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 

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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.

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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.

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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.

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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.

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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.

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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 

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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

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Inflammation of the stomach

Caused  by alcohol, corrosive agents.

Changes the normal pattern of gastric mucosa, which can lead to peptic ulcers

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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.

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adynamic ileus

When fluid and gas do not move through the bowel, when there is no obstruction.

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Telescoping of of a part of intestinal tract caused by peristalsis.

More common in children

Barium enema or if risk of perf then gastromiro

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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

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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.

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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

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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, 

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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.

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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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