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AJT CORE > CORE - GI > Flashcards

CORE - GI Flashcards

1
Q

Normal liver attenuation

A

40-60 HU; >75 HU = hyperattenuating; hypoattenuating = less than spleen on NECT or 25 HU less than spleen on CECT

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2
Q

Hot quadrate sign

A

SVC occlusion

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3
Q

Empty gallbladder fossa sign

A

hepatic parenchyma surrounding GB replaced by fat in early cirrhosis

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4
Q

Criteria for distended GB

A

> 4 cm

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5
Q

Porcelain GB

A

calcified GB wall; increased risk of gallbladder cancer

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6
Q

GB wall thickening

A

> 3 mm

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7
Q

Thoratrast complications (liver)

A

angiosarcoma, HCC, cholangiocarcinoma

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8
Q

Indications for gallbladder polyp removal

A

> 10 mm or >6 mm + suspicious features

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9
Q

Most common type of gallbladder polyp

A

cholesterol polyps

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10
Q

Transplant type with highest incidence of PTLD

A

small bowel > pancreas > heart & lung

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11
Q

Most common organ involved in PTLD

A

liver

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12
Q

Multiple hepatic adenomas

A

von Gierke disease or adenomatosis

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13
Q

Most common hepatitis virus to cause HCC worldwide

A

hepatitis B (can occur in acute or chronic HepB infection)

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14
Q

Light bulb sign

A

hemangioma - appears very T2 bright

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15
Q

Micronodular cirrhosis

A

<3 mm; assoc. with alcoholism

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16
Q

Macronodular cirrhosis

A

> 3 mm; assoc. with viral hepatitis

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17
Q

Starry sky pattern

A

periportal edema in the setting of hepatitis

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18
Q

Hydatid sand

A

echinococcal cyst; fine sediment caused by separation of membranes; may occur in liver or spleen

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19
Q

Water lily sign

A

echinococcal cyst; undulating membrane; may occur in liver or spleen

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20
Q

Daughter cysts

A

echinococcal cyst; may occur in liver or spleen

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21
Q

Hepatic candidiasis

A

multipe small “targetoid” or “bull’s eye” lesions

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22
Q

Hepatic PCP

A

punctate echogenic foci in liver +/- spleen; after inhaled pentamidine

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23
Q

Target sign

A

implies malignancy; hypoechoic halo surrounding a liver lesion

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24
Q

Double target sign (hypo-hyper-hypo)

A

pyogenic abscess; CT finding

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25
Q

Amebic abscess

A

Entamoeba histolytica; characteristic location is near dome of right lobe

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26
Q

Most common complication of amebic abscess

A

pleuropulmonary amebiasis (20-35%) > peritoneal, pericardial or renal amebiasis

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27
Q

Amebic abscess in the left hepatic lobe

A

may rupture into pericardium; emergent drainage necessary to avoid

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28
Q

Primary hemochromatosis

A

liver + pancreas; cirrhosis, diabetes, cardiomyopathy, arthritis, bronze skin; inherited; Tx phlebotomy

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29
Q

Secondary hemochromatosis

A

liver + spleen and bone marrow; due to chronic illness or multiple transfusions; Tx chelation

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30
Q

Scalloping of the liver

A

pseudomyxoma peritonei

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31
Q

Periportal hypoechoic infiltration

A

Kaposi’s sarcoma (in AIDS patient)

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32
Q

Increased liver signal on out-of-phase

A

hemochromatosis; liver is very T2 dark

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33
Q

Anti-mitochondrial antibodies

A

primary biliary cirrhosis

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34
Q

Mirizzi syndrome

A

stone in cystic duct causing obstruction of CHD; assoc. with GB carcinoma

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35
Q

Injury to bare area of the liver

A

retroperitoneal bleed

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36
Q

Falciform ligament location

A

divides segments 2/3 and 4; ligamentum teres runs within

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37
Q

Cantlie’s line

A

divides the liver into the functional left and right hepatic lobes; between segments 5/8 and 4

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38
Q

Most common hepatic vascular variant

A

replaced RHA

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39
Q

Most common biliary ductal variant

A

right posterior segmental branch draining into the left hepatic duct

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40
Q

T1 characteristics of liver-pancreas-spleen

A

pancreas (brightest) > liver > spleen (darkest)

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41
Q

Regenerative and dysplastic nodules

A

T2 iso/dark, no arterial enhancement; high grade dysplastic nodules may demonstrate arterial enhancement

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42
Q

Nodule within a nodule

A

HCC (T2 bright) within a regenerative/dysplastic nodule (T2 dark); suggests malignant transformation

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43
Q

Well-differentiated HCC

A

enhances during hepatobiliary phase with Eovist (normal HCC does not)

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44
Q

Massively dilated hepatic artery

A

HHT; multiple hepatic and pulmonic AVMs

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45
Q

Solitary pyogenic hepatic abscess

A

Klebsiella

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46
Q

Multiple pyogenic hepatic abscesses

A

E. coli

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47
Q

Gas in a hepatic abscess

A

suggests pyogenic etiology

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48
Q

Tortoise shell appearance of the liver

A

schistosomiasis

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49
Q

Hemangioma ultrasound characteristics (liver)

A

hyperechoic (unless liver is fatty), no internal flow, posterior acoustic enhancement

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50
Q

Most common benign liver neoplasm

A

hemangioma > FNH

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51
Q

T1 hyper- or isointense liver lesion DDx

A

HCC, FNH, hepatic adenoma

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52
Q

Threshold for hepatic adenoma resection

A

> 5 cm

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53
Q

Liver lesion with intralesional (microscopic) fat

A

HCC, hepatic adenoma

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54
Q

Non-enhancing T2 dark central scar

A

fibrolamellar HCC (gallium avid)

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55
Q

Late-enhancing T2 bright central scar

A

FNH (sulfur colloid avid, visible on HIDA)

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56
Q

Most common location for a hepatic adenoma

A

right hepatic lobe

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57
Q

Alternate name for Eovist

A

Gd-EOB-DTPA

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58
Q

Risk factors for cholangiocarcinoma

A

PSC, choledochal cysts, recurrent pyogenic cholangitis (chlonorchis senesis), FAP, thorotrast

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59
Q

Cholangiocarcinoma

A

delayed enhancement, ductal dilatation, capsular retraction

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60
Q

Risk factors for hepatic angiosarcoma

A

arsenic (25 year latent period), polyvinyl chloride exposure, radiation, thorotrast, hemochromatosis, NF1

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61
Q

Calcified liver mets

A

mucinous neoplasms (stomach, colon, ovary, breast)

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62
Q

Hypervascular liver mets

A

hemorrhagic mets + carcinoid, PNET

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63
Q

NASH

A

hepatic steatosis + abnormal LFTs

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64
Q

Budd-Chiari

A

most commonly: hypercoagulable state => hepatic vein thrombosis => nutmeg liver +/- multiple regenerative nodules

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65
Q

Nutmeg liver DDx

A

Budd-Chiari, hepatic veno-occlusive disease, right heart failure, constrictive pericarditis

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66
Q

Caudate lobe hypertrophy DDx

A

cirrhosis, Budd-Chiari, PSC, PBC

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67
Q

Causes of hepatic veno-occlusive disease

A

post-BMT, chemotherapy, Jamaican bush tea (alkaloids); occlusion of post-sinusoidal venules with patent hepatic veins; caudate lobe is NOT spared

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68
Q

Pseudocirrhosis

A

treated breast cancer mets; causes capsular retraction

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69
Q

Donor liver segments

A

right lobe (segments 5-8) in adults; segments 2/3 in peds

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70
Q

Indications for liver transplant

A

hepatitis C, alcoholic cirrhosis, HCC, PSC, cryptogenic cirrhosis (NASH)

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71
Q

Contraindications to liver transplant

A

extrahepatic malignancy, advanced cardiac or pulmonary disease, active substance abuse

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72
Q

Impending thrombosis post-liver transplant

A

days 3-10; normal waveform => loss of diastolic flow => tardus parvus arterial waveform + RI <0.5 => loss of hepatic artery waveform

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73
Q

“Central regenerative hypertrophy”

A

pattern in cirrhosis due to PSC

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74
Q

Dilated intrahepatic bile ducts in the setting of cirrhosis

A

PSC

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75
Q

Withered tree on MRCP

A

PSC

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76
Q

AIDS cholangiopathy

A

findings of PSC + papillary stenosis; classically due to cryptospordium infection (or CMV)

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77
Q

Malignant biliary strictures

A

long with shouldering (vs. benign strictures which are short and abrupt)

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78
Q

Charcot triad

A

fever, jaundice, RUQ pain; in ascending cholangitis

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79
Q

Recurrent pyogenic cholangitis

A

left lobe predominant disease burden

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80
Q

Primary biliary cirrhosis

A

autoimmune, middle-aged women, irregular intrahepatic ducts, normal extrahepatic ducts; increased risk of HCC

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81
Q

Most common type of choledochal cyst

A

type 1

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82
Q

Caroli’s disease associations

A

polycystic kidney disease, medullary sponge kidney

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83
Q

Complications of choledochal cysts

A

cholangiocarcinoma, bile duct stones, cirrhosis, cholangitis; Tx is resection

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84
Q

Duct of Luschka

A

accessory cystic duct; may cause bile leak after cholecystectomy

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85
Q

Multiple “halo” or “targetoid” liver masses

A

epitheloid hemangioendothelioma

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86
Q

Lace-like hepatic fibrosis

A

primary biliary cirrhosis

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87
Q

Cholesterolosis

A

cholesterol deposition within the gallbladder lamina propria; similar appearance to adenomyomatosis

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88
Q

Diffuse hepatic hypoattenuation

A

steatosis, amyloidosis (may also be focal)

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89
Q

Diffuse hepatic hyperattenuation

A

hemochromatosis, hemosiderosis, Wilson’s disease, amiodarone, methotrexate, gold, glycogen excess

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90
Q

Wilson’s disease

A

AR; hyperattenuating liver with multiple nodules; progresses to cirrhosis

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91
Q

Caudate-to-right lobe size ratio suggesting cirrhosis

A

> 0.65

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92
Q

von Meyenburg complexes

A

biliary hamartomas; small, irregular, non-communicating

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93
Q

Caroli syndrome

A

Caroli disease + hepatic fibrosis

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94
Q

Central dot sign (liver)

A

Caroli disease

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95
Q

Gallbladder wall thickening with intraluminal membranes

A

gangrenous cholecystitis; Tx emergent cholecystectomy (or -ostomy)

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96
Q

Most common islet cell tumor

A

insulinoma (almost always benign) > gastrinoma > glucagonoma

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97
Q

Gastrinoma

A

Zollinger-Ellison syndrome; assoc. with MEN1

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98
Q

Gastrinoma triangle

A

typical location; bounded by junction of cystic duct, CBD and duodenum inferiorly, and pancreas medially

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99
Q

Serous cystadenoma

A

grandmother tumor; benign; hypervascular, head most commonly, peripheral calcifications; assoc. with VHL; resection only if symptoms related to mass effect

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100
Q

Mucinous cystadenoma

A

mother tumor; pre-malignant; body and tail most commonly; Tx resection

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101
Q

Solid and papillary epithelial neoplasm (SPEN)

A

daughter tumor; tail most commonly; heterogenous, prone to hemorrhage; Tx resection (malignant potential)

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102
Q

Intraductal papillary mucinous neoplasm (IPMN)

A

grandfather tumor; main branch has higher malignant potential

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103
Q

Indications for IPMN resection

A

> 3 cm, mural nodularity, or ductal dilatation >10 mm

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104
Q

Lipase hypersecretion syndrome

A

syndrome related to acinar cell carcinoma (rare, aggressive, elderly males); subcutaneous fat necrosis, eosinophilia, bone infarcts=>polyarthralgias

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105
Q

Whipple triad

A

clinical symptoms of insulinoma: hypoglycemia, symptoms of hypoglycemia, alleviation with glucose administration

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106
Q

Crossing duct sign

A

pancreas divisum; CBD crosses the main pancreatic duct (which drains via minor papilla)

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107
Q

VHL associations (pancreas)

A

pancreatic cysts; increased risk of serous cystadenoma and PNETs

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108
Q

Sausage pancreas + associations

A

autoimmune pancreatitis; assoc. with IgG-4 and Sjogren’s

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109
Q

Wide duodenal sweep (fluoro)

A

mass effect from pancreatic cancer

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110
Q

Dorsal pancreatic agenesis

A

increased risk of diabetes; assoc. with polysplenia

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111
Q

Pancreatic lipomatosis DDx

A

CF, Schwachmann-Diamond, obesity, Cushing’s, chronic steroids, hyperlipidemia

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112
Q

Pancreatic agenesis

A

no duct present (vs. lipomatosis which still has a duct)

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113
Q

Next step in suspected pancreatic duct injury

A

MRCP or ERCP

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114
Q

Pancreas in CF

A

fibrosis, lipomatosis, or cystosis

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115
Q

Causes of acute pancreatitis

A

gallstones, EtOH, scorpion bite, ERCP, valproic acid, trauma, ascariasis

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116
Q

Pancreas hypoechoic relative to the liver

A

inflammation/edema

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117
Q

Most common anatomic variant of the pancreas

A

pancreas divisum; increased risk of pancreatitis

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118
Q

Complication(s) of chronic pancreatitis

A

increased risk of pancreatic cancer

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119
Q

Loss of T1 signal in the pancreas

A

suggests fibrosis (normally very T1 bright); chronic pancreatitis, CF

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120
Q

Capsule surrounding the pancreas

A

autoimmune pancreatitis; capsule may demonstrate delayed enhancement

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121
Q

Cause of groove pancreatitis

A

duodenal or biliary obstruction (stenosis or stricture)

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122
Q

Cystic change of duodenal wall

A

groove pancreatitis

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123
Q

Large pancreatic calcifications with ductal dilation

A

tropical pancreatitis; younger patients, assoc. with malnutrition; increased risk of pancreatic cancer

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124
Q

Most common cause of pancreatic pseudocyst

A

acute or chronic pancreatitis (inflammatory pseudocyst)

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125
Q

DDx for true pancreatic cysts (non-pseudocysts)

A

ADPKD, VHL, CF

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126
Q

Atrophic pancreas with dystrophic calcifications

A

chronic pancreatitis, IPMN

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127
Q

Strongest risk factor for pancreatic adenocarcinoma

A

smoking

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128
Q

Elevated CA-19-9

A

pancreatic adenocarcinoma

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129
Q

Syndromes assoc. with increased risk of pancreatic adenocarcinoma

A

HNPCC, BRCA, ataxia-telangiectasia, Peutz-Jeghers

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130
Q

Periampullary pancreatic cancer

A

originates within 2 cm of major papilla; increased incidence in Gardner syndrome

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131
Q

Unresectable pancreatic cancer

A

involvement of SMA or celiac axis

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132
Q

Large hyperenhancing pancreatic mass with calcifications

A

non-functional PNET; +/- necrosis

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133
Q

Whipple procedure

A

resection of pancreatic head, adjacent duodenum, and gastric antrum => attach CBD and pancreatic remnant to distal duodenum + gastrojejunostomy

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134
Q

Causes of pancreatic transplant failure

A

acute rejection > donor splenic vein thrombosis (usually within 6 weeks); both may demonstrate reversal of diastolic flow

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135
Q

Shrinking pancreas transplant

A

chronic rejection

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136
Q

Santorinicele

A

occurs in pancreas divisum; may cause obstruction => pancreatitis

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137
Q

Enhancing pancreatic mass

A

PNET, splenule, met (RCC most commonly), serous cystadenoma

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138
Q

Common channel syndrome

A

absent septum between distal CBD and pancreatic allowing reflux

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139
Q

Splenomegaly size criteria

A

> 14 cm; remember mono can cause this; volume >500 cc

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140
Q

Gamna-gandy bodies

A

splenic microhemorrhages (increased susceptibility); secondary sign of portal hypertension

141
Q

Splenic hemangioma

A

assoc. with Kasabach-Merritt and Kllippel-Trenaunay-Weber

142
Q

Splenic hamartoma

A

assoc. with tuberous sclerosis

143
Q

Wheel within a wheel or bull’s eye appearance (spleen)

A

pyogenic abscess

144
Q

Most common splenic mets

A

breast, lung, melanoma; same as adrenal gland

145
Q

Tigroid spleen

A

normal striated appearance of spleen in the arterial phase

146
Q

Wandering spleen + association

A

predisposed to torsion; assoc. with abnormalties of intestinal rotation

147
Q

Gaucher disease

A

glucocerebrosidase deficiency; splenomegaly +/- multiple nodules

148
Q

Multiple hypodense splenic nodules DDx

A

sarcoidosis, pelosis, Gaucher’s, splenic PCP

149
Q

Massive splenomegaly

A

myelofibrosis

150
Q

Peliosis

A

blood-filled cystic spaces in the liver and/or spleen; related to OCPs, anabolic steroids, AIDS, renal transplant, lymphoma

151
Q

Most common visceral artery aneurysm

A

splenic artery aneurysm; most commonly in the setting of trauma or pancreatitis

152
Q

Indication for splenic artery aneurysm repair

A

size >2 cm

153
Q

Splenic infarction

A

sickle cell disease

154
Q

Splenic vein thrombosis

A

may lead to gastric varices; most commonly due to pancreatitis, also diverticulitis or Crohn’s

155
Q

Multiple round splenic calcifications

A

histoplasmosis, TB; a.k.a. “prior granulomatous disease”

156
Q

Splenic abscess in a trauma or sickle cell patient

A

consider Salmonella

157
Q

Most common cystic lesion in the spleen

A

pseudocyst (post-traumatic); no epithelial lining, may have mural calcifications

158
Q

Felty syndrome

A

splenomegaly, rheumatoid arthritis, neutropenia

159
Q

Epidermoid cyst (spleen)

A

2nd most common cystic lesion of spleen; “true” cyst (epithelial lining), may have septations

160
Q

Most common benign neoplasm of the spleen

A

hemangioma

161
Q

Littoral cell angioma (spleen)

A

multiple hypoattenuating lesions, hemosiderin (low T1/T2)

162
Q

Malignant masses of the spleen

A

angiosarcoma, lymphoma, mets

163
Q

Multilocular cyst with enhancing septations (spleen)

A

splenic lymphangioma

164
Q

Cystic lesion with internal flow on US (spleen)

A

lymphoma; not truly cystic, but appears so on ultrasound

165
Q

Benign splenic cystic lesions

A

true cyst (epidermoid cyst), pseudocyst, lymphangioma, intrasplenic pancreatic pseudocyst

166
Q

Splenomegaly DDx

A

passive congestion, AIDS, lymphoma, leukemia, Gaucher’s, myelofibrosis, mononucleosis

167
Q

Splenic cyst with mural calcifications

A

pseudocyst; true splenic cysts rarely have mural calcifications

168
Q

Esophageal fold thickening

A

esophagitis (non-specific)

169
Q

Cricopharyngeus muscle

A

at C5-6; border between the pharynx and cervical esophagus; UES

170
Q

A ring

A

muscular ring

171
Q

B ring

A

mucosal ring a.k.a. lower esophageal ring

172
Q

C ring

A

diaphragmatic impression

173
Q

Schatzki ring

A

narrowing of B ring (<13 mm) causing dysphagia; almost always assoc. with a hiatal hernia

174
Q

Zollinger-Ellison syndrome

A

peptic esophagitis from increased acid from gastrin

175
Q

Scleroderma (esophagus)

A

sphincter fibrosis => incompetence => reflux => esophagitis +/- stricture/Barrett’s/cancer

176
Q

Shaggy or foamy esophagus

A

candidiasis; immunocompromised or motility disorders; painful

177
Q

Candidiasis-like appearance in an asymptomatic elderly woman

A

glycogen acanthosis; painless

178
Q

Large flat ulcers

A

CMV or HIV esophagitis

179
Q

Small randomly distributed ulcers

A

HSV esophagitis; may have “halo of edema”

180
Q

Medication esophagitis

A

ulcer at the arotic arch or distal esophagus (sites of narrowing)

181
Q

Numerous small esophageal outpouchings

A

pseudodiverticulosis; dilated submucosal glands due to chronic reflux esophagitis

182
Q

Long, smooth, narrow stricture

A

caustic, radiation induced (>50 Gy), or NGT stricture; caustic strictures assoc. with increased risk of cancer

183
Q

Peptic stricture

A

at or just above GEJ; fibrosis may lead to esophageal shortening

184
Q

Barrett stricture

A

mid esophageal, above metaplastic adenomatous transition (adenomatous tissue is acid-resistant)

185
Q

Barrett esophagus

A

shown as a high stricture + hiatal hernia; precursor to adenocarcinoma

186
Q

Regurgitation of fleshy mass

A

fibrovascular polyp (pedunculated mass usually occuring in cervical esophagus); intralesional fat

187
Q

Uphill varices

A

seen in portal hypertension; lower half of esophagus

188
Q

Downhill varices

A

seen in SVC obstruction; upper half of esophagus

189
Q

Bird’s beak (esophagus)

A

achalasia (‘A’ for Auerbach’s plexus)

190
Q

Corkscrew or shish-kebab esophagus

A

diffuse esophageal spasm

191
Q

Zenker diverticulum

A

in the hypopharnx (above cricopharyngeus); posterior (through Killian’s dehiscence)

192
Q

Killian-Jameson diverticulum

A

in the cervical esophagus (below cricopharyngeus); lateral, often bilateral

193
Q

Dysphagia lusoria

A

most commonly due to aberrant right SCA

194
Q

Esophageal concentric rings

A

eosinophilic esophagitis; Tx steroids

195
Q

Fine transverse folds in lower esophagus

A

feline esophagus; transient, assoc. with reflux; not seen during swallowing

196
Q

Most common benign mucosal lesion of esophagus

A

papilloma

197
Q

Achalasia

A

increased risk of carcinoma and candidiasis; sphincter will relax eventually (vs. malignancy)

198
Q

Pseudoachalasia

A

causes include Chagas, reflux esophagitis, prior vagotomy, malignancy; a.k.a. secondary achalasia

199
Q

Fundoplication

A

for reflux or hiatal hernia; complications include slipping and obstruction

200
Q

Esophageal cancer - stage 3 vs. 4

A

stage 3 = limited to adventitia; stage 4 = invasion into adjacent structures

201
Q

Most common location of esophageal duplication cyst

A

ileum > esophagus

202
Q

Traction diverticulum

A

triangular shape; due to TB or granulomatosis disease => mediastinal scarring; will empty

203
Q

Pulsion diverticulum

A

round shape; due to increase intra-esophageal pressure; do not empty

204
Q

Epiphrenic diverticulum vs. paraesophageal hernia

A

epiphrenic diverticulum occurs on the right (medial); paraesophageal hernia occurs on the left (lateral)

205
Q

Esophageal web + associations

A

anterior impression; most commonly in cervical esophagus; increased risk of hypopharyngeal/esophageal carcinoma; assoc. with Plummer-Vinson syndrome (anemia)

206
Q

Large dilated esophagus DDx

A

achalasia, pseudoachalasia, scleroderma

207
Q

Boerhaave’s syndrome

A

transmural tear, typically 2-3 cm proximal to GEJ; assoc. wtih left-sided pleural effusion

208
Q

Hypopharynx (boundaries)

A

hyoid bone to cricopharyngeus muscle

209
Q

Oropharynx (boundaries)

A

uvula to hyoid bone

210
Q

Esophageal contraction waves

A

primary = initiated by swallowing; secondary = initiated by food/liquid bolus; tertiary = abnormal, but not clinically significant

211
Q

Umbilicated submucosal nodule (stomach)

A

ectopic pancreatic rest

212
Q

Krukenberg tumor

A

GI met to ovary (gastric or colon most commonly)

213
Q

Hampton line sign

A

benign ulcer; line of non-ulcerated acid resistant mucosa surrounding the ulcer crater

214
Q

Carmen meniscus sign

A

malignant ulcer; splaying of large flat malignant ulcer when compression is applied; pathognomonic for gastric carcinoma

215
Q

Menetrier’s disease

A

idiopathic rugal thickening usually involving the fundus; spares antrum

216
Q

Gastric lymphoma

A

classically crosses the pylorus, but does not cause obstruction

217
Q

Most common location for sarcoid in the GI tract

A

stomach

218
Q

History of BilIroth II

A

increased risk of gastric cancer

219
Q

Gardner syndrome

A

FAP + Desmoid tumors, Osteomas, Papillary thyroid cancer, Epidermoid cysts (“DOPE Gardner”)

220
Q

Turcot syndrome

A

FAP + gliomas, medulloblastomas

221
Q

Risk factors for gastric cancer

A

polycyclic hydrocarbons and nitrosamines (processed meats), atrophic gastritis, pernicious anemia, prior subtotal gastrectomy, H. pylori

222
Q

Most common mesenchymal tumor of GI tract

A

GIST

223
Q

Most common location for GIST + associations

A

stomach most commonly, rare before 40 y/o; assoc. with Carney’s triad and NF1

224
Q

Carney’s triad

A

pulmonary chondroma, extra-adrenal pheochromocytoma, GIST

225
Q

Virchow node

A

gastric met to left supraclavicular node

226
Q

Sister Mary Joseph node

A

GI met to umbilical node

227
Q

Most common extra-nodal site for NHL

A

stomach

228
Q

Linitis plastica

A

scirrhous adenocarcinoma with diffuse submucosal infiltration; diffusely thickened stomach on CT

229
Q

Organoaxial gastric volvulus

A

old ladies with paraesophageal hernias; Tx surgical repair

230
Q

Mesenteroaxial gastric volvulus

A

peds, may cause ischemia and/or obstruction; Tx surgical repair

231
Q

Gastric diverticulum

A

most commonly arises posteriorly from the fundus

232
Q

Enlargement of the areae gastricae

A

H. pylori gastritis; typically in elderly patients

233
Q

Multiple gastric ulcers

A

chronic aspirin use or ZES; if duodenal ulcers also => ZES

234
Q

Roux-en-Y patient with weight gain years later

A

gastro-gastric fistula

235
Q

Jejunogastric intussusception

A

occurs at the gastrojejunostomy (Roux-en-Y or Billroth); may cause gastric obstruction

236
Q

H. pylori gastritis

A

assoc. with MALT lymphoma (low grade) and increased risk of gastric adenocarcinoma

237
Q

Gastric carcinoid association

A

high gastrin levels (gastrinoma); carcinoid may regress after gastrinoma resection

238
Q

Paradoxical increase in gastrin level after secretin administration

A

ZES

239
Q

Hyperplastic polyp (stomach)

A

benign, due to chronic inflammation (gastritis)

240
Q

Fundic gland polyp (stomach)

A

sporadic or FAP

241
Q

Adenomatous polyp (stomach)

A

neoplastic polyp with malignant potential, especially if >2 cm; Tx polypectomy

242
Q

Hamartomatous polyp (stomach)

A

benign; assoc. with Peutz-Jeghers, juvenile polyposis, Cronkhite-Canada, Cowden

243
Q

Retrocolic Roux limb

A

increased risk of internal hernia

244
Q

Upper limit of normal small bowel diameter

A

3 cm

245
Q

Whirl sign (swirling mesentery)

A

closed loop obstruction; surgical emergency

246
Q

Fossa of Landzert

A

mesenteric defect through which paraduodenal hernias occur; behind the 4th segment of the duodenum

247
Q

Foramen of Winslow

A

communication between lesser sac and greater peritoneal cavity; potential space for internal hernia

248
Q

Aneurysmal expansion of the small bowel

A

lymphoma; could also be melanoma mets or GIST (but classically lymphoma)

249
Q

Rigler triad

A

seen with gallstone ileus; pneumobilia (from cholecystoduodenal fistula), SBO, ectopic gallstone in small bowel lumen

250
Q

Cobblestone appearance on endoscopy and fluoroscopy (small bowel)

A

Crohn disease; result of criss-crossing ulcerations

251
Q

Creeping fat

A

Crohn disease; fibrofatty mesenteric change seen as a result of Crohn disease

252
Q

String sign

A

Crohn disease; segment of narrowed bowel lumen due to wall thickening in Crohn disease

253
Q

Hidebound bowel

A

scleroderma; thin, straight bowel folds stacked together; due to fibrosis

254
Q

Enteritis involving the terminal ileum

A

TB, yersinia, Crohn’s, campylobacter, salmonella

255
Q

Whipple disease

A

arthralgias, increased skin pigmentation, malabsorption, abdominal pain; low density lymph nodes

256
Q

Ribbon bowel

A

GVHD (after BMT); bowel may appear hyperenhancing

257
Q

Celiac sprue associations

A

iron deficiency anemia, idiopathic pulmonary hemosiderosis, dermatitis herpetiformis; increased risk of small bowel lymphoma and adenocarcinoma

258
Q

Infections with duodenal predilection

A

Giardia, Strongyloides

259
Q

Sand-like nodules in jejunum

A

Whipple disease; with thickened mucosal folds

260
Q

Sand-like nodules in jejunum and low CD4 count

A

MAI (pseudo-Whipple disease); with splenomegaly and retroperitoneal lymphadenopathy

261
Q

Moulage pattern

A

Celiac disease - supposedly looks like a tube into which wax has been poured

262
Q

Fold pattern reversal of jejunum and ileum

A

Celiac disease

263
Q

Duodenal obstruction after recent weight loss

A

SMA syndrome

264
Q

Jejunal ulcer

A

think ZES; especially if also ulcers in stomach and/or duodenal bulb

265
Q

Cloverleaf sign

A

healed ulcer of the duodenal bulb

266
Q

Numerous small filling defects (small bowel)

A

lymphoid hyperplasia

267
Q

Low density mesenteric lymph nodes

A

TB/MAI, treated lymphoma, CMLNS (occurs in celiac sprue), Whipple disease

268
Q

Jejunal diverticulosis associations

A

occur along mesenteric border; association with bacterial overgrowth and malabsorption

269
Q

Increased risk of small bowel lymphoma

A

celiac disease, Crohn’s, AIDS, SLE

270
Q

Most common malignant tumor of the small bowel

A

adenocarcinoma > carcinoid; most common benign tumor is a leiomyoma

271
Q

Most common location for carcinoid

A

carcinoids occur predominately in the small intestine (44.7%) followed in decreasing frequency by the rectum (19.6%), appendix (16.7%), colon (10.6%), and stomach (7.2%)

272
Q

Femoral hernia

A

medial to femoral vein; likely to obstruct

273
Q

Littre hernia

A

hernia containing a Meckel diverticulum

274
Q

Spigelian hernia

A

along the semilunar line through the transversus abdominus aponeurosis

275
Q

Richter hernia

A

contains one wall of bowel; does not obstruct, but may strangulate

276
Q

Increased risk of internal hernia after gastric bypass

A

laproscopic over open; extensive weight loss (less protective mesenteric fat)

277
Q

Most common type of internal hernia

A

paraduodenal hernia (between stomach and pancreas)

278
Q

Most common complication of internal hernia

A

closed-loop obstruction +/- strangulation

279
Q

Paraduodenal hernia

A

small bowel between stomach and pancreas; often contains IMV and left colic artery

280
Q

Small bowel met that causes intussusception

A

melanoma mets

281
Q

Complications of celiac disease

A

intussusception, pneumatosis intestinalis, splenic atrophy, CMLNS; increased risk of venous thromboembolism

282
Q

Typhlitis

A

neutropenic colitis; limited to cecum

283
Q

Accordion sign

A

pseudomembranous colitis (C. difficile); after antibiotics

284
Q

Thumbprinting

A

colonic edema seen on fluoroscopy; non-specific, but classically in C. diff

285
Q

Collar-button ulcer

A

ulcerative colitis; represents mucosal ulceration undermined by submucosal extension

286
Q

Lead pipe colon

A

ulcerative colitis; featureless and foreshortened colon

287
Q

Upper limit of normal appendiceal diameter

A

6 mm

288
Q

Cone-shaped cecum

A

amebiasis (spares TI), TB (involves TI)

289
Q

“Fat gran and an old crone skipping down the cobblestone street away from the wreck”

A

Crohn’s with granulomas, creeping fat, skip lesions, cobblestoning, and rectal sparing

290
Q

Ulcerative colitis associations

A

colon cancer, PSC, cholangiocarcinoma

291
Q

Epiploic appendigitis vs. omental infarct

A

EA smaller and on the left; OI larger and on the right (ROI)

292
Q

Appendiceal mucocele

A

mural calcifications; may occur with or without an associated neoplasm

293
Q

Pseudomyxoma peritonei

A

due to rupture of an appendiceal mucocele or mucin-producing neoplasm (ovary, appendix, colon, pancreas)

294
Q

Coffee bean sign

A

sigmoid volvulus (adults)

295
Q

Cecal volvulus

A

young patients, points to LUQ, less common than sigmoid volvulus

296
Q

Toxic megacolon

A

seen in UC, Crohn’s, C. diff, amebiasis, Hirschsprung’s; lack of haustral markings; colonoscopy is contraindicated

297
Q

Behcet’s (GI tract)

A

ileocecal ulcers; look for oral/genital ulcers and pulmonary artery aneurysms

298
Q

Ogilvie syndrome

A

a.k.a. colonic ileus or colonic pseudobstruction

299
Q

Rectal cavernous hemangioma

A

enhancing with phleboliths (venous malformation); assoc. with Klippel-Trenaunay-Weber and blue rubber bleb syndromes

300
Q

Mucous diarrhea

A

villous adenoma; may lead to severe fluid/electrolyte depletion (McKittrick-Wheelock syndrome)

301
Q

Colonic polyp with highest risk for malignancy

A

adenomatous (includes villous polyps)

302
Q

Rectal cancer staging

A

T3 = invasion beyond muscularis into mesorectal fat; indication for neoadjuvant chemoradiation

303
Q

Most important sequence for rectal cancer staging

A

T2

304
Q

Causes of ischemic colitis

A

acute arterial thromboembolism, chronic arterial stenosis, venous thrombosis, low-flow states

305
Q

Rectal sparing

A

Crohn’s, ischemic colitis

306
Q

Syndromes associated with adenomatous colonic polyps

A

FAP, HNPCC; both are AD

307
Q

Indications for surgery in diverticulitis

A

fistula, 2 prior episodes treated conservatively

308
Q

Syndromes associated with hamartomatous colonic polyps

A

Peutz-Jeghers (AD), Cowden syndrome (AD), Cronkhite-Canada

309
Q

True mesenteries

A

transverse mesocolon, small bowel mesentery, sigmoid mesentery; greater and lesser omentum are not “true”

310
Q

Misty mesentery

A

mesenteric panniculitis, but can also be seen with infiltrating neoplasm

311
Q

Malignancy involving mesentery

A

Relatively common site of metastaseas - NHL, carcinoid (80% of GI carcinoids spread to mesentery), pancreatic, biliary, colon, breast, GIST, mesothelioma, melanoma. Primaries are less common than mets - desmoid a/w Gardner’s syndrome being one.

312
Q

Sandwich sign

A

mesenteric lymphoma - mesenteric fat and vessles engulffed by bulky lymphomatous masses

313
Q

Most common location for peritoneal carcinomatosis

A

retrovesicle space; natural flow of ascites dictates distribution

314
Q

Barium peritonitis

A

inflammatory reaction => hypovolemic shock; give IV fluids

315
Q

Calcified mesenteric mass

A

carcinoid

316
Q

Upstream stenosis findings

A

tardus parvus waveform, RI <0.5

317
Q

Downstream stenosis findings

A

RI >0.7

318
Q

At level of stenosis findings

A

elevated PSV, spectral broadening

319
Q

Hepatic venous waveform

A

above line = away from heart; below line = towards heart; A, S, and D waves

320
Q

Absent hepatic venous waveform

A

Budd-Chiari (hepatic vein occlusion/thrombosis)

321
Q

Increased hepatic vein pulsatility

A

right heart failure or tricuspid regurgitation (D-wave is Deeper in Drug users); both have accentuated A-wave

322
Q

Decreased hepatic vein pulsatility

A

cirrhosis, Budd-Chiari, veno-occlusive disease, IVC thrombosis

323
Q

Slow flow in the PV (number)

A

<16 cm/s

324
Q

Causes of slow flow in the PV

A

portal hypertension (any cause), PV thrombosis, right heart failure, tricuspid regurgitation, Budd-Chiari

325
Q

Causes of increased PV pulsatility

A

right heart failure, tricuspid regurgitation, HHT (from shunting), cirrhosis with arterioportal shunting

326
Q

Normal PV velocity

A

16-40 cm/s

327
Q

Obturator hernia

A

between obturator and pectineus muscles

328
Q

Foramen of Winslow hernia

A

small bowel between PV and IVC

329
Q

MRCP technique

A

fast spin echo, heavily T2-weighted

330
Q

Complications of BMT (4)

A

PTLD, GVHD, veno-occlusive disease, typhlitis

331
Q

Peritoneal inclusion cyst

A

h/o prior surgery or inflammatory disease; closely assoc. with an ovary; may be septated

332
Q

Lymphocele (peritoneum)

A

h/o prior lymph node dissection or renal transplant; along pelvic sidewall

333
Q

Complication of post-transplant hepatic arterial stenosis

A

biliary ischemia => biloma

334
Q

Treatment for biliary cystadenoma

A

resection (risk of malignant transformation)

335
Q

MR findings of confluent hepatic fibrosis

A

low T1, mildly T2 hyperintense, delayed enhancement; may be diffuse, focal, or ill-defined; usually in setting of cirrhosis

336
Q

Hypervascular masses (liver)

A

HCC, FNH, adenoma, hypervascular mets, flash-filling hemangioma

337
Q

Ligamentum teres

A

a.k.a. round ligament; runs within falciform ligament; represents obliterated umbilical vein

338
Q

Small bowel polyps

A

Peutz-Jeghers

339
Q

Multiple target lesions (small bowel)

A

mets (especially melanoma)

340
Q

Position of GDA relative to CBD

A

GDA is anterior to the CBD (could be shown on US in the region of pancreatic head)

341
Q

Colon cancer screening guidelines (average risk patient)

A

ACR/ACS recommends colonoscopy q10, flex sig q5, double contrast BE q5, or virtual colonoscopy q5; starting at age 50

342
Q

Lane Hamilton syndrome

A

celiac disease + idiopathic pulmonary hemosiderosis

343
Q

Liver window and level

A

W 200, L 100

344
Q

Fissure separating the left and right hepatic lobes

A

interlobar fissure (fissure of the gallbladder)

345
Q

Nodular small bowel fold thickening

A

Whipple disease, Crohn’s, lymphoma, infection, mets (melanoma)

346
Q

Location: valeculla vs. pyriform sinuses

A

vallecula are above the epiglottis and pyriform sinuses

347
Q

Foamy esophagus (fluoro)

A

achalasia, scleroderma

348
Q

Glucagonoma

A

diabetes, dermatitis, DVT, depression, death

349
Q

Increased risk of small bowel adenocarcinoma

A

FAP, HNPCC, Peutz-Jegher, celiac disease, Crohn’s

AJT CORE (12 decks)

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