Core Review GI Flashcards
Which enzyme may be elevated in pancreatic ductal adenocarcinoma?
CA19-9
Identify the following structures:
D: celiac a.
E: SMA
F: splenic v.
G: pancreas
H: distal esophagus
- Aspiration of a pancreatic pseudocyst will typically contain what?
- High levels of amylase.
Most common cause of this?
“Double duct” sign = pancreatic adenocarcinoma at the pancreatic head.
Name the most common met to the pancreas
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.
- What is the most common cause of this lesion in the spleen?
- 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.
What is the most likely etiology for these findings?
- 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.
Identify the following structures:
A: liver
B: stomach
C: portosplenic confluence
D: splenic vein
E: pancreatic body
F: SMA
Name the most common benign splenic tumour.
Hemangioma.
68yo female; Dx?
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.
Identify the following structures:
A: SMA
B: L renal vein
C: R renal artery
Name the most common primary to met to the spleen
Melanoma
These splenic findings are most commonly associated w/what process?
- Most sensitive sequence to find these?
Gamna-Gandy bodies = PHTN.
- 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.
Dx?
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.
What is the most common GI tract site for sarcoidosis?
Gastric antrum
If you see isolated gastric varices, what should you think of?
Splenic vein thrombosis.
Dx?
Brucellosis: solitary, large (>2cm) targetoid calcified, splenic lesion.
Name each of the structures
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_
DDx hyperdense hepatic parenchyma
- Amiodarone
- Hemochromatosis (iron)
- Wilson disease (copper)
- Gold therapy
- Glycogen storage disease
List the LI-RADS major features favouring HCC.
- Arterial enhancement
- Washout
- Capsule
- Threshold growth
On what side of the bowel do jejunal diverticula occur?
Mesenteric
Dx?
- Do these communicate w/the biliary tree?
von Meyenburg complex: tiny T2 hyperintensities throughout the hepatic parenchyma.
- No!!!
What is the generic name for Bayer HealthCare’s Eovist?
Gadoxetate
Name 5 indications for Eovist use
- Distinguish FNH from adenoma: FNH shows early uptake & iso- to hyper on HPB phase.
- Bile leak detection: used w/MRCP to localize leaks on HPB phase.
- Assess colorectal mets burden: detects more lesions, esp <1cm than anything else.
- Assess biliary anatomy: can detect smaller order bile ducts on HPB phase.
- Screening for new HCC nodules in pts w/cirrhosis: once you’ve established a baseline MRI, it can better detect small (<1cm) HCCs.
- What is the Dx?
- Mnemonic for recalling iron vs. fat liver hypointensity on MR
- Hemochromatosis, 2dry (xsfusions): liver & spleen dark on in-phase imaging.
- 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).