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Gastrointestinal > duodenum > Flashcards

duodenum Flashcards

1
Q

Differential for thickened and nodular folds in the first and second portions of the duodenum

A

Duodenitis
Brunner gland hyperplasia - cobblestone appearance
Crohns

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2
Q

What is brunner gland hyperplasia

A

Edema causes multiple enlarged discrete nodules that form a cobblestone appearance

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3
Q

Differentiate a pyloric channel ulcer from a torus defect

A

Ulcer shape will not change

Torus defect is usually diamond or triangular in shape

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4
Q

How does a duodenal ulcer present radiographically

A

Persistent collection of barium in the duodenal bulb that doesnt change shape with compression or peristalsis

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5
Q

How common are multiple duodenal ulcers? What do multiple ulcers suggest?

A

10-15%

Zollinger ellison

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6
Q

Perforation is more common in gastric or duodenal ulcers?

A

Duodenal

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7
Q

What is giant duodenal ulcer

A

Ulcer of the bulb >2.5cm, prone to more complications

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8
Q

What is the most common cause of perforated viscus in a nontraumatic patient

A

Perforated duodenal ulcer, most perforate anteriorly

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9
Q

What gives a “cloverleaf” appearance?

A

Duodenal bulb ulcer/scar

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10
Q

Differentiate acute from chronic duodenal bulb scarring?

A

Active ulceration is a fixed abnormality

Chronic will change shape with peristalsis

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11
Q

What is the differential for a multichannel pylorus

A

Congenital deformity vs. Fistulous channel from PUD

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12
Q

Postbulbar ulcers - benign or malignant? Should prompt search for what?

A

Malignancy, zollinger ellison

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13
Q

Why are postbulbar ulcerations rare?

A

Acid is usually neutralized by pancreatic secretions by that point

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14
Q

What differentiates mass effect on the duodenum (eg pancreatitis) vs carcinoma induced narrowing?

A

Intact mucosa is seen with adjacent inflammation

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15
Q

What do tethered folds suggest?

A

Adjacent inflammation (pancreatitis, cholecystitis)

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16
Q

Give a DDx for multiple flat ulcerations in the duodenum

A 
PUD
Crohns
Viral
Medication induced
Zollinger Ellison
17
Q

Thickened and nodular duodenal folds

duodenal erosions and luminal dilation

Small angular filling defects with w mosaic/bubbly appearance of the duodenal bulb

A

Celiac sprue

18
Q

Short segmental narrowing with abrupt edges in the duodenum

A

Duodenal adenocarcinoma

19
Q

Where is duodenal adenocarcinoma most common

A

Distal to the ampulla

20
Q

Ampullary mass lesion Ddx

A

Ampullary adenocarcinoma
Edematous papilla due to impacted distal stone
Large duodenal polyp

21
Q

What type of tumors chracteristically have intratumoral calcification

A

Smooth muscle tumor

22
Q

Enhancing mass with brisk washout

bulky lesion and central necrosis

A

Malignant GIST

23
Q

Small, multiple, hyperenhacing lesions in the proximal duodenum

A

Gastrinomas (ZES)

24
Q

What is the reverse 3, or Epsilon, sign?

A

Narrowing and distortion of the medial second duodenal portion border due to pancreatic cancer

25
Q

Villous adenoma is suggested by what kind of appearance

A

Raspberry or cauliflower

26
Q

Do GI polyps enhance?

A

Yes, most do

27
Q

What is the difference between gastric and duodenal polyps in FAP?

A

Gastric - hyperplastic

Duodenal - adenomatous

28
Q

What is the Ddx for multiple tiny filling defects in the duodenum?

Variable size vs same size

A

Heterotopic gastric mucosa - raised, angular configuration, confined to the duodenal bulb

Effervescent granules - change in size and shape

Brunner gland hyperplasia - larger, less numerous, variable in size

Lymphoid nodules - small and UNIFORM, evenly distributed

29
Q

Polypoid filling defect in the junction of the first and second portions of the duodenum suggest what?

A

Flexural pseudopolyp

30
Q

Most common location of duodenal diverticulum?

A

Medial wall of the second portion

31
Q

A radiolucent band surrounding a polypoid intraluminal mass?

A

Intraluminal duodenal diverticulum

32
Q

Dilation of the first and second portions of the duodenum with a stricture/narrowing at the third portion?

Tx?

A

SMA syndrome, turning patient will relieve constriction

33
Q

Most common GI site for hemorrhage

A

Small bowel

34
Q

Loss of the fat plane between the aorta and duodenum suggests what? What is the cause?

A

Aortoenteric fistula

Infection

Gastrointestinal (13 decks)

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