Gastrointestinal system
- Created by: Emmatjies
- Created on: 18-05-20 15:03
Tracheoesophageal fistula
The lack of development of the lumen resulting in a blind pouch
Atresia- an abnormal narrowing of a body passage.
EA- oesophageal atresia, TEF- Tracheo-oesdophageal fistula
4 types:
- EA with distal TEF
- Isolated EA
- Isolated TEF
- EA with proximal TEF
- EA with double TEF
CXR for initial assesment, CT without contrast (3D) for surgical planning
Oesophagitis
Gastro-oesophageal reflux is most common cause, also caused by infection, meds and physical injury.
Develops when lower oesophageal sphincter loses effectiveness.
Barium swallow is imaging used.
Pathology causes superficial ulcerations.
Oesophageal carcinoma
Smoking and alcohol are two major factors.
Caused by underconsumption of fruit and veg, Asbestos, drinking especially hot beverages.
Causes dysphagia
Direct -into surrounding fascia
Blood- Next capillary networks (lungs)
Lymphatics- Multiple affected- need to be removed
PET CT- detects distant mets, but due to poor spatial resolution the small mets may be missed.
Barium swallow
Surgical ressection.
Oesophageal varicies
Dilated veins in the wall of the oesophagus.
Result of increased pressure in portal venos system
When portal blood cannot go along the usual pathway it chooses other pathways such as oesophagus.
Downhill varices- blood from head cannot reach heart through usual pathway, and so goes through oesophagus.
Double contrast barium swallow
Treatment is vasoconstrictor.
Achalasia
Narrowing of distal oesophagus caused by incomplete relaxation of oesophageal sphincter.
CXR- Tortuous oesophagus, dilated, widened mediastinum.
Barium studies or endoscopy
Meds relax sphincter allow for eating meals.
Dysphagia, regurgitation, chest pain, and weightloss.
Hiatal hernia
Either sliding or narrowing
If its small its monitored through barium study
If its large its seen on a CXR
No treatment needed.
Peptic ulcers
Group of inflammatory processes in the stomach, duodenum caused by inappropriate secretion of gastric acid and pepsin.
Complications are haemorrage, gastric outlet obstruction and perforation.
Causes dyspepsia (indigestion), nausea, abdo pain
Gastric carcinoma
Is an adenocarcinoma
Monitored through endoscopy, double contrast and barium meal, CT liver lung and brain for mets.
Spread through lymph.
Treatment surgical ressection
Gastritis
Inflammation of the stomach
Caused by alcohol, corrosive agents.
Changes the normal pattern of gastric mucosa, which can lead to peptic ulcers
Small bowel obstruction
Causes by constipation, foreing bodies, failure of peristalsis, MS,
Plain AXR is sufficient, central dilated loops proximal to obstruction
Surgery needed to decompress bowel prevent necrosis or bowel perf.
adynamic ileus
When fluid and gas do not move through the bowel, when there is no obstruction.
Intersussception
Telescoping of of a part of intestinal tract caused by peristalsis.
More common in children
Barium enema or if risk of perf then gastromiro
Diverticula
They are out pouchings of herniated mucosa.
Diverticulosis is multiple diverticula
Diverticulitis- When diverticula rupture and become inflammed with strictures.
Treatment is a diet adjustment, and antibiotics
Imaging is colonoscopy or CT colonography
Ulcerative colitis
A form of irritable bowel syndrome
Causes inflammation and ulcers in the mucosa of the colon and rectum. Develops retrogradely
No skip lesions, has remissions and exudative periods.
Bowel wall is thickened
Pseudopolyps may also be evident
Stearrohea- mucus-like stools with blood
Considerable chance of developing colerectal cancer.
Loss of haustrations on barium enema or colonoscopy.
Crohn's disease
Inflammatory response in any area of the digestive tract
Slow progesssion
Skip lesions (good bowel inbetween affected bowel)
Bowel wall is thinned, and lacks submucosa pattern
Fistulas and strictures are common with porridge like stools
Requires regular monitoring
CT colonography is gold standard then MRI and U/S
Comb sign and target sign
Polyps
Non-plastic polyps-
- Hyperplastic Polyps
- Juvenille polyps
Neoplastic polyps-
- Tubular adenoma
- Villous adenoma
Polyps over 1 cm are potentially malignant. Colorectal cancer develops from neoplastic polyps,
Colorectal carcinoma
Adenomas are pre cursers to carcinoma
It spreads through blood. Portal vein to the liver, to the lung and then to bone.
Apple core lesions
CT is done to identify mets in the liver as that is wher eit first metastises to.
Imaging: Colonscopy, Barium enema, CT colongraphy,
Mostly found in the rectum and sigmoid.
Large Bowel Obstruction and volvulus
Less acute than SBO.
Thin and stretched bowell wall Lose of haustrations.
Causes, volvulus, diverticulitis, colorectal cancer, perforation and sepsis.
Volvulus is twisting of the bowel, creates a coffee bean appearance, often in the caecum and sigmoid.
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