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RAD112 -Pathology

Pathology of Upper and Lower GI and urinary

What is achalasia? B p466/Path p166 also called cardiospasm; a motor disorder of esophagus in which peristalsis is reduced along the distal 2/3. Caused by incomplete relaxation of the lower esophageal sphincter. Most common ages 20-40.
Describe the x-ray appearance of achalasia. Esophagus presents as dilated, tortuous w/widened mediastinum and gradually tapered smooth, conical distal esophageal segment. (often with air/fluid levels on right adj to heart shadow)
What are anatomic anomolies in GI system? Abnormalities present at birth. Congenital or caused by a disease, such as cancer. Impaired swallowing mechanisms
What is Barrett esophagus? Also called Barrett syndrome - columnar-lined epithelium ulcer tissue replaces normal squamous epithelium. May produce stricture in distal esophagus. Nuclear Medicine is best way to diagnose.
List 3 types of carcinoma of the esophagus. ADENOCARCINOMA (most common) - causes dysphagia, localized pain during meals and bleeding. CARCINOSARCOMA (large, irregular polyp). PSUEDOCARCINOMA tumor that LOOKS like cancer
Describe the x-ray appearance of carcinoma in the esophagus. early presents as flat, plaquelike lesion. As progresses, irregularity of the wall (indicates mucosal destruction). Advanced cancer, presents as annular constrictions and possibly dilation, or polyps. CT is generally used to diagnose
Describe bezoar. solid mass of indigestible material that accumulates in your digestive tract, sometimes causing a blockage. Usually in stomach but can occur throughout GI. Example is Trichobezoar (made of hair).
Describe x-ray appearance of bezoar. presents as "filling defect" during Barium study
What is dysphagia? difficulty swallowing - most common symptom prior to Barium studies
what are esophageal varices? Dilated veins in distal esophagus usually caused by acute liver disease.
Describe x-ray appearance of esophageal varices. Wormlike or cobblestone appearance around esophagus; (resemble rosary beads) diffuse round/oval filling defects
What are foreign bodies? any material that lodges in the esophagus - bolus of food, metallic objects (coin), fish bone etc
What is gastritis? Inflammation of the stomach. Caused by variety of irritants - alcohol, corrosive agents, infection (H. Pylori)
How does gastritis present on x-ray? thickened gastric folds, gastric erosions, fibrosis and scarring, narrowing of stomach, or possibly bubbles in gastric wall (produced by bacteria)
What is GERD? Gastroesophageal Reflux Disease - the entry of stomach contents into the esophagus, irritating the lining. Feels like heartburn.
Describe x-ray appearance of GERD. distal esophagus demonstrates longitudinal streaks or dots on flat mucosa
What are gastric ulcers? Where are they most common? a form of peptic ulcer disease that occurs in lesser curvature of stomach.
How do gastric ulcers present on x-ray? barium penetrates mucosal wall, with a demarcation (evidence of edema) or with radiating folds to ulcer
What is hiatal hernia? a portion of the stomach protrudes through the diaphragmatic opening. also there is a condition called SLIDING HIATAL HERNIA - caused by weakened esophageal sphincter (can move)
What is HPS? p 626 Hypertrophic Pyloric Stenosis - an overgrowth of muscles in pylorus causing narrowing or blockage at pylorus in infants
what is Zenker Diverticulum? p468 characterized by large outpouching of the esophagus just above the upper esophageal sphincter. Patient may experience dysphagia, aspiration, and regurgitation of food eaten hours earlier
Describe x-ray appearance of Zenker Diverticulum. Enlarged recess or cavity in proximal esophagus
What is Hirschsprung's Disease? p626 also called congenital megacolon - nerves in the large intestine are missing, resulting in severe constipation or vomiting.
What is Intussusception? P500-501 when intestine telescopes or invaginates into another part of the intestine (common in infants under 2) ACUTE - may result in necrosis or obstruction
What is the possible radiographic appearance of Intussusception? "mushroom-shaped" dilation at distal aspect of Intussusception, with little to no barium or gas passing beyond; classic coiled spring appearance of Ba trapped by intussusceptum and surrounding bowel
What is volvulus? A twisting portion of the intestine or mesentery, leading to mechanical obstruction. Blood supply is reduced, leading to necrosis and obstruction. Types - CECAL VOLVULUS (ascending colon), SIGMOID VOLVULUS (descending colon)
How does volvulus present on x-ray? tapered or corkscrew appearance with air filled distended region of intestine
What is ileus? List the common types. obstruction of the small intestine - 2 types A) adynamic (paralytic) cessation of peristalsis or B) mechanical (twisting)
What is the possible radiographic appearance of ileus? Abnormal gas patterns, dilated loops of bowel, "circular staircase" or "herringbone" pattern
What are diverticula? small, outpouchings of the colon - very common
What is diverticulosis? the condition of having diverticula
What is diverticulitis? inflammation of the diverticula
How do diverticula present on x-ray? Barium fills circular defects projecting outward from colon wall; jagged or "sawtooth" appearance of mucosa
what is Meckel diverticulum P496 - a common birth defect caused by persistence of the yolk sac (sac-like outpouching of intestinal wall)
What is the possible radiographic appearance of Meckel diverticulum? Best seen with nuclear medicine (rarely seen in barium studies due to rapid emptying)
What is Whipple disease? p496 - rare disorder of small bowel (infection of mucosal lining), cause unknown. Symptoms include dilation of intestine, edema, malabsorption, deposits of fat in bowel wall and mesenteric nodules
How does Whipple disease look in x-ray? Dilation and distorted loops of small intestine, scratchy appearance
What is regional enteritis? inflammatory bowel disease of unknown origin, commonly involving terminal ileum. Also known as Crohn's disease or segmental enteritis
How does Crohn's disease present on x-ray? segments of lumen narrowed and irregular; "cobblestone" appearance and "string sign" are common - terminal ileum may be distended or barium not proceeding through to colon.
What is annular carcinoma? ADENOCARCINOMA - most typical form of colon cancer - tumor grows and infiltrates bowel wall - results in obstruction
How does annular carcinoma look on x-ray? "apple-core" or "napkin-ring" sign
What is a intestinal polyp? a saclike projection into the lumen - can become inflamed and bleed -
How does a polyp appear on x-ray? barium filled, saclike projection into the lumen of the bowel=
What is Malabsorption Syndrome? conditions in which GI tract is unable to process and absorb certain nutrients. Includes SPRUE - group of intestinal malabsorption diseases involving an inability to absorb certain proteins and fat. Many causes
What is the possible radiographic appearance of Malabsorption Syndrome? Thickening of mucosal folds and poor definition of normal "feathery" appearance
What is COLITIS? inflammatory condition of large intestine - ULCERATIVE colitis is a severe form among young adults, often leads to development of coin-like ulcers within mucosal wall
How does COLITIS appear on radiograph? Thickening of mucosal wall with loss of haustral markings
How does ULCERATIVE COLITIS appear on radiograph? "Cobblestone" and "stovepipe" appearance with severe forms
What are neoplasms? Tumors -may be benign or malignant - common in large intestine - may begin as polyps
How do neoplasms appear on radiograph? Filling defects; narrowness or tapering of lumen; "apple-core" or "napkin-ring" lesions
What is Giardiasis? common infection of the lumen of small intestine caused by flagellate protozoa Giardia Lamblia. Spread via contaminated food or water or person-person contact
How does giardiasis appear in x-ray? Dilation of intestine with thickening of circular folds
What is Bright disease? p545 Glomerulonephritis - inflammation of the capillaries of the loops of glomeruli; chronic condition results in small kidneys with blunt, rounded calyces (best demonstrated with sonography)
Describe cystitis. p544/Path p227 inflammation of the urinary bladder caused by bacteria or fungal infection (most common in females)
Describe renal cell carcinoma p546/Path p237-240 Most frequent type of malignant tumor of kidney; 3x more common in males; presents as large, irregular mass with internal areas of necrosis and hemorrhage
Describe renal calculi. p545/Path p228-231 Calcifications that occur in luminal aspect of urinary tract, leading to obstruction; may occur in renal parenchyma
What are some anomolies of the urinary system? structural or chemical imperfections or alterations - MALROTATION (kidney rotated A or P); DUPLICATION - 2 ureters/2 renal pelvises from 1 kidney; ECTOPIC - kidney fails to ascend, short ureter; HORSESHOE - fused lower poles of kidneys (do not ascend)
Describe polycystic kidneys p545 disorder marked by cysts scattered throughout one or both kidneys; Most common cause of large kidneys; Kidneys appear grapelike
Explain BPH. p543 Benign Prostatic Hyperplasia - enlargement of the prostate that generally begins in 5th decade. Although benign, may cause urethral compression/obstruction (painful and possible frequent urination as well as vesicoureteral reflux)
Describe renal obstruction. p546 May be caused by necrotic debris, calculus, thrombus, or trauma; may present as reduced perfusion of contrast taking hours to visualize; or calyces may show signs of enlargement/hydronephrosis
Describe hydronephrosis p546/Path p231 Distention of the renal pelvis and calyces resulting from obstruction of ureters or renal pelvis; common causes - pregnancy, calculi, or anomolies
Describe bladder carcinoma p544/Path p240-243 Tumor 3x more common in males; usually over 50
What is Wilm's tumor? p626/Path p240-241 Most common abdominal cancer in infants/children; usually affects 1 kidney; of embryonal origin; usually under 5
Explain supernumerary kidneys Path p219 - presence of extra kidney; 3rd kidney is usually small but can cause secondary infections
What is radiographic appearance of bladder carcinoma? May present as fingerlike projections into lumen or may infiltrate bladder wall. may demonstrate calcifications encrusted on surface of tumor (or within); filling defect
Created by: Larobbins