Radiologic Pathology - Digestive System

diverticulum

pouch created by the herniation of the mucous membrane through the muscular coat

stmach and small intestine

diverticulum commonly occurs where

diverticulum

RA: out pouching of mucosal wall

zenker's diverticulum

large out pouching of the esophagus just above the
upper esophageal sphincter

zenker's diverticulum

RA: enlarged recess or cavity in proximal esophagus

traction diverticulum

CAUSE: due to scarring from pulmonary tuberculosis or an inflammatory process within the mediastinum

epiphrenic diverticulum

arises in the distal esophagus just superior to the lower esophageal sphincter (LES)

dysphagia

difficulty swallowing

dysphagia

RA: narrowing or enlargement of esophagus, depending on cause

hiatal hernia

protrusion of the stomach through the esophageal hiatus of the diaphragm

hiatal hernia

RA: gastric bubble or protruding aspect of stomach above diaphragm or Schatzki’s ring

paraesophageal hiatal hernia

occurs when a portion of the stomach herniates into the thorax while the esophagus and lower esophageal
sphincter or gastroesophageal junction remains stationary

gastroesophageal reflux diease (GERD)

a form of indigestion felt as a burning sensation in the chest characterized by a backward flow of gastric contents into the esophagus due to an incompetent lower esophageal sphincter (LES)

esophagogram

what procedure is used to detect early signs of GERD

gastroesophageal reflux diease (GERD)

demonstrates longitudinal streaks in the distal esophagus during an esophagogram because of changes in the mucosa

achalasia

failure of the smooth muscle of the alimentary canal to relax

achalasia

esophageal motility disorder that occurs due to the
inability of the lower esophageal sphincter (LES) to relax wherein, the esophagus fills with ingested food and fluids

achalasia

RA: stricture or narrowing of the esophagus; bird’s beak sign

esophageal varices

dilated, tortuous/twisted veins of the distal esophagus which may rupture

esophageal varices

RA: “wormlike” and “cobblestone” appearance in an
esophagogram

esophageal cancer

ragged/ratty and/or “apple-core” appearance in a barium swallow radiograph

candida

an opportunistic fungus that commonly inhabits the mouth, throat, GI tract and vagina

barrett's esophagus

replacement of the normal squamous epithelium with
columnar-lined epithelium ulcer tissue in the lower
esophagus

barrett's esophagus

considered the precursor lesion for oesophageal
adenocarcinoma

barrett's esophagus

RA: stricture or “streaked” appearance of distal esophagus

nuclear medicine

what is the modality of choice for barrett's esophagus

peptic ulcer disease

ulcers of the stomach and duodenum; usually a chronic disease

gastric carcinoma

classic “apple-core” appearance; irregular filling within the stomach

bezoar

a hard mass of entangled material found within the stomach or intestines that cannot be digested

trochobezoar

made up of indigested hair

phytobezoar

ingested vegetable fiber or seeds

bezoar

RA: filling defect or ill-defined mass within the stomach

bowel obstruction

partial or complete loss of the normal peristaltic action of the small and/or large intestine thus impeding the normal transit of chyme

adynamic/paralytic ileus

type of bowel obstruction that is caused by a
reduction in the normal peristaltic action of the
intestines

adynamic/paralytic ileus

cessation of peristalsis

adynamic/paralytic ileus

RA: air in both the small and large intestines is an indication of this condition

dynamic/mechanical obstruction

obstruction are caused by hernia, adhesion, volvulus,
intussusception, neoplasm (adenoma/polyp,
adenocarcinoma), Crohn’s disease, constipation

dynamic/mechanical bowel obstruction

R.A : “circular staircase” or “herringbone pattern”

inguinal hernia

portion of the bowel to rupture through the abdominal wall wherein some instances, the bowel will descend into the scrotum

regional enteritis/crohn's disease

idiopathic disease which is characterized by a
chronic inflammation of the bowel accompanied
with abdominal cramping, diarrhea, constipation,
weight loss or gain, and vomiting

regional enteritis/crohn's disease

RA: “cobblestone” and “string sign” in the small
bowel series; distended loops of air-filled small
intestine

bowel/fibrous adhesion

fibrous band of connective tissue that interrelates/connect organs and tissues that are normally separate which create a blockage

RA: distended loops of air-filled small intestine

what is the radiographic appearance of a fibrous adhesion?

volvulus

loop of intestine that has twisted around itself
causing either a partial or complete obstruction

volvulus

large amount of air in sigmoid; tapered or “corkscrew” appearance, with air-filled distended region of intestine

intussusception

section of bowel is constricted by peristalsis causing it to prolapse or telescope into itself

ileocecal valve

intussusception commonly affects what valve

intussusception

RA: “coiled spring” appearance; “mushroomshaped” dilation at distal aspect with very little barium or gas passing beyond it

adenomatous polyp/adenoma

neoplasm that grows into the lumen of the colon

pedunculated polyp

polyp projecting upward from a slender stalk

sessile/barnacle polyp

polyp projecting inward and directly attached to the bowel wall

adenocarcinoma/colorectal cancer

a type of neoplasm that originates in glandular tissue and can be the cause a bowel obstruction

constipation

very common digestive complaint where the patient
experiences hard stool that can be be difficult to defecate

diverticulosis

a condition of having diverticula without inflammation

diverticulitis

inflammation of diverticula in the alimentary canal

diverticulitis

often caused by entrapment of chyme or feces within the diverticulum

enteritis

RA: thickening of mucosal folds and poor definition of
circular fold

giardiasis

beaver fever

giardiasis

caused by contaminated food and water by a flagellate protozoan (Giardia lamblia)

neoplasm

new growth

neoplasm

“apple-core” or “napkin-ring sign”

sprue/malabsorption syndrome

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

sprue/malabsorption syndrome

radiographic features:
- small bowel dilatation
- stack of coins appearance
- Moulage sign

sprue/malabsorption syndrome

RA: thickening of mucosal folds and poor definition of
normal “feathery” appearance

celiac disease/sprue

malabsorption disease caused by a mucosal defect in the jejunum

celiac disease/sprue

it commonly involves the insoluble protein (gluten) found in cereal grains

whipple's disease

CAUSE: by the actinobacteria (Tropheryma whipplei)

whipple's disease

RA: dilatation and distorted loops of proximal small bowel

appendicitis

result of entrapment of feces within the appendix and the presence of an appendicolith

appendicitis

symptoms include right lower quadrant pain and an increase in the white blood cell count

ascites

abnormal accumulation of fluid in the peritoneal cavity

Transudate

thin, low protein count and low specific gravity

transudate

CAUSE: cirrhosis of the liver, alcoholic hepatitis, heart failure, hypoproteinemia, portal vein thrombosis, peritoneal dialysis

exudate

high protein count and specific gravity

exudate

CAUSE: peritoneal carcinomatosis, pancreatitis,
abscess, nephrotic syndrome, peritonitis, and/or bowel obstruction

ascites

RA: general abdominal haziness

pneumoperitoneum

presence of free air or gas in the peritoneal cavity

pneumoperitoneum

RA: thin, “crest-shaped” radiolucency under dome of the right hemidiaphragm on erect

colitis

inflammatory condition of the large intestine that may be caused by many factors, including bacterial infection, diet, stress, and other environmental conditions

colitis

RA: thickening of mucosal wall with loss of haustral markings

ulcerative colitis

recurrent disorder causing inflammatory ulceration in the colon

ulcerative colitis

intestinal wall has a “saw-tooth” or jagged appearance

ulcerative colitis

RA: deep air-filled mucosal protrusion of colon wall;
“cobblestone” and possible “stovepipe” appearance with severe form

HIRSCHSPRUNG’S DISEASE/CONGENITAL AGANGLIONIC MEGACOLON

absence of parasympathetic ganglia, usually in the distal colon, resulting in the absence of peristalsis

RA: dilated loop of colon

what is the radiographic appearance of hirschsprung disease?

meckel's diverticulum

this out pouching is seen in the ileum of the small bowel

meckel's diverticulum

RA: large diverticulum of ileum, proximal to ileocecal valve

hypertrophic pyloric stenosis

a narrowing or blockage at the pylorus or stomach outlet that occurs in infants, frequently resulting in repeated, forceful vomiting

hypertrophic pyloric stenosis

most common type of gastric obstruction in infants

hypertrophic pyloric stenosis

RA: distention of stomach owing to obstruction of pylorus