Transcript Abdomen & GI system FINAL RT 91- Pathology Spring 2010 Regions & Quadrants of Abdomen.

Abdomen & GI system
FINAL
RT 91- Pathology
Spring 2010
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Regions & Quadrants of Abdomen
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Contents of Abdominal Cavity
1. Digestive system
– Stomach and Intestines
2. Hepatobiliary System
– Liver, gallbladder, & pancreas
3. Urinary system
– Kidneys, ureters and bladder
4. Circulatory system
– spleen
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Gastrointestinal
System
1. Alimentary tractserves to digest &
absorb food
– Consists of
•
•
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•
•
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Mouth
Pharynx
Esophagus
Stomach
SM & LG bowel
Rectum
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Small Bowel
1. 21 FT long
2. Duodenum
1. Duodenal c-loop
ends at ligament of
Treitz
3. Jejunum
1. Connects to ileum
4. Ileum
1. Terminates at
ileocecal junction
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Large Intestine
1. 6 FT long
– Extends from
ileocecal junction
– Ascending colon
(hepatic flexure)
– Transverse colon
(splenic flexure)
– Descending colon
– Sigmoid
– Rectum
– Anus
Hepatic
flexure
Splenic
flexure
Sigmoid
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Congenital and Hereditary
Anomalies
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Esophageal Atresia
1.
Looping of the feeding tube
2. Atypically short esophagus & terminates
in blind pouch
2. Air in stomach
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Esophageal Atresia
1. Congenital anomaly
2. Esophagus fails to
_______________
past some point
3. Symptoms come soon
after birth
–
Salivation, gagging,
choking, dyspnea,
cyanosis
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Tracheoesophageal Fistula
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Tracheoesophageal Fistula
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Duodenal
Atresia
On x-ray a “double-bubble” sign is
demonstrated gas in stomach is one
bubble
Gas in proximal duodenum is the
second bubble
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Duodenal Atresia
1. Congenital anomaly
2. ________________
of duodenum does
not exist
3. Resulting in a
complete
_________________
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Colonic
Atresia
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Colonic Atresia
1. Congenital failure of
development of the
________________
2. Frequent
complication
includes fistula
formation to the
genitourinary system
3. Must be repaired
surgically
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Hypertrophic Pyloric Stenosis
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Hypertrophic
Pyloric Stenosis
Pyloric canal leading
out of the stomach is
greatly narrowed
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Hypertrophic Pyloric Stenosis
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Hypertrophic Pyloric Stenosis
1. Congenital anomaly of
the stomach
2. Pyloric canal leading out
of the stomach is greatly
narrowed because of
hypertrophy of the
pyloric sphincter
3. Most common indication
for surgery in infants
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Malrotation
Small bowel on
right and colon
on left
Cecum is not
located in the
RLQ
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1. Intestines are not in
their normal position
Malrotation
2. Usually
asymptomatic
3. Can lead to bowel
volvulus or
incarceration of
bowel
1. Surgery is required
with a resection of
bowel involved
Cecum
on left
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Hirschsprung's
Disease
1. ______________
Feces
Narrowing
Dilated
Sigmoid
2. Dilated ______
colon with massive
amounts of feces
3. Narrowed segment
just below the
dilatation
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Hirschsprung’s Disease
AKA Congenital Megacolon
1. Absence of neurons
in the bowel wall
2. This absence
prevents normal
relaxation of the
colon & subsequent
peristalsis
3. Results in gross
dilatation
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Meckel’s
Diverticulum
Difficult to diagnose with xray
Nuclear Medicine is better
Sac-like anomaly within
ileocecal valve
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1. Congenital
________________
of the distal ileum
Meckel’s
Diverticulum
2. Is remnant of a duct
connecting the SB to
the umbilicus in the
fetus
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Celiac
Sprue
X-rays show segmentation of the barium column,
flocculation (resembling tufts of cotton) &
edematous mucosal changes
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1. Hereditary disorder
with increased
sensitivity to gluten
Celiac Sprue
2. Interferes with normal
_____________ and
_____________ of
food
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Inflammatory Disease
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Esophageal Strictures
X-rays show
peristalsis
is transitory
Contour appears
ragged
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1. Caused by ingestion
of caustic materials
1.
2.
3.
4.
Esophageal
Strictures
Household cleaners
Detergents
Sulfuric acid
Sodium hydroxide
2. ____ the esophagus
causing edema,
swelling, & possible
perforation
3. Requires repeated
_______________
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1. Incompetent ______
sphincter allowing
backward flow of
gastric acid and food
into esophagus
GERD
2. ________________
3. ________may not
be evident with
barium swallow but
strictures & ulcers
may be present
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GERD
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1. Erosion of the
mucous membrane
of the esophagus,
stomach &
duodenum
Peptic Ulcer
2. Primarily affects
PT’s over 40 years
3. Diagnosis is made
mostly with
endoscopy
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Peptic Ulcer
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Barrett’s Esophagus
Peptic ulcer of the esophagus often with a stricture
Fibrotic healing of the ulceration
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Barrett’s Esophagus
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Crohn’s Disease
Radiographically looks like
“cobblestone”
The ______________________
sign is demonstrated where the
TI is so diseased and stenotic
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Regional Enteritis
(Crohn’s Disease)
1. Chronic
inflammatory
disease of no cause
2. Typically occurs in
lower ileum but can
be seen throughout
bowel
String
sign
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Appendicitis
CT is the gold standard
Shows an appendiceal abscess
As a round or oval soft tissue
Density that may contain gas
Appendix is dilated
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Fecolith within Appendix
Common cause of
Appendicitis
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1. Inflammation of the
appendix resulting
from an __________
Appendicitis
1. Caused by a fecolith
or neoplasm (rarely)
2. Most common
abdominal surgery in
the US
3. Sonography & CT
used in diagnosis
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Ulcerative Colitis
BE demonstrates an
irregular outline of the
colon
_______ _________
appearance
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1. Inflammatory lesion
of the colon mucosa
Ulcerative Colitis
1. Causes abscess
leading to epithelial
necrosis & ulceration
2. It is idiopathic,
thought to be an
autoimmune disease
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Esophageal Varices
On x-ray looks like wormlike
defects within the column of
BA
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Esophageal Varices
Varicose veins that are
abnormally lengthened,
dilated& superficial
Can be fatal
Occurs from conditions such
as cirrhosis that bypass the
normal venous drainage
mechanism
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Gastritis
Evidenced by gas
bubbles (produced by
bacteria) in the stomach
Wall
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Endoscopy for Gastritis
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1. Inflammation of the
_______ of the stomach
Gastritis
2. Results from various
irritants: alcohol,
corrosive agents, &
infection
3. Most commonly
demonstrated with
___________________
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Degenerative Diseases
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Inguinal Herniation
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1. Protrusion of a loop of
bowel through a small
opening, usually in the
abdominal wall.
Inguinal
Herniation
2. Can cause obstruction
3. Can be surgically
repaired, sometimes
needing resection
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Hiatal Hernia
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1. Weakness of
esophageal hiatus that
permits some portions
of the stomach to
herniate into the
thoracic cavity
Hiatal Hernia
2. Chronic herniation can
be associated w/
______
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1. A type of hiatal hernia
2. Occurs when a portion of
the stomach and the
gastroesophageal
junction are both above
the diaphragm (99%)
Schatzki’s Ring
1. This ring is visible
radiographically with this
condition
2. May be related to reflux
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Bowel Obstructions
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Mechanical
Bowel
Obstruction
Large dilated colon
Little small bowel gas
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1. Occurs from a
blockage of the
bowel lumen
Mechanical Bowel
Obstruction
2. Bowel sounds are
_______________ &
high pitched
3. Vomiting _________
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Gallstone Ileus
X-ray show air-fluid levels or air
in biliary tree
Gallstone may also be visible
in the TI where it causes the
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obstruction
1. A type of mechanical
obstruction
Gallstone Ileus
2. Gallstone can erode
& create a fistula in
the SB
3. Obstruction occurs
when stone reaches
ileocecal valve
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Paralytic Ileus
Gas distributed
throughout both LG &
SB
Normal bowel sounds
are absent
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Paralytic Ileus
1. Results from failure
of peristalsis
2. Absent bowel
sounds
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Volvulus
X-ray shows
collection of air
conforming to the
shape of affected
bowel
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1. Twisting of bowel loop
1. Usually at the
sigmoid or ileocecal
junction
Volvulus
2. Identifiable with x-ray
3. Usually happens in
elderly
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Intussusception
X-ray looks like a coiled spring
Air fluid levels LG bubble within mid
abdomen
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1. Is a kind of
mechanical
obstruction
Intussusception
2. Segment of bowel
telescopes into distal
segment and is
driven further into
distal bowel by
peristalsis
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Neurogenic Diseases
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Achalasia
X-ray shows dilated esophagus
with little or no peristalsis
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Achalasia
Failure of the
esophageal sphincter to
relax causing dysphasia
Distal esophagus open
intermittently
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Diverticular Diseases
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Esophageal Diverticula
• Occurs when mucosal
outpouchings
penetrate through the
muscular layer of the
esophagus
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Esophageal Diverticula (traction)
• Involves all layers of
esophagus and
results in adjacent
scar tissue that pulls
esophagus toward
area of involvement
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Zenker’s Diverticulum
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Zenker’s Diverticulum
1. Involves mucosa only
& results from a
__________ disorder
2. Allows esophagus to
_________ outwardly
3. Found at
pharyngealesophageal
junction
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Colonic
Diverticula
Appear as round – oval
Outpouchings of BA projecting
beyond bowel lumen
Vary in size 2cm or more
Tend to occur in clusters
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Colonic
Diverticula
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1. The presence of
diverticula
_________inflammation
Colonic
Diverticula
2. Diverticula are
associated with
hypertrophy of the
muscular layer of the
bowel
3. Most common in
_____________ (95%)
4. Most patients are
asymptomatic
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Diverticulitis
1. Inflammation of the diverticulum
2. Exacerbated by feces lodging in the
diverticulum
3. Signs and symptoms: fever, LLQ pain,
tenderness and increased WBC count
4. BA shows diverticulum
5. Treatment centers on reduction of
inflammation and infection
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Neoplastic Diseases
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Leimyomas
Appear as intramural defects in the
barium outlined esophageal wall
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Leimyomas of Esophagus
1. __________ tumors
2. Have smooth
muscular tumors
3. Exact location can
be determined on
CT
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Gastroesophageal
Adenocarcinomas
Appears as mucosal destruction,
ulceration, narrowing and sharp
demarcation between normal
Tissue & malignant tumor
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1. Occur in the lower
esophagus around
the
gastroesophageal
junction
Adenocarcinomas
2. Some believe there
is a direct link
between Barrett’s
esophagus &
adenocarcinoma
1. 90% have been
found to arise from
Barrett’s mucosa
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Small Bowel Neoplasms
Most common means of
identifying is through
endoscopy with biopsy
Can be seen on CT &
with SBS
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Small Bowel Neoplasms
1. Most occur in the
duodenum &
proximal jejunum
2. Some predisposing
factors include:
1. Polyposis
2. Kaposi’s sarcoma
3. Crohn’s disease
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Colonic Polyps
BE is exam of choice, showing
rounded filling defects
Proctosigmoidoscopy and
colonoscopy are critical in
evaluation and removal of polyps
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Colonic Polyps
1. Small masses of tissue
arising from the bowel
wall to project inward in
the lumen
2. More frequently in the
left colon
3. Most cancers of the
colon & rectum usually
arise from previous
benign polyps
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Colon Cancer
1. 2nd most common
cause of cancer
mortality
2. Adenocarcinoma is
the most common
type of colorectal
cancer
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Colon Cancer
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Colon Cancer
“Apple-Core lesion”
1. X-ray shows “napkin
ring” or “apple core”
lesions
2. Double contrast BE
more accurate than
single contrast
3. CT colonoscopy also
useful
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CT of Abdomen & GI
1. Clearly demonstrates abdominal organs
that are normally not apparent on x-ray
w/o contrast
2. Recommended for bowel obstruction
diagnosis
3. Virtual colonoscopy can be done to see
areas not seen during a regular
colonoscopy
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MRI imaging of Abdomen & GI
1. Still limited due to bowel motion
2. Useful in demonstrating retroperitoneal
masses impinging on GI system
3. Can differentiate between pathology &
normal tissue
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US imaging of Abdomen & GI
1. Not useful in imaging of the GI system
2. Extensively used to image the
retroperitoneum because of the flexibility
of angling the transducer
3. With this modality it is possible to image
behind the bowel & assess for
abnormalities
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Nuclear Medicine imaging for
Abdomen & GI
1. Useful is detecting:
1.
2.
3.
4.
GI bleeds
Gastric emptying time
Presence of H. Pylori
Infection from gastric ulcers
2. PET has been known to demonstrate
20% of esophageal cancer undetected by
CT
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Endoscopic Procedures
1. Fiberoptic tube device to look inside hollow organs or cavities
2. Upper endoscopy can see esophagus, stomach, duodenum & proximal
jejunum
3. Colonoscopy to the terminal ileum
4. Small bowel is still out of reach
5. Capsule endoscopy is a camera pill that is swallowed and takes
pictures of the GI tract
1. Drawbacks include inability to biopsy area and locate pathology
2. Insurance reimbursement
6. Also used for several therapeutic applications
1.
2.
3.
4.
Biopsies
Stent placement
Polyp removal
Stone removal
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