Gastrointestinal Pathology

congenital abnormality in which the organs of the chest and abdomen are arranged in a perfect mirror image reversal of the normal positioning

• congenital abnormality in which there is narrowing and elongation of the pyloric canal due to thickening of the pyloric sphincter
• vomiting, mild at first, increasing to projectile
• Radiographic Appearance: confirmed with ultrasound or S&D exam

failure of the esophagus to develop as a continuous passage ending in a blind pouch

• congenital - due to the failure of the esophageal lumen to develop completely separate from the trachea
• acquired - may be caused by malignancy in mediastinum, infectious process or trauma
• delayed surgical repair may result in aspiration pneumonia and become fatal

• congenital abnormality in which absence of marked reduction of the parasympathetic ganglion cells in the colorectal wall causes intestinal immobility and severe constipation resulting in enlargement of the colon
• Radiographic Appearance: abdominal radiograph will demonstrate excessive fecal material and gas due to constipation; barium enema may be performed

• congenital
• small pouch in the wall of the intestine, near the junction of the small and large intestines
• pouch is a remnant of tissue from the prenatal development of the digestive system producing acid causing ulcers in the bowel
• Radiographic Appearance: small bowel contrast exam will demonstrate the diverticulum as an outpouching near the distal ileum

difficulty swallowing

• backward flow of gastric contents into the esophagus
• develops with the lower sphincter fails
• produces burning chest pain
• Radiographic Appearance: demonstrated by barium study

• most occur at the esophagogastric junction
• progressive difficulty swallowing
• strong correlation between excessive alcohol intake, smoking, and esophageal carcinoma
• Radiographic Appearance: barium swallow will show irregularity in esophageal wall indicating mucosal destruction

• dilated veins in the wall of the esophagus that are most commonly the result of increased pressure in the portal venous system (portal hypertension)
• usually a result of cirrhosis of the liver
• Radiographic Appearance: serpiginous (wavy border) thickening of folds, which appear as round or oval filling defects during a barium study

• neuromuscular disorder in which the gastroesophageal sphincter fails to relax
• related to absence of ganglion cells in the distal esophagus
• Radiographic Appearance: barium study demonstrating progressively dilated esophagus with narrowing at distal end

• anatomical abnormality in which part of the stomach protrudes through the diaphragm and into the chest cavity
• most do not produce symptoms and are clinically of no importance
• Radiographic Appearance: demonstrated by S&D; large hiatal hernia may be demonstrated on CXR as soft tissue mass with air fluid level

• chronic inflammatory disease
• most involve terminal ileum of small bowel and/or proximal portion of the colon
• involves all layers of the intestinal wall
• ulceration is common, as well as fistula's
• irregular thickening and distortion of mucosal folds caused by submucosal inflammation and edema
• Radiographic Appearance: barium studies show irregular thickened mucosal folds, cobblestone appearance or string sign and skip lesions; CT also demonstrates thick mucosal walls

disease in which damage to the mucosal surface of the small intestine is caused by an immunologically toxic reaction to the ingestion of gluten and interferes with the absorption of nutrients

• blockage of the small intestine that may be due to adhesions from previous surgeries, hernias, intussusception, neoplastic or inflammatory strictures or vascular insufficiency
• Radiographic Appearance: will be demonstrated on either an upright of decubitus abdomen - air fluid levels will be seen and loops of bowel will the distended

occurs in the groin area when an organ, usually a part of the intestine, protrudes through the abdominal wall into the inguinal canal

telescoping of one part of the intestinal tract into another because of peristalsis (forces proximal segment of bowel to move distally within the ensheathing outer portion)

stricture due to a tumor or growth

• stricture due to inflammation
• Eg. Crohn's or ulcerative colitis

• inhibition of intestinal motility
• occurs to some extent in all patients who undergo abdominal surgery
• causes may include peritonitis, trauma, certain medications, electrolyte and metabolic disorders
• Radiographic Appearance: retention of large amounts of gas and fluid in dilated small and large bowel with no demonstrable point of obstruction

• diverticulum/diverticula is (are) outpouchings (herniations) of mucosa and submucosa through the muscular layers at points of weakness in the bowel wall (diverticulosis)
• low-fiber diets are thought to be main case of diverticular disease

• complication of diverticular disease, especially in sigmoid region
• retained fecal material trapped in a diverticula causes inflammation and possible perforation
• Radiographic Appearance: barium study demonstrates round or oval out-pouching projecting beyond lumen (usually multiple) with possible perforation and abscess

• inflammatory disease of the mucosal layer of the colon
• usually starts in the rectosigmoid region and may spread to involve the entire colon
• Radiographic Appearance: double contrast barium enema shows fine granularity of mucosa and progression of disease results in deep ulcerations (collar-button ulcers) extending into the submucosal layer

• Location: Crohn’stypically affects the terminal ileum of the small bowel and/or proximal portion of the colon; Ulcerative Colitis typically affects the rectosigmoidregion of the colon and may spread to involve entire colon
• Radiographic appearance: Crohn’s appears as skipped lesions; Ulcerative Colitis is continous

• growth that arises from the mucosa of the large intestine
• malignant polyp is sessile lesion (without stalk) with an irregular or lobulated surface or polyp larger than 2 cm in diameter
• benign growth is smooth with stalk (pedunculated)
• removed due to cancer of cancer risk
• Radiographic Appearance: double contrast barium enema will show filling defect; several images taken to confirm; screening for patients with family history

• most adenocarcinomas are found in the rectum and sigmoid
• two diseases which predispose to cancer of colon are ulcerative colitis and familial polyposos
• if detected early there is a high cure rate
• Radiographic Appearance: barium enema will demonstrate apple-core or napkin ring filling defect or demonstrate polyp larger than 2 cm

• refers to twisting of the bowel on itself
• may lead to obstruction
• most frequently involves cecum or sigmoid colon
• Radiographic Appearance: distended cecum, displaced upward and to the left and barium enema to confirm; distended rectum without haustral markings and a sausage of balloon shape and a barium enema to confirm (bird's-beak appearance)

• commonly referred to as gallstones
• made up of cholesterol making most stones radiolucent unless they contain some calcium
• Radiographic Appearance: ultrasound for confirmation; ERCP - diagnostic and therapeutic; KUB - cholelithiasis evident if stones calcified

• free air in the peritoneal cavity
• caused by perforation of gas-containing viscus indicating surgical emergency
• can also be resolving (post-op abdominal or gynecologic surgery)
• Radiographic Appearance: upright abdominal x-ray will demonstrate free air under diaphragm; easiest to recognize sickle-shaped lucency right side because of homogeneous density of liver; lateral decubitus view with left side down to demonstrate if patient too ill to stand

• functional disorder due to alteration in intestinal motility
• can cause cramping, bloating, gas, diarrhea, and constipation
• doesn't damage the bowel or lead to other health problems
• eating foods with fiber and eating small meals throughout the day may reduce symptoms
• Radiographic Appearance: no specific findings but patients with this condition usually undergo barium studies to rule out other pathology

• inflammation of the gall bladder
• usually occurs after obstruction of the cystic duct by an impacted gallstone in which mucosal wall has been injured allowing bacteria to enter
• Radiographic Appearance: ultrasound, NM, MR to demonstrate

• inflammatory process in which digestive enzymes become activated within the pancreas and begin to digest the organ itself
• excessive alcohol consumption common cause and can become chronic
• can be related to gallstones
• Radiographic Appearance: CT and ultrasound; barium studies - enlargement of the head can cause widening and pressure changes on the inner aspect of the duodenal loop