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Abdomen GI system FINAL

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Abdomen GI system FINAL

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    1. 1 Abdomen & GI system FINAL RT 91- Pathology Spring 2010

    2. 2 Regions & Quadrants of Abdomen

    3. 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. 4 Gastrointestinal System Alimentary tract- serves to digest & absorb food Consists of Mouth Pharynx Esophagus Stomach SM & LG bowel Rectum

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

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

    7. 7 Congenital and Hereditary Anomalies

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

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

    10. 10 Tracheoesophageal Fistula

    11. 11 Tracheoesophageal Fistula

    12. 12 Duodenal Atresia

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

    14. 14 Colonic Atresia

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

    16. 16 Hypertrophic Pyloric Stenosis

    17. 17 Hypertrophic Pyloric Stenosis

    18. 18 Hypertrophic Pyloric Stenosis

    19. 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. 20 Malrotation Small bowel on right and colon on left Cecum is not located in the RLQ

    21. 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

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

    23. 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. 24 Meckel’s Diverticulum

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

    26. 26 Celiac Sprue

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

    28. 28 Inflammatory Disease

    29. 29 Esophageal Strictures

    30. 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. 31 GERD 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

    32. 32 GERD

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

    34. 34 Peptic Ulcer

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

    36. 36 Barrett’s Esophagus

    37. 37 Crohn’s Disease

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

    39. 39 Appendicitis

    40. 40 Fecolith within Appendix

    41. 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

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

    43. 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. 44 Esophageal Varices

    45. 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. 46 Gastritis Evidenced by gas bubbles (produced by bacteria) in the stomach Wall

    47. 47 Endoscopy for Gastritis

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

    49. 49 Degenerative Diseases

    50. 50 Inguinal Herniation

    51. 51 Inguinal Herniation 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

    52. 52 Hiatal Hernia

    53. 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. 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

    55. 55 Bowel Obstructions

    56. 56 Mechanical Bowel Obstruction

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

    58. 58 Gallstone Ileus

    59. 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. 60 Paralytic Ileus Gas distributed throughout both LG & SB Normal bowel sounds are absent

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

    62. 62 Volvulus

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

    64. 64 Intussusception

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

    66. 66 Neurogenic Diseases

    67. 67 Achalasia

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

    69. 69 Diverticular Diseases

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

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

    72. 72 Zenker’s Diverticulum

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

    74. 74 Colonic Diverticula

    75. 75 Colonic Diverticula

    76. 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. 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. 78 Neoplastic Diseases

    79. 79 Leimyomas

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

    81. 81 Gastroesophageal Adenocarcinomas

    82. 82 Adenocarcinomas 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

    83. 83 Small Bowel Neoplasms

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

    85. 85 Colonic Polyps

    86. 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. 87 Colon Cancer 2nd most common cause of cancer mortality Adenocarcinoma is the most common type of colorectal cancer

    88. 88 Colon Cancer

    89. 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. 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. 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. 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. 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. 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

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