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
2
Q
Hot quadrate sign
A
SVC occlusion
3
Q
Empty gallbladder fossa sign
A
hepatic parenchyma surrounding GB replaced by fat in early cirrhosis
4
Q
Criteria for distended GB
A
> 4 cm
5
Q
Porcelain GB
A
calcified GB wall; increased risk of gallbladder cancer
6
Q
GB wall thickening
A
> 3 mm
7
Q
Thoratrast complications (liver)
A
angiosarcoma, HCC, cholangiocarcinoma
8
Q
Indications for gallbladder polyp removal
A
> 10 mm or >6 mm + suspicious features
9
Q
Most common type of gallbladder polyp
A
cholesterol polyps
10
Q
Transplant type with highest incidence of PTLD
A
small bowel > pancreas > heart & lung
11
Q
Most common organ involved in PTLD
A
liver
12
Q
Multiple hepatic adenomas
A
von Gierke disease or adenomatosis
13
Q
Most common hepatitis virus to cause HCC worldwide
A
hepatitis B (can occur in acute or chronic HepB infection)
14
Q
Light bulb sign
A
hemangioma - appears very T2 bright
15
Q
Micronodular cirrhosis
A
<3 mm; assoc. with alcoholism
16
Q
Macronodular cirrhosis
A
> 3 mm; assoc. with viral hepatitis
17
Q
Starry sky pattern
A
periportal edema in the setting of hepatitis
18
Q
Hydatid sand
A
echinococcal cyst; fine sediment caused by separation of membranes; may occur in liver or spleen
19
Q
Water lily sign
A
echinococcal cyst; undulating membrane; may occur in liver or spleen
20
Q
Daughter cysts
A
echinococcal cyst; may occur in liver or spleen
21
Q
Hepatic candidiasis
A
multipe small “targetoid” or “bull’s eye” lesions
22
Q
Hepatic PCP
A
punctate echogenic foci in liver +/- spleen; after inhaled pentamidine
23
Q
Target sign
A
implies malignancy; hypoechoic halo surrounding a liver lesion
24
Q
Double target sign (hypo-hyper-hypo)
A
pyogenic abscess; CT finding
25
Amebic abscess
Entamoeba histolytica; characteristic location is near dome of right lobe
26
Most common complication of amebic abscess
pleuropulmonary amebiasis (20-35%) > peritoneal, pericardial or renal amebiasis
27
Amebic abscess in the left hepatic lobe
may rupture into pericardium; emergent drainage necessary to avoid
28
Primary hemochromatosis
liver + pancreas; cirrhosis, diabetes, cardiomyopathy, arthritis, bronze skin; inherited; Tx phlebotomy
29
Secondary hemochromatosis
liver + spleen and bone marrow; due to chronic illness or multiple transfusions; Tx chelation
30
Scalloping of the liver
pseudomyxoma peritonei
31
Periportal hypoechoic infiltration
Kaposi's sarcoma (in AIDS patient)
32
Increased liver signal on out-of-phase
hemochromatosis; liver is very T2 dark
33
Anti-mitochondrial antibodies
primary biliary cirrhosis
34
Mirizzi syndrome
stone in cystic duct causing obstruction of CHD; assoc. with GB carcinoma
35
Injury to bare area of the liver
retroperitoneal bleed
36
Falciform ligament location
divides segments 2/3 and 4; ligamentum teres runs within
37
Cantlie's line
divides the liver into the functional left and right hepatic lobes; between segments 5/8 and 4
38
Most common hepatic vascular variant
replaced RHA
39
Most common biliary ductal variant
right posterior segmental branch draining into the left hepatic duct
40
T1 characteristics of liver-pancreas-spleen
pancreas (brightest) > liver > spleen (darkest)
41
Regenerative and dysplastic nodules
T2 iso/dark, no arterial enhancement; high grade dysplastic nodules may demonstrate arterial enhancement
42
Nodule within a nodule
HCC (T2 bright) within a regenerative/dysplastic nodule (T2 dark); suggests malignant transformation
43
Well-differentiated HCC
enhances during hepatobiliary phase with Eovist (normal HCC does not)
44
Massively dilated hepatic artery
HHT; multiple hepatic and pulmonic AVMs
45
Solitary pyogenic hepatic abscess
Klebsiella
46
Multiple pyogenic hepatic abscesses
E. coli
47
Gas in a hepatic abscess
suggests pyogenic etiology
48
Tortoise shell appearance of the liver
schistosomiasis
49
Hemangioma ultrasound characteristics (liver)
hyperechoic (unless liver is fatty), no internal flow, posterior acoustic enhancement
50
Most common benign liver neoplasm
hemangioma > FNH
51
T1 hyper- or isointense liver lesion DDx
HCC, FNH, hepatic adenoma
52
Threshold for hepatic adenoma resection
>5 cm
53
Liver lesion with intralesional (microscopic) fat
HCC, hepatic adenoma
54
Non-enhancing T2 dark central scar
fibrolamellar HCC (gallium avid)
55
Late-enhancing T2 bright central scar
FNH (sulfur colloid avid, visible on HIDA)
56
Most common location for a hepatic adenoma
right hepatic lobe
57
Alternate name for Eovist
Gd-EOB-DTPA
58
Risk factors for cholangiocarcinoma
PSC, choledochal cysts, recurrent pyogenic cholangitis (chlonorchis senesis), FAP, thorotrast
59
Cholangiocarcinoma
delayed enhancement, ductal dilatation, capsular retraction
60
Risk factors for hepatic angiosarcoma
arsenic (25 year latent period), polyvinyl chloride exposure, radiation, thorotrast, hemochromatosis, NF1
61
Calcified liver mets
mucinous neoplasms (stomach, colon, ovary, breast)
62
Hypervascular liver mets
hemorrhagic mets + carcinoid, PNET
63
NASH
hepatic steatosis + abnormal LFTs
64
Budd-Chiari
most commonly: hypercoagulable state => hepatic vein thrombosis => nutmeg liver +/- multiple regenerative nodules
65
Nutmeg liver DDx
Budd-Chiari, hepatic veno-occlusive disease, right heart failure, constrictive pericarditis
66
Caudate lobe hypertrophy DDx
cirrhosis, Budd-Chiari, PSC, PBC
67
Causes of hepatic veno-occlusive disease
post-BMT, chemotherapy, Jamaican bush tea (alkaloids); occlusion of post-sinusoidal venules with patent hepatic veins; caudate lobe is NOT spared
68
Pseudocirrhosis
treated breast cancer mets; causes capsular retraction
69
Donor liver segments
right lobe (segments 5-8) in adults; segments 2/3 in peds
70
Indications for liver transplant
hepatitis C, alcoholic cirrhosis, HCC, PSC, cryptogenic cirrhosis (NASH)
71
Contraindications to liver transplant
extrahepatic malignancy, advanced cardiac or pulmonary disease, active substance abuse
72
Impending thrombosis post-liver transplant
days 3-10; normal waveform => loss of diastolic flow => tardus parvus arterial waveform + RI <0.5 => loss of hepatic artery waveform
73
"Central regenerative hypertrophy"
pattern in cirrhosis due to PSC
74
Dilated intrahepatic bile ducts in the setting of cirrhosis
PSC
75
Withered tree on MRCP
PSC
76
AIDS cholangiopathy
findings of PSC + papillary stenosis; classically due to cryptospordium infection (or CMV)
77
Malignant biliary strictures
long with shouldering (vs. benign strictures which are short and abrupt)
78
Charcot triad
fever, jaundice, RUQ pain; in ascending cholangitis
79
Recurrent pyogenic cholangitis
left lobe predominant disease burden
80
Primary biliary cirrhosis
autoimmune, middle-aged women, irregular intrahepatic ducts, normal extrahepatic ducts; increased risk of HCC
81
Most common type of choledochal cyst
type 1
82
Caroli's disease associations
polycystic kidney disease, medullary sponge kidney
83
Complications of choledochal cysts
cholangiocarcinoma, bile duct stones, cirrhosis, cholangitis; Tx is resection
84
Duct of Luschka
accessory cystic duct; may cause bile leak after cholecystectomy
85
Multiple "halo" or "targetoid" liver masses
epitheloid hemangioendothelioma
86
Lace-like hepatic fibrosis
primary biliary cirrhosis
87
Cholesterolosis
cholesterol deposition within the gallbladder lamina propria; similar appearance to adenomyomatosis
88
Diffuse hepatic hypoattenuation
steatosis, amyloidosis (may also be focal)
89
Diffuse hepatic hyperattenuation
hemochromatosis, hemosiderosis, Wilson's disease, amiodarone, methotrexate, gold, glycogen excess
90
Wilson's disease
AR; hyperattenuating liver with multiple nodules; progresses to cirrhosis
91
Caudate-to-right lobe size ratio suggesting cirrhosis
>0.65
92
von Meyenburg complexes
biliary hamartomas; small, irregular, non-communicating
93
Caroli syndrome
Caroli disease + hepatic fibrosis
94
Central dot sign (liver)
Caroli disease
95
Gallbladder wall thickening with intraluminal membranes
gangrenous cholecystitis; Tx emergent cholecystectomy (or -ostomy)
96
Most common islet cell tumor
insulinoma (almost always benign) > gastrinoma > glucagonoma
97
Gastrinoma
Zollinger-Ellison syndrome; assoc. with MEN1
98
Gastrinoma triangle
typical location; bounded by junction of cystic duct, CBD and duodenum inferiorly, and pancreas medially
99
Serous cystadenoma
grandmother tumor; benign; hypervascular, head most commonly, peripheral calcifications; assoc. with VHL; resection only if symptoms related to mass effect
100
Mucinous cystadenoma
mother tumor; pre-malignant; body and tail most commonly; Tx resection
101
Solid and papillary epithelial neoplasm (SPEN)
daughter tumor; tail most commonly; heterogenous, prone to hemorrhage; Tx resection (malignant potential)
102
Intraductal papillary mucinous neoplasm (IPMN)
grandfather tumor; main branch has higher malignant potential
103
Indications for IPMN resection
>3 cm, mural nodularity, or ductal dilatation >10 mm
104
Lipase hypersecretion syndrome
syndrome related to acinar cell carcinoma (rare, aggressive, elderly males); subcutaneous fat necrosis, eosinophilia, bone infarcts=>polyarthralgias
105
Whipple triad
clinical symptoms of insulinoma: hypoglycemia, symptoms of hypoglycemia, alleviation with glucose administration
106
Crossing duct sign
pancreas divisum; CBD crosses the main pancreatic duct (which drains via minor papilla)
107
VHL associations (pancreas)
pancreatic cysts; increased risk of serous cystadenoma and PNETs
108
Sausage pancreas + associations
autoimmune pancreatitis; assoc. with IgG-4 and Sjogren's
109
Wide duodenal sweep (fluoro)
mass effect from pancreatic cancer
110
Dorsal pancreatic agenesis
increased risk of diabetes; assoc. with polysplenia
111
Pancreatic lipomatosis DDx
CF, Schwachmann-Diamond, obesity, Cushing's, chronic steroids, hyperlipidemia
112
Pancreatic agenesis
no duct present (vs. lipomatosis which still has a duct)
113
Next step in suspected pancreatic duct injury
MRCP or ERCP
114
Pancreas in CF
fibrosis, lipomatosis, or cystosis
115
Causes of acute pancreatitis
gallstones, EtOH, scorpion bite, ERCP, valproic acid, trauma, ascariasis
116
Pancreas hypoechoic relative to the liver
inflammation/edema
117
Most common anatomic variant of the pancreas
pancreas divisum; increased risk of pancreatitis
118
Complication(s) of chronic pancreatitis
increased risk of pancreatic cancer
119
Loss of T1 signal in the pancreas
suggests fibrosis (normally very T1 bright); chronic pancreatitis, CF
120
Capsule surrounding the pancreas
autoimmune pancreatitis; capsule may demonstrate delayed enhancement
121
Cause of groove pancreatitis
duodenal or biliary obstruction (stenosis or stricture)
122
Cystic change of duodenal wall
groove pancreatitis
123
Large pancreatic calcifications with ductal dilation
tropical pancreatitis; younger patients, assoc. with malnutrition; increased risk of pancreatic cancer
124
Most common cause of pancreatic pseudocyst
acute or chronic pancreatitis (inflammatory pseudocyst)
125
DDx for true pancreatic cysts (non-pseudocysts)
ADPKD, VHL, CF
126
Atrophic pancreas with dystrophic calcifications
chronic pancreatitis, IPMN
127
Strongest risk factor for pancreatic adenocarcinoma
smoking
128
Elevated CA-19-9
pancreatic adenocarcinoma
129
Syndromes assoc. with increased risk of pancreatic adenocarcinoma
HNPCC, BRCA, ataxia-telangiectasia, Peutz-Jeghers
130
Periampullary pancreatic cancer
originates within 2 cm of major papilla; increased incidence in Gardner syndrome
131
Unresectable pancreatic cancer
involvement of SMA or celiac axis
132
Large hyperenhancing pancreatic mass with calcifications
non-functional PNET; +/- necrosis
133
Whipple procedure
resection of pancreatic head, adjacent duodenum, and gastric antrum => attach CBD and pancreatic remnant to distal duodenum + gastrojejunostomy
134
Causes of pancreatic transplant failure
acute rejection > donor splenic vein thrombosis (usually within 6 weeks); both may demonstrate reversal of diastolic flow
135
Shrinking pancreas transplant
chronic rejection
136
Santorinicele
occurs in pancreas divisum; may cause obstruction => pancreatitis
137
Enhancing pancreatic mass
PNET, splenule, met (RCC most commonly), serous cystadenoma
138
Common channel syndrome
absent septum between distal CBD and pancreatic allowing reflux
139
Splenomegaly size criteria
>14 cm; remember mono can cause this; volume >500 cc
140
Gamna-gandy bodies
splenic microhemorrhages (increased susceptibility); secondary sign of portal hypertension
141
Splenic hemangioma
assoc. with Kasabach-Merritt and Kllippel-Trenaunay-Weber
142
Splenic hamartoma
assoc. with tuberous sclerosis
143
Wheel within a wheel or bull's eye appearance (spleen)
pyogenic abscess
144
Most common splenic mets
breast, lung, melanoma; same as adrenal gland
145
Tigroid spleen
normal striated appearance of spleen in the arterial phase
146
Wandering spleen + association
predisposed to torsion; assoc. with abnormalties of intestinal rotation
147
Gaucher disease
glucocerebrosidase deficiency; splenomegaly +/- multiple nodules
148
Multiple hypodense splenic nodules DDx
sarcoidosis, pelosis, Gaucher's, splenic PCP
149
Massive splenomegaly
myelofibrosis
150
Peliosis
blood-filled cystic spaces in the liver and/or spleen; related to OCPs, anabolic steroids, AIDS, renal transplant, lymphoma
151
Most common visceral artery aneurysm
splenic artery aneurysm; most commonly in the setting of trauma or pancreatitis
152
Indication for splenic artery aneurysm repair
size >2 cm
153
Splenic infarction
sickle cell disease
154
Splenic vein thrombosis
may lead to gastric varices; most commonly due to pancreatitis, also diverticulitis or Crohn's
155
Multiple round splenic calcifications
histoplasmosis, TB; a.k.a. "prior granulomatous disease"
156
Splenic abscess in a trauma or sickle cell patient
consider Salmonella
157
Most common cystic lesion in the spleen
pseudocyst (post-traumatic); no epithelial lining, may have mural calcifications
158
Felty syndrome
splenomegaly, rheumatoid arthritis, neutropenia
159
Epidermoid cyst (spleen)
2nd most common cystic lesion of spleen; "true" cyst (epithelial lining), may have septations
160
Most common benign neoplasm of the spleen
hemangioma
161
Littoral cell angioma (spleen)
multiple hypoattenuating lesions, hemosiderin (low T1/T2)
162
Malignant masses of the spleen
angiosarcoma, lymphoma, mets
163
Multilocular cyst with enhancing septations (spleen)
splenic lymphangioma
164
Cystic lesion with internal flow on US (spleen)
lymphoma; not truly cystic, but appears so on ultrasound
165
Benign splenic cystic lesions
true cyst (epidermoid cyst), pseudocyst, lymphangioma, intrasplenic pancreatic pseudocyst
166
Splenomegaly DDx
passive congestion, AIDS, lymphoma, leukemia, Gaucher's, myelofibrosis, mononucleosis
167
Splenic cyst with mural calcifications
pseudocyst; true splenic cysts rarely have mural calcifications
168
Esophageal fold thickening
esophagitis (non-specific)
169
Cricopharyngeus muscle
at C5-6; border between the pharynx and cervical esophagus; UES
170
A ring
muscular ring
171
B ring
mucosal ring a.k.a. lower esophageal ring
172
C ring
diaphragmatic impression
173
Schatzki ring
narrowing of B ring (<13 mm) causing dysphagia; almost always assoc. with a hiatal hernia
174
Zollinger-Ellison syndrome
peptic esophagitis from increased acid from gastrin
175
Scleroderma (esophagus)
sphincter fibrosis => incompetence => reflux => esophagitis +/- stricture/Barrett's/cancer
176
Shaggy or foamy esophagus
candidiasis; immunocompromised or motility disorders; painful
177
Candidiasis-like appearance in an asymptomatic elderly woman
glycogen acanthosis; painless
178
Large flat ulcers
CMV or HIV esophagitis
179
Small randomly distributed ulcers
HSV esophagitis; may have "halo of edema"
180
Medication esophagitis
ulcer at the arotic arch or distal esophagus (sites of narrowing)
181
Numerous small esophageal outpouchings
pseudodiverticulosis; dilated submucosal glands due to chronic reflux esophagitis
182
Long, smooth, narrow stricture
caustic, radiation induced (>50 Gy), or NGT stricture; caustic strictures assoc. with increased risk of cancer
183
Peptic stricture
at or just above GEJ; fibrosis may lead to esophageal shortening
184
Barrett stricture
mid esophageal, above metaplastic adenomatous transition (adenomatous tissue is acid-resistant)
185
Barrett esophagus
shown as a high stricture + hiatal hernia; precursor to adenocarcinoma
186
Regurgitation of fleshy mass
fibrovascular polyp (pedunculated mass usually occuring in cervical esophagus); intralesional fat
187
Uphill varices
seen in portal hypertension; lower half of esophagus
188
Downhill varices
seen in SVC obstruction; upper half of esophagus
189
Bird's beak (esophagus)
achalasia ('A' for Auerbach's plexus)
190
Corkscrew or shish-kebab esophagus
diffuse esophageal spasm
191
Zenker diverticulum
in the hypopharnx (above cricopharyngeus); posterior (through Killian's dehiscence)
192
Killian-Jameson diverticulum
in the cervical esophagus (below cricopharyngeus); lateral, often bilateral
193
Dysphagia lusoria
most commonly due to aberrant right SCA
194
Esophageal concentric rings
eosinophilic esophagitis; Tx steroids
195
Fine transverse folds in lower esophagus
feline esophagus; transient, assoc. with reflux; not seen during swallowing
196
Most common benign mucosal lesion of esophagus
papilloma
197
Achalasia
increased risk of carcinoma and candidiasis; sphincter will relax eventually (vs. malignancy)
198
Pseudoachalasia
causes include Chagas, reflux esophagitis, prior vagotomy, malignancy; a.k.a. secondary achalasia
199
Fundoplication
for reflux or hiatal hernia; complications include slipping and obstruction
200
Esophageal cancer - stage 3 vs. 4
stage 3 = limited to adventitia; stage 4 = invasion into adjacent structures
201
Most common location of esophageal duplication cyst
ileum > esophagus
202
Traction diverticulum
triangular shape; due to TB or granulomatosis disease => mediastinal scarring; will empty
203
Pulsion diverticulum
round shape; due to increase intra-esophageal pressure; do not empty
204
Epiphrenic diverticulum vs. paraesophageal hernia
epiphrenic diverticulum occurs on the right (medial); paraesophageal hernia occurs on the left (lateral)
205
Esophageal web + associations
anterior impression; most commonly in cervical esophagus; increased risk of hypopharyngeal/esophageal carcinoma; assoc. with Plummer-Vinson syndrome (anemia)
206
Large dilated esophagus DDx
achalasia, pseudoachalasia, scleroderma
207
Boerhaave's syndrome
transmural tear, typically 2-3 cm proximal to GEJ; assoc. wtih left-sided pleural effusion
208
Hypopharynx (boundaries)
hyoid bone to cricopharyngeus muscle
209
Oropharynx (boundaries)
uvula to hyoid bone
210
Esophageal contraction waves
primary = initiated by swallowing; secondary = initiated by food/liquid bolus; tertiary = abnormal, but not clinically significant
211
Umbilicated submucosal nodule (stomach)
ectopic pancreatic rest
212
Krukenberg tumor
GI met to ovary (gastric or colon most commonly)
213
Hampton line sign
benign ulcer; line of non-ulcerated acid resistant mucosa surrounding the ulcer crater
214
Carmen meniscus sign
malignant ulcer; splaying of large flat malignant ulcer when compression is applied; pathognomonic for gastric carcinoma
215
Menetrier's disease
idiopathic rugal thickening usually involving the fundus; spares antrum
216
Gastric lymphoma
classically crosses the pylorus, but does not cause obstruction
217
Most common location for sarcoid in the GI tract
stomach
218
History of BilIroth II
increased risk of gastric cancer
219
Gardner syndrome
FAP + Desmoid tumors, Osteomas, Papillary thyroid cancer, Epidermoid cysts ("DOPE Gardner")
220
Turcot syndrome
FAP + gliomas, medulloblastomas
221
Risk factors for gastric cancer
polycyclic hydrocarbons and nitrosamines (processed meats), atrophic gastritis, pernicious anemia, prior subtotal gastrectomy, H. pylori
222
Most common mesenchymal tumor of GI tract
GIST
223
Most common location for GIST + associations
stomach most commonly, rare before 40 y/o; assoc. with Carney's triad and NF1
224
Carney's triad
pulmonary chondroma, extra-adrenal pheochromocytoma, GIST
225
Virchow node
gastric met to left supraclavicular node
226
Sister Mary Joseph node
GI met to umbilical node
227
Most common extra-nodal site for NHL
stomach
228
Linitis plastica
scirrhous adenocarcinoma with diffuse submucosal infiltration; diffusely thickened stomach on CT
229
Organoaxial gastric volvulus
old ladies with paraesophageal hernias; Tx surgical repair
230
Mesenteroaxial gastric volvulus
peds, may cause ischemia and/or obstruction; Tx surgical repair
231
Gastric diverticulum
most commonly arises posteriorly from the fundus
232
Enlargement of the areae gastricae
H. pylori gastritis; typically in elderly patients
233
Multiple gastric ulcers
chronic aspirin use or ZES; if duodenal ulcers also => ZES
234
Roux-en-Y patient with weight gain years later
gastro-gastric fistula
235
Jejunogastric intussusception
occurs at the gastrojejunostomy (Roux-en-Y or Billroth); may cause gastric obstruction
236
H. pylori gastritis
assoc. with MALT lymphoma (low grade) and increased risk of gastric adenocarcinoma
237
Gastric carcinoid association
high gastrin levels (gastrinoma); carcinoid may regress after gastrinoma resection
238
Paradoxical increase in gastrin level after secretin administration
ZES
239
Hyperplastic polyp (stomach)
benign, due to chronic inflammation (gastritis)
240
Fundic gland polyp (stomach)
sporadic or FAP
241
Adenomatous polyp (stomach)
neoplastic polyp with malignant potential, especially if >2 cm; Tx polypectomy
242
Hamartomatous polyp (stomach)
benign; assoc. with Peutz-Jeghers, juvenile polyposis, Cronkhite-Canada, Cowden
243
Retrocolic Roux limb
increased risk of internal hernia
244
Upper limit of normal small bowel diameter
3 cm
245
Whirl sign (swirling mesentery)
closed loop obstruction; surgical emergency
246
Fossa of Landzert
mesenteric defect through which paraduodenal hernias occur; behind the 4th segment of the duodenum
247
Foramen of Winslow
communication between lesser sac and greater peritoneal cavity; potential space for internal hernia
248
Aneurysmal expansion of the small bowel
lymphoma; could also be melanoma mets or GIST (but classically lymphoma)
249
Rigler triad
seen with gallstone ileus; pneumobilia (from cholecystoduodenal fistula), SBO, ectopic gallstone in small bowel lumen
250
Cobblestone appearance on endoscopy and fluoroscopy (small bowel)
Crohn disease; result of criss-crossing ulcerations
251
Creeping fat
Crohn disease; fibrofatty mesenteric change seen as a result of Crohn disease
252
String sign
Crohn disease; segment of narrowed bowel lumen due to wall thickening in Crohn disease
253
Hidebound bowel
scleroderma; thin, straight bowel folds stacked together; due to fibrosis
254
Enteritis involving the terminal ileum
TB, yersinia, Crohn's, campylobacter, salmonella
255
Whipple disease
arthralgias, increased skin pigmentation, malabsorption, abdominal pain; low density lymph nodes
256
Ribbon bowel
GVHD (after BMT); bowel may appear hyperenhancing
257
Celiac sprue associations
iron deficiency anemia, idiopathic pulmonary hemosiderosis, dermatitis herpetiformis; increased risk of small bowel lymphoma and adenocarcinoma
258
Infections with duodenal predilection
Giardia, Strongyloides
259
Sand-like nodules in jejunum
Whipple disease; with thickened mucosal folds
260
Sand-like nodules in jejunum and low CD4 count
MAI (pseudo-Whipple disease); with splenomegaly and retroperitoneal lymphadenopathy
261
Moulage pattern
Celiac disease - supposedly looks like a tube into which wax has been poured
262
Fold pattern reversal of jejunum and ileum
Celiac disease
263
Duodenal obstruction after recent weight loss
SMA syndrome
264
Jejunal ulcer
think ZES; especially if also ulcers in stomach and/or duodenal bulb
265
Cloverleaf sign
healed ulcer of the duodenal bulb
266
Numerous small filling defects (small bowel)
lymphoid hyperplasia
267
Low density mesenteric lymph nodes
TB/MAI, treated lymphoma, CMLNS (occurs in celiac sprue), Whipple disease
268
Jejunal diverticulosis associations
occur along mesenteric border; association with bacterial overgrowth and malabsorption
269
Increased risk of small bowel lymphoma
celiac disease, Crohn's, AIDS, SLE
270
Most common malignant tumor of the small bowel
adenocarcinoma > carcinoid; most common benign tumor is a leiomyoma
271
Most common location for carcinoid
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
Femoral hernia
medial to femoral vein; likely to obstruct
273
Littre hernia
hernia containing a Meckel diverticulum
274
Spigelian hernia
along the semilunar line through the transversus abdominus aponeurosis
275
Richter hernia
contains one wall of bowel; does not obstruct, but may strangulate
276
Increased risk of internal hernia after gastric bypass
laproscopic over open; extensive weight loss (less protective mesenteric fat)
277
Most common type of internal hernia
paraduodenal hernia (between stomach and pancreas)
278
Most common complication of internal hernia
closed-loop obstruction +/- strangulation
279
Paraduodenal hernia
small bowel between stomach and pancreas; often contains IMV and left colic artery
280
Small bowel met that causes intussusception
melanoma mets
281
Complications of celiac disease
intussusception, pneumatosis intestinalis, splenic atrophy, CMLNS; increased risk of venous thromboembolism
282
Typhlitis
neutropenic colitis; limited to cecum
283
Accordion sign
pseudomembranous colitis (C. difficile); after antibiotics
284
Thumbprinting
colonic edema seen on fluoroscopy; non-specific, but classically in C. diff
285
Collar-button ulcer
ulcerative colitis; represents mucosal ulceration undermined by submucosal extension
286
Lead pipe colon
ulcerative colitis; featureless and foreshortened colon
287
Upper limit of normal appendiceal diameter
6 mm
288
Cone-shaped cecum
amebiasis (spares TI), TB (involves TI)
289
"Fat gran and an old crone skipping down the cobblestone street away from the wreck"
Crohn's with granulomas, creeping fat, skip lesions, cobblestoning, and rectal sparing
290
Ulcerative colitis associations
colon cancer, PSC, cholangiocarcinoma
291
Epiploic appendigitis vs. omental infarct
EA smaller and on the left; OI larger and on the right (ROI)
292
Appendiceal mucocele
mural calcifications; may occur with or without an associated neoplasm
293
Pseudomyxoma peritonei
due to rupture of an appendiceal mucocele or mucin-producing neoplasm (ovary, appendix, colon, pancreas)
294
Coffee bean sign
sigmoid volvulus (adults)
295
Cecal volvulus
young patients, points to LUQ, less common than sigmoid volvulus
296
Toxic megacolon
seen in UC, Crohn's, C. diff, amebiasis, Hirschsprung's; lack of haustral markings; colonoscopy is contraindicated
297
Behcet's (GI tract)
ileocecal ulcers; look for oral/genital ulcers and pulmonary artery aneurysms
298
Ogilvie syndrome
a.k.a. colonic ileus or colonic pseudobstruction
299
Rectal cavernous hemangioma
enhancing with phleboliths (venous malformation); assoc. with Klippel-Trenaunay-Weber and blue rubber bleb syndromes
300
Mucous diarrhea
villous adenoma; may lead to severe fluid/electrolyte depletion (McKittrick-Wheelock syndrome)
301
Colonic polyp with highest risk for malignancy
adenomatous (includes villous polyps)
302
Rectal cancer staging
T3 = invasion beyond muscularis into mesorectal fat; indication for neoadjuvant chemoradiation
303
Most important sequence for rectal cancer staging
T2
304
Causes of ischemic colitis
acute arterial thromboembolism, chronic arterial stenosis, venous thrombosis, low-flow states
305
Rectal sparing
Crohn's, ischemic colitis
306
Syndromes associated with adenomatous colonic polyps
FAP, HNPCC; both are AD
307
Indications for surgery in diverticulitis
fistula, 2 prior episodes treated conservatively
308
Syndromes associated with hamartomatous colonic polyps
Peutz-Jeghers (AD), Cowden syndrome (AD), Cronkhite-Canada
309
True mesenteries
transverse mesocolon, small bowel mesentery, sigmoid mesentery; greater and lesser omentum are not "true"
310
Misty mesentery
mesenteric panniculitis, but can also be seen with infiltrating neoplasm
311
Malignancy involving mesentery
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
Sandwich sign
mesenteric lymphoma - mesenteric fat and vessles engulffed by bulky lymphomatous masses
313
Most common location for peritoneal carcinomatosis
retrovesicle space; natural flow of ascites dictates distribution
314
Barium peritonitis
inflammatory reaction => hypovolemic shock; give IV fluids
315
Calcified mesenteric mass
carcinoid
316
Upstream stenosis findings
tardus parvus waveform, RI <0.5
317
Downstream stenosis findings
RI >0.7
318
At level of stenosis findings
elevated PSV, spectral broadening
319
Hepatic venous waveform
above line = away from heart; below line = towards heart; A, S, and D waves
320
Absent hepatic venous waveform
Budd-Chiari (hepatic vein occlusion/thrombosis)
321
Increased hepatic vein pulsatility
right heart failure or tricuspid regurgitation (D-wave is Deeper in Drug users); both have accentuated A-wave
322
Decreased hepatic vein pulsatility
cirrhosis, Budd-Chiari, veno-occlusive disease, IVC thrombosis
323
Slow flow in the PV (number)
<16 cm/s
324
Causes of slow flow in the PV
portal hypertension (any cause), PV thrombosis, right heart failure, tricuspid regurgitation, Budd-Chiari
325
Causes of increased PV pulsatility
right heart failure, tricuspid regurgitation, HHT (from shunting), cirrhosis with arterioportal shunting
326
Normal PV velocity
16-40 cm/s
327
Obturator hernia
between obturator and pectineus muscles
328
Foramen of Winslow hernia
small bowel between PV and IVC
329
MRCP technique
fast spin echo, heavily T2-weighted
330
Complications of BMT (4)
PTLD, GVHD, veno-occlusive disease, typhlitis
331
Peritoneal inclusion cyst
h/o prior surgery or inflammatory disease; closely assoc. with an ovary; may be septated
332
Lymphocele (peritoneum)
h/o prior lymph node dissection or renal transplant; along pelvic sidewall
333
Complication of post-transplant hepatic arterial stenosis
biliary ischemia => biloma
334
Treatment for biliary cystadenoma
resection (risk of malignant transformation)
335
MR findings of confluent hepatic fibrosis
low T1, mildly T2 hyperintense, delayed enhancement; may be diffuse, focal, or ill-defined; usually in setting of cirrhosis
336
Hypervascular masses (liver)
HCC, FNH, adenoma, hypervascular mets, flash-filling hemangioma
337
Ligamentum teres
a.k.a. round ligament; runs within falciform ligament; represents obliterated umbilical vein
338
Small bowel polyps
Peutz-Jeghers
339
Multiple target lesions (small bowel)
mets (especially melanoma)
340
Position of GDA relative to CBD
GDA is anterior to the CBD (could be shown on US in the region of pancreatic head)
341
Colon cancer screening guidelines (average risk patient)
ACR/ACS recommends colonoscopy q10, flex sig q5, double contrast BE q5, or virtual colonoscopy q5; starting at age 50
342
Lane Hamilton syndrome
celiac disease + idiopathic pulmonary hemosiderosis
343
Liver window and level
W 200, L 100
344
Fissure separating the left and right hepatic lobes
interlobar fissure (fissure of the gallbladder)
345
Nodular small bowel fold thickening
Whipple disease, Crohn's, lymphoma, infection, mets (melanoma)
346
Location: valeculla vs. pyriform sinuses
vallecula are above the epiglottis and pyriform sinuses
347
Foamy esophagus (fluoro)
achalasia, scleroderma
348
Glucagonoma
diabetes, dermatitis, DVT, depression, death
349
Increased risk of small bowel adenocarcinoma
FAP, HNPCC, Peutz-Jegher, celiac disease, Crohn's
