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Gastrointestinal Imaging (Beri) > Duodenum (PBR 2) > Flashcards

Duodenum (PBR 2) Flashcards

1
Q

90% of tumors in the duodenal bulb are:

a. benign
b. malignant

A

a. Benign

In the second and third portions of the duodenum, tumors are 50% benign and 50% malignant

In the fourth portion of the duodenum, most tumors are malignant

benign tumors of the duodenum usually present as smooth, polypoid filling defects

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2
Q

Presentation of benign tumors of the duodenum

A

Small, smooth, polypoid filling defects

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3
Q

CT is helpful, but not specific, in predicting malignancy
Biopsy is required

What are the signs of malignancy of duodenal lesions?

A
  1. Central necrosis
  2. Ulceration or excavation
  3. Exophytic or intramural mass
  4. Evidence of tumor beyond the duodenum
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4
Q

Most common/frequent malignant tumor of the duodenum

A

Duodenal adenocarcinoma

Rare lesion

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5
Q

Malignant tumor of the duodenum are most commonly located at what part?

A

Periampullary region

Rare in the bulb

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6
Q

What are the morphologic patterns of duodenal adenocarcinoma

A
  1. Polypoid mass
  2. Ulcerative mass
  3. Annular constricting lesion
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7
Q

CT and MR finding of duodenal adenocarcinoma

A

Enhancing intramural or exophytic soft tissue mass with frequently a bilobed “dumbbell” shape

Central necrosis and ulceration occur
Regional adenopathy, hepatic metastases, and local extent of tumor are demonstrated for surgical planning

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8
Q

Metastases to the duodenum occurs in what layer?

A

In the wall or subserosa presenting with wall thickening

As the tumor grows, it may extend into the lumen and present as an intraluminal mass that may ulcerate

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9
Q

Most common primary malignancy to metastasize to the duodenum

A

Breast, lung, and other GI malignancies

The duodenum may be invaded by tumors of adjacent organs including the pancreas and kidney

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10
Q

Presentation of lymphoma in the duodenum

A

Nodules with thickened folds

The nodules associated with lymphoma are distinctly larger than those seen with benign lymphoid hyperplasia

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11
Q

Presentation of duodenal adenoma

A

Polypoid lesion that may be pedunculated or sessile

Adenomas account for about half of the neoplasms of the duodenum

Multiple adenomatous polyps are associated with polyposis syndromes

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12
Q

This adenoma have a high incidence of malignant degeneration and a characteristic “cauliflower” appearance on double- contrast UGI series

A

Villous adenoma

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13
Q

GISTs of the duodenum present as what kind of mass?

A

Intramural, endoluminal, or exophytic mass

Most commonly in the 2nd or 3rd portion of the duodenum

Ulceration is common

Malignant tumors range up to 20 cm size and are most common in the more distal duodenum

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14
Q

Second most common primary malignant tumor of the duodenum

A

Malignant gastrointestinal stromal tumors

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15
Q

This presents as small (1 to 3 mm) polypoid nodules diffusely throughout the duodenum

The condition is usually benign, especially in children

It is associated with immunodeficiency states in some adults

A

Lymphoid hyperplasia

No evidence supports the concept that lymphoid hyperplasia is a precursor to lymphoma

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16
Q

This may cause a lobulated mass at the base of the duodenal bulb

The diagnosis of this disease is suggested by characteristic location and change in configuration with peristalsis, which may
be observed on UGI

A

Gastric mucosa prolapse

Prolapse through the pylorus during peristalsis

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17
Q

This lesion has the appearance of areae gastricae in the duodenal bulb, or as clusters of 1- to 3-mm plaques on the smooth duodenal bulb mucosa

It may also appear as a solitary polyp that is indistinguishable from other polypoid lesions of the duodenum

A

Heterotopic gastric mucosa in the duodenal bulb is common on endoscopy (12%) but seen infrequently on imaging

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18
Q

This glands are located in the submucosa of the proximal two-thirds of the duodenum and secrete an alkaline substance that buffers gastric acid

A

Brunner glands

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19
Q

Brunner gland lesion smaller than 5 mm are termed what?

A

Hyperplasia

Lesions larger than 5 mm are termed hamartomas
Larger lesions are more likely to be symptomatic

All lesions are benign and without cellular atypia

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20
Q

Diffuse nodular gland hyperplasia is a common cause of multiple nodules, often with a cobblestone appearance

True or false

A

True

Brunner gland hamartoma usually presents as a solitary nodule and is identical in appearance to other benign duodenal nodules

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21
Q

Ectopic pancreas may occur in what portion of the duodenum

A

Most commonly in the proximal descending portion

A solitary mass with central dimple is most characteristic

22
Q

Valvulae conniventes, or Kercking folds, of the small bowel begin where?

A

Second portion of the duodenum and continue throughout the remainder of the bowel

23
Q

How many milimeters is duodenal thickening?

A

Folds greater than 2 to 3 mm

24
Q

This refers to inflammation of the duodenum without discrete ulcer formation

A

Duodenitis

25
Q

What i the the major cause of duodenitis?

A

H . pylori infection

Alcohol and anti-inflammatory medications are additional causes

26
Q

UGI findings of duodenitis

A
  1. Thickening (>4 mm) of the proximal duodenal folds
  2. Nodules or nodular folds (enlarged Brunner glands), 3. Deformity of the duodenal bulb
  3. Erosions

CT shows nonspecific wall thickening and inflammatory changes

27
Q

This diseases thicken the duodenal folds by paraduodenal inflammation

May also cause mass impressions on the duodenal lumen

CT or US demonstrates the extent and nature of the paraduodenal process

A

Pancreatitis and cholecystitis

28
Q

Crohn disease involves what part of the duodenum?

A

First and second portions

Almost always associated with contiguous involvement of the stomach

Duodenal involvement is manifest by thickened folds, aphthous ulcers, erosions, and single or multiple strictures

29
Q

Frequent cause of of traveler’s diarrhea

A

Gardiasis

30
Q

Imaging finding of gardiasis

A
  1. Distorted thickened folds in the duodenum and jejunum
  2. Hypermotility and spasm
  3. Increased secretions
31
Q

This is caused by trauma, anticoagulation, and bleeding disorders

The regular pattern of thickened folds resembles a stack of coins

Partial or complete duodenal obstruction is usually present

A

Intramural hemorrhage

Mural hematomas may result in a large mass

The fixed retroperitoneal position of the third portion of the duodenum makes it susceptible to blunt abdominal trauma and compression against the lumbar spine

32
Q

Most frequent cause of duodenal ulcers?

A

H. pylori infection - 95% of cases

Additional causes include anti-inflammatory medications, Crohn disease, Zollinger–Ellison syndrome, viral infections, or penetrating pancreatic cancer

Duodenal ulcers are associated with acid hypersecretion

33
Q

Most common location of duodenal ulcers?

A

In the duodenal bulb with the anterior wall being most often involved

34
Q

Imaging diagnosis of a duodenal ulcer depends on what finding?

A

Demonstration of the ulcer crater or niche

35
Q

Usual size of of duodenal ulcers

A

Smaller than 1 cm diameter

Giant ulcers larger than 2 cm resemble diverticuli or a deformed bulb

36
Q

Ulcer craters have no mucosal lining and therefore no mucosal relief pattern, and do not contract with peristalsis

True or false

A

True

Ulcer scarring may cause a pattern of radiating folds with a central barium collection that is indistinguishable from an acute ulcer

37
Q

Postbulbar ulcers represent about 5% of the total, but are more commonly associated with what disease?

A

Serious upper GI hemorrhage

Most involve the second and third portions of the duodenum, which are frequently narrowed

38
Q

Complications of duodenal ulcer

A

Obstruction
Bleeding
Perforation

*Creator’s notes: Similar to gastric ulcer

39
Q

This is caused by a gastrin-secreting neuroendocrine tumor (gastrinoma)

A

Zollinger-Ellison syndrome

40
Q

Most frequent location of gastrinomas?

A

Pancreas (75%)

Duodenum (15%) and in 10% in extraintestinal sites (liver, lymph nodes, and ovary)

The tumor is malignant in 60% of cases

41
Q

Gastrinomas also occur as part of what hereditary syndrome?

A

Multiple endocrine neoplasia, type I (MEN-I)

*Creator’s notes:
Parathyroid adenoma
Pituitary gland tumor
Pancreatic islet cell tumor (gastrinoma)

42
Q

UGI finding of Zollinger-Ellison syndrome

A
  1. Multiple peptic ulcers in the stomach, duodenal bulb, and, most characteristically, in the postbulbar duodenum
  2. Hypersecretion with high-volume gastric fluid diluting the barium and impairing mucosal coating
  3. Thick edematous folds in the stomach, duodenum, and proximal jejunum
43
Q

Most common location of duodenal diverticula

A

Inner aspect of the descending duodenum (2nd part)

44
Q

How to differentiate duodenal diverticular from ulcers if UGI series?

A

By demonstration of mucosal folds entering the neck of the diverticulum and change in appearance with peristalsis

45
Q

CT scan finding of duodenal diverticula

A

On CT they may be filled with fluid and mimic a pancreatic pseudocyst, or they may contain air and fluid and mimic a pancreatic abscess

46
Q

Rare complications of duodenal diverticula

A

Perforation and hemorrhage

Diverticuli adjacent to the ampulla of Vater may rarely obstruct the common bile duct or pancreatic duct

47
Q

These are caused by a thin, incomplete, congenital diaphragm that is stretched by moving intraluminal contents to form a “windsock” configuration within the duodenum

A

Intraluminal duodenal diverticula

The diverticulum is partially obstructing eventually resulting in postprandial epigastric pain and fullness.

Some patients present with vomiting or GI bleeding

48
Q

This is the most common congenital anomaly of the pancreas

A

Annular pancreas

Pancreatic tissue encircles the descending duodenum and narrows its lumen

49
Q

UGI findings of annular pancreas

A

Typically demonstrates eccentric or concentric narrowing of the descending duodenum

Annular pancreas is associated with a high incidence of postbulbar peptic ulceration in adults

CT confirms the diagnosis by demonstration of pancreatic tissue encircling the duodenum

50
Q

Refers to bleeding with the site of origin proximal to the ligament of Treitz

A

UGI hemorrhage

51
Q

Causes of upper GI hemorrhage

A

Approximate order of frequency:

  1. Duodenal ulcer
  2. Esophageal varices
  3. Gastric ulcer
  4. Acute hemorrhagic gastritis
  5. Esophagitis
  6. Mallory–Weiss tear
  7. Neoplasm
  8. Vascular malformation
  9. Vascular enteric fistula
52
Q

Endoscopy is less accurate than a UGI series in demonstrating the bleeding site

True or false

A

False

Endoscopy is much more accurate than a UGI series in demonstrating the bleeding site

Barium studies should be avoided in patients in the acute stages of UGI hemorrhage

Gastrointestinal Imaging (Beri) (26 decks)

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