Gastrointestinal System PDF (RT-304)

Duodenal ulcer. An ulcer position appears Chronic duodenal ulcer disease. Typical as a rounded collection of barium (white cloverleaf deformity is visible arrow) surrounded by lucent edema Gastrointestinal System RT- 304 – Radiographic Pathology By: Jerahmeel Dale B. Fu...

Duodenal ulcer. An ulcer position appears Chronic duodenal ulcer disease. Typical as a rounded collection of barium (white cloverleaf deformity is visible arrow) surrounded by lucent edema Gastrointestinal System RT- 304 – Radiographic Pathology By: Jerahmeel Dale B. Fusingan, RRT  Digestive systems alters the chemical and physical composition of food so Digestive System that it can be absorbed and used by body cells. The digestive tract of the body contains all the organs, ducts and components to start and complete the digestive process. Mastication (chewing) – mechanical breakdown of food. Deglutition – is a complex process that requires coordination of head, neck and the precise opening/closing of esophageal sphincters.  Esophagus – is a vertical tube about 10inches long. It extends to C6, inferior Digestive System of pharynx to the stomach at the level of T11. Stomach – is a large inflatable sac that is located in the left upper quadrant of the abdomen. It is the most dilated portion of digestive tract; it can hold almost 1.5 quarts (qt) of food and liquid.  Small bowel (intestines) – Extends from the pyloric sphincter to the cecum. It is Digestive System called small bowel because it is short (measures 18-23 feet) but because its lumen is smaller than the large bowel. Three division; duodenum, jejunum, ileum. Large bowel (intestines)- average 5-6 feet in length. It extends from cecum to anus. It is divided into ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal. Pathology: Esophagus (Congenital Anomaly)  Atresia Esophageal atresia refers to an absence in the continuity of the esophagus due to an inappropriate division of the primitive foregut into the trachea and esophagus. This is the most common congenital anomaly of the esophagus. Clinical Manifestation: Esophageal atresia may be suspected in the neonate due to inability to swallow saliva or milk, aspiration during early feedings, or failure to pass a nasogastric tube into the stomach successfully.  Tracheoesophageal Fistula (passageway) Failure of a satisfactory esophageal lumen to develop completely separate from the trachea. The lack of the development of the esophageal lumen resulting in a blind pouch describes congenital esophageal atresia. Esophageal atresia and TE fistulas are often associated with other congenital malformations involving the skeleton, cardiovascular system, and GI tract. Pathology: Esophagus (Acquired type)  Esophagitis Reflux (GERD – Gastroesophageal Reflux Disease) Is a spectrum of disease that occurs when gastric acid refluxes from the stomach into the lower end of the esophagus across the lower esophageal sphincter. Alchohol, chocolate, caffeine, and fatty food tend to decrease the pressure of the esophageal sphincter, allowing reflux to occur.  Radiographic features The difficulty in the radiographic diagnosis of gastro-esophageal reflux disease lies in the presence of spontaneous reflux on upper GI examination in 20% of normal individuals, while some patients with pathologic gastro- esophageal reflux disease may present with reflux only after provocative maneuvers such as Valsalva, leg raising, and coughing Appearance – They consist of superficial ulcerations or erosion that appear as streaks or dots of barium superimposed on the flat mucosa of the distal esophagus.  Barrett’s Esophagus A condition related to severe reflux esophagitis in which the normal squamous lining of the lower esophagus is destroyed and replaced by columnar epithelium similar to that of the stomach. Has an unusually high susceptibility for development of malignancy in the columnar cell-lined portion. These tumors are almost always adenocarcinoma which are otherwise very rare in the esophagus( (5% of esophageal cancer). Candida and Herpes Virus Candida (fungal) and herpes virus are the organisms most responsible for infectious esophagitis, which usually occurs in patients with widespread malignancy who are receiving radiation therapy, chemotherapy, corticosteroids, or other immunosuppressive agents and antibiotics (tetracycline). Candida Esophagitis Herpes Esophagitis Candida and Herpes Virus Appearance – Irregular cobblestone pattern with a shaggy (hairy) marginal contour of the esophagus caused by deep ulceration and sloughing of the mucosa. Candida infection manifests as plaques and nodules resulting from a superficial collection Candida Esophagitis Herpes Esophagitis of fungi. Characteristics of herpetic esophagitis include small mucosal ulcers or plaques.  Ingestion of Corrosive Agents Alkaline and acidic corrosive agents produces acute inflammatory changes in the esophagus. Ingestion of strong alkaline agents causes deeper lesions than ingestion of strong acids, and only half of those who ingest an acid suffer severe injury. Appearance : Alkaline →Deeper Ulceration and Stricture Formation Acidic → Superficial minimal ulceration and Stricture Formation  Esophageal Cancer is a relatively uncommon tumor Clinical Manifestation: that occurs within the esophagus of affected individuals. Patients increasing dysphagia present with symptoms of worsening reflux increasing dysphagia that progress from solid foods to hoarseness and cough liquids.  Esophageal Cancer Radiographic Appearance: Barium Swallow Double Contrast: Flat plaque like lesion, infiltrating lesion, (irregular wall) and polypoid mass (deep ulceration) CT Scan w/ C+ : wall thickening greater than 3-5mm.  Esophageal Diverticula (Outpouching) Are common lesions that either contain all layers of the wall (traction or true diverticula) or are composed of only mucosa and submucosa herniating through the muscular layer (pulsion or false diverticula). Small diverticula do not retain food or secretions and are asymptomatic. When a diverticulum fills with food or secretions, aspiration pneumonia may result. The sacs found in espophageal diverticula can appear anywhere on the esophagus. Esophageal diverticula are classified differently based on where they are located along the esophagus and include: Zenker's diverticula: These are esophageal diverticula found in the top area of the esophagus. Mid-esophageal diverticula: Pouches occur in the middle of the esophagus. Ephiphrenic diverticula: Pouches occur at the base of the esophagus. ESOPHAGEAL DIVERTICULA CAN FORM IN A VARIETY OF WAYS Traction Diverticula An esophageal diverticulum known as a traction diverticulum occurs when there is an external force on the wall of the esophagus that creates the pouch. This most commonly occurs in the middle area of the esophagus. Pulsion Diverticula Also referred to as epiphanic diverticula, these pouches occur in the lower part of the esophagus. This happens when the esophagus is being pushed due to incoordination of the sphincter muscle in the lower esophagus. The sphincter is a ring made of muscle that helps connect the esophagus with the stomach. Zenker's Diverticulum Occurring in the top part of the esophagus, a Zenker's diverticulum is caused by abnormal tightening of the upper esophageal sphincter between the lower pharynx (throat) and the upper esophagus. This causes a bulge to form, and over time pressure will cause a diverticulum to develop. This is the most common type of esophageal diverticulum.  Esophageal Varices These are dilated veins in the wall of the esophagus that are most commonly the result of increased pressure in the portal venous system (portal hypertension), which is in turn usually a result of cirrhosis of the liver. Are infrequently demonstrated in the absence of portal hypertension.  Esophageal Varices Two types of Esophageal varices Uphill esophageal varices – most common form, typically caused by portal hypertension, as a collateral pathway between the portal vein and the superior vena cava Downhill esophageal varices - relatively rare, typically caused by superior vena cava obstruction, as part of superior vena cava syndrome, as a collateral pathway between the superior vena cava into the portal circulation and/or the inferior vena cava Esophageal Varices Appearance: Serpiginous (wavy border) thickening of folds which appear as round oval filling defects resembling the bead of rosary.  Hiatal Hernia It occur in about half of the population over age 50 years. In its early stages, a hiatal hernia is reducible. Chronic herniation may be associated with GERD. Patients with hiatus hernia are asymptomatic, and it is an incidental finding. However, symptoms may include epigastric or chest pain, postprandial fullness, nausea and vomiting There are two main types of hiatus hernia (although they may co-exist): Sliding Hiatal Hernia (90% most common & Rolling (paraesophageal) Hiatal Hernia. Radiographic appearance: Plain Radiograph - A retrocardiac mass with or without an air-fluid level. Schatzki ring – Sliding Hiatal Hernia (Trendelenburg Position). Fluorouscopy - numerous coarse thick gastric folds within the suprahiatal pouch tortuous esophagus with an eccentric gastro-esophageal junction  Achalasia Refers to the combined failure of peristalsis to pass food down the esophagus and failure of relaxation of the cardia. Or a failure of organized esophageal peristalsis that causes impaired relaxation of the lower esophageal sphincter, resulting in food stasis and often marked dilatation of the esophagus.  Achalasia Radiographic Features: Achalasia characteristically involves a short segment (less than 3.5 cm in length) of the distal esophagus. Appearance: Rat tail or bird beak sign.  Esophageal Perforation It may be a complication of esophagitis, peptic ulcer, neoplasm, external trauma, or instrumentation. At times, perforation of a previously healthy esophagus can result from severe vomiting (the most common cause) or coughing, often from dietary or alcoholic recklessness. Mallory-Weiss syndrome refers to a tear or laceration of the mucous membrane, most commonly at the point where the esophagus and the stomach meet  Radiographic Appearance: A perforation that extends throughout the entire esophageal wall can lead to free air in the mediastinum or peri- esophageal soft tissues. The administration of radiopaque contrast material may demonstrate extravasation through the perforation or an intramural dissection channel separated by an intervening lucent line from the normal esophageal lumen.