Digestive pathology

First part
Radiografie esogastroduodenala cu substanta de
contrast posisibil suspensie baritata centrata pe
1. From what is made of the
digestive system?
2. Methods of exploring the
digestive system?
 Pharynx
 • Nasopharynx: Extends from the base of the skull to
the soft palate.
 • Oropharynx: Located behind the mouth and extends
from the uvula to the hyoid bone.
 • Hypopharynx: Extends from the hyoid bone to the
cricopharyngeus muscle, which is located at the lower
end of the cricoid cartilage.
 Esophagus
 • The cricopharyngeus muscle, located at C5–6, is the
upper esophageal sphincter and demarcates the
transition between the pharynx superiorly and the
cervical esophagus.
 • The esophagus extends from the neck to the
gastroesophageal junction. The distal esophagus
passes through the diaphragmatic hiatus at
approximately T10.
Simple abdominal XRay
Used in emergencies.
Pneumoperitoneum
Oclusion
Barium swallow
a jeun
in the morning (secretions
accumulate in time)
In orthostatism
With barium sulfate (Barium is an
atom with high molecular mass
=> it absorbes the xrays)
-Oblique view of
a
normal barium
swallow shows
the
normal
impressions
made by the (A)
aortic
arch , (B) left
mainstem
bronchus
The esophagus
- 3 portions: (cervical), (thoracic),
(abdominal).
Eso-gastric junction - T11 lever -
> Hiss angle (<90 degrees)
Esophagus
a) Diverticulum:
◦ Pulsion
◦ Traction
◦ Zenker
b) Esophageal Ulceration
c) Esophageal Tumors
d) Smooth Esophageal Strictures
e) Irregular Esophageal Strictures
f) Motility Disorders
g) Hiatus Hernia
h) Esophageal Atresia & Tracheo-
Esophageal
 RADIOLOGIC
SEMIOLOGY

Dilatation

Addition image
Lacunar image Stenosis
Modificari de calibru
- dilatatie : crestere a calibrului » 3 cm
- stenoza benigna: centrata in ax,
contur neted, trecere lenta spre zona
supraiacenta
- stenoza maligna: excentrica, contur
neregulat, trecere brusca spre zona
supraiacenta, aspect de ’’cotor in
mar’’
Imag de aditie:
- ulceratia benigna (nisa): colectie
baritata rotunda sau ovalara, ce
proemina din lumen, inconjurata de
edem (zona lacunara perilezionala),
spre care converg pliurile mucoasei
(imag. Stelara)
- ulceratie maligna: nisa cu contur
neregulat, nodular, localizata
intraluminal, lacuna periulceroasa
proeminenta, asimetrica, pliuri
ingrosate ce se opresc la distanta de
nisa
- diverticul: imag de aditie, bine
delimitata, in care patrund pliurile
de mucoasa, fara edem perilezional
- fistula: traiect liniar, extraluminal,
ce poate comunica cu o alta
structura cavitara
- perforatia: imagine de aditie
voluminoasa, cu contur neregulat,
ce ocupa spatiul anatomic adiacent
mediastin
Imaginea lacunara (defect de umplere):
- intraluminala (corp strain)
- mucoasa (leziune tumorala)
- extramucoasa intraparietala (tumori
ce apartin stratului muscular)
- extramucoasa intraparietala
(compresiune extrinseca sau invazie de
la structurile adiacente)
Lacuna cu caractere de benignitate
este bine delimitata, nu intrerupe
pliurile mucoasei si nu afecteaza
peristaltismul

Lacuna cu caractere de malignitate

este imprecis delimitata, cu semiton
periferic (contur neregulat), intrerupe
conturul (baza larga de implantare)
Radiologic semiology
1. changes in the
calibre:
◦ Dilatation ( > 3cm
esophagus, >3 cm
small bowel)
◦ Stenosis
◦ Benign Malignant:
◦ 1. centred 1. excentric
2. not regular
◦ 2. net contour
contour
◦ 3. uniform 3. sudden
◦ 4. “funnel form” crossing to the
upper area
4. “apple core”
Achalasia
Absenta relaxarii sfincterului esofagian in
timpul deglutitiei
Absenta peristaltismului esofagian
Creste presiunea de repaus la nivelul
sfincterului esofagian
-dilatarea uniforma a esofagului, cu staza
alimentara ce realizeaza nivel aer-fluid
Alungirea esofagului ce determina cuduri
sau orizontalizarea port inf a esofagului
Cioc de pasare
Dilatation of the
esophagus with
air fluid level
Multiple filling
defects due to
stasis of the
ingested food
Absence of the
peristaltic
waves
Smoothly
tapered
stricture of the
lower
esophageal
sphincter
Diffuse esophageal spasm
Lumen obliterating
nonperistaltic
contractions (in the
smooth muscle part of
the esophagus) ->
compartmentalization of
barium swallow -> shish
kebab esophageal
configuration
 Contractii:

1.Primar
2.Secundary (in sens opus)
3.Third tipes, like the rings
sindromul Barsony - a
neurogenic disorder
characterized by
periodically contraction of
the lower oesophagus that
occiur spontanously
Pot simula diverticuli
 Stenosis
Postcaustic
stenosis: 1/3 inf
of the
esophagus,
centered, with
supraiiacent
dilatation, with
regular contour
- benign
Excentric
stenosis ; •
asymmetrical
junction with
the overlying
esophagus; •
Absence of
distension at
the passage
of the opaque
bowl; •
dilatation of
the
esophagus
2. changes in the mucosa:

◦ 1. Addition image: +
◦ 2. Lacunar image: -
Esophageal diverticula
Diverticulii se formeaza prin
hernierea mucoasei (diverticuli de
pulsiune) sau a tuturor straturilor
peretelui digestive (de tractiune)
Imagine de aditie, bine delimitate,
care proemina din contur, cu colet
larg(diverticul de tractiune) sau
ingust si cu staza baritata
(diverticul de pulsiune)
Diverticul Zencker
-diverticul de pulsiune
- Imagine de aditie sacciforma,
cu colet mai ingust decat sacul
diverticular, favorizand staza
(imagini lacunare la interior);
diverticulul se umple inaintea
esofagului si se goleste prin
prea plin; cand devine
voluminos comprima si
deplaseaza esofagul
Round addition image, 3 cm in
size, located in the upper
esophagus, homogenous fiiling
with contrast medium, neck
narrower than the diverticular
sac, esophageal mucoasal folds
are continuous
Pulsion diverticula:

1.contain only the mucosa

2. most of the times located in 1/3
inferior of the esophagus
3.at the faringo-esofageal jonction:
ZENKER
4.look like a light ball
5.have a neck and a sac
6.may have an air-fluid level
 Traction diverticula
- contain all
3 layers of
the wall
- they are
triangular in
form /
spiculiform
- medio-
esophageal
The baryted
exam reveals
an image of
addition
sacciform, with
a neck more
narrow than
the diverticular
sac, favoring
the stasis
(gaps in the
interior) ; at
the level of the
f-e jonction
Diverticulum
fills up to the
esophagus and
empties too full
• When it
becomes
voluminous
compress and
moves the
esophagus
Addition
image –
traction
diverticula
Barium
(contrast) on
the left
bronhia =>
the
diverticulum
cis
complicated
with a eso-
bronchial
fistula
Lacunar Image - BENIGN
-forma geometrica bine
delimitata(round, oval);
Contur – net, regular
Nu intrerupe pliurile mucoasei;
Conturul organului afectat este
pastrat, peristaltism pastrat;
Evolutia radiologica lenta, nu
influenteaza starea generala a
pacientului
Imagine lacunara, bine delimitate, contur
regulat, (in general dim mici), nu intrerup
pliurile mucoasei, nu afecteaza
supleteaparietala
Leiomiom- fara obstruct
Polip fibrovascular
Their movement during the examination
produces an inconstant position.
Lacunar image -
MALIGNANT
Variaza in fct de marime si forma
Contur polilobat, iregular
Semiton periferic
Baza larga de implantare
Forma infiltrativa – stenoza cu contur
relativ neted, excentrica, rigiditate
parietala
Forma ulcerata - nisa plata ce nu
proemina sau proemina putin din contur,
nisa localizata excentric intr-o imagine
lacunara, nisa superficiala cu diametrul
mai mare decat profunzimea, margini
neregulate/nodulare, colectie baritata
lenticulara convexa spre lumen
Forma vegetanta – imagine lacunara,
imprecis delimitata, cu semiton, cu
intreruperea conturului parietal
Esophageal Tumor -
Vegetant lacuna, cu semiton
şi regiditate
segmentară
(the contrast goes
between the folds
of the mucosa =>
semitone image )
Esophageal vegetant
cancer
Irregular
stricture of the
mid esophagus
Abrupt margins
toward the
normal
esophagus
Multiple irregular
filling defects
ulcerations
Esophageal Tumor -
Infiltrative
Stenoza, excentrica.
Esophageal cancer - infiltrating
type
Eccentrically
narrow stricture
of the upper
esophagus
3-4 cm length
Abrupt margins
(asymmetrical)
Encricling mass
Esophageal tumor –
ulcerative
Addition image ( cu
semitonuri), se
inscrie în contur,
frecvent pe-o zonă
de rigiditate
segmentară)