Imaging-GI

Question 1

What is the landmark that divides the oropharynx from the hypo pharynx?

Answer 1

Hyoid bone.

Question 2

What pharyngeal muscle is found near the epiglottis?

Answer 2

Middle constrictor.

Question 3

What structures are indicated in the image?

Answer 3

To = base of tongue, E= epiglottis, V= volleculae, A= aryepiglottic folds, P= pyriform recesses. H= hypopharynx, L = larynx, HB = hyoid bone

Question 4

What causes barium to stop on the left side of the image?

Answer 4

Epiglottis

Question 5

What is your diagnosis in this patient who presented with heart burn?

Answer 5

Sliding hiatal hernia. Note that the mucosal ring is > 2 cm superior to the diaphragm.

Question 6

Where will you see thickening of gastric rugae?

Answer 6

In the antrum of the stomach.

Question 7

4 parts of the duodenum, which parts are retroperitoneal?

Answer 7

1) Bulb 2) Descending 3) Horizontal 4) ascending. Parts 3 and 4 are retroperitoneal.

Question 8

What is your diagnosis?

Answer 8

Note the large thickened areas at the base of the tongue, indicating lymphoid hyperplasia.

Question 9

What is your diagnosis?

Answer 9

Lateral pharyngeal pouches from weakening in the mucosa. These can eventually become diverticula and present with halitosis.

Question 10

What is your diagnosis?

Answer 10

There is a mass blocking flow of the barium during the swallow indicating a filling defect. This is a large squamous cell carcinoma.

Question 11

What could be causing the asymmetry seen on the right side of the image shown below?

Answer 11

It is a slight filling defect, it could be an early carcinoma.

Question 12

What could be causing the sign shown below?

Answer 12

An advanced carcinoma. Note the multiple filling defects with ulcerations.

Question 13

What causes this?

Answer 13

Weakness of muscular layer (cricopharyngeaus) in the esophagus that allows mucosa to protrude through and form a Zenker Diverticulum.

Question 14

What type of diverticulum originates inferior to the cricopharyngeus?

Answer 14

Killian-Jaimeson Diverticulum

Question 15

What causes this type of diverticulum?

Answer 15

Granulomatous disease or radiation of the chest cause a diverticulum of all layers of the wall (traction diverticulum). These will still clear food.

Question 16

What is your diagnosis of this image of the esophagus?

Answer 16

Epiphrenic diverticulum. These are often associated with reflux and are located near the GE junction.

Question 17

What could cause this?

Answer 17

Pseudodiverticulosis. This is a result of chronic inflammation or irritation of the submucosal glands that causes tiny outpouchings.

Question 18

What causes a shaggy esophagus?

Answer 18

HIV patients with oral thrush and candidiasis cause these pseudodiverticula.

Question 19

What is your diagnosis?

Answer 19

Schatzki ring. Normally you give a 13mm ring and if that cannot pass they need to be dilated.

Question 20

What is your diagnosis?

Answer 20

Reflux esophagitis. Note the multiple tiny ulcerations.

Question 21

What are these all signs of?

Answer 21

Fixed transverse folds, feline esophagus and tertiary waves are all associated with reflux esophagitis or eosinophilic esophagitis.

Question 22

Why do you keep an eye on this condition?

Answer 22

This is Barrett esophagus. It is precancerous.

Question 23

What is your diagnosis in this patient with liver disease?

Answer 23

Uphill varices. Note the serpigineous nodularity in the distal esophagus. This is a result of portal hypertension

Question 24

What is your diagnosis in this patient who presented with no history of liver disease or alcohol abuse?

Answer 24

Varicoid carcinoma. These look like varices, but aren’t.

Question 25

What is your diagnosis?

Answer 25

Note the mid-esophageal filling defects. This is a downhill varices case due to superior vena cava syndrome from tumor compression.

Question 26

What is your diagnosis?

Answer 26

Note the bird-beak opening indicative of achalasia. This can be idiopathic, from chagas or from obstruction by a tumor.

Question 27

Which of the stomach ulcers shown below are malignant?

Answer 27

The bottom one. Note that it is irregular with haphazard borders

Question 28

What is indicated by diffuse rugal fold thickening?

Answer 28

Gastritis, most commonly caused by H. pylori. (note antrum and pyloric thickening below)

Question 29

What is your diagnosis in this patient?

Answer 29

Menetrier disease. Note the hyper enhancing rugal folds along the greater curvature.

Question 30

What is your diagnosis?

Answer 30

Gastric bezoar, these are undigested material that accumulates in the stomach.

Question 31

What is your diagnosis?

Answer 31

Note the featureless folds beyond the lumenal mucosa. This is a peptic ulcer.

Question 32

What is your diagnosis in this patient?

Answer 32

Note the Ram’s horn near the antrum indicative of Crohn’s disease.

Question 33

What are you thinking outside of ulcerations if you see marked thickening of the gastric wall?

Answer 33

Gastric cancer.

Question 34

What is the only gastric tumor that grows exophytically (out and away from the lumen)?

Answer 34

GIST (gastrointestinal stromal tumor)

Question 35

What cancers like to metastasize to the stomach?

Answer 35

Melanoma, breast cancer or lung. They will present with a submucosal mass with central ulceration.

Question 36

Volvulus associated with hiatal hernia

Answer 36

Organoaxial volvulus

Question 37

Diagnosis?

Answer 37

Adenocarcinoma is the most common type of cancer seen in the duodenum.

Question 38

What is your diagnosis?

Answer 38

Note multiple filling defects along the bulb of the duodenum. This is a normal response to peptic ulcer disease, Brunner Gland hyperplasia

Question 39

What are complications of this condition?

Answer 39

Perforations, stones, infections all can happen in duodenal diverticula.

Question 40

What infection could cause this condition?

Answer 40

Giardiasis or strongyloidiasis., note the haphazard, thickened mucosal folds.