Bowel Flashcards

1
Q

What is the DDx for a Gasless Abdomen?

A

Gasless Abdomen DDx

Adults:

  1. High obstruction
  2. Ascites (Cirrhosis, Malignant; Hypoalbuminaemia; Peritonitis)
  3. Pancreatitis - acute
  4. Fluid-filled bowel - total active colitis; closed loop obstruction
  5. Large abdominal mass

Child:

  1. High Obstruction
  2. Vomiting
  3. Fluid-filled loops
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1
Q

DDx of Dysphagia in Adults

A

DDx for Dysphagia in Adults

Intrinsic:

  1. Reflux strictiure
  2. Tumours - carcinoma; lymphoma; leiomyoma
  3. Iatrogenic strictures - corrosives, radiotherapy
  4. Plummer-Vinson web (previous case; from C4 to T1; iron def. anaemia; post gastrectomy; is premalignant)
  5. Schatzki ring - acute obstruction occurs if diameter < 6mm.
  6. Candida
  7. Skin disorders - Epidermolysis bullosa; pemphigus

Extrinsic:

  1. Tumours - LNs, mediastinal masses
  2. Vascular - aberrant Rt Sub. art (cases below - not oblique filling defect and post indentation on AP and lat film); aortic aneurysm
  3. Pharyngeal pouch - air fluid level in neck
  4. Goitre
  5. Paravertebral abscess / haematoma

Neuromuscular:

  1. Achalasia
  2. Scleroderma
  3. Chagas
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2
Q

DDx for Smooth Oesophageal Strictures

A

DDx includes:

Inflammatory:

  1. Peptic / Reflux oesophagitis
  2. Corrosives - long, symmetrical, takes years
  3. Iatrogenic - prolonged NG

Neoplastic:

  1. Leiomyoma - eccentric, polypoid mass
  2. Mediastinal mass - Ca bronchus; LNs
  3. Squamous Ca of Oesophagus

Others:

  1. Achalsia
  2. Scleroderma
  3. Epidermolysis Bullosa (prev.image)
  4. Pemphigus (image below)
    5.
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3
Q

DDx or Stomach filling defects.

A

Primary Malignant Neoplasms:

  • Carcinoma - usually 1 - 4 cm (any polyp >2cm should be considered malignant). Risk factors include:
    • Asbestosis
    • Peutz - Jeghers
    • Adenomatous polyps
  • Lymphoma: usually non-Hodgkin’s; extension across the pylorus is suggestive of lymphoma.

Polyps:

  • Hyperplastic (see previous image): commonest gastric polyp. Usually multiple and small. Associated with chronic gastritis.
  • Adenomatous: usually solitary; 1-4 cm. Increased risk of malignant transformation. Associated with pernicious anaemia.
  • Hamartomatous: multiple, small, rare in Antrim. Associated with Peutz-Jeghers syndrome, familiar polyposis coli and Gardener’s syndrome.

Submucosal:

  • Leiomyoma - associated with central ulceration and patients can present with massive haematemesis.
  • Lipoma: can change shape with patient position and may be relatively mobile on palpation.
  • Metastasis: frequently ulcerate forming the “bull’s-eyes” / target lesion. These are usually due to melanoma, but also bronchus, breast and Kaposi’s.

Extrinsic Indentation:

  • Pancreatic tumour / pseudocyst
  • Hepatomegaly / splenomegaly
  • Retroperitoneal tumours

Others:

  • Lymphoid hyperplasia (see case below); associated with Helicobacter pylori gastritis
  • Pancreatic rest: usually on the inferior wall of the Antrim and create a “bull’s-eye” or target lesion.
  • Bezoar
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4
Q

“Bull’s Eye” / Target lesion DDx

A
  • Submucosal metastasis:
    • melanoma
    • Lymphoma
    • Carcinoma - breast, bronchus, pancreas
    • Carcinoid
  • Leiomyoma
  • Pancreatic “rest”
  • Neurofibroma: may be multiple.
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