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Gastrointestinal > Colon > Flashcards

Colon Flashcards

1
Q

Ahaustral and diffusely granular appearing mucosa

A

UC

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2
Q

What are the critical radiographic findings for UC

A

Granular or stippled appearance of involved mucosa

Continuous colon involvement

Circumferential bowel wall symmetry

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3
Q

What are the extraintestinal manifestations of UC

A

Erythema nodosum, pyoderma gangrenosum, PSC, cholangiocarcinoma, arthritis, sacroilitis, spondylitis, iritis

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4
Q

What are the two polypoid changes that can develop in UC?

Which one occurs in milder disease

A

1) Pseudopolyps - islands of normal colonic mucosa surrounded by denuded ulcerative mucosa
2) Inflammatory polyps - inflamed/elevated mucosa surrounded by granular mucosa, usually in patients with less severe disease

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5
Q

What is toxic megacolon?

What is the risk?

A

Complication with UC/crohns

Dilation (>6cm) and adynamic ileus due to inflammatory changes in the muscular layers and serosa. Can have PSEUDOPOLYPS as well

Perforation!

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6
Q

What is the most common presentation of IBD on CT

A

Bowel wall thickening with wall enhancement w/wo polypoid filling defects

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7
Q

What suggests active IBD

A

Hyperenhancement of bowel wall and vascular engorgement

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8
Q

What is the healing pattern in UC?

A

Same as inflammation, begins in rectum and progresses proximally

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9
Q

How long after dx until theres an increased risks for CRC in UC?

A

10 years

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10
Q

T or F - the clinical activity of UC has a correlation with cancer risk

A

False

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11
Q

What are the possible presentations of CRC in UC?

A

Annular constricting lesions
Flat, infiltrating tumors
Strictures (25%)

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12
Q

How does chronic UC appear on BE?

A

Colon devoid of normal haustral markings and a diffusely shortened and often narrowed colonic lumen. FEATURELESS and RIGID

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13
Q

Which comes first in UC - spondylitis or IBD

A

spondylitis

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14
Q

Differentiatie pseudomembranous colitis and UC

A

Pseudomembranous colitis has thicker colonic wall with preserved but thickened haustrations.

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15
Q

Fatty attenuation in a thickened colon wall suggests what

A

Inactive IBD

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16
Q

What is the earliest change in crohns colitis and how does it present radiographically?

A

Submucosal granulomatous inflammation

Enlarged lymphoid follicles with poorly defined borders and small central umbilication

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17
Q

What is the difference between strictures in UC and crohns?

A

Crohns strictures do not have the same malignant potential

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18
Q

UC vs Crohns

Higher risk of cancer
Granular vs aphthous ulcer
Symmetric or asymmetric?

A

UC - higher risk of cancer, granular mucosa, symmetric

Crohns - aphthous ulcer, asymmetric

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19
Q

What is the earliest sign of diverticulitis

A

Fat stranding surrounding the colon

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20
Q

What is the size cutoff for ABx in diverticulitis abscess

A
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21
Q

Differentiate crohns from colitis in the setting of an intramural fluid collection

A

Crohns will have ulcerated mucosa, diverticulitis will have normal mucosa

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22
Q

What is a phlegmon

A

Diffuse inflammation of the soft tissues due to infection

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23
Q

What is the normal diameter and wall thickness of the appendix

A

Normal diameter - 6mm

Wall - 2mm

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24
Q

What are the three categories of appendiceal abscess?

A

Phlegmon - abx
Well defined abscess - percutaneous drainage
Poorly defined multicompartmentalized abscess - operation

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25
Q

Where is the most common place for bowel ischemia

A

Splenic flexure

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26
Q

What are the 3 events that occur in bowel ischemia?

A

1) mucosal sloughing w/wo collateral blood flow or reconstitution
2) deeper ischemia resulting in stricture formation
3) Severe ischemia resulting in transmural necrosis/perforation

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27
Q

What are the findings of an ischemic bowel?

A

Adynamic ileus
Pneumatosis
Pneumoperitoneum
Thickened haustral folds (thumbprinting)

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28
Q

What is the usual dose for radiation enteritis? What is the underlying path?

A

45 Gy

Occlusive endarteritis

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29
Q

When do radiation induced strictures usually occur?

A

2 years

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30
Q

What is the appearance of acute radiation enteritis? Chronic?

A

Acute - shaggy apperance with wall thickening and luminal narrowing

Chronic - absent haustral folds with stricture

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31
Q

Diffusely thickened haustral folds DDx - differentiate them

A

Pseudomembranous colitis - abx use

IBD - occasional polyps, can be segmental

Ischemic - segmental

Neutropenic - history

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32
Q

Tx pseudomembranous colitis?

A

Vancomycin

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33
Q

What part of gi system do chemo drugs affect most often?

A

Cecum or right colon - direct effect

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34
Q

What is the life cycle of entamoeba histolytica

A

Ingestion of amebic cyst
Shedding of inner capsule and trophozoite release in alkaline small bowel
Burrow into intestinal wall and cause ulceration
Secondary bacterial infection

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35
Q

Where does amebiasis most commonly affect bowel

A

Cecum and sigmoid

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36
Q

How does amebiasis present on imaging?

A

Wall thickening and ulcerations, usually in the cecum

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37
Q

What is the colon cutoff sign? What is it seen in?

A

Gaseous distention of right and transverse colon with little gas seen beyond splenic flexure due to pancreatic mass effect due to inflammation

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38
Q

Where is a pancreatic effusion most commonly seen

A

Left anterior pararenal space and lesser sac

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39
Q

Where do fistualas form in pancreatitis

A

Splenic flexure

40
Q

What is the pathology behind bowel scleroderma

A

Patchy replacement of muscular layers of colon with collagen and elastic fibers

Intimal proliferation of feeding arteries with possible ischemia occurs

41
Q

How does scleroderma present radiographically?

A

ANTIMESENTERIC border develops sacculations or pseudodiverticula due to limb supporting tissues.

Mesenteric side is spared because tissues and vessels in this regions support bowel wall

Haustral loss, redundancy, narrowing (secondary to ischemia)

42
Q

Main DDx for wide mouth sacculations and asymmetric wall involvement?

A

Scleroderma - antimesenteric

Crohns - segmental, mesenteric or antimesenteric

43
Q

Fold thickening with skeletal sclerosis

A

Mastocytosis

44
Q

Most common site for epiploic appendigitis?

Differentiate between diverticulitis

A

Sigmoid

Lack of bowel wall thickening and epicenter located away from bowel wall

45
Q

What are the three types of bowel polyps?

A

Adenomatous
Hyperplastic
Hamartomatous

46
Q

What are the three subtypes of adenomatous polyp

A

Tubular
Tubulovillous
Villous

47
Q

Which adenomatous polyp has worst potential?

A

Villous

48
Q

Risk of malignancy in colonic polyps is proportional to size T or F

A

T, greatest if >2cm

49
Q

On barium enema, how does a villous adenoma present assuming it is larger than 2cm

A

Barium will fill interstices within a soft and compressible mass

50
Q

What is a flat polyp? What is their significance

A

Polyp that is 2x wide as they are tall and not more than 3mm above flush surface

Higher risk of cancer

51
Q

Why do patients with peutz-jeghers get cramping?

A

Transient intussuceptions

52
Q

What is the difference between polyps in the SB vs colon in peutz-jeghers?

A

SB is more common (95%) and usually hamartomatous

Colon is rare and usually adenomatous

53
Q

What are the extraintestinal manifestations of gardner syndrome

A

Sebaceous cysts
Benign mesencyhymal tumors (lipoma, fibroma)
Malignant mesenchymal tumors
Fibrous tissue proliferation (Desmoids, keloids)
Dense bone formation

54
Q

What are the extraintestinal manifestations of Turcot syndrome

A

CNS tumors, thyroid tumors

55
Q

What are the extraintestinal manifestations of Lynch syndrome?

A

Endometrial and ovarian tumors

56
Q

What are the extraintestinal manifestations of peutz-jeghers syndrome?

A

Mucocutaneous pigmentation

Breast/ovary/endometrium/pancreatic cancer

57
Q

What are the extraintestinal manifestations of Cronkhite-Canada syndrome?

A

Alopecia, onychodystrophy, hyperpigmentation

58
Q

What are the extraintestinal manifestations of Cowden syndrome?

A

Malignancies of breast and thyroid

Lhermitte duclos

59
Q

Most frequent submucosal tumor of colon? Changeable shape

A

Lipoma

60
Q

Colonic filling defect with very smooth surface suggest what location?

A

Submucosal

61
Q

Characteristic features of coloinc lipoma?

A

Smooth surface and changeable shape

62
Q

Where, in the colon, do GISTS form

A

Rectum

63
Q

Mass at base of cecum
T1 hypo
T2 hyper
+CE

A

Appendiceal carcinoid/adeno

64
Q

What percentage of patients have multifocal colon cancer?

A

5%

65
Q

Mesenteric fat and vessels within a colonic mass are pathognomonic for what?

A

Intussuception

66
Q

What are the 4 layers of bowel from inside to outside

A

Mucosa
Submucosa
Muscularis propria
Serosa

67
Q

What two key findings need to be reported for rectal cancer in MRI?

A

T stage and distance from mesorectal fascia

68
Q

What is the T staging for rectal cancer

A

T1 - invades submucosa
T2 - invades muscularis propria
T3 - Penetrates the muscularis propria and extends into perirectal tissues (mesorectum)
T4 - Directly invades other organs/structures

69
Q

What is the defining feature deciding between radiation and surgery in rectal cancer

A

Tumor involvement

70
Q

What is key to rule out when suspecting perforated diverticulitis?

A

Perforated colon cancer

71
Q

What is the recurrence rate for colon cancer following resection

A

30-50% in 2 years

72
Q

Which primary tumors affect the following aspects of colon:

Anterior wall of rectum, inferior sigmoid
Anterior rectum only
Large intraluminal nonobstructing polypoid mass
Transverse colon via gastrocolic and transverse mesocolon
Inferior transverse
Superior transverse

A 
Pelvic
Prostate
Renal
Pancreatic/Gastric
Pancreatic
Gastric
73
Q

Where are the 4 common sites of peritoneal seeding

A

Pouch of douglas
Ileocolic region
Superior aspect of sigmoid
Right paracolic gutter

74
Q

Where does colonic lymphoma usually present?

A

Cecum and rectum

75
Q

Why does colonic lymphoma have a propensity to perforate?

A

Lack of usual desmoplastic response

76
Q

Multiple round submucosal cyst like filling defects in the rectum

A

Colitis cystica profunda

77
Q

Association with colitis cystica profunda

A

Pellagra

Celiac disease

78
Q

DDx for multiple submucosal filling defects in rectum

A

Colitis cystica profunda
Lymphoma - LN and usually more diffuse
UC - usually more extensive

79
Q

Filiform polyps with normal mucosal background?

A

Postinflammatory polyps

80
Q

On BE, differentiate pseudopolyp from polyp

A

Psuedopolyp will have ring of barium surrounding it

81
Q

UNIFORMLY distributed and small

A

Follicular lymphoid hyperplasia

82
Q

Main DDx for multiple small filling defects with umbilication in colon

A

Follilcular lymphoid hyperplasia and Crohns

83
Q

Smooth filling defect at base of cecum on BE

CT shows thin walled cystic and tubular structure with mural calcification

A

Appendiceal mucocele

84
Q

Rounded and grapelike collections of gas within the bowel wall

A

Pneumatosis cystoides coli

85
Q

What are the causes of pneumatosis

A 
Ischemia
Steroids
Collagen vascular disease
Biopsy/interventional
COPD
86
Q

What is a dolichosigmoid?

A

Redundant sigmoid loop, risk for volvulus

87
Q

Differentiate sigmoid and cecal volvulus

A

Sigmoid will twist upon an epicenter in the LLQ, with the apex of the closed loop in the RUQ, will have dilated proximal colon

Cecal will twist in the RLQ, with the apex ranging anywhere from LUQ to LLQ to pelvis, will not have any dilated colon

Follow the dilated loops, they will point to the origin!

88
Q

What are two signs of midgut malrotation?

A

Jejunum in RUQ

SMA to right of SMV

89
Q

What is an adynamic ileus?

A

Atony and dilation of a portion of the colon

90
Q

What is the major risk factor in cecal ileus for perforation?

A

Time (2-3 days)

91
Q

What are the associations with rectal prolapse

A

Uterine/Bladder prolapse

Cystocele

92
Q

What is an enterocele?

A

Herniation of peritoneal sac along ventral rectal wall into cul-de-sac

93
Q

Inability to relax puborectalis muscle on defacating proctogram

A

Spastic pelvic floor syndrome

94
Q

Lack of haustrations, shortening and luminal constrictions on right sided colon mainly

A

Cathartic colon

95
Q

Key differentiating feature of cathartic colon vs UC

A

Wall remains distensible with normal size and contour of distal colon

UC will have lack of distensibility and narrowing

96
Q

Hyperlucent pelvis on plain film

Narrowed and less distensible rectum on BE

fatty widening of presacral space with TEARDROP shape of the bladder

A

Pelvis lipomatosis

Gastrointestinal (13 decks)

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