Pathology - GI/Urinary (Unit 1-4)

Fluoro Contrast and Technique (3)

• Contrast media uses higher atomic #

• Higher kVp is used (110-125)

  • Double contrast uses 100

• Short exposure times

Gallstones (Cholelithiasis)

Presence of one or more calculi (gallstones) in the gallbladder.

The majority of gallstones are radio-_____.

Lucent

What factors predispose a patient to gallstones?

• Family hx

• Over 40 years of age

• Overweight

• Female

What is the primary cause of Acute Cholecystitis?

Impacted gallstone in the cystic duct.

What are the symptoms of acute cholecystitis?

• Abdominal pain

• RUQ tenderness

• Fever

Dysphagia

Difficulty swallowing due to a congential or acquired condition, a trapped bolus of food, paralysis of the pharyngeal or esophageal muscles, or inflammation.

Achalasis

(aka Cardiospasm). Motor disorder of the esophagus in which peristalsis is reduced along the distal 2/3 of the esophagus.

A patient with achalasia is unable to relax their _______, which causes:

• Esophagogastric sphincter

• Regurgitation and chest pain

Esophageal Varices

Dilation of the veins in the wall of the distal esophagus; often asymptomatic until bleeding occurs.

What condition often accompanies esophageal varices?

Acute liver disease

What do esophageal varices look like on an esophagogram?

Cobblestone, wormlike appearance

GERD

Entry of gastric contents into the esophagus, irritating the lining of the esophagus, aka heartburn.

Valsalva Maneuver

Patient is asked to take a deep breath and while holding the breath in, to bear down.

Why is the Valsalva maneuver useful in evaluating GERD?

It distends the organs with air for more effective mucosal lining assessment.

Zenker Diverticulum

Large outpouching of the esophagus just above the upper esophageal sphincter, potentially caused by weaking of the muscle wall.

Bezoar

A mass of undigested material that becomes trapped in the stomach.

Trichobezoar

Undigested hair

Gastritis

Inflammation of the stomach mucosa.

What causes gastritis?

Irritants

• Alcohol

• Corrosive agents

• Infection

Peptic Ulcer Disease

Group of inflammatory processes involving the stomach and duodenum.

What are common causes of peptic ulcer disease?

Infection (H. pylori) and long-term use of NSAIDs

What type of ulcers can perforate when the patient has peptic ulcer disease?

Large, acute ulcers

Hiatal Hernia

Portion of the stomach herniates though the diaphragmatic opening.

• Commonly seen on Upper GI exams

What causes a hiatal hernia?

Congentially short esophagus or weakening of the muscle that surrounds the opening

Hiatal hernias are common in ____% of the US population over the age of ____.

• 50

• 50

Crohn’s Disease (Regional Enteritis)

Idiopathic, chronic, inflammatory disorder involving any part of the gastrointestinal tract but commonly involving the terminal ileum.

Crohn's disease may lead to ___, ____, or the formation of an ____.

• Obstruction

• Fistula

• Abscess

Diverticulosis

Condition of having numerous diverticula or small, outpouchings of colon.

Diverticulitis

Inflamed infected diverticula; leading to bleeding, necrosis, perforation, abscess, fistulas.

Meckel Diverticulum

Common birth defect of the ileum caused by the persistence of the yolk sac, resulting in a saclike outpouching of the intestinal wall.

Surgical removal of a Meckel diverticulum is often recommended to prevent which conditions from developing?

• Diverticulitis

• Obstruction

• Blood loss

What is the best modality to diagnose a Meckel diverticulum?

Nuc med

Malabsorption Syndrome

Conditions in which the gastrointestinal tract is unable to process and absorb certain nutrients.

Sprue

Inability to absorb certain proteins and dietary fats.

Celiac Disease

Sprue that affects the small bowel; gluten intolerance.

What does malabsorption syndrome look like on a SBS?

Mucosa may appear thickened as a result of constant irritation.

Ulcerative Colitis

Chronic idiopathic inflammatory disease of the colon.

UC primarily affects which age group?

Young adults

UC most frequently involves the _____ region of the colon.

Rectosigmoid

What conditions can UC cause?

Toxic megacolon or perforation

Where do most carcinomas of the large intestine (colon) occur?

Rectum and sigmoid colon

What are some predisposing conditions of cancer in the colon?

• Ulcerative colitis

• Hereditary polyposis

Peristalsis

Smooth muscle contractions that move the contents of the digestive system along the GI tract

What position is the patient in? Air = black. Barium = white

Supine

What position is the patient in? Air = black. Barium = white

Prone

What position is the patient in? Air = black. Barium = white

Erect

Identify the Position

RAO (40-70 degrees)

Identify the Position

Prone

Identify the Position

LPO (40-70 degrees)

Small Bowel Series Timing and CRs

• First 15-30 minutes view - CR is 2” above iliac crest to include the stomach since contrast has just entered the body

• 60+ minute radiographs - CR is at the iliac crest to include symphysis because the contrast has gone down further into the anatomy

Small Bowel at 1 Hour: Is this Image Good?

This is at an hour, so the stomach does not need to be included, but the symphysis does (which it is). It is a little off-centered in terms of right and left, but it does not warrant a repeat since no barium filled anatomy was clipped.

Large Intestine: Is this Image Good?

Proper positioning with the anatomy. CR is at the crests

What position is the patient in? Air = black. Barium = white

Supine

• Air fills the anterior (stomach) portions while barium fills the posterior (back) portions.

What position is the patient in? Air = black. Barium = white

Prone

• Air fills the posterior (back) portions while barium fills the anterior (stomach) portion

Barium Enema: Identify the Position

Prone (PA)

Barium Enema: Identify the Position

Supine (AP)

Barium Enema: Identify the Position

Right Lateral Decub

• Barium in lateral ascending and medial descending

Barium Enema: Identify the Position

Left Lateral Decub

• Barium in medial ascending and lateral descending

Barium Enema: Identify the Position

RAO or LPO

Barium Enema: Identify the Position

LAO or RPO

AP Barium Enema: Is this Image Good?

• Overexposed (too dark)

  • Fix by lowering mAs

• Clipped the Splenic Flexure and Transverse Colon

AP BE: Is this Image Good?

• Hepatic Flexure is open and spine is off-centered

• Spinous Processes are not aligned with the midline of the vertebral bodies

• Patient is rotated LPO

  • Bring right side back toward IR

Urinary Calculi (kidney stones)

• Formed in the kidneys

• Asymptomatic (no pain) until they lodge in the ureter and cause partial obstruction (extreme pain)

Hydronephrosis

Distention of the renal pelvis and calyces of the kidneys that results from some obstruction of the ureters or renal pelvis.

What causes hydronephrosis?

• Calculi

• Tumors

• Structural abnormalities

Hydronephrosis can occur along with ____.

Hydroureter

Renal Cyst

Most common unifocal mass of the kidney; fluid-filled.

• “beak sign” on radiograph

Polycystic Kidney Disease

Hereditary disorder marked by multiple cysts of varying size scattered throughout one or both kidneys

• “Bunch of grapes” scattered throughout the kidney

Acute Renal Failure

Rapid deterioration in kidney function

• Results in accumulation of nitrogen-containing wastes

• Caused by impaired blood flow, infection to kidneys, ureteral obstruction, Tylenol overdose

Malrotation

Abnormal position of the kidney in relationship to the psoas muscle or longitudinal or horizontal axis

Ectopic Kidney

Abnormal position, such as in the pelvis (pelvic kidney), or high near the diaphragm (intrathoracic kidney)

Horseshoe Kidney

Congenital fusion of the kidneys during development of the fetus, usually at the lower poles

• Usually does not affect function

Duplication

Involves two ureters and/or the renal pelvis originating from the same kidney

• Most common type of congenital anomaly of the urinary system

Cystitis

Inflammation of the urinary bladder caused by a bacterial or fungal infection

• Common in females due to shorter urethra

• Urinary frequency, urgency, burning sensation

Glomerulonephritis

Inflammation of the capillary loops of the glomeruli of the kidneys; sonography and nuc med

• Causes oliguria

• Acute - enlarged, darkened kidney

• Chronic - small kidney size caused by fibrosis and cortex destruction from long-standing inflammation

Pyelonephritis

Inflammation of the kidney and renal pelvis caused by pyogenic bacteria

• Primary affects the interstitial tissue between the nephron tubules

Renal Carcinoma

Most frequent type of malignant tumor of the kidney

• 3x more frequent in males

Carcinoma of the Bladder

Tumor usually is diagnosed after the age of 50 years, usually men

Vesicorectal Fistula

Abnormal communication between the bladder and rectum/aspects of colon