1. Abdomen & GI system FINAL
RT 91- Pathology
Spring 2011

2. Regions & Quadrants of Abdomen

3. Contents of Abdominal Cavity
Digestive system
Stomach and Intestines
Hepatobiliary System
Liver, gallbladder, & pancreas
Urinary system
Kidneys, ureters and bladder
Circulatory system
spleen

4. Gastrointestinal System
Alimentary tract- serves to digest & absorb food
Consists of
Mouth
Pharynx
Esophagus
Stomach
SM & LG bowel
Rectum

5. Small Bowel 21 FT long Duodenum Jejunum Ileum
Duodenal c-loop ends at ligament of Treitz
Jejunum
Connects to ileum
Ileum
Terminates at ileocecal junction

6. Large Intestine 6 FT long Extends from ileocecal junction
Hepatic
flexure
Splenic
flexure
6 FT long
Extends from ileocecal junction
Ascending colon (hepatic flexure)
Transverse colon (splenic flexure)
Descending colon
Sigmoid
Rectum
Anus
Sigmoid

7. Congenital and Hereditary Anomalies

8. Esophageal Atresia Looping of the feeding tube
2. Atypically short esophagus & terminates in blind pouch
2. Air in stomach

9. Esophageal Atresia Congenital anomaly
Esophagus fails to _______________ past some point
Symptoms come soon after birth
Salivation, gagging, choking, dyspnea, cyanosis

10. Tracheoesophageal Fistula

11. Tracheoesophageal Fistula

12. 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

13. Duodenal Atresia Congenital anomaly
________________ of duodenum does not exist
Resulting in a complete _________________

14. Colonic Atresia

15. Colonic Atresia
Congenital failure of development of the ________________
Frequent complication includes fistula formation to the genitourinary system
Must be repaired surgically

16. Hypertrophic Pyloric Stenosis

17. Hypertrophic Pyloric Stenosis
Pyloric canal leading out of the stomach is greatly narrowed

18. Hypertrophic Pyloric Stenosis

19. Hypertrophic Pyloric Stenosis
Congenital anomaly of the stomach
Pyloric canal leading out of the stomach is greatly narrowed because of hypertrophy of the pyloric sphincter
Most common indication for surgery in infants

20. Malrotation Small bowel on right and colon on left Cecum is not
located in the
RLQ

21. Malrotation Intestines are not in their normal position
Usually asymptomatic
Can lead to bowel volvulus or incarceration of bowel
Surgery is required with a resection of bowel involved
Cecum
on left

22. Hirschsprung's Disease
______________
Dilated ______ colon with massive amounts of feces
Narrowed segment just below the dilatation
Feces
Narrowing
Dilated
Sigmoid

23. Hirschsprung’s Disease AKA Congenital Megacolon
Absence of neurons in the bowel wall
This absence prevents normal relaxation of the colon & subsequent peristalsis
Results in gross dilatation

24. Meckel’s Diverticulum
Difficult to diagnose with x-ray
Nuclear Medicine is better
Sac-like anomaly within ileocecal valve

25. Meckel’s Diverticulum
Congenital ________________ of the distal ileum
Is remnant of a duct connecting the SB to the umbilicus in the fetus
Meckel’s Diverticulum

26. Celiac Sprue X-rays show segmentation of the barium column,
flocculation (resembling tufts of cotton) &
edematous mucosal changes

27. Celiac Sprue Hereditary disorder with increased sensitivity to gluten
Interferes with normal _____________ and _____________ of food

28. Inflammatory Disease

29. Esophageal Strictures
X-rays show
peristalsis
is transitory
Contour appears
ragged

30. Esophageal Strictures
Caused by ingestion of caustic materials
Household cleaners
Detergents
Sulfuric acid
Sodium hydroxide
____ the esophagus causing edema, swelling, & possible perforation
Requires repeated _______________

31. Incompetent ______ sphincter allowing backward flow of gastric acid and food into esophagus
________________
________may not be evident with barium swallow but strictures & ulcers may be present
GERD

32. GERD

33. Erosion of the mucous membrane of the esophagus, stomach & duodenum
Primarily affects PT’s over 40 years
Diagnosis is made mostly with endoscopy
Peptic Ulcer

34. Peptic Ulcer

35. Barrett’s Esophagus
Peptic ulcer of the esophagus often with a stricture
Fibrotic healing of the ulceration

36. Barrett’s Esophagus

37. Crohn’s Disease Radiographically looks like “cobblestone”
The ______________________ sign is demonstrated where the TI is so diseased and stenotic

38. Regional Enteritis (Crohn’s Disease)
Chronic inflammatory disease of no cause
Typically occurs in lower ileum but can be seen throughout bowel
String
sign

39. 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

40. Fecolith within Appendix
Common cause of
Appendicitis

41. Appendicitis Inflammation of the appendix resulting from an __________
Caused by a fecolith or neoplasm (rarely)
Most common abdominal surgery in the US
Sonography & CT used in diagnosis
Appendicitis

42. Ulcerative Colitis BE demonstrates an irregular outline of the colon
_______ _________ appearance

43. Ulcerative Colitis Inflammatory lesion of the colon mucosa
Causes abscess leading to epithelial necrosis & ulceration
It is idiopathic, thought to be an autoimmune disease

44. Esophageal Varices
On x-ray looks like wormlike defects within the column of BA

45. 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

46. Gastritis Evidenced by gas bubbles (produced by
bacteria) in the stomach
Wall

47. Endoscopy for Gastritis

48. Gastritis 1. Inflammation of the _______ of the stomach
2. Results from various
irritants: alcohol,
corrosive agents, &
infection
3. Most commonly
demonstrated with
___________________
Gastritis

49. Degenerative Diseases

50. Inguinal Herniation

51. Protrusion of a loop of bowel through a small opening, usually in the abdominal wall.
Can cause obstruction
Can be surgically repaired, sometimes needing resection
Inguinal Herniation

52. Hiatal Hernia

53. Hiatal Hernia
Weakness of esophageal hiatus that permits some portions of the stomach to herniate into the thoracic cavity
Chronic herniation can be associated w/ ______

54. Schatzki’s Ring A type of hiatal hernia
Occurs when a portion of the stomach and the gastroesophageal junction are both above the diaphragm (99%)
This ring is visible radiographically with this condition
May be related to reflux
Schatzki’s Ring

55. Bowel Obstructions

56. Mechanical Bowel Obstruction
Large dilated colon
Little small bowel gas

57. Mechanical Bowel Obstruction
Occurs from a blockage of the bowel lumen
Bowel sounds are _______________ & high pitched
Vomiting _________

58. 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
obstruction

59. Gallstone Ileus A type of mechanical obstruction
Gallstone can erode & create a fistula in the SB
Obstruction occurs when stone reaches ileocecal valve

60. Paralytic Ileus Gas distributed throughout both LG & SB
Normal bowel sounds
are absent

61. Paralytic Ileus Results from failure of peristalsis
Absent bowel sounds

62. Volvulus
X-ray shows collection of air conforming to the shape of affected bowel

63. Volvulus Twisting of bowel loop Identifiable with x-ray
Usually at the sigmoid or ileocecal junction
Identifiable with x-ray
Usually happens in elderly
Volvulus

64. Intussusception X-ray looks like a coiled spring
Air fluid levels LG bubble within mid abdomen

65. Intussusception Is a kind of mechanical obstruction
Segment of bowel telescopes into distal segment and is driven further into distal bowel by peristalsis
Intussusception

66. Neurogenic Diseases

67. Achalasia
X-ray shows dilated esophagus with little or no peristalsis

68. Achalasia Failure of the esophageal sphincter to
relax causing dysphasia
Distal esophagus open
intermittently

69. Diverticular Diseases

70. Esophageal Diverticula
Occurs when mucosal outpouchings penetrate through the muscular layer of the esophagus

71. Esophageal Diverticula (traction)
Involves all layers of esophagus and results in adjacent scar tissue that pulls esophagus toward area of involvement

72. Zenker’s Diverticulum

73. Zenker’s Diverticulum
Involves mucosa only & results from a __________ disorder
Allows esophagus to _________ outwardly
Found at pharyngealesophageal junction

74. Colonic Diverticula Appear as round – oval
Outpouchings of BA projecting
beyond bowel lumen
Vary in size 2cm or more
Tend to occur in clusters

75. Colonic Diverticula

76. Colonic Diverticula The presence of diverticula _________inflammation
Diverticula are associated with hypertrophy of the muscular layer of the bowel
Most common in _____________ (95%)
Most patients are asymptomatic

77. Diverticulitis Inflammation of the diverticulum
Exacerbated by feces lodging in the diverticulum
Signs and symptoms: fever, LLQ pain, tenderness and increased WBC count
BA shows diverticulum
Treatment centers on reduction of inflammation and infection

78. Neoplastic Diseases

79. Leimyomas Appear as intramural defects in the
barium outlined esophageal wall

80. Leimyomas of Esophagus
__________ tumors
Have smooth muscular tumors
Exact location can be determined on CT

81. Gastroesophageal Adenocarcinomas
Appears as mucosal destruction,
ulceration, narrowing and sharp
demarcation between normal
Tissue & malignant tumor

82. Occur in the lower esophagus around the gastroesophageal junction
Some believe there is a direct link between Barrett’s esophagus & adenocarcinoma
90% have been found to arise from Barrett’s mucosa
Adenocarcinomas

83. Small Bowel Neoplasms Most common means of identifying is through
endoscopy with biopsy
Can be seen on CT &
with SBS

84. Small Bowel Neoplasms Most occur in the duodenum & proximal jejunum
Some predisposing factors include:
Polyposis
Kaposi’s sarcoma
Crohn’s disease

85. Colonic Polyps BE is exam of choice, showing rounded filling defects
Proctosigmoidoscopy and colonoscopy are critical in evaluation and removal of polyps

86. Colonic Polyps
Small masses of tissue arising from the bowel wall to project inward in the lumen
More frequently in the left colon
Most cancers of the colon & rectum usually arise from previous benign polyps

87. Colon Cancer 2nd most common cause of cancer mortality
Adenocarcinoma is the most common type of colorectal cancer

88. Colon Cancer

89. Colon Cancer “Apple-Core lesion”
X-ray shows “napkin ring” or “apple core” lesions
Double contrast BE more accurate than single contrast
CT colonoscopy also useful

90. CT of Abdomen & GI
Clearly demonstrates abdominal organs that are normally not apparent on x-ray w/o contrast
Recommended for bowel obstruction diagnosis
Virtual colonoscopy can be done to see areas not seen during a regular colonoscopy

91. MRI imaging of Abdomen & GI
Still limited due to bowel motion
Useful in demonstrating retroperitoneal masses impinging on GI system
Can differentiate between pathology & normal tissue

92. US imaging of Abdomen & GI
Not useful in imaging of the GI system
Extensively used to image the retroperitoneum because of the flexibility of angling the transducer
With this modality it is possible to image behind the bowel & assess for abnormalities

93. Nuclear Medicine imaging for Abdomen & GI
Useful is detecting:
GI bleeds
Gastric emptying time
Presence of H. Pylori
Infection from gastric ulcers
PET has been known to demonstrate 20% of esophageal cancer undetected by CT

94. Endoscopic Procedures
Fiberoptic tube device to look inside hollow organs or cavities
Upper endoscopy can see esophagus, stomach, duodenum & proximal jejunum
Colonoscopy to the terminal ileum
Small bowel is still out of reach
Capsule endoscopy is a camera pill that is swallowed and takes pictures of the GI tract
Drawbacks include inability to biopsy area and locate pathology
Insurance reimbursement
Also used for several therapeutic applications
Biopsies
Stent placement
Polyp removal
Stone removal