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Digestive System

PharynxSwallowing function evaluation


Indications
! Cough induced by eating or drinking, dysphagia, varying degrees of
aspiration
! Nasopharyngeal reflux
! Sensation of food sticking, lump or tightness in the pharynx
! Change in swallowing or the inability to handle secretions
secondary to neurological disorders (head trauma, stroke, etc.)
or myopathies.
! Up to 50% of patients in nursing homes have feeding or
swallowing disorders.
Methods of examination
Video recording of swallowing during fluoroscopicimaging. .
This method utilizes high density barium in varying degrees
of thickness, sometimes mixed with foods of varying consistency.
Pharyngeal Abnormalities
Pharyngeal Abnormalities

Zenkers diverticula
Congenital Pharyngeal
Webs
External Impingement by
osteophytes, enlarged
lymph nodes, tumors or
enlarged thyroids
Traumaswallowed
sharp foreign bodies
(chicken or fish bones),
penetrating trauma,
caustic agents (lye),
iatrogenic injuries.
Inflammation
Pharyngeal Abnormalities
Zenkers diverticula
Congenital Pharyngeal
Webs
External Impingement by
osteophytes, enlarged
lymph nodes, tumors or
enlarged thyroids
Traumaswallowed
sharp foreign bodies
(chicken or fish bones),
penetrating trauma,
caustic agents (lye),
iatrogenic injuries.
Inflammation
Pharyngeal Abnormalities

Benign Tumors
Malignant TumorsSquamous cell carcinoma
most common; may develop at the base of the
tongue, epiglottis, pyriform sinuses, valleculae,
and the palatine tonsils. CT is helpful, not
only in identifying the tumor but also in
detecting invasion of adjacent structures.
Synchronous esophageal carcinoma may coexist
in 5% of patients with head and neck cancer.

Esophageal Evaluation
Indicationsheartburn;
difficult or painful
swallowing; sensation of
food sticking
Methods of examination
at fluoroscopy, the
esophagus is usually
imaged by double
contrast techniques
(barium and
effervescent granules);
water soluble contrast
when perforation
suspected; CT has value
in CA of the esophagus.
Normal
Normal Air-contrast
Air-contrast
Esophagram
Esophagram
Esophageal Diseases
Inflammation

Gastroesophageal Reflux
Disease (GERD)hiatal
hernia; esophagitis;
columnar lined esophagus
(Barretts esophagus)--
occurs in 10-20% of patients
with GERD and have inc.
incidence (15%) of
adenocarcinoma.
Esophageal Diseases

Gastroesophageal Reflux
Disease (GERD)hiatal
hernia; esophagitis;
columnar lined esophagus
(Barretts esophagus)--
occurs in 10-20% of patients
with GERD and have inc.
incidence (15%) of
adenocarcinoma.

The Stomach and


Duodenum-Hiatal Hernia

in sliding type GE
junction is displaced
cephalad
in paraesophageal
type, the stomach is
along side of a normally
positioned esophagus
mixed type is
combination of the above
with GE reflux,
esophagitis, ulcerations
and strictures can occur
Esophageal Diseases
Inflammation cont.

Extrinsic Agents
caustic (acid or alkaline) ingestion may cause strictures
with and inc. incidence of carcinoma after 3 to 4
decades.
Radiation therapy can cause esophagitis
a variety of oral medications (antibiotics, such as
tetracycline or doxycycline, potassium chloride,
quinidine, vitamin C tablets, and oral ferrous sulfate) can
cause mucosal irritation and ulceration usually because
not enough oral fluids are taken with medication.

Esophageal Diseases
Inflammation cont.

Infectious
Esophagitis
immunosuppression
and general
debilitation are
generally the
background for:
herpes simplex
Cytomegalovirus
Candida infection
Esophageal Disease
Motility Disorders

Presbyesophagus
Diffuse Esophageal
Spasm, the
Nutcracker
Esophagus, and the
Hypertonic Lower
Esophageal Sphincter

Esophageal Disease
Motility Disorders

Achalasiaa
hypertonic lower
esophageal
sphincter; fluid-
filled, dilated
esophagus with
birds beak
appearance distally.
Chagas Disease
picture like that of
achalasia
Barium swallow examination: Early stage: The esophagus has
smooth contour and is narrowed conically at the esophago-
cardial junction (arrow), above this the distal part of the
esophagus is dilated. (=> picture)
Late stage: The esophagus is
extremely dilated above the
severely narrowed cardia (arrow),
with a slightly tortuous course
and inhomogenous contrast
material filling pattern because of
the residual food inside.
Esophageal Disease
Motility Disorders

Sclerodermaloss of
muscle function in the
lower two thirds of the
thoracic esophagus seen
after ingestion of
barium during
fluoroscopy
Miscellaneous
rheumatoid arthritis
(RA), systemic lupus
erythematosus SLE and
alcoholism may have
esophageal dysmotility

Esophageal Disease
Motility Disorders

Esophageal
Diverticula
frequently occur in
the middle and
lower third
Traction typemid-
esophagus
Pulsion typedistal
esophagus
Esophageal Disease
Varices

produced by either liver


disease with portal
hypertension or thrombosis
of the splenic-portal trunk
occur in the distal
esophagus and bulge into
the esophageal lumen on
esophagram
CT can also detect
esophageal or gastric
varices
endoscopy most sensitive
method

Esophageal Disease
Varices
produced by either liver
disease with portal
hypertension or thrombosis
of the splenic-portal trunk
occur in the distal
esophagus and bulge into the
esophageal lumen on
esophagram causing
multiple small defects due to
the varicies.
CT can also detect
esophageal or gastric varices
endoscopy most sensitive
method

Esophageal Disease
Foreign bodies (FB)

if radiopaque,
detectable with
plain films
need barium for
non-opaque FBs
in adults, oversized
piece of meat is
most common FB.
1.
Esophageal Disease
Neoplasms

Benign
Leiomyomas
duplication cysts
and lipomas
epithelial polyps
are rare
1.
Esophageal Disease
Malignant Neoplasms

Primaryasymptomatic
until large enough to
interfere with food
transport
Squamous-cellmost
common
Adenocarcinoma
develops in the setting of
dysplastic mucosa ass.
with Barretts esophagus

Esophageal Disease
Malignant Neoplasms

Primary
asymptomatic until
large enough to
interfere with food
transport
Squamous-cellmost
common
Adenocarcinoma
develops in the setting
of dysplastic mucosa
ass. with Barretts
esophagus

Esophageal Disease
Malignant Neoplasms

Lymphomas rare
Spindle-cell tumor
(carcinosarcoma or
pseudosarcoma)
Leiomyosarcoma

Esophageal Disease
Malignant Neoplasms

Lymphomas rare
Spindle-cell tumor
(carcinosarcoma or
pseudosarcoma)
Leiomyosarcoma

Esophageal Disease
Malignant Neoplasms
CT useful in staging
preoperatively
90% accuracy in
detecting
mediastinal
metastases; MRI
has similar
accuracy; CT and
MRI also useful in
detecting liver aorta
metastases
Esophageal Disease
Malignant Neoplasms
Metastatic
lung, breast, and
renal CA as well
as melanoma and
Kaposis sarcoma
(in AIDS
patients) can
involve or spread
to esophagus
Esophageal Disease
Malignant Neoplasms
Metastatic
lung, breast, and
renal CA as well
as melanoma and
Kaposis sarcoma
(in AIDS
patients) can
involve or spread
to esophagus
Esophageal Disease
Trauma
may rupture with major
trauma
rupture more often occurs esophagus
secondary to severe
vomiting (Boerhaaves
syndrome); tends to occur
in the left side of the
lower esophagus and may
extend into the left pleural
space; fluoroscopy with a
small amount of water-
soluble contrast will show
extravasation in area of
rupture

stomac
Esophageal Disease
Trauma
instrumentation may cause
perforation particularly after
dilatation for treatment of stricture
or achalasia
leaks can occur post-operatively
following gastroesophageal
anastomoses

The Stomach and


Duodenum
Indications
peptic ulcer disease may cause epigastric
pain, hematemesis and melena
nausea and vomiting suggest possibility of
obstruction
a palpable mass may involve the stomach

weight loss and anorexia are non-specific but


can occur with gastric cancer

The Stomach and


Duodenum
Methods of Examination
Fluoroscopic-radiographic examination
utilizing barium sulfate suspension alone in
infants, children and some adults, or high
density barium along with effervescent
powders and glucagon (air contrast exam or
biphasic exam); water soluble contrast is used
when perforation is suspected
CT and ultrasound can demonstrate large
gastric masses

Normal Biphasic Upper GI


series
The Stomach and
Duodenum Disease-

Congenital
Duplication and
Anomalies
Diverticula (tics)
Gastric tics occur in
cardia
Duodenal tics are
common in 2nd and 3rd
portions
duplications are rare
Congenital Rests
aberrant pancreatic
tissue can occur in the
gastric antrum and
proximal duodenum;

The Stomach and


Duodenum Disease-
Peptic Ulcer Disease

Gastritis
Fold Enlargement
and Mucosal
Distortion
Erosionsgastric or
duodenal
The Stomach and
Duodenum Disease-
Peptic Ulcer Disease
Ulcers
most common in the
antrum, pyloric canal,
and duodenal bulb
greater curvature
ulcers are often
caused by ingestion
of medications such
nonsteroidal anti-
inflammatory drugs

The Stomach and


Duodenum Disease-
Peptic Ulcer Disease
Radiographic Findings cont.
Perforated Ulcersupright films will show
free air
Scarring and obstruction

Hypergastrinism (Zollinger-Ellison
syndrome)multiple ulcers and inc.
gastric secretion secondary to
gastrinomas; ulcers may be in small bowel

The Stomach and


Duodenum Inflammatory
Diseases
Extrinsic Agentsalcohol, anti-
Extrinsic Agentsalcohol, anti-
inflammatory drugs, ferrous sulfate
tablets
Specific infections
tuberculosis and syphilis
Strongyloidiasis in South America

opportunistic infections with herpes virus

The Stomach and


Duodenum Inflammatory
Crohns Disease

Diseases
Gluten Enteropathy
Miscellaneous Disorders
Menetriers disease
Eosinophilic
gastroenteritis
Scleroderma
Cystic fibrosis may cause
inflammatory changes in
stomach and duodenum

The Stomach and


Duodenum Motility

disorders
Nuclear medicine
gastric emptying
studies (radionuclide
is mixed with food).
gastroparesis
especially in diabetics
patients after truncal
vagotomy may combine
lack of motility and
diminished gastric acid
secretion
bezoars may form in
the stomach

The Stomach and


Duodenum Vascular
disorders

gastric or duodenal varices


best visualized on CT
scans

The Stomach and


Duodenum-Benign

Neoplasms
Adenomatous and
Inflammatory Polyps and
Villous Adenomas
Intramural Tumors
(Lipomas, neurofibromas,
and leiomyomas)
Polyposis syndromes
(familial colonic
polyposis, Gardners
syndrome, Peutz-Jeghers
syndrome, Cronkhite-
Canada syndrome)

The Stomach and


Duodenum-Benign
Neoplasms

Adenomatous and
Inflammatory Polyps and
Villous Adenomas
Intramural Tumors
(Lipomas, neurofibromas,
and leiomyomas)
Polyposis syndromes
(familial colonic polyposis,
Gardners syndrome,
Peutz-Jeghers syndrome,
Cronkhite-Canada
syndrome)

The Stomach and


Duodenum- Primary
Malignant Neoplasms
Imaging
Barium studies vs.
Endoscopy in Gastric
CA detectionin a
recent review of a large
series of gastric cancers,
double contrast UGI
studies detected 99% of
cancers and malignant
tumor was diagnosed or
suspected in 96% of
cases, compared to the
reported sensitivity of
endoscopy and biopsy of
94% to 99%.
The Stomach and
Duodenum- Primary
Malignant Neoplasms

CT is useful in
detecting
lymphadenopathy
and liver metastases
but is not accurate in
staging because it
does not accurately
image the true extent
of pathology

The Stomach and


Duodenum-Primary
Malignant Neoplasms

Adenocarcinoma
of the stomach
scirrhous
carcinomas (linitis
plastica)

The Stomach and


Duodenum-Primary
Malignant
Leiomyosarcoma
Neoplasms
bulky tumors with
large ulcerations
The Stomach and
Duodenum-Primary
Malignant Neoplasms

Lymphoma
mimics
adenocarcinoma

stomach

liver
spleen
The Stomach and Duodenum-
Primary Malignant Neoplasms
Carcinoidmay mimic all the
benign and
malignant lesions
The Stomach and
Duodenum-Primary
Malignant
Adenocarcinoma of
Neoplasms
the duodenum is
rare

The Stomach and


Duodenum-Metastatic
Melanoma
Neoplasms
Lymphoma
Kaposis sarcoma
Breast carcinoma--
mimics linitis
plastica

The Stomach and


Duodenum-
Metastatic Neoplasms
Melanoma
Lymphoma
Kaposis sarcoma
Breast carcinoma-- --
mimics linitis plastica
Stomach and Duodenum- iatrogenic Conditions
Surgery for PUD
! fewest complications following vagotomy and pyloroplasty
! gastric resection and gastroduodenostomy(Bilroth I), and gastric
resection with gastrojejunostomy (Bilroth II) not uncommon
prior to advent of drug therapy
! marginal ulcers can occur in postop patients
Small Intestine

Indications for evaluationunexplained


diarrhea,, unexplained intestinal bleeding,
malabsorption,
- abdominal pain or tenderness, suspected
partial SB
- obstruction not clear from plain films
Most common fluoroscopic exam done today
because
endoscopy of stomach and colon is usually
performed for evaluation of those structures.
Small Intestine
Methods of Examination
Oral Barium for routine evaluation
patient drinks 480 to 600 ml; ; must be
NPO for at least 8 hours prior to exam
because food interferes with evaluation of
the mucosa
Small Intestine
Methods of Examination Methods of Examination
Enteroclysis when routine exam negative and high clinical
suspicion-- --barium and methylcellulose pumped into SB via
nasointestinal tube during fluoroscopic observation
- Improved visualization of focal lesions
- partial bowel obstructive such as adhesions processes
- occasionally demonstrate Meckel's diverticula-- --usually
asymptomatic but can bleed or be a site of volvulus or
intussusception
Computerized Tomography
Crohn's Disease-- --helps to identify abscesses and
fistulas and determine extent of disease
Intestinal Ischemia-- dilated, thick-walled, , fluidfilled loops
of SB
Primary SB malignancies-- --to determine extraluminal
extent of tumor
Small Intestine
Methods of Examination
Nuclear Medicine
Meckel's Diverticulum-- ; gastric mucosa can bleed;
detectable with Technetium scans
GI Bleeding not detectable by endoscopy
Nuclear Medicine
! Meckel's
Diverticulum-
-can bleed; gastric
mucosa can bleed;
detectable with
Technetium scans
! GI Bleeding not
detectable by endoscopy
! Meckel's Diverticulum-
- ; gastric mucosa can
bleed;
detectable with
Technetium scans
! GI Bleeding not
detectable by endoscopy
Angiography
! GI bleeding must
exceed 2 cc/min in order
to be visualized
! Intestinal Ischemia-- --
patients with post
prandial pain and weight
loss
Submucosal Infiltration
. What can infiltrate.
! Edema
! Inflammatory exudate
! Blood
! Lymph tissue
! Tumor
Two Patternsdepend on amt. of
infiltration
! Small amount = stack-of of-coins
Little separation of the normal folds
! Large amount = picket fence
Greater separation of normal folds
Hallmark features are
- Dilatation
- Dilution, especially in jejunum
Segmentation
- Masses of barium separated from adjacent clumps
- Not commonly seen with newer barium mixtures
Scleroderma
- Entire small bowel is usually dilated
- Close approximation of valvulae (hide-bound
appearance)
- Does not have increased secretions as does Sprue
- May be associated with pneumatosis intestinalis
Hallmarks of the disease are
- Nodules
- Markedly thickened bowel wall (picket-fence)
Small bowel may or may not be dilated
Affects jejunum mostly
Amyloid
-Marked thickening of the valvulae (picket-fence)
- No dilatation or dilution
Affects entire small bowel
Small Intestine
Inflammatory Diseases
Crohn's Disease-- --unknown etiology; usually begins in
ileum but can involve all parts of SB; begins with
aphthous ulcerations, mucosal fold thickening and
distortion; progresses to deep ulcerations, , nodular mucosal
pattern, and eventual stenosis
Small Intestine
Inflammatory Diseases
Whipple's Disease--
mucosal fold thickening
(picket fence) and irregular
fold distortion with or
without dilatation; jejunum
affected primarily
Ascariasis
Giardia lambliausually
limited to duodenum and
jejunum
Thickening of the folds
Marked spasm and
irritability of the bowel
Increased secretions is
common

Small Intestine
Motility Disorders
Scleroderma --dilated SB; ;
mucosal sacculations
Small Intestine
Vascular Diseases

Intestinal Ischemia
mild dilatation or normal on barium
studies
mesenteric artery stenosis on
angiogram

Small Intestine
Foreign Bodies

Bezoars, drugs, enteroliths,


gallstones, miscellaneous (bones,
sharp objects)
Small Intestine
Malabsorption
Nontropical
Sprue--2ndary to
gluten
hypersensitivity
Small Intestine
Malabsorption
Spruethe
hallmark
features are:
dilatation and
dilution,
especially in
jejunum with
stacked coin
appearance.
Sprue the hallmark
features are: dilatation
and dilution, especially
in jejunum with
stacked coin
appearance.
Small Intestine
Benign Neoplasms
Solitary
Leiomyomas
Carcinoid tumors
Adenomatous
polyps
Multiple
Lipomatosis
Peutz-Jeghers
syndrome
Cronkhite-Canada
syndrome
Malignant Neoplasms
! Primary
! Adenocarcinomas
! Leiomyosarcomas
! Lymphoma
Small Intestine
Malignant Neoplasms
Metastatic--Breast,
lung, kidney,
melanoma,
carcinoid and
Kaposi's sarcoma
Enterography: Polypoid filling defect in the terminal ileum (arrows).
Filling defect caused by fibrosis is visible at the lover contour of the
tumor.
CT examination: Contrast enhanced axial scans: An intraluminal,
bulging soft tissue mass is visible in the ventral wall of the
ascending colon (upper pictures-arrows). Distally the lumen is
narrowed, the circular thickening of the mucosal wall is irregular,
the adjacent fat is infiltrated (lower pictures - arrows).
3. Picture: Larger ulcers (arrows) involve deeper layers of the
bowel wall.
Double-contrast barium examination: 1. Picture:
'Cobble-stoning' caused by swelling of longitudinal
and transversal mucosal folds is visible. (=> picture)
Small Intestine
Hernias
Inguinal
Paraduodenal
Colon and Appendix

Indications (colon CA and inflammatory


bowel disease are the major reasons for
studying)
subacute or chronic diarrhea, change in caliber of
stool, constipation, and weight loss suggest colon
disease but most often no organic disease is found
severe anemia seen with right colon neoplasms
abdominal distension suggests obstruction
left-lower-quadrant mass suggests diverticulitis or
tubo-ovarian mass
right-lower-quadrant mass suggests appendiceal or
tubo-ovarian mass

Colon and Appendix


Radiologic Techniques
clean colon is of vital importance therefore require
colon prep with large volumes of oral liquids,
laxatives and enemas
Air or Double Contrast (Barium and air)--
preferred technique particularly for evaluation of
blood in the stool or suspected polyps ; not feasible
in all patients particularly frail elderly individuals;
detects 94% of colo-rectal CA
Single Contrast (Barium only)good method for
evaluation of non-specific complaints; preferred for
elderly debilitated patients; detects 89% of colon
CA

Colon and Appendix


Radiologic Techniques
Computerized Tomography
Appendicitisinflammatory changes in fat and
enlargement
Diverticulitis--inflammatory changes in fat
surrounding area of involvement (usually in sigmoid
colon) and bowel wall thickening; CT is method of
choice since you can evaluate patient during acute
illness (in contradistinction to BE)
Adenocarcinoma--staging sensitivity, specificity
and accuracy varies from 48% to 100%; mean
accuracy in detecting recurrent tumor is 90%
Lymphoma--staging
Colon and Appendix
Radiologic Techniques
Ultrasonography
Appendicitisan enlarged non-
compressible appendix in patients with
RLQ pain
Intussusceptionin the pediatric
population

Colon and Appendix


Radiologic Techniques
Nuclear Medicine
Immunoscintigraphycolon CA
recurrences
GI bleeding study with tagged RBCs

Meckels Diverticulum scanning


with pertechnetateGI bleeding in
the pediatric population

Colon and Appendix
Congenital Anomalies
Failures of
Rotationwith
incomplete
rotation mobile
cecum can result
in volvulus; when
complete, entire
colon in left
abdomen
Barium enema: An approximately 1 cm long segment of the colon is
narrow (arrow) in the recto-sigmoideal region, above which the
colon is markedly dilated, the haustration disappeared completely.
Colon and Appendix
Inflammatory Diseases
Extrinsic Agents
long standing
laxative abuse
radiation damage
to the rectum and
sigmoid following
treatment of pelvic
malignancies
Ulcerative colitis
Crohns Disease
Colon and Appendix
Inflammatory Diseases
Specific Organismsnumerous causes of
colitis--Tuberculosis, Shistosomiasisis,
Amebiasis, Yersinia, Clostridium perfringens
and septicum, Herpes simplex, Herpes
zoster, Campylobacter, venereal-related
colitis 2ndary to gonococcus, mycoplasma,
Lymphogranuloma venereum, Clostridium
difficile causes pseudomembranous colitis in
patients after antibiotic therapy

Colon and Appendix


Diseases
Motility Disorders
Scleroderma--wide mouthed
sacculations
Diabetic Diarrhea

Spastic colon--functional

Colon and Appendix


Vascular Disease
Ischemic Colitis
thumbprint pattern due to intramural
hemorrhage
usually reversible

Colon and Appendix


Diseases
Diverticulosisdiverticulae are most
common in the sigmoid and
descending colon
DiverticulitisCT is the technique of
choice; can mimic CA
Colon and Appendix
Colon Malignancies
Predisposing factorsulcerative
colitis, Crohns, familial polyposis,
family history, breast CA, uterine CA,
pelvic irradiation, previous
uterosigmoidostomy, retinitis
pigmentosa, 5% adenomatous polyps
(< 5-6mmno risk, 6-10mm1%
risk, 1-2 cm5% risk, >2cm10%
risk, multiple adenomashigh risk).
Colon and Appendix
Neoplasms
Benign Polyps--
both hyperplastic
and adenomatous
Colon and Appendix
Neoplasms
Polyposis Syndromes
Familial Polyposis--
hereditary; colon CA
precursor
Gardner's syndrome--colon
polyps ass. with soft-tissue
tumors; colon Ca precursor
Turcot syndrome--
combination of intracerebral
tumors and colon polyps
Peutz-Jeghers
(hamartomas) and
Cronkhite-Canada (juvenile
polyps) syndromes both have
colon polyps
Colon and Appendix
Neoplasms
Adenocarcinoma--there
is an adenoma to cancer
sequence that takes
several years to develope;
5-6 mmno risk, 1-2 cm
5% risk, >2cm10%
risk; villous adenomas
40% risk; multiple
adenomasinc. risk
Lymphomacan mimic
adenoCA or be
multinodular and involve
entire colon
Colorectal CA
screening strategies
Screening for colorectal CA is both
effective and cost-effective.
The cost-effectiveness of colorectal
CA screening is likely to be twice as
effective as screening for cervical
CA and breast CA.
Colorectal CA
screening strategies
Although it has been shown to be an
effective screening method, the fecal
occult blood test (FOBT) is the least
effective method and must be
performed every 1 to 2 years.
Colorectal CA
screening strategies
Sigmoidoscopy has been shown to be
effective but misses many polyps and
cancers in the remainder of the colon,
therefore colonoscopy is likely better and
can be performed less often (possibly
every 10 years) because of the slow
growth of colorectal CA.
But, are there enough qualified
endoscopists?
Colorectal CA
screening strategies
Air-contrast BE is less effective than
colonoscopy but does evaluate the
entire colon (every 5 years) and
would likely be needed in order to
screen the entire population.
Virtual colonoscopy is currently
being developed with imaging
techniques and may prove to be an
effective method.
Colorectal CA
screening strategies
The high risk population should be
intensively screened. Because of
their 2 to 5 fold higher incidence of
colorectal CA, screening of this
population is more effective and
cost-effective than screening the
general population.
Colon and Appendix
Neoplasms
Appendiceal
Tumors
Mucocele--caused
by low grade
adenoCA; may
calcify
Carcinoid
Colon and Appendix
Hernias
Inguinal
Morgagni--anterior at cardiophrenic
angle; esophageal hiatus rarely
Spigelian--in fascia of rectus muscle

Organs of Digestion
Livercongenital
Hemochromatosis
autosomal recessive; defect in iron
absorption causing iron deposition in the
liver, pancreas and skin with classic
triad of cirrhosis, diabetes and bronze
pigmentation
Imaginghyperechoic liver on U.S.;
increased density of liver on non-
contrast images by CT; hypodensity on
T2-weighted images
Organs of Digestion
Liverinflammatory
CirrhosisCT and
UShepatomegaly,
heterogenous
hepatic parenchyma,
nodularity of livers
surface, ascites,
signs of portal
hypertension
including varices
and splenomegaly

Organs of Digestion
Liverinflammatory
Sclerosing cholangitisprogressive
fibrotic inflammation of the biliary
tree leading to biliary obstruction
and cirrhosis. Imaging
cholangiography demonstrates
multiple focal strictures of the bile
ducts
Organs of Digestion
Livertumorous
Cavernous
hemangiomamost
prevalent non-
malignant tumor
Imaginghyperechoic
lesions with posterior
acoustic enhancement
by US; hyperintense on
MRI; enhances from
periphery to center by
CT; increased uptake
on tagged RBCs scan
of liver
Organs of Digestion
Livertumorous
Metastasescolorectal
CA, stomach, pancreas,
breast and lung most
common.
Imagingmost hypodense
on contrast CT; renal and
melanoma may be
hyperintense; MRI equal
to CT in detecting mets
but more expensive and
less effective in detecting
disease elsewhere in the
abdomen.
Needle biopsyCT or US
guidance.
Organs of Digestion
Livertumorous
Hepatocellular CArisk factors are
chronic hepatitis B and C, cirrhosis,
glycogen storage diseases
Imaginghypodense enhancing
lesion that often invades vascular
structures such as the portal vein
Needle biopsy with CT or US
guidance
Organs of Digestion
Liverinfectious
Echinococcal cysts or abscesses-
Imaginghypodense on CT or US
Organs of Digestion
Pancreascongenital
Pancreas divisumlack of fusion of the
dorsal and ventral pancreatic buds
resulting in the main pancreatic drainage
occurring through the minor papilla
(proximal to the papilla of Vater) that may
be too small to accommodate the full
volume of pancreatic secretions, resulting
in obstruction and pancreatitis
ImagingERCP and MRI
Organs of Digestion
Pancreastumorous
CA pancreas95% are
adenocarcinomas with dismal
prognosis; other tumors include
insulinoma, gastrinoma, macrocystic
and microcystic adenomas
Imaging3 or 4 phase CT best
showing hypodense mass;
hypoechoic on US
Splenic vein
Longitudinal
image
g
References
Essential Radiology, Richard Gunderman,
Thieme publishers, 1998.
http://brighamrad.harvard.edu
http://www.indyrad.iupui.edu/rtf/index.html
http://www.rad.uab.edu:591/tf/browse_search
.htm

http://www.uhrad.com/Default.htm
http://
www.learningradiology.com/medstudents/med
s
tudtoc.htm
http://www.vh.org/Providers/Providers.html

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