Upper GI Pathology

Normal levels of the esophagus that are narrowed

C6, T3, T4-5, T10

Extrinsic causes of Abnormal Stenosis

aortic aneurism
tumour
achalasia
double ring aortic arch

Intrinsic causes of Abnormal Stenosis

ingestion of corrosives
varices
neoplasia
esophagitis
polyps
cutting
stomach acids

True of False: The most common symptom associated with esophageal disorders is pain

True

True of False: The major cause of reflux esophagitis is dyspepsia

False (dyspepsia isn't a cause. GERD, vomit, hernia, irritant foods, intubation, and corrosives are causes)

What is the most common area for ulcers in the GI

duodenum/duodenal bulb

What is a complication of a rolling hiatus hernia?

volvulus formation

What is a complication of ulcers?

fibrosis and stricture formation
perforation
gastric outlet obstruction
hemorrhage

What is the radiographic sign for a sliding hiatus hernia?

many thick folds without parallel orientation in the posterior mediastinum

What disorder can be visualized by serpiginous and wormlike filling defects in the esophagus?

esophageal varices (aka rosary beads)

What is the most common abnormality detected on and upper GI examination?

hiatus hernia

True or False: Achalasia is a mechanical obstruction

False, it's a functional obstruction

Does achalasia have a difficulty relaxing or contracting the LES?

difficulty relaxing

What do air-fluid levels detected on a lateral chest x-ray indicate?

hiatus hernia (can be an abscess if well circumscribed)

What are the major symptoms of esophageal diseases?

dysphagia
heart burn

What is the age group and predominant sex related to cancer of the esophagus?

50-70 years
male

What is the age group and predominant sex related to cancer of the stomach?

70-80 in low risk countries
40's in high risk countries (Japan, Chile, East Europe)
5:1 male predominance

How does stomach cancer appear on a radiograph?

thickened walls
large, irregular mass

What causes pyloric stenosis?

congenital: hypertophy of the circular layer of smooth muscle in the pyloric region
Acquired: ulcers, cancer

What part of the stomach most often gets cancer?

distal stomach

How can ulcers be treated?

less caffeine and alcohol
antibiotics to treat H. pylori
antacids to neutralize acids

What type of ulcer is considered pre-malignant?

gastric ulcer

What must be visualized to have an unequivocal diagnosis of a duodenal ulcer?

the ulcer crater

What are the major complications of peptic ulcer disease?

hemorrhaging

What is the most common cause of gastric outlet obstruction?

PUD

What is the modality of choice for pyloric stenosis?

ultrasound

What does pyloric stenosis appear as when imaged with the modality of choice?

thickened pyloric muscle, elongated pyloric canal, and a doughnut shape when on transverse scan

What condition has symptoms of aspiration and dysphagia?

Zenkers Diverticulum

What is the best way to view PUD?

endoscopy

What is the most common tracheo-esophageal fistula?

Blind pouch (atresia of the esophagus with distal portion of esophagus attached to the trachea)

How do you radiograph a TE fistula?

plain x-ray (no contrast)
water soluble contrast study (fluoro and a catheter)

What conditions would be radiographed if the patient was in a trandelenburg position?

esophageal varices
TE fistula (to prevent aspiration)

What type of breathing technique should a radiographer utilize to demonstrate varices?

valsalva in the supine or trandelenburg position

What is the most common location of esophageal cancer?

lower 2/3 of the esophagus

What are the major causes of esophageal cancer?

increased alcohol intake
smoking

If a patient complains of progressive dysphagia and sudden hemoptysis, what condition would they most likely have?

esophageal cancer

What's another word for cardiospasm?

achalasia

What is an anatomical condition that can cause esophagitis

incompetent lower esophageal sphincter

What are some non-anatomical causes of esophagitis?

vomitting
irritant foods
corrosive agents
prolonged nasogastric intubation

What type of ulceration could reach the submucosa layer of the GI tract?

deep ulceration

What is the prognosis of esophageal cancer?

less than 10% 5 year survival rate

What are some of the treatments for achalasia?

drugs to relax the sphincter
botox injections to paralyze
laproscopic myotomy
balloon in the sphincter to dilate

What is the difference between a benign and malignant ulcer radiographically?

benign: radiation of mucosal folds of the edge of the crater
malignant: irregular folds that merge into a mound of tissue

What are the indications for performing a Barium Swallow Study?

Dysphagia
Pain

What are the contraindications of performing a Barium Swallow Study?

sensitivity to the contrast

What is the routine procedure for a Barium Swallow Study?

Esophogram: RAO, L lat, AP/PA, LAO

What are the complications when performing a Barium Swallow Study?

leak due to perforation
aspiration

Upper GI series contraindication

complete bowel obstruction

Patient prep for Upper GI series

NPO after midnight
no smoking
no gum

What concentration of barium is needed for a single contrast study

30-50% w/v

What concentration of barium is needed for a double contrast study

up to 250% w/v

When studying motility, what type of study should be performed?

single contrast study

When studying mucosa, what type of study should be performed?

double contrast study

RAO upper GI

loop in profile
Ba in pyloris

R lat upper GI

duodenal loop in profile
Ba in pyloris

PA upper GI

entire stomach
Ba in pyloris and body

LPO upper GI

bulb without superimposition
Ba in fundus

AP upper GI

entire stomach visualized
Ba in fundus