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Flashcards in Ch 4-5 Deck (208)
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1

2 highly specialized connective tissues the skeletal system is composed primarily of

Bone
Cartilage

2

Consists of an organic matrix in which organic salts (primarily calcium and phosphate) are deposited

Bone

3

Fibrous membrane that covers the outer surfaces of bone, except at joint surfaces, where articular cartilage covers the bone and acts a protective cushion
Contains a network of blood vessels from which nutrient arteries penetrate into the underlying bone

Periosteum

4

Main shaftlike portion of bone

Diaphysis

5

Ends of the bone

Epiphysis

6

Hollow, tubelike structure within the diaphysis

Medullary cavity/marrow

7

Inner membrane that lines the medullary cavity

Endosteum

8

2 major types of bone

Compact
Cancellous

9

Outer layer of bone

Compact bone

10

Spongy inner layer of bone composed of a web-like arrangement of marrow-filled spaces

Cancellous (spongy) bone

11

Thin processes of bone that separate the spaces of cancellous bone

Trabeculae

12

Until the linear growth of bone is complete, the epiphysis remains separated from the diaphysis by a cartilaginous plate

Epiphyseal cartilage

13

Where the diaphysis meets the epiphyseal growth plate is a slight flaring

Metaphysis

14

2 special types of bone cells

Osteoblasts
Osteoclasts

15

Enlarge the diameter of the medullary cavity by removing bone from the diaphysis wall

Osteoclasts

16

Produce new bone around the outer circumference

Osteoblasts

17

Bone formation

Ossification

18

Bone destruction

Resorption

19

Connective tissue membrane bones can also develop within

Intramembranous ossification

20

Flat bones grow in size by the addition of osseous tissue to their outer surfaces

Appositional growth

21

Spinal canal defect caused from failure of the posterior elements to fuse properly

Spina bifida

22

Large defects of spina bifida have 2 complications of hernias

Meningocele
Myelomeningocele

23

Herniation of the meninges

Meningocele

24

Herniation of the meninges and a portion of the spinal cord or nerve roots

Myelomeningocele

25

3 malformations associated with a meningocele

Gait disturbances
Clubfoot
Bladder incontinence

26

Rare hereditary bone dysplasia in which failure of the resorptive mechanism of calcified cartilage interferes with the normal replacement by mature bone
Results in very brittle bones
Location: entire skeleton
Imaging appearance: generalized increased bone density

Osteopetrosis
"Marble bones"

27

An inherited generalized disorder of connective tissue characterized by multiple fractures and an unusual blue color of the normally white sclera of the eye

Osteogenesis imperfecta (OI)
"Brittle bone disease"

28

Most common form of dwarfism
Results from diminished proliferation of cartilage in the growth plate (decreased enchondral bone formation)
Autosomal dominant condition
Characterized by short limbs with a normal axial skeleton
Thick bones
Location: vertebrae (short stature), long bones
Imaging appearance: progressive interpedicular distance from superior to inferior, and scalloping of posterior vertebral bodies; widened metaphysis (Erlenmeyer flask deformity)

Achondroplasia

29

Results from incomplete acetabulum formation caused by physiologic and mechanical factors

Congenital hip dysplasia/dislocation
Developmental hip dysplasia

30

9 inflammatory and infectious disorders

Rheumatoid arthritis
Osteoarthritis (degenerative joint disease)
Infectious arthritis
Tuberculous arthritis
Bursitis
Rotator cuff tears
Tears of the menisci of the knee
Bacterial osteomyelitis
Tuberculous osteomyelitis

31

Chronic systemic idiopathic disease that appears primarily as a noninfectious inflammatory arthritis of the small joints of the hands and feet
Location: small joints symmetrically
Imaging appearance: periarticular soft tissue swelling and symmetric joint destruction and deformity

Rheumatoid arthritis (RA)

32

3 rheumatoid arthritis (RA) variants

Ankylosing spondylitis
Reiter's syndrome
Psoriatic arthritis

33

Very common generalized disorder characterized by loss of joint cartilage and reactive bone formation
Part of the wear and tear of the aging process
Affects the weight-bearing joints (spine, hip, knee, ankle) and the interphalangeal joints of the fingers
Imaging appearance: irregular narrowing of joint space with small bony spurs

Osteoarthritis (degenerative joint disease)

34

Chronic, indolent infection that has a gradual onset and a slowly progressive course
Most patients have pulmonary TB
Rare

Tuberculous arthritis

35

3 joints usually involved in tuberculous arthritis

Spine
Hips
Knees

36

An inflammation of the small fluid-filled sacs located near the joints that reduce the friction caused by movement
Location: shoulder most common
Imaging appearance: calcific tendinitis in 50%

Bursitis

37

The rotator cuff of the shoulder is a musculotedinous structure composed of the teres minor, infraspinatus, supraspinatus, and subscapularis muscles
Tears produce a communication between the shoulder joint and the subacromial bursa
MRI is the modality of choice, inject contrast (arthrogram) before

Rotator cuff tears

38

5 causes of bursitis

Repeated physical activity (most common)
Trauma
Rheumatoid arthritis
Gout
Infections

39

2 causes of tears of the menisci of the knee

Acute trauma
Degeneration due to chronic trauma

40

Common cause of knee pain, MRI is the modality of choice

Tears of the menisci of the knee

41

An inflammation of the bone and marrow caused by a variety of infectious organisms that reach bone by hematogenous spread, extension from an adjacent site of infection, or direct introduction of organisms (after trauma or surgery)
In infants and kids, the metaphysis of long bones (high in red marrow), especially the femur and tibia, are most often affected
In adults, acute hematogenous primarily occurs in the vertebrae, causing localized back pain and muscle spasms
Begins as an abscess of the bone; pus produced by the acute inflammation spreads down the medullary cavity and out to the surface
Imaging appearance: soft tissue swelling with periosteal elevation

Bacterial osteomyelitis

42

Rare osteomyelitis today that usually affects the T and L spine
Location: vertebra
Imaging appearance: lytic lesion without periosteal elevation and collapsed vertebra with kyphosis

Tuberculous osteomyelitis (Pott's disease)

43

2 types of osteomyelitis

Bacterial osteomyelitis
Tuberculous osteomyelitis (Pott's disease)

44

5 metabolic bone diseases

Osteoporosis
Osteomalacia
Rickets
Gout

45

A generalized or localized deficiency of bone matrix in which the mass of bone per unit volume is decreased in amount but normal in composition
Causes include aging and postmenopausal hormonal changes, more common in females
Location: loss of bone mass in entire skeleton (accelerated bone resorption)
Imaging appearance: cortical thinning appears as a relatively dense and prominent thin line

Osteoporosis

46

A ________ in kVp is required to obtain quality images of a patient with osteoporosis

Decrease

47

Insufficient mineralization of the adult skeleton
May be caused by inadequate intake or absorption of calcium, phosphorus, or vitamin D
Other nutritional causes are chronic kidney failure or kidney diseases that cause calcium secretion in the urine
Softening of the bone
Location: deossification of medullary bone
Imaging appearance: loss of bone density and cortex becomes thin and often indistinct

Osteomalacia

48

Systemic disease of infancy and childhood that is the equivalent of osteomalacia in adults
Calcification of growing skeletal elements is defective because of a deficiency of vitamin D in the diet or a lack of exposure to ultraviolet radiation (sunshine) which converts sterols in the skin into vitamin D
Soft bones
Location: insufficient mineralization of the immature skeleton
Imaging appearance: cupped and frayed metaphysis in long bone

Rickets

49

A disorder in the metabolism of purine (a component of nucleic acids)
Increases uric acid in the blood, which leads to the deposition of uric acid crystals in the joints, cartilage, and kidney
Manifests as very painful arthritis that initially attacks a single joint, primarily the first metatarsophalangeal joint
Additive and destructive
"Rate bite" erosions
If you have a mass forming, calcium will get into it and show up on x-rays
Location: 1st MTP joint but may attack any joint
Imaging appearance: joint inflammation (effusion) and destruction and/or uric crystals (tophi) in joint space

Gout

50

One of the most common chronic metabolic diseases of the skeleton
Associated increased risk of osteosarcoma
No known cure
Bone destroys itself, then comes back thicker; painful
Middle-age +
Most common in pelvis, seen well in skull
Can go into other areas of the bone
Location: destruction and reparative process in pelvis, weight-bearing bones, and skull
Imaging appearance: radiolucencies in destructive (lytic) phase and cotton-wool appearance in reparative phase

Paget's disease
Osteitis deformans

51

Results from the ingestion of lead-containing materials (especially paint) or from the occupational inhalation of lead fumes
Environmental exposure occurs when drinking water (leaded pipes) and eating food that's processed, preserved, or stored in containers made with lead
Currently lead is the number one major environmental pollutant worldwide
Chronic form may cause mental retardation, seizures, behavioral disorders, or delayed development
Children are more susceptible to lower doses (eat lead containing paint = pica)
In kids, because lead and calcium are used interchangeably by bone, high concentrations of lead are deposited in the most rapidly growing portions of the skeleton, especially the metaphysis at the distal ends of the femur

Lead poisoning

52

Characterized by the proliferation of fibrous tissue within the medullary cavity that causes loss of trabecular markings and widening of the bone

Fibrous dysplasia

53

Occurs due to a loss of blood supply with many different causes

Ischemic necrosis of bone

54

8 benign bone tumors

Osteochondroma
Enchodroma
Giant cell tumor (osteoclastoma)
Osteoma
Osteoid osteoma
Simple bone cyst
Aneurysmal bone cyst
Bone island

55

5 malignant bone tumors

Osteogenic sarcoma
Chondrosarcoma
Ewing's sarcoma
Multiple myeloma
Bone metastases

56

Benign projection of bone with a cartilaginous cap that arises in childhood or teen years, commonly near the knee
Location: epiphyseal plate growing laterally in long bones
Imaging appearance: tumor runs parallel to long bone and points away from nearest joint

Osteochondroma

57

2 characteristics of osteochondromas

Long axis of tumor runs parallel to the bone shaft
Points away from the nearest joint

58

Slow-growing benign cartilaginous tumors arising in the medullary canal
Primarily in the small bones of the hands and feet
Often found when a fracture occurs with minimal force
Most frequent in kids and young adults and primarily involve the small bones of the hands and feet

Enchondroma

59

Typically arises at the end of the distal femur or proximal tibia of a young adult after epiphyseal closure (20-40 years old)
Does not affect the joint
Location: metaphysis extends into subarticular cortex
Imaging appearance: multiple large bubbles separated by strips of bone

Giant cell tumor (osteoclastoma)

60

Most often arise in the outer table of the skull, the paranasal sinuses (especially frontal and ethmoid) and the mandible
Cause pain
Appear radiographically as well-circumscribed, extremely dense, round lesions that are rarely larger than 2 cm in diameter

Osteoma

61

Typically imaged as a small, round or oval, lucent center (the nidus), less than 1 cm in diameter, that is surrounded by a large, dense sclerotic zone of cortical thickening
It is most common in teenagers or young adults.
Symptom is local pain, which increases at night and is easily relieved by aspirin
Location: femur and tibia, osteoblastic cells

Osteoid osteoma

62

A true fluid-filled cyst with a wall of fibrous tissue, which most often occurs in the proximal humerus or femur at the metaphysis
Asymptomatic and often discovered either incidentally or after pathologic fracture

Simple bone cyst

63

Not a true neoplasm or cyst
Consists of numerous blood-filled, arteriovenous communications thought to be caused by trauma

Aneurysmal bone cyst

64

Solitary, sharply demarcated areas of dense compact bone that occur most commonly in the pelvis and upper femur
Appear in every bone except the skull

Bone island

65

Generally occurs in the end of a long bone in the metaphysis (especially about the knee)
A malignant tumor of osteoblasts, which produce osteoid and spicules of calcified bone
Most common in persons between 10 and 25 years old
Smaller peak incidence is seen in older persons who have a preexisting bone disorder, particularly Paget’s disease
Metastases to the lungs
Mixed destructive and sclerotic lesion associated with a soft tissue mass
Imaging appearance: "sunburst" pattern or Codman’s triangle

Osteogenic sarcoma

66

A malignant tumor of cartilaginous origin that may originate anew or within a preexisting cartilaginous lesion, e.g., osteochondroma and enchondroma
Commonly occurs in long bones, but often originates in a rib, scapula, or vertebra
About half as common as osteogenic sarcoma
It develops at a later age (peak incidence in 35- to 60-year olds), grows more slowly, and metastasizes later

Chondrosarcoma

67

A primary malignant tumor arising in the bone marrow of long bones
Occurs in children and young adults and is rare over age 30
Destructive (takes away calcium) to whole area of bone
Major clinical complaint is local pain
Imaging appearance: medullary destruction with "onionskin" periosteal reaction

Ewing’s sarcoma

68

A widespread malignancy of plasma cells associated with bone destruction, bone marrow failure, hypercalcemia, renal failure, and recurrent infections
Affects primarily persons between 40 and 70 years of age
Eats away at the bone
Location: intramedullary canal of the diaphysis
Imaging appearance: multiple punched-out lesions

Multiple myeloma

69

The most common malignant bone tumors that are more common than primary neoplasms
They spread from primary tumors by means of the bloodstream or lymphatic vessels or by direct extension
The most common primary tumors are carcinomas of the breast, lung, prostate, kidney, and thyroid.
Favorite sites of spread are bones containing red marrow, such as the spine, pelvis, ribs, skull, and the upper ends of the humerus and femur
Location: entire skeleton
Imaging appearance: irregular, poorly defined lucent lesions or poorly defined increased densities depending on site of origin

Bone metastases

70

Metastases from carcinomas of the kidney and thyroid typically produce a single large metastaic focus that may appear as an expansive trabuculated lesion

"Blowout"

71

In the spine, bone metastases may produce a characteristic uniform density

"Ivory" vertebral body

72

Generally considered evidence of slow growth in a neoplasm that has allowed time for a proliferation of reactive bone (additive)

Osteoblastic metastases

73

A disruption of bone caused by mechanical forces applies either directly to the bone or transmitted along the shaft of a bone
Although often obvious, some are subtle and difficult to detect
Typically appears as a radiolucent line crossing the bone and disrupting the cortical margins

Fracture

74

4 ways fractures are defined and classified

Extent
Direction and position
Number of fracture lines
Integrity of the overlying skin

75

Fracture that results in discontinuity between two or more bone fragments

Complete fracture

76

Fracture that causes only partial discontinuity, with one side of bone cortex intact

Incomplete fracture

77

Fracture with overlying skin intact

Closed fracture

78

Fracture with associated skin wound, overlying skin is disrupted

Open/compound fracture

79

Fracture line is horizontal/runs at a right angle to long axis of bone
Most commonly results from a direct blow or is a fracture within pathologic bone

Transverse fracture

80

Fracture line extends at approximately a 45 degree angle to long axis of bone and is caused by angulation or by both angulation and compression forces

Oblique fracture

81

Fracture line encircles the shaft, is generally longer than an oblique fracture, and is caused by torsional forces

Spiral fracture

82

Small fragments torn from bony prominences by being pulled from bone by attached ligaments or tendons

Avulsion fractures

83

Fracture composed of more than two bone fragments

Comminuted fracture

84

Elongated triangular fragment of cortical bone separated from two larger fragments

Butterfly fragment

85

A piece/segment of the shaft is separated by proximal and distal fracture lines

Segmental fracture

86

Results from compression force that causes compaction the trabeculae and results in decreased length or width of a portion of a bone
Most commonly occur in the vertebral body as a result of flexion of the spine; they may also be seen as impacted fractures of the humeral or femoral

Compression fracture

87

Fragment driven inward, e.g., skull fragment pushed into brain; tibial plateau

Depressed fracture

88

The response of bone to repeated stresses, none of which is sufficient to cause a fracture

Stress/fatigue fracture

89

Occurs in bone at an area of weakness caused by a process such as tumor, infection, or metabolic bone disease
Usually not significant enough to cause a fracture in healthy bone
Weak bones
Frequently occurs in soldiers during basic training ("march" fracture)

Pathologic fracture

90

Occurs in immature bone (infant and children); incomplete fracture where one side of cortex remains intact

Greenstick fracture

91

Cortex is intact with buckling or compaction of one side of the cortex

Torus (buckle) fracture

92

Plastic deformity of bone caused by a stress that is too great to permit a complete recovery of normal shape but is less than the stress required to produce a fracture

Bowing fracture

93

A plane of cleavage exists in the bone without angulation or separation

Undisplaced fracture

94

Separation of bone fragments; the direction of displacement describes the relationship of the distal fragment with respect to the proximal fragment and is usually measured in terms of the thickness of the shaft

Displacement

95

Angular deformity of the axes of the major fracture fragments and also describes the position of the distal fragment with respect to the proximal one

Angulation

96

The displacement of a bone that is no longer in contact with its normal articulation
Most commonly shoulder joint anteriorly

Dislocation

97

Only partial loss of continuity of the joint surfaces

Subluxation

98

The healing of fracture fragments in a faulty position; leads to impairment of normal function or a cosmetic appearance that may require surgical correction

Malunion

99

An ill-defined term arbitrarily applied to any fracture that takes longer to heal than the average fracture at that anatomic location
May result from infection, inadequate immobilization, limited blood supply, or loss of bone at the fracture site

Delayed union

100

A condition in which the fracture healing process has completely stopped and the fragments remain ununited even with prolonged immobilization

Nonunion

101

Refers to multiple, repeated, physically induced injuries in young children caused by parents or guardians
Imaging professionals have a legal responsibility to report suspicious cases to their supervisors
The facility is legally obligated to notify authorities

Battered-child syndrome
Suspected nonaccidental trauma (SNAT)

102

Transverse fracture through the distal radius with dorsal (posterior) angulation
Common for ulnar styloid to fracture, too
Usually caused by a fall on the outstretched hand; most common fracture in wrist

Colles' fracture

103

Transverse fracture of the neck of the 5th metacarpal with palmar angulation of the distal fragment
Often caused by hitting an object with a closed fist

Boxer's fracture

104

Most common fracture involving the carpal bones

Navicular (scaphoid)

105

Ulnar shaft fracture associated with anterior dislocation of the radius at the elbow

Monteggia

106

Radial shaft fracture and a dorsal (posterior) dislocation of the ulna at the wrist

Galeazzi

107

Fracture of both malleoli with ankle dislocation

Pott's

108

Fracture of both malleoli
One side is usually spiral or oblique and the other transverse

Bimalleolar

109

Fracture of both malleoli and the posterior lip of the tibia; usually represent fracture-dislocations

Trimalleolar

110

Transverse fracture of the 5th metatarsal base

Jones

111

2 classifications of fractures of the spine (result of direct trauma, hyperextension-flexion inuries [whiplash])

Stable
Unstable

112

Leave one of the two major columns of the spine intact

Stable fracture

113

Fractures that disrupt both major columns of the spine

Unstable fracture

114

Comminuted fracture of C1
Ring of atlas, involves both anterior and posterior arches and causes displacement of the fragments

Jefferson

115

Most occur at base of dens

Odontoid fractures

116

Fracture of C2 arch with subluxation of C2–C3
Patients who had been hanged

Hangman's

117

Avulsion fracture of a spinous process in the lower cervical or upper thoracic spine

Clay shoveler's fracture

118

Transverse fracture of a lumbar vertebra that is often associated with significant visceral injuries

Seat belt fracture

119

A twisting and curvature of the vertebral column in the lateral perspective
It is generally shaped somewhat like an "S"

Scoliosis

120

4 most common types of scoliosis

Idiopathic
Functional
Neuromuscular
Degenerative

121

Protrusion of a portion of the disk

Herniation of intervertebral disks

122

5 most common sites of herniation of intervertebral disks

L4–L5
L5–S1
C5–C6
C6–C7
T9–T12

123

A cleft in the pars interarticularis without displacement, usually bilateral
Most common site L5
Affects 5% of the population

Spondylolysis

124

Situated between the superior and inferior articular process
Lamina = neck of the scotty dog

Pars interarticularis

125

The forward displacement of one vertebra on another, causes chronic back pain
It may be caused by spondylolysis, a cleft in the pars interarticularis with displacement

Spondylolisthesis

126

Generally cause soft tissue swelling and cortisol bone erosion with a margin that is poorly defined
or absent
The neoplasm extends into soft tissue through spiculations (finger-like projections)
Plain radiographs may identify a single lesion
A radionuclide bone scan or PET scan can detect
silent lesions when minimal cellular destruction has occurred
CT and MRI can precisely define the location of a malignant bone tumor and its extension into the medullary cavity/surrounding
structures

Malignant bone lesions

127

What is the basic function of the digestive system and what does this process depend on?

To alter the chemical and physical composition of food so that it can be absorbed and used by body cells depends on secretions of the endocrine and exocrine glands and on the controlled movement of ingested food through the tract so the absorption can occur

128

The mechanical breakdown of food

Mastication/chewing

129

Where does digestion begin?

In the mouth with mastication/chewing

130

Secretion of saliva moistens the food in preparation for this complex process that requires coordination of many muscles in the head and neck and the precise opening and closing of esophageal sphincters

Deglutition/swallowing

131

Digestion continues in the stomach with the churning movement of gastric contents that have become mixed hydrochloric acid and the proteolytic enzyme pepsin; the resulting milky white substance is propelled through the pyloric sphincter into the duodenum by peristalsis

Chyme

132

Rhythmic smooth muscle contractions

Peristalsis

133

Where does the greatest amount of digestion occur?

Duodenum (first part of small bowel)

134

Controls the level of circulating blood glucose by secreting insulin and glucagon in the islets of Langerhans
Secretes enzymes for the digestion of proteins, fat, and carbohydrates and an alkaline solution to neutralize the acid carried into the small intestine from the stomach

Pancreas

135

An emulsifier secreted by the liver, stored in the gallbladder, and enters the duodenum through the common bile duct
Essential for the digestion and absorption of dietary fat and fat-soluble vitamins
Greenish liquid

Bile

136

A substance that acts like soap by dispersing the fat into very small droplets that permit it to mix with water

Emulsifier

137

Green pear-shaped sac that lies on the undersurface of the liver; function is to store bile

Gallbladder

138

Numerous finger-like projections that increase the inner surface area of the small bowel and proved the largest amount of surface area for possible for digestion and absorption

Villi

139

Material that has not been digested passes into the colon, where water and minerals are absorbed, and the remaining matter is excreted

Feces

140

If the contents of the lower colon and rectum move at a rate that is slower than normal, extra water is absorbed from the fecal mass to produce hardened stool

Constipation

141

Results from increased motility of the small bowel, which floods the colon with an excessive amount of water that cannot be completely absorbed

Diarrhea

142

Vermiform (worm-shaped) accessory digestive organ arises from the inferomedial aspect of the cecum approximately 3 cm below the ileocecal valve
No functional importance in digestion

Appendix

143

Largest gland in the body that is responsible for several vital functions
Cells detoxify a variety of poisonous substances that enter the blood from the intestines
Secrete approximately 1 pint of bile each day
Plays a vital role in the metabolism of proteins, fats, and carbohydrates
Major site of synthesis of the enzymes necessary for various cellular activities throughout the body

Liver

144

The liver plays an important role in maintaining the proper level of glucose in the blood by taking up excess glucose absorbed by the small intestine and storing it

Glycogen

145

Results from the failure of the esophageal lumen to develop completely separate from the trachea resulting in a blind pouch
Often associated with other congenital malformations involving the skeleton, cardiovascular system, and GI tract

Congenital tracheosophageal (TE) fistula

146

Tracheosophageal fistula caused by cancer, infection, trauma, instrumentation perforation

Acquired tracheosophageal (TE) fistula

147

Acute form is most commonly the result of reflux of stomach contents into distal esophagus
Chronic may result in strictures or Barrett’s esophagus
It may also be caused by infection: herpes virus or candida (fungal); usually occurs in patients with widespread malignancy who are receiving radiation or chemotherapy
Alcohol, chocolate, caffeine, and fatty foods tend to decrease the pressure of the esophageal sphincter, allowing reflux to occur

Esophagitis
Gastroesophageal reflux disease (GERD)

148

Produces acute inflammatory changes in the esophagus
Superficial penetration of the toxic agent results in only minimal ulceration
Deeper penetration of the submucosa and muscular layers causes sloughing of destroyed tissue and deep ulceration

Ingestion of corrosive agents

149

Most are squamous cell type
Most common site is esophagogastric junction
Associated with excessive alcohol intake and smoking
Dysphagia occurs late in the disease
Incidence far higher in men than women
CT is major method of staging patients with 90% accuracy

Esophageal cancer

150

Difficulty swallowing

Dysphagia

151

Outpouchings of the esophageal wall


Composed of only mucosa and submucosa herniating through the muscular layer

Esophageal diverticula

152

Outpouchings of the all the esophageal walls

True/traction esophageal diverticula

153

Outpouchings composed of only mucosa and submucosa herniating through the muscular layer of the esophageal wall

False/pulsion esophageal diverticula

154

Esophageal diverticula that arise from the posterior wall of the upper (cervical) esophagus

Zenker's diverticula

155

Dilated veins in the distal esophagus
Caused by portal hypertension usually caused by cirrhosis
May hemorrhage

Esophageal varices

156

Protrusion of a portion of the stomach into the thoracic cavity through the esophageal hiatus in the diaphragm
Commonly causes GERD
Degree of herniation varies widely
Most common abnormality (50% of population) detected on upper GI
Range from large esophagogastric hernias to small hernias that emerge above the diaphragm
Prominent air fluid levels can be seen on chest x-rays

Hiatal hernia

157

Functional obstruction of the distal esophagus with proximal dilation
Caused by incomplete relaxation of the lower esophageal sphincter

Achalasia

158

May be radiopaque or radiolucent
Radiopaque is often seen without the aid of contrast
Radiolucent is best seen with the aid of barium swallow
Two projections 90 degrees from each other required to truly determine object is lodged in esophagus

Foreign bodies

159

6 causes of perforation of the esophagus

Esophagitis
Peptic ulcer
Neoplasm
External trauma
Instrumentation
Severe vomiting (the most common cause) or coughing, often from dietary or alcoholic indiscretion

160

Inflammation of the stomach mucosa
Changes the normal surface pattern of the gastric mucosa

Gastritis

161

Alcohol
Corrosive agents
Infection (helicobacter pylori can cause chronic gastritis that may lead to peptic ulcer disease)

3 irritants that cause gastritis

162

Two muscular layers of the pylorus become hyperplastic and hypertrophic
Causes are thought to be a combination of environmental and hereditary factors
Demonstrates as: lengthening of the gastric antrum and pyloric canal or edematous and thickened mucosa
Causes obstruction (incomplete or complete), preventing food from entering into the duodenum.
Can be palpated and is often described as a mobile, hard "olive"

Pyloric stenosis
Infantile hypertrophic pyloric stenosis (IHPS)

163

A group of inflammatory processes involving the stomach and duodenum caused by the action of acid and the enzyme pepsin secreted by the stomach
Most common location is the lesser curvature
Disease spectrum varies from small and shallow superficial erosions to huge ulcers that may perforate
Most common cause of acute upper gastrointestinal bleeding
Duodenal is the most common manifestation
Majority occur in the duodenal bulb

Peptic ulcer disease

164

3 major complications of peptic ulcer disease

Hemorrhage (20%)
Gastric outlet obstruction (5-10%)
Perforation (<5%)

165

Rare in the United States; prevalent in Japan, Chile, and parts of Eastern Europe
Pain is not an early symptom, so diagnosis usually occurs late stage and prognosis is poor
Predisposing risk factors: atrophic gastric mucosa, as in pernicious anemia or 10 to 20 years after a partial gastrectomy for peptic ulcer disease

Cancer of the stomach

166

Malignancy of the lymphoreticular system
Gastric lymphoma often is seen as a large, bulky polypoid mass, usually irregular and ulcerated
It may be indistinguishable from a carcinoma

Lymphoma of the stomach

167

The lack of the development of the esophageal lumen resulting in a blind pouch

Esophageal atresia

168

An idiopathic, chronic, inflammatory disorder
Most often involves the terminal area of the ileum but can affect any part of the GI tract
Most common in young adults
Cause is unknown, but stress or emotional upsets are frequently related to the onset or relapse of the disease

Crohn’s disease

169

Most often caused by fibrous adhesions from previous surgery (75%)
Second most common cause is hernias
Other causes: luminal occlusion (gallstone, intussusception) or intrinsic lesions (neoplastic or inflammatory strictures, vascular insufficiency)

Small bowel obstruction

170

Occurs more often than mechanical bowel obstruction
A common disorder of intestinal motor activity
Fluid and gas do not progress normally through a nonobstructed small and large bowel
Neural, hormonal, and metabolic factors can trigger reflexes that impede intestinal motility
It occurs in almost every patient who undergoes abdominal surgery
Other causes: peritonitis, medications that decrease intestinal peristalsis (those with an atropine-like effect), electrolyte and metabolic disorders, or trauma

Adynamic ileus/paralytic ileus

171

The telescoping of one part of the intestinal tract into another because of peristalsis
It forces the proximal segment of bowel to move distally within the outer portion
A major cause of obstruction in children

Intussusception

172

This refers to a multitude of conditions in which there is defective absorption of carbohydrates, proteins, and fats from the small bowel that results in steatorrhea

Malabsorption disorders

173

The passage of bulky, foul-smelling, high-fat-content stools that float

Steatorrhea

174

The inflammation of the appendix
Causes: obstruction of fluid flow by fecalith or scarring
Complications: gangrene, abscess, or perforation
More common in children
Develops when the neck of the appendix becomes blocked

Appendicitis

175

Outpouchings that are acquired herniations of mucosa and submucosa through the muscular layers at points of weakness in the bowel wall
Incidence increases with age, can be demonstrated in half of persons older than 60
Occurs most commonly in the sigmoid portion
Can be cancerous

Diverticulosis

176

A complication of diverticulosis defined as necrosing inflammation in the diverticula
Complications: perforation, abscess, or fistulas to adjacent organs
Estimated 20% of patients with diverticulosis develop this

Diverticulitis

177

An idiopathic inflammatory disease of the bowel
May have an autoimmune or psychogenic factor (stress exacerbates condition)
A characteristic feature is alternating periods of remission and relapse
Increased risk of malignancy associated

Ulcerative colitis

178

The second major cause of inflammatory bowel disease
Identical to Crohn’s disease in the small bowel
Must be differentiated from ulcerative colitis
Most commonly affects the proximal colon
Most also have disease of the terminal ileum
Rarely affects the rectum

Crohn’s colitis

179

Characterized by the abrupt onset of lower abdominal pain and rectal bleeding
Diarrhea is common
Often accompanied by abdominal tenderness
Most common in those over 50 years old
Most have a history of cardiovascular disease

Ischemic colitis

180

Refers to several conditions that have an alteration in intestinal motility as the underlying pathophysiologic abnormality
Most common symptoms are alternating periods of constipation and diarrhea

Irritable bowel syndrome

181

The third leading cause of cancer death in the United States even though is can be easily diagnosed
Peak age incidence is 50 to 70 years old
Twice as common in men.
Predisposing factors: long-term ulcerative colitis and familial polyposis

Cancer of the colon

182

About 70% result from primary colonic carcinoma
Diverticulitis and volvulus account for most other cases
It is usually less acute than small bowel obstructions
Symptoms develop more slowly
Fewer fluid and electrolyte disturbances are produced

Large bowel obstructions

183

A twisting of the bowel on itself that may cause obstruction

Volvulus

184

2 most common sites of volvulus

Cecum
Sigmoid (more commonly found in elderly, results from a low-fiber diet causing constipation)

185

Varicose veins of the distal rectum
Symptoms include pain, itching, and bleeding
Caused by increased venous pressure, such as with: constipation, pelvic tumor, or pregnancy

Hemorrhoids

186

2 major types of gallstones

Cholesterol (predominant type in the United States)
Pigment

187

Predispositions: family history, over age 40, overweight, female
Ultrasound is the imaging modality of choice to diagnosis
Oral cholecystography (OCG) was the traditional technique for diagnosis

Gallstones (cholelithiasis)

188

Acute inflammation of the gallbladder usually caused by cystic duct obstruction by a gallstone

Acute cholecystitis

189

Rare condition that occurs when stasis, ischemia, and cystic duct obstruction (stones) allow the growth of gas-forming organisms in the gallbladder that occurs most commonly in elderly men and in patients with poorly controlled diabetes mellitus

Emphysematous cholecystitis

190

Calcification of the gallbladder walls caused by chronic cholecystitis
Walls become fibrous, then calcified

Porcelain gallbladder

191

Most prevalent inflammatory disease of the liver

Hepatitis

192

Transmitted in the digestive tract from oral or fecal contact

Hepatitis A virus (HAV)

193

Contracted by exposure to contaminated blood or blood products and sexual contact
Healthcare workers are at risk of exposure
Vaccine is available and often required for employment

Hepatitis B virus (HBV)

194

The common cause of chronic hepatitis and cirrhosis
Contracted by blood transfusion or sexual contact

Hepatitis C virus (HCV)

195

Self-limited and acquired by the ingestion of food or water that has been contaminated by fecal matter

Hepatitis E virus (HEV)

196

The chronic destruction of liver cells and structure, with nodular regeneration of liver parenchyma and fibrosis
An end-stage liver disease
The major cause is chronic alcoholism (i.e., 10 to 20 years of alcohol abuse) in which damage to the liver is related either to the toxic effect of alcohol or to the malnutrition that frequently accompanies chronic alcoholism
Large amount of fat accumulates within the liver
Other causes: postnecrotic viral hepatitis, hepatotoxic drugs and chemicals, biliary cirrhosis, hemochromatosis
Most characteristic symptom: ascites
Incurable and irreversible

Cirrhosis

197

Fluid accumulation in the abdomen

Ascites

198

Primary liver cell cancer most common in those with cirrhosis or alcoholic
CT is modality of choice for diagnosis

Hepatocellular carcinoma

199

The most common malignancy of the liver
Diagnosed via: CT, US, MRI, or NM
Prognosis is very poor

Hepatic metastasis

200

Inflammatory process in which protein- and lipid-digesting enzymes become activated within the pancreas and begin to digest the organ itself
Most common cause: excessive alcohol consumption
Other causes: gallstones obstructing bile flow
US and CT

Acute pancreatitis

201

Results when frequent injury to the pancreas causes scar tissue
Recurring episodes usually result from chronic alcohol abuse
Causes the gland to lose its ability to produce digestive enzymes, insulin, and glucagon
Three symptoms: pain, malabsorption causing weight loss, and diabetes
Imaging appearance: pancreatic calcifications

Chronic pancreatitis

202

Walled-off fluid collections that occur due to inflammation, necrosis, or hemorrhage
Causes: acute pancreatitis or trauma
X-ray, CT, US

Pancreatic pseudocyst

203

Most common type of cancer of the pancreas
Usually advanced at time of diagnosis and prognosis is poor

Adenocarcinoma

204

Where is the most common site of cancer of the pancreas?

Head of the pancreas

205

3 other less common pancreatic tumors

Insulinoma
Gastrinoma
Diarrheogenic islet cell tumors

206

Pneumoperitoneum is defined as free air in the peritoneal cavity
Causes: perforation of a gas-containing viscus (surgical emergency), abdominal, gynecologic, intrathoracic, or iatrogenic causes (does not require operative intervention)
Imaging appearance: gas accumulates beneath the domes of the diaphragm

Pneumoperitoneum

207

Enlargement of the spleen associated with numerous conditions, including: infections (subacute bacterial endocarditis, tuberculosis, infectious mononucleosis, malaria), connective tissue disorders, neoplastic hematologic disorders (lymphoma, leukemia), hemolytic anemia, hemoglobinopathies, or portal hypertension (cirrhosis)

Splenomegaly

208

Most common cause is trauma
Rapid blood loss usually requires immediate surgery
May be a complication of the palpation of a spleen enlarged by infection (especially infectious mononucleosis) or leukemia

Splenic rupture