Gastrointestinal Flashcards
What is a Schatzki?
When B ring (mucosal ring below vestibule) is narrowed (<13mm) AND symptomatic (dysphagia)
Level of upper oesophageal sphincter
C5-6
Muscle which makes up the upper oesophageal sphincter
Cricopharyngeus
Barrett’s is a precursor to what malignancy?
Adenocarcinoma
Reticular mucosal pattern is found in what?
Barrett’s oesophagus
High stricture with an associated hiatal hernia
Barrett’s oesophagus
Young patient with atopia and eosinophilia with long history of dysphagia
Eosinophilic oesophagitis
Ringed oesophagus is feature of what?
Eosinophilic oesophagitis
Treatment for eosinophilic oesophagitis
Steroids
Concentric rings in oesophagus on barium?
Eosinophilic oesophagitis
Where is the most common location of oesophageal squamous cell carcinoma?
Middle third oesophagus
Arises from mucosa
(More common in afro-Caribbean males)
What are the risk factors for squamous cell carcinoma of the oesophagus?
Drinking
Smoking
Radiotherapy
Alkaloid ingestion
Where is the most common location for an oesophageal adenocarcinoma?
Majority in lower third of the oesophagus and arises from columnar epithelium or submucosal glands
What are the risk factors for oesophageal adenocarcinoma?
Reflux
Scleroderma
Drinking
Smoking
What is the difference between T3 and T4 cancer of oesophagus?
T3 is invasion of adventitia
T4 is invasion to adjacent structures
What are the risk factors for oesophageal candidiasis?
Immunocompromised (HIV/ transplant)
Achalasia
Scleroderma
What are the barium findings of oesophageal candidiasis?
Discrete plaque-like lesions.
Muscosal inflammation and oedema (nodularity, granularity, fold thickening).
Looks “shaggy” when severe.
What is the diagnosis in an asymptomatic elderly patient with imaging findings similar to that of oesophageal candidiasis?
Glycogen acanthosis
What are the barium findings in oesophageal herpes ulcer?
Small/ multiple punctate or linear ulcers with surrounding radiolucent halo
What are the risk factor(s) for herpes oesophagitis?
Immunocompromised patients, particularly those with AIDS
What are the cause(s) of uphill varices?
Portal hypertension
(confined to bottom half of oesophagus)
What are the cause(s) of downhill varices?
SVC obstruction (catheter related or tumour related)
Confined to top half of oesophagus
How can you differentiate between varices and varicoid carcinoma on imaging?
Varices will flatten out with a large barium bolus.
What are the appearances of varices on barium?
Linear, serpentine filling defects causing scalloped contour.
Water density posterior mediastinal cyst. Diagnosis?
Oesophageal duplication cyst
(Most common location is ileum)
What is the name given to a posterior hypopharyngeal diverticulum at the site of Killian dehiscence?
Zenker diverticulum
Dilated submucosal glands that cause multiple small out-pouchings usually due to chronic reflux. Diagnosis?
Oesophageal pseudodiverticulosis
What is the difference between traction and pulsion diverticulum?
Traction- triangular and will empty.
Pulsion- round and will not empty (contain no muscle in their walls).
What is a “feline oesophagus”?
Fine transverse folds coursing the oesophagus
Can be normal or associated with oesophagitis
Oesophageal web is a risk factor for what?
Oesophageal and hypopharyngeal carcinoma
What are the features of Plummer-Vinson syndrome?
Oesophageal web
Dysphagia
Weight loss
Thyroid issues
Iron deficiency anaemia
What is achalasia?
Motor disorder of distal 2/3 of the oesophagus where the lower oesophageal sphincter won’t relax.
What is the differential for a dilated oesophagus with smooth stricture at the GOJ junction?
Achalasia
Chagas disease
Pseudoachalasia
Scleroderma
Dilated oesophagus with signs of reflux and lung changes (NSIP). Diagnosis?
Scleroderma
What are the causes of a long stricture?
NG tube in too long
Radiation
Caustic ingestion
Dilated oesophagus due to cancer at GOJ junction is called what?
Pseudoachalasia
Name the three variants of familial adenomatous polyposis (FAP)?
Gardner syndrome
Attenuated familial adenomatous polyposis
Familial polyposis coli
Syndrome characterised by multiple colonic polyps and increased risk of colon and CNS tumours (glioblastoma/ medulloblastoma).
Turcot syndrome
Autosomal dominant polyposis syndrome resulting in cancer pretty much everywhere.
Lynch syndrome
(hereditary non-polyposis colorectal cancer)
What is the most common benign tumour of the stomach?
Leiomyoma
(can be calcified)
A patient undergoes a double-contrast barium meal examination which demonstrates multiple filling defects. On endoscopy, the filling defects were confirmed as multiple gastric polyps.
What is the most likely histological pattern?
A. Adenomatous polyps
B. Metastases
C. Hyperplastic polyps
D. Leiomyoma
E. Hamartomatous polyps
Hyperplastic polyps.
(Occur mainly in the body and fundus, measure less than 1cm, make up around 80-90% of gastric polyps and are a recognised complication of long term PPI use)
A gastric ulcer was visible during a double-contrast barium meal examination.
Which of the features below favour a benign aetiology?
A. Irregular modular folds
B. Shallow
C. Hamptons line
D. No protrusion beyond the stomach
E. Asymmetry
Hamptons line
(thin translucent line at the edge of an ulcer)
What is the most common benign tumour of the duodenum?
Adenoma
“Hide bound pattern” is seen in which condition?
Scleroderma
What cancers are people with achalasia more at risk of?
Squamous cell carcinoma
Oesophageal stricture with dilated submucosal gland. Diagnosis?
Pseudodiverticulosis.
Usually due to chronic reflux oesophagitis
What is the most common mesenchymal tumour of the GI tract?
Gastrointestinal stromal tumour (GIST)
“Jejunal ulcers” is buzzword for which syndrome?
Zollinger-Ellison syndrome
What is Carney’s triad?
Chondroma
Extra-adrenal pheochromocytoma
GIST
Which cancers most frequently metastasise to liver?
Colorectal, lung, breast
Less frequently:
Thyroid, Ewing’s sarcoma, neuroendocrine, renal cell, prostate
What are the CT findings in focal nodular hyperplasia (FNH)?
Arterial phase-low attenuation “scar” in centre of large hypervascular mass
No wash out
Venous phase-same scar “fills in”- as it contains central veins
What is the most common type of hypervascular liver metastasis?
Neuroendocrine
What are Aphthoid ulcers?
Shallow puncate “spot” with mucosal oedema
Aphthoid ulceration is found in which disorders?
Crohn’s disease
Yersinia enterocolitis
CMV enterocolitis
Amoebic enterocolitis
Polyarteritis nodosa (PAN)
Ischaemic colitis
Behçet’s disease
What are the causes of pseudosacculations?
Scleroderma
Crohn’s disease
What is Mirizzi syndrome?
When the hepatic duct is obstructed secondary to an impacted cystic duct stone. The stone can eventually erode into the CHD or GI tract.
Mirizzi syndrome occurs more in patients with which anatomical variant?
Low insertion of the cystic duct
What are the 5 types of choledochal cysts?
Type 1 : focal dilation of CBD (most common)
Type 2 : diverticulum of bile duct
Type 3 : choledochocele
Type 4 : intra + extra-hepatic
Type 5 : Caroli’s - intrahepatic only
“Comet-tail” artefact in the gallbladder is specific for what?
Adenomyomatosis
What other conditions are associated with Caroli disease?
Hepatic fibrosis (Caroli syndrome)
Polycystic kidney disease (AD and AR)
Medullary sponge kidney
Southeast Asian patient with dilated biliary ducts full of pigmented stones.
Ducts were described as “straight rigid intrahepatic ducts”
What is the diagnosis?
Recurrent pyogenic cholangitis
Which antibodies are present in primary biliary cirrhosis?
Antimitochondrial antibodies
(in 95%)
How can you differentiate between AIDs cholangiopathy and primary sclerosing cholangitis (PSC)?
Both have intrahepatic and extrahepatic strictures, AIDS is also associated with papillary stenosis
Extrahepatic strictures in AIDs > 2cm, whereas they are rarely > 5mm in PSC.
PSC has saccular deformities of the ducts.
What are the normal vascular US findings following liver transplant?
Rapid systolic upstroke (diastolic → systolic in less than 0.08s)
Resistive index 0.5 - 0.7
Hepatic artery peak velocity < 200 cm/sec
The liver and which other organ is involved in primary haemochromatosis?
(genetic increased gastrointestinal uptake of iron)
Primary = pancreas
The liver and which other organ is involved in secondary haemochromatosis?
(chronic inflammation/ multiple transfusions)
Secondary = spleen
What are the causes of massive caudate lobe hypertrophy?
Budd Chiari
Primary sclerosing cholangitis
Primary biliary sclerosis
What is the differential for decreased early enhancement of the periphery of the liver with delayed enhancement of the periphery, also called “nutmeg liver”?
Budd Chiari
Hepatic veno-occlusive disease
Congenstive hepatopathy(right heart failure, constrictive pericarditis, pulmonary hypertension)
What are the imaging features of the liver in haemochromatosis?
Liver is T1 and T2 dark
Drop out on IN phase imaging (opposite of fat)
Iron = in
What are the causes of hypervascular liver metastases?
Renal
Melanoma
Carcinoid
Choriocarcinoma
Thyroid
Islet cell
What are the risk factors for hepatic angiosarcoma?
Polyvinyl chloride
Arsenic
Radiation
Thorotrast
Associated with haemochromotosis and neurofibromatosis type 1
What are the risk factors for cholangiocarcinoma?
Primary sclerosing cholangitis
Recurrent pyogenic cholangitis
Clonorchis sinensis (East China)
HIV, Hep B&C
Alcohol
Thorotrast
What are the imaging features of a fibrolamellar HCC (subtype seen in younger patients <35)?
T2 dark with a non-enhancing central scar
Gallium avid
Calcifies more than conventional HCC
Not associated with elevated AFP or cirrhosis
In which situations would you find a hepatic adenoma?
Oral contraceptive use
Anabolic steroids
Glycogen storage disease
Obesity
Metabolic syndrome
Diabetes
What is the only hepatic lesion that is avid on sulfur colloid scan?
Focal nodular hyperplasia (FNH)
What is the difference between the central scar of focal nodular hyperplasia vs central scar of fibrolamellar HCC?
The central scar of FNH is T2 bright and enhances on delayed scans
The central scar of fibrolamellar HCC is usually T2 dark with no enhancement.
What are the imaging features of focal nodular hyperplasia (FNH)?
Well defined with a central scar
On arterial phase there is centrifugal filling (opposite to haemangioma/adenoma)
On portal venous phase the lesion will be isointense to background liver
Central scar can be high on T2 and can enhance on delayed scans
What are the imaging features of a hepatic haemangioma?
Bright on ultrasound with no internal doppler signal
CT/MRI : peripheral discontinuous nodular enhancement with progressive filling in
T2 bright
Patient with massively dilated hepatic artery and multiple AVMs in liver and lungs.
Diagnosis?
Hereditary haemorrhagic telangiectasia
(Osler-Weber-Rendu syndrome)
What are the MRI characteristics of regenerative hepatic nodules?
T1 & T2 dark with no enhancement
What are the MRI features of dysplastic hepatic nodules?
T2 dark, T1 bright, usually no enhancement.
What are the prehepatic, hepatic and post-hepatic causes of portal hypertension?
Pre-hepatic : portal vein thrombosis, tumour compression
Hepatic : cirrhosis, schistosomiasis
Post-hepatic : Budd-Chiari
What is McKittrick-Wheelock syndrome?
Villous adenoma which causes a mucous diarrhoea leading to severe fluid and electrolyte depletion.
Cowdry type A intranuclear inclusion bodies can be seen on pathology in which colitis?
Colonic CMV
What are the ultrasound features of an appendix mucocele?
Layering within a cystic mass “onion sign”.
What are the common associations with ulcerative colitis?
Primary sclerosing cholangitis
Ankylosing spondylitis
Colorectal carcinoma
Moyamoya phenomenon.
What are the barium appearances of ulcerative colitis?
Colon “ahaustral” with a diffuse granular appearing mucosal
“Lead pipe”
Pseudodiverticula in Crohns is typically found where?
Anti-mesenteric border of the colon
The hernial sac of a left paraduodenal internal hernia typically contains which vessels?
IMV and left colic artery
A right paraduodenal hernia results from bowel herniating through which fossa?
Fossa of Waldeyer
Lesser sac hernias result in herniation of abdominal contents through which foramen?
Foramen of Winslow
A left paraduodenal internal hernia results from bowel herniating through which fossa?
Fossa of Landzert
Which factors during a Roux-en-Y gastric bypass increase the risk of subsequent internal hernia?
Laparoscopic approach
Greater degrees of weight loss following procedure
What are the 3 potential sites for an internal hernia following Roux-en-Y gastric bypass?
Defect in the transverse mesocolon through which the Roux limb passes (if retrocolic)
Mesenteric defect at the enteroenterostomy
Behind the Roux limb mesentery (retrocolic/anterocolic Peterson types)
Which abdominal wall hernia is located lateral to the inferior epigastric artery + passes through deep inguinal ring.
Indirect inguinal hernia
Which abdominal wall hernia is located medial to the inferior epigastric artery and passes through a defect in Hesselbach triangle?
Direct inguinal hernia
What are the features of a femoral hernia?
Medial to the femoral vein
Posterior to the inguinal ligament
(most common in elderly ladies)
Which conditions increase the risk of small bowel lymphoma?
Coeliac disease
Crohn’s disease
AIDs
SLE
Coeliac disease is associated with which conditions?
Idiopathic pulmonary haemosiderosis (Lane Hamilton syndrome)
Dermatitis herpetiformis
IgA deficiency
Small bowel lymphoma
CEC syndrome (coeliac, epilepsy, cerebral calcification)
What is the difference between SMA syndrome and nutcracker syndrome?
SMA syndrome is where the SMA compresses the 3rd part of duodenum (normally following severe weight loss)
Nutcracker syndrome is compression of the left renal vein, usually between the SMA and aorta
What are the imaging features of coeliac disease?
Fold reversal
Dilated bowel with effaced folds
Coiled spring appearance (intussusceptions)
Low density lymphadenopathy
Splenic atrophy
What is the differential for loop separation on fluoroscopy without tethering?
Ascites
Wall thickening (Crohns, lymphoma)
Adenopathy
Mesenteric tumours
A 54 year old man has imaging which finds diffuse “sand-like” micronodules in the jejunum with enlarged low density nodes. What is the diagnosis?
Whipple’s (Tropheryma Whipplei)
What is the diagnosis for loop separation on fluoroscopy with tethering?
Carcinoid
What is the differential for diffuse thick small bowel folds > 3 mm on fluoroscopy?
Low protein
Venous congestion
Cirrhosis
Multiple uniform discrete nodules along the mucosal surface of the terminal ileum.
What is the diagnosis?
Gastrointestinal nodular lymphoid hyperplasia.
What is the differential for segmental fold thickening of the small bowel on fluoroscopy?
Ischaemia
Radiation
Haemorrhage
Adjacent inflammation
Which medication can cause multiple gastric ulcers?
Chronic aspirin therapy
(doesn’t cause duodenal ulcers)
Describe mesenteroaxial gastric volvulus.
Rotation around short axis perpendicular to the cardiopyloric line
Displacement of antrum above GOJ
Stomach “upside down” with antrum + pylorus above fundus
Describe organoaxial gastric volvulus.
Stomach is rotated along its long axis
Antrum rotates anterosuperiorly
Fundus rotates posteroinferiorly
Gastric volvulus seen in old ladies with paraoesophageal hernias?
Organoaxial volvulus
Which gastric volvulus type is more common in children?
Mensentero-axial volvulus
What is the most common extra-nodal site for non-Hodgkins lymphoma?
Stomach
Linitis plastica tends to result from adenocarcinoma of which two primaries?
Breast
Lung
Where would you find a Virchow node?
Left supraclavicular region
(sign of metastatic abdominal malignancy)
Name two associations with gastrointestinal stromal tumours (GIST)
Carneys triad (chordoma, extraadrenal pheochromocytoma, GIST)
NF-1
Which malignancies are associated with Cowden syndrome?
Breast
Thyroid (usually follicular)
Dysplastic cerebellar gangliocytoma (AKA Lhermitte-Duclos disease)
Which polyposis syndromes are associated with multiple hamartomatous polyps?
Peutz-Jeghers (mucocutaneous hyperpigmentated macules of nose, buccal, axilla, genetalia)
Cowden’s (breast cancer_)_
Cronkhite - Canada (rash, alopecia + watery diarrhoea)
Hereditary nonpolyposis colorectal cancer (HNPCC), AKA Lynch syndrome is associated with which malignancies?
Colorectal cancer
Small bowel (most commonly duodenum)
Gastric
Genitourinary (endometrial, ovarian, urothelial)
Hepatobiliary
Pancreatic
CNS (most often gliomas)
Gardner syndrome is characterised by what?
Familial adenopolyposis
Multiple osteomas (skull and mandible)
Desmoid tumours of mesentry + abdominal wall
Supernumerary teeth
Papillary thyroid carcinoma
Which gastric malignancy tends to cross the pyloris and NOT result in gastric outlet obstruction despite extensive involvement?
Lymphoma
Mucosa-associated lymphoid tissue (MALT) lymphoma is associated with what?
Helicobacter pylori (and may regress following treatment of this)
Menetrier’s disease (AKA giant hypertrophic gastritis) classically affects and spares which parts of the stomach?
Usually affects the fundus (enlarged and tortuous folds esp. along greater curvature)
Classically spares the antrum
What is the classic triad of Menetrier’s disease?
Achlorhydria
Hypoproteinameia (ascites + pleural effusions)
Oedema
(Also characterised by excessive mucus production)
MEN 1 is an autosomal dominant condition characterised by what?
Pituitary adenomas
Pancreatic islet cell tumours (gastrinoma/glucagonoma)
Parathyroid disease (hyperplasia, adenoma, carcinoma)
Zollinger-Ellison syndrome is associated with which other syndrome?
Multiple endocrine neoplasia type 1
(Wermer syndrome)
What are the imaging features in the pancreas in patients with cystic fibrosis?
Complete fatty replacement (lipomatous pseudohypertrophy)
Small 1-3mm pancreatic cysts
Pancreatic duct strictures
Progressive submucosal fibrosis of the proximal colon (fibrosing colonopathy) is associated with what?
High dose lipase supplementation used to treat exocrine insufficiency of the pancreas (e.g. in CF)
What are the features of Shwachman-Diamond syndrome?
Exocrine pancreatic insufficiency (lipomatous pseudohypertrophy)
Metaphyseal chondroplasia (short stature)
Eczema
How do you differentiate between pancreatic agenesis and pancreatic lipomatosis?
Lipomatosis will have a duct, agenesis will not
What is pancreatic divisum and why is this important?
Anatomical variant where the main portion of the pancreas is drained by the minor/ accessory papilla
Importance: increased risk of pancreatitis
What are the imaging characteristics of late chronic pancreatitis?
Small atrophic pancreas - may have focal enlargement
Pseudocyst formation
Dilation and beading of the pancreatic duct with calcifications
Autoimmune pancreatitis is associated with elevation of what?
IgG4
What are the imaging findings of autoimmune pancreatitis?
Sausage shaped pancreas
Capsule like delayed rim enhancement around pancreas
What are the imaging features of tropical pancreatitis?
Multiple large calculi within a dilated pancreatic duct
Which conditions are associated with IgG4?
Autoimmune pancreatitis
Retroperitoneal fibrosis
Sclerosing cholangitis
Inflammatory pseudotumour
Riedels thyroiditis
Serous cystadenoma is associated with what?
Von Hippel Lindau
What are the imaging features of a serous cystadenoma?
Located in the pancreatic head
Heterogenous mixed density lesion made up of multiple small cysts
Do NOT communicate with the pancreatic duct
Can have a central scar
If calcification present, will be central
Mucinous cystic neoplasm of the pancreas is a pre-malignant lesion found in woman in their 50s.
What are the typical imaging features?
Located in the pancreatic body/ tail
No communication with the pancreatic duct
Typically unilocular
If calcification present, tend to be peripheral
What are the imaging features of a solid pseudopapillary tumour of the pancreas?
Large solid lesion with cystic parts in the tail of the pancreas
Thick capsule
Progressive fill in of the solid component
Migratory thrombophlebitis is associated with malignancy is which syndrome?
Trousseau’s syndrome
Which hereditary syndromes are associated with pancreatic cancer?
HNPCC
BRCA mutation
Peutz-Jeghers sydrome
There is an increased risk of ampullary carcinoma in which polyposis syndrome?
Gardner syndrome
Islet cell/ neuroendocrine pancreatic tumours are associated with which conditions?
MEN 1
Von Hippel Lindau
“Shrinking transplant” in regards to the pancreas is a buzzword for what?
Chronic rejection
What are the features of LEFT isomerism?
Bilateral bilobed lungs
Bilateral hyparterial bronchi
Bilateral left atria
Multiple splenules (without parent spleen)
Midline/ transverse liver
Intestinal malrotation
What are the features of RIGHT isomerism?
Bilateral trilobed lungs
Bilateral eparterial bronchi
Bilateral right atria
Absent spleen
Severe congenital heart disease
Midline/ transverse liver
Intestinal malrotation
A wandering spleen is associated with what?
Splenic torsion/ infarction
Intestinal malrotation
Gamma gandy bodies (siderotic nodules) are small foci of haemorrhage in the splenic parenchyma.
They are associated with what?
Portal hypertension
Splenic abscess in the immunocompetent patient, normally in the setting of underlying splenic damage (trauma/ sickle cell) is caused by which infection?
Salmonella
Feltys syndrome consists of which triad?
Splenomegaly
Rheumatoid arthritis
Neutropenia
What is the most common primary neoplasm to metastasise to the spleen?
Melanoma
Small bowel dilatation without increase in fold thickness is the pattern seen in which condition?
Coeliac disease
Small bowel dilatation without loss of the valvulae conniventes and prolonged transit time is the pattern seen in which condition?
Scleroderma
Dilatation of the proximal small bowel due to hypersecretion is seen in what syndrome?
Zollinger-Ellison syndrome
Small bowel fold thickening and lymph node enlargement is the pattern seen in what condition?
Lymphoma
Nodular small bowel fold thickening with sclerotic bone lesions is a pattern seen in what condition?
Mastocytosis
Thickened small bowel folds with or without nodularity, with NO dilatation and normal transit time is a pattern seen in which condition?
Whipple disease
Which infections cause diffuse involvement of the whole colon?
CMV
E. coli
Which infections affect the right colon?
Salmonella
Shigella
Which infections affect the left colon?
Schistosomiasis
Which infections affect the rectosigmoid colon?
Gonorrhoea
Herpes
Chlamydia
What are the features of familial adenomatous polyposis?
Colonic carpet of polyps
Stomach hamartomas
Duodenal adenomas
Periampullary carcinoma
Desmoid tumours
What are the features of Turcot syndrome?
Diarrhoea (colonic polyps)
Seizures (glioblastoma)
What are the features of Cowden syndrome?
Rectosigmoid polyps
Fibrocystic breast disease
Dysplastic cerebellar gangliocytoma
Trichilemmomas
What are the features of Peutz-Jegher syndrome?
Hamartomatous polyps
Mucocutaneous pigmentation
Increased risk of multiple cancers
Clinical syndrome which occurs secondary to functional gastrinoma resulting in GORD and peptic ulcer disease
Zollinger-Ellison syndrome
What are the causes of achalasia?
Idiopathic
Chagas disease (parasite in the jungle)
Allgrove syndrome
What are the fluoroscopic findings of a double aortic arch?
Frontal: “reverse S” sign. Upper indentation from right aortic arch. Lower indentation from left arch.
Lateral: posterior indentation (mostly right arch)
What are the fluoroscopic findings in pulmonary sling/ aberrant left pulmonary artery?
Mass between trachea + oesophagus just above the level of the carina
Indentation on anterior oesophagus
What are the fluoroscopic findings of an aberrant right subclavian artery?
“Bayonet sign”
Obliquely orientated posterior indentation of the oesophagus
What is the most common symptomatic vascular ring?
Double aortic arch
Which is the only vascular ring to pass between the oesophagus and the trachea?
Pulmonary sling
AKA aberrant left pulmonary artery
What are the two types of hiatal hernia and how do you differentiate them?
Sliding (axial) where the GOJ will be above the diaphragm
Rolling (paraoesophageal) with the GOJ below the diaphragm and piece of stomach above it
Pulmonary sling is associated with which other cardiopulmonary and systemic anomalies?
Tracheal stenosis
Complete tracheal rings
Tracheo-oesophageal fistula
Hypoplastic right lung
Imperforate anus
Which type of hiatus hernia has a higher rate of incarceration?
Rolling (paraoesophageal)
What is the most common benign mucosal lesion of the oesophagus?
Papilloma
Lower oesophageal pulsion diverticula with a strong association with oesophageal dysmotility. What is it and which side does it usually occur?
Epiphrenic diverticula
Usually on the right
Where does a Killian-Jamieson diverticulum arise?
Anterolateral cervical oesophagus
Below attachment of cricopharyngeus
Lateral to ligaments that help suspend the oesophagus on the cricoid cartilage
What is a traction diverticulum (oesophagus)?
True diverticulum occurring secondary to pulling forces on the outer aspect of the oesophagus.
What is the barium findings of CMV oesophagitis?
Large approx 2cm superficial mid-oesophageal ulcers (characteristic)
Small well-circumscribed ulcers with normal mucosal between them
CMV infection of the GI tract can be seen in HIV patients with what CD4 count?
CD4 < 100
What are the common infective causes of oesophagitis in a patient with HIV?
CMV
Herpes
Candida
“Corkscrew” oesophagus appearance is seen in what?
Diffuse oesophageal spasm
Severe forms of glycogen acanthosis can be seen in what syndrome?
Cowden syndrome
Multiple small nodules and plaques in the upper to mid oesophagus in asymptomatic elderly patient. What is the diagnosis?
Glycogen acanthosis
What is the most common reason for recurrent reflux following nissen fundoplication?
Slipped nissen wrap which is seen as narrowed oesophagus over a length of >2cm
“Ribbon like” bowel is a buzzword for what condition?
Graft vs host disease
What is the likely diagnosis of multifocal peripheral portal nodules with variable attenuation in a patient with AIDS?
Kaposi sarcoma
What is the most common islet cell tumour?
Insulinoma
What is the most common islet cell tumour associated with MEN?
Gastrinoma
Which cystic pancreatic lesion has an elevated CEA?
Mucinous cystadenoma
(serous cystadenoma does not)
What are the imaging features of a flash haemangioma?
Immediate and uniform enhancement which persists on delayed sequences
Lymph from the bare area of the liver drain into which lymph node group?
Mediastinal
What are the imaging features of angiodysplasia?
Most common in the caecum and ascending colon
Cluster of arterially enhancing vessels on the anti-mesenteric border
Early opacification of the draining ileocolic vein
What conditions may cause low T2 signal in the spleen?
Haemochromotosis
Spherocytosis
Sickle cell disease
MRI safe prosthetic heart valve
What is the diagnosis in an immunosupressed patient with thickened and markedly oedematous caecum?
Neutropenic colitis
(typhlitis)
Liver cirrhosis and a grossly dilated hepatic artery are suggestive of what diagnosis?
HHT
(Osler-Weber-Rendu syndrome)
What is the syndrome associated with hamartomatous polyps in the stomach and colon as well as alopecia and nail atrophy?
Cronkhite-Canada syndrome
What are the causes of Budd-Chiari syndrome?
Thrombocytosis
OCP
Pregnancy
Polycythaemia rubra vera
Right atrial myxoma
Mechanical compression by a tumour
Constrictive pericarditis
In which types of oesophageal atresia will have no gas in the bowel?
Type A: pure oesophageal atresia with no fistula
Type B: oesophageal atresia with fistula between proximal pouch and tracheal
What is the most common type of oesophageal atresia?
Type C: oesophageal atresia with fistula from the trachea or main bronchus to the distal oesophageal segment
What is a type D oesophageal atresia?
Oesophageal atresia with both proximal and distal fistulas
Which conditions increase the risk of duodenal cancer?
Crohns
Coeliac
What are the predisposing factors of gastric malignancy?
H.pylori
Pernicious anaemia
Gastric polyps
Atrophic gastritis
Diet
Partial gastrectomy
What are the fluoroscopy features of gastric lymphoma?
Diffusely thickened irregular mucosal folds
Multiple ulcers associated with a mass and polypoid lesions
Which condition causes small evenly distributed filling defects throughout the duodenal cap on fluoroscopy?
Lymphoid hyperplasia
Which condition causes irregular filling defects within the duodenum, spreading from the pylorus and referred to as “crazy pavement”?
Gastric metaplasia
Which condition causes a cobblestone appearance of the duodenal cap with large nodules which are not effaced with distension?
Brunner’s gland hyperplasia
(duodenitis causes similar appearance but will be effaced with distension)
Simple hepatic cysts are associated with which conditions?
Polycystic liver disease
Polycystic kidney disease
Tuberous sclerosis
Von Hippel-Lindau
What are the imaging features of a benign hepatic cystadenoma?
Arise from bile ducts, often in the right lobe
Multi-locular with internal septa (which can enhance)
Mural papillary projections (characteristic)
What are the imaging appearances of a hepatic adenoma?
Well defined and mixed echogenicity on US
High on T2, low in T1 (can be mixed if haemorrhage/ fat)
Rapid homogenous arterial enhancement that becomes isointense on later phase imaging
Cold on sulphur colloid scans (unlike FNH)
Conventional hepatocellular carcinomas are hyper-enhancing in the arterial phase and washout in the portal-venous. What is the reason for this?
They are supplied by the hepatic arteries not the portal system
What is the difference between adenoma and FNH when using hepatocyte specific contrast?
FNH will have enhancement which persists into the delayed phases due to the presence of hepatocytes
Hepatic adenomas do not retain hepatocyte specific contrast on the delayed phase as they do not have hepatocytes
Which nodal groups are deemed “local nodes” in regards to gastric cancer?
Perigastric, lesser and greater curve, common hepatic, splenic, left gastric and coeliac nodes
