GI Radiology

Question 1

Pathogenesis of GERD: What increases the frequency of GER? (2)

Answer 1

Decreased LES tone

Multiple transient LES relaxations

Question 2

What are the two main factors in pathogenesis of GERD?

Answer 2

Increased frequency of GER
Increased duration of GER
Increased acidity of refluxate
Resistance of mucosa

Question 3

What can increase the duration of GER?

Answer 3

Abnormal motility (i.e from scleroderma)

Question 4

What can increase the acidity of refluxate?

Answer 4

ZES (increased acid)
Billroth II (bile)

Question 5

What increases the resistance of mucosa?

Answer 5

Age

Debilitation

Question 6

What are the clinical findings of GERD? (4)

Answer 6

Heartburn/regurg
Epigastric/RUQ pain
Upper GI bleeding
Dysphagia

Question 7

How do esophageal ulcers from GERD present on imaging?

Answer 7

Tiny stellate/punctate lit up areas

Question 8

What are two the most common causes of infectious esophagitis?

Answer 8

1st: Candida
2nd: Herpes

Question 9

What are symptoms of candida esophagitis? What is the treatment of choice?

Answer 9

Dysphagia or odynophagia

Treat with fluconazole (an antifungal)

Question 10

How does esophageal candidiasis present on contrast imaging?

Answer 10

Multiple plaque-like lesions

If severe, fulminate “shaggy” looking

Question 11

How does herpes esophagitis present? What’s the recommended treatment?

Answer 11

Dysphagia or odynophagia

Treat with acyclovir

Question 12

How does herpes esophagitis present on imaging?

Answer 12

Multiple tiny punctate ulcers filled with barium

Question 13

How does CMV esophagitis present on imaging? How do you treat it?

Answer 13

Giant barium ulcers with thin adenomatous ring

Gancyclovir

Question 14

Should follow up be done with suspected CMV esophagitis?

Answer 14

Yes, do endoscopy– treatment is toxic to BM, and esophagitis can be caused by HIV

Question 15

How does HIV esophagitis present?

What is recommended treatment?

Answer 15

Odynophagia, giant ulcers with presence of palatal ulcers, maculopapular rash

Treat with steroids

Question 16

What drugs are associated with contact esophagitis?

Answer 16

Oral meds such as tetracycline/doxycyclince, NSIADs, KCl, Fosomax

Question 17

What is the clinical presentation of drug-induced esophagitis? How does it appear on contrast imaging?

Answer 17

Presents as severe odynophagia with rapid clinical improvement

Appears as discrete superficial ulcers at level of aortic arch or left main bronchus

Question 18

Eosinophilic esophagitis: What is epidemiology?

Answer 18

young men with history of allergies/asthma

Question 19

How does eosinophilic esophagitis present?

Answer 19

Young man with longstanding dysphagia and food impactions-- can have esophageal stricture, ringed esophagus or small caliber esophagus
Peripheral eosinophilia (differentiates it from GERD)

Question 20

How do you treat idiopathic eosinophilic esophagitis?

Answer 20

Inhaled steroids

Question 21

Squamous Cell Carcinoma of esophagus: Where does it present and what is prognosis

Answer 21

Accounts for 50% of esophageal cancers

Usually in upper or mid esophagus and has dismal prognosis

Question 22

Adenocarcinoma of esophageal cancer: Pathogenesis

Answer 22

Arises in Barrett’s esophagus, often in distal esophagus

Usually invades stomach

Question 23

Where do most gastric ulcers arise?

How many are benign

Answer 23

Gastric ulcers are usually located in the antrum or fundus

95% are benign ulcers, but they must be differentiated from cancer

Question 24

How do benign gastric ulcers appear on barium contrast imaging?

Answer 24

Ovoid or button

Question 25

How do malignant gastric ulcers appear on imaging?

Answer 25

Irregular crater in tumor mass Nodularity/clubbing Projects inside lumen

Question 26

Which gastric ulcers require endoscopy follow up? What do you do for the ones that don't require endoscopy?

Answer 26

Only malignant or equivocal appearing ulcers require endoscopy. For benign ulcers, repeat Ba study in 8 weeks

Question 27

What are causes of erosive gastritis? (6)

Answer 27

``` Peptic ulcer disease Alcohol Trauma Stress Crohn's disease NSAIDs ```

Question 28

Where do most NSAID-related ulcers appear?

Answer 28

The greater curvature of the stomach (due to effect of gravity)

Question 29

How do most duodenal ulcers present? | Location, symptoms, benign/malignant

Answer 29

Most occur in the bulb Present with pain or upper GI bleeding Deodenal ulcers are always benign-- no need for endoscopy

Question 30

How do duodenal ulcers appear on imaging?

Answer 30

Ovoid barium dots on duodenum

Question 31

How many ulcers are associated with H Pylori infection? Answer for both gastric and duodenal ulcers

Answer 31

80% gastric ulcers | 95-99% duodenal ulcers