Abdominal and Gastrointestinal Pathology Lecture 1

atresia

a congenital absence or closure of an orifice in the body

common sites of atresia in the GI tract

esophageal

small bowel

duodenal

colonic

esophageal atresia

esophagus fails to develop past some point resulting in discontinuation

symptoms are visible soon after birth

requires immediate surgery to treat

radiographic appearance of esophageal atresia

lack of GI air below the diaphragm

OG tube blocked

what is common with esophageal atresia

tracheoesophageal fistula

most common type of tracheoesophageal fistulas

the lower portion of the esophagus forms a fistula with the trachea

small bowel atresia

congenital discontinuation of a portion of the small bowel

most common in the duodenum

duodenal atresia

dilated stomach and duodenum above obstruction with no other abdominal gas

requires immediate surgery

duodenal atresia is common with

downs syndrome

radiographic sign of duodenal atresia

double-bubble sign

colonic atresia is AKA

imperforated anus

colonic atresia

congenital failure of the development of the anus

usually forms a fistula with the bladder

treated with surgeries

• colostomy

• then a creation o fa rectum and opening

pyloric stenosis

congenital abnormality of the stomach in which the pyloric canal muscle is greatly thickened narrowing the opening

treated with surgery

• pyloromyotomy

  • cuts muscle to widen the opening

visualized in via ultrasound or UGI

radiographic sign of puloric stenosis

apple core or string sign

hirschsptung’s disease is AKA

congenital megacolon

Hirschsprung’s disease common site

sigmoid colon

hirschsprung’s disease

caused by a lack of nerve cells in the muscle layers of the distal colon that normally trigger contractions

causes no peristalsis

can lead to bacterial infections from not excreting stool

radiographic appearance of Hirschsprung’s disease

abdomen XR

• gross dilation

• no air/fluid in the distal colon

BE

• dilated proximal colon

• constriction

gastroesophageal reflux disease (GERD) is AKA

esophagitis

GERD

results from weak cardiac sphincter allowing backflow of gastric acid and contents into the esophagus

diagnosed via UGI

• Valsalva maneuver

• Trendelenburg

can lead to precancerous tissue development

primary cause of esophageal inflammation

GERD

esophageal strictures

narrowing or tightening of the esophagus

treated with repeated dilations to remain open

Barrett’s esophagus

caused by severe reflux

normal lining of the lower esophagus is destroyed and replaced by abnormal tissue

• precancerous

treated with radiofrequency ablation

radiographic appearance of Barrett’s esophagus

granular appearance

reticular mucosal pattern

strictures are common

types of hiatal hernias

sliding

paraesophageal

sliding hiatal hernia

type I

90% of hiatal hernias

schatzki’s ring

paraesophageal hiatal hernia

type II

10% of hiatal hernias

treatment of hiatal hernias

sutures and surgiacal mesh to reinforce after surgery

gastroenteritis is AKA

gastritis

gastroenteritis

thickening of the gastric rugae with superficial erosions

caused by consumption of NSAIDs, alcohol, tobacco, stress, and bacterial

diagnosed via double contrast UGI

treated with anti-biotics, steroids, and acid-blocking meds

peptic/gastric ulcer disease

inflammatory process involving the stomach and duodenum

occurs more frequently in duodenum and lesser curvature

complications with peptic/gastric ulcers

GI bleeds

perforation

outlet obstruction

radiographic appearance of peptic ulcers

halo sign

appears as a persistent collection of barium surrounded by a halo of edema

Crohn’s disease is AKA

regional enteritis

Crohn’s disease is most common in

terminal ileum

Crohn’s disease

1st major chronic inflammatory disease

continued inflammation results in severely narrowed, rigid segment of the small bowel in which the mucosal pattern is lost

no cure

• treated with immunosuppressants and steroids

common result of Crohn’s disease

enterocolic fistulas

found in about 50% of patients

ulcerative colitis

2nd major inflammatory disease

inflammatory lesion of the colon

primarily only effects colon

• tends to start in rectosigmoid area

appearance of ulcerative colitis on XR

thumb printing of colon

when chronic

• progressive loss of haustra

• colon appears smooth

ulcerative colitis vs Crohn’s

ulcerative colitis

• inner lining

• in the colon primarily

Crohn’s

• all layers

• in all areas of bowel

appendicitis

inflamed vermiform

develops when the neck of the appendix becomes blocked by an appendicolith

RLQ pain, fever, increased WBC count

diagnosed with CT or US

treated with an appendectomy

esophageal varices

dilated veins in the wall of the esophagus caused by increased pressure of the portal venous system

diagnosed with esophagram in supine position with thin barium

treated by banding the engorged veins to prevent further enlargement/rupture

radiographic appearance of esophageal varices

cobblestone appearance