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INFLAMMATORY DISEASES:

 Esophageal Strictures GASTROESOPHAGEAL REFLUX DISEASE

 Gastroesophageal Reflux Disease (GERD)
 Peptic Ulcer
- Regurgitation
 Gastroenteritis
 Regional Enteritis (Crohn Disease) - Results from an incompetent cardiac sphincter
 Appendicitis which allows the backward flow of gastric acid
 Ulcerative Colitis and contents into the esophagus

Reflux Esophagitis:
ESOPHAGEAL STRICTURES
- The primary cause of esophageal inflammation
- Abnormal narrowing of the esophagus
Clinical Manifestations: heart burn or
Caused by: symptomatic reflux
 Ingestion of acoustic materials (strong Etiology: No definitive pathologic cause
acid or alkalines)
 Any factor that inflames the mucosa and Chronic Complications:
creates scarring
 Esophagitis
Caustic Agents:  Stricture
 Esophageal Ulcer
 Household cleaners
 Detergents containing sulfuric acid and Diagnosis:
sodium hydroxide
EFFECTS: Esophageal Manometry:
Edema, Swelling or perforations  Used to determine the upper and lower
 Endoscopy: Used to assess the damage esophageal sphincter
to the esophagus
pH monitoring or the extended pH probe
Treatment:
 The gold standard
 Corticosteroids Therapy
- For esophageal reflux Acid perfusion ( Bernstein) test
 Special mercury-filled tubes
- Used to maintain proper patency Esophagoscopy
EXAMPLES: Barium Swallow
Hurst dilator
Maloney dilator UGIS
Pneumatic balloon dilator
 Not considered a useful test
Radiographic Appearance:

Sonography:

- Demonstrates more episodes of reflux in

comparison to UGIS

- Provides functional and Morphologic information

- Useful for identifying patient who should be

referred for pH monitoring
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Causative Factors:

NSAIDS

Treatment:  Inflame the mucosa

 Rationale: because they are able to
Head Elevation
diffuse through the mucosa into the
Avoid Coffee or Alcohol epithelium and damage the epithelial cells.

 Stimulate acid secretion H. pylori

Avoid chocolate and smoking  Increases gastrin production

 Increases susceptibility of the mucosa to
 Decreases sphincter competence acid damage

Antacid - Found in adults of all ages

 Used to wash the gastric acids out of the - Almost always benign
esophagus
 Used for pain relief Diagnosis:

Histamine 2 blockers ( H blockers)  Endoscopy

 Double contrast GI studies
 Used to inhibit their production or
prokinetic agents Radiographic Appearance:
 Used to enhance motility  Radiating spikelike wheels of mucosal
Surgical Intervention folds that run to the edge of the crater
 The edge of the ulcer appears round and
 Last option regular
 For those who do not respond to medical
therapy

PEPTIC ULCER

- An erosion of the mucous membrane of the

lower end of the esophagus, stomach or
duodenum

- Results from disruption of the normal mucosal

defense and repair mechanism

Most Common Sites:

 Duodenal Bulb
 Lesser curvature of the stomach
Treatment:

Food ingestion or antacids

Clinical Manifestations:
 provide temporary relief
 Pain above the epigastrium radiation to
Multidrug Therapy
all parts of the abdomen (main symptom)
 Consistent pain and generally begins  Antibiotics
midmorning  Acid-blocking drugs
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Proton pump inhibitor, omeprazole or  Relief of nausea and vomiting

lansoprazole, clarithromycin, amoxicillin or
metronidazole and bismuth citrate Radiographic Appearance:

 Used to eradicate H. pylori Complete erosions:

 Slitlike collections of barium surrounded

by radiolucent halos of swollen, elevated
Surgical Intervention mucosa.

 Rarely performed Scalloped or nodular antral folds

 Required only for complications of ulcer

Complications:

 Ulceration into an artery (most common)

 Bleeding
 Perforation
 Pneumoperitoneum
 Peritonitis
 Life-threatening haemorrhage
 Edema
 Spasm
 Bowel obstruction

CT Scan and Conventional Erect Abdominal

Radiography:
Antral Gastritis:
- Used to confirm perforations
 Decrease distensibility of the antrum in
combination with thickened mucosal folds
GASTROENTRITIS within the antrum

- Inflammation of the mucosal lining of the Cause of Antral Gastritis:

stomach and small bowel
 Alcohol
 Smoking
 H. pylori infection
Causes of Gastroenteritis:
Erosive Gastritis:
Ingestion of foods contained with salmonella:
 A precursor to gastric ulcer formation
 Poultry Meat
 Dairy Products Causes of Erosive Gastritis:
 Eggs
 Aspirin
Diagnosis:  NSAIDs
 Alcohol
Double contrast studies of the stomach
 Steroids
- Used to identify gastric erosions  Physical Stress
 Trauma
Treatment:  Viral or Fungal Infections
 Proper fluid intake management REGIONAL ENTERITIS:
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 Crohn disease or granulomatous colitis

 A chronic inflammatory bowel disease
 A chronic disease characterize by periods
of exacerbation interspersed with periods
of inactivity
 Etiology: Unknown
 Most Common Site: Lower Iluem (ileum
and cecum)

Sonography:
Clinical Manifestations:
 Target sign seen in cross-section
 Suggestive of appendicitis or acute bowel
obstruction Skip Areas:

 Presentation of the disease in two or more

areas with normal intervening bowel
Diagnosis:
between (regional)
 Combination of clinical, laboratory,
histologic and imaging findings ( for initial
diagnosis)
 Small bowel series
 Enteroclysis
 Double contrast BE

Treatment:

Drug therapy

 Used to decrease inflammation

 Used to relieve diarrhea
 Used to treat infection

Bowel resection Radiography:

 If perforation or haemorrhage is present  Reserved for evaluating for the presence

of obstruction, perforation or toxic colon
Radiographic Appearance: distention

Cobblestone Appearance: Small Bowel Barium Studies:

 Due to the combination of mucosal edema
and crisscrossing fine ulcerartions
String Sign
 When the terminal Ileum is so diseased
and stenotic that the barium mixture can
only trickle through a small opening that
looks like a string
 The primary method for this disease
Small Bowel Follow Through (SBFT):
 A screening tool prior to capsule
endoscopy examinations
Barium enema:
 Reserved for patients with unsuccessful
colonoscopies or those with
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contraindications ( e.g. anticoagulant Treatment: Surgical Intervention (most common)

therapy)
Radiographic Appearance:
Transabdominal Sonography:

 Used to demonstrate the presence of the

disease through finding of bowel wall
thickening (>2-5mm)

APPENDICITIS

- An inflammation of the vermiform appendix

resulting from an obstruction caused by a fecalith
or rarely by a neoplasm

- The most common abdominal surgical

emergency

- The most frequent in the late teens and 20s

Clinical Manifestations:

 Initial Pain in the epigastrium that moves

to the RLQ and becomes persistent
 Nausea and vomiting
- A reflex symptom
- Rationale: because the vagus nerve
supplies both the stomach and the
appendix
 Low grade fever
 Sudden onset of constipation
 Elevated WBC’s count

Diagnosis:

 CT
 Sonography

Complications: Ulcerative Colitis

 Abscess formation  An inflammatory lesion of the colonic
 Gangrenous appendicitis mucosa
 Perforated Appendicitis  Generally starts in the rectum and spreads
 General Peritonitis to the sigmoid
CT: The most accurate imaging modality for Etiology:
evaluating patient who do not have a clear clinical
diagnosis of acute appendicitis  Unknown
 Autoimmune disease
SONOGRAPHY:
Clinical Manifestations:
 An alternative to CT and used for
diagnosing suspected appendicitis  Intermittent spells of bloody diarrhea
 Preferred in children and pregnant women  Abdominal cramping
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Radiographic Appearance: with skip areas

 Rough, cobblestone appearance Often results in Rarely produces

 Irregular colon outlines megacolon and megacolon or
 Lead pipe sign bowel perforations bowel perforations
and frequently
- Loss of colon haustration and mucosal
progresses to
edema cancer
Diagnosis:

 Sigmoidoscopy Radiographic Appearance:

 Colonoscopy
 Barium Enema
- Used to support the clinical diagnosis
- Used to assess the progression of the
disease
- Contraindicated for patients with toxic
colitis

Complications:

 Colon Strictures
- Rare complication
 Toxic colitis or Megacolon

Treatment:

 Dietary Restrictions
 Steroid Therapy
- Orally or rectally
 Surgical Intervention
- If obstruction or neoplasm develops
- Removal of the colon from cecum to
sigmoid with established ileostomy or
ileoractal or ileonal anastomosis

ULCERATIVE COLITIS VS. REGIONAL

ENTERITIS
ULCERATIVE REGIONAL
COLITIS ENTERITIS

A disease of the Affects all the

mucosa of the colon layers of the bowel

Typically begins at Usually begins in

the anus and the terminal ileum
ascends and cecum and
descends through
the bowel often