CTC GI Flashcards
Barretts gi
Mid oesophageal stricture often with hiatus hernia vs cancer (sq vs adeno) irregular with shouldered edges
Oesophageal lesions
Candida - shaggy, differential is glycogenic acanthosis
Herpes - small and multiple with oedema halo
Cmv/hiv large shallow ulcer
Crohns - discrete sphthous ulcers with mound of oedema
Pseudodiverticulae - mucous glands in reflux
Eosinophilic eospophagitis - young men, concentric rings
Stomach cancer
95% adenocarcinoma, 5% lymphoma, few GISTS, melanoma, breast, lung
Gists stomach>jI>d>rectum. Pacemaker cells cajal, carneys triad
Stomach ulcer
Cancer - irregular, within lumen, wider than deep, carmen meniscus
Benign - most lesser cervature, deeper than wide, hampton line
Liver haemangioma
F5M1
HHT, kasabach merritt (haemangioma thrombocytopaenia)
Benign liver lesions are rare in cirrhosis
Hyperechoic
T1 dark t2 bright dwi
Peripheral nodular late arterial enhancment that fills in to isointense on delayed
Fnh
2nd mosst common benign liver
F5m1
Young to mid age
Hyperplastic normal hepatocytes and kupfer cells, deformed biliary drainage
T2/t1 iso to bright/dark central scar t2 bright
Arterial enhancment then iso on PV, delayed enh scar in 80%
Takes up primovist, sulphur colloid (kuppfer) and HIDA which shows delayed clearance
No relationship to birth control
Hepatic adenoma
Female on ocp - man on steroids, glycogen storage disease (von gierke), obesity, diabetes
Predilection to haemorrhage. Fat no bile
Inflammatory most common and bleed, hnf1 alpha mutated 2nd, beta catenin-glycogen storage, fap, unclassified
Noncon iso arterial hyper pv iso, t2 hyper, t1 variable, drop out due to fat
> 5cm resect as bleed and cancer
Dont take up primovist, characteristically sulphur colloid cold (23% prob hot)
Fibrolamellar hcc
20-40 adult m=f
Normal afp, no cirrhosis, 50% calcify -also adenoma, atypical hcc/fnh
Central t2 dark non enhancing scar
T1 iso, t2 iso/bright
Arterial enhancement, pv iso-washout
Does not uptake primovist or sulphur colloid
Cholangiocarcinoma
15% primary hepatic
65 m>f asians
Psc (UC), oriental cholangitis, caroli, hiv, hepatitis, cirrhosis
High ca199 (panc) and cea (crc)
Bile duct epithelial. Fibrosis is prominent - t2/t1 dark, capsular retraction, late enhancement, ductsl dialtstion
Mass forming, periductal infiltrating or intraductal
Peripheral parenchymal 10%, perihilar klatskin 70%, distal extrahepatic 20%
Bismuth 1-chd 2-confluence rhd lhd 3a confluence + rhd, 3b +lhd 4- 3a + 3b 5- stricture distal chd
Fitz hugh curtis
Peritoneal spread to liver capsule in PID. Gonorrhoea, chlamydia or Tb
Fatty liver
non con <40hu or 10hu
Normal transplant hepatic artery
Ri 0.5-0.7
Psv <200cms
Psc
Strong association with UC so seen in 30-40y0 men
Progressive bd inflammation with intra and extrahepatic strictures
Beaded, pruned tree, caudate pseudotumour, risk cholangiocarc9noma
Different ials - aids cholangiopathy - exrrahepatic strictures are >2cm, cd4<100
Igg4 related
Pbc in women 40-50. Vanishing bile ducts. Intrahepatic only. Lace like fibrosis between regenerating nodules in cirrhosis, risk hcc
Tondani
1-extra 2-divertic 3-choledococoele 4-intra and extra 5-caroli disease + fibrosis =syndrome
Caroli is ar. Associated -pckd and msk
Get cirrhosis and cholangiocarcinoma, stones and cholangitis
If see dilated ducts with stones thing recurrent pyogenic cholangitis
Shadowing gb differential
Full of stones, porcelain, emphysematous cholecystitis
Air-dirty shadow
Wall echo shado complex - stones
Porcelain risk ca. ?dystrophic vs supersat vs haemorrhage
Gb polyp
Benign - <5mm, almost always cholesterol polyps with comet tail, multiple pedunculated
Malignant- <1cm, solitary, sessile, flow on doppler or enhance on mri>wall
Doppler angle
<60deg
Stenosis spectral dopple
Upstream - increased ri
Stenosis - increased psv, spectral broadening
Downstream, tardis parvus (acceleration time >70ms)
Hep vein, portal vein
Hep- predominantly anterograde can have retrofrage a wave. Asvd. Increased pulsatility in tcr and rhf, decr in cirrhosis or hep vein obstruction
Pv - normal <13mm, 20-40cms hepatopetal constant flow some undulation
Pulsatile with rhf, tcr, cirrhosis with av shunting
Velocity <15cms in portal htn. Pre - pv thrombosis, hepatic - cirrhosis, post - rhf, tcr, bud chiari
Pancreatitis grading and collections
Grading balthazar
A. Normal, b. Large c. Inflammation d. 1 collection e. 2+ collections
Ctsi is balthazar + % necrosis
Collections
Acute interstitial pancreatitis (95%) forms acute peripancreatic collections (<4/52) then psudocysts
Necrotising pancreatitis forms acute necrotic collections then walled off necrosis
Complications include splenic vein thrombosis and splenic/GDa pseudoaneurysm
Infection is the killer - look for gas in collections
Cystic pancreatic lesions
Serous cystadenoma - old women, multiloculated (>6, <2) central scar/calcification, benign, pancreatic head, vhl
Mucinous cystic neoplasm (premalignant) mid age woman, Unilocular <6, >2, peripheral calc. Body and tail
SPEN -young asian woman, solid or mixed, calcification, haemorrhage, tail, capsule
Ipmn- old man, mucin producing, side br typically dont enlarge duct (can), <3cm benign, main branch dilate duct considered malignant. Any enhancing or sold nodules =malignant. In continuity with duct. Main br often has calcs so differential for chronic pancreatitis
Pseudocyst is most common - cant differentiate on imaging alone
Simple cyst - vhl, pckd
Pancreatic solid
Ductal carcinoma - old man smoker, head, hypovascular and t1 dark with double duct. Dismal prognosis. 20% 5y if operable. Inoperable if >180d sma/coeliac/pv/smv/hep artery or mets. Raised ca199. Seen in hnpcc, brca, peutz jager
Net - hypervascular. Functional or non. Vhl and men1
Insulinoma most common. <2cm, 90% benign
Gastrinoma 2nd, 60% cancer, zollinger elison, most common type in men1
Non functional 3rd, 80% cancer
Intrapancreatic spleen - t2 bright, tiger stripes on cect, take up rbcs and sulphur colloid
Gamna gandy
Splenic siderosis Portal htn Sickel cell Haemolytic anaemias Leukaemia lymphoma
Splenic lesions
Histioplasmosis, tb give multiple calcs
Sarcoid gives splenomegally or multiple lesions, can calcify
Most common cyst is pseudocyst post trauma/infection etc, epidermoid/true cysts are congenital, echinococcal cysts show floating membranes
Enhancing likely haemangioma or hamartoma
Most common malignancy is lymphoma, mets are rare (think melanoma), amgiosarcoma most common primary malignancy large, aggressive, heterogenous, necrosis, rupture t1/2 dark
