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Questions and Answers
What characterizes a duplication cyst?
What characterizes a duplication cyst?
In which area of the GI tract are duplication cysts most commonly found?
In which area of the GI tract are duplication cysts most commonly found?
What is a common symptom associated with a gastric bezoar?
What is a common symptom associated with a gastric bezoar?
Which type of bezoar is associated with hair ingestion?
Which type of bezoar is associated with hair ingestion?
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What type of imaging is preferred for diagnosing a gastric bezoar?
What type of imaging is preferred for diagnosing a gastric bezoar?
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What is the most common type of benign tumor in the stomach?
What is the most common type of benign tumor in the stomach?
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Gastric polyps tend to be asymptomatic when they are:
Gastric polyps tend to be asymptomatic when they are:
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What distinguishing feature does an ultrasound reveal about duplication cysts?
What distinguishing feature does an ultrasound reveal about duplication cysts?
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What is the minimum size of an appendix that suggests appendicitis?
What is the minimum size of an appendix that suggests appendicitis?
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Which imaging method is primarily used to evaluate suspected appendicitis in children?
Which imaging method is primarily used to evaluate suspected appendicitis in children?
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What condition is characterized by fluid-filled collections that may lead to abscess formation?
What condition is characterized by fluid-filled collections that may lead to abscess formation?
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Which demographic is at high risk for misdiagnosis during the initial physical examination for appendicitis?
Which demographic is at high risk for misdiagnosis during the initial physical examination for appendicitis?
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What is typically seen in the imaging of a dilated fluid-filled appendix?
What is typically seen in the imaging of a dilated fluid-filled appendix?
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Which of the following suggests extras of inflammation around the appendix?
Which of the following suggests extras of inflammation around the appendix?
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Which imaging technique helps demonstrate compressibility of the appendix?
Which imaging technique helps demonstrate compressibility of the appendix?
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What does peripheral hyperemia of the wall in appendicitis indicate?
What does peripheral hyperemia of the wall in appendicitis indicate?
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Study Notes
GI Tract Pathology - DMS 152
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Duplication Cyst
- Embryologic mistakes
- Can be seen in stomach or bowels
- Asymptomatic or symptomatic, depending on size and location
- Criteria: lined with epithelium, well-developed muscular wall, contiguous with stomach/bowel
- Often found on the greater curvature of the stomach; can originate from the pancreas or duodenum
- Clinical symptoms: high intestinal obstruction, distension, vomiting, abdominal pain, hemorrhage and fistula formation
- Sono appearance: well-defined, round fluid-filled mass, anechoic, acoustic enhancement, hypoechoic outer muscular rim, hyperechoic inner rim of mucosa
- U/S & CT: duplication cysts appear anechoic, thin inner echogenic rim (mucosa), wider outer hypoechoic rim (muscle layer). CT contrast helpful for gastric duplication cysts.
Gastric Bezoar
- Intragastric movable mass of accumulated ingested material
- Classified into three categories:
- Trichobezoars - hair balls (young women)
- Phytobezoars - vegetable matter (e.g., unripe persimmons)
- Concretions - inorganic materials (e.g., sand, asphalt, shellac)
- Symptoms: nausea and vomiting, pain
- Sono appearance: hyperechoic curvilinear dense strip/band at anterior margin, mobile, complex appearance
Benign Tumors: Polyp
- Small, tumor-like growth projecting from mucous membrane
- Gastric polyp, outgrowth of tissue from gastric wall
- Symptoms: asymptomatic when small; abdominal pain as the polyp grows
- Sono appearance: solid mass attached to gastric wall, seen with fluid distension of stomach, large ones may be inhomogeneous, pedicle may be seen
- Endoscopic view often reveals the polyp in the gastrointestinal tract
Benign Tumors: Leiomyoma
- Most common stomach tumor
- Seen as a mass, similar to carcinoma
- Usually small and asymptomatic
- Sono appearance: solid mass, hypoechoic, necrosis- cystic areas, mass continuous with muscle layer
- Can be seen on TRV image in LUQ
Malignant Tumors: Gastric Carcinoma
- Most common stomach cancer; 5th leading cause of death in men
- More frequent in older men
- 50% of tumors occur in the pylorus
- Lesions: ulcerated, diffuse, polypoid, or superficial
- Sono appearance: target sign, pseudokidney sign, gastric wall thickening, polypoid mass, lobulated or fungating (cauliflower-like) masses
- Can cause obstruction of the gastric outlet
Malignant Tumors: Lymphoma
- Can be a primary tumor of the GI tract
- Disseminated lymphoma: multifocal lesion in the GI tract, hypoechoic lesions
- Leiomyosarcoma (aka gastric sarcoma): occurs in older people, masses are generally globular or irregular; hypoechoic; may become extremely large -Outstrip blood supply and have central necrosis and cystic degeneration
Malignant Tumors: Metastatic Disease
- Stomach mets very rare; originate from melanoma, lung, or breast cancer
- Tumors appear in the submucosal layer as circumscribed nodules or plaques
- Sono appearance: target pattern, wall thickening (without layering visible)
Lower GI Tract - Obstruction and Dilation
- Small bowel obstruction: dilation of bowel loops proximal to the obstruction site
- Causes: gallstone accumulation, tumors (small bowel adenocarcinoma), congenital atresia/stenosis, annular pancreas
- Sono of bowel obstruction: hyperactive, dilated bowel loops; bowel wall thickening in some cases, duodenum and stomach seen as large anechoic structures
Acute Appendicitis
- Results from luminal obstruction and inflammation, leading to ischemia
- Obstruction: fecal material, foreign body, carcinoma, stenosis, inflammation, kinking
- Ischemia produces necrosis, leading to complications like perforation, periappendicular abscess, peritonitis.
- Symptoms include pain (RLQ, McBurney's sign), abdominal rigidity, nausea and vomiting, diarrhea, leukocytosis, and fever
- Sono: tubular noncompressible structure (target appearance), outer hypoechoic muscular layer and echogenic submucosa layers, appendicolith, fluid-filled center
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6mm AP, fecalith, enlarged mesenteric lymph nodes, inflamed fat and free fluid
- Complications: Perforation (especially in children under age three), complex masses, abscess formation, peritonitis. High rate of perforation (up to 70%) in preschoolers.
- Differential diagnoses: acute gastroenteritis, mesenteric lymphadenitis, ruptured ectopic pregnancy, Mittelschmerz, Meckel's diverticulum, right ovarian torsion
Mucocele
- Distension of the appendix by mucus
- Common symptom: RLQ pain, resembling appendicitis
- Patients may be asymptomatic
- Classified into three groups: hyperplasia, focal or diffuse, mucinous cystadenoma, mucinous cystadenocarcinoma (malignant potential)
- Significant complications from rupture: massive accumulation of gelatinous ascites, pseudomyxoma peritonei
- Sono: cystic or complex mass up to 7 cm in diameter, with through transmission, located in RLQ. Possible differential considerations include ovarian cysts, mesenteric cysts, duplication cysts, renal cysts, or even abdominal abscess.
Meckel Diverticulitis
- Pouchlike herniation through the muscular wall of a tubular organ (most common in the colon).
- Localized on the antemesenteric border of the distal ileum
- 3-6 cm long, present in ~2% of population
- Symptoms: intestinal obstruction, rectal bleeding, diverticular inflammation, mimics acute appendicitis
- Sono: the wall of the Meckel diverticulum consists of mucosal, muscular, and serosal layers. Noncompressibility of the obstructed, inflamed diverticulum indicates trapped intraluminal fluid
Crohn's Disease
- Autoimmune, regional enteritis, inflammatory disease affecting any part of GI tract (common in terminal ileum and colon)
- Entire bowel wall thickness affected
- Symptoms: diarrhea, fever, RLQ pain
- Sono: symmetrically thickened hypoechoic bowel walls.
- Non- or partially compressible.
- Possible target sign, pseudo-kidney sign, increased vascularity, secondary appendicitis, lymphadenopathy
- Use graded compression during exam
Tumors of the Colon: Lymphoma
- Usually occurs late in life (60s), although can occur in young children
- Symptoms: intestinal blood loss, weight loss, anorexia, abdominal pain
- Sono: large, discrete mass with a target pattern; small anechoic mass representing subserosal nodes, mesenteric nodal involvement
- Bowels may show a pseudokidney sign or hydronephrotic pseudokidney sign
- CT and ultrasound images can show thickening of the sigmoid colon wall
Tumors of the Colon: Leiomyosarcoma
- Rare smooth muscle tumor, malignant
- Typically occurs in the duodenum, jejunum, and ileum
- Patients are usually in their 50s and 60s
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Description
Explore the intricacies of GI tract pathology in DMS 152, focusing on conditions like duplication cysts and gastric bezoars. Understand their embryologic origins, clinical symptoms, and imaging characteristics. This quiz covers essential details for effective diagnosis and management of these conditions.
