Pathology gastrointestinal system

What is peristalsis?

Rhythmic muscular contractions of the alimentary canal that move contents along the GI tract

Where does digestion begin?

Mouth

What is mastication?

Chewing

What is deglutition?

Swallowing

Where does the greatest amount of digestion occur in the small intestine?

Duodenum

What is the function of bile?

Transport bilirubin out of the body and emulsify fats for digestion

Where is bile produced?

Liver

What forms the common bile duct?

Common hepatic duct and cystic duct

What is a tracheoesophageal fistula (TEF)?

An abnormal connection between the esophagus and trachea

What causes congenital TEF?

Failure of the esophageal lumen to develop completely separate from the trachea

What is esophageal atresia?

Lack of development of the esophageal lumen resulting in a blind pouch

What are symptoms of congenital TEF/esophageal atresia?

Excessive salivation, choking/gagging, dyspnea, and cyanosis

How is congenital TEF treated?

Surgery to correct it and a gastrostomy tube for feeding

What is the radiographic appearance of Type I congenital TEF?

Contrast-filled esophageal pouch with absence of air in the abdomen

What is the radiographic appearance of acquired TEF?

Contrast-filled esophagus and trachea

What causes reflux esophagitis (GERD)?

Failure of the lower esophageal sphincter, allowing gastric contents to reflux

What is Barrett's esophagus?

Replacement of the normal squamous lining of the esophagus with columnar epithelium similar to the stomach

What is the double-contrast appearance of reflux esophagitis?

Ulcerations appearing as streaks or dots of barium

What is the single-contrast appearance of reflux esophagitis?

Hazy, serrated appearance of the outer borders of the esophagus

What does endoscopy use to visualize the GI tract?

Fiberoptics

What happens with ingestion of corrosive agents?

Acute inflammatory changes occur in the esophagus

What can deeper penetration from corrosive agents cause?

Sloughing of destroyed tissue and deep ulceration

What is the treatment for ingestion of corrosive agents?

Call poison control

What is an esophageal diverticulum?

An outpouching of the esophageal wall

What is a true or traction diverticulum?

A diverticulum affecting all layers of the esophageal wall

What is a false or pulsion diverticulum?

A diverticulum affecting only the mucosal and submucosal layers

What is Zenker diverticulum?

A pulsion-type esophageal diverticulum

Where is Zenker diverticulum located?

Posterior wall of the upper esophagus at the pharyngoesophageal junction

What is a thoracic diverticulum?

An outpouching in the thoracic portion of the esophagus

What is an epiphrenic diverticulum?

An outpouching in the distal 10 cm of the esophagus

What are esophageal varices?

Abnormally lengthened and dilated superficial veins of the esophagus

What commonly causes esophageal varices?

Increased pressure in the portal venous system

What is the radiographic appearance of esophageal varices?

Rosary beads appearance

What is a hiatal hernia?

When part of the stomach and gastroesophageal junction bulge through the esophageal hiatus into the thoracic cavity

What are symptoms of a hiatal hernia?

Reflux, heartburn, and dysphagia

What is a sliding/direct hiatal hernia?

The stomach and gastroesophageal junction emerge above the diaphragm and can slide back into the abdomen

What is an intrathoracic/rolling hiatal hernia?

A large portion of the stomach lies in the thoracic cavity while the gastroesophageal junction remains below the diaphragm

What is the radiographic appearance of a hiatal hernia?

Stomach visualized above the diaphragm

What is achalasia?

A neuromuscular abnormality causing failure of the lower esophageal sphincter to relax

What are symptoms of achalasia?

Dysphagia, regurgitation, chest pain, and weight loss

What is the radiographic appearance of achalasia?

Dilated esophagus with a beaked appearance

What is gastritis?

Inflammation of the stomach

What can cause gastritis?

Alcohol, infection, or corrosive substances

What are symptoms of gastritis?

Nausea, vomiting, and burning pain

What is the radiographic appearance of alcoholic gastritis?

Thickening of the gastric folds

What is the radiographic appearance of corrosive gastritis?

Scarring causing severe narrowing of the antrum

What is peptic ulcer disease?

A group of inflammatory processes involving the stomach and duodenum

Where is peptic ulcer disease most common?

Duodenal bulb or lesser curvature of the stomach

What causes peptic ulcer disease?

Erosion of mucous membranes usually due to increased amounts of pepsin and acid

What is the radiographic appearance of a benign gastric ulcer?

Thick, smooth, radiating spike-like mucosal folds

What is the radiographic appearance of a malignant gastric ulcer?

Thick folds radiate to an irregular mound of tissue around the ulcer

What is a characteristic finding of gastric cancer?

Diffuse thickening, narrowing, and fixation of the stomach wall

What findings suggest gastric malignancy?

Irregularity and ulceration

What is Crohn's disease also called?

Regional enteritis

What part of the GI tract does Crohn's disease most often involve?

Terminal ileum

What type of disease is Crohn's disease?

Inflammatory bowel disease (IBD)

What are symptoms of Crohn's disease?

Diarrhea, pain/cramping, bloody stool, and weight loss

What is the early radiographic appearance of Crohn's disease?

Cobblestone appearance

What causes the cobblestone appearance in Crohn's disease?

Transverse and longitudinal ulcerations separating islands of thickened mucosa and submucosa

What is the late radiographic appearance of Crohn's disease?

String sign

What are skip lesions?

Widely separated areas of disease

What is a mechanical small bowel obstruction?

An obstruction caused when the lumen of the bowel becomes blocked

What are symptoms of mechanical small bowel obstruction?

Abdominal distension, cramping, and vomiting

What is the radiographic appearance of mechanical small bowel obstruction?

Distention and stepladder appearance with multiple air-fluid levels

What is paralytic ileus also called?

Adynamic ileus

What is paralytic ileus?

Failure of normal peristalsis

What is the most common cause of paralytic ileus?

Surgery and intra/retroperitoneal infections

What are symptoms of paralytic ileus?

Cramping, bloating, constipation, and vomiting

What is the radiographic appearance of paralytic ileus?

Uniformly dilated bowel loops

What is intussusception?

Telescoping of one part of the intestinal tract into another

What can happen if the blood supply is cut off during intussusception?

Necrosis

What are symptoms of intussusception?

Abdominal pain and blood in stool

What is the treatment for intussusception?

Rectal insufflation with air or barium may force out the telescoped bowel

What is the radiographic appearance of intussusception?

Coiled spring appearance

What is appendicitis?

An inflammatory condition of the vermiform appendix

What commonly causes appendicitis?

Blockage by a fecalith, appendicolith, or rarely a neoplasm

What are symptoms of appendicitis?

Pain, fever, and slight leukocytosis

What is the treatment for appendicitis?

Surgical removal

What is an appendicolith?

A round or oval laminated and calcified fecalith in the appendix

What is diverticulosis?

Outpouchings of the colon

What are the outpouchings in diverticulosis?

Herniations of mucosa and submucosa through the muscular layers

Where does diverticulosis most commonly occur?

Sigmoid colon

What is the radiographic appearance of diverticulosis?

Round or oval outpouchings

What is diverticulitis?

Necrosing inflammation and perforation of a diverticulum

What are symptoms of diverticulitis?

Pain, tenderness, vomiting, bloating, and constipation or diarrhea

What is the radiographic appearance of diverticulitis?

Extravasation/leakage of barium and narrowing of the affected area

What is ulcerative colitis?

An inflammatory condition of the colon and a form of inflammatory bowel disease

What is ulcerative colitis thought to be?

Autoimmune

What are symptoms of ulcerative colitis?

Bloody diarrhea, abdominal pain, and cramping

What is the radiographic appearance of ulcerative colitis?

Ulcers and loss of haustral markings

What is the "lead pipe" colon?

A colon with shortening and rigidity and loss of haustral markings

What is Crohn's colitis?

An inflammatory disease of the colon

What portion of the colon does Crohn's colitis most commonly affect?

Proximal colon

What is the radiographic appearance of Crohn's colitis?

Deep irregular ulcerations, fistula formation, and narrowed bowel lumen

What are colonic polyps?

Slow-growing masses of the mucosal wall that project inward

What can colonic polyps potentially become?

Malignant after dysplastic changes

Where are colonic polyps more common?

Rectosigmoid region

What is the radiographic appearance of colonic polyps?

Rounded filling defects

What are two diseases commonly associated with colon cancer?

Pre-existing polyps and long-standing ulcerative colitis

What is the classic radiographic appearance of colorectal adenocarcinoma?

Apple-core appearance