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Core > Gastrointestinal: Luminal, Large Bowel > Flashcards

Gastrointestinal: Luminal, Large Bowel Flashcards

1
Q

Age range for Crohn’s disease

A

Bimodal:

  • 15-30 (most common)
  • 60-70
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2
Q

“Squaring” of the bowel mucosal folds…

A

Think Crohns

Note: This is an early manifestation from obstructive lymphedema.

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3
Q

What are “proud loops” in Crohns disease?

A

Separation of bowel loops due to fat infiltration of the mesentery (creeping fat)

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4
Q

What are the pseudopolyps in Crohns disease?

A

Islands of hyperplastic mucosa

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5
Q

What is the best location to evaluate if looking for signs of Crohn’s disease?

A

The terminal ileum

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6
Q

Age range for ulcerative colitis

A

Bimodal:

  • 15-30 (most common)
  • 60-70

Note: This is the same as for Crohn’s disease.

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7
Q

What is the best location to evaluate if looking for signs of ulcerative colitis?

A

The rectum (involved in 95% of cases)

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8
Q

How often is the terminal ileum involved in ulcerative colitis?

A

5-10% (due to backwash ileitis)

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9
Q

Pt with longstanding ulcerative colitis and a newly enlarged abdominal lymph node…

A

Suspicious for cancer

Note: Unlike in Crohn’s disease, lymphadenopathy is not common in ulcerative colitis unless a cancer has developed.

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10
Q

Ulcerative colitis is associated with…

A
  • Colon cancer
  • Primary sclerosis cholangitis
  • Arthritis
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11
Q
A

Ulcerative colitis

Note: Ahaustral colon with diffusely granular colonic mucosa.

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12
Q
A

Ulcerative colitis

Note: Diffusely irregular colonic mucosa (no skip lesions) without any haustra.

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13
Q

Gallstones are more common in Crohns/UC

A

Crohns

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14
Q

Primary sclerosis cholangitis is more common in Crohns/UC

A

Ulcerative colitis

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15
Q

hepatic abscesses are more common in Crohns/UC

A

Crohns

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16
Q

Pancreatitis is more common in Crohns/UC

A

Crohns

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17
Q

Colonic fistulae are more common in Crohns/UC

A

Crohns

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18
Q
A

Think toxic megacolon

Note: Gaseous dilatation of the transverse colon with loss of haustra.

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19
Q

Common causes of toxic megacolon

A
  • Ulcerative colitis (most common)
  • Crohns
  • C. diff colitis (less common)
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20
Q

What should you not do if you are suspecting toxic megacolon?

A

Barium enema (due to risk of perforation)

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21
Q

Crohns appearance of the bowel in the ileocecal region in a pt with ulcers of the penis and mouth…

A

Behcets

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22
Q

What vascular complication is associated with Behcets?

A

Pulmonary artery aneurysm

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23
Q

Behcets

A
  • Ulcers of the mouth and penis
  • Crohns appearance of the bowel in the ileocecal region
  • Pulmonary artery aneurysms
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24
Q

What is the most common cause of gastrointestinal fistula formation?

A

Diverticulitis

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25
Q
A

Epiploic appendagitis

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26
Q
A

Omental infarction

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27
Q

Which side is epiploic appendagitis more common on?

A

The left side

Note: Mental infarction is more common on the right.

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28
Q

Best test to evaluate for appendicitis in a pregnant female

A

MRI without contrast

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29
Q

Common causes of appendicitis

A
  • Obstructing appendicolith
  • Obstructing reactive lymphoid tissue
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30
Q
A

Think appendix mucocele

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31
Q

Appendix ultrasound

A

Think appendix mucocele

Note: This is the “onion sign” on ultrasound (layering within the cyst).

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32
Q

Appendices mucocele

A

Dilatation of the appendix with mucous due to a benign (e.g. retention cyst) or malignant (e.g. mutinous cystadenocarcinoma) process

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33
Q

What are the most common mucinous tumors of the appendix?

A

Mucinous cystadenoma

Note: These look the same as mucinous cystadenocarcinomas and can also lead to perforation and pseudomyxoma peritonei.

34
Q

What is the most common adult form of colonic volvulus?

A

Sigmoid volvulus

Note: Cecal volvulus is the next most common and occurs more often in younger pts.

35
Q
A

Sigmoid volvulus

Note: “Coffee bean sign”.

36
Q
A

Cecal volvulus

Note: Tip of dilated twist points to the LUQ.

37
Q

Cecal bascule

A

An uncommon form of cecal volvulus where the cecum folds up over itself without twisting, but can still lead to obstruction (usually isolated cecal/appendiceal dilatation)

38
Q
A

Think cecal bascule

39
Q

What features should make you consider cecal volvulus over sigmoid volvulus?

A

More common in cecal volvulus:

  • Extends to the LUQ
  • Haustra are maintained
  • Small bowel is dilated
  • Distal large bowel is not dilated
40
Q

Marked dilatation of the entire large bowel without clear transition point…

A

Think colonic pseudo-obstruction (AKA Ogilvie syndrome, AKA colonic ileus)

41
Q

Diversion colitis (AKA pouchitis)

A

Bacterial overgrowth in a blind loop of bowel that no longer passes feces

Note: This classically occurs in pts with pre-existing inflammatory bowel disease.

42
Q

Colitis cystica

A

Cystic dilatation of the colonic mucous glands, can be superficial or deep

43
Q
A

Think colitis cystica profunda

44
Q

What are the two types of colitis cystica?

A
  • Superficial (small cysts involving the entire colon)
  • Deep/profunda (larger cysts involving the pelvic colon and rectum)
45
Q

Common causes of colitis cystica

A
  • Vitamin deficiency
  • Tropical sprue
46
Q
A

Think rectal cavernous hemangioma

Note: Numerous phleboliths in the rectal region.

47
Q

Rectal cavernous hemangioma is associated with…

A
  • Klippel-Trenaunay-Weber
  • Blue Rubber Bleb
48
Q
A

Gossypiboma (retained surgical sponge)

49
Q

Bloody diarrhea

A

Think Entamoeba histolytica

Note: “Coned cecum” appearance with normal appearance of the terminal ileum. Colonic tuberculosis can also appear similar.

50
Q

Imaging findings of Entamoeba histolytica

A
  • Inflammation of the cecum and ascending colon (sparing the terminal ileum)
  • Liver abscess
  • Splenic abscess
51
Q

Imaging findings of colonic tuberculosis

A
  • “coned cecum” with involvement of the terminal ileum
  • Fleischner sign (AKA inverted umbrella sign: enlarged, gaping ileocecal valve with narrowing of the terminal ileum)
  • Sterling sign (swollen lips of the ileocecal valve allowing for rapid emptying of contrast from the cecum but retained contrast in the terminal ileum)
52
Q

Enlarged gaping of the ileocecal valve with narrowing of the terminal ileum giving the impression of an inverted umbrella…

A

Think colonic tuberculosis

Note: This is the “Fleischner sign” or “inverted umbrella sign”.

53
Q

Swollen lips of the ileocecal valve leading to persistent barium in the terminal ileum despite rapid emptying of the cecum…

A

Think acute on chronic colonic tuberculosis

Note: This is the “Stierlin sign”.

54
Q

What pt population gets colonic CMV?

A

Immunosuppressed

55
Q
A

Think C. difficile colitis

Note: This is the “accordion sign” (enhancing edematous mucosa with contrast trapped between mucosal folds).

56
Q
A

Think colon inflammation (e.g. ulcerative colitis, C. difficile colitis, etc.)

Note: This is the “thumb printing” sign.

57
Q

Colonic CMV

A

A colonic infection that causes deep ulcerations (can lead to perforation)

58
Q

Typhlitis

A

Infection limited to the cecum that can occur in pts with neutropenia

59
Q

Which GI infections like to affect the duodenum and proximal small bowel?

A
  • Giardia
  • Strongyloides
60
Q

Which infections like to affect the terminal ileum?

A
  • Tuberculosis
  • Yersinia
61
Q

Clinical presentation of colon cancer

A
  • Obstruction/stool caliber change (left-sided cancer)
  • Anemia/bloody stools (right-sided cancer)
62
Q

Large bowel intussusception in an adult…

A

Think colon cancer

63
Q

How do colon adenocarcinoma mets to liver appear on MRI?

A

T dark and T2 mildly bright (“evil grey”) with heterogeneous non-progressive enhancement

64
Q

Where is squamous cell carcinoma most common in the large bowel?

A

Anus (think HPV infection)

65
Q

What type of cancer is rectal cancer?

A

Adenocarcinoma (98%)

66
Q

What imaging study is used to stage rectal cancer?

A

MRI

Note: T2 images are most important for staging.

67
Q

When does a rectal cancer become stage T3?

A

When the tumor breaks out of the rectum into the perirectal fat

Note: This is crucial to identify because it changes management. For stage 3 rectal cancer they get neoadjuvant chemotherapy.

68
Q

What location of rectal cancer has a high recurrence rate?

A

Lower rectal cancer (0-5 cm from the anorectal angle)

69
Q

Treatment for rectal cancer

A
  • Low anterior resection (high rectal cancer, >5 cm above the anorectal angle)
  • Abdomino-Perineal Resection (low rectal cancer),

Note: LAR maintains fecal continence, but APR does not (requires a colostomy).

70
Q

What is the second most common tumor in the colon?

A

Colonic lipoma

71
Q

What is the most common benign tumor of the colon and rectum?

72
Q

Which type of colonic adenoma has the highest risk for malignancy?

A

Villous adenoma

73
Q

McKittrick-Wheelock syndrome

A

Mucous diarrhea caused by a villous adenoma, leading to severe fluid and electrolyte depletion

74
Q

80 y/o F with diarrhea, hyponatremia, hypokalemia, and hypochloremia…

A

McKittrick-Wheelock syndrome due to a villous adenoma

Note: The villous adenoma causes a mucous diarrhea that leads to severe fluid and electrolyte depletion.

75
Q

At what point does the sigmoid colon become the rectum?

A

When it stops having mesentery at the level of S3 (the rectosigmoid junction)

76
Q

At what point does the rectum become the anal canal?

A

The anorectal angle (created by the puborectalis sling at the level of the coccyx)

77
Q

What portion of the rectum is retroperitoneal?

A

The proximal third

Note: The distal third is extraperitoneal.

78
Q

Which gastrointestinal structures are retroperitoneal?

A
  • Duodenum (2nd and 3rd portions)
  • Pancreas (except tail)
  • Colon (ascending and descending)
  • Rectum (proximal third)
79
Q

Is the pancreas retroperitoneal?

A

Yes, except for the pancreatic tail

80
Q

Which portions of the duodenum are retroperitoneal?

A

2nd and 3rd portions

Core (98 decks)

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