Peptic Ulcer – Radiological Features

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RADIOLOGICAL FEATURES OF PEPTIC ULCER (BARIUM MEAL

SERIES)

Peptic ulceration only occurs in those parts of the alimentary canal

which are bathed in the acid and pepsin secretions. The radiological

features of peptic ulcer vary from a mild mucosal errosion to a malignant

ulcer.

a. Sites of gastro duodenal ulcers – Acute gastric ulcer.

b. Acute duodenal ulcer.

c. Benign ulcers.

d. Malignant.

Although in clinical experience duodenal ulcer are far more frequent

than gastric ulcer in the ratio of 10 or 20:1 they are approximately equal.

ROENTGEN SIGNS OF ULCERATION

The presence of a ‘fleck’ or crater. This sign represents the

presence of barium and is regarded as essential for the diagnosis.

CHANGES IN THE NEIGHBOURING RUGAE

These are oedema, irregularity and the cart wheel appearance in

which the rugae radiate from the fleck or crater.

Functional changes such as spasm, increase in peristalsis or

irritability are common.

CHARACTERISTICS ASSOCIATED WITH THE SITE OR ULCERATION

Ulcers in the body of the stomach are more prevalent along the

lesser curvature. Ulcers of the greater curvature are rare.

MUCOSAL RELIEF WITH SMALL AMOUNT OF BARIUM SHOWS

1. Barium sport or fleck.

2. Edematous mucosa at base.

3. Radiating rugae.

4. Coarse rugae often there.

5. When seen in profile it is an out pouching with a broad base. Most

often on lesser curvature. But requires flourscopy in every degree of

obliquity for demonstration.

RADIOLOGICAL FEATURES OF MALIGNANT GASTRIC ULCER

1. Irregularity in mucosa adjoining ulcer niche.

2. No peristalsis here.

3. The niche does not extend beyond line of stomach.

4. Associated duodenal ulcer usually indicated the gastric ulcer is

benign.

5. Ulceration of greater curvature is usually malignant.

A less common site for ulcers is the pyloric but ever here it tends

to occur along the lesser curvature. This ulcer produces a gastric

stasis.

DUODENAL ULCER

The common site for duodenal ulcer is in the duodenal cap and they

may occur on either cap and they may occur on either the anterior or

posterior walls. Less frequently post bulbar area.

Radiological features are

A. Acute penetrating or errosive stage

1. Ulcer niche.

2. Edematous mucosal halo.

3. Thick pyloric rugae.

4. Spastic.

B. Begining scar formation

1. Ulcer niche.

2. Thickened surrounding mucosa.

3. Rugae converging like chart wheel spokes.

4. Pseudo diverticulum formation.

5. Bulb may appear fragmented on compression.

C. Late scarring stage

1. Niche or pseudo diverticulum.

2. Contracted deformed fibrotic bulb rigid walls.

3. Thick pyloric rugae.

Post bulbar ulcers shows deformed bulb.

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