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CORE studying > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Fluoro: Esophagus

  • Reticulated mucosal pattern
    Lace-like pattern associated with a stricture
A

Barrett’s esophagus

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2
Q

Fluoro: Esophagus

  • Plaque-like lesions
  • Linear or irregular filling defects, longitudinally oriented
  • Shaggy
A

Candidiasis

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3
Q

Who gets candidiasis (esophagus)

A
  • Immunocompromised - HIV, transplant

- Motility disorder - achalasia, scleroderma

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4
Q

Looks like candidiasis (esophagus), but asymptomatic elderly person

A

Glycogenic acanthosis

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5
Q

Esophageal cancer: Name the type

  • Mid esophagus? Lower esophagus?
  • Smoker/drinker?
  • H/o caustic/alkaloid ingestion
  • Barretts?
  • H/o chronic reflux despite PPI use?
A
  • Squamous = mid esophagus, drinker/smoker, caustic ingestion
  • Adeno = Lower esophagus, reflux/PPI use, Barretts
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6
Q

Types of Hiatal Hernia?

A

Type 1 = sliding
Type 2 = GE stays in place, fundus herniates
Type 3 = GE and fundus herniate
Type 4 = Type 3 + other organ (eg bowel)

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7
Q

Cricopharyngeus

  • What is it?
  • Separates what two structures?
A
  • Cricopharyngeus = “true upper esophageal sphincter”

- Separates “hypopharynx” and “cervical esophagus”

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8
Q

Pulsion vs traction diverticulum

  • Shape?
  • Which empties? And why?
A

Traction = triangular; usually related to scarring, fixing part of the esophagus in place; this will still empty because it has muscle

Pulsion = round; will NOT empty, because it contains no muscle in the walls

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9
Q

Esophageal diverticula:
Zenker vs Killian-Jamieson
- Location?

A
  • Posterior wall, above cricopharyngeus (ie hypopharynx)

- Anterior and lateral wall, below cricopharyngeus (ie cervical esophagus)

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10
Q

Epiphrenic diverticulum vs para-esophageal hernia:

- laterality (LEFT vs RIGHT)?

A 
Tic = Right
Hernia = Left (fundus lies to the left)
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11
Q

DDX: dilated esophagus (3 dx?)

A
  • Achalasia (primary/idiopathic or Chagas) - BIRD BEAK
  • Pseudoachalasia - ie cancer at GE junction
  • Scleroderma
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12
Q

Differentiate achalasia from pseudoachalasia on imaging?

A

Achalasia will eventually relax;

Pseudo WON’T relax - FIXED OBSTRUCTION

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13
Q

Lungs show GGO with subpleural sparing
Esophagus is dilated

  • dx?
  • descriptor for lung pattern…
A

Scleroderma

NSIP

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14
Q

3 complications/sequelae of achalasia

A
  • Cancer (usually mid esophagus, usually squamous cell)
  • Candida
  • Aspiration
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15
Q

Fluoro: Esophagus

Dilated submucosal glands in the setting of chronic reflux esophagitis

A

Pseudodiverticulosis

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16
Q

Types of motility disorders?

Primary vs secondary

A
  • Primary = achalasia or idiopathic

- Secondary = systemic disease (scleroderma is most common); related to reflux

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17
Q

Cause of achalasia:

  • General mechanism
  • Underlying pathophysiology
A
  • Caused by failure of LES to relax

- Loss/destruction of neurons in the AUERBACH/myenteric plexus

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18
Q

Dilated submucosal glands causing hairlike projections on esophagram:

  • dx/name?
  • underlying path?
A
  • Pseudodiverticulosis

- Chronic reflux esophagitis

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19
Q

“Ringed esophagus” on esophagram

  • Young person, long standing dysphagia… dx?
  • Treatment?
A
  • Eosinophilic esophagitis

- PPIs will have failed; treat with steroids

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20
Q

I say jejunal ulcer, you say??

A

Zollinger-Ellison

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21
Q
  • What is Zollinger-Ellison?

- Who gets it?

A
  • Peptic ulcer dz due to gastrinomas (gastrin causes hypersecretion of acid)
  • MEN 1

3 P’s =

  • Pancreatic islet cell tumors (like gastrinomas)
  • Pituitary adenomas
  • hyper-Parathyroidism)
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22
Q

Young pt s/p total colectomy develops locally invasive tumor… wtf?

A

FAP, desmoid

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23
Q

DNA mismatch repair…

  • Name the syndrome
  • This causes?
A
  • Lynch syndrome or Hereditary Non-Polyposis Syndrome (HNPCC)
  • Colon cancer, endometrial cancer, others
24
Q

Carney’s triad?

A

Carney Eats Garbage

  • Chondromas (pulmonary)
  • Extra-adrenal pheos
  • GIST
25
Q

Who gets GISTs…

  • What age group?
  • What syndromes?
A
  • Old people; rare before 40’s

- NF-1 and Carney Triad

26
Q

Diffuse infiltration of the stomach with contracted desmoplastic appearance…

  • Name?
  • Cause?
A
  • Linitis plastica

- Think breast or lung cancer

27
Q

Giant mucosal folds involving the fundus, sparing the antrum…?

A

Menetrier’s disease

- Bimodal disease (linked to CMV in kids)

28
Q

Immediate postprandial abdominal pain, tachycardia, faintness, nausea… patient had “stomach surgery”…

  • What surgery did they have?
  • How do you treat?
A
  • Billroth 2

- Low carb diet and/or conversion to Roux-en-Y

29
Q
  • Markedly dilated small bowel + absent pancreas in an adult… dx?
  • What if it’s a baby?
A
  • DIOS = distal intestinal obstruction syndrome
  • Cystic fibrosis (hence pancreas) with distal obstruction from inspissated material
  • Meconium ileus in a baby
30
Q

Absent/fatty replaced pancreas (with pancreatic insufficiency) + short stature (NOT CF)

A

Schwachman-Diamond

31
Q

What is gleevac?

  • Mechanism?
  • Treats?
A
  • tyrosine kinase inhibitor

- tx for GIST

32
Q

Jejunal-ileal fold reversal + intussusception

A

Celiac sprue

33
Q

Cystic pancreatic lesion:
MACROcystic with thick wall septations + PERIPHERAL calcifications

  • dx?
  • demographic?
  • benign or malignant?
A
  • Mucinous cystic neoplasm
  • Middle aged women… Mucinous = mother = MACRO (big MOTHER fucker)
  • Premalignant –> mucinous cystadenocarcinoma
34
Q

Cystic pancreatic lesion:
MICROcystic/HONEYCOMBED cyst with CENTRAL scar and calcifications

  • dx?
  • demographic?
  • benign or malignant?
A
  • Serous cystic neoplasm
  • OLD women… serous = silly old fart (grammy)
  • Benign, but can grow and cause issues
35
Q
  • What cystic pancreatic lesion do daughters (20s-30s) get?
  • Where?
  • What does it look like?
A
  • Solid pseudopapillary epithelial neoplasm
  • Pancreatic head
  • Solid tumor with cystic/necrotic components
36
Q

Pancreas:

  • Where are the CALCIFICATIONS in a MUCINOUS cystic neoplasm?
  • SEROUS cystic neoplasm?
A
  • Mucinous = peripheral (big “MOTHER” F’ing MACROcysts with peripheral calcs)
  • Serous = central (SENTRAL scar/calc with SMALL microcysts)
37
Q

GI findings look like Crohns, but CT chest shows pulmonary artery aneurysms…

  • Dx?
  • Other classic findings?
A
  • Behcet’s disease (vasculitis)

- Oral and genital ulcers

38
Q

Cecum is folded anteromedially (NOT rotated), resulting in marked distention of the cecum…

A

Cecal BASCULE

39
Q

Large hepatic mass with central scar:

- Classic differential?

A

FNH vs fibrolamellar HCC

40
Q

FNH vs fibrolamellar HCC

  • Scar characteristics?
  • Which has calcification?
  • Helpful nuclear medicine scans?
A

FNH:
T2 BRIGHT scar, delayed enhancement (scars enhance); NO calcs; SULFUR COLLOID uptake

FL HCC:
T2 DARK scar (black hole of death), NO ENHANCEMENT; +/- CALCS; GALLIUM uptake

41
Q
  • Hepatic adenoma in male+steroids or glycogen storage disease?
  • Risks?
A
  • BETA CATENIN (CTNNB1 mutation)
  • GREATEST risk of malignant degeneration (HCC)
  • Can bleed (like inflammatory adenomas)
42
Q
  • What type of adenoma demonstrates signal dropout on opposed phase imaging?
  • Risks?
A
  • HNF1-alpha mutated (mutation causes lipogenesis/fat deposit)
  • Generally low risk of bleeding/malignant degeneration
43
Q

Why to FNHs take up SULFUR COLLOID??

A

Kupffer cells (reticuloendothelial cells lining hepatic sinusoids)

44
Q

Types of hemochromatosis - extrahepatic sites of involvement?

A 
“P”rimary = “P”ancreas involved (signal dropout on in phase)
“S”econdary = “S”pleen involved (signal dropout on in phase)

Primary also involves… heart, thyroid, pituitary

45
Q

Hemochromatosis which involves the heart…?

A

Primary

46
Q

Infant with thrombocytopenia (+/- anemia) and a big vascular lesion… dx?

A

Kasabach-Merritt

Platelet sequestration in a hemangioma (or maybe a Kaposiform hemangioendothelioma)

47
Q

Cancer by tumor markers:

  • CEA(+)?
  • CA19-9(+)?
  • CEA(+) and CA19-9(+)?
A
  • CEA(+) = colon
  • CA19-9(+) = pancreas
  • CEA(+) and CA19-9(+) = cholangiocarcinoma
48
Q

“Double rim sign”

  • Describe
  • Classic dx?
A
  • Fluid collection with rim enhancement surrounded by halo of hypodensity/edema
  • Pyogenic liver abscess
49
Q

Important pressures (mmHg) for portal hypertension

A

Hepatic venous pressure gradient (HVPG)

  • HVPG >10 mm Hg = clinically significant PHTN (dx of PHTN at 6-8 mm Hg)
  • HVPG >12 mm Hg = increased risk for variceal bleeding + ascites
50
Q

Femoral vs inguinal hernia

A
  • Femoral is ENTIRELY LATERAL to the pubic tubercle

- Medial to femoral vein with compression of femoral vein

51
Q

Ddx: HYPER-enhancing hepatic mets?

A 
Neuroendocrine
Renal cell
Thyroid
Melanoma
Sarcoma
52
Q

Scattered hepatic cysts with central enhancing vessel

A

aka “Central dot sign”

  • Caroli disease
  • Dilated biliary cystic spaces surround portal vessels
53
Q

Types of choledochal cysts?

A 
1 = focal dilatation of CBD
2 = CBD diverticulum
3 = choledochocele 
4 = both intra/extra bil dil
5 = ONLY intra bil dil (Caroli disease)
54
Q

What is a choledochocele?

A

Cystic dilatation of the distal CBD within the duodenal wall

55
Q

Early hyperenhancement of hepatic segment 4…

  • name of sign?
  • what causes this?
A
  • Hot quadrate sign (classically Tc99m sulfur colloid scan; CTs as well)
  • SVC obstruction; portosystemic shunting through the “superior vein of Sappey”
56
Q

Hilar cholangiocarcinoma = aka?

A

Klatskin tumor

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