GI Pathologies Flashcards
(22 cards)
Esophageal Atresia and Tracheoesophageal fistula (TE)
- Congenital or acquired
- In congenital cases, the esophagus has formed with two blind ends (atresias)
- With TE, there are abnormal passageways between the esophagus and trachea.
Symptoms:
- aspiration pneumonia, choking, cyanosis, cant swallow saliva
- may be associated with other congenital malformations
Indications:
- contrast eosophagram is contraindicated
- non-contrast CT is safest
- abdominal radiographs show presence or absence of air in stomach
Achalasia
-lower esophageal sphincter cannot relax due to compromised nerve control (STENOSIS)
Symptoms:
-sternal pain and dysphagia
Indications:
- dilated esophagus with absence of peristalsis leading to RAT-TAIL appearance of barium
- treated with dilatation, meds, botulinum toxin (botox) or myotomy
Foreign body
-Foreign objects lodged in cervical esophagus or anywhere in GI tract
Symptoms:
- pt cant swallow without regurgitation
- Obstructions lasting more than 12 hours may lead to perforation (hole)
Indications:
- objects are radio-opaque
- poorly chewed food can only be demonstrated with barium
Soft tissue neck routine:
- 15 AP axial
- Lateral (include nasal pharynx- light at bridge of nose, no eyes, pt gently breathes, light kVp)
GERD
- most common cause of esophagitis
- Gastroesophageal Reflux Disease (specifically referring to the distal esophagus sphincter not closing properly)
- Any disease that allows retrograde flow of stomach into the distal esophagus
- may be caused by chocolate, caffeine, alcohol, overeating
symptoms:
- heart burn, chest pain
- chronic cases: compromise peristalsis
- tumor in stomach could cause lack of room and acid could splash up
Indications:
- barium swallow
- treatment: lifestyle changes
Esophageal Carcinoma
- progressive difficulty in swallowing may indicate cancer
- symptoms appear late
- poor prognosis due to high chance of metastasis
- tumors usually originate at GE junction
Symptoms:
- caused by excessive ETOH intake and smoking
- requires palliative care
indications:
- clear visual difference between healthy tissue and cancerous tissue
- wall thickening > 3-5mm on a CT scan
- walls normally should be nice and smooth but becomes rough/ragged –> FILLING EFFECT
Sliding Hiatal Hernia
-some portion of the stomach and gastroesophageal juction moves into the chest temporarily when intra-abdominal pressure is increased
symptoms:
- relux or heart burn
indications:
- upper GI will demonstrate the position when pt is placed in trendelenburg position
Rolling Hiatal Hernia
or
Paraesophageal Hernia
- part or all of the stomach pushing up into the thoracic cavity through a defect in the diaphragm
- the gastro-esophageal sphincter stays below the diaphragm
symptoms:
- may cause volvulus, esophagitis, esophageal ulcers, but most are related to reflux
- most hernias are not clinically significant and produce no symptoms
indications:
- diagnosed with chest xray or upper GI
- laparoscopic surgery to push stomach back
- could live with it without knowing, but it could cut off blood supply (incarcerated stomach)
Hypertrophic Pyloric stenosis
- hyperplasia, hypertrophy, and elongation of the pylorus
- the edematous thickened tissue can be palpated as a mobile hard “olive”
symptoms:
- projectile vomitting
- most common in young boys
indications:
- shown in upper GI with thin barium STRING SIGN
- treated by surgery
Gastritis
- inflammation of the stomach
- most common cause pylori bacteria
- causes alcohol, corrosive agents
symptoms:
- errosions and peptic ulcers (secondary to gastritis)
indications:
- thickening of gastric folds (rugae)
- gas bubbles given off by the bacteria are visualized in stomach wall
Peptic Ulcer
- inflammatory processes in the stomach and duodenum secondary to gastritis
- gastric digestive enzyme pepsin and stomach acid wearing through the mucosal lining of the stomach
- usually in lesser curvature of stomach or duodenal bulb
- duodenal ulcers are most common (95%) and benign
- usually aggravated by NSAID’s and bacterium pylori
symptoms:
- hemorrhage, gastric outlet obstruction, perforation leading to pneumoperitoneum and peritonitis
- could have more than one in different locations
- ulcer into artery (coughing up blood)
indications:
- benign ulcers demonstrate as barium filled projections surrounded by smooth, slender, radiolucent folds of mucosal tissue
- malignant ulcers are surrounded by irregular folds
- treatments: lifestyle changes, low acid foods, stress reduction, antibiotics
Gastric CA
- tumor of the stomach
- > 5year survival rate
- usually in pyloric and antrum regions especially in lesser curvature
- treated with surgical gastrectomy
symptoms:
-symptoms rarely present before tumor is advanced so poor prognosis
indications:
- upper GI exam will demonstrate the stomach as a fibrotic tubular structure with fixed unpliable wall
- CT is used in staging (to show metastazizing)
- no motion of GI tract is not good
Crohn’s (Regional Enteritis)
- Chronic inflammation of all three layers of the bowel wall
- can affect entire GI tract but most often centers around terminal ileum
- cause is unknown and usually affects young adults
symptoms:
- palpable masses, pain and fever
- ulceration and fistulas are common (occur in at least 50% of patients)
- inflammation of the serosa and mesentery causes bowel loops to be matted together
indications:
- rigid thickening of ulcerated bowel wall causes COBBLESTONE appearance
- as disease continues bowel becomes narrow causing STRING SIGN
- treated with medication or surgery
rarely fatal, rarely cured
Small bowel obstruction
-bowel blockage due to a variety of conditions such as hernia, tumors, inflammation, most common is surgery
symptoms:
-strangulation of the bowel from hernia or volvulus
indications:
- 3-5 hours after, loops of bowel proximal to the blockage will become distended and show air fluid levels on an upright xray
- most of the gas is from swallowed air
- STEP LADDER appearance in proximal loops
- surgery required
Large bowel obstruction
- blockage in the large bowel most commonly caused by bowel cancer
- severity depends on how competent the ileocecal valve is
symptoms:
-perforation (most likely in the cecum)
indications:
- if the IC valve is competent the colon will be greatly distended and there will be little or no gas in the small bowel
- if the IC valve is not competent gas filled loops will be seen in the large and small bowels
Intussusception
- Acute telescoping of one part of intestinal tract into another because of peristalsis
- usually occurs near the ileocecal valve
- more common in children than adults
symptoms:
- abdominal pain, blood in stool, palpable mass in right side of abdomen
- if treated in 48 hours prognosis is good
- in adults this is chronic
indications:
- COILED SPRING appearance
- therapeutic enema can be used to reduce the bowel, but also surgery
Volvulus
- bowel blockage caused by a twisting of bowel around its mesentery
- most common in cecum and sigmoid colon
- rarely occurs in transverse colon because of its short mesentery
- most common in elderly
symptoms:
- >360 represents a surgical emergency as necrosis or perforation of bowel is life threatening
indications:
-surgery is required
Adynamic Illeus
- compromised motility in the small and large bowels due to neural, hormonal, metabolic or physical causes
- almost always occurs after abdominal surgery
symptoms:
- may occur in a localized bowel that is adjacent to inflamed tissue
indications:
- air fluid levels in both the small and large bowel with no obvious point of obstruction indicated
- if caused by surgery it should be resolved in 36-48 hours
- NG tube can be used
Diverticulosis
- colonic outpouchings caused by herniations of mucosa and submucosa through the muscularis at points of weakness in the bowel wall
- occurs in older individuals with low fiber diet
- most common in sigmoid colon
- Diverticulitis is a necrosing inflammation of the diverticula caused by trapped fecal material
symptoms:
- often none but may have chronic lower abdominal pain around meals
- peridiverticular abscesses can be walled off by fibrous adhesions
indications:
- barium filled diverticuli visible ranging from 2-25cm
- noninvasive: no seeds or nuts, popcorn, and exercise to increase peristalsis and antibiotics
- surgery
Diverticulitis
-a necrosing inflammation of the diverticula caused by abscessing of trapped fecal material
symptoms:
- peridiverticular abscesses can be walled off by fibrous adhesions
- may lead to inflammation of colon wall, fistulas, or narrowing of lumen
indications:
- noninvasive: no seeds or nuts, popcorn, and exercise to increase peristalsis and antibiotics
- surgery
Ulcerative colitis
- having this increases chance of bowel cancer x10
- inflammatory lesions that ONLY involves the mucosal layer of the colon
- unknown etiology
- arises in rectosigmoid colon
- seen in young caucasian adults
symptoms:
- bloody diarrhea, abdominal pain, fever, weight loss, toxic megacolon
- mucosal edema can lead to loss of haustration
indications:
- barium enema contraindicated during attack of toxic megacolon
- mucosa appears granular, stippled, COLLAR BUTTONED in contrast studies
- LEAD PIPE because of loss of haustration
- diet changes, anti-inflammatories, stress control, surgical resection
Colonic Polyp
- abnormal neoplasm projecting from a mucous membrane
- initially benign but may become malignant
- may be pedunculated (has a stalk) or sessile (no stalk)
- most commonly found in left colon and rectosigmoid
- > 2cm has >50% chance of becoming malignant
symptoms:
- usually asymptomatic
- rectal bleeding and pain, diarrhea or constipation
indications:
- removed during colonoscopy
- double contrast barium enema will show filling defects
Colon Cancer
- bowel cancer in the colon and rectum
- 50 to 70 yrs old
- most cancers arise from pre-existing polyps especially those greater than 2cm
- predispositions: family history (mom & dad), slow to metastasize so prognosis good
symptoms:
- vague or absent
- obstruction or bleeding
- may spread to lymph, liver, lungs
indications:
- APPLE CORE sign
- surgery, chemo, radiotherapy
