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Core Exam > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Where are Gastric diverticula located within the stomach?

A

Fundus (congenital and less curve) or

antrum (acquired and greater curve)

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2
Q

When does pyloric stenosis occur?

What are the imaging criteria for diagnosis?

A

Infantile pyloric stenosis: First 6 weeks of life with projectile bilious vomiting.

Pylorus length of 15mm and diameter of 3mm

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3
Q

What are the types of volvulus?

Which is more common?

A

Organoaxial- long axis rotation (most common)

Mesenteroaxial- Rotation along mesenteric axis

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4
Q

Which type of hiatal hernia is associated with gastric volvulus?

A

Oganoaxial gastric volvulus is associated with sliding hiatal hernia

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5
Q

What are benign causes of diffuse gastric thickening?

Malignant?

A

Benign

  • Pseudolymphoma
  • Gastritis
  • Varicies

Malignant

  • Lymphoma
  • Carcinoma (Linitis Plastica)
  • mets
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6
Q

Factors which suggest a gastric ulcer is malignant?

A
  • Non-antral location
  • Eccentric position on mucosal mound
  • Irregular margin
  • Absence of or irregular Hampton’s line (i.e. ulcer collar)
  • mucosal folds do not reach ulcer margin
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7
Q

What are complications of benign gastric ulcers?

A
  • perforation
  • erosion into vessel
  • antral scaring (and gastric outlet obstruction)
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8
Q

What type of gastric ulcers is Crohn’s disease associated with?

What is their morphology

A
  • Aphthous ulcers

- small bull’s eye appearance on UGI

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9
Q

What is the most commonly affected GI organ in sarcoidosis?

A

The stomach

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10
Q

Types of infectious gastritis? Populations each affects?

A
  • phlegmanous: alcoholics
  • emphysematous: diabetics
  • tb: endemic areas
  • syphilis
  • candidal: immunocompromised
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11
Q

What is menetrier disease?

A

AKA hypertrophic gastritis. Gastritis with gastric fold hypertrophy, hypoalbuminemia, and weight loss.

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12
Q

Most common causes of gastritis?

A
  • Helicobactor pylori
  • NSAIDS, KCl, clopidogrel, steroids
  • EtOH
  • Crohn Diseas
  • CMV, HSV
  • Behchet syndrome
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13
Q

Imaging findings associated with Zollinger Ellison Syndrome?

A
  • Massive ulceration of the gastric antrum and proximal small bowel including the jejunum
  • Hypervascular arterially enhancing small tumor in the duodenum (most common) or pancreas
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14
Q

What is the pathophysiology of atrophic gastritis?

A

Gastrinoma > parietal cell hyperplasia and acid hypersecretion > ulcers

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15
Q

What is the etiology of atrophic gastritis?

A
  • Prolonged H. Pylori

- Autoimmune gastritis

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16
Q

What syndromes are associated with adenomatous gastric polyps?

A

Adenomatous polyps are associated with carcinoma
Gardner
Familial polyposis coli

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17
Q

What syndromes are associated with hamartomatous gastric polyps?

A
  • Peutz Jeghers

- Crobkhite Canada

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18
Q

What organs are affected in Cowden syndrome?

A
  • GI
  • breast cancer
  • thyroid follicular cancer
  • CNS dysplasia - lhermitte duclose
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19
Q

Where do gastrointestinal stromal tumors most commonly arise?

What is their histologic location?

A 
#1 stomach
#2 small intestine
#3 esophagus

Submucosal. Arise from cells of cajal which express c kit

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20
Q

Carney Triad?

A
  • GIST
  • Extra adrenal paraganglioma
  • pulmonary chondroma
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21
Q

Imaging appearence of GIST?

A
  • Smooth submucosal mass with possible central ulcer if large
  • heterogeneous enhancement with areas of necrosis is larger.
  • 25% demonstrate calcification
22
Q

Symptoms of ectopic pancreas?

Location of ectopic pancreas?

A

Bleeding

Submucosal of gastric antrum or proximal duodenum

23
Q

Imaging characteristics of ectopic pancreas

A
  • submucosal mass in antrum or duodenum with central umbilication that represents rudimentary pancreatic duct
24
Q

What disease is are Gastric varicies associated with?

Esophageal varicies?

A
  • Splenic vein thrombosis (secondary to pancreatitis or pancreatitis). Although may also be seen in portal htn
  • portal htn
25
Q

What are risk factors associated with gastric adenocarcinoma?

A
  • H pylori
  • EtOH
  • smoking
  • pernicious anemia
  • stomach surgery
  • salted and smoked food (fish)
  • nitrates/nitrites
26
Q

What is the Carman meniscus sign?

A

Central tumor ulcer crater with heaped up edges– suggests malignancy

27
Q

Types of gastric carcinoma?

A
  • GE juncional/cardinal
  • Scirrhous - frequently causes linitus plastica
  • Polypoid carcinoma- commonly ulcerates
28
Q

Patterns of gastric carcinoma metastasis?

A
  • Krukenberg tumors

- Peritoneal spread: omental caking

29
Q

What factors differentiate malignant GISTs from benign GISTs?

A
  • Tend to be larger
  • Exophytic extension
  • Polypoid morphology
  • Frequent ulceration
30
Q

What is the most common location for extranodal lymphoma?

A

The GI tract

The stomach is the most commonly affected organ in the GI tract

31
Q

What is the most common type of lymphoma in the GI tract?

A

Diffuse large B Cell lymphoma

32
Q

What is PTLD? What the the etiology?

A

Posttransplat lymphoproliferative disorder. Secondary to immunosuppresion and EBV

33
Q

What organs are most commonly affected in PTLD?

A

In descending order of frequency

  • Small bowel
  • Colon
  • Stomach
  • Esophagus
34
Q

Imaging features of GI lymphoma

A
  • Circumferential wall thickening
  • Aneurysmal luminal dilation
  • Ulceration/perforation
35
Q

What is the classic presentation of Burkitt Lymphoma

A

Central African child with maxillary tumor 2/2 to EVB

36
Q

What are the types of Burkitt Lymphoma?

A
  • Endemic
  • Sporadic (ileocecal lymphoma)
  • Immunodeficiency associated Burkitt lymphoma
37
Q

What cancers metastasize to the stomach?

What’s the classic appearance of these lesions

A
  • Melanoma
  • Breast cancer
  • Lung cancer

Multiple “bull’s eye lesions”

38
Q

What are the imaging features of linitus plastica?

A
  • No mucosal folds
  • Luminal narrowing
  • Starts with the antrum and spreads proximaly
39
Q

What is EATL?
What disease is it associated with?
What organ does it usually affect?

A
  • Enteropathy associated T cell lymphoma.
  • Celiac disease
  • Jejunum
40
Q

What are malignant causes of linitis plastica?

A
  • Gastric carinoma
  • Lymphoma
  • Mets (breast and lung)
41
Q

What are non-malignant causes of linitis plastica?

A
  • Eosinophilic gastroenteritis
  • Crohn disease
  • TB, syphilis
  • Caustic ingestion
  • Sarcoidosis
  • Zollinger Ellison (2/2 to multiple ulcers)
42
Q

What is a Bilroth i?

A

pylroantrectomy with end to end gastroduodenostomy

43
Q

What is a Bilroth ii?

A

Pyloroantrectomy with side to side gastrojejunostomy with blind ending duodenum as afferent limb. (preverved

44
Q

What is a Roux en Y gastric bypass?

A

Gastric pouch gastroejunostomy. Excluded stomach continuous with physiologic anatomy until jejunojenostomy with

45
Q

Common late complications of gastric surgery?

A
  • Gastric cancer
  • Marginal Ulcer
  • Gastroparesis
  • Anastamotic stricture
  • Dumping syndrome
46
Q

What are brunner’s glands?

A

Glands in the duodenum that produce alkaline fluid to neutralize gastric chyme

47
Q

What is Rigler’s sign?

A

Inner and outer edge of bowel wall is seen. Sign of pneumoperitoneum.

48
Q

What are the imaging findings of gangrenous cholecystitis?

A
  • Nonenchancement of the gallbladder mucosa

- Other findings of acute chole: wall thickening, stones, pericholecystic fluid

49
Q

Whats the next step after identifying diverticulitis/appendicitis?

A
  • Look for perf: pneumoperitoneum
50
Q

Whats an important differential for colonic diverticulitis?

A

Epiploic appendigitis.

51
Q

How to differentiate phlebolith from ureteric stone?

A

Soft tissue rim sign: nephrolithiasis will demonstrate “soft tissue halo” indicative of inflamed ureter. Phlebolith will immediately be surrounded by fat

52
Q

What can help identify transition point in an SBO

A

Fecalization is often seen just proximal to the transition point in an SBO

Core Exam (6 decks)

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