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LESSON 10DIAGNOSTIC RADIOLOGY OF DIGESTIVE SYSTEM. DIAGNOSTICS
OF ESOPHAGEAL AND GASTRIC DISEASES.
Endoscopy is often the first investigation, because it shows mucosal lesions
directly and also allows biopsy material to be obtained.
Contrast examinations.
Barium sulfate is the best contrast medium for the gastrointestinal tract. It
produced excellent opacification, good coating of the mucosa and is completely
inert. The patient drinks about 200 ml of barium. The other available contrast
agents are water soluble media, of which Gastrografin is the most widely used.
Most Barium and Gastrografin examinations are carried out under fluoroscopic
control so that the passage of contrast can be observed on a television monitor.
Double contrast examination of the stomach and colon is now the standard
technique for barium examinations. In double contrast examinations the mucosa is
coated with barium and the lumen is distended by introducing air or some other
gas.
CT can show the full width of the bowel wall. It is useful for diagnosing and
staging tumours, and for assessing the complications of gastrointestinal diseases
and surgery.
MRI is major use for assessing the local spread of rectal carcinpma priorto surgical
resection, and for assessing perianal fistula and abscess formation.
Ultrasound can assess the bowel wall and detect intraabdominal fluid but gives
limited information about the mucosa.
OESOPHAGUS
The barium swallow is the standard contrast examination employed to visualize of
eosophagus. The patient drinks some barium and its passage down the oesophagus
is observed on a television monitor. Films are taken with the oesophagus both full
of barium to show the outline, and following the passage of the barium to show the
mucosal pattern. Peristaltic waves can be observed during fluoroscopy.
OESOPHAGEAL ATRESIA . In oesophageal atresia, the oesophagus ends as a
blind pouchin the upper mediastinum. The diagnosis of oesophageal atresia is
made by passing a soft tube into the oesophagus and showing that the tube holds
up or coils in the blind-ending pouch.
, 2
OESOPHAGEAL DIVERTICULA . Diverticula are saccular outpouchings,
which are often seen as chance findings, in the introthoracic portion of the
oesophagus. One type of diverticulum, the pharyngeal pouch or Zenker*s
diverticulum, is important as it may give rise to symptoms caused by retention of
food and pressure upon the oesophagus. To pulsation diverticulum is character
weakness of muscle fibers. It may reach a very large size and can cause
displacement and compression of the oesophagus. Pulsating diverticula are found
at the back wall of the esophagus in the entering of pharynx to esophagus.
Traction diverticulum develops after inflammation around the esophagus.
VARICES. Esophageal varices are dilated veins of the subepithelial connective
tissue that are usually caused by portal hypertension in patients with cirrhosis or
other liver pathology. ... Barium studies should be performed with the patient in a
recumbent position (often prone, right anterior oblique). en flow through the portal
venous system or superior vena cava (SVC) is obstructed. Esophageal varices are
collateral veins within the wall of the esophagus that project directly into the
lumen. The veins are of clinical concern because they are prone to hemorrhage.
Paraesophageal varices are collateral veins beyond the adventitial surface of the
esophagus that parallel intramural esophageal veins. Paraesophageal varices are
less prone to hemorrhage. Esophageal and paraesophageal varices are slightly
different in venous origin, but they are usually found together. The primary
diagnostic test to confirm or exclude oesophageal varices is endoscopy. Varices
appear as lucent, tortuous, wormlike filling defects on barium swallow, thickened
folds, which distort the mucosal pattern.
ESOPHAGEAL BURNS. Clinical features of esophageal burns are determined
by the degree and extent of injury. In the initial phase, there are complaints from
mouth and sub-external areas, increased salivation, pain in swallowing and
dysphasia. ... Esophageal extensive necrosis caused perforation that can be treated
with resection.Radiological signs of esophageal burns are hypotonia and
narrowing of the lumen
ACHALASIA is a neuromuscular abnormality resulting in failure of relaxation at
the cardiac sphincter which presents at barium swallow examination as a smooth,
tapered narrowing which is always at the lower end of the oesophagus. The dilated
oesophagus usually contains food residues and may be visible on the plain chest
radiographs. X-ray contrast study of the digestive tract is useful for achalasia.
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