Gi Oral

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BARRETT’S ESOPHAGUS

Columnar metaplasia
2-10% of Reflux Esophagitis
8-10% develop adenocarcinoma

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CROHNS DISEASE

90+% Involvement of TI
DDX:
Yersinia
Tb
Lymphoma

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GALLSTONE ILEUS

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DIVERTICULITIS

inflammation of pericolonic fat (98%)
diverticula (84%)
bowel wall thickening of 4-12 mm (70%)
abscess (47%)
fluid +/- air of peritonitis (16%); fistula (14%); obstruction (12%); intramural sinus tract (9%); ureteral obstruction (7%)

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BENIGN GASTRIC ULCER

projection beyond luminal contour
depth > width
smooth fading of gastric folds
lesser curvature (not reliable)
concomitant duodenal ulcers
Hampton’s line (1-mm lucent line)
persistent pooling of barium in crater

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ENDOMETRIOSIS

Involves bowel 15-20%
Extramucosal mass effect at rectosigmoid junction
Tx: Hormonal therapy, Resection
Usually asymptomatic

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MIRIZZI SYNDROME

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ZOLLINGER-ELLISON

Gastrinoma: 60% malignant
Multiple ulcers of stomach + duodenum
Tx: gastrectomy
10% ectopic (stomach, duodenum, splenic hilum)
50% of Z-E ==> MEN-1

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FAMILIAL POLYPOSIS COLI

autosomal dominant (33% sporadic)
adenomas ==> colon Ca
absent at birth
adenomas develop in teenagers
associations:
desmoid tumors
SB adhesions

POLYPOSIS SYNDROMES

Inher Malig Type
familial polyposis coli AD + adenoma
Gardner syndrome AD + "
Turcot syndrome AR CNS "
Peutz-Jeghers syndrome AD + hamartoma
Cowden syndrome AD ? "
juvenile polyposis coli ? - inflamm
Cronkhite-Canada syndrome NR - "

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CANDIDA ESOPHAGITIS

Immunocompromised
Odynophagia
“Shaggy” esophagus: Suggest AIDS

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CROHNS DISEASE

Crohn disease ulcerative colitis
Location right side left side
Ulcers deep shallow
Contraction no yes
Ileocecal valve thickened gaping
Fistulae yes no
Eccentricity yes no
Carcinoma slight increase marked increase
Megacolon unusual yes

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GASTRIC VOLVULUS

Organoaxial
rare in kids
associated with large hiatus hernia
rotation along long axis of stomach

Mesenteroaxial
antrum lies above cardia (i.e., rotation around line connecting greater and lesser curvature)
form seen in neonates
obstruction at pylorus or GE junction
usually acute
associated with eventration of LEFT hemidiaphragm or diaphragmatic hernia

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POLYP

ADENOMATOUS POLYP

Villous
Cancer Risk: <1 cm = 10% >2 cm = 54%

Tubular (More Common)
Cancer Risk: <1 cm = 1% >2 cm = 34%

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GASTRIC CARCINOMA

GASTRIC NARROWING

neoplastic
carcinoma (linitis plastica)
lymphoma
metastases
inflammatory
caustic
radiotherapy
granulomatous disease: Crohn disease, TB, sarcoidosis
eosinophilic enteritis

GASTRIC CARCINOMA

location:
60% lesser curvature
30% GE junction
10% greater curvature
probability of malignancy of an ulcer:
fundus 90%
greater curvature 70%
lesser curvature 10-15%

3rd most common GI malignancy (after colorectal + pancreas)
95% adenocarcinoma (rarely squamous cell or adenoacanthoma)
predisposing factors:
pernicious anemia (2X risk)
chronic atrophic gastritis
adenomatous + villous polyp (7-27% are malignant)
gastrojejunostomy

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BOWEL WALL THICKENING

hemorrhage
edema
ischemia
sprue
malabsorption
hypoproteinemia
Whipple disease
amyloidosis
Henoch-Schonlein syndrome
abetalipoproteinemia
Crohn disease

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PNEUMOTOSIS CYSTOIDES COLI

complication: assymptomatic large pneumoperitoneum (may persist for months/years)

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GASTRIC LYMPHOMA

Secondary Involvement

Primary
NHL
MALT- H. Pylori

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GLYCOGENIC ACANTHOSIS

benign (no malignant potential)
degenerative accumulation of glycogen in squamous epithelium
multiple small 1-3mm mucosal nodules in mid to distal esophagus
Asymptomatic

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ULCERATIVE COLITIS

acute
fine mucosal granularity
"double tracking" = longitudinal submucosal ulcers
"collar button" ulcers
"thumbprinting" = symmetric thickening of colonic folds
pseudopolyps = islands of edematous mucosa and granulation tissue
subacute
inflammatory polyps (sessile)
coarse granular mucosa
chronic
"lead pipe" colon = rigidity + symmetrical narrowing of lumen
"burnt-out colon" = distensible colon without haustral markings
filiform polyposis = postinflammatory polyps (10-20%)

complications:
toxic megacolon
colon Ca (1-16%)
strictures (10%)

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ANGIOSARCOMA

THOROTRAST

previously used contrast agent
accumulated in RE system
liver
spleen
lymph nodes
thorium emits alpha particles
associated with:
hepatobiliary Ca (Angiosarcoma)
leukemia
aplastic anemia
dense liver and spleen
"bone within a bone"

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BUDD-CHIARI

etiology:
thrombus (OCs, dehydration, septicemia, polycythemia vera, paroxysmal nocturnal hemoglobinuria)
congenital (web in hepatic v. or IVC)
tumor or other mass (eg, hydatid cyst)
sickle cell anemia
trauma

findings:
HM
ascites
esophageal varices
"hot" caudate lobe

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AMIODARONE TOXICITY

Ddx: Dense Liver
hemochromatosis
hemosiderosis
Wilson disease
Thorotrast
amiodarone
gold (for RA)
thallium overdose
glycogen storage diseases

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CARCINOID

"rule of one-third"
1/3 of GI carcinoid in SB
1/3 ==> mets
1/3 have 2nd malignancy
1/3 multiple

90% from distal ileum or appendix
90% of appendicial tumors

desmoplastic reaction ==> kinking + angulation of SB
angio: intensely vascular lesions

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CHOLEDOCHAL CYST I

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DOXY ESOPHAGITIS

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EMPHYSEMATOUS CHOLECYSTITIS

males (3:1), esp. diabetics
usually acalculous
high mortality

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GIST

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HCC

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INSULINOMA

Usually solitary
85% benign
Hypervascular

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INTUSSUSCEPTION

75% in kids <2 y/o
ileocolic (75%), ileo-ileocolic (15%)
90% idiopathic
leading point: lymphoid tissue (possibly increased 2' to enteritis)
in older kids + adults (ileo- or colocolic)
Meckel diverticulum
Peyer's patches
lymphoma
large mesenteric nodes
duplications
polyps
"currant jelly" stools
"coiled spring" on BE
** transient intussusception: a/w sprue

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CHOLEDOCHOLITHIASIS

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MESENTERIC PANNICULITIS

Ddx
Neoplasm: Met, Carcinoid, Sarcoma or desmoid tumor
Inflammatory: pancreatitis, inflammatory bowel disease, and extra-abdominal fat necrosis (ie, Weber-Christian disease), mesenteric adenitis, acquired immune deficiency syndrome, Whipple's disease, sprue, sarcoidosis, or tuberculosis

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SBO

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SMA SYNDROME

Partial obstruction of third part of duodenum by superior mesenteric artery (SMA)
Seen with:
marked weight loss
anorexia nervosa
total body casting
X-ray:
distension of proximal duodenum
classically disappears when prone

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SPRUE

gluten enteropathy
celiac disease (kids), nontropical sprue (adults)
hypersensitivity to gluten
tx: remove gluten from diet
tropical sprue
clinically & radiologically similar to nontropical sprue
tx: folate, B-12, antibiotics
a/w ** transient intussusception
esophageal Ca () + small bowel Ca (QUESTIONABLE!!)
diffuse intestinal lymphoma (rare; except in Middle East)

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UC

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SIGMOID VOLVULUS

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GIARDIASIS

Nonspecific findings
Thickening, distortion and spasm of the duodenum and the proximal jejunum
rapid transit of barium
segmentation and increased luminal fluid due to hypersecretion and hypermotility, simulating sprue.

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PORCELAIN GALLBLADDER

0.6-0.8% of cholecystectomy patients
80% female
10-20% develop gallbladder Ca
90% associated with gallstones