Week 9: Gastrointestinal Pathologies Part 1

Question 1

Tracheoesophageal Fistula

Answer 1

• congenital or acquired communication between the trachea and esophagus
• can be acquired from malignancy, infection, trauma
• often lead to severe and fatal pulmonary complications (aspiration pneumonia)

Question 2

Esophageal Atresia

Answer 2

• failure of the esophagus to develop as a continuous passage, ending in blind pouch
• often accompanied but a tracheoesophageal fistula
• immediate surgery requires to repair esophagus and prevent starvation

Question 2

Gastroesophageal Reflux Disease (GERD)

Answer 2

• broad term for any type of reflux of the stomach contents (stomach acid) into the esophagus
• often seen with hiatal hernia
• develops when the lower esophageal sphincter doesn’t not work properly

Question 3

Dysphagia

Answer 3

• difficulty swallowing
• usually due to malignancy in esophagus
• radiographic appearance: structure abnormalities, masses, barium not getting swallowed as normal on barium swallow

Question 4

Esophageal Carcinoma

Answer 4

• most common site is the esophagogastric junction
• progressive difficulty swallowing (dysphagia)
• strongly correlated to alcohol and smoking

Question 5

Zenker’s/Zenker Diverticulum

Answer 5

• diverticulum: small, bulging pouches that can form in the lining of your digestive system
• zenker: pharynx-esophagal punch that can trap food and liquid
• posterior out pouching occurs because cricopharyngeal muscle (dividing throat from esophagus)does not work properly

Question 6

Esophageal Varices

Answer 6

• dilated veins in the walls of the esophagus most commonly due to portal hypertension
  -blood cannot use normal liver route, so rings other ways and increased blood flow through gastric and esophageal veins causes distention

Question 7

Esophageal Varices Radiographic Appearance

Answer 7

• double contrast barium swallow
• serpiginous (wavy border) thickening of folds which are seen as round or oval filling defects

Question 8

Hiatal Hernia

Answer 8

• most common pathology seen on GI exams
• acquired anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest/thoracic cavity
• can cause stomach acid in esophagus and related esophagitis, ulcers
• may be sliding (protrudes the returns to normal repeatedly)
• may be negligible and asymptomatic

Question 9

Diaphragmatic Hernia (Congenital)

Answer 9

• term applied to a variety of birth defects that involve abnormal development of the diaphragm
• malformation of the diaphragm allows the abdominal contents to protrude into the chest impeding proper lung development
• radiographic appearance: can see some abdominal contents above the diaphragm (in thoracic cavity)

Question 9

Diaphragmatic Hernia (Acquired)

Answer 9

• in adults mostly associated with trauma
• abdominal organs can prolapse into the thoracic cavity
• radiographic appearance: can see some abdominal contents above the diaphragm (in thoracic cavity)

Question 10

Achalasia

Answer 10

• functional obstruction of the distal section of the esophagus
• proximal dilation caused by incomplete relaxation of the lower esophageal sphincter
• radiographic appearance: barium study demonstration progressively dilated esophagus with narrowing at distal end

Question 11

Foreign Bodies

Answer 11

• FB: aspirated, ingested or penetrated
• In GI area = ingested (or penetrated)
• Some radiopaque, some radiolucent
• If ingested, FB may be anywhere along GI tract, or ends up in nasopharynx
• Image from top of nasopharynx to anus in young children to include all GI tract (and chest)
• May be done all in one image
• Radiographic appearance: if radiopaque, can see item, if radiolucent, may have secondary signs (e.g., obstruction – filling defect on barium exam)

Question 12

Perforation of Esophagus

Answer 12

• due to severe vomiting (most common cause), coughing, or sue to underlying conditions such as esophagitis, peptic ulcer, neoplasm, trauma, instrumentation
• CT imaging preferred

Question 13

Situs Inversus

Answer 13

• body organs (stomach in this case) may be on opposite sides from normal
• normal variant
• radiographic appearance:
  organs, etc. will be seen on opposite side from normal
• mark images with left or right

Question 14

Pyloric Stenosis

Answer 14

• congenital abnormality
• infantile hypertrophic pyloric stenosis (IHPS)
• occurs when two muscular layers of the pylorus become hyperplasticity and hypertrophic
• thickened pyloric sphincter
• projectile vomiting, food in unable to enter the duodenum
• confirmed with ultrasound or S&D exam (stomach and duodenum)

Question 15

Peptic Ulcer Disease

Answer 15

• a group of inflammatory processes involving stomach and duodenum
• peptic: pertains to digestion and acid
• most common cause of acute upper GI bleeding
• gastric ulcer and/or duodenal ulcer
• due to stomach acid and pepsin enzyme eroding lining of stomach or duodenum
• may be small shallow versions or large ulcers that can perforate wall, causing pneumoperitoneum with peritonitis
• ulcers causes GI bleed
• ulcers can cause gastric outlet obstruction

Question 16

Duodenal Ulcers

Answer 16

• most common manifestation of peptic ulcer disease
• most are in duodenal bulb
• seen on radiographic image as a collection of contrast medium in a crater projecting outwards from the duodenal lumen with lucent mucosal folds leading to it
• thickened mucosal folds and bulb deformity

Question 17

Gastric Ulcers

Answer 17

• 5% are malignant
• usually occur in lesser curvature
• seen on radiographic image as a collection of contrast medium protruding outside the stomach lumen
• gastric erosions are very small ulcers that show only as dots of barium surrounded by a halo

Question 18

Carcinoma of the Stomach

Answer 18

• stomach cancer/gastric cancer
• most are adenocarcinomas (start in mucosa, innermost stomach layer)
• can start any site in stomach, sally gastroesophageal junction
• as with other cancer, can metastasize