Double Contrast Upper Gastrointestinal Radiography

Gastritis

• Gastritis adalah peradangan pada dinding lambung.• Lambung memiliki sel-sel penghasil asam dan enzim

yang berguna untuk mencerna makanan. Untuk melindungi lapisan lambung dari radang atau pengikisan asam, sel-sel tersebut juga sekaligus menghasilkan lapisan “lendir”. Lapisan lendir ini berfungsi melindungi dinding lambung dari iritasi akibat asam yang diproduksi. Gastritis terjadi ketika lapisan lendir tersebut rusak sehingga dinding lambung mulai teriritasi.

Ulkus Gaster

• Definisi• Ulkus gaster adalah suatu gambaran bulat

atau semi bulat/oval, ukuran >5 mm kedalam sub mucosal pada mukosa lambung akibat terputusnya kontinuitas/integritas mukosa lambung. Ulkus gaster merupakan luka terbuka dengan pinggir edema diserati indurasi dengan dasar ulkus ditutupi debris.

• Features suggesting benign gastric ulcer• outpouching of ulcer crater beyond the gastric contour (exoluminal)• smooth rounded and deep ulcer crater• smooth ulcer mound• smooth gastric folds that reach the margin of ulcer• Hampton's line• Features suggesting malignant gastric ulcer• does not protrude beyond the gastric contour (endoluminal)• irregular and shallow ulcer crater• nodular and angular ulcer mound• nodular gastric folds that do not reach the ulcer margin• Carman meniscus sign

• Benign. lesser curvature gastric ulcer. Red arrows point to Hampton's Line, a thin, straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa. The blue arrows point to the ulcer mound, a smooth, sharply delineated soft-tissue mass surrounding a benign ulcer. Note how the ulcer projects beyond the confines of the expected wall of the stomach.

• The Carman meniscus sign describes the lenticular shape of barium in cases of large and flat gastric ulcers, in which the inner margin is convex toward the lumen. It usually indicates a malignant ulcerated neoplasm.

• Double contrast-enhanced ultrasound imaging of gastric ulceration. A: Three-dimensional (3D) double contrast-enhanced ultrasound imaging showed the gastric cavity and wall with a focal defect area consistent with an ulcer (arrow); B: Another 3D imaging with different angle showed the ulcerative lesion (arrow) and the folds of gastric wall with pseudo-color which similar to gastroscopic imaging; C: The ulcerative lesion (arrow) is seen on gastroscope imaging.

• An ulcerative lesion with larger ulcer (A), and the ulcerating tumor (arrow) with a penetrating, infiltrating ulcer base (large arrow) (B).

Gastric Polyp

• A gastric polyp is an abnormal growth of tissue projecting from the gastric mucosal membrane. Encountering a polyp in the stomach prompts concerns regarding its histology, cause, natural history, and whether specific therapy is required.

• Polyps that reveal a malignancy upon histopathologic examination lose their polyp status, irrespective of their initial endoscopic appearance, and we have excluded them from this review. Furthermore, because it is impossible to be simultaneously practical and comprehensive, we also had to neglect lesions (eg, lipomas, heterotopias, and leiomyomas) because they are unlikely to cause clinical dilemmas.

• Hyperplastic polyp (inflammatory polyp) (75-90%)

• Proliferated gastric mucosa and inflammatory cells

• Associated with pernicious anemia• Random distribution in stomach• Usually multiple• Usually <1cm with no progression• No malignant potential

• Adenomatous polyp (10-20%)• True neoplasm with very low malignant potential

(<4%)• Associated with Gardner’s syndrome, juvenile

polyposis and Cronkhite-Canada syndrome• Occurs more commonly in antrum• Often single• Usually>1.5cm in size• Occurs in patients over 50 years old

• Hyperplastic gastric polyps. Upper photo. White arrows point to multiple filling defects on the anterior and posterior walls of the stomach, some outlined by the barium pool, others etched in barium representing numerous, small gastric polyps. Bottom photo: The same polyps are again shown (blue arrows).

• Double contrast-enhanced ultrasound imaging of gastric polyp. A: Two-dimensional double contrast-enhanced ultrasound (DCUS) imaging displayed a polyp with a wide base projecting into the gastric cavity. Contrast enhancement was seen on both polyp and gastric wall; B: Three-dimensional DCUS imaging of the polyp showed in figure A; C: The surgical specimen of the polyp confirmed the DCUS finding

HPS

• Hipertropi pyloric stenosis (HPS) merupakan suatu kondisi yang terjadi pada bayi dengan lambung bagian pilorus mengalami penebalan yang abnormal.

• HPS adalah penyempitan di jalan keluar lambung sampai bagian pertama dari duodenum menyebabkan pembesaran (hipertropi) muskulus sekitar jalan keluar tersebut (pilorus) dan mengalami spasme saat lambung kosong.

• An upper GI series demonstrates pyloric obstruction with a string sign. The findings are consistent with pyloric stenosis.

• Figure 1 An ultrasonography scans pyloric region. The markers are measuring the thickness of pyloric muscle, which is 3.8 mm.

Gastric Carcinoma

• Gastric carcinoma is the most common cancer in the world after lung cancer and is a major cause of mortality and morbidity. Though a marked reduction has been observed in the incidence of gastric carcinoma in North America and Western Europe in the last 50 years, 5-year survival rates are less than 20%, as most patients present late and are unsuitable for curative, radical surgery. Gastric tumors are seen in the images below.

• Double-contrast barium upper GI examination is widely recognized as the radiologic technique of choice for diagnosing early gastric cancers. These lesions are confined to the mucosa or submucosa and are classified into 3 types:– Type I - Elevated lesions that protrude more than 5 mm

into the lumen (polypoid)– Type II - Superficial lesions that are elevated (IIa), flat

(IIb), or depressed (IIc)– Type III - Shallow, irregular ulcers surrounded by nodular,

clubbed mucosal folds

• Double contrast-enhanced ultrasound imaging of ulcerative gastric cancer. A: Two-dimensional double contrast-enhanced ultrasound (DCUS) images (conventional imaging on the right and harmonic imaging on the left) showed a contrast-enhanced mass with crater-like ulcerative defect (arrow); B: Three-dimensional DCUS imaging showed distorted nourishing vasculature within the gastric cancer (arrow).

• CT (C+ portal venous phase) CT axial Mass in stomach; omental thickening and intestinal obstruction