4) Oesophagus and stomach Flashcards Preview

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Flashcards in 4) Oesophagus and stomach Deck (11):
1

Imaging modalities - oesophagus

CT
- oral or IV C+
- good for pathology, physiology, staging diseases, great for tumours
Plain radiography
- AP
- OBL & OBR (30 or 45). Obliques solve superimposition problems
Endoscopy
- can see inside oesophagus in real time. Often combined with US
MRI
- not that common due to cost and availability

2

Anatomy issues

-Due to close proximity of oesophagus and trachea, a pathology in one can effect the other
- Common problems arise when the lower oesophageal sphincter isn't working properly and stomach acid frequently comes up the oesophagus

3

Oesophagitis (cause, signs: M, I, U, A, S, B)

Cause: usually GERD
Signs
- mucosal folds
- irregular thickened mucosa
- ulcers and erosions
- adenocarcinoma
- strictures (hiatal hernia in >95% of pt's with stricture)
- Barrett's oesophagus: heterogeneous CM spread. Erosions at distal oesoph may be present. Reticular mucosa is a characteristic

4

Candida oesophagus (double C+ oesophagram...), achalasia, schatzki ring (occurs where)

Candida oesop
- Double C+ oesophagram: discrete plaques with longitudinal orientation. "Cobblestone" or "snakeskin" appearance

Achalasia
- motility disorder characterised by the absence of peristalsis in oesoph and impaired relaxation of lower oesophageal sphincter in response to swallowing. Bird beak sign

Schatzki ring
- Occurs near oesoph sphincter (LES)
- causes dysphagia with solid food

5

Hiatus hernia. Happens to... Types... Detected by...

- can happen in pt's with reflux BUT there are pt's with reflux without hernia
Can be
- sliding hernia: distal end enlarged
- paraoesophaeal hernia: sac
- mixed
- detected by seeing air under diaphragm in CXR

6

Corkscrew oesophagus (what, findings, sphincter), diverticula, pseudodiverticulosis

Corkscrew oesophagus
- motility disorder of oesophagus
- classical but uncommon finding is corkscrew appearance, especially of distal oesophagus
- Lower oesophageal sphincter will relax normally, unlike achalasia

Diverticula
- a diverticula is a pouch arising from a tubular organ

Pseudodiverticulosis
- oesophageal intramural pseudodiverticula are dilated excretory ducts of the deep mucosal glands in the oesophagus

7

Tumours (W, T, O, S, U)

- walls of oesophagus may be thickened
- Tumours grow and cause strictures
- oedema associated walls become larger
- search for tumours near stomach (caused by acid)
- US + endoscope technique to see if lymphnodes associated

8

Imaging modalities - stomach

CT
- solves superimposition issues
- water is better than Ba for C+ as Ba is too bright, covering anatomical detail
Plain x-ray/fluoro --> obliques
MRI
Endoscopy

9

Gastric studies by plain x-ray (S, W, I)

- shape, size and position are important to radiologists
- water shows better results than Ba to promote contrast
- IV C+ is essential for evaluating neoplastic and inflammatory diseases of stomach

10

Gastritis and ulcers (look for...)

- look for change of folds
- look for ulcer signs, C+ concentrated around ulcers

11

Gastric varices (CT, Radiographic findings)

CT
- appear as well defined clusters of tubular soft tissue attenuation in posterior wall of stomach
Radiographic findings
- Thick, tortuous folds in cardia or fundus
- folds change in shape and size with compression and luminal distension
- May see extrinsic pressure defect on greater curvature if there is associated splenomegaly