RADPATHO

Disease Any condition that impairs normal function of a part or the

entire organism, associated with specific signs and
symptoms

Main types: pathogenic, deficiency,

hereditary, physiology
Disorder Functional abnormality or disturbance
Types: mental, physical, genetic, behavioral
Signs ➢ Objective
➢ Quantifiable
➢ Observed by physician
➢ Ex. Fever, swelling, skin rash
Symptoms ➢ Subjective
➢ Observed by the patient
➢ Patient’s perception of the disease
➢ Ex. Headache
Syndrome ➢ Association of several signs, symptoms, and
other characteristics that often occur
together
➢ May have single or multiple causes
Etiology • Study of the cause of a disease
• Common agents: viruses, bacteria, trauma, heat, chemical
agents, poor nutrition
Nosocomial infection Hospital acquired
Iatrogenic infection Adverse responses to medical treatment itself
Idiopathic If no causative factor can be identified
Pathogenesis Refers to the sequence of events in the response of cells
and tissues to the etiologic agent, from the initial stimulus
to the ultimate expression of the disease
Acute diseases usually have a quick onset and last for a short
period
Chronic diseases may manifest more slowly and last
for a very long time
Sequelae An acute illness may be followed by lasting effects
Diagnosis the identification of a disease an individual is believed to
have
Prognosis the predicted course and outcome of the disease
Morphology structure of cells or tissue
Additive or sclerotic some pathologic conditions cause an increase in the
normal density of a tissue
Subtractive, lytic, or destructive Cause a decrease in the normal density of a tissue
Epidemiology the investigation of disease in large groups
Prevalence number of cases found in a given population
Incidence number of new cases found in a given period
Endemic diseases of high prevalence in an area where a given
causative organism is commonly found
Mortality rate average number of deaths caused by a particular disease in
a population
Morbidity rate incidence of sickness sufficient to interfere with an
individual’s normal daily routine
Altered cellular biology to protect themselves and avoid injury, cells adapt by
altering the genes responsible for their function and
differentiation in response to their environment
Atrophy decrease in cell size
Hypertrophy Increase in cell size
Hyperplasia Excessive proliferation
Metaplasia Conversion of one cell type into another cell
Type
Dysplasia abnormal changes of mature cells
Disease Classifications
Congenital Diseases present at birth, Resulting from genetic or
environmental factors
Hereditary caused by developmental disorders genetically
transmitted from either parent to a child through
abnormalities of individual genes in chromosomes and are
derived from
ancestors
Hemophilia is a well-known hereditary disease
Inflammatory Results from the body’s reaction to a localized injurious
agent. An infective disease results from invasion by
microorganisms such as viruses, bacteria, or fungi
 Infection - inflammatory process caused by a
disease-causing organism
 Virulence - Ease with which an organism can
overcome body defenses
Degenerative Caused by deterioration of the body. Although they are
usually associated with the aging process, some
degenerative conditions may exist in younger patients
Metabolic Diseases caused by a disturbance of the normal
physiologic function of the body are classified as metabolic
diseases
Traumatic may result from mechanical forces such as crushing or
twisting of a body part or from the effects of ionizing
radiation on the human body
Neoplastic ➢ new, abnormal tissue growth
➢ Differentiated
▪ if differences are small and has a low
probability for malignancy
➢ Poorly differentiated/Undifferentiated
▪ If the cells within the neoplasm exhibit
atypical characteristics and have a
 higher probability of malignancy
Benign vs. Malignant
• In the case of a benign neoplasm, the suffix “oma” is added to the word root, for instance,
adenoma.
• Malignant neoplasms are named by adding the name of the tissue type to the word root, for
instance, adenocarcinoma
TNS System
• The “T” refers to the size of the untreated primary cancer or tumor.
• As the size increases, lymph node involvement (N) occurs, eventually leading to distant metastases
(M). • Staging: Extent of disease; local involvement or metastasis

➢ Numerical value (0-4)

➢ Stage I – T1, N0, M0
▪ Small lesion confined to ORGAN of origin with NO evidence of vascular and lymphatic spread or
metastasis
➢ Stage II – T2, N1, M0
▪ Tumor of LESS than 5 cm INVADING surrounding tissue and first-station lymph nodes but NO
evidence of metastasis
➢ Stage III – T3, N2, M0
▪ Extensive lesion GREATER than 5 cm with fixation to DEEPER structure and with bone and lymph
node invasion but NO evidence of metastasis
➢ Stage IV – T4, N3, M1
▪ More extensive lesion than above or with DISTANT metastasis (M1)
Benign neoplasm composed of well-differentiated cells with uncontrolled
growth
Malignant neoplasm  exhibits the loss of control of both cell
proliferation and cell differentiation, which
changes its functional capabilities
 grow at a faster rate compared with benign
neoplasms and tend to spread and invade other
tissues
Metastasis the spread of malignant cancer cells resulting in a
secondary tumor distant from the primary lesion
Invasion If the cancerous cells spread into surrounding tissue by
virtue of the proximity of the areas or neighboring areas
only
Seeding If the cancerous cells travel to a distant site or distant
organ system
Lesion Describe the many types of cellular change that may occur
in response to disease
Cancer General term often used to denote various types of
malignant neoplasms
Carcinoma one type of cancer and is derived from epithelial tissue.
Sarcoma arises from connective tissue
Leukemia arises from blood cells
Lymphoma arises from lymphatic cells
 Cardinal Signs
Dolor Pain
Calor Heat
Rubor Redness
Tumor Swelling
Function Lasea Loss of function
SKELETAL ANATOMY • 206 BONES (ADULT)
• APPENDICULAR: 126 BONES
• AXIAL SKELETON: 80 BONES
COMPACT BONE OUTER PORTION OF BONE IS COMPOSED OF ______
CANCELLOUS BONE INNER PORTION, TERMED THE MEDULLARY CANAL, IS
MADE UP OF ______
TRABECULAE BONE MARROW IS LOCATED WITHIN THE MEDULLARY
CANAL AND IS INTERSPERSED BETWEEN THE_____
TRABECULAR PATTERN THIS INTRICATE, WEBLIKE BONY STRUCTURE IS VISIBLE ON
A PROPERLY EXPOSED RADIOGRAPH OF THE SKELETAL
SYSTEM AND IS OFTEN REFERRED TO AS THE
DIPLOË SPECIFIC TO THE CANCELLOUS BONE LOCATED WITHIN THE
SKULL.
RED BONE MARROW RESPONSIBLE FOR THE PRODUCTION OF BONE
ERYTHROCYTES AND LEUKOCYTES.
YELLOW BONE MARROW AT THE APPROXIMATE AGE OF 20 YEARS, THE MAJORITY
OF THE RED BONE MARROW IS REPLACED BY
DIAPHYSIS SHAFT PORTION, PRIMARY SITE OF OSSIFICATION
EPIPHYSIS EXPANDED END PORTION, SECONDARY SITE OF
OSSIFICATION
METAPHYSIS GROWTH ZONE BETWEEN THE DIAPHYSIS AND EPIPHYSIS;
AREA OF GREATEST METABOLIC ACTIVITY IN BONE.
OSTEOBLASTS • THESE ARE BONE-FORMING CELLS THAT LINE THE
MEDULLARY CANAL AND ARE INTERSPERSED
THROUGHOUT THE PERIOSTEUM.

• THEY ARE RESPONSIBLE FOR BONE GROWTH AND

THICKENING, OSSIFICATION, AND REGENERATION.
OSTEOCLASTS • SPECIALIZED CELLS THAT BREAK DOWN BONE TO
ENLARGE THE MEDULLARY CANAL AND ALLOW FOR BONE
GROWTH.
OSTEOCYTES MATURED BONE CELLS
CARTILAGINOUS GROWTH PLATE IS LOCATED BETWEEN THE METAPHYSIS AND THE
EPIPHYSIS IN THE BONE OF A GROWING CHILD.
• RADIOGRAPHICALLY, THESE GROWTH AREAS APPEAR
RADIOLUCENT.
• AS THE BODY MATURES, THIS CARTILAGE CALCIFIES AND
IS NO LONGER RADIOGRAPHICALLY VISIBLE IN THE ADULT.

CONGENITAL AND HEREDEARY DISEASE

OSTEOGENESIS IMPERFECTA • “BRITTLE-BONE” DISEASE
 • AUTOSOMAL DOMINANT
• DEFICIENT AND IMPERFECT FORMATION OF BONE
TISSUE, SKIN, SCLERA, INNER EAR, AND TEETH
• RADIOGRAPHIC EVALUATION WILL DEMONSTRATE
MULTIPLE FRACTURES IN VARIOUS STAGE OF HEALING AND
A GENERAL DECREASE IN BONE MASS.
OSTEOGENESIS IMPERFECTA • PRESENT AT BIRTH.
CONGENITA • INFANTS WITH THIS DISEASE USUALLY HAVE MULTIPLE
FRACTURES AT BIRTH THAT HEAL ONLY TO GIVE WAY TO
NEW FRACTURES.
• THIS RESULTS IN LIMB DEFORMITIES AND DWARFISM
AND MAY LEAD TO DEATH.
OSTEOGENESIS IMPERFECTA TARDA • FRACTURES MIGHT NOT APPEAR FOR SOME YEARS AFTER
BIRTH AND THEN GENERALLY STOP ONCE ADULTHOOD IS
REACHED.
ACHONDROPLASIA • MOST COMMON INHERITED DISORDER AFFECTING THE
SKELETAL SYSTEM.
• AUTOSOMAL DOMINANT.
• DISTURBANCE IN ENDOCHONDRAL BONE FORMATION
RESULTS IN THE INABILITY OF CARTILAGE IN THE EPIPHYSIS
TO NORMALLY CONVERT TO BONE, IMPAIRING THE
LONGITUDINAL GROWTH OF THE BONE
MANIFESTATIONS • NORMAL TRUNK SIZE AND SHORTENED EXTREMITIES.
• AN ADULT WITH ACHONDROPLASIA IS USUALLY NO
MORE THAN 4 FEET IN HEIGHT, WITH LOWER EXTREMITIES
USUALLY LESS THAN HALF THE NORMAL LENGTH.
• ADDITIONAL CLINICAL MANIFESTATIONS OF THIS
DISORDER INCLUDE EXTREME LUMBAR SPINE LORDOSIS,
BOWED LEGS, A BULKY FOREHEAD WITH MIDFACE
HYPOPLASIA AND A NARROWING OF THE FORAMEN
MAGNUM WITHIN THE SKULL, WHICH CAUSES NEURAL
COMPRESSION.
OSTEOPETROSIS • “MARBLE BONE” DISEASE
• INCREASE IN BONE DENSITY AND DEFECTIVE BONE
CONTOUR.
• ALL BONES ARE AFFECTED
• RADIOGRAPHS DEMONSTRATE INCREASE IN DENSITY AND
THICKNESS OF THE CORTEX, INCREASE IN THE NUMBER
AND SIZE OF TRABECULAE, AND DECREASE IN MARROW
SPACE.
ALBERS-SCHÖNBERG DISEASE • FAIRLY COMMON FORM OF OSTEOSCLEROTIC
OSTEOPETROSIS.

• THIS AUTOSOMAL DOMINANT, DELAYED, BENIGN

SKELETAL ANOMALY INVOLVES INCREASED BONE DENSITY
IN CONJUNCTION WITH FAIRLY NORMAL BONE CONTOUR.
HAND & FOOT MALFORMATIONS
SYNDACTYLY - FAILURE OF FINGERS OR TOES TO SEPARATE
- PHYSICAL APPEARANCE OF WEBBED DIGITS
POLYDACTYLY - PRESENCE OF EXTRA DIGITS
CLUB FOOT (TALIPES) • MORE COMMON IN MALES
• MAY OCCUR BILATERALLY
• IT IS GENERALLY CORRECTED BY CASTING OR SPLINTING
THE FOOT IN THE CORRECT ANATOMIC POSITION.
• TALIPES EQUINOVARUS
• TALIPES EQUINOVALGUS
DEVELOPMENTAL DYSPLASIA OF THE • DUE TO ACETABULAR MALFORMATION, CAUSING THE
HIP (DDH) HEAD OF THE FEMUR TO BE DISPLACED SUPERIORLY AND
POSTERIORLY.
• DDH MAY BE UNILATERAL OR BILATERAL
• MORE COMMON IN FEMALES
• RADIOGRAPHIC MEASUREMENTS OF THE AP PELVIS ARE
OBTAINED.
TREATMENT OF DDH • THIS ANOMALY SHOULD BE TREATED EARLY WITH
IMMOBILIZATION THROUGH CASTING OR SPLINTING THE
AFFECTED HIP TO ALLOW THE ACETABULUM TO GROW
AND FORM A NORMAL JOINT.
• IF LEFT UNTREATED, THIS ANOMALY MAY RESULT IN
UNEVEN LIMB LENGTH, HIP MUSCLE WEAKNESS, AND AN
UNEVEN GAIT.
SCOLIOSIS • ABNORMAL LATERAL CURVATURE OF THE SPINE
• INITIAL EVALUATION USING AP AND LATERAL STANDING
RADIOGRAPHS.
SCOLIOSIS TREATMENT • SCOLIOSIS MAY BE CORRECTED BY PLACING THE
INDIVIDUAL IN A BRACE OR BODY CAST IN PATIENTS WITH
CURVES OF 25 TO 35 DEGREES.
• SURGICAL TREATMENT WITH SPINAL FUSION IS
PRESCRIBED FOR CURVES GREATER THAN 40 DEGREES.
TRANSITIONAL VERTEBRA • OCCURS AT THE JUNCTION BETWEEN THE THORACIC AND
LUMBAR VERTEBRAE OR AT THE LUMBAR VERTEBRA AND
SACRUM.
SPINA BIFIDA • INCOMPLETE CLOSURE OF THE VERTEBRAL CANAL,
COMMONLY IN THE LUMBO-SACRAL AREA.
CRANIAL ANOMLIES
CRANIOSYNOSTOSIS • PREMATURE OR EARLY CLOSURE OF ANY CRANIAL
SUTURE, LEADING TO OVERGROWTH IN THE UNFUSED
SUTURE TO ACCOMMODATE BRAIN GROWTH.
• ALTHOUGH THIS DEFECT MAY BE CORRECTED WITH
SURGERY, BRAIN DAMAGE MAY OCCUR.
ANENCEPHALY NON FORMATION OF THE BRAIN AND CRANIAL VAULT
• USUALLY ONLY FACIAL BONES ARE FORMED
• THIS ABNORMALITY RESULTS IN DEATH SHORTLY AFTER
BIRTH AND MAY BE DIAGNOSED BEFORE BIRTH BY
ULTRASONOGRAPHY.
 • ANENCEPHALY IS A NEURAL TUBE DEFECT, AND ITS
CAUSE IS UNKNOWN.
OSTEOMYELITIS • INFECTION OF BONE AND BONE MARROW CAUSED BY A
PATHOGENIC MICRO-ORGANISM
• INFECTION MAY BE VIA HEMATOGENOUS ROUTE, FROM
A CONTIGUOUS SITE, INJECTION, OR DIRECT
INTRODUCTION
• IMAGING MODALITY: RADIOGRAPHY IS NOT AS SENSITIVE
AS NUCLEAR SCANS OR MRI IN DETECTION.

COMMONLY AFFECTED IN CHILDREN:

• THE DISTAL FEMUR, PROXIMAL TIBIA, HUMERUS, AND
RADIUS COMMONLY AFFECTED IN ADULTS:
• VERTEBRAE

IMAGING CONSIDERATIONS
RADIOGRAPHY
• MAY DEMONSTRATE SOFT TISSUE SWELLING IN THE AREA
AROUND THE AFFECTED BONE.
MRI
• DEMONSTRATES WATERLIKE SIGNAL CHARACTERISTICS.
TUBERCULOSIS • CHRONIC INFLAMMATORY DISEASE CAUSED BY
MYCOBACTERIUM TUBERCULOSIS
• HIP, KNEE, AND SPINE (POTTS DISEASE) ARE MOST
COMMONLY AFFECTED
• “WORM-EATEN” APPEARANCE IN RADIOGRAPHS
POTT DISEASE • TUBERCULOSIS OF THE SPINE
• IT DESTROYS THE SPINE, CAUSING SOFTENING AND
EVENTUAL COLLAPSE OF THE VERTEBRAE, WHICH RESULTS
IN PARAVERTEBRAL ABSCESS FORMATION AND EXERTS
ABNORMAL PRESSURE ON THE SPINAL CORD.
ARTHROPATHIES
INFECTIOUS ARTHRITIS • PATHOGENIC MICRO-ORGANISMS
RHEUMATOID ARTHRITIS • AUTOIMMUNE DISEASE
ANKYLOSING SPONDYLITIS • PROGRESSIVE, USUALLY INVOLVES THE SPINE
(MARIESTRUMPELL DISEASE)
OSTEOARTHRITIS • MOST COMMON TYPE, ALSO KNOWN AS DEGENERATIVE
JOINT DISEASE
GOUTY ARTHRITIS • INHERITED METABOLIC DISEASE
• TOPHI
• “RAT BITE” EROSION
REITER SYNDROME • IS A VARIANT OF RHEUMATOID ARTHRITIS OCCURRING
MOST COMMONLY IN YOUNG MALES.
• IT HAS BEEN ASSOCIATED WITH BACTERIAL INFECTIONS
OF THE GIT AND GENITOURINARY SYSTEMS.
 • THE SACROILIAC JOINTS, HEELS (CALCANEI), AND TOES
ARE GENERALLY AFFECTED IN THIS SYNDROME,
SOMETIMES REFERRED TO AS “LOVER’S HEEL.”
• ALTHOUGH THE RADIOGRAPHIC APPEARANCE MAY
MIMIC RA, REITER SYNDROME AFFECTS FEET INSTEAD OF
HANDS.
METABOLIC
PAGET DISEASE • THE OSTEOID MATERIAL THAT REPLACES NORMAL BONE
(OSTEITIS DEFORMANS) TISSUE DIMINISHES THE TRABECULAE AND IS VERY BULKY
AND POROUS, WITH EXCEPTIONAL VASCULARITY.
• ITS SOFTNESS OFTEN LEADS TO WEIGHT-BEARING,
STRESS-INDUCED DEFORMITIES AND FRACTURES.
• “COTTON-WOOL” APPEARANCE RADIOGRAPHICALLY.
• RADIONUCLIDE BONE SCANS READILY DETECT PAGET
DISEASE EVEN IN ITSVERY EARLY STAGES.
• RADIOGRAPHICALLY, AFFECTED BONES TYPICALLY
DEMONSTRATE CORTICAL THICKENING, WITH A COARSE,
THICKENED TRABECULAR PATTERN.
• MIXED AREAS OF RADIOLUCENT OSTEOLYSIS AND
RADIOPAQUE OSTEOSCLEROSIS MAY BE SEEN.
• NO KNOWN CURE EXISTS
TRAUMATIC DISEASES
COMPRESSION FRACTURE • MOST FREQUENT
• DAMAGE IS LIMITED TO THE UPPER PORTION OF THE
VERTEBRAL BODY, PARTICULARLY TO THE ANTERIOR
MARGIN.
• GENERALLY OCCUR IN THE THORACIC AND LUMBAR
VERTEBRAE WITH THE MOST COMMON SITE BEING T11-
T12 IN THE THORACIC SPINE AND T12-L1 AT THE
THORACOLUMBAR JUNCTURE.
HANGMAN’S FRACTURE • FRACTURE OF THE ARCH OF THE SECOND CERVICAL
VERTEBRA.
• USUALLY ACCOMPANIED BY ANTERIOR SUBLUXATION OF
THE SECOND VERTEBRA TO THE THIRD CERVICAL
VERTEBRA.
• SOMETIMES REFERRED AS “TRAUMATIC SPONDYLOSIS”
RESULTS FROM ACUTE HYPEREXTENSION OF THE HEAD.
JEFFERSON’S FRACTURE • “BURST FRACTURE” OF THE FIRST CERVICAL VERTEBRA
(ATLAS).
• GENERALLY OCCURS AS A RESULT OF A SEVERE AXIAL
FORCE THAT CAUSES COMPRESSION, AS IN A DIVING
ACCIDENT.
• THE VERTEBRAL ARCH LITERALLY BURSTS.
• MRI – PREFERRED IMAGING MODALITY TO BEST EXAMINE
THE TRANSVERSE LONGITUDINAL LIGAMENT
FRACTURE DISCONTINUITY OF BONE CAUSED BY MECHANICAL
FORCES EITHER APPLIED TO THE BONE OF TRANSMITTED
DIRECTLY ALONG THE LINE OF A BONE.
OPEN OR COMPOUND FRACTURE IS ONE IN WHICH THE BONE HAS PENETRATED THE SKIN.
THIS TYPE OF FRACTURE LEAVES AN OPEN ROUTE FOR
BACTERIA TO ENTER FROM OUTSIDE THE BODY, WHICH
MAY LEAD TO INFECTION.
SIMPLE OR CLOSED FRACTURE IS ONE IN WHICH THE SKIN IS NOT PENETRATED, WHICH
REDUCES THE CHANCES OF INFECTION.
IMPACTED FRACTURE WHEN ONE OF THE FRACTURED BONE ENDS IS JAMMED
INTO THE CANCELLOUS TISSUE OF ANOTHER FRAGMENT.
CLOSED REDUCTION • REQUIRES THAT A LOCAL OR GENERAL ANESTHETIC BE
GIVEN TO THE PATIENT FOR PAIN MANAGEMENT.
• A SPLINT OR CAST IS THEN APPLIED
OPEN REDUCTION • IS REQUIRED WHEN ORTHOPEDIC HARDWARE IS NEEDED
TO MAINTAIN FRACTURE REDUCTION OR WHEN AN OPEN
FRACTURE NEEDS TO BE IRRIGATED.
• GENERALLY, THIS IS REFERRED TO AS OPEN REDUCTION
INTERNAL FIXATION (ORIF)
COMMINUTED FX • SOMETIMES, ONE OR MORE FRAGMENTS SEPARATE
ALONG THE EDGES OF THE MAJOR FRAGMENT IN
ADDITION TO THE MAJOR LINE OF THE FRACTURE.
BUTTERFLY FX A COMMINUTED FRACTURE IN WHICH ONE OR TWO
BUTTERFLY WING– SHAPED OR WEDGE-SHAPED
FRAGMENTS SPLIT OFF FROM THE MAIN FRAGMENTS.
SPLINTERED FX A COMMINUTED FRACTURE WITH LONG, SHARP-POINTED
FRAGMENTS.
COMPLETE, NONCOMMINUTED ONE IN WHICH THE BONE HAS SEPARATED INTO TWO
FRACTURES FRAGMENTS.

THE FRACTURE MAY BE RECOGNIZED ACCORDING TO THE

DIRECTION OF THE FRACTURE LINE.
SPIRAL OR OBLIQUE FX SUCH A FRACTURE USUALLY RESULTS FROM A ROTARY
TYPE OF INJURY THAT TWISTS THE BONE APART AND IS
PARTICULARLY COMMON IN THE SHAFTS OF LONG BONES
TRANSVERSE FX IS ANOTHER TYPE OF COMPLETE, NONCOMMINUTED
FRACTURE.
PATHOLOGIC FX • COMMONLY A TRANSVERSE FRACTURE OCCURRING IN
ABNORMAL BONE THAT IS WEAKENED BY VARIOUS
DISEASES SUCH AS A BONE CYST OR METASTATIC BONE
NEOPLASM.
• IT MAY RESULT FROM THE DISEASE PROCESS ITSELF OR
FROM A RELATIVELY MINOR TRAUMA.
MULTIPLE FX A TYPE OF COMPLETE, NONCOMMINUTED FRACTURE IN
WHICH TWO OR MORE COMPLETE FRACTURES OCCUR
INVOLVING THE SHAFT OF A SINGLE BONE.
AVULSION FX • OCCUR WHEN A FRAGMENT OF BONE IS PULLED AWAY
FROM THE SHAFT.
• SUCH FRACTURES USUALLY OCCUR AROUND JOINTS
BECAUSE OF LIGAMENT, TENDON, AND MUSCLE TEARING,
AS ASSOCIATED WITH A SPRAIN OR DISLOCATION.
CHIP FX • AVULSION FX OF A SMALL FRAGMENT OR CHIP OF BONE
FROM THE CORNER OF A PHALANX OR OTHER LONG BONE.
• THESE ARE VERY COMMON IN THE FINGERS AND ARE
OFTEN TINY. A MALLET FINGER IS AN EXAMPLE OF THIS.
INCOMPLETE FX • ONLY PART OF THE BONY STRUCTURE GIVES WAY, WITH
LITTLE OR NO DISPLACEMENT.
• GREENSTICK FX - THE CORTEX BREAKS ON ONE SIDE
WITHOUT SEPARATION OR BREAKING OF THE OPPOSING
CORTEX.
• THE EFFECT IS SIMILAR TO THAT OF TRYING TO BREAK A
GREEN TWIG, HENCE ITS NAME.
• TORUS FX, COMMONLY REFERRED TO AS A BUCKLE
FRACTURE, IS A GREENSTICK FRACTURE IN WHICH THE
CORTEX BULGES OUTWARD, USUALLY IN THE METAPHYSIS,
PRODUCING ONLY A SLIGHT IRREGULARITY.
• COMMONLY FOUND IN THE DISTAL FOREARM OR TIBIA-
FIBULA AFTER A FALL.
PENETRATING FX A TYPE OF INCOMPLETE FRACTURE RESULTING FROM
PENETRATION BY A SHARP OBJECT SUCH AS A BULLET OR
A KNIFE.
STRESS AND FATIGUE FX • USUALLY OCCUR AS A RESULT OF AN ABNORMAL DEGREE
OF REPETITIVE TRAUMA.
• THEY ARE GENERALLY FOUND AT THE POINT OF
MUSCULAR ATTACHMENTS, AS IN THE TIBIA OR FIBULA OF
A RUNNER.
• STRESS FRACTURES MAY NOT BE CLEARLY VISIBLE ON
PLAIN RADIOGRAPHS, ESPECIALLY INITIALLY ON INJURY,
BUT MAY BE DIAGNOSED WITH A NUCLEAR MEDICINE
BONE SCAN OR MRI OF THE AFFECTED AREA.
COLLES FX A FRACTURE THROUGH THE DISTAL INCH OF THE RADIUS.
THE DISTAL FRAGMENT IS USUALLY ANGLED BACKWARD
ON THE SHAFT, WITH IMPACTION ALONG THE DORSAL
ASPECT.
• MOST COMMON WRIST FRACTURE.
• USUALLY RESULTS FROM FALLING ON AN OUTSTRETCHED
HAND.
• THE EXTERNAL SKIN CONTOUR IN COLLES FRACTURE
DISPLAYS A “DINNER FORK” DEFORMITY.
SMITH FX • OPPOSITE OF COLLES FRACTURE, WITH DISPLACEMENT
OF THE DISTAL FRAGMENT TOWARD THE PALMAR ASPECT
OF THE HAND.
 • A DIRECT BLOW OR FALL WITH THE WRIST IN
HYPERFLEXION IS THE USUAL MECHANISM OF INJURY
BOXER’S FX OCCURS WHEN THE FIFTH METACARPAL (AND
OCCASIONALLY THE FOURTH METACARPAL) FRACTURES AS
A RESULT OF A BLOW TO OR WITH THE HAND.
BENNETT FX • FRACTURE AND DISLOCATION OF THE FIRST
CARPOMETACARPAL JOINT.
• THE INJURY OCCURS WHEN THE THUMB IS FORCED
BACKWARD WHILE IN PARTIAL FLEXION AND IS
COMMONLY SEEN IN BASKETBALL PLAYERS AND SKIERS.
MONTEGGIA FX • FRACTURE OF THE PROXIMAL THIRD OF THE ULNAR
SHAFT, WITH ANTERIOR DISLOCATION OF THE RADIAL
HEAD. (Proximal)
GALEAZZI FX • OCCURS AT THE PROXIMAL RADIUS, WITH A
DISLOCATION OF THE DISTAL RADIAL-ULNAR JOINT (distal)
DISLOCATION/LUXATION RESULTS WHEN A BONE IS OUT OF ITS JOINT AND NOT IN
CONTACT WITH ITS NORMAL ARTICULATION.
SUBLUXATION A PARTIAL DISLOCATION, OFTEN OCCURRING WITH
FRACTURE.
THE ANKLE AND VERTEBRAL COLUMN, ESPECIALLY THE
CERVICAL SPINE, ARE COMMON SITES OF SUBLUXATIONS.
OTHER TRAUMATIC DISEASES OF THE SS
BATTERED CHILD SYNDROME • ASSOCIATED WITH A PHYSICAL FORM OF CHILD ABUSE.
• NO ACCIDENTAL TRAUMA (NAT).
• BRUISES, BURNS, ABRASIONS, AND FRACTURES IN
VARIOUS STAGES OF HEALING
• RADIOGRAPHIC SKELETAL SURVEYS TO INCLUDE BONES
OF THE UPPER EXTREMITIES, LOWER EXTREMITIES, SKULL,
SPINE, AND RIBS
• SHAKEN BABY SYNDROME – SEVERE TYPE OF ABUSE.
AVASCULAR NECROSIS DENOTE BONE DEATH RESULTING FROM INADEQUATE
BLOOD SUPPLY.
LEGG-CALVE-PERTHES DISEASE COMMON FORM OF AVASCULAR NECROSIS AFFECTING
THE FEMORAL HEAD. PERTHES - REFERS SPECIFICALLY TO
ISCHEMIC NECROSIS OF THE HEAD OF THE FEMUR.
Neoplastic
OSTEOCHONDROMA (EXOSTOSIS) - MOST COMMON BENIGN TUMOR; FEMUR OR TIBIA -
“CAULIFLOWER”/ “MUSHROOM” STALK APPEARANCE
OSTEOMA - DENSE, WELL-CIRCUMSCRIBED; SKULL
- HYPEROSTOSIS FRONTALIS INTERNA
ENCHONDROMA - SLOW-GROWING TUMORS; SMALL BONES OF THE HANDS
AND FEET
- “BUBBLY” LESION
BONE CYST (SIMPLE UNICAMERAL -WALL OF FIBROUS TISSUE FILLED WITH FLUID
BONE CYST)
MALIGNANT
GIANT CELL TUMOR “SOAP BUBBLE” APPEARANCE
(OSTEOCLASTOMA)
OSTEOSARCOMA (OSTEOGENIC • HIGHLY AGGRESSIVE BONE FORMING NEOPLASM
SARCOMA) • “SUNBURST”/ “SUNRAY” APPEARANCE
EWING SARCOMA • ARISES FROM MEDULLARY CANAL
• GIVES RISE TO UNIFORM THICKENING OF THE BONE
CHONDROSARCOMA • CARTILAGINOUS ORIGIN METASTASIS FROM OTHER SITES
• OSTEOLYTIC
• OSTEOBLASTIC
Cardio Vascular system
PULMONARY CIRCULATION • TRANSPORTS BLOOD BETWEEN THE HEART AND
LUNGS FOR GAS EXCHANGE.
SYSTEMIC CIRCULATION TRANSPORTS BLOOD FROM THE HEART TO THE
REST OF THE BODY.
HEART • ACTS AS A PUMP THAT PROPELS BLOOD THROUGHOUT
THE BODY VIA THE CIRCULATORY VESSELS
• LIES IN THE ANTERIOR CHEST WITHIN THE
MEDIASTINUM
• THE INTERIOR IS DIVIDED INTO TWO UPPER CHAMBERS
(RIGHT AND LEFT ATRIA) AND TWO LOWER CHAMBERS
(RIGHT AND LEFT VENTRICLES)
• IT LIES IN AN OBLIQUE PLANE WITHIN THE MEDIASTINUM
ENDOCARDIUM • SMOOTH, INNERMOST LAYER
• VALVES ARE MADE UP OF ENDOCARDIUM
MYOCARDIUM • THICK, MUSCULAR LAYER
PERICARDIUM • THIN, OUTERMOST LAYER
• MADE UP OF PARIETAL AND VISCERAL LAYERS
CARDIAC CYCLE
SYSTOLE: CONTRACTION OF THE MYOCARDIUM
DIASTOLE RELAXATION OF THE MYOCARDIUM
SINO-ATRIAL (SA) NODE • PACEMAKER OF THE HEART
• LOCATED AT THE UPPER PORTION OF THE RIGHT
ATRIUM NEAR THE SUPERIOR VENA CAVA
General Considerations
RADIOGRAPHY • SAME CONSIDERATIONS AS IN THE RESPIRATORY SYSTEM
• ATTENTION TO TECHNICAL FACTORS AND PATIENT
POSITIONING
• RADIOGRAPHERS CONTROL
- PATIENT POSTURE
- DEGREE OF INSPIRATION
- CORRECT POSITIONING
- GEOMETRIC FACTORS
- EXPOSURE TECHNIQUE SELECTION
ECHOCARDIOGRAPHY • M-MODE
• 2D
• TRANS-ESOPHAGEAL
• COLOR DOPPLER
 • SPECTRAL DOPPLER
• STRESS ECHO
NUCLEAR CARDIOLOGY • MYOCARDIAL PERFUSION SCAN
• GATED CARDIAC BLOOD POOL SCAN
• POSITRON EMISSION TOMOGRAPHY
MYOCARDIAL PERFUSION SCAN • MOST WIDELY USED PROCEDURE IN NUCLEAR
CARDIOLOGY
• USEFUL IN DETECTING REGIONS OF MYOCARDIAL
ISCHEMIA AND SCARRING
• FOR PATIENTS COMPLAINING OF CHEST
PAIN OF UNKNOWN ORIGIN, CORONARY
ARTERY STENOSIS, AND AS FOLLOW-UP
TO BYPASS SURGERY, ANGIOPLASTY,
AND THROMBOLYSIS
• SCANNING IS PERFORMED BY SPECT OR
PET
GATED CARDIAC POOL SCAN • ALSO KNOWN AS RADIONUCLIDE VENTRICULOGRAM OR
MULTIPLE GATE ACQUISITION SCAN (MUGA)
- EVALUATES VENTRICULAR FUNCTION AND VENTRICULAR
WALL MOTION
COMPUTED TOMOGRAPHY SCAN (CT) • MULTIDETECTOR (MULTISLICE)
• ELECTRON BEAM CT (EBCT)
• CT ANGIOGRAPHY (CTA)
MULTISLICE / EBCT • CORONARY ARTERY CALCIFICATION SCORING
CTA • EVALUATION OF RIGHT AND LEFT CORONARY ARTERIES,
CIRCUMFLEX ARTERY, ANTERIOR DESCENDING ARTERY
• IMAGE VASCULAR STRUCTURES FOR ORGAN DONORS
• DIAGNOSE PULMONARY EMBOLISM
• IMAGE ABDOMINAL AORTIC ANEURYSM
MAGNETIC RESONANCE IMAGING • EVALUATE MYOCARDIAL WALL THICKNESS AND
CHAMBER VOLUMES
• EVALUATE VIABLE VS NON-VIABLE MYOCARDIUM
• MRA IS THE CHOICE FOR PATIENTS UNABLE TO UNDERGO
CTA DUE TO RENAL FAILURE
ANGIOGRAPHY DIAGNOSTIC
• FOR PATIENTS WITH CORONARY ARTERY DISEASE,
CONGENITAL HEART DISEASE, AND CONDUCTION
DISTURBANCES.
• ABILITY TO MEASURE INTRACARDIAC AND ARTERIAL
PRESSURES.

THERAPEUTIC
• PTCA
PATHOLOGY
CONGENITAL AND HEREDITARY - FETAL CIRCULATION AND BLOOD- GAS EXCHANGE
DISEASES OCCURS IN THE PLACENTA
 - FETAL CIRCULATORY SYSTEM HAS CHARACTERISTICS THAT
NORMALLY DISAPPEAR AT BIRTH

• FORAMEN OVALE – OPENING AT

THE INTER-ATRIAL SEPTUM

• DUCTUS ARTERIOSUS –
CONNECTS THE PULMONARY
ARTERY TO THE DESCENDING
PATENT DUCTUS ARTERIOSUS (PDA) • DUCTUS ARTERIOSUS SHUNTS BLOOD
FROM THE PULMONARY ARTERY INTO
THE AORTA IN THE FETAL CIRCULATION.

• PERSISTENCE OF THIS VESSEL AT BIRTH

RESULTS IN THIS DISEASE, MOST
COMMONLY SEEN IN PREMATURE
INFANTS

• BLOOD IS FORCED FROM THE AORTA

INTO THE PULMONARY ARTERY,
INCREASING THE PULMONARY BLOOD
FLOW AND LEADS TO PULMONARY
CONGESTION

• PRESENCE OF MURMURS AND CYANOSIS

COARCTATION OF THE AORTA • CAUSED BY A NARROWING OF THE AORTA AT THE
REGION OF THE DUCTUS ARTERIOSUS
• BLOOD FLOW INTO THE LOWER CIRCULATION IS WEAKER
THAN IN THE UPPER CIRCULATION
• MAY LEAD TO HEARTFAILURE
SEPTAL DEFECTS • ATRIAL
• VENTRICULAR
• ALLOWS BLOOD TO BE SHUNTED BETWEEN THE TWO
CHAMBERS, RESULTING IN MIXING OF PULMONARY AND
SYSTEMIC BLOOD
• USUALLY SHUNTED FROM LEFT TO RIGHT DUE TO HIGHER
PRESSURE IN THE LEFT
• RESULTS IN ENLARGEMENT OF THE RIGHT VENTRICLE
AND INCREASED PULMONARY VASCULARITY
TRANSPOSITION OF THE GREAT • ANOMALY WHERE THE AORTA ARISES FROM THE RIGHT
VESSELS (TGV) VENTRICLE AND THE PULMONARY ARTERY ARISES FROM
THE LEFT VENTRICLE
• NO COMMUNICATION BETWEEN PULMONARY AND
SYSTEMIC SYSTEMS

• INCOMPATIBLE WITH LIFE WITHOUT A SEPTAL DEFECT

OR A PDA
 • 'EGG ON ITS SIDE' APPEARANCE
TETRALOGY OF FALLOT - COMBINATION OF FOUR DEFECTS
• PULMONIC STENOSIS
• VENTRICULAR SEPTAL DEFECT
• OVER-RIDING OF THE AORTA
• HYPERTROPHIC RIGHT VENTRICLE
- MOST COMMON CAUSE OF
CYANOSIS IN INFANTS WITH
CARDIOVASCULAR ANOMALIES
- 'COR-EN-SABOT' APPEARANCE OF
THE HEART.
VALVULAR DISEASES • MOST COMMON CAUSE OF CHRONIC VALVULAR
DISEASE IS RHEUMATIC FEVER
• USUALLY AFFECTS THE MITRAL AND AORTIC
VALVES
• INFLAMMATORY CHANGES PRODUCES CHANGES
IN THE HEART VALVES, RESULTING IN STENOSIS
OR INSUFFICIENCY.
• CAUSED BY SCARRING OF VALVE CUSPS THAT
EVENTUALLY ADHERE TO EACH OTHER
• MITRAL VALVE STENOSIS INHIBITS THE FLOW OF BLOOD
FROM THE LEFT ATRIUM INTO THE LEFT VENTRICLE; IT
ALSO SLOWS THE BLOOD FLOW THROUGH THE LUNGS AND
THE RIGHT SIDE OF THE HEART, RESULTING IN
ENLARGEMENT OF THE LEFT ATRIUM AND THE RIGHT-
SIDED
VALVULAR INSUFFICIENCY • OCCURS WHEN THE VALVES DO NOT CLOSE PROPERLY
AND ALLOW BLOOD TO REFLUX DURING SYSTOLE.
• USUALLY FOLLOWS ENDOCARDITIS OR MITRAL VALVE
PROLAPSE.
CONGESTIVE HEART FAILURE • OCCURS WHEN THE HEART IS UNABLE TO PROPEL
BLOOD AT A SUFFICIENT RATE AND VOLUME.
• RESULTS IN CONGESTION OF THE CIRCULATORY
SUBSYSTEMS.
• MAY AFFECT EITHER SIDE OF THE HEART INITIALLY.
LEFT-SIDED FAILURE

• OVERLOADS THE PULMONARY CIRCULATORY SUBSYSTEM

• FLUID LEAKS FROM THE CAPILLARIES INTO THE
INTERSTITIAL TISSUE WITHIN THE LUNGS.

RIGHT-SIDED FAILURE

• NOT AS COMMON
• CAUSES VENOUS BLOOD TO SLOW DOWN, RESULTING IN
EDEMA OF THE LOWER EXTREMITIES.
DEGENERATIVE DISEASES
ATHEROSCLEROSIS • AFFECTS THE MAJOR ARTERIES

• ATHEROMA FORMATIONS BEGIN AS FATTY STREAKS

AND
PROGRESS INTO FIBROUS PLAQUES, WHICH COLLECTS
WITHIN THE VESSEL.
• PATIENT MAY REMAIN ASYMPTOMATIC UNTIL THERE IS
GREATER THAN 50% NARROWING OF THE LUMEN
CORONARY ARTERY DISEASE • RESULTS FROM DEPOSITION OF ATHEROMAS IN THE
ARTERIES THAT SUPPLY BLOOD TO THE HEART MUSCLES.

• MYOCARDIAL INFARCTION

- MOST COMMONLY CAUSED BY

AN ACUTE THROMBUS OF THE
CORONARY ARTERIES, PRIMARILY
AFFECTING THE LEFT VENTRICLE

ANEURYSMS • LOCALIZED 'BALLOONING' OR OUTPOUCHING OF THE

VESSEL WALL

• RESULTS FROM WEAKENING OF THE WALL BY

ATHEROMATOUS PLAQUES, TRAUMA, INFECTION, OR
CONGENITAL DEFECTS.

SACCULAR
• LOCALIZED BULGE

FUSIFORM
• BULGING OF THE ENTIRE WALL

DISSECTING
• RESULTS WHEN THE INTIMA TEARS
AND ALLOWS BLOOD TO FLOW WITHIN THE VESSEL WALL
VENOUS THROMBOSIS • PRESENCE OF BLOOD CLOTS WITHIN A VEIN
• COMMONLY FORMS IN THE LOWER EXTREMITIES

PULMONARY EMBOLI / • BLOOD CLOT FORMS OR BECOMES LODGED IN A

THROMBOEMBOLISM PULMONARY ARTERY
• USUALLY ARISES FROM LOWER EXTREMITIES
• MAY ARISE AS FAT EMBOLISM FROM FRACTURE SITES
• MAY ARISE AS AIR EMBOLISM FROM IV LINES

Gastro Intestinal
ABDOMINAL CAVITY
PERITONEUM SEROUS MEMBRANE
VISCERAL SEROUS LINING ATTACHED TO THE ORGANS
PARIETAL SEROUS LINING ATTACHED DIRECTLY TO THE ABDOMINAL
WALL.
MESENTERY: DOUBLE FOLD OF PARIETAL PERITONEUM FROM THE
POSTERIOR ABDOMINAL WALL IN THE LUMBAR REGION
MOST OF THE SMALL INTESTINES ARE ATTACHED AT THE
OUTER EDGES
ALIMENTARY TRACT • MOUTH • PHARYNX • ESOPHAGUS • STOMACH • SMALL
INTESTINE • LARGE INTESTINE • RECTUM

ESOPHAGUS • APPROXIMATELY 10 – 12 INCHES LONG

• THE UPPER PORTION IS MIDLINE, BUT COURSES TO THE
LEFT TO PASS BEHIND THE AORTIC ARCH
• NORMAL ESOPHAGEAL INDENTATIONS
• LEVEL OF AORTIC ARCH
• LEVEL OF THE LEFT MAIN STEM BRONCHUS
• GASTROESOPHAGEAL JUNCTION
STOMACH • OCCUPIES THE LEFT UPPER QUADRANT
• PERISTALSIS MIXES FOOD AND GASTRIC JUICES TO FORM
CHYME AND PROPELS IT TOWARDS THE DUODENUM.
• RUGAL FOLDS INCREASE THE SURFACE AREA OF THE
GASTRIC LUMEN
SMALL INTESTINE
DUODENUM • C-LOOP
 • ARISES FROM THE GASTRIC ANTRUM UP TO THE
LIGAMENT OF TREITZ
• COARSE, TRANSVERSE MUCOSAL PATTERN
JEJUNUM • COILS IN THE LUQ AND TERMINATES IN THE RUQ
• DELICATE AND FEATHERY MUCOSAL PATTERN
ILEUM • COURSES THROUGH THE LOWER QUADRANTS
• MUCOSAL PATTERN SIMILAR TO DUODENUM BUT LESS
COARSE.
LARGE INTESTINE

LIVER • LARGEST ORGAN IN THE BODY LOCATED IN

FUNCTIONS OF THE LIVER THE RUQ.
• HELD IN PLACE BY PERITONEAL LIGAMENTS
• DUAL BLOOD SUPPLY
• HEPATIC ARTERY, ARISING FROM THE CELIAC
TRUNK
• PORTAL VEIN, FROM THE UNION OF THE
SUPERIOR MESENTERIC AND SPLENIC VEINS
• METABOLISM OF SUBSTANCES FROM THE PORTAL
CIRCULATION.
• SYNTHESIS OF SUBSTANCES ASSOCIATED WITH BLOOD
CLOTTING, VITAMIN B1.
• DETOXIFICATION AND EXCRETION OF VARIOUS
SUBSTANCES.
•Produces Bile

GALLBLADDER • PEAR-SHAPED SAC AT THE UNDERSURFACE OF

THE RIGHT HEPATIC LOBE.
• STORES AND CONCENTRATES BILE PRODUCED
BY THE LIVER VIA THE HEPATIC DUCT.
• EMPTIES BILE INTO THE DUODENUM TO AID IN
THE DIGESTION AND ABSORPTION OF FAT.
PANCREAS • ELONGATED, FLAT ORGAN, CROSSES OBLIQUELY
TOWARDS THE LEFT BEHIND THE STOMACH.
FUNCTIONS:
• EXOCRINE
• PRODUCTION OF ENZYMES: TRYPSIN, AMYLASE, AND
LIPASE
• ENDOCRINE
 • PRODUCES HORMONES: INSULIN, GLUCAGON
CONGENITAL AND HEREDITARY
ESOPHAGEAL ATRESIA • RARE
• RESULTS IN DISCONTINUATION OF THE ESOPHAGUS DUE
TO A DEFECT IN CELL DIFFERENTIATION BETWEEN THE
ESOPHAGUS AND TRACHEA.
• SYMPTOMS ARE IMMEDIATELY VISIBLE AT BIRTH
• REQUIRES IMMEDIATE SURGERY
BOWEL ATRESIA ILEAL
• MOST COMMON TYPE
DUODENAL
• “DOUBLE-BUBBLE” SIGN IN RADIOGRAPH
COLONIC
• USUALLY INVOLVES THE RECTUM AND ANUS
HYPERTROPHIC PYLORIC STENOSIS • HYPERTROPHY AND HYPERPLASIA OF THE PYLORIC
(HPS) SPHINCTER RESULTS IN NARROWING OF THE PYLORIC
CANAL.
• MOST COMMON INDICATION OF SURGERY IN INFANTS
• SONOGRAPHY, UPPER GI STUDIES ARE THE MODALITIES
OF CHOICE.
HIRSCHSPRUNG DISEASE • ABSENCE OF NEURONS IN THE BOWEL WALL.
(CONGENITAL AGANGLIONIC • PREVENTS THE NORMAL RELAXATION OF THE
MEGACOLON) MUSCLES AND LOSS OF PERISTALSIS.
MECKEL DIVERTICULUM • CONGENITAL DIVERTICULUM OF THE DISTAL ILEUM.
• REMNANT OF THE DUCT CONNECTING THE ILEUM TO THE
UMBILICUS IN THE FETUS.
• FREQUENTLY CAUSES ULCER FORMATION IN THE
ADJACENT BOWEL.
• USUALLY IDENTIFIED IN NUCLEAR MEDICINE SCANS
USING TECHNETIUM-99.
GLUTEN-SENSITIVE ENTEROPATHY • CELIAC SPRUE OR CELIAC DISEASE
• SENSITIVE TO GLUTEN, FOUND IN
WHEAT, BARLEY, RYE

INFLAMMATORY DISEASES
ESOPHAGEAL STRICTURES • MAY BE SECONDARY TO INGESTION OF CAUSTIC
SUBSTANCES.
• ANY FACTOR THAT INFLAMES THE MUCOSA AND CAUSE
SCARRING.
GASTROESOPHAGEAL REFLUX • RESULTS FROM AN INCOMPETENT CARDIAC SPHINCTER,
DISEASE (GERD ALLOWING THE BACKWARD FLOW OF GASTRIC ACID AND
CONTENTS INTO THE ESOPHAGUS.
PEPTIC ULCER • EROSION OF THE MUCOUS MEMBRANE AT THE DISTAL
PORTION OF THE ESOPHAGUS, STOMACH (LESSER
CURVATURE), OR DUODENUM (DUODENAL BULB)
• “SPIKE WHEEL” APPEARANCE
• ENDOSCOPY, UGIS
CROHN’S DISEASE (REGIONAL • CHRONIC INFLAMMATORY BOWEL DISEASE.
ENTERITIS) • USUALLY AFFECTS THE ILEUM BUT MAY OCCUR
ANYWHERE IN THE ALIMENTARY CANAL.
• “COBBLESTONE” APPEARANCE
COMBINATION OF MUCOSAL EDEMA AND CRISSCROSSING
FINE ULCERATIONS.
• “STRING” SIGN
TERMINAL ILEUM IS SO DISEASED AND STENOTIC THAT THE
BARIUM MIXTURE CAN ONLY TRICKLE THROUGH A SMALL
OPENING
ULCERATIVE COLITIS • INFLAMMATORY LESION OF THE COLONIC MUCOSA.
• CAUSE IS UNKNOWN
• AFFECTS 15-25 YEAR-OLDS, WHO DEVELOP EXCESSIVE
DIARRHEA WITH BLOOD, PUS, AND MUCUS IN STOOL.
• GENERALLY STARTS IN THE RECTUM AND SPREADS TO
THE SIGMOID, SOMETIMES ENTIRE COLON
APPENDICITIS • INFLAMMATION OF THE VERMIFORM APPENDIX
• USUALLY FROM OBSTRUCTION BY A FECALITH.
• CT IS THE MOST ACCURATE IMAGING
MODALITY FOR PATIENTS WHO DO NOT HAVE
A CLEAR CLINICAL DIAGNOSIS OF ACUTE AP.
• SONOGRAPHY IS AN ALTERNATIVE CHOICE
ESPECIALLY FOR CHILDREN AND PREGNANT
WOMEN.

ESOPHAGEAL VARICES • ABNORMALLY LENGTHENED, DILATED, SUPERFICIAL

VEINS OF THE ESOPHAGUS.
• SECONDARY TO PORTAL HYPERTENSION.
• ESOPHAGOGRAM IN THE RECUMBENT POSITION.
DEGENERATIVE DISEASES
HERNIATION • PROTRUSION OF A LOOP OF BOWEL THROUGH AN
OPENING.
• REDUCIBLE VS INCARCERATED VS STRANGULATED
HERNIA.
REDUCIBLE HERNIA IF A HERNIATED LOOP OF BOWEL CAN BE PUSHED BACK
INTO THE ABDOMINAL CAVITY
INCARCERATED HERNIA IF IT BECOMES STUCK AND CANNOT BE REDUCED
STRANGULATED HERNIA • IF THE CONSTRICTION THROUGH WHICH THE BOWEL
LOOP HAS PASSED IS TIGHT ENOUGH TO CUT OFF BLOOD
SUPPLY TO THE BOWEL.
• PROMPT SURGICAL INTERVENTION IS
REQUIRED TO AVOID NECROSIS
• BOWEL THAT HAS ALREADY BECOME
NECROTIC CAN GENERALLY BE
SURGICALLY RESECTED.
• INGUINAL HERNIA • MOSTLY IN MEN
• HERNIATION THROUGH THE INGUINAL RING, MAY
EXTEND INTO THE SCROTAL SAC
HIATAL HERNIA • WEAKNESS OF THE ESOPHAGEAL HIATUS
• HERNIATION INTO THE THORACIC CAVITY
• SLIDING HIATAL HERNIA: “SCHATZKI RING”
BOWEL OBSTRUCTION
• MECHANICAL • OCCLUSION OF THE BOWEL LUMEN
• MOST DUE TO INCARCERATED HERNIA
VOLVULUS • TWISTING OF A BOWEL LOOP ABOUT ITS MESENTERIC
BASE.
• “COFFEE BEAN” SIGN
• IS A TWISTING OF A BOWEL LOOP UPON ITSELF, LEADING
TO A MECHANICAL TYPE OF OBSTRUCTION.
• BLOOD SUPPLY TO THE TWISTED PORTION IS
COMPROMISED, LEADING TO OBSTRUCTION AND
LOCALIZED DEATH OF TISSUE (NECROSIS).
• MAY BE FOUND IN PORTIONS OF THE JEJUNUM OR
ILEUM.
• INTUSSUSCEPTION • TELESCOPING OF A BOWEL SEGMENT INTO A MORE
DISTAL SEGMENT
• “COILED SPRING” APPEARANCE.
GALLSTONE ILEUS • GALLSTONES MAY ERODE FROM THE GALLBLADDER AND
CREATE A FISTULA TO THE SMALL BOWEL.
• THIS LEADS TO OBSTRUCTION, USUALLY WHEN THE
GALLSTONES REACHES THE ILEOCECAL VALVE.
• RADIOGRAPHIC SIGN: AIR AND FLUID LEVELS OR AIR IN
THE BILIARY TREE.
PARALYTIC ILEUS (ADYNAMIC ILEUS) • FAILURE OF NORMAL PERISTALSIS.
• SECONDARY TO ABDOMINAL SURGERY, PERITONEAL
INFECTIONS, ELECTROLYTE IMBALANCE.
MECHANICAL ILEUS “CIRCULAR STAIRCASE” APPEARANCE”
ACHALASIA • FAILURE OF THE LOWER ESOPHAGEAL SPHINCTER TO
RELAX
• DILATED ESOPHAGUS WITH LITTLE OR NO PERISTALSIS
• “BIRDS-BEAK” APPEARANCE / “RAT TAIL” SIGN
DIVERTICULAR DISEASES
DIVERTICULAR DISEASES • A POUCH OR SAC THAT IS CREATED BY HERNIATION OF A
MUCOUS MEMBRANE THROUGH A DEFECT IN ITS
MUSCULAR COAT
ESOPHAGEAL
PULSION TYPE • INVOLVES ONLY THE MUCOSA
• APPEARS AS A ROUNDED PROJECTION WITH A NARROW
NECK
TRACTION TYPE • INVOLVES ALL LAYERS OF THE MUCOSA
• RESULTS FROM SCAR TISSUE THAT PULLS THE
ESOPHAGUS TOWARDS THE AREA OF INVOLVEMENT.
ZENKER DIVERTICULUM • PULSION TYPE FOUND AT THE PHARYNGOESOPHAGEAL
JUNCTION AT THE UPPER END OF THE ESOPHAGUS ON THE
POSTERIOR ASPECT JUST ABOVE THE CRICOPHARYNGEAL
MUSCLE.
KILLIAN-JAMIESON DIVERTICULUM • SIMILAR WITH ZENKER DIVERTICULUM
• ORIGINATES ON THE LATERAL ASPECT
COLONIC DIVERTICULA • MOST FREQUENT IN THE SIGMOID COLON
• ASSOCIATED WITH HYPERTROPHY OF THE MUSCULAR
LAYER OF THE BOWEL WALL
DIVERTICULUM • OUTPOUCHING OF THE MUCOSAL WALL THAT MAY
RESULT FROM HERNIATION OF THE INNER WALL OF THE
COLON.
• COMMON IN THE SIGMOID COLON
DIVERTICULOSIS • HAVING NUMEROUS DIVERTICULA
• WITHOUT INFLAMMATION OR SYMPTOMS
DIVERTICULITIS • INFLAMMATION OF DIVERTICULA IN THE ALIMENTARY
CANAL
NEOPLASTIC
ESOPHAGUS • BENIGN - LEIOMYOMAS
• MALIGNANT - ADENOCARCINOMAS

STOMACH • MOSTLY MALIGNANT,

PREDOMINANTLY
ADENOCARCINOMA
• MOSTLY NEAR THE
ANTRUM OR LESSER
CURVATURE
COLON POLYPS
• SMALL MASSES OF TISSUE ARISING
FROM THE BOWEL WALL AND
PROJECTS INWARD INTO THE LUMEN.
• MOSTLY ASYMPTOMATIC
• MAY BECOME MALIGNANT

MALIGNANT
• MOST COMMON GI CARCINOMA
• BOTH BENIGN AND MALIGNANT TUMORS MAY BEGIN AS
POLYPS.
• ADENOCARCINOMA (ANNULAR CARCINOMA) IS THE
MOST COMMON MALIGNANT GI CANCER
• “NAPKIN-RING” OR “APPLE-CORE” APPEARANCE

Hepatobiliary System
 Inflamattory diseases
ALCOHOL-INDUCED LIVER DISEASE • RANGES FROM ALCOHOLIC FATTY LIVER TO ALCOHOLIC
LIVER CIRRHOSIS
• INITIALLY MAY PRESENT AS HEPATOMEGALY.
• ALCOHOL IS A KNOWN TOXIN, WHICH, WHEN
METABOLIZED BY THE LIVER, CAUSES CELLULAR DAMAGE;
ALCOHOL ABUSE HAS LONG BEEN ASSOCIATED WITH LIVER
DISEASE.
• CHRONIC ALCOHOL ABUSE OFTEN LEADS TO FATTY LIVER
FOLLOWED BY HEPATITIS, CIRRHOSIS, HEPATOCELLULAR
CARCINOMA, OR ALL OF THESE DISEASES. FATTY LIVER IS
THE MOST FREQUENT EARLY RESPONSE TO ALCOHOL
ABUSE.
FATTY LIVER • OTHER FACTORS SUCH AS DIABETES MELLITUS,
HYPERLIPIDEMIA, OBESITY MAY GIVE RISE TO FATTY LIVER.
• THIS RESULTS IN AN EXCESS OF FATTY ACIDS WITHIN THE
LIVER, WHICH LEADS TO FATTY INFILTRATION OF THE
LIVER, TERMED STEATOSIS, AND FATTY LIVER DISEASE.
CIRRHOSIS • CHRONIC LIVER CONDITION
• DESTRUCTION OF LIVER STRUCTURE AND PARENCHYMA
• CONSIDERED AN END-STAGE CONDITION
• IMPAIRED HEPATIC FUNCTION LEADS TO JAUNDICE AND
PORTAL HYPERTENSION.
• ASCITES IS COMMON
• USUALLY SPARES THE CAUDATE LOBE
• INCREASED RISK OF DEVELOPING HEPATOCELLULAR
CARCINOMA.

ASCITES • THE ACCUMULATION OF FLUID WITHIN THE PERITONEAL

CAVITY IS ALSO SEEN AS A RESULT OF PORTAL
HYPERTENSION AND THE LEAKAGE OF EXCESSIVE FLUIDS
FROM THE PORTAL CAPILLARIES.
• MUCH OF THIS EXCESS FLUID IS COMPOSED OF HEPATIC
LYMPH WEEPING FROM THE LIVER SURFACE.
 • ABDOMINAL SONOGRAPHY IS COMMONLY USED IN THE
DETECTION OR CONFIRMATION OF ASCITES.
VIRAL HEPATITIS • THIS INFLAMMATION INTERFERES WITH THE LIVER’S
ABILITY TO EXCRETE BILIRUBIN, THE ORANGE OR
YELLOWISH PIGMENT IN BILE.
• ADDITIONAL SIGNS AND SYMPTOMS INCLUDE FATIGUE,
ANOREXIA, PHOTOPHOBIA, AND GENERAL MALAISE.
• JAUNDICE MAY ALSO DEVELOP WITHIN 1 OR 2 WEEKS
BECAUSE OF THE DISTURBANCE OF BILIRUBIN EXCRETION.
• IF THE LIVER INFLAMMATION LASTS 6 MONTHS OR
MORE, THE CONDITION IS CLASSIFIED AS CHRONIC.
HEPATITIS A • A SINGLE-STRANDED RIBONUCLEIC ACID (RNA)
PICORNAVIRUS.
• IT IS EXCRETED IN THE GI TRACT IN FECAL MATTER AND IS
SPREAD BY CONTACT WITH AN INFECTED INDIVIDUAL,
NORMALLY THROUGH INGESTION OF CONTAMINATED
FOOD SUCH AS RAW SHELLFISH OR THROUGH
CONTAMINATED WATER.
• IT IS THE MOST COMMON FORM OF HEPATITIS AND IS
HIGHLY CONTAGIOUS
• HAV INFECTION DOES NOT LEAD TO CHRONIC HEPATITIS
OR CIRRHOSIS OF THE LIVER.
HEPATITIS B • IS TRANSMITTED PARENTERALLY THROUGH INFECTED
SERUM OR BLOOD PRODUCTS.
• ITS INCUBATION PERIOD IS MUCH LONGER (50 TO 160
DAYS)
HEPATITIS C • IS CAUSED BY A PARENTERALLY TRANSMITTED RNA
VIRUS.
• TYPE C ACCOUNTS FOR 80% OF THE CASES OF HEPATITIS
THAT DEVELOP AFTER BLOOD TRANSFUSIONS.
• HCV MAY CAUSE EITHER ACUTE OR CHRONIC HEPATITIS,
WITH 10% TO 20% OF AFFECTED PATIENTS EVENTUALLY
DEVELOPING CIRRHOSIS OF THE LIVER.
CHOLELITHIASIS • MOSTLY IN WOMEN, OLDER ADULTS, OBESE, HIGH FAT,
(CHOLECYSTOLITHIASIS) SUGAR AND SODIUM, LOW FIBER DIET.
• 80% ARE COMPOSED OF CHOLESTEROL, BILE PIGMENT,
AND CALCIUM SALTS
• MOST ARE RADIOLUCENT
• MAY OCCUR ANYWHERE IN THE BILIARY TREE.
• ULTRASOUND IS THE MODALITY OF CHOICE
CHOLECYSTITIS • INFLAMMATION OF THE GALLBLADDER.
• USUALLY ACUTE
• CHRONIC STATE MAY GIVE RISE TO GANGRENE OR
PERFORATION IF LEFT UNTREATED.
• MAY CREATE A FISTULA WITH THE ADJACENT SMALL
BOWEL.
 • IF THERE IS A STONE, MAY GIVE RISE TO GALLSTONE
ILEUS
• AIR IN THE BILIARY DUCT, STONE WITHIN THE SMALL
BOWEL
PANCREATITIS • ACUTE PANCREATITIS USUALLY RESOLVES WITH NO
MAJOR IMPAIRMENT.
• CHRONIC PANCREATITIS CAUSES DAMAGE TO TISSUE
AND MAY LEAD TO IMPAIRMENT OF FUNCTION
Neoplastic Diseases
HEMANGIOMA • MOST COMMON BENIGN TUMOR OF THE LIVER.
• COMPOSED OF NEWLY FORMED BLOOD VESSELS.
HEPATOCELLULAR • PRIMARY NEOPLASM OF THE LIVER.
CARCINOMA (HEPATOMA) • ASSOCIATED WITH CIRRHOSIS
LIVER METASTASIS • MORE COMMON THAN PRIMARY TUMORS
• COMMON SITE FOR METASTASIS FROM COLON,
PANCREAS, STOMACH, LUNG, AND BREAST
GALL BLADDER CARCINOMA • RARE
• “PORCELAIN” GALLBLADDER INCREASES THE RISK FOR
MALIGNANT TUMORS WHICH RESULTS FROM CHRONIC
CHOLECYSTITIS.
• CARCINOMA OF THE GALLBLADDER IS MORE COMMON
IN WOMEN AND OLDER ADULTS, WITH GALLSTONES
PRESENT IN ABOUT 75% OF ALL CASES.
• THE BEST METHODS FOR IMAGING GALLBLADDER
CARCINOMA INCLUDE CT AND SONOGRAPHY
PANCREATIC • USUALLY RAPIDLY FATAL
CARCINOMA • LACK OF SYMPTOMS AND LOCATION MAKE IT DIFFICULT
TO DIAGNOSE EARLY.
• EVEN WITH ADVANCES IN CT AND SONOGRAPHY, THE
PROGNOSIS IS POOR.
• THE RICH SUPPLY OF NERVES TO THE PANCREAS RESULTS
IN PAIN AS A PROMINENT FEATURE OF THIS CARCINOMA.
• THE TUMOR INFILTRATES AND REPLACES NORMAL TISSUE
WITHOUT SIGNIFICANT HEMORRHAGE, NECROSIS, OR
CALCIFICATION.