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Kim's > Abdo > Flashcards

Abdo Flashcards

1
Q

Carcinoid nuc med

A

octreotide concentrates in GIT carcinoid as well as liver mets
MIBG concentrates in carcinoid tumors, including low percentage that are negative on octreotide

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2
Q

MALT lymphoma

A

low grade non Hodgkins

associated he pylori and sjogrens (salivary glands)

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3
Q

cholesterol stones vs pigmented. causes

A

cholesterol. OCP, pregnancy, obesity, hyperlipidaemia, GB stasis, disorder of bile acid metabolism.
pigmented. hemolytic anemia, biliary infection, GI absorption disorders (crohns, ileal bypass), CF with Pancreatic insufficiency

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4
Q

renal calculi types

A

Calcium oxalate - most common, radio opaque
struvite - urea splitting bacteria. stag horn Calc 》xanthogranulomatous pyelonephritis.
uric acid - gout and leukaemia. not radio opaque, but still appear dense on CT.

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5
Q

cystic kidneys

A

simple cyst
tumour. MLCN (multilocular cystic nephroma), cystic RCC, cystic Wilms
genetic. AD/AR polycystic kidney disease, AD/AR medullary cystic disease, glomerulocystic. (AD are adult onset, AR are paeds onset)
syndrome. TS, VHL, Medullary sponge
post dialysis.

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6
Q

medullary nephrocalcinosis

A

HAMHOP
Hyperparathyroid, renal tubular acidosis,medullary sponge kidney, hypercalcaemia, oxalosis (saturation of calcium oxalate genetic), Papillary necrosis.
causes papillary necrosis. NSAID. Nsaids, Sickle cell, Amyloid, Infection, Diabetes (most common)

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7
Q

Cortical nephrocalcinosis

A 
COAG
Cortical necrosis 
Oxalosis
Alport syndrome (genetic collagen mutation disorder)
Glomerulonephritis (chronic)
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8
Q

wilms association

A

WAGR. wilms, aniridia (no iris), genitourinary malformation, retardation
Beckwith widerman
pearl man (overgrowth disorder)
denyrs drash. gonadotropin dysgenesis and wilms

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9
Q

renal mass.
cystic
vascular
kids

A

cystic. RCC, wilms, MLCN
vascular. RCC, AML, Oncocytoma, AVM
Kids. Wilms (<5yo)》clear cell sarcoma (3-5yo) 》 RCC 》rhabdoid (<1yo)
mets. lung, breast, melanoma
lymphoma

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10
Q

AML asdociations

A

80% sporadic
20% syndromic. TS, NF1, ADPCKD

**fat, mm, vascular

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11
Q

Testicular infection

A

Epididymis only: Tb
Orchitis only: Mumps, syphilis
both: e.coli, chlamydia, gonococcus, Tb

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12
Q

DTPA vs Mag 3

A

renal blood flow MAG3 Tc99
glomerular filtration DTPA Tc99
Reflux scars DMSA (cortical agent)
** in neonates, the DTPA is unreliable until at least 1 month old, so MAG 3 is used for GFR initially.

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13
Q

neuroblastoma recommend..

A

MIBG

Urinary VMA

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14
Q

Retroperitoneal mass

A 
1.Liposarcoma
Lipoma
3.Leiomysarcoma
2.Malignant fiborous histiocytoma
4.Rhabdomyosarcoma 1. in kids
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15
Q

oesophageal diverticulum

A

zenkers- posteromedial above cricopharyngeus Killen Jamieson - lateral at level cricopharyngeus epiphrenic diverticulum - at GOJ secondary to motility traction diverticulum - adhesions in mediastinum. Tb, malignancy pseudodiverticulum - dilated mucous glands

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16
Q

renal mass lesion

A

Tumour. Infection - lobar nephronia, abscess, xgp Congenital - duplicated collecting system, foetal lobular ion, dromedary hump, column bertin Trauma - haematoma

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17
Q

Solid renal tumour. Malignant and Benign

A

Malignant. - RCC - TCC - Wilms in child. can be cystic - Mets. multiple. lung, colon, melanoma RCC - lymphoma - SCC Benign - AML. fat density locules - Oncocytoma

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18
Q

Suggestions a mass is not an RCC

A
  • Contains fat. AML. Ca+ Think RCC again or wilms in kids - Fever. pyeloneohritis or abscess - Immunocompromised. Lymphoma - Known primary elsewhere. Mets
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19
Q

Bilateral renal lesions

A
  • Lymphoma - RCC - Mets - AML - Oncocytoma
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20
Q

Hypervascular mass

A

RCC AML. Bizarre with tortuous feeding aa circumferential Oncocytoma. Central spoke wheel AVM or AVF. HHT

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21
Q

Cystic mass

A

RCC, Wilms, MLCN Cortical cyst, dialysis, MCDK, ADPCKD Syndromic. TS, VHL, NF. Look for liver and panc disease Other. Abscess, hydronephrosis, Hydatid, AVM

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22
Q

Bosniak

A

I. Simple cyst. II. Thin septa, Fine Ca+, Hyperdense (>60) >3cm IIF. Multiple septa with percieved flow or ca+, HyperdenHyperdense >3cm III. Thick septa with flow. Need partial resection IV. Soft tissue component. Need nephrectomy

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23
Q

Multiple renal cysts

A

ADPCKD. Look for liver, panc, spleen or lung Dialysis TS. Plus AMLs VHL. Plus RCC or panc cysts.

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24
Q

Hyperechoic renal mass

A

AML RCC Milk of ca+ cyst Nephritis Hamartoma Infarct

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25
Q

Peripheral enhancing met

A

carcinoid, islet cell of pancread

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26
Q

Pneumatosis

A

CPPV, COPD, asthma, cf, Ischaemia, Endoluminal surgery (is colonoscopy), GvH, Toxic magacolon, colagen vascular disease, steroids, trauma

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27
Q

Collitis by location

A

Diffuse. Toxic MC/Pseudomembranous collitis, UC or CMV Right side. Crohns, salmonella, Tb, Typhlitis, SMA ischaemia Left. UC, shigella, Ghonorrhoea, IMA isch (uncommon as dual supply)

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28
Q

LBO

A

Mass (adeno), Stricture (duvertic), Pseudo (anti Parkinson, trauma, burns, DM or metabolic abno, Ileus ), Volvulus (sigmoid to RUQ, Caecal to LUQ or Bastule)

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29
Q

GIH

A

Angiodysplasia (multifocal mucosal c+ on PV <5mm, >60yo), Diverticulitis, giant sigmoid diverticulum, stercoral proctitis (impacted rectum with perireftal stranding)

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30
Q

Hypoperfusion complex

A

thick bowel wall >3mm, increased c+ of walls cf psoas on c-, IVC <0mm in 3 parts, aorta <13mm above and below renal aa, hypo c+ spleen and liver

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31
Q

gas in biliary tree

A

ercp, biliary fistula or gallstone Ileus, incompetent sphincter oddi

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32
Q

GB wall thickening

A

> 5mm Acute cholecystitis, Empyema ( echogenic, DM), Xanthogranulomatosis cholecystitis (60yo female, can’t ddx from malig), Acalculus cholecystitis (ICU), Gangrenous cholecystitis (painless, over distended, no c+), Neoplasm ( porcelain, focal or diffuse), Adenomyomatosis (ring down), Secondary (aids, Cirrhosis, ascities)

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33
Q

Crohns cf UC

A

Crohns. Male, 15 to 35, skips, anywhere in GI, Transmural with strictures and fistulas UC. Female, 15-35, starts rectum and heads rt, continuous, Mucosal and submucosal only, +/- backwash Ileus

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34
Q

complications of crohns and uc

A

Cirrhosis, PSC, primary colonic cancer, gallstones, arthritis (SIJ symmetric), pancreatitis

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35
Q

Liver cysts

A

Caroli. connect with bile duct, central dot Polycystic disease. VHL, PCKD, medullary sponge Harmartomas. high on us. Von meyenberg, not cw ducts Hydatid. Few, daughter, Lilly pad on us Abscess. fever, gas, rind c+, Cystic mets. Biliary cystaednomas

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36
Q

Periportal hypoecho

A

Congestion!! Cirrhosis, hepatitis, pancreatitis, Budd chiari, Tx rejection, low protein, trauma

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37
Q

Periportal hyperechoic

A

Inflammation Recurrent ascending cholangitis, cholecystitis, air in tree, fibrosis, schistosomiasis

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38
Q

perfusion abno in liver

A

Portal htn (big spleen, PV >13mm, varicies), shunt (areas of C+ during aa. cirrhosis, HCC or big haemangioma), PV thrombus, Congestion, infarct (rare as has dual supply), HELLP

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39
Q

Portal vv thrombus

A

HCC, hepatitis, Chronic pancreatitis, pregnancy, hypercoagulable

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40
Q

Hepatic congestion

A

CCF, Budd chiari, nutmeg liver, IVC occlusion (thrombus, tumor)

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41
Q

Aortitis

A

Acute. Infectious. syphilis, tb,pyogenic (salmonella), bacteraemia, HIV Non infectious. Vasculitis (giant cell >60yo, Takayasu <60yo, bechets), CTD (RA, SLE, wegners) Chronic. IgG4, Rxt., autoimmune.

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42
Q

In and out of phase

A

Macro fat doesn’t loose signal Microfat does loose signal out of phase. Adenoma, fatty liver

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43
Q

Cirrhosis

A

Etoh, hepatitis, biliary (PSC, PBC. intra only), Cardiac (RhF or hep vv/IVC obtstrn), Wilsons, Alpha 1 (cystic lungs), Cystic fibrosis (panc atrophy and bronchiectesis lungs) Caudate, II and III increase in size, Lt>Rt

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44
Q

High density liver CT

A

Haemachromatosis (high risk HCC, also panc and heart iron depo), Haemosiderrhosis (no cirrhosis, spleen also iron depo) Wilson’s (spares caudate, BG and thalami high T2), Iron overload, Amiodarone (UIP lung), Glycogen storage (elmeyer flask Neiman pick and gauchers )

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45
Q

Nutmeg liver

A

Budd chiari. diffuse, hep vv occlusion. caudate can hypertrophy and also c+ as has own supply Hepato-veno occlusion disease. Budd chiari 2* Toxic insult (chemo, bone marrow tx, jiamacan tea) RHF, constructive pericarditis Infection/inflammation

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46
Q

Portal HTN

A

Pre hepatic. PV thrombus, PV compression, schistosomiasis Hepatic. Cirrhosis, sclerosing cholangitis Post hepatic. Budd chiari, RHF, Hepato-veno occlusion disease

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47
Q

Liver mass with cirrhosis

A

Not a met!! HCC, Cholangioca (capsule retraction), Haemangioma (peripheral puddling)

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48
Q

LB Polyp

A

FAP. >100, adolescent onset, anywhere Peutz jagher. hamartomas, Intussusception, ovarian, stomach or duodenal ca Gardners. FAP with osteoma or Desmoid +/- thyroid ** look for bowel resection Turcot. FAP + Medulloblastoma or GBM Juvenile polyposis. Single or 100s rectal polyps

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49
Q

High T1 liver

A

Fat. Lipoma, AML, Focal fat depo, HCC (usually ca+ also) Blood. SWI/ GE Melanoma mets Relative. Normal, but liver is reduced elsewhere. hemachromatosis, oedema, regenerating nodule

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49
Q

High T1 liver

A

Fat. Lipoma, AML, Focal fat depo, HCC (usually ca+ also) Blood. SWI/ GE Melanoma mets Relative. Normal, but liver is reduced elsewhere. hemachromatosis, oedema, regenerating nodule

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50
Q

Rim c+ lesions liver

A

Hydatid, met with capsule, abscess, haematoma, primary with capsule (HCC)

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51
Q

Misty mesentry

A

Lymphoma, Messenteric panniculitis, IgG4, oedema, haemorrhage, mets (carcinoid, peritoneal) If no LN then lymphoma unlikely. do f/u in 6-12 months

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52
Q

peritoneal ca+

A

Previous peritonitis/mec, dialysis, prior tb, rx ovarian ca

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53
Q

Intra peritoneal mass

A

Desmoid. young female, look for bowel resection FAP Desmoplastic small cell tumour (child, rare) Rhabdo. child Leiomyoma. Fat Lymphoma. Most common Paraganglioma. iliac bifurcation.

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54
Q

Liver solid mass BENIGN

A

BENIGN Haemangioma. US. hyperechoic with periph vasc. CT hypo noncon, periphearl puddling and fill in on PV so iso on delayed. MR Light bulb bright T2, DWI and ADC high, peripheral fill in on c+ FNH. US central scar, may be undetectable, CT hypo on noncon with bright aa C+ except for scar. washes out to iso/hypo on PV and delayed but scar hold c+. MR same as CT for gad, central scar is high on T2. With primovist it’s only lesion that high or iso on delayed. rest are hypo. Adenoma. US well defined heterogenous of variable echo. CT well defined lesion +/- hyperdense haem or hypo fat. homog C+ and return to iso on PV and delayed. MR loose signal in out-of-phase. Also hypo on hepatobiliary phase. AML Regenerative nodule Focal fatty infiltration. Pseudotumor that looses on out-of-phase

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55
Q

Liver solid mass MALIGNANT

A

HCC. Cirrhosis. doesn’t cause capsule retraction. look for tumor thrombus in vv and aa. US hypo to heterogenous. can have a hypo capsule/halo. CT low on noncon with vivid c+ aa and rapid washout, so low on PV and Delayed. MRI same, can retain c+ in capsule. DWI high. Fibrolamella HCC. young, normal liver Mets. No c+ and liver not cirrhotic Cholangiocarcinoma. Capsule retraction and bile duct dilatation. Peripheral target DWI.

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56
Q

hypervascular liver mets

A

Melanoma, Sarcoma, carcinoid (can have peripheral c+), RCC, neuroendocrine (islet cell, phaeo, carcinoid), thyroid, breast, chorioca

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57
Q

Aa c+ lesion in liver

A

Benign. FNH (retains c+ in delayed), Adenoma (looses in out-of-phase), Flash haemangioma Malig. HCC, Cholangioca (usually peripheral c+) Hypervascular mets. RCC, neuroendocrine, thyroid, melanoma, breast, sarcoma, chorioca

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58
Q

Hyperechoic liver lesion US

A

haemangioma, hyper mets, HCC, adenoma, lipoma, fical fat, aml (ts), fnh, Hamartoma (von meyenberg)

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59
Q

ca+ liver lesions

A

Mets. mucinous adeno colon, stomach, ovary (+ pseudomyxoma peritoni), treated mets Fibrolamella HCC, HCC, Cholangioca (peripheral) Granulomatous infection. Tb, fungal, Hydatid Haemangioma. punctuate foci ca+

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60
Q

Mass in cirrhotic liver

A

Regen nodule. Iso T1 and T2 (HCC is low T1 and high T2) Dysplastic nodule. High T1 and iso T2 and post gad HCC. High T2, c+ aa and low on delayed.

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61
Q

Liver lesions with central scar

A

FNH. High T2 scar. stays high on delayed Fibrolamella HCC. Low T2 scar Giant haemangioma. Puddling fill in HCC

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62
Q

Fat containing liver lesions

A

Micro fat. looses signal in out-of-phase but no fat suppressed. Adenoma and multifocal Steatosis Macro fat. No signal loss in out-of-phase, but fat suppresses. Lipoma, liposarcoma, teratoma, HCC

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63
Q

Low liver signal on MR

A

** cw mm… should be iso to mm haemachromatosis. also low signal in panc and heart. spleen ok. higher signal out of phase cw in Haemosiderrhosis. Spleen also low. panc and heart ok. Wilson’s disease.

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64
Q

Biliary obstruction by level

A

Intra pancreatic. Panc ca, calculus, chronic pancreatitis Supra pancreatic. Cholangiocarcinoma, met LNs Portal. Invasive GB ca, surgical stricture, Cholangioca, hepatoma, calculus, mirizzi, LNs

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65
Q

Bile duct narrowing/irregularity

A

Cholangioca, ampulla or panc adenoca, mets, cystadenoma, PSC (intra and extra, Uc/crohns), Ascending cholangitis (bacterial, intra and extra), Aids Cholangiopathy (can’t ddx from PSC), Pancreatitis, PBC (intra only, caroli

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66
Q

Inflammatory lesions bile ducts

A

PSC. IHD and EHD beaded/pruned tree appearance. UC and crohns. young adult male. PBC. IHD autoimmune. cirrhosis with crowding and deformity of ducts. middle aged female. Bacterial ascending cholangitis. Strictures, small abscesses and cavities that communicate with ducts. fever or hx recent cholecystitis Caroli. IHD only. cw ducts. central dot sign Choledochal cyst. focal.

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67
Q

echogenic shadowing GB wall

A

Gallbladder full of stones, porcelain GB, Emphysematous cholecystitis (dirty shadowing)

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68
Q

Pancreatitis

A

GETSMASHED Gallstones, etoh, trauma (check L1#),steroids, mumps, autoimmune, hyperlipidaemia, ercp, drugs/divisium

69
Q

Pancreatic cysts Grandpa, Grandma, Mum, Daughter

A

Grandpa. IPMN.Main or branch. Main >3mm, branch is bunch grapes in head/uncinate. * these are cw duct, whereas rest aren’t. Grandma. Serous cystadenoma, cut orange, lots small cysts in head. usually <2cm size Mother. Mucinous cystadenoma. Bigger cysts in body/tail. can have peripheral ca+ . usually >2cm size Daughter. Solid pseudo papillary. tail. solid to cystic Other. Pseudocyst post pancreatitis (>6wks post), True cyst (VHL, TS, ADPCKD, CF),Lymphangioma

70
Q

Big spleen

A

> 13mm Mild. Sarcoid, amyloid, viral (mono, hepatitis), bacterial (tb), fungal (candida), RA (felt sx RA, big spleen and reduced neutrophils) Moderate. Portal htn, Haemolytic disorder- sickle cell. (CRF, stroke, bone infarct, h vert, autosplenectomy, recurrent chest infection), thalassemia Severe. Lymphoma, leukaemia, myelofibrosis, myeloproliferative (polycythaemia, mastocytosis, gauchers ), malaria

71
Q

Splenic lesions general

A

Haemangioma. Most common cystic Lymphoma. Most common solid. Angisarcoma. Most common primary malignancy Infarct. wedge Simple cyst

72
Q

splenic cyst

A

Abscess, lymphangioma, tb, post trauma, epidermoid, Hydatid, schistosomiasis.

73
Q

Splenic solid lesion

A

Lymphoma, LCH, mets (melanoma,ovary, lung, breast), Hamartoma, sarcoid, siddherosis

74
Q

Solid pancreatic mass

A

Ductal adenoca. hypo mass. vascular >180sma means inoperable. Smv depends on length involved. Islet cell tumour. hyper c+ mass. ca+. Clincal sx (diarrhoea, etc), hypervascular mets (for GI ask if any sx as need liver mets for sx) Solid pseudo papillary. young women. solid/ cystic. ca+ common Acinar cell ca. hypo mass. larger than ductal. older men. Lymphoma. Large and well defined. homog and mild c+ with LNs or spleenomegaly Mets. RCC. hypervascular. Focal pancreatitis. Hypo or iso. inflamm change and clinical correlation.

75
Q

ca+ panc mass

A

mucinous or serous cystadenoma, islet cell, pseudo papillary, sarcoid, Granulomatous infection

76
Q

hyperechoic pancreas

A

CF or lipomatosis of pancreas

77
Q

Emphysematous nephritis, cholecystitis, cystitis, gastritis

A

Trauma, infection (DM, etoh, immunosup), Ischaemia, increased intraluminal pressure (recent endoscopy)

78
Q

Appendix lesion

A

Carcinoid (+/- ca+), Mucocele (+/- pseudomyxoma peritoni), Mucinous cystadenoma

79
Q

Terminal Ileus thickening

A

Tb. TI only Salmonella. Caecum Typhlitis. TI +/- ca ecumenical and whole colon Yersinia. TI and caecum

80
Q

Vascular syndrome

A

SMA. d3 compression secondary to SMA acute angle. aa angle <25° on swallow Median arcuate. Med arc lig compresses coeliac trunk. increased when lie supine Nutcracker. SMA compressed by L renal vv. May turner. L IMV compressed by R IMA

81
Q

Meckels

A

2s 2” long, 2% population, 2ft from ileocaecal, 2% symptomatic, 2/3 contain ectopic panc or gastric tissue

82
Q

Malrotation

A

LB left and SB right DJ flexure doesn’t cross midline at level of VB and remains inferior to D1 bulb SMA/SMV cross over/swirl Corkscrew on swallow +/- Volvulus

83
Q

Hiatus hernia

A

Sliding. common Para oesophageal. GOJ stays in normal location and stomach slides up alongside. increased risk obstruction

84
Q

Gastric volvulus

A

Organoaxial. Organoaxial Ok. Over top. Most common, not increased risk isch, greater curve goes over top lesser curve Mesenteroaxial. Increased risk of isch. fundus higher than an trim thick walled and non c+

85
Q

Oesophageal ulcers

A

GORD ( lower 1/3), Adenoca (lower 1/3), SCC (upper 2/3, etoh or hpv), rxt, crohns, coeliac, ingested caustic (long segment), Infection (CMV big >2cm, HSV diffuse small, candida plaque like whole oesoph)

86
Q

Stomach mass

A

Malignant, polyp, mimic

87
Q

Malignant stomach mass

A

Adenoca. most common. nodular or diffuse Lymphoma. MALT. most common 1* outside LNs. GIST. <2cm nodule benign, big is ugly, necrotic and bad Carcinoid Mets Leiomyoma. Fat density Lipoma

88
Q

Gastric polyps

A

Hamartoma. Peutz jagher Hyperplastic. FAP. 90% Adenomatous. 1-4cm. single.

89
Q

Mass mimic in stomach

A

Bezoa (moves), nissen fundoplication, lymphoid hyperplasia

90
Q

Thickened gastric folds

A

Inflammatory. gastritis, zollinger Ellison (pancreatic gastrinoma ca) crohns, tb Infiltration. Lymphoma, Adenoca, sarcoid, eosinophiloa, amyloid Varices

91
Q

Colon fat halo

A

IBD, isch (chronic ), SLE vasculitis, chronic infection, rxt enteritis, gvh

92
Q

Oesophageal diverticulum

A

Zenkers. midline posterior above cricopharyngeus Killen Jamieson. Lateral at level cricopharyngeus Pharyngocele. lateral hypopharyngeal Epiphrenic. Motility disorder Traction. pulling from mediastinal adhesions. all layers (tb, rxt, malig) Pseudodiverticulum intramural. dilated mucous glands from chronic irritation or reflux

93
Q

Thickened oesoph folds (longitudinal)

A

oesophagitis. scleroderma, reflux, zollinger Ellison Neoplasm. Varicoid carcinoma, lymphoma Varices

94
Q

Oesophageal strictures by location

A

Upper to mid. web (shelf like), vascular ring, Barrett, caustic ingestion, rxt, extrinsic compression, skin diseases (wry them a multiforme) Lower. Reflux, scleroderma, NGT, zollinger Ellison, adenoca , schatzzki ring

95
Q

Dilated oesophagus

A

Achalasia (tight LOS) Scleroderma (patios LOS) Malignancy Stricture Chaggas Post vagotomy DM or Etoh neuropathy

96
Q

Oesophageal tear/contrast extravasation

A

Oesophagitis, tumour, Mallory Weiss vomiting (only mucosa), borehave vomiting (entire wall), tracheoesoph fistula, bronchopulm forget malformation

97
Q

Oesophageal filling defect

A

Benign. SMOOTH. leiomyoma (most common +/-ca+), GIST, fibrovascular, neurofibroma, lipoma, Hamartoma Malignant. SCC (upper 2/3), adenoca (lower 1/3), mets, lymphoma Non neoplastic. duplication cyst, Fb, varices, extrinsic lesion (LN or mediastinal mass)

98
Q

Gastric erosion/ulcer

A

Solitary. peptic ulcer (h. pylori), ectopic panc, adenocarcinoma, lymphoma, mets, gist Multiple. Erosive gastritis (aspirin, etoh, steroids, stress), crohns, h. pylori, candida, hsv, CMV, submucosal mets.

99
Q

Linus plastica

A

Tumor, Granulomatous, iatrogenic, infiltrating Tumour. Adenoca (most common), lymphoma, mets (breast, lung, melanoma), panc carcinoma invasion Granulomatous. Crohns (rams horn diffuse narrowing), sarcoid, eosinophiloa gastroenteritis, tb Iatrogenic. Rxt, corrosive ingestion, haematoma Infiltration. Amyloid

100
Q

Gastric dilation

A

inflammatory, obstructing mass, Volvulus, hypertrophic pyloric stenosis, proximal SBO, post op, post vagotomy, anticholinergic drugs

101
Q

Thick duodenal folds BADHELP

A

Brunner gland hyperplasia, Amyloid, Duodenitis, Haemorrhage/ haematoma, Edema/eosinophilic enteritis, Lymphoma, Pancreatitis

102
Q

Duodenal mass

A

BENIGN. Gist, lipoma, carcinoid MALIG. Usually distal to ampulla. adenoca, amullary ca, lymphoma, gist, mets (stomach, panc, colon, kidney, melanoma, lung)

103
Q

Duodenal narrowing

A

Inflammatory. Chronic peptic ulcer, crohns, pancreatitis Neoplasia. Adenoca, lymphoma, gist, mets Annular pancreas Haematoma SMA syndrome. worse when supine

104
Q

Small bowel fold types

A

-Type 1. Dilated lumen with thin <3mm straight folds. SOS Sprue (coeliac, floccules), Obst, (scleroderma) -Type 2. Thick >3mm fold. Haem with oedema (vascular). Segmental. Isch (vv or aa), Rxt enteritis, intramural haem (trauma, isch, vasculitis) Diffuse. Venous congestion (ccf), lymph obst, low protein -Type 3. Thick nodular folds. Infection, inflammation, neoplasm Crohns, lymphoma, amyloid, infection (Giardia proximal, Yersinia and tb if distal), whipples, eosinophilic gastroenteritis, mastocytosis, mets

105
Q

Thick c+ bowel with ascities

A

eosinophilic enteritis, tb, lymphangectasia (ascities chylous), whipples

106
Q

Malabsorptive pattern sb

A

dilution of barium (hypersecretion), floccules, segmentation of barium column, delay in transit time Coeliac, sprue

107
Q

Bowel ischaemia causes

A

Occlusion. aa thrombus (atherosclerosis), emboli (AF or ventricular aneuysm), Venous thrombus (portal htn, pancreatitis, tumour) Hypotension Hypovolaemia

108
Q

SB dilation

A

Sprue (coeliac), Obstruction, Scleroderma Localized. inflamm. pancreatitis, Appendicitis, cholecystitis, diverticulitis Metabolic. Hypovolaemia, magnesia, calcaemia

109
Q

SBO

A

Adhesions, Hernia, Neoplasm, Intussusception, gallstone Ileus, Malrotation with volvulus, inflamm with stricture ** look for -free gas - hernia. inguinal, obturator, femoral - previous sx - pneumobilia - bony mets

110
Q

SB tumours

A

Adenoma (most common,assoc with FAP, HNPCC) Lipoma, gist, leiomyoma, haemangioma, neurogenic (in NF 1) Mets (melanoma, kidney, breast), carcinoid (most common malig, if have sx look for liver mets), adenoca (FAP, NF 1), lymphoma, sarcoma (malignant gist)

111
Q

Separated SB loops

A

Ascities, Thickening (Crohns, radiation, tb, haemorrhage), Lymphoma, Carcinoid, Peritoneal carcinomatosis, Inflamm (abscess, GvH)

112
Q

Caecal mass

A

Appendicitis or abscess, appendix mucocele, adenoca, carcinoid, lymphoma, mets, gist, adnexal mass.

113
Q

Fat containing ileocaecal mass

A

ileocaecal valve lipoma, Intussusception, lipoma to us infiltration

114
Q

Appendix mass

A

carcinoid (desmoplastic reaction ), Mucocele, adenoca, lymphoma, abscess

115
Q

LB polyps

A

Hyperplastic (90%), adenomatous (malig potential), Hamartomaous (rare, peutz jager)

116
Q

LB filling defect

A

lymphoid follicle (<4mm), polyp (adenomatous or post inflammatory UC/crohns), lipoma, adenoca, mets, lymphoma, endometriosis, foreign body

117
Q

LB stricture

A

Short segment. neoplasm (carcinoma, lymphoma, mets), Ischaemia. splenic flexure > sigmoid Infectious. Tb (ikeocaecal), Typhlitis (ileocaecal) schistosomiasis (desc colon) Inflamm. UC, CD Iatrogenic. Rxt, post op

118
Q

Megacolon

A

Toxic. UC, Pseudomembranous Non toxic. Obstruction, Ileus, purgative abuse, cathartic colon, Ischaemic. splenic flexure or deacending

119
Q

Thumbprint in colon

A

Infection. Pseudomembranous collitis (c. diff ), CMV, Typhlitis (rt), Diverticulitis Inflamm. Crohns (skips), UC Vascular. ischaemia, portal htn (PV thrombus) Neoplasia. Colorectal ca, lymphoma Hemorrhage. Henoch schonlein (thrombocytopenia), coagulopathy

120
Q

Colon thickening by side

A

Rt side. Crohns, Typhlitis, SMA obst Lt side. Pseudomembranous colitis, diverticulitis, UC, IMA obst, adj Messenteric ischaemia with reactive

121
Q

Long segment narrowing large bowel

A

scirrhous adenoca, lymphoma, diverticulosis smooth mm hypertrophy, UC, crohns, isch stricture, rxt

122
Q

ahaustral colon

A

cathartic abuse (rt side), UC > crohns, amoebiasis, age (lt)

123
Q

LBO

A

carcinoma, Stricture (divertic, crohns, isch, infection tb), Volvulus, fecal impaction, Hernia, adhesion, extrinsic (endometriosis, abscess)

124
Q

Presacral widening

A

Rectal. IBD, abscess Sacral. Mets, chordoma, OM, neurofibroma Retroperitoneal. lipomatosis, fibrosis

125
Q

Proctitis

A

Gonococcal, stercoral (impaction ), UC, crohns,

126
Q

Colonic fistula

A

Surgery, rxt, diverticulitis, crohns, malignancy, trauma

127
Q

Inguinal hernia

A

direct. med to inf epigastric indirect. lat to inf epigastric femoral. med to fem vv. narrow neck, pear shaped

128
Q

Pelvic cystic lesions

A

Common. duplication cyst (double wall), mesenteric cyst (lymphagioma), Choledochal, pancreatic pseudocyst, abscess, haematoma, urachal remnant Uncommon. teratoma, cystic mesothelioma, Hydatid rupture, necrotic LNs, cystic/necrotic stromal tumour Males. seminal vesicles cyst (ADPCKD) Females. Ovarian, peritoneal inclusion

129
Q

Peritoneal fluid collection

A

Water. ascities, urinoma, Biloma, lymphocyte, panc pseudocyst, csf from vp shunt Complex. abscess, haematoma, pseudomyxoma peritoni, panc necrosis

130
Q

Intra peritoneal ca+ axr

A

Appendicolith, Messenteric node, dropped gallstones, panc Calc, porcelain GB, Renal Calc, uterine leiomyoma, fetal, teratoma old haematoma or abscess, aa

131
Q

Omental mass cystic

A

Ascities (loculated), abscess, panc pseudocyst, peritoneal mets, lymphangioma, lymph nodes, inclusion cyst female, duplication cyst, Messenteric cyst

132
Q

Messenteric mass solid

A

Mets, carcinoid (liver mets, desmoplastic reaction ca+), Desmoid (Gardners look for LB resection), lymphoma, retraction mesenteritis (panniculitis), gist, mesothelioma, sarcoma LN. Tb, mac, inflammation, ca Haematoma Splenosia Tb peritonitis. wet or dry Omental infarct Torted appendices epiploica

133
Q

Widespread peritoneal disease

A

Complicated ascities, Abscess, Pseudomyxoma peritoni (gelatinous, mucinous adenoca of appendix or ovary), Peritoneal carcinomatosis (direct invasion, ovarian, colon, breast, melanoma, lung, carcinoid) Tb wet or dry Mesothelioma

134
Q

Ca LN abdomen

A

Mucinous adenoca, sarcoma, rx lymphoma, tb,

135
Q

Adrenal washout

A

> 60% from c- HU = adenoma >4cm unlikely to be adenoma

136
Q

Adrenal mass

A

> 5cm with avid c+ = phaeo, hetero c+ = carcinoma or met small. cons ( increased aldosterone), adenoma, aml (fat and vascular), mets, carcinoma, haemorrhage, hyperplasia (cerebriform ), Granulomatous (tb)

137
Q

Small kidneys

A

Decreased vascularity. aa (isch secondary to stenosis, vasculitis, emboli) Reduced parenchymal. hypoplasia /congenital, chronic GN MCDK involuted Post renal. chronic reflux or obstruction

138
Q

Big kidneys

A

Pre renal. acute aa infarct, Acute vv thrombosis Renal. infection, lymphoma, amyloid, congenital (horseshoe or PCKD), trauma Poat renal. hydronephrosis, infection

139
Q

Cortical nephrocalcinosis

A

COAG Cortical necrosis ( Nsaids, Tx rejection, infarct, preg), oxalate, alport (CvD), GN chronic

140
Q

Rim nephrogram

A

Cortical supply is seperate from parenchyma Acute renal aa occlusion or severe hydronephrosis with occlusion of intra renal aa

141
Q

Persisting nephrogram

A

stasis of c+ Hypotension, Acute obst, Renal vv thrombus, ATN, Pyelonephritis (acute)

142
Q

Increased echo on us parenchyma

A

nephrocalcinosis. HAMHOP Hyperparathyroid, Renal tubular acidosis,Medullary sponge kidney, Hypercalcaemia, Oxalosis (increased ca+ oxalate from inherited or liver failure), polycystic ARPCKD baby

143
Q

Decreased echo renal parenchyma US

A

Oedema or hypoperfusion Vascular. ischaemia (atherosclerosis, emboli), vv thrombus, vasculitis Cortical necrosis TX rejection

144
Q

Renal pelvis filling defect

A

Calc, blood, TCC, fat (renal lipomatosis), pus (tb corkscrew, e.coli, Xanthogranulomatosis pyelonephritis), scar mass. TCC, RCC, SCC, papilloma

145
Q

Retroperitoneal fibrosis

A

Idiopathic, IgG4, lymphoma, mets, rxt, inflammation (Crohns, pancreatitis, diverticulitis), CTD (Ank spon, pan, sle)

146
Q

Bladder ca+

A

Schistosomiasis, Tb, Rxt, Infection (chronic), Calc, TCC

147
Q

Bladder gas

A

Instrumentation, fistula, infection, pnet rating trauma, emphasematous cystitis (DM or immunocompromised)

148
Q

Bladder mass

A

TCC. Most common. smoker. do IVP for higher lesion SCC. Chronic irritation, schistosomiasis or Calc, large and solitary mass Adenoca. Urachus. diffuse thickening, cystic/solid Rhabdo. kids

149
Q

stag horn calculus

A

xanthogranulomatosis pyelonephritis. DM, ecoli, proteus Pyonephrosis with obstructing stone Ca+ neoplasm

150
Q

Renal vv thrombus

A

tumour. RCC, adrenal, pancreatic, gonadal Renal disease. SLE, PAN, amyloid sis, sarcoidosis, diabetes, pyonephritis/abscess Extra luminal compression hypoperfusion from Hypovolaemia Trauma/sx Extension from ovarian vv or IVC thrombus sickle cell anaemia

151
Q

Striated nephrogram

A

acute pyelonephritis, Acute Ureteric obst, Renal vv thrombosis, Hypotension, medullary sponge, ARPCKD

152
Q

Renal aa aneurysm

A

FMD (most common), atherosclerosis, mycotic, trauma, congenital, rxt

153
Q

Renal aa stenosis

A

atherosclerosis (most common). at osteum or proximal 2cm. >50yo FMD. mid to distal aa. young adults Mechanical thromboembolism or congenital stenosis Neurofibromatosis Arteritis (PAN or takayasu) Rxt

154
Q

Dilated ureter

A

Obstruction. Calculus, Stricture, neoplasm, bladder outlet obst, urethral stricture, retroperitoneal fibrosis, retro caval ureter Functional. VUR, primary mega ureter, prune belly sx Extrinsic compression

155
Q

Ureteral stricture

A

Neoplasm. TCC, mets, lymphadenopathy, extrinsic Infection. Tb (corkscrew appearance), schistosomiasis Inflammatory. Retroperitoneal fibrosis, endometriosis, diverticulitis, Appendicitis VUR, ectopic ureterocele, congenital stenosis/PUJ, retro caval ureter (rt), primary megaureter

156
Q

Ureteral diverticula

A

Congenital, Ureteritis cystica, pseudodiverticulum, Tb

157
Q

Medial deviated ureters

A

Retroperitoneal fibrosis. primary idiopathic, inflammatory aaa, medications (migraine drugs), desmoplastic malignancy (lymphoma, carcinoid), autoimmune, rxt Psoas mm hypertrophy Pelvic lipomatosis Retro caval ureter Post op Posterior bladder diverticulum Enlarged prostate (J ureter)

158
Q

Lateral deviated ureter

A

Retroperitoneal adenopathy, aortic aneurysm, retroperitoneal fluid collection, Malrotation kidney, ovarian or uterine mass

159
Q

Reflux grade

A
  1. within ureter 2. ureter and collecting system. reaches renal pelvis 3. bunting of calyces 4. Tortuous dilatation 5. very tortuous dilated ureter
160
Q

Bladder wall ca+

A

TCC, urachal adenoca, schistosomiasis, Tb, rxt

161
Q

Adrenal mass solitary

A

Adenoma (HU <30), mets, phaeo, lymphoma, neuroblastoma (<2yo), fatty lesions (myelolipoma, lipoma), cystic tumours (simple cyst, pseudocyst post haem), Haem (trauma, coagulopathy, sepsis, neonatal) Tb

162
Q

Adrenal mass bilateral

A

mets lymphoma granulomatous infection. Tb adenoma phaeo. NF, VHL, MEN II Adrenal hyperplasia. cerebriform haemorrhage in neonates, DM or sepsis

163
Q

Adrenal ca+

A

neuroblastoma phaeo cyst (peripheral) tb haemorrhage wolman’s disease. AR fat deposition with bilateral enl adrenals and punctuate foci ca+

164
Q

Solid testicular mass

A

Primary Germinal. Yolk sac (<2yo), teratoma (child), Seminoma (adult, homog), lymphoma (old man) Mets. prostate, kidney, lymphoma Infection. orchitis, abscess, granuloma trauma fracture

165
Q

Ca+ testicular lesion

A

Microlithiasis Previous trauma Resolved infarct Sertoli cell tumour burnt out

166
Q

Cystic testicular mass

A

Intra testicular cyst, tubal ectasia of rete testes, epidermoid, NSCGT (teratoma), necrosis or haemorrhage in tumour

167
Q

Epididymal mass

A

epididymitis, epididymal cyst, spermatocele, adenomatoid tumour

168
Q

Spermatocele cord mass

A

varicocoele, rhabdomyosarcoma

169
Q

Scrotal.fluid

A

hydrocele (post trauma, Inflam, vasectomy, epididymitis, tumour) Pyocele. septate with low level.echos Haematocele. Trauma, torsion, infarct

170
Q

paratesticular mass

A

rhabdomyosarcoma in kids, lipoma, liposarcoma. Uncommon - mesothelioma

171
Q

free gas/pneumoperitineum

A

riglers, falciform, lucencies over liver, triangles between bowel loops. Any concern, do erect cxr

Kim's (6 decks)

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