Gastrointestinal Flashcards
Fluoro: Esophagus
- Reticulated mucosal pattern
Lace-like pattern associated with a stricture
Barrett’s esophagus
Fluoro: Esophagus
- Plaque-like lesions
- Linear or irregular filling defects, longitudinally oriented
- Shaggy
Candidiasis
Who gets candidiasis (esophagus)
- Immunocompromised - HIV, transplant
- Motility disorder - achalasia, scleroderma
Looks like candidiasis (esophagus), but asymptomatic elderly person
Glycogenic acanthosis
Esophageal cancer: Name the type
- Mid esophagus? Lower esophagus?
- Smoker/drinker?
- H/o caustic/alkaloid ingestion
- Barretts?
- H/o chronic reflux despite PPI use?
- Squamous = mid esophagus, drinker/smoker, caustic ingestion
- Adeno = Lower esophagus, reflux/PPI use, Barretts
Types of Hiatal Hernia?
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)
Cricopharyngeus
- What is it?
- Separates what two structures?
- Cricopharyngeus = “true upper esophageal sphincter”
- Separates “hypopharynx” and “cervical esophagus”
Pulsion vs traction diverticulum
- Shape?
- Which empties? And why?
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
Esophageal diverticula:
Zenker vs Killian-Jamieson
- Location?
- Posterior wall, above cricopharyngeus (ie hypopharynx)
- Anterior and lateral wall, below cricopharyngeus (ie cervical esophagus)
Epiphrenic diverticulum vs para-esophageal hernia:
- laterality (LEFT vs RIGHT)?
Tic = Right Hernia = Left (fundus lies to the left)
DDX: dilated esophagus (3 dx?)
- Achalasia (primary/idiopathic or Chagas) - BIRD BEAK
- Pseudoachalasia - ie cancer at GE junction
- Scleroderma
Differentiate achalasia from pseudoachalasia on imaging?
Achalasia will eventually relax;
Pseudo WON’T relax - FIXED OBSTRUCTION
Lungs show GGO with subpleural sparing
Esophagus is dilated
- dx?
- descriptor for lung pattern…
Scleroderma
NSIP
3 complications/sequelae of achalasia
- Cancer (usually mid esophagus, usually squamous cell)
- Candida
- Aspiration
Fluoro: Esophagus
Dilated submucosal glands in the setting of chronic reflux esophagitis
Pseudodiverticulosis
Types of motility disorders?
Primary vs secondary
- Primary = achalasia or idiopathic
- Secondary = systemic disease (scleroderma is most common); related to reflux
Cause of achalasia:
- General mechanism
- Underlying pathophysiology
- Caused by failure of LES to relax
- Loss/destruction of neurons in the AUERBACH/myenteric plexus
Dilated submucosal glands causing hairlike projections on esophagram:
- dx/name?
- underlying path?
- Pseudodiverticulosis
- Chronic reflux esophagitis
“Ringed esophagus” on esophagram
- Young person, long standing dysphagia… dx?
- Treatment?
- Eosinophilic esophagitis
- PPIs will have failed; treat with steroids
I say jejunal ulcer, you say??
Zollinger-Ellison
- What is Zollinger-Ellison?
- Who gets it?
- 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)
Young pt s/p total colectomy develops locally invasive tumor… wtf?
FAP, desmoid
DNA mismatch repair…
- Name the syndrome
- This causes?
- Lynch syndrome or Hereditary Non-Polyposis Syndrome (HNPCC)
- Colon cancer, endometrial cancer, others
Carney’s triad?
Carney Eats Garbage
- Chondromas (pulmonary)
- Extra-adrenal pheos
- GIST
Who gets GISTs…
- What age group?
- What syndromes?
- Old people; rare before 40’s
- NF-1 and Carney Triad
Diffuse infiltration of the stomach with contracted desmoplastic appearance…
- Name?
- Cause?
- Linitis plastica
- Think breast or lung cancer
Giant mucosal folds involving the fundus, sparing the antrum…?
Menetrier’s disease
- Bimodal disease (linked to CMV in kids)
Immediate postprandial abdominal pain, tachycardia, faintness, nausea… patient had “stomach surgery”…
- What surgery did they have?
- How do you treat?
- Billroth 2
- Low carb diet and/or conversion to Roux-en-Y
- Markedly dilated small bowel + absent pancreas in an adult… dx?
- What if it’s a baby?
- DIOS = distal intestinal obstruction syndrome
- Cystic fibrosis (hence pancreas) with distal obstruction from inspissated material
- Meconium ileus in a baby
Absent/fatty replaced pancreas (with pancreatic insufficiency) + short stature (NOT CF)
Schwachman-Diamond
What is gleevac?
- Mechanism?
- Treats?
- tyrosine kinase inhibitor
- tx for GIST
Jejunal-ileal fold reversal + intussusception
Celiac sprue
Cystic pancreatic lesion:
MACROcystic with thick wall septations + PERIPHERAL calcifications
- dx?
- demographic?
- benign or malignant?
- Mucinous cystic neoplasm
- Middle aged women… Mucinous = mother = MACRO (big MOTHER fucker)
- Premalignant –> mucinous cystadenocarcinoma
Cystic pancreatic lesion:
MICROcystic/HONEYCOMBED cyst with CENTRAL scar and calcifications
- dx?
- demographic?
- benign or malignant?
- Serous cystic neoplasm
- OLD women… serous = silly old fart (grammy)
- Benign, but can grow and cause issues
- What cystic pancreatic lesion do daughters (20s-30s) get?
- Where?
- What does it look like?
- Solid pseudopapillary epithelial neoplasm
- Pancreatic head
- Solid tumor with cystic/necrotic components
Pancreas:
- Where are the CALCIFICATIONS in a MUCINOUS cystic neoplasm?
- SEROUS cystic neoplasm?
- Mucinous = peripheral (big “MOTHER” F’ing MACROcysts with peripheral calcs)
- Serous = central (SENTRAL scar/calc with SMALL microcysts)
GI findings look like Crohns, but CT chest shows pulmonary artery aneurysms…
- Dx?
- Other classic findings?
- Behcet’s disease (vasculitis)
- Oral and genital ulcers
Cecum is folded anteromedially (NOT rotated), resulting in marked distention of the cecum…
Cecal BASCULE
Large hepatic mass with central scar:
- Classic differential?
FNH vs fibrolamellar HCC
FNH vs fibrolamellar HCC
- Scar characteristics?
- Which has calcification?
- Helpful nuclear medicine scans?
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
- Hepatic adenoma in male+steroids or glycogen storage disease?
- Risks?
- BETA CATENIN (CTNNB1 mutation)
- GREATEST risk of malignant degeneration (HCC)
- Can bleed (like inflammatory adenomas)
- What type of adenoma demonstrates signal dropout on opposed phase imaging?
- Risks?
- HNF1-alpha mutated (mutation causes lipogenesis/fat deposit)
- Generally low risk of bleeding/malignant degeneration
Why to FNHs take up SULFUR COLLOID??
Kupffer cells (reticuloendothelial cells lining hepatic sinusoids)
Types of hemochromatosis - extrahepatic sites of involvement?
“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
Hemochromatosis which involves the heart…?
Primary
Infant with thrombocytopenia (+/- anemia) and a big vascular lesion… dx?
Kasabach-Merritt
Platelet sequestration in a hemangioma (or maybe a Kaposiform hemangioendothelioma)
Cancer by tumor markers:
- CEA(+)?
- CA19-9(+)?
- CEA(+) and CA19-9(+)?
- CEA(+) = colon
- CA19-9(+) = pancreas
- CEA(+) and CA19-9(+) = cholangiocarcinoma
“Double rim sign”
- Describe
- Classic dx?
- Fluid collection with rim enhancement surrounded by halo of hypodensity/edema
- Pyogenic liver abscess
Important pressures (mmHg) for portal hypertension
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
Femoral vs inguinal hernia
- Femoral is ENTIRELY LATERAL to the pubic tubercle
- Medial to femoral vein with compression of femoral vein
Ddx: HYPER-enhancing hepatic mets?
Neuroendocrine Renal cell Thyroid Melanoma Sarcoma
Scattered hepatic cysts with central enhancing vessel
aka “Central dot sign”
- Caroli disease
- Dilated biliary cystic spaces surround portal vessels
Types of choledochal cysts?
1 = focal dilatation of CBD 2 = CBD diverticulum 3 = choledochocele 4 = both intra/extra bil dil 5 = ONLY intra bil dil (Caroli disease)
What is a choledochocele?
Cystic dilatation of the distal CBD within the duodenal wall
Early hyperenhancement of hepatic segment 4…
- name of sign?
- what causes this?
- Hot quadrate sign (classically Tc99m sulfur colloid scan; CTs as well)
- SVC obstruction; portosystemic shunting through the “superior vein of Sappey”
Hilar cholangiocarcinoma = aka?
Klatskin tumor
