Presentation on theme: "Gastrointestinal Inflammation"— Presentation transcript:
1 Gastrointestinal Inflammation In this segment, we will be discussing various types of gastrointestinal inflammation.
2 Gastrointestinal Inflammation Mucosal changesIndirect evaluation in most casesEvaluate lumen and effect on lumenDegree of mucosal involvement determines the imaging findingsSuperficial – little effectPenetrating – affect adjacent areasGastrointestinal inflammation, as evaluated by radiologists, is primarily going to be evaluated by the effect on the mucosa by the inflammatory process. In most cases we can only provide an indirect evaluation of mucosal change. We are able to evaluate the lumen and the effects of the inflammatory process on the lumen, the degree of mucosal involvement that will determine the imaging findings. Superficial involvement such as gastritis or esophagitis may have very little effect on the lumen or the mucosa, as visualized radiographically. Penetrating lesions, however, will cause some changes in the adjacent areas, which may be easier to see with our imaging techniques.
3 Gastrointestinal Inflammation Superficial processLittle imaging findingSpasmMucosal edema and irregularityPenetrating processUlcer developmentPerforationAdjacent inflammatory processSuperficial processes will have little or no imaging findings. There may be spasm as a result of the inflammatory process and this may be visualized either on overhead films obtained, static images, or during the fluoroscopic process. Mucosal edema and irregularity may be seen in certain circumstances, depending upon the extent and the extent of the effect on the adjoining mucosa. Penetrating processes however, such as ulcers where there is a perforation through the surface of the mucosa will easily be identified using radiographic imaging techniques. Using some of our cross sectional techniques adjacent inflammatory processes will also be easy to identify.
4 Ulcer In Stomach Wall Silhouette Extension of barium outside of the expected wallOn this line drawing, much like the line drawing we used when talking about neoplasm, this silhouette of the stomach demonstrates an extension of barium outside the expected wall, or lumen, of the stomach. This is as a result of ulceration of the lesser curvature of the stomach.
5 Gastric UlcerBarium projection from lesser curve – ulcer crater (arrow)Line of edema (arrowheads)On this radiograph of the stomach during a barium upper GI examination, note the barium projection from the lesser curvature of the stomach, this being an ulcer crater. Note the band of lucency, or edema, at the base of this ulcer crater as a result of inflammatory process, edema is seen at the margin of an ulcer.
6 Gastric Ulcer Overhead film with ulcer on greater curve (arrows) *Overhead film with ulcer on greater curve (arrows)Lucent halo of edema base of ulcer (arrowhead)Ulcer extends outside expected mucosal marginIncidental note of contrast in gallbladder (*): In another patient we also note on the overhead film an ulcer on the greater curvature aspect of the stomach. This tube demonstrates a lucent halo of edema at the base of the ulcer as indicated by the arrow head. This ulcer extends outside the expected mucosal margin which helps us differentiate benign ulcers from malignant ulcers. Incidentally contrast material in the gallbladder as a result of prior oral gallbladder examination, a study done prior to the development of ultrasound and nuclear medicine techniques for gallbladder evaluation.
7 Pyloric Channel Ulcer Spot film Projection of barium from pyloric channelEdematous haloIn another individual we identify a protrusion of barium on the spot film from the superior surface or lesser curvature aspect of the pyloric canal. This representing a pyloric canal or channel ulceration in this individual is indicated by the arrows. Note as well an edematous halo at the base of this ulceration resulting from edema at the ulceration.
8 Post-bulbar Doudenal Ulcer Barium collection just beyond the duodenal bulb greater curve aspect (large arrow)Probable small ulcer lesser curve aspect as well (small arrow)Another individual is demonstrated to have at least two ulcerations in the region just distal to the bulb. These post bulbar duodenal ulcers are easily identified as indicated by the large and smaller arrow. Most likely, the smaller arrow indicates a second ulceration.
9 Inflammatory Lesions of the Colon Diverticulosis and DiverticulitisUlcerative colitisRegional enterocolitis (Crohn’s disease): Inflammatory diseases involving the colon include diverticulosis and diverticulitis, ulcerative colitis, and regional enteritis, which will occasionally involve the colon.
10 Inflammatory Lesions of the Colon AppearanceNarrowing due to spasm, stricture, extrinsic massDilatation resulting from partial/ complete obstructionMucosal changes: edema, hypertrophy, ulceration, etc.: Inflammatory processes in the colon can cause spasm leading to narrowing, can cause stricture as a result of scarring, and can present with extrinsic masses when the inflammatory process has spread outside the colon itself. There may be dilatation proximal to an area of inflammatory process, as a result of partial or complete obstruction to the passage of colonic contents. Mucosal changes, including edema, mucosal hypertrophy, and ulceration can also be visualized.
11 Diverticulosis, Diverticulitis and their complications DiverticulaMucosa protrudes out of bowel lumen through a weak point in muscle layerDiverticulosisMultiple diverticulaDiverticulosis and diverticulitis represent a spectrum of diseases that arise as a result of the development diverticula within the colon. Mucosa protruding out of the bowel lumen through weak point in the muscle layer can lead to subsequent inflammatory processes. The presence of multiple diverticula is described as diverticulosis. The process of inflammatory involvement of diverticular processes is referred to as diverticulitis.
12 Diverticulosis, Diverticulitis and their complications Complication of diverticulosisPenetrating inflammatory processCauses perforation of diverticulumInflammatory process usually localized and forms pericolic abscessCan develop fistulas to vagina, bladder, etc.In diverticulitis, a complication of diverticulosis, there is a penetrating inflammatory process. This process causes, or is a result of the perforation of a diverticulum. Inflammatory process is typically localized and usually only presents by the formation of a pericolic abscess. However, because of this process extending outside of the colon, fistulous tracts can develop to other organs including vagina, bladder, or other loops of bowel.
13 Diverticulosis Single contrast barium enema Multiple outpouchings representing diverticulaMore prominent descending and sigmoid colonn this single contrast barium enema, we note the presence of multiple diverticula scattered throughout the colon, but most concentrated in the descending and sigmoid portions of the colon. This is a typical distribution of diverticulosis.
14 Diverticulitis Oblique film Extravasation from lumen Abscess cavity with bariumIn another individual we note that barium has escaped from diverticula in the region of the sigmoid colon. This escape of contrast material is the radiographic gold standard for the diagnosis of diverticulitis; this representing extravasation and development of an abscess cavity that contains barium in the peridiverticular soft tissues.
15 CT of DiverticulitisInflammatory process in the mesentery (diffuse gray area) with air collections (arrows)CT scanning can be useful for evaluation diverticulitis. In this individual, we note an inflammatory process in the mesenteric as represented by a diffuse gray area containing some air bubbles. The diffuse gray representing edema, an inflammatory content within the fat of the mesentery and air collections being related to the abscess in communication with the bowel.
16 Diverticulitis –CT Scanning Another CT scan of diverticulitis demonstrating an abscess being measured in the region of the sigmoid colon. Note the small air collections along the colonic margin representing air trapped within numerous diverticula, within the sigmoid colon.
17 Appendicitis / Appendicolith Calcific density RLQ: CT scanning and plain film evaluation can also be utilized for evaluation of appendicoliths within the appendix. In this individual, this child, we identify an oval calcification in the expected location of the appendix, this calcification representing an appendicolith, a precursor to development of appendicitis in a child.
18 Appendicitis CT is useful study Irregular gray density represents inflammatory change in the RLQ in the area of the appendixMay see stone in appendixCT scanning can also be utilized for the evaluation of possible appendicitis. In this case, CT demonstrates an irregular area of attenuation within the fat adjacent to the cecum in the expected location the appendix, in the right lower quadrant, as representing the inflammatory changes of appendicitis. We will also look for the appendix, the presence of a calculus within the appendix, and the presence of barium and/or fluid within the appendix. Measurement of this appendiceal size can offer some information regarding potential presence of appendicitis.