pathology of digestive system

Question 1

Salivary gland calculi

Answer 1

Describes the formation of calculi inside the salivary glands, most commonly the submandibular ducts and glands
causes - may be no known cause, but dehydration, smoking and some autoimmune diseases are linked
symptoms - history of recurrent swelling and pain in the involved gland usually associated with eating and may also be infection

Question 2

salivary gland calculi diagnosis and treatment

Answer 2

diagnosis = plain film, sialography, CT and MRI
complications = infection and pain
treatment = hydrationnand heat may need surgical removal

Question 3

GORD

Answer 3

description = Reflux of gastric acid from the stomach into the lower oesophagus across the oesophageal sphincter
causes = hiatus hernia, smoking, alcohol, pregnancy, certain medications, certain asthma meds etc
symptoms = epigastric and retrosternal burning, acidic taste in mouth and chronic dry cough

Question 4

diagnosis and treatment of GORD

Answer 4

diagnosis = barium swallow - will see reflux
complications = exposure of the oesophagus to acid causes inflammation that leads to Barretts oesophagus and then can result in cancer
treatment = drugs to inhibit gastric acid peoduction and surgery for severe cases

Question 5

Barretts oesophagus

Answer 5

description = a change in the type of cells in the oesophagus (squamous epithelium to columnar epithelium)
causes = seen more in patients with oesophagtis, risk factors include being male and smoking
symptoms = asymptomatic and seen incidently when patients present with GORD

Question 6

diagnosis and treatment of barretts oesophagus

Answer 6

diagnosis = endoscopy, may not be seen on imaging util it is advanced, barium swallow
treatment = patients will be monitored with endoscopy every 3,6 or 12 depending on severity

Question 7

Oesophageal cancer

Answer 7

causes = alcohol and smoking, barrett oesaphagus, coeliac disease, radiation and HIV
symptoms = dysphagia, weight loss, reflux, hoarseness and cough

Question 8

diagnosis and treatment of oesaphageal cancer

Answer 8

diagnosis = cxr, barium swallow, us, ct and pet ct
treatment = surgery - oesophagectomy

Question 9

Gastric adenocarcinoma

Answer 9

description = Is a primary malignancy arising from the gastric epithelium. Most common gastric malignancy
causes = rare before 40, causes non specific anaemia, gastritis, smoking, reflux
symptoms = often non specific, weight loss and vague pain, nausea and vomitting in late stage

Question 10

Gastric adenocarcinoma diagnosis and treatment

Answer 10

diagnosis = endoscopy is the gold standard
CT - can assess the tumour and look for local and distant spread
treatment = surgery, chemotherapy and radiotherapy

Question 11

small bowel obstruction

Answer 11

Description
•Is a mechanical blockage of the transit of food through the small bowel.
•Can be complete or incomplete (high grade or partial)

Question 12

causes and symptoms of small bowel obstruction

Answer 12

causes = adhesions, inflammatory bowel disease, cancer, hernias, foreign body
symptoms = depends on many factors but pain, no/few bowel movement and vomitting

Question 13

diagnosis and treatment of small bowel obstruction

Answer 13

CT, oral contrast and MRI
treatment = non operative - bowel rest and NG tube, IV nutrition
operative - bowel resection

Question 14

Small bowel follow through / Gastrografin

Answer 14

Often performed on inpatients with a suspected SBO
Are diagnostic and therapeutic
Patient drinks 100mls of water-soluble contrast orally or down the NG tube
AXR performed 6-12 hours later to see if the contrast has reached the large bowel.
If not contrast at 24 hours – indication for surge

Question 15

large bowel obstruction

Answer 15

Description
• Less common than small bowel. Mechanical blockage again

Question 16

large bowel obstruction causes and symptoms

Answer 16

Causes
• Most common cause is colonic cancer, then diverticulitis, volvulus, hernias, faecal / foreign
body impaction
Symptoms
• Again, can be complete or incomplete / partial. Same symptoms

Question 17

diagnosis and treatment of large bowel obstruction

Answer 17

AXR and CT
treatemt depends on cause, surgery, colonic stent

Question 18

volvulus

Answer 18

Description
•There is torsion of the bowel around its mesentery. This results in narrowing of the lumen at the point of rotation and compromise of the blood vessels that supply the bowel / stomach at that poin

Question 19

causes and symptoms volvulus

Answer 19

causes = some medications for psychiatric conditions and neurological conditions like MS and parkisons, chronic constipation
symptoms = same as an onstruction. in the stomach - sudden epigastric pain, retching but no vomitting,

Question 20

diagnosis and treatment of volvulus

Answer 20

gastric - AXR, CT
treatment = flatus tube at endoscopy, surgery if this does not work

Question 21

Ulcerative colitis

Answer 21

Description
• Type of inflammatory bowel disease that primarily affects the large bowel

Question 22

Ulcerative colitis causes and symptoms

Answer 22

causes = no known cause may be associated with stress poor immune system family history other environmental and genetic factors
symtpoms = chronic diarrhoea, pain fever

Question 23

Ulcerative colitis diagnosis and treatment

Answer 23

diagnosis = axr, CT, MRI
treatment = drugs
may require surgery

Question 24

Crohn’s disease

Answer 24

Description
•Inflammatory bowel disease that can affect anywhere in the GI tract. However, terminal ileum and proximal colon are most commonly affected

Question 25

causes and symptoms of crohns disease

Answer 25

causes =no known cause. May be associated with stress, poor immune system, family history, other environmental and genetic factors symptoms = depend on location but pain fever blood diarrhoea

Question 26

diagnosis and treatment of crohns disease

Answer 26

endoscopy, axr, ct and mei, us useful for looking at treatment response treatment = corticosteroids, immunosuppression, surgery in severe cases

Question 27

coeliac disease

Answer 27

Description • Gluten intolerance characterised by loss of villi in the proximal small bowel and GI malabsorption • Is a chronic autoimmune disease

Question 28

coeliac disease causes and symptoms

Answer 28

causes = less common in Asian and black population. Associated with inflammatory bowel disease Symptoms = Iron deficiency anaemia, abnormal bowel habit, malabsorption, weight loss

Question 29

diagnosis and treatment of coeliac disease

Answer 29

diagnosis = ct/mri enterography treatment = gluten free diet

Question 30

acute appendicitis

Answer 30

Acute inflammation of the appendix

Question 31

causes and symptoms of acute appendicitis

Answer 31

causes = Blockage of the opening of the appendix, family history, viral infections Symptoms = Pain in the periumbilical area (T10) which moves to the right iliac fossa. Vomiting, raised inflammatory markers

Question 32

diagnosis and treatment of acute appendicitis

Answer 32

diagnosis = axr, us , ct , mri treatmet = appendicectomy

Question 33

toxic megacolon

Answer 33

Acute complication of IBD, and other forms of colitis. The colon loses its tone which results in severe dilatation and high risk of perforation

Question 34

causes and symptoms of toxic megacolon

Answer 34

causes = UC is the most common cause. symptoms = Pain, no bowel movement. If perforated there may be signs of peritonitis

Question 35

diagnosis and treatment of roxic megacolon

Answer 35

AXR – distended transverse colon, may see it increasing over time. Signs of perforation. •CT – loss of haustral markings, distension and signs of ulceration •DO NOT DO colonoscopy due to risk of perforation treatment = may need bowel rest and surgery if it does not resolve

Question 36

Colorectal cancer

Answer 36

Cancer of the colon and rectum. 3rd most common cancer worldwide. 98% are adenocarcinomas from preexisting polyps

Question 37

causes and symtpoms of colorectal cancer

Answer 37

causes = Lifestyle factors, mainly individuals over 50 Symptoms • Anaemia, rectal bleeding, change in bowel habit, pain, signs of obstruction

Question 38

diagnosis and treatment of colorectal cancer

Answer 38

• Most common in the rectum and sigmoid. • CTC for diagnosis • CT for staging • MRI is the best imaging for the rectum treatment = surgery chemo radiotherapy

Question 39

Diverticular disease

Answer 39

General term for any pathology involving diverticula. Can be diverticulosis, diverticulitis as well

Question 40

causes and symptoms of diverticular disease

Answer 40

causes = A diverticulum is a small outpouching of the GI tract between the haustra. most common in signoid. lack of fibre in diet, increasing age, use of laxatives are all causes. symptoms = Often asymptomatic. But in acute setting there will be pain, blood stools, vomiting, signs of obstruction

Question 41

diagnosis and treatment of diverticular disease

Answer 41

often seen incidentally at CTC / CT scans. If acute, CT will show mucosal thickening and signs of perforation treatment = bowel rest and diet change if severe surgery is often used

Question 42

gallstones

Answer 42

Description • Also called cholelithiasis. Is stone formation at any point along the biliary tree

Question 43

causes and symptoms of gallstones

Answer 43

causes = Female, middle age, obesity, family history, recent rapid weight loss Symptoms = Only symptomatic in approx. 25% of cases. Pain – RUQ, nausea, bloating, right scapula tip pain

Question 44

diagnosis and treatment of gallstones

Answer 44

axr, ct, us treatment = Laparoscopic cholecystectomy

Question 45

Pancreatic calcifications

Answer 45

Description Calcifications within the pancreas Causes • Mainly due to chronic pancreatitis Symptoms • Asymptomatic but the cause of them may be causing symptoms Diagnosis • Generally seen incidentally on CT and AXR

Question 46

Pancreatic cancer

Answer 46

There are many different cancers of the pancreas because of its endocrine and exocrine functions. 99% are exocrine in origin

Question 47

causes and symptoms of pancreatic cancer

Answer 47

Causes • Smoking, chronic pancreatitis, obesity, diabetes, family history Symptoms • Pain, new onset diabetes

Question 48

diagnosis and treatment of pancreatic cancer

Answer 48

ct and mri treatment = surgery if possible

Question 49

Liver cancer – hepatocellular carcinoma

Answer 49

80-90% of liver cancers. Most common primary cancer of the liver

Question 50

causes ans symptoms of liver cancer

Answer 50

Causes • Strongly associated with cirrhosis from alcohol and viral causes such as hepatitis B and C Symptoms • Jaundice, hepatomegaly, pain

Question 51

diagnosis ans treatment of liver cancer

Answer 51

us, ct, pet ct treatment = liver transplantation, resection, chemo, radiotherapy

Question 52

liver cysts

Answer 52

• Simple hepatic cysts are common benign lesions with no malignant potential. • Nearly always seen incidentally. • Can be isolated or multiple • On imaging they are typically round or ovoid in shape with well defined margins