RADPATHOLOGY as barium trickles through the narrowed pyloric canal.

Malrotation
CHAPTER 5: ABDOMEN AND GASTROINTESTINAL SYSTEM
Malrotation exists when the intestines are not in their normal position, which
CONGENITAL AND HEREDITARY ANOMALIES
occurs in an equal male-to-female ratio.
Esophageal Atresia Situs inversus is a rare complete reversal of all abdominal organs.

Atresia is a congenital absence or closure of a normal body orifice or tubular Hirschsprung Disease (Congenital Aganglionic Megacolon)
organ.
Hirschsprung disease or congenital aganglionic megacolon refers to the
Esophageal atresia is a rare congenital anomaly in which the esophagus fails
absence of neurons (Meissner and Auerbach autonomic plexus) in the bowel
to develop past some point, resulting in discontinuation of the esophagus.
wall, typically in the sigmoid colon.
Bowel Atresia
Meckel Diverticulum
Ileal atresia, a congenital discontinuation of the ileum, is the most frequent
Meckel diverticulum is a congenital diverticulum of the distal ileum.
type of bowel atresia, followed by duodenal atresia.
Duodenal atresia is a congenital anomaly in which the lumen of the Gluten-Sensitive Enteropathy
duodenum does not exist, resulting in complete obstruction of the GI tract at
Gluten-sensitive enteropathy, formally known as celiac sprue or celiac
the duodenum.
disease, is an autoimmune hereditary disorder involving increased sensitivity
- Radiographic indication of D.A. is the “double bubble sign”
to the gliadin fraction of gluten, an agent found in wheat, barley, and rye
Colonic atresia is a congenital failure of development of the distal rectum and
products such as bread, which interferes with normal digestion and
anus, which may occur to a variable extent.
absorption of food through the small bowel. This is also a Malabsorption
Imperforate anus or anal agenesis is a congenital disorder in which anal
Syndrome.
opening to the exterior is absent.
Carbohydrate Intolerance
Hypertrophic Pyloric Stenosis
Carbohydrate intolerance is the inability to digest certain carbohydrates,
Stenosis is narrowing
including lactose, because of an acquired lactase deficiency.
Hypertrophic pyloric stenosis (HPS) is a congenital anomaly of the stomach The small bowel lacks enough of the enzyme lactase, which is used to break
in which the pyloric canal leading out of the stomach is greatly narrowed down lactose into simple sugars that can be absorbed. The result is that
because of hypertrophy and hyperplasia of the pyloric sphincter. lactose stays in the bowel and acts as an osmotic agent, causing fluid to weep
If “olive” sign of hypertrophied pyloric muscle is palpated, the from the wall into the lumen of the colon, creating cramping and diarrhea.
diagnosis of HPS can be made clinically.
An upper GI study demonstrates delayed gastric emptying accompanied by
the:
 mass impression of the hypertrophied pyloric muscle on the barium-
filled antrum (“shoulder sign”),
 the filling of the proximal pylorus (“beak sign”),
 the entire elongated pylorus (“string sign”),
INFLAMMATORY DISEASES Regional Enteritis (Crohn Disease)

Esophageal Strictures Regional enteritis, also known as Crohn disease (CD) or granulomatous
colitis, is a chronic Inflammatory bowel disease (IBD) of unknown cause and
Esophageal strictures may occur in varying degrees, with the symptoms
is increasing in prevalence.
displayed differing according to the amount of obstruction produced.
- CD eventually affects all layers of the bowel wall. The bowel wall thickens in
Strictures may be secondary to the ingestion of caustic materials such as
response to the inflammation and may form fistulas to adjacent loops of
strong acids or alkalines or from any factor that inflames the mucosa and
bowel, skin, or other abdominal viscera.
creates scarring.
 The combination of mucosal edema and crisscrossing fine ulcerations
Gastroesophageal Reflux Disease gives the bowel a “cobblestone” appearance on the radiograph.
 The string sign is demonstrated when the terminal ileum is so
Gastroesophageal reflux disease (GERD) results from an incompetent cardiac
dis eased and stenotic that the barium mixture can only trickle
sphincter, which allows the backward flow of gastric acid and contents into
through a small opening that looks like a string.
the esophagus.
Appendicitis
Peptic Ulcer
Appendicitis is an inflammation of the vermiform appendix resulting from an
Peptic ulcer is an erosion of the mucous membrane of the lower end of the
obstruction caused usually by a fecalith or rarely by a neoplasm.
esophagus, stomach, or duodenum. The most likely site of a peptic ulcer is in
the duodenal bulb and on the lesser curvature of the stomach Ulcerative Colitis
Nonsteroidal anti-inflammatory drugs (NSAIDs) and the bacterium
Ulcerative colitis is an inflammatory lesion of the colonic mucosa.
H. pylori alter the mucosa, making it more susceptible to the effects of acid
 It is an easily recognized loss of colon haustration and mucosal
normally residing in the GI tract.
edema, which may be referred to as the “lead pipe” sign.
Gastric ulcer is pain, usually above the epigastrium and radiating to all parts
of the abdomen. Esophageal Varices
Duodenal ulcer are more consistent, and pain generally begins midmorning.
Perforation Ulcer is the complications of ulcer that may include Varicose veins are abnormally lengthened, dilated, and superficial veins;
pneumoperitoneum or peritonitis if the ulcer perforates into the abdomen. those in the esophagus are referred to as esophageal varices.
Transjugular intrahepatic portosystemic shunts (TIPSS), applied via
Gastroenteritis interventional radiology or in surgery, may be used to help redirect liver blood
flow, thus reducing portal hypertension and easing venous pressure in the
Gastroenteritis, inflammation of the mucosal lining of the stomach and small
esophageal and gastric collateral circulation.
bowel.
Erosive gastritis appears to be a precursor to gastric ulcer formation and
results from a compromised mucosal barrier within the stomach.

Antral gastritis is a scalloped or nodular antral folds visualized.

DEGENERATIVE DISEASES Mechanical Bowel Obstruction

Herniation Mechanical Bowel Obstruction is one in which the lumen of the bowel
becomes occluded, as might occur for a variety of reasons such as hernias,
Hernia is a protrusion of a loop of bowel through a small opening, usually in
tumors, volvulus, intussusceptions, or, most often postoperatively,
the abdominal wall. It is popularly referred to as a rupture, it occurs because
adhesions.
of an anatomic weakness. As the bowel loop herniates, it pushes the
peritoneum ahead of it.  Entrapment of a hernia, usually involving the small bowel, causes
Inguinal hernia, which is common in men, occurs when a bowel loop impairment of blood flow and swelling of the affected tissues.
protrudes through a weakness in the inguinal ring and may descend  A volvulus is a twisting of a
downward into the scrotum. bowel loop about its mesenteric
base, usually at either the
 If a herniated loop of bowel can be pushed back into the abdominal
sigmoid or the ileocecal
cavity, it is said to be reducible.
junction.
 If it becomes stuck and cannot be reduced, it is called an incarcerated
 An intussusception occurs when
hernia.
a segment of bowel, constricted
 If the constriction through which the bowel loop has passed is tight
by peristalsis, telescopes into a
enough to cut off blood supply to the bowel, it is called a strangulated
distal segment and is driven
hernia.
further into the distal bowel by
Hiatal Hernia peristalsis.
o Radiographically, the
Hiatal hernia is a weakness of the esophageal hiatus that permits some area of intussusception
portions of the stomach to herniate into the thoracic cavity. may appear as a “coiled
A direct, or sliding, hiatal hernia when a portion of the stomach and spring.”
gastroesophageal junction are both situated above the diaphragm.
 Gallstone ileus is a condition where a gallstone may erode from the
- A Schatzki ring is often visible with this condition. gallbladder and create a fistula to the small bowel.
A rolling, or paraesophageal, hiatal hernia occurs when a portion of the
stomach or adjacent viscera herniates above the diaphragm while the Paralytic Ileus
gastroesophageal junction remains below the diaphragm.
Paralytic ileus or adynamic ileus is a failure of normal peristalsis that may
Bowel Obstructions result from a variety of factors.

 Mechanical Bowel NEUROGENIC DISEASES

Obstruction, as occurs
Achalasia
from a blockage of the
bowel lumen Achalasia is a neuromuscular abnormality of the esophagus that results in
 Paralytic Ileus, which failure of the lower esophageal sphincter of the distal esophagus to relax,
results from a failure of leading to dysphagia.
peristalsis. The distal esophagus itself is described as a “beaked” appearance
DIVERTICULAR DISEASES Tumors of the Stomach

Esophageal Diverticula Benign tumors account for fewer than 10% of all stomach tumors.

Diverticulum is a pouch or sac of variable size that occurs normally or is Gastric carcinomas may also be polypoid with a plaquelike, lobulated
created by herniation of a mucous membrane through a defect in its muscular appearance.
coat. (outward)

Esophageal diverticula occur when mucosal outpouchings penetrate through

Small Bowel Neoplasms
the muscular layer of the esophagus.
A pulsion diverticulum involves only the mucosa and results from a motility Small bowel tumors represent fewer than 5% of all benign and malignant GI
disorder of the esophagus that allows the mucosa to herniate outward. neoplasms.
 Zenker diverticulum is a pulsion type found at the Kaposi sarcoma, most common in patients with acquired immunodeficiency
pharyngoesophageal junction at the upper end of the esophagus on syndrome (AIDS).
the posterior aspect just above the cricopharyngeal muscle.
Colonic Polyps
 Killian-Jamieson diverticulum is similar to that of a Zenker
diverticulum except that it originates on the lateral aspect of the Polyps inward growth
esophagus.
 Epiphrenic Diverticulum is another pulsion type, but it is found in the Colonic polyps are small masses of
distal esophagus just above the hemidiaphragm. tissue arising from the bowel wall to
project inward into the lumen
A traction diverticulum involves all layers of the esophagus and results from Polyps are more frequently noted in
adjacent scar tissue that pulls the esophagus toward the area of involvement the left colon, and particularly in the
rectosigmoid areas.
Colonic Diverticula

Diverticulosis, the presence of diverticula without inflammation, is seen in all

parts of the colon, most frequently in the sigmoid colon.

NEOPLASTIC DISEASES

Tumors of the Esophagus Colon Cancer

Benign tumors are almost always leiomyomas, which are smooth muscle
tumors.
Squamous cell carcinomas most commonly arise in the body of the
esophagus; those at the gastroesophageal junction are typically
adenocarcinomas.
Barrett Esophagus involves progressive columnar metaplasia of the distal
esophagus as a result of chronic gastroesophageal reflux.
Colorectal cancers are the third most common tumors in the United States
and the most common GI cancer.
The radiographic appearance of adenocarcinoma has led to its designation as
the “napkin-ring” carcinoma or the “apple-core” lesion, as the edges of the
lesion tend to overhang and form acute angles with the bowel wall.