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Core Review GI Flashcards

1
Q

Which enzyme may be elevated in pancreatic ductal adenocarcinoma?

A

CA19-9

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2
Q

Identify the following structures:

A

D: celiac a.

E: SMA

F: splenic v.

G: pancreas

H: distal esophagus

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3
Q
  • Aspiration of a pancreatic pseudocyst will typically contain what?
A
  • High levels of amylase.
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4
Q

Most common cause of this?

A

“Double duct” sign = pancreatic adenocarcinoma at the pancreatic head.

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5
Q

Name the most common met to the pancreas

A

RCC!

  • 30% of all mets to panc are RCC.
    • Presents as hypervascular mass-see below.
    • They met quickly, i.e., w/in 6-12 mths post-presentation.
  • Next most common = lung.
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6
Q
  • What is the most common cause of this lesion in the spleen?
A
  • Trauma. This is a simple pseudocyst.
    • Splenic hematomas evolve & become liquefied seromas surrounded by a pseudocapsule.
    • The cyst wall may sometimes calcify.
    • True splenic cysts (lined w/epithelium) are rare & thought to be congenital.
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7
Q

What is the most likely etiology for these findings?

A
  • Histoplasmosis.
    • These are multiple splenic calcs.
    • DDx: histo, TB, brucellosis, trauma.
      • TB: usually <6 calcs, typically smaller than those in histo.
      • Brucellosis: a few large rim-calcified lesions.
  • When >6 calcified granulomas are seen, the most likely cause is histoplasmosis.
  • Histoplasmosis:
    • Histoplasma capuslatum fungus endemic to the Ohio River Valley.
    • The fungal spores are inhaled & taken up by bronchial LNs.
    • They then disseminate hematogenously & some may be filtered by the spleen where they incite an inflammatory reaction, form granulomas & calcify.
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8
Q

Identify the following structures:

A

A: liver

B: stomach

C: portosplenic confluence

D: splenic vein

E: pancreatic body

F: SMA

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9
Q

Name the most common benign splenic tumour.

A

Hemangioma.

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10
Q

68yo female; Dx?

A

Dx: pancreatic serous cystadenoma.

  • Grandmother tumour: grandmothers are serious!
  • Benign cystic tumour.
  • Often in the pancreatic head.
  • Usually >6 cysts, each smaller than 2cm.
    • If the cysts are small the lesion may appear solid on US.
  • A central scar may be present, sometimes w/calcifications.
  • Pancreatic duct dilation & parenchymal atrophy are usually not seen.
  • Aspirate will not contain appreciable levels of amylase, CEA or CA 19-9.
    • Mucinous cystic tumours will contain high CEA & high CA 19-9 if malignant.
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11
Q

Identify the following structures:

A

A: SMA

B: L renal vein

C: R renal artery

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12
Q

Name the most common primary to met to the spleen

A

Melanoma

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13
Q

These splenic findings are most commonly associated w/what process?

  1. Most sensitive sequence to find these?
A

Gamna-Gandy bodies = PHTN.

  1. GRE
  • These are microhemorrhages which do not enhance, & contain a combo of iron, fibrosis & Ca2+.
  • Found in ~10% of pts w/PHTN but can also be found in sickle cell pts.
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14
Q

Dx?

A

Angiosarcoma of the spleen & liver: complex cystic appearance w/central necrosis & irregular foci of internal nodularity.

  • Can spontaneously hemorrhage.
  • Early mets to liver, bone, lung.
  • Assoc w/Thorostrast exposure.
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15
Q

What is the most common GI tract site for sarcoidosis?

A

Gastric antrum

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16
Q

If you see isolated gastric varices, what should you think of?

A

Splenic vein thrombosis.

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17
Q

Dx?

A

Brucellosis: solitary, large (>2cm) targetoid calcified, splenic lesion.

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18
Q

Name each of the structures

A

A: seg 7

B: seg 8

C: seg 4A

D: seg 2

E: seg 1/caudate

F: fissure of ligamentum venosum

G: seg 6

H: seg 5

I: 4B

J: fissure for falciform ligament

K: seg 3

L: interlobar fissure (for the GB, separates R & L lobes_

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19
Q

DDx hyperdense hepatic parenchyma

A
  • Amiodarone
  • Hemochromatosis (iron)
  • Wilson disease (copper)
  • Gold therapy
  • Glycogen storage disease
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20
Q

List the LI-RADS major features favouring HCC.

A
  • Arterial enhancement
  • Washout
  • Capsule
  • Threshold growth
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21
Q

On what side of the bowel do jejunal diverticula occur?

A

Mesenteric

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22
Q

Dx?

  1. Do these communicate w/the biliary tree?
A

von Meyenburg complex: tiny T2 hyperintensities throughout the hepatic parenchyma.

  1. No!!!
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23
Q

What is the generic name for Bayer HealthCare’s Eovist?

A

Gadoxetate

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24
Q
A
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25
Q

Name 5 indications for Eovist use

A
  1. Distinguish FNH from adenoma: FNH shows early uptake & iso- to hyper on HPB phase.
  2. Bile leak detection: used w/MRCP to localize leaks on HPB phase.
  3. Assess colorectal mets burden: detects more lesions, esp <1cm than anything else.
  4. Assess biliary anatomy: can detect smaller order bile ducts on HPB phase.
  5. Screening for new HCC nodules in pts w/cirrhosis: once you’ve established a baseline MRI, it can better detect small (<1cm) HCCs.
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26
Q
  1. What is the Dx?
  2. Mnemonic for recalling iron vs. fat liver hypointensity on MR
A
  1. Hemochromatosis, 2dry (xsfusions): liver & spleen dark on in-phase imaging.
  2. Mnemonic:
  • Iron on In: dark on in-phase (4.4ms on 1.5T).
  • If you’re fat, get OUT! dark on out-of-phase (2.2ms).
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27
Q
A
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28
Q

Dx?

A

Hepatic AML, tuberous sclerosis: fat-signal lesion in the liver.

29
Q

Dx, this finding?

A

THID: transient hepatic intensity difference: increased arterial flow (only seen on arterial, early PV phase) near a mass.

  • Can be seen b/c of: masses, cirrhosis, PV clot, abscess/infection.
30
Q
  1. What is a RF for malignant xformation of HCA (hepatocellular adenomas)?
  2. What is the % risk of xformation?
  3. Which is the subtype that is more common in men & at highest risk of xformation?
A
  1. MEN!
  2. 5-15% (it’s thought that HCAs are of hepatocellular origin).
  3. Beta-catenin-mutated subtype.
31
Q

Dx? 30yo female, using Eovist.

A

Fibrolamellar HCC: T2 dark scar & mass does not enhance on delays, unlike FNH.

32
Q

Most common cause of this & DDx?

A

“Starry-sky” = diffuse edema, acute hepatitis.

DDx: entities that cause diffuse edema/infiltration

  • Toxic shock
  • R heart failure
  • Leukemia/lymphoma
33
Q

Mnemonic for hypervascular hepatic mets

A

MR CT

Melanoma

RCC

Carcinoid

Choriocarcinoma

Thyroid

34
Q

List the Milan criteria for pts w/cirrhosis & HCC & eligibility for liver transplant.

A

Milan criteria, pts must have:

  • 1 HCC <5cm
  • 3 HCC <3cm
  • No vascular invasion in the liver, e.g., PV tumour thrombus.
  • No extrahepatic mets.
35
Q

The most common etiology of liver xplant graft failure?

36
Q

This mass may be associated w/what syndrome?

A

Giant cavernous hemangioma = Kassabach-Merritt

  • Thrombocytopenia 2° to sequestration & destruction of platelets within the GCA.
  • GCA size criteria: 4-10cm.
  • Other GCA complications: pain, rupture, K-M syndrome.
37
Q

Dx: arterial & delayed T1 Ixs w/conventional extracellular contrast.

A

Hepatic peliosis: delayed filling from inner to outer (opposite to hemangioma).

  • Rare vascular disorder of dilated sinusoids & blood-filled cavities.
  • Centrifugal pattern, unlike hemangioma which is centripetal.
  • May also see this w/mets but mets will not show delayed enhancement.
  • Can see this in AIDS pts b/c of Bartonella infection.
38
Q

The most common cause of benign biliary stricture?

A
  • Prior HPB surgery: 90%, and most 2° to prior cholecystectomy.
39
Q

Name the structures:

A
  1. Common hepatic duct
  2. Proper hepatic artery
  3. Main portal vein
40
Q

What % of UC have this?

A

~5% of UC pts have PSC.

Whereas ~70-90% of PSC pts have UC.

41
Q

Dx: 34yo pt w/CD4 = 46/mm3.

  1. Most common feature of this process?
A

AIDS cholangiopathy, most often due to Cryptosporidium.

  1. 70% have papillary stenosis. Sometimes this can be in isolation.
42
Q

The most common Ix presentation of GB carcinoma is?

A

A large mass replacing the GB (40-65%).

  • This happens b/c the pts frequently present w/advanced disease.
  • 2nd most common = a broad-based polyploid lesion on the GB wall.
43
Q

DDx of this:

A

Vicarious excretion of contrast.

DDx:

  • Impaired renal function: since most contrast is excreted by the kidneys but a small amount is excreted into the biliary tree.
  • Higher contrast dose
  • Reduced GB emptying, e.g., in the fasting state
44
Q

Dx?

A

Schatzki ring: thickened, narrowed (<13mm) B-ring w/associated type 1 (sliding) hiatal hernia (classic association).

45
Q

Dx, pt w/HIV.

A

CMV-related esophageal ulcer: large, flat, diamond-shaped ulcer.

46
Q

Dx, 25yo male w/dysphagia & atopia.

  1. Tx?
A

Eosinophilic esophagitis: multiple concentric rings or corrugated appearance.

  1. Steroids; they fail Tx w/PPIs.
  • High association w/food allergies.
  • Also, asthma.
47
Q

Name the structures:

A

A: pyriform sinus

B: true cord

C: false cord

D: laryngeal ventricle

48
Q

Name the structures:

A

E: vallecula

F: epiglottis

G: laryngeal vestibule

H: trachea

49
Q

List the components of normal pharyngeal phase of swallowing

A
  • Elevation of the soft palate to seal the nasopharynx.
  • Elevation & anterior movement of the hyoid & larynx.
  • Adduction & apposition of the vocal cords & laryngeal closure.
  • Epiglottic inversion & upper esophageal sphincter relaxation.
51
Q

Dx, 65yo male, immunohistochemistry + for CD117.

  1. Name 2 associated conditions.
A

Gastric GIST: large mass w/central ulceration.

  1. NF-1
  2. Carney’s triad: (Carneys Eat Garbage) pulmonary chondroma, extra-adrenal pheo, GIST.
  • CD117 = a KIT protein, specific for GIST.
52
Q

H. pylori:

  1. Most common location for gastritis b/c of it?
  2. What type of Gram bacterial rod?
  3. What 2 entities can it cause?
A
  1. Antrum!
  2. Gram-negative!
  3. Gastric adenoca, 1° gastric (MALT) lymphoma.
53
Q
  1. What are the borders of the Z-E gastrinoma triangle?
  2. Where are the gastrinomas commonly found in the triangle?
A
  1. Borders:
  • Superiorly: junction of cystic duct & CBD.
  • Medially: pancreatic neck/body junction.
  • Inferiorly: 2/3 duodenum junction.
  1. 50% pancreas, 50% duodenum.
54
Q

DDx?

A

Gastric emphysema: gas in the stomach wall.

  • Emphysematous gastritis: most commonly from E. coli (60-80% mortality).
  • Caustic ingestion
  • EtOH abuse
  • Iatrogenic: from ERCP or NG tube insertion; benign.
  • COPD: when pt is coughing, but more likely in the bowel.
  • Gastric outlet obstruction: can lead to intragastric pressure.
  • Mucosal disruption: from ulcer/tumour.
55
Q

Dx, 39yo female w/Hx of bloating & abdo pain.

A

NSAID-related SB stricture: thin, diaphragm-like stricture in a pt who has used NSAIDs on a long-term basis.

56
Q

The most common malignancy assoc w/untreated celiac is?

A

T-cell lymphoma of the SB

57
Q
  1. Most common location for GI carcinoid?
  2. 2nd?
  3. Most common site for small bowel carcinoid? PRIOR EXAM Q!!!
A
  1. Rectum-34%
  2. Small bowel-26%
  3. Ileum (prior exam Q!!!).
58
Q

The most common tumour involving small bowel? (PRIOR EXAM Q!!!!)

A

Mets!!!

  • Most commonly intraperitoneal spread from ovarian, colonic or appendiceal.
59
Q

Most common cause for SBO in the US?

60
Q

What other anomaly may arise from the same embryologic origin as a Meckel diverticulum?

A

vitelline duct cyst

  • Both come from the omphalomesenteric duct.
    • This is the embryonic communication b/w the yolk sac & developing midgut.
61
Q
  1. What’s the name of the watershed area in the colon b/w the SMA & IMA arterial territories at the splenic flexure?
  2. Rectosigmoid area?
A
  1. Griffiths point
  2. Sudeck point

(G comes before S)

62
Q

DDx of this

A

Colonic pneumatosis

  • Bowel ischemia
  • If asymptomatic:
    • Meds: steroids
    • Recent endoscopy, colonic insufflation or surgery
    • Emphysema
    • Barotrauma
    • Lupus
63
Q
  1. C. diff is what kind of bacterium (Gram-wise)?
  2. Which C. diff toxin produces pseudomembranous colitis?
A
  1. Gram-positive anaerobe.
  2. Toxin B.
64
Q

T-stage?

A

T3: nodular projection along the L lateral rectal wall extending into the perirectal fat.

65
Q

The most common cause of colovesical fistula?

A

Diverticulitis

66
Q

What is the most common cause of large bowel obstructions?

67
Q

Where is the most common site for perforation due to an obstruction from a sigmoid colonic neoplasm?

A

The cecum

  • B/c of Laplace’s law as the cecum has the greatest diameter of any segment of colon.
68
Q

Which is the most common of the hereditary colorectal cancer syndromes?

A

Lynch syndrome aka hereditary nonpolyposis colorectal cancer

KB-GI radiology (11 decks)

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