duodenum Flashcards
Differential for thickened and nodular folds in the first and second portions of the duodenum
Duodenitis
Brunner gland hyperplasia - cobblestone appearance
Crohns
What is brunner gland hyperplasia
Edema causes multiple enlarged discrete nodules that form a cobblestone appearance
Differentiate a pyloric channel ulcer from a torus defect
Ulcer shape will not change
Torus defect is usually diamond or triangular in shape
How does a duodenal ulcer present radiographically
Persistent collection of barium in the duodenal bulb that doesnt change shape with compression or peristalsis
How common are multiple duodenal ulcers? What do multiple ulcers suggest?
10-15%
Zollinger ellison
Perforation is more common in gastric or duodenal ulcers?
Duodenal
What is giant duodenal ulcer
Ulcer of the bulb >2.5cm, prone to more complications
What is the most common cause of perforated viscus in a nontraumatic patient
Perforated duodenal ulcer, most perforate anteriorly
What gives a “cloverleaf” appearance?
Duodenal bulb ulcer/scar
Differentiate acute from chronic duodenal bulb scarring?
Active ulceration is a fixed abnormality
Chronic will change shape with peristalsis
What is the differential for a multichannel pylorus
Congenital deformity vs. Fistulous channel from PUD
Postbulbar ulcers - benign or malignant? Should prompt search for what?
Malignancy, zollinger ellison
Why are postbulbar ulcerations rare?
Acid is usually neutralized by pancreatic secretions by that point
What differentiates mass effect on the duodenum (eg pancreatitis) vs carcinoma induced narrowing?
Intact mucosa is seen with adjacent inflammation
What do tethered folds suggest?
Adjacent inflammation (pancreatitis, cholecystitis)
Give a DDx for multiple flat ulcerations in the duodenum
PUD Crohns Viral Medication induced Zollinger Ellison
Thickened and nodular duodenal folds
duodenal erosions and luminal dilation
Small angular filling defects with w mosaic/bubbly appearance of the duodenal bulb
Celiac sprue
Short segmental narrowing with abrupt edges in the duodenum
Duodenal adenocarcinoma
Where is duodenal adenocarcinoma most common
Distal to the ampulla
Ampullary mass lesion Ddx
Ampullary adenocarcinoma
Edematous papilla due to impacted distal stone
Large duodenal polyp
What type of tumors chracteristically have intratumoral calcification
Smooth muscle tumor
Enhancing mass with brisk washout
bulky lesion and central necrosis
Malignant GIST
Small, multiple, hyperenhacing lesions in the proximal duodenum
Gastrinomas (ZES)
What is the reverse 3, or Epsilon, sign?
Narrowing and distortion of the medial second duodenal portion border due to pancreatic cancer
