Gastrointestinal System

Achalasia

Esophageal obstruction due to the inability of the lower esophageal sphincter to relax

Manifestations of a patient with achalasia

• Coughing

• Heartburn

• Weight loss

• Chest pain

• Regurgitation

What modality best demonstrates achalasia and what is the radiographic appearance?

Fluroscopy (UGI)

Tapering of the distal 1-3cm of the esophagus

Rat tail or bird beak

name the pathology

Achalasia

Name the pathology

Ascites

What is the transition point of a SBO

The point where bowel returns to normal

What can cause a LBO

• Carcinoma (usually)

• Diverticulitis

• Volvulus

Which is more dangerous, LBO or SBO?

SBO, develops faster and creates more gastric disturbance

Why is carcinoma of the stomach difficult to detect?

Symptoms overlap with many non-cancerous pathologies:

• Poor appetite

• Pain

• Feeling of fullness

• Heartburn

• Nausea

• Swelling and edema of abdomen

How is stomach carcinoma diagnosed?

• Endoscopy usually

• UGI: single or double contrast

• CT: with or without for staging or to see if cancer has spread

Stomach carcinoma radiographic appearance (UGI)

• Diffuse thickening, narrowing and thickening

• Ulceration and ittegulatiy

• Gastric wall infiltration

• Polypoid mass

Name the pathology

Carcinoma of the stomach

What are cholelithiasis made of?

Gallstones made of cholesterol or pigment

Only 20% contain enough calcium to detect on x-ray

Best modality to view the gallbladder?

US

What x-ray would be done for cholelithasis? What will the radiographic appearance be?

KUB, stones visible if they contain calcium

Name the pathology

Cholelithasis

What is cholecystitis

Inflammation of the gall bladder usually caused by gall stone impaction

Cirrhosis

Deterioration of healthy liver tissue, formation of scar tissue. The result is a decreased ability for blood to flow and inability to produce proteins and bile or process nutrients, hormones, drugs and toxins.

What are the most common causes of cirrhosis?

• Hep C

• fatty liver disease

• Alcohol consumption

Clinical manifestations of cirrhosis

• Asymptomatic

• Jaundice

• Bruising easily

• Lethargy

• Itching (bile salts in skin)

• Poor appetite

• Portal hypertension

• Ascites

What modalities are used to diagnose cirrhosis and what is the radiographic appearance?

KUB - hazy due to ascites

CT - fatty infiltrate in liver, portal vein involvement, ascites/fluid collection, atrophy of liver, decreased attenuation of liver

US - coarse nodules (scar tissue)

Name the pathology

Cirrhosis - atrophy of right lobe

Name the pathology

Cirrhosis - decreased attenuation of liver surrounded fy hepatic fat

Colorectal cancer risk factors

• 50-70 years old

• men (X2 more likely)

• Ulcerative colitis

• Family history

Colorectal cancer manifestations

• Constipation

• Diarrhea

• Bloody stool

• Narrow stool

• Pain

• Weight loss

• Nausea

What modalities are used for colorectal cancer and what is the radiographic appearance?

CT - colonography, lesion larger than 2cm with apple-core or napkin ring appearance, bowel wall thickening, mets, lymphadenopathy

Fluoro - Double barium enema, apple core lesion

US - tumor invasion of lymph tissue

PET - nodular metastasis

Name the pathology

Colorectal cancer - apple core lesion

Where is colorectal cancer most commonly found?

Rectum

Crohn’s disease

Chronic inflammation of the digestive tract, especially the colon and ileum

Chron’s disease demographic

Young adults

Chron’s disease manifestations

• Pain

• Nausea

• Weight loss

• Uncontrollable diarrhea

• Lack of energy

• Arthritis

• Eye inflammation

• Mouth sores

• Skin disorders

• Attacks and remissions

Radiographic appearance of chrons disease

• Thick mucosal folds

• Cobblestone appearance

• String sign, skip lesions

• Ulcerations, fistula formations

• Dirty fat mesenteric appearance

Name the pathlolgy

Chron’s disease - string sign

Diabetes mellitus

Inability to produce or use insulin, cannot metabolize glucose

Type 1 diabetes

Insulin dependant, childhood, rare

Type 2 diabetes

Non insulin dependant, adult, common

Manifestations of diabetes mellitus

• Polyurea (peeing)

• Polydipsia (thirsty)

• Polyphagia (hungry)

• Fatigue

• Weight changes

• Infections

• Slow healing

  • Vision issues

Sliding hernia

Stomach and lower esophagus slide into chest

Paraesophageal hernia

Part of stomach squeezes through hiatus and sits beside esophagus

Name the pathology

Hiatal hernia

Diaphragmatic hernia

Hole in diaphragm causing organs to move into chest. Surgical correction at an early age

Name the pathology

Diaphragmatic hernia

Inguinal hernia

Abdominal organs protrude through abdominal muscles

What is the danger of inguinal hernias?

Organs trapped outside of abdominal cavity, twisting and impaction leads to necrosis

Diverticulosis

Diagnosis of diverticula - one or more found

Atresia

The closing or absence of a passage or lumen

Risk factors for esophageal carcinoma

• Men

• Alcohol use

• Smoking

Radiographic appearance of esophageal carcinoma

Irregular wall, mucosal destruction, absent mucosal folds

CT - wall thickening greater than 3mm

Name the pathology

Esophageal carcinoma

What causes esophageal varices

Portal hypertension from increased venous pressure, often the result of cirrhosis

Radiographic appearance of esophageal varices

Filling defects, wall thickening

Rosary bead sign

Name the pathology

Esophageal varices - rosary beads

How is reflux best demonstrated on a UGI?

Valsalva maneuver or trendelenburg

Hemangioma

Bright red birthmark, cluster of blood vessels under the skin

Manifestations of liver hemangioma

• Almost always asymptomatic

• bloating and discomfort

• loss of appetite

  • fullness

Hepatitis

Inflammatory disease of the liver caused by viral infection or toxin exposure

Types of hepatits

Hep A - self-contained, good prognosis

Hep B - healthcare workers are susceptible, 90% recovery

Hep C - chronic, cause cirrhosis, 50% will develop hepatocellular carcinoma

Hep E - self - limited, from ingesting feces

Hepatitis imaging modalities and appearance

CT - contrast can show lobulated liver

MRI - diffuse enhancement

US - nodules

Ileus

Failure of peristalsis causing an obstruction, no bowel sounds

Liver cancer appearance

CT - mass with irregular contour, contrast uptake, invasion of hepatic and portal venous system

Name the pathology

Liver carcinoma

Radiographic appearance of pancreatic cancer

CT - tumor, ductal dilation, invasion of adjacent tissues

US - tumor 2cm or greater with irregularity

Pancreatic cancer prognosis

Less than 2% survicve

Pancreatitis causes

Excessive alcohol, gallstones

Pancreatitis

Inflammatory process of pancreas, protein and lipid digesting enzymes activate and destroy pancreas

Acute vs chronic pancreatitis

Acute: sudden, life-threatening often caused by binge drinking or gallstone misplacement

Focal enlargment

Chronic: long term inflammation causing permanent damage, chronic alcohol use, scar tissue

Calcifications, enlarged pancreas, ductal dilation

Name the pathology

Acute pancreatitis - diffuse enlargement with fatty obliteration

Name the pathology

Chronic pancreatitis - diffuse calcifications

Most common location of peptic ulcers

Duodenal bulb

Imaging for pneumoperitoneum

LLD - air along liver

Ulcerative colitis radiographic appearance

Lead pipe sign

Loss of haustra

Ulcerative colitis location

Large bowel, often rectosigmoid

Radiographic difference between chrons and ulceratice colitis

Chrons - skip lesions

UC - continuous lesions

Name the pathology

Ulcerative colitis

Radiographic appearance of volvulus

Cecal volvulus - barium fills colon to cecum

Sigmoid - coffee bean / beak appearance

Name the pathology

Cecal volvulus

Name the pathology

Sigmoid volvulus