Rad Pathology Week 2 Day 2 (Part 1)

Front 1

• Congenital form -results from the failure of the esophageal lumen to develop completely separate from the trachea
• Acquired type — caused by cancer, infection, trauma, instrumentation perforation
• Both cases of this require immediate surgical repair. Without repair starvation or aspiration will result

Back 1

Tracheoesophageal Fistula

Front 2

• Acute form of this is most commonly the result of reflux of stomach contents into distal esophagus.
> GERD — gastroesophageal reflux disease
• it may also be caused by infection
> Herpes virus

Candida

Back 2

Esophagitis

Front 3

• A condition related to severe reflux esophagitis in which normal squamous liningof the lower esophagus is destroyed and replaced by columnar epithelium similar to that of the stomach
• A hiatal hernia is commonly demonstrated on a radiograph
• Candida (fungal) and herpesvirus are the organisms most often responsible for infectious esophagitis

Back 3

Barrett’s
Esophagus

Front 4

Progressive dysphagia in a person over 40 years must be assumed to be caused by cancer until proven otherwise
There is a strong correlation between excessive alcohol, smoking and
Double-contrast barium swallow studies are used to detect these
CT has become the modality of choice when diagnosing people with this
If the cancer has not metastasized, surgical removal is an option. The prognosis for later stages is extremely poor

Back 4

Esophageal Cancer

Front 5

•Dilated veins in the wall of the esophagus

• caused by portal hypertension
> Portal hypertension is usually caused by cirrhosis
• May hemorrhage
• Double contrast barium swallow study will demonstrate snake or worm like filling defects
• Vasoconstrictors are used to constrict dilated vessels

Back 5

Esophageal Varices

Front 6

• Protrusion of a portion of the stomach into the thoracic cavity through the esophageal hiatus in the diaphragm
• 50% of the population reveal hiatal hernias during UGI series
• May require surgery, but most often it fixes itself

Back 6

Hiatal Hernia

Front 7

• These when in the esophagus may be radiopaque or radiolucent.
• Radiopaque is often seen without the aid of contrast.
• Radiolucent is best seen with the aid of barium swallow.
• Two projections 90 degrees from each other required to truly determine object is lodged in esophagus.

Back 7

Foreign Bodies

Front 8

• May be a complication of:
Esophagitis
Peptic ulcer
Neoplasm
External trauma
> Instrumentation
• Some perforations may result from severe vomiting (the most common cause) or coughing, often from dietary or alcoholic indiscretion.
• Usually requires surgical intervention

Back 8

Perforation of the Esophagus

Front 9

is defined as inflammation of the stomach mucosa.
• Caused by irritants including:
> Alcohol
> Corrosive agents
> Infection
Helicobacterpylori can cause chronic gastritis that may lead to peptic ulcer disease.
• It changes the normal surface pattern of the gastric mucosa.
• Eliminating causative agents, antacids, and antibiotics are used as treatment

Back 9

Gastritis

Front 10

• is also known as (IHPS)
• Two muscular layers of the pylorus become hyperplastic and hypertrophic
• Causes are thought to be a combination of environmental and hereditary factors.
• Demonstrates as:
> Lengthening of the gastric antrum and pyloric canal
> Edematous and thickened mucosa

causes obstruction (incomplete or complete), preventing food from entering into the duodenum.
• Can be palpated
> It is often described as a mobile hard “olive.”

Back 10

Pyloric Stenosis

Front 11

• is a group of inflammatory processes involving the stomach and duodenum
• It is caused by the action of acid and the enzyme pepsin secreted by the stomach.
• Most common location is the lesser curvature.
• Disease spectrum varies from small and shallow superficial erosions to huge ulcers that may perforate.

• Major complications:
> Hemorrhage
Gastric outlet obstruction
> Perforation
• is the most common cause of acute upper gastrointestinal bleeding
• Duodenal ulcer is the most common manifestation of peptic ulcer disease
• The majority of gastric ulcers occur on the lesser curvature of the stomach
• Similar treatments as gastritis

Back 11

Peptic Ulcer Disease

Front 12

• This cancer is rare in the United States.
> It is prevalent in Japan, Chile, and parts of Eastern Europe.
• Pain is not an early symptom, so diagnosis usually occurs late stage.
• CT is the best modality for staging of cancer of the stomach and prognosis is poor.
• Predisposing risk factors:
> Atrophic gastric mucosa, as in pernicious anemia 10 to 20 years after a partial gastrectomy for peptic ulcer disease.
Treatment usually requires resection

Back 12

Cancer of the Stomach

Front 13

• Most often caused by fibrous adhesions created from previous surgery
• External hernias are the second most common cause of obstructions
• Other causes:
o Luminal occlusion (gallstone, intussusception)
Intrinsic lesions (neoplastic or inflammatory
strictures, vascular insufficiency)
• Complete mechanical bowel obstruction demonstrates little or no gas in the colon
• Surgery is usually required to distend the bowel repair the obstruction

Back 13

Small Bowel Obstruction

Front 14

• Also termed paralytic ileus- is disorder of intestinal motor activity in which fluid and gas do not move through a non obstructed bowel
• occurs more often than mechanical bowel obstruction.
• Neural, hormonal, and metabolic factors can trigger reflexes that impede intestinal motility.
• It occurs in almost every patient who undergoes abdominal surgery. If caused by surgery, it will usually relieve itself.
• A nasogastric tube may also be used to reset the bowel

• Other causes:
5. Peritonitis
Medications that decrease intestinal peristalsis (those with an atropine-like effect),
> Electrolyte and metabolic disorders
> Trauma

Back 14

Adynamic Ileus

Front 15

the telescoping of one part of the intestinal tract into another because of peristalsis.
> It forces the proximal segment of bowel to move distally within the outer portion.
• This is a major cause of obstruction in children.
• May be reduced my rectal insufflation

Back 15

Intussusception

Front 16

is the inflammation of the appendix.
• Causes:
Obstruction of fluid flow by fecalith or scarring
• Complications:
Gangrene
Abscess
> Perforation
• Appendicitis is more common in children.
• CT will demonstrate an appendiceal abscess as a round or oval mass of soft tissue density that may contain gas
• An appendectomy is usually required as treatment

Back 16

Appendicitis

Front 17

are outpouchings that are acquired herniations of mucosa and submucosa through the muscular layers at points of weakness in the bowel wall.
• Incidence increases with age
• It occurs most commonly in the sigmoid portion.
• Fecal material trapped in the diverticulum causes inflammation of the mucosal lining lead to diverticulitis
• Early diverticulosis can be treated with diet and exercise. Diverticulitis may require surgery and antibiotics

Back 17

Diverticulosis

Front 18

is a complication of diverticulosis of the colon.
• It is defined as necrosing inflammation in the diverticula.
• Complications:
Perforation
> Abscess
> Fistulas to adjacent organs

Back 18

Diverticulitis

Front 19

is an idiopathic inflammatory disease of the bowel.
> It may have an autoimmune or psychogenic factor (stress exacerbates condition).
• A characteristic feature is alternating periods of remission and relapse.
• Less than 15% of patients with ulcerative colitis will develop the ominous complication of toxic megacolon
• With chronic ulcerative colitis, the colon becomes rigid, haustral patterns disappear and the colon takes on a lead pipe appearance
• Diet, nutritional supplements, decreased stress, and anti-inflammatory drugs are used to treat this. Surgery may also be necessary

Back 19

Ulcerative Colitis

Front 20

is characterized by the abrupt onset of lower abdominal pain and rectal bleeding.
• Diarrhea is common.
> It is often accompanied by abdominal tenderness.
• It is most common in those over 50 years old with have a history of cardiovascular disease. Usually goes away on its own but surgery may be required for infarctions

Back 20

Ischemic Colitis

Front 21

refers to several conditions that have an alteration in intestinal motility as the underlying pathophysiologic abnormality.
• Most common symptoms are alternating periods of constipation and diarrhea.
• Treatment include: removing trigger food from diet, relaxation, meditation and exercise

Back 21

Irritable Bowel Syndrome

Front 22

is the third leading cause of cancer death in the United States.
• Peak age incidence is 50 to 70 years old.
• It is twice as common in men.
• Predisposing factors:
Long-term ulcerative colitis

Back 22

Cancer of the Colon

Front 23

• About 70% of these result from primary colonic carcinoma.
> Diverticulitis and volvulus account for most other cases.
• It is usually less acute than small bowel
obstructions.
> Symptoms develop more slowly.
Fewer fluid and electrolyte disturbances are produced.
Enemas or surgery may relieve the obstruction

Back 23

Large Bowel Obstruction

Front 24

refers to a twisting of the bowel on itself.
May cause obstruction.
• Most common sites:
> Cecum
> Sigmoid
Enemas or surgery may relieve this

Back 24

Volvulus of the Colon

Front 25

• Varicose veins of the lower end of the rectum that cause pain, itching, and bleeding
• are caused by increased venous pressure
• Treatments may include rubber band ligation or
surgical removal

Back 25

Hemorrhoids

Front 26

Two major types of these:
Cholesterol — predominant type in the United States.
> Pigment
• Predispositions:
Family history
Over age 40
> Overweight
> Female
• Ultrasound is the imaging modality of choice to diagnosis

Back 26

Gallstones (Cholelithiasis)

Front 27

is acute inflammation of the gallbladder.
• It is usually caused by cystic duct obstruction by a gallstone.

Back 27

Acute Cholecystitis

Front 28

is a rare condition that occurs when stasis, ischemia, and cystic duct obstruction (stones) allow the growth of gas-forming organisms in the gallbladder.
• It occurs most commonly in elderly men and in patients with poorly controlled diabetes mellitus.

Back 28

Emphysematous Cholecystitis

Front 29

refers to calcification of the gallbladder walls.
• It is caused by chronic cholecystitis.
> Walls become fibrous, then calcified.

Back 29

Porcelain Gallbladder

Front 30

Inflammation of the liver, caused by infectious or toxic agents and characterized by jaundice, fever, liver enlargement, and abdominal pain.

There are five types of this: A, B,C, D, and E.

A, an acute infection caused by a virus of the genus Hepatovirus is transmitted by contaminated food and water.
B, is transmitted by contaminated blood or blood derivatives in transfusions, by sexual contact with an infected person, or by the use of
contaminated needles and instruments.
C, caused by a virus of the genus Hepacivirus, are more serious infections that are transmitted through infectednd bodily fluids such
as blood and semen

Back 30

Hepatitis

Front 31

refers to the chronic destruction of liver cells and structure, with nodular regeneration of liver parenchyma and fibrosis.
• It is an end-stage liver disease.
• The major cause is chronic alcoholism (i.e., 10 to 20 years of alcohol abuse

• Other causes:
> Postnecrotic viral hepatitis
> Hepatotoxic drugs and chemicals
> Biliary cirrhosis
Hemochromatosis
• Most characteristic symptom — ascites
> Fluid accumulation in the abdomen
• Incurable and irreversible. A liver transplant is possible. Diet and exercise may treat the symptoms

Back 31

Cirrhosis

Front 32

is primary liver cell cancer.
• It is most common in those with cirrhosis.
• CT is modality of choice for diagnosis.

Back 32

Hepatocellular Carcinoma

Front 33

is the most common malignancy of the liver..
• Diagnosed via:
> CT
us
> MRI
> NM
• Prognosis is very poor

Back 33

Hepatic Metastasis

Front 34

is an inflammatory process in which protein- and lipid-digesting enzymes become activated within the pancreas and begin to digest the organ itself.
• Most common cause
> Excessive alcohol consumption
• Other causes
Gallstones obstructing bile flow

Back 34

Acute Pancreatitis

Front 35

results when frequent injury to the pancreas causes scar tissue.
• Recurring episodes usually result from chronic alcohol abuse.
> It causes the gland to lose its ability to produce digestive enzymes, insulin, and glucagon.
• Three symptoms:
> Pain
> Malabsorption causing weight loss
> Diabetes

Back 35

Chronic Pancreatitis

Front 36

is defined as walled- off fluid collections.
• They occur due to inflammation, necrosis, or hemorrhage.
• Causes:
Acute pancreatitis
Trauma

Back 36

Pancreatic Pseudocyst

Front 37

Most common type of this is
adenocarcinoma.
> Usually advanced at time of diagnosis.
> Prognosis is poor.
• Most common site is the head of the pancreas.
• CT is the most effective in detecting pancreatic cancer
• Other less common tumors:
Insulinoma
Gastrinoma
> Diarrheogenic islet cell tumors

Back 37

Cancer of the Pancreas

Front 38

is defined as free air in the peritoneal cavity.
• Causes:
> Perforation of a gas-containing viscus (surgical emergency)
> Abdominal, gynecologic, intrathoracic, or iatrogenic causes (does not require operative intervention)

Back 38

Pneumoperitoneum

Front 39

is enlargement of the spleen.
• It is associated with numerous conditions, including:
Infections (subacute bacterial endocarditis, tuberculosis, infectious mononucleosis, malaria)
> Connective tissue disorders
> Neoplastic hematologic disorders (lymphoma, leukemia)
> Hemolytic anemia
> Hemoglobinopathies
Portal hypertension (cirrhosis)

Back 39

Splenomegaly

Front 40

Most common cause of this is trauma.
> Rapid blood loss usually requires immediate surgery.
• It may be a complication of the palpation of a spleen enlarged by infection (especially infectious mononucleosis) or leukemia.

Back 40

Splenic Rupture