Pathology-Abdomen and Gastrointestinal

Modalities Used

1. Diagnostic
2. CT
3. MRI
4. US
5. NM

Atresia

a congenital absence or closure of an orifice in the body

\-esophageal

\-small bowel

\-duodenal

\-colonic

Esophageal Atresia

esophagus fails to develop past some point resulting in discontinuation

\-symptoms are visible soon after birth

\-cause: no cause, from other birth defects

\-treatment: surgery

Radiographic Appearance of Esophageal Atresia

lack of any GI air below the diaphragm

\-orogastric tube blocked

\-common result

Tracheoesophageal Fistula

pneumonia in both lungs

\-can lead to severe and fatal respiratory problems

Small Bowel Atresia

congenital discontinuation of a portion of the small bowel

\-most common part: ileum

\-dilated bowel proximal to obstruction

\-cause: utero, disruption of blood flow

\-treatment: surgery

Duodenal Atresia

dilated stomach and dilated duodenum above obstruction with no other abdominal gas

\-cause: utero, disruption of blood flow

\-treatment: surgery

Radiographic Appearance of Duodenal Atresia

“double bubble”

Colonic Atresia

imperforated anus

\-congenital failure of the development of the anus

\-complication: fistula (bladder and colon)

\-cause: no cause

\-treatment: surgery (create man-made opening)

Pyloric Stenosis

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

\-cause/treatment: pyloromyotomy

\-modality: US

Radiographic Appearance of Pyloric Stenosis

string sign

What is the most common indication for pyloric stenosis?

vomiting

Malrotation

intestines fail to coil correctly in abdomen during development

\-complications: obstructions, necrotic intestines

\-clearly visualized on a barium enema/UGI/SB exam

\-treatment: surgery

Hirschsprung’s Disease

congenital megacolon

\-common site: sigmoid

\-cause: lack of nerve cells/neurons in the muscle layers of the distal colon that trigger contractions (no peristalsis)

\-treatment: surgery

Radiographic Appearance of Hirschsprung’s Disease

Abdomen: gross dilation, no air/fluid in distal colon

BE: dilated proximal colon, constriction

Esophageal Strictures

narrowing or tightening of the esophagus

\-cause: chronic reflux

\-require repeated dilation to remain open

Gastroesophageal Reflux Disease (GERD)

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

\-primary cause of esophageal inflammation (reflux)

\-diagnosed: UGI, EGD

\-demonstrated: valsava maneuvar to increase intra abdominal pressure

\-can lead to precancerous tissue development

Sliding Hernia

type 1

\-90 % (most common)

\-LES

\-SCHATZKI’S RING

\-cause: chronic reflux

Paraesophageal

type 2

\-10%

\-LES

\-fundus of stomach pops through the opening

Type 3 Hernia

LES and fundus of stomach

Type 4 Hernia

both and abdominal organs pop through

Treatment for Hernia’s

surgery: enlarged esophageal hiatus is narrowed with sutures and a surgical mesh for reinforcement

Barrett’s Esophagus

normal lining of lower esophagus is destroyed and replaced new abnormal tissue

\-pre cancerous

\-cause: severe reflux

Radiographic Appearance of Barrett’s Esophagus

granular appearance

\-reticular mucosal pattern

\-strictures are common

Treatment for Barrett’s Esophagus

endoscopic resection

radiofrequency ablation

Gastroenteritis

gastritis

\-thickening of the gastric rugae (folds) with superficial erosions

\-cause: anti-inflammatory, alcohol

\-Diagnosis: UGI

\-Treatment: antibiotic, acid block

Peptic/Gastric Ulcer Disease

inflammatory process involving the stomach and the duodenum (duodenum more common)

\-occurs most frequently on the lesser curvature

\-complication: GI bleed, perforation (more common), and outlet obstruction

Radiographic Appearance of Peptic/Gastric Ulcer

when viewed straight on, appears as a persistent collection of barium surrounded by a halo of edema

\-”bullseye appearance)

Crohn’s Disease

regional enteritis

\-IBD

\-1st major chronic inflammatory disease of bowel

\-terminal ileum

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

\-treatment: no treatment

Enterocolic Fistulas

hallmark of chronic Crohn’s disease

\-found in approx 1/2 of all patients

Appendicitis

cholecystitis

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

\-RLQ pain, low grade fever, increase in white blood count

\-diagnosis: CT, US

\-treatment: surgery

Ulcerative Colitis

inflammatory lesion of the colon

\-2nd major inflammatory disease

\-primarily affects only colon

\-”thumb printing”

Progressive Appearance of Ulcerative Colitis

tendency to begin in rectosigmoid area

\-progressive shortening and loss of haustra

Esophageal Varices

are dilated veins in the wall of the esophagus

\-worm like filling defect

\-”cobblestone appearance”

\-dilation caused by increased pressure in the portal venous system

\-complication: rupture and bleeding

Dynamic Small Bowel Ileus

mechanical

\-causes: adhesions and FB’s

Radiographic Appearance of a Dynamic Ileus

air filled levels and dilated loops of SB proximal to the obstruction

\-treatment is to decompress the bowel as soon as possible to prevent necrosis or perforation

Radiographic Appearance of a Dynamic SBO

string of beads/pearls sign

\-”beads” corresponds to pockets of gas orientated in a line

Adynamic Small Bowel Ileus

paralytic ileus

\-post op

\-medications

\-metabolic disorders

\-trauma

\-occurs more frequently then mechanical ileus

\-occurs more frequently in the SB

\-colon and rectum

Sentinel Loop

isolated segment of distended loop of bowel

\-the portion of the bowel involved can offer a clue to the underlying disease

Acute Pancreatitis

dilated jejunum or transverse colon

Acute Cholecystitis

hepatic flexure

Acute Appendicitis

terminal ileum

Large Bowel Obstruction

symptoms develop slowly compared to SB obstruction

\-colon distal to the obstruction is usually collapsed and free of gas

Volvulus

twisting of colon on itself

\-BE shows: “bird beak sign” at the level of the stenosis pointing toward the site of the twist

\-affected loop appears decreased haustral markings

\-radiographic sign: coffee-bean sign

\-common site: proximal or distal

Intussusception

telescoping of one part of the intestinal tract into another

\-common site: terminal ileum

\-radiographic sign: crescent sign

Diverticula

outpouching that represent acquired herniations of the mucosa and submucosa

\-appear as round or oval outpouching of barium

\-diagnosis: single BE

\-saw tooth appearance

\-sigmoid area

Zenker’s Diverticula

outpouching in the esophagus that arises from the posterior wall of upper esophagus

\-causes: age, weak muscle

\-diagnosis: esophagram

\-symptoms: dysphagia, cough, bad breath

Meckel’s Diverticula

congenital diverticulum of the distal ileum

\-complications: rupture, obstruction

\-the rule of twos

Pneumoperitoneum

abnormal presence of air or other gas in the peritoneal cavity

\-often caused by perforation and indicates surgical emergency

\-upright abdomen

\-decubitus

Cupola Sign

air accumulation underneath the central tendon of the diaphragm in midline on a supine CXR

Rigler’s Sign

indication of free air in the abdomen on a supine abdomen xray

\-double walled sign

Esophageal Cancer

symptoms occur late in the course of the disease

\-most occur near esophageal junction

\-cause: alcohol, smoking

Gastric Carcinoma

major form of gastric carcinoma is a large irregular polypoid mass

\-location: lesser curvature

\-most common type: adenocarcinoma

\-metastasize: liver, pancreas, colon

Polyps

small masses of tissue arising from the bowel wall to project inward into the lumen

Colorectal Cancer

carcinoma of the colon is the leading cause of death from cancer in the US

\-annular cancer: apple core lesion

Cirrhosis

chronic destruction of liver cells and structure

cause: alcoholism

Ascites

increase technical factors

Hepatomegaly

causes: infection, alcohol, autoimmune diseases

Gallstones

cholelithiasis

\-cholesterol or bile pigment stones

\-80 % of stones are cholesterol

\-diagnosed: US

\-treatment: cholecystectomy

Pancreatitis

large organ behind the stomach

\-endocrine function and exocrine function

\-pancreas becomes inflamed

\-modalities: US, CT

\-radiographically it is calcified