pathology midterm

The common area a PICC line will travel to by mistake during placement is the ___________.

Right atrium. you want it in the superior vena cava or above cavoatrial junction

to see if patient has a pneumothorax what breathing should be done

inspiration and expiration.

an _______ image can demonstrate both the generator of the pacemaker and the electrodes.

overexposed

thrombi or thrombosis is another word for?

a clot

_______ is caused by breathing in building materials where these long thin fiber particles are found and can lead to Mesothelioma.

asbestosis

On a basic level what is the purpose of the digestive system?

break down food we eat

absorb water for bodily function

turn food into chemical composition for energy

Gastric juices from the pancreas and liver enter into the __________ where the most amount of digestion occurs.

duodenum

The stair step or step ladder sign is most consistent with findings of _____________.

small bowel obstruction

What condition does the text describe as a collection of barium seen surrounded by a Halo or flowering effect?

benign ulcer

Name the 3 factors referred to in the "radiographer notes" section of vital importance for skeletal imaging. Proper;

positioning, correct alignment, and correct technical factors for optimal contrast (want short scale)

What are the two main connective tissues which make up the skeletal system?

cartilage, bone

What is the healing area of a fracture called that surrounds the pieces of bone and we can see on a follow up x-ray image?

callus

osteoporosis shows cortical _______

thinning

Bacterial Osteomyelitis is commonly caused by which organisms that cause fever, localized warmth, swelling and tenderness to the area?

streptococcus, staphylococcus

digestion begins in the mouth with the mechanical breakdown of food or chewing this is also called?

mastication

term for swallowing

deglutition

mix of hydrochloric acid and enzyme pepsin. this milky white substance goes through pyloric sphincter to duodenum. what is it called

chyme

function of pancreas

accessory gland that secretes enzymes like trypsin and chemotrypsin, lipase and amylase.

emulsifier secreted by the liver which acts like soap by making fat into very small droplets that let it mix with water

bile

gastroesophageal reflux disease. reflux of stomach contents into esophagus. occurs when lower esophageal sphincter is not a barrier against gastric content. common in patients with hiatal hernias.

esophagitis

what tends to make esophagitis worse

chocolate, alcohol, caffeine, fatty foods.

signs of this can be seen on double contrast studies. superficial erosions or ulcerations look like streaks or dots of barium. seen on distal esophagus. can also cause large penetrating ulcers on distal esophagus, or smooth tapered strictures with no mucosal pattern.

esophagitis (GERD)

condition related to reflux esophagitis where the normal squamous lining gets replaced with columnar epithelium similar to the stomach. has propensity for malignancy to occur in columnar portion (usually adenocarcinoma)

Barrett esophagus

may have hiatal hernia, but this in radiographs this has an ulceration usually separate from the hernia by healthy esophagus. healing of ulceration may lead to smooth tapered stricture.

Barrett esophagus

dysphagia in people older than 40 is assumed to be this. squamous cell type, often occurring at esophagogastric junction. happens more in men than women. correlation between this diagnosis and excessive alcohol intake and smoking.

esophageal cancer

can appear on esophagus as flat plaquelike lesion. may have central ulceration. later wall of esophagus looks irregular with mucosal destruction. lesions encircle the lumen. can also have localized polypoid mass, with deep ulceration.

esophageal cancer

outpouching of esophagus. can contain all layers of the wall, or submucosa or mucosa. when filled with food cause aspiration pneumonia may result.

esophageal diverticula

arise from posterior wall of cervical esophagus can become so large they occlude the esophageal lumen.

esophageal diverticula (Zenker is cervical)

dilated veins in the wall of the esophagus. can be caused by increased pressure in the portal venous system (portal hypertension) which could be caused by cirrhosis of the liver. major complication is bleeding.

esophageal varices

radiographic appearance serpiginous (wavy border), thickening of folds, appear as oval filling defects resembling beads of the rosary.

esophageal varices

most common abnormality occurring in 50 percent of the population. can be seen on upper GI images. stomach may lie within the thoracic cavity. predisposition for volvulus.

hiatal hernia

radiographic appearance usually requires barium. but large one may appear on chest radiograph as soft tissue mass in posterior mediastinum.

hiatal hernia

inflammation of the stomach can be from variety of irritants. like alcohol corrosive agents and infection. changes normal surface pattern of gastric mucosa.

gastritis

pronounced thickening of rugal folds can appear from this pathology

gastritis

this pathology usually involves inflammatory processes that involve secretion of acid and pepsin most commonly occurs on the lesser curvature. can cause hemorrhage, and gastric outlet obstruction

peptic ulcer disease

the more common manifestation of peptic ulcer disease usually occur in duodenal bulb. ulcer crater rounded collection of barium and deformity of bulb

duodenal ulcer

peptic ulcer that appears on lesser curvature of the stomach. 5 percent are malignant. unlike duodenal ulcers that are almost always benign

gastric ulcer

this type of gastric ulcer in profile has penetration with thin lucency at the base of the ulcer. when viewed en face it appears as collection of barium with halo of edema (ulcer collar). folds are smooth and slender extend to edge of crater

benign gastric ulcer

in this type of gastric ulcer has irregular folds, that merge into mound of polypoid tissue around the crater. abrupt transition between normal tissue and abnormal tissue is also present.

malignant gastric ulcer

chronic inflammatory disorder of small bowel of unknown cause. usually involves terminal ileum. common in young adults. stress or upset can cause onset or relapse. has granulomatous inflammatory process diseased segments of small bowel are surround with healthy portions, and ulceration is common.

Crohn disease (regional enteritis)

radiographic signs of this are irregular thickening and distortion of mucosal folds. ulcerations seperate mucoa and submucosa giving cobblestone appearance. also has diseased segments surrounded by healthy portions (skip areas). rigid thickening of bowel can cause narrowing.

Crohn disease (regional enteritis)

fibrous adhesions caused by previous surgery or peritonitis account for 75% of this. external hernias can also cause this, and occlusion from gallstones and intussusception.

Small bowel obstruction

presence of gas fluid levels at different heights, and loops usually occupy central part of abdomen. may demonstrate little to no gas in the colon. also shows dilated loops of the small bowel.

Small bowel obstruction

common disorder of intestinal motor activity. fluid and gas do not progress normally through a non obstructed small or large bowel. occurs to some extend with every patient who has abdominal surgery. medication, metabolic disorders, trauma, and peritonitis can be causes

adynamic ileus

in images there is retention of large amounts of gas and fluid in small and large bowel. uniformly dilated with no point of obstruction. can be localized (isolated distention) or colonic in large bowel

adynamic ileus

major cause of bowel obstruction in children. telescoping of part of the intestinal tract into another because of peristalsis. common in the ileocecal valve. will have pain in abdomen, blood in stool, and right sided mass. Barium enema can be therapeutic. if treatment is delayed for 48 hours can become fatal

intussusception

produces coiled spring appearance of barium.

intussusception

neck of appendix becomes blocked by a fecalith or by post inflammatory scarring, creates closed loop obstruction. fluid accumulates and serves as breeding ground for bacteria. more common in children.

appendicitis

A patient presents with a sudden onset of RLQ pain, fever, anorexia, nausea and ememsis which the provider orders a CT with contrast. What are they most likely ruling out?

appendicitis

may show a rounded or oval fecalith in RLQ. but can be seen in pelvic area or RUQ.

appendicitis

outpouchings in the colon. herniations of mucosa. increases with age. occurs sometimes with pressure exerted when passing large stool and with low fiber low bulk diets. common in sigmoid. may have no symptoms but some have abdominal pain

Diverticulosis

appear as outpouchings of barium beyond confines of lumen. occur in clusters but can be solitary. when multiple they have deep criss crossing ridges of thickened circular muscle (sawtooth configuration) series of sacculations

diverticulosis

complication of diverticular disease of colon. usually in sigmoid. perforation of diverticulum leads to abscess. retained fecal matter trapped in diverticulum causes inflammation of lining.

diverticulitis

can have intramural mass in colon, or segmental narrowing. diagnosis from an image requires evidence of perforation. (extravasation)

diverticulitis

this is the third leading cause of death from cancer in the us. usually occurs in rectum and sigmoid region. ulcerative colitis, and family polyposis can predispose someone to this

colon cancer

usually arises from preexisting polyps. Malignant polyp tends to be sessile lesion without a stalk. (benign has a stalk) if annular carcinoma is called apple core, or napkin ring is most typical. infiltrates bowel wall as it grows.

colon cancer

70 percent of these arise from colon carcinoma. diverticulitis and volvulus account for the others. tend to be less acute than small bowel. symptoms develop slower.

large bowel obstruction

radiographic appearance depends on the competency of the ileocecal valve. danger is perforation. especially if valve is competent. cecum likely site of perforation

competent= large dilated colon with thin walled cecum that is distended and little small bowel gas

not competent= gas filled loops in colon and small bowel which may seem like adynamic ileus

large bowel obstruction

twisting of the bowel on itself. can lead to obstruction. requires long movable mesentery so transverse usually not involved. usually occurs in cecum and sigmoid colon. low fiber can cause sigmoid. cecum if patient has a mobile one

volvulus

in this type of volvulus it tends to be upwards and to the left and kidney shaped mass. mesentery may resemble renal pelvis. water soluble contrast can show level of stenosis

cecal volvulus

volvulus. twists on its mesenteric axis usually closed loop and looks like an inverted U shape rising out of the pelvis can even reach the diaphragm

sigmoid volvulus

two major types of these stones in the gallbladder. cholesterol and pigment. Cholesterol predominates. can happen when bile does not have enough bile salts.

cholelithiasis (Gallstones)

may not appear since cholesterol is radiolucent. (So US is imaging of choice) but if they have enough calcium they may be seen on an abdominal x-ray. can have central nidus or focus of calcification. giving a laminated appearance (opaque and lucent rings)

cholelithiasis (Gallstones)

extensive calcification in the wall of the gallbladder. forms an oval density corresponding to the size and shape of the gallbladder. which has become fibrotic and calcified. also has blue discoloration and brittle consistency

Porcelain Gallbladder

can appear as broad continuous band in the muscular layers or be in glandular spaces of mucosa. oval density corresponding to shape of gallbladder. 60 percent of people with this also have a carcinoma

porcelain gallbladder

most prevalent inflammatory disease of the liver. can be viral or from drugs or toxins. can not really be seen in the early stages. but later cirrhosis and hepatocellular carcinoma can be seen on US or CT and MRI.

Hepatitis

infectious hepatitis. transmitted via digestive tract through oral or fecal contact

HAV (A)

serum hepatitis. from exposure to contaminated blood or blood products or through sexual contact. healthcare workers may be exposed to this.

HBV

common cause of chronic hepatitis. cirrhosis and hepatocellular carcinoma. blood transfusion and sexual contact can spread this. cirrhosis from this can become cancer

HCV

normally density of the liver is similar to the spleen. but with this the liver becomes fatty. giving areas of low density making the liver appear darking than the spleen. (CT)

hepatitis

chronic destruction of liver cells. with regeneration of the liver parenchyma and fibrosis it is end stage liver disease. chronic alcoholism is usually the cause. fibrous connective tissue replaces liver cells with cells that have no liver function. liver enlarges initially then contracts.

cirrhosis of the liver

fat accumulates in the liver, making it darker than spleen in ct. portal veins appear high density. portal vein becomes obstructed making the spleen also enlarged usually. one of the most characteristic signs is fluid in the peritoneal cavity (ascites) causing abdominal distention. with ascites may see ground glass appearance

cirrhosis of the liver

inflammatory process where protein and lipid digesting enzymes activate in pancreas and begin to digest the organ. necrosis may expand to blood vessels. excessive alcohol consumption is common cause. but gallstones can also cause this. severe abdominal pain radiating to back is common

acute pancreatitis

US and CT define degree of pancreatic inflammation. CT will show enlargement of the pancreas margins are not delineated. fat planes are obliterated

acute pancreatitis

loculated walled off fluid collection arising from inflammation necrosis or hemorrhage associated with acute pancreatitis or trauma. has shaggy lining surrounded by dense white scar tissue.

pancreatic pseudocyst

in US this appears as echo free structure with sharp posterior wall. CT shows this as sharply marginated fluid filled collection often delineated after contrast material. if large may be seen on abdominal x-ray if they displace gas filled stomach and bowel.

Pancreatic pseudocyst

free air in the peritoneal cavity. associated with abdominal pain and tenderness. can be caused by perforation of gas containing viscus.

pneumoperitoneum

free air in peritoneal cavity best shown when pt is upright. usually beneath domes of diaphragm. sickle shaped lucency. usually seen best on right side between diaphragm and liver. best if pt upright 10 min. or lateral decubitus. children may show as more lucency in entire abdomen

pneumoperitoneum

enlargement of spleen. can be from infection, connective tissue disorders, and cirrhosis.

splenomegaly

in abdominal radiograph may see lower border of spleen below costal margin. spleen may elevate left hemidiaphragm and bring stomach closer to midline. can also displace left kidney and splenic flexure downwards.

splenomegaly

fibrous membrane that covers the outer surface of bones

periosteum

main shaftlike portion of bone

diaphysis

ends of bone

epiphysis

posterior defect of the spinal canal. mild insignificant is occulta. large defect may cause loss of bladder or bowel control. can also be accompanied by meningocele.

spina bifida

defect with absence of laminae and increased interpediculate distance. and large bony defects spinal content may be seen as soft tissue mass posterior to spine. (meningocele or myelomeningocele may occur (herniation of meninges or spinal cord)

spina bifida

also called marble bones. rare hereditary bone dysplasia where failure of resorptive mechanism of calcified cartilage interferes with replacement of mature bone. prevents bone marrow from forming so bones are brittle and stress fractures occur often. pt may also become anemic.

osteopetrosis

symmetric increase in bone density (look bright white) increase exposure factors. image may appear blurred due to structural changes

osteopetrosis

brittle bones. inherited generalized disorder of connective tissue. pt will have multiple fractures and unusual blue color in the normally white sclerae of the eyes. usually wheelchair bound.

osteogenesis imperfecta

pt usually suffers repeated fractures. due to thin cortices. usually heal with exuberant callus formation. (could even look like a tumor) can cause bizarre deformities. need to lower kvp due to cortical bone loss. ossification of skull is slow leading to wide sutures and accessory bones within suture (Wormian bones)

osteogenesis imperfecta

results from incomplete acetabular formation. fetus is exposed to increase in hormone levels during delivery. more common in females. when leg is flexed hip may pop out of joint and click

congenital hip dysplasia

ap pelvis and frog leg can show this. ap may appear normal with only slightly larger joint space of hip. frog leg hip is dislocated posteriorly and superiorly. US can also be used now.

congenital hip dysplasia

causes noninfectious inflammatory changes in the small joints of the hands and feet. chronic systemic disease of unknown origin. often progresses proximally to the trunk. begins as synovitis. then erosion of cartilage occurs. bone fusion can also occur.

rheumatoid arthritis

small foci of destruction at the edges of the joint where articular cartilage is absent as well as erosions with poorly defined edges. can also cause soft tissue swelling. and narrowing of joint space. in cervical increased distance between odontoid and atlas.

rheumatoid arthritis

degenerative joint disease and loss of joint cartilage. common generalized disorder. tends to affect weight bearing joints (spine, hip, knee, ankle) and ip joints of finger,

osteoarthritis (DJD)

narrowing of joint space is shown and small bony spurs (osteophytes). does not have smooth even narrowing like rheumatoid arthritis this is more irregular and pronounced where weight bearing occurs. in fingers usually involves distal interphalangeal joints.

osteoarthritis (DJD)

inflammation of bursae, small fluid filled sacs located near the joints with a thin layer of synovial fluid. physical actvitiy can cause this but trauma, gout, and RA can also. usually seen on US.

Bursitis

can sometimes see deposition of calcium in adjacent tendons. usually the shoulder. but can also show prominent soft tissue swelling.

bursitis

inflammation of the bone and bone marrow. caused by infectious gram positive organisms. usually staph or strep. reach bone by hematogenous spread. usually involves bone rich with red marrow. usually experience localized warmth, fever and swelling and tenderness. for children femur and tibia for adults usually vertebrae affected.

bacterial osteomyelitis

bone has a moth eaten appearance. patient may have gotten infection from trauma or surgery. deep soft tissue swelling adjacent to metaphysis may be early radiographic sign. when chronic bone appears thickened.

bacterial osteomyelitis

deficiency of the bone matrix where the actual bone mass itself is decreased in amount but has normal composition or makeup. loss of bone salt causes bone lucency (50-70% bone density lost before really seen) aging and postmenopausal hormone changes usually cause this.

osteoporosis