

Pancreatic Carcinoma

A
  • most common pancreatic cancer is adenocarcinoma (cancer that starts in the glands of the lining of the pancreas)
  • 60% are located in the head of the pancreas
  • har may enlarge, block bile duct and cause obstructional jaundice
22
Q

Diabetes Mellitus

A
  • common endocrine disorder
  • pancreas fails to secrete insulin or failure of target cells thought out the body to respond to insulin
  • lack of insulin prevents glucose from entering cells which leads to hyperglycemias as glucose stays in blood
  • body pH lowers (acidosis) and dehydration can occur (diabetic coma)
  • symptoms: polyuria, polydipsia and glycosuria
23
Q

Diabetes Mellitus Radiographic Appearance

A
  • peripheral vessel calcification
  • severe osteomyelitis
  • neuropathic joints
  • gas gangrene (necrotizing infection)
  • ischemic gangrene
24
Q

Hypoglycemia

A
  • Low blood sugar
  • can occur with diabetic patients if too much insulin, not enough food or too much exercise
  • suddenly feel lightheaded, faint, shaky, sweaty
  • give them sugar
25
Q

Pneumoperitoneum

A
  • free air in the peritoneal cavity
  • often caused by perforation of the GI tract, such as form a perforated peptic or duodenal ulcer or septic infection, penetration injuries or blunt trauma
  • peritonitis can occur
  • indicates a surgical emergency
26
Q

Pneumoperitoneum Radiographic Appearance

A
  • needs horizontal beam (upright or left decubitus)
  • leave pt in position for 10 minutes
    -air under diaphragm appears as sick shaped lucency
  • if a lot of free air, may see it in supine position (both inner and outer walls of intestine seen)

Pathology (14 decks)

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