Week 9: Gastrointestinal Pathologies Part 1 Flashcards
1
Q
Tracheoesophageal Fistula
A
- congenital or acquired communication between the trachea and esophagus
- can be acquired from malignancy, infection, trauma
- often lead to severe and fatal pulmonary complications (aspiration pneumonia)
2
Q
Tracheoesophageal Fistula Radiographic Appearance
A
imaging with contrast media will show contrast outlining the areas with esophageal communication
3
Q
Esophageal Atresia Radiographic Appearance
A
imaging with contrast media will show the esophagus ending abruptly
3
Q
Esophageal Atresia
A
- failure of the esophagus to develop as a continuous passage, ending in blind pouch
- often accompanied but a tracheoesophageal fistula
- immediate surgery requires to repair esophagus and prevent starvation
4
Q
Gastroesophageal Reflux Disease (GERD)
A
- broad term for any type of reflux of the stomach contents (including stomach acid) in to the esophagus
- often seen with haital hernia
- develops when the lower esophageal sphincter does not work properly
- causes reflux esophagitis
- produces superficial ulcerations
- causes burning chest pain
5
Q
Gastroesophageal Reflux Disease (GERD) Radiographic Appearance
A
- demonstrated by barium study of the esophagus, usually double contrast (barium and air/co2)
- barium returns to esophagus from stomach
- streaks or dots of barium of esophagus from erosions and ulcerations
- can result in large, discrete, penetrating ulcers in the distal esophagus
- the outer borders of the barium filled esophagus are not sharply seen; hazy in single contrast studies (barium or iodine only - use iodine if perforation suspected)
6
Q
Dysphagia
A
- difficulty swallowing
- usually due to malignancy in esophagus
- radiographic appearance: structure abnormalities, masses, barium not getting swallowed as normal on barium swallow
7
Q
Esophageal Carcinoma
A
- most common site is the esophagogastric junction
- progressive difficulty swallowing (dysphagia)
- strongly correlated to alcohol and smoking
8
Q
Esophageal Carcinoma Radiographic Appearance
A
- done with barium swallow
- flat plaque-like lesions with central ulceration
- irregularity in esophageal wall indicating mucosal destruction as cancer infiltrates
- constriction as cancer encircles esophagus
- increased thickness of lumen of the esophagus indicates early carcinoma
9
Q
Zenker’s/Zenker Diverticulum
A
- diverticulum: small, bulging pouches that can form in the lining of your digestive system
- zenker: pharynx-esophagal punch that can trap food and liquid
- posterior out pouching occurs because cricopharyngeal muscle (dividing throat from esophagus)does not work properly
10
Q
Esophageal Varices
A
- dilated veins in the walls of the esophagus most commonly due to portal hypertension
-blood cannot use normal liver route, so rings other ways and increased blood flow through gastric and esophageal veins causes distention
11
Q
Esophageal Varices Radiographic Appearance
A
- double contrast barium swallow
- serpiginous (wavy border) thickening of folds which are seen as round or oval filling defects
12
Q
Hiatal Hernia
A
- most common pathology seen on GI exams
- acquired anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest/thoracic cavity
- can cause stomach acid in esophagus and related esophagitis, ulcers
- may be sliding (protrudes the returns to normal repeatedly)
- may be negligible and asymptomatic
13
Q
Hiatal Hernia Radiographic Appearance
A
- demonstrated by S&D (stomach and duodenum)
- can see part of stomach above sphincter (lower esophageal/gastroesophageal/cardiac sphincter)
- large hiatal hernia may be demonstrated on CXR as soft tissue mass with air fluid level
14
Q
Diaphragmatic Hernia (Congenital)
A
- term applied to a variety of birth defects that involve abnormal development of the diaphragm
- malformation of the diaphragm allows the abdominal contents to protrude into the chest impeding proper lung development
- radiographic appearance: can see some abdominal contents above the diaphragm (in thoracic cavity)
14
Q
Diaphragmatic Hernia (Acquired)
A
- in adults mostly associated with trauma
- abdominal organs can prolapse into the thoracic cavity
- radiographic appearance: can see some abdominal contents above the diaphragm (in thoracic cavity)
15
Q
Achalasia
A
- functional obstruction of the distal section of the esophagus
- proximal dilation caused by incomplete relaxation of the lower esophageal sphincter
- radiographic appearance: barium study demonstration progressively dilated esophagus with narrowing at distal end
16
Q
Foreign Bodies
A
- FB: aspirated, ingested or penetrated
- In GI area = ingested (or penetrated)
- Some radiopaque, some radiolucent
- If ingested, FB may be anywhere along GI tract, or ends up in nasopharynx
- Image from top of nasopharynx to anus in young children to include all GI tract (and chest)
- May be done all in one image
- Radiographic appearance: if radiopaque, can see item, if radiolucent, may have secondary signs (e.g., obstruction – filling defect on barium exam)
17
Q
Perforation of Esophagus
A
- due to severe vomiting (most common cause), coughing, or sue to underlying conditions such as esophagitis, peptic ulcer, neoplasm, trauma, instrumentation
- CT imaging preferred
18
Q
Perforation of Esophagus Radiographic Appearance
A
- free air in mediastinum or periesophageal soft tissues
- extravasation of contracts materials (use iodine, not barium, if suspected)
- lucent line if intra mural dissection
19
Q
Situs Inversus
A
- body organs (stomach in this case) may be on opposite sides from normal
- normal variant
- radiographic appearance:
organs, etc. will be seen on opposite side from normal - mark images with left or right
20
Q
Pyloric Stenosis Radiographic Appearance
A
- filling defect
- delayed stomach emptying
- mushroom sign
21
Q
Pyloric Stenosis
A
- congenital abnormality
- infantile hypertrophic pyloric stenosis (IHPS)
- occurs when two muscular layers of the pylorus become hyperplasticity and hypertrophic
- thickened pyloric sphincter
- projectile vomiting, food in unable to enter the duodenum
- confirmed with ultrasound or S&D exam (stomach and duodenum)
22
Q
Peptic Ulcer Disease
A
- a group of inflammatory processes involving stomach and duodenum
- peptic: pertains to digestion and acid
- most common cause of acute upper GI bleeding
- gastric ulcer and/or duodenal ulcer
- due to stomach acid and pepsin enzyme eroding lining of stomach or duodenum
- may be small shallow versions or large ulcers that can perforate wall, causing pneumoperitoneum with peritonitis
- ulcers causes GI bleed
- ulcers can cause gastric outlet obstruction
23
Q
Duodenal Ulcers
A
- most common manifestation of peptic ulcer disease
- most are in duodenal bulb
24
Q
Duodenal Ulcers Radiographic Appearance
A
- seen on radiographic image as a collection of contrast medium in a crater projecting outwards from the duodenal lumen with lucent mucosal folds leading to it
- thickened mucosal folds and bulb deformity
25
Q
Gastric Ulcers
A
- 5% are malignant
- usually occur in lesser curvature
26
Q
Gastric Ulcers Radiographic Appearance
A
- seen on radiographic image as a collection of contrast medium protruding outside the stomach lumen
- gastric erosions are very small ulcers that show only as dots of barium surrounded by a halo
27
Q
Stomach Cancer Radiographic Appearance
A
barium exam:
- may show narrowing and loss of elasticity (called linitis plastica pattern)
- may show as uneven stomach contours and/or small masses indenting the stomach
- may show as a polypoid mass containing irregularity and ulceration
CT: used for staging, treatment planning, response to therapy, assessing recurrence
27
Q
Carcinoma of the Stomach
A
- stomach cancer/gastric cancer
- most are adenocarcinomas (start in mucosa, innermost stomach layer)
- can start any site in stomach, sally gastroesophageal junction
- as with other cancer, can metastasize
