Brant & Helms

Question 1

DDx for Aphthous ulcers includes

Answer 1

Crohns
Erosive gastritis
Mets-melanoma

Question 2

Filling defects in the duodenum include:

Answer 2

1: Duodenal Adenocarcinoma - rare
2: Mets: from breast, lung, renal, GI
3: Lmphoma
4: Adenomatous polyp
5: Lymphoid hyperplasia - small, multiple
5: Hypertrophied Brunner’s Gland
6: GIST
7: Lipoma
8: Extrinsic compression: Pancreas; GB

Question 3

What is carcinoid syndrome?

Answer 3

Only 7% of patients with carcinoid have liver metastases. This results in carcinoid syndrome:
Cutaneous flushing
abdominal cramps,
Diarrhoea
This is because the liver inactivates the vasoactive substances

Question 4

Why does Carcinoid tumours of the small bowel cause a desmoplastic reaction?

Answer 4

The marked fibrotic response of the bowel wall and mesentery is due to the serotonin produced by the tumor , which induces an intense local desmoplastic
reaction

Question 5

What conditions are associated with an increased risk of small bowel Adenocarcinoma?

Answer 5

1: adult celiac disease,
2: Crohn disease,
3: Peutz -Jeghers syndrome

Question 6

Disease processes that affect the small bowel include:

Answer 6

1: Carcinoid - Ileum; soft tissue mass, radiating mesenteric strands, desmoplastic reaction; MIBG
2: Adenocarcinoma - Duodenum; prox. Jejunum
3: Lymphoma - distal ileum; can cause aneurysmal dilatation of the bowel, due to lack of fibrosis
4: Nodular Lymphoid Hyperplasia - diffuse tiny filling defects associated with recent viral infection
5: Mets:

Question 7

What is a unique feature of small bowel lymphoma?

Answer 7

Aneurysmal dilation of the lumen is a feature of lymphoma caused by
replacement of the muscularis and destruction of the autonomic plexus
by tumor without inducing fibrosis.

Question 8

What is the difference between the contrast enhancement of an exophytic SB lymphoma and a GIST or SB Adenocarcinoma

Answer 8

Lymphoma will show no or little enhancement whilst SB Adenocarcinoma and GIST will