GI Flashcards
liver –> Couinaud segmts –> sup segmts? inf?
- sup: 2, 4, 8, 7, 1
- inf: 3, 4, 5, 6
liver –> caudate lobe –> draining V?
IVC
liver MRI –> steatosis vs hemochromatosis –> inphase/out phase signal?
- out of phase –> low signal –> fat
- in phase –> low signal –> iron
liver –> amyloid –> CT appearance?
hypodense –> focal or diffuse
Wilson dz –> copper deposit –> locations? (3)
- basal ganglia
- cornea
- liver
Wilson dz –> liver –> CT appearance?
mult hyperdense nodules
iron overload –> accum in what cell type? —> hemochromatosis vs hemosiderosis
- hemochromatosis –> hepatocytes
- hemosiderosis –> reticuloendothelial system –> hepatic Kupffer cells
hemochromatosis vs hemosiderosis –> affected organs?
hemochromatosis:
- liver
- pancreas
- myocardium
- skin/jt
hemosiderosis:
- liver
- spleen
- BM
hemochromatosis vs hemosiderosis –> MOA?
- hemochromatosis: genetic defect –> inc iron absorb
- hemosiderosis: blood transfusion or defective erythrocytosis
hemochromatosis vs hemosiderosis –> tx?
- hemochromatosis: phlebotomy
- hemosiderosis: iron chelator
what is 2ary hemochromatosis?
chronic hemosiderosis –> RES saturated –> hepatic damage
noncontrast CT –> hyperdense liver –> HU?
> 75
noncontrast CT –> hyperdense liver –> ddx? (4)
- iron overload
- med (amiodarone, gold, methotrexate)
- copper overload (Wilson dz)
- glycogen excess
mult tiny hypodense liver lesions –> (5)
- candidiasis –> microabscesses
- mets
- lymphoma
- biliary hamartoma
- Caroli dz
liver abscess –> MC etiology?
bowel process:
- diverticulitis
- appendicitis
- Crohn
- bowel surg
hepatic echinococcus –> hydatid cyst –> CT appearance?
well-defined hypodense mass –> floating membrane or assoc daughter cyst
cirrhosis –> early findings? (3)
- preportal space expand
- caudate lobe enlrg –> caudate to R lobe size ratio >0.65
- empty gallbladder fossa sign
what is Gamma-Gandy bodies?
cirrhosis –> 2nary finding –> splenic microhemorrhage
liver cirrhosis –> regenerative nodule –> arterial phase –> enhance or not?
not enhance
liver cirrhosis –> what is siderotic nodule?
iron-rich regenerative or dysplastic nodule
cirrhosis –> hypervasc liver mass –> ddx? (1)
HCC until proven otherwise
HCC –> classic enhancemt pattern?
- arterial phase –> enhance
- portal venous phase –> washout
cirrhosis –> what is “nodule in a nodule”?
enhancing nodule w/in dysplastic nodule –> early HCC
fibrolamellar HCC –> epidemiology?
young –> no cirrhosis
fibrolamellar HCC –> MRI findings? (3)
- lrg heterogeneous mass
- central fibrotic scar –> T1/T2 hypo
- 10% –> capsular retract
liver mets –> best seen on what phase imaging?
most –> hypovasc –> portal venous –> hypodense
hypervasc liver mets? (5)
- neuroendocrine tumor –> pacnreatic, carcinoid
- RCC
- thyroid CA
- melanoma
- sarcoma
liver mets –> T1/T2 signal?
- T1 hypo
- T2 hyper
what is pseudocirrhosis?
mult scirrhous liver mets –> macronodular liver contour
pseudocirrhosis –> MC etiology?
treated breast CA
liver –> capsular retraction –> ddx? (6)
- mets –> usu post-tx
- fibrolamellar HCC
- HCC
- epithelioid hemangioendothelioma
- intrahep cholangioCA
- confluent hepatic fibrosis
what is epithelioid hemangioendothelioma?
liver –> rare vasc malig –> mult round subcapsular mass –> can confluent
epithelioid hemangioendothelioma –> mass appearance?
halo or target
what is focal nodular hyperplasia (FNH)?
disorganized liver tissue
focal nodular hyperplasia (FNH) –> assoc w OCP –> T/F?
F
focal nodular hyperplasia (FNH) –> enhancemt pattern?
- arterial –> avid enhance –> quick washout
- portal venous –> unenhancing central “scar”
- delayed –> scar enhance
what is hepatic hemangioma? blood supply?
benign mass –> disorg endothelial-lined pockets of blood vessels –> supplied by hep A
liver –> giant hemangioma –> nonenhancing central area –> what is it?
cystic degen
hepatic hemangioma –> enhancemt pattern?
peripheral nodular enhance –> progress fill-in
hepatic hemangioma –> noncontrast CT –> density?
hypo
what is hepatic adenoma?
benign neoplasm:
- hepatocytes
- scattered Kupffer cells
- no bile ducts
focal nodular hyperplasia (FNH) –> contain bile ducts –> T/F?
T
hepatic adenoma –> assoc RF? (2)
- OCP
- anabolic steroid
mult hepatic adenoma –> synd? (1)
von Gierke dz (type 1 glycogen storage dz)
hepatic adenoma –> tx? why?
resect –> high risk hemorrhage
hepatic adenoma –> MRI appearance? (3)
- arterial phase –> hypervasc
- if fatty –> hypo OOP
- hemorrhage –> T1 hyper
what is Budd-Chiari?
hepatic venous outflow obstruct –> thrombotic vs non
acute Budd-Chiari –> clinical triad?
- abd pain
- hepatomeg
- ascites
Budd-Chiari –> vascular findings? (3)
- hep V –> no flow
- hep V/IVC –> thrombus
- collateral vessels
liver –> what is veno-occlusive dz?
patent hep V –> destruction of post-sinusoidal venules
liver –> what is veno-occlusive dz –> epidemiology?
BM tx
liver –> what is veno-occlusive dz –> imaging findings? (4)
nonspecific:
- hepatomeg
- heterogen enhance
- narrow hep V
- periportal edema
what is cardiac hepatopathy?
HF, constrictive pericarditis, R valve dz –> passive hepatic congest –> cirrhosis
cardiac hepatopathy –> imaging findings? (3)
- contrast reflux into IVC/hepV
- enlrg IVC/hepV
- enlrg liver –> mottled enhance
what is biliary hamartoma (von Meyenburg complex)?
embryology fail normal bile duct formation –> small cystic liver lesions that not comm w biliary tree
liver injury –> MDCT grading system? (5)
- grade I: superficial lac or subcapsular hematoma –> <1cm
- II: 1-3cm
- III: >3cm
- IV: >10cm or 1 hep lobe devasc
- V: both hep lobes –> devasc
eovist –> excretion? T1 signal?
biliary excretion
T1 hyper biliary fluid
choledochal cyst –> Todani classification?
- type I: CBD –> fusiform dilate
- II: extrahep –> saccular dilation
- III: intra-duodenal
- IVA: mult –> intra & extra-hep
- IVB: mult –> extra-hep only
- V (Caroli dz): intrahep
choledochal cyst –> tx or no? why?
resect –> inc risk cholangioCA
choledochal cyst V (Caroli dz) –> assoc condition?
polycystic kidneys
choledochal cyst V (Caroli dz) –> sign?
central dot sign
what is Caroli synd?
- Caroli dz
- hep fibrosis
gangrenous cholecystitis –> MOA?
inc intralum pressure –> GB wall ischemia
Charcot triad? dx?
ascending cholangitis:
- fever
- abd pain
- jaundice
ascending cholangitis –> key imaging finding?
biliary wall –> thick & hyperenhance
what is 1ary sclerosing cholangitis (PSC)?
idiopathic –> bile duct inflamm –> destroy
1ary sclerosing cholangitis (PSC) –> assoc condition?
ulc colitis
1ary sclerosing cholangitis (PSC) –> imaging appearance?
CBD & intrahep bile duct –> beaded irreg appearance
1ary sclerosing cholangitis (PSC) –> ddx? (1)
HIV cholangitis (cholangiopathy)
1ary sclerosing cholangitis (PSC) –> comp? (3)
- cirrhosis
- cholangioCA
- recurrent biliary infx
what is 1ary biliary cirrhosis (PSC)?
smaller bile duct –> inflamm –> destroy
1ary biliary cirrhosis (PSC) –> epidemiology?
middle age F
1ary biliary cirrhosis (PSC) –> initial ssx? (1)
pruritis
HIV cholangitis (cholangiopathy) –> MC org? (2)
- Cryptosporidium
- CMV
HIV cholangitis (cholangiopathy) vs 1ary biliary cirrhosis (PSC) –> differentiating imaging finding?
HIV cholangitis –> papillary stenosis
recurrent pyogenic cholangitis (Oriental cholangiohepatitis) –> MC org?
parasite Clonorchis sinensis
recurrent pyogenic cholangitis (Oriental cholangiohepatitis) –> imaging triad?
- pneumobilia
- lamellated bile duct filling defect
- intra & extra-hep biliary dilate & stricture
what is biliary cystadenoma?
benign cystic neoplasm
biliary cystadenoma –> epidemiology?
middle age F
biliary cystadenoma –> comm w biliary system –> T/F?
F
biliary cystadenoma –> imaging appearance?
lrg multiloculated cystic mass
what is cholangioCA?
biliary duct epithelium –> malig tumor
what is Klatskin tumor?
MC form of cholangioCA –> at hilum
cholangioCA –> imaging appearance?
- intrahep –> confluence of central bile ducts –> mass
- biliary dil
- capsular retraction
- tumor fingers into bile ducts
gallbladder CA –> MC appearance?
scirrhous mass –> invade GB wall –> into liver
GB mets –> 1ary CA?
melanoma
pancreas neoplasm –> 3 broad types?
- solid epithelial
- cystic epithelial
- endocrine
pancreas –> solid epithelial neoplasm –>2 types?
- ductal adenoCA
- acinar cell CA
pancreas –> cystic epithelial neoplasm –> 4 types?
- serous cystic
- mucinous cystic
- solid & papillary epithelial neoplasm (SPEN)
- intraductal papillary mucinous neoplasm (IPMN)
pancreas –> endocrine neoplasm –> 5 types?
- insulinoma
- gastrinoma
- glucagonoma
- VIPoma
- somatostatinoma
pancreas –> cystic epithelial neoplasm –> epidemiology?
- serous cystic
- mucinous cystic
- solid & papillary epithelial neoplasm
- intraductal papillary mucinous neoplasm (IPMN)
- serous cystic: old F (grandmother tumor)
- mucinous cystic: middle age F (mother)
- solid & papillary epithelial neoplasm: young F (daughter)
- intraductal papillary mucinous neoplasm: old M (grandfather)
MC pancreatic neoplasm?
pancreas adenoCA
pancreas adenoCA –> RF? (3)
- smoke
- alcohol
- chronic panc
pancreas adenoCA –> MC location?
panc head
CT –> pancreas –> phases?
- noncontrast
- late art
- portal venous
pancreas adenoCA –> CT appearance? T1 signal?
- hypodense/T1 hypo –> ill-defined, hypovasc
- panc duct obstruct –> double duct sign
- panc tail –> atrophy
pancreas mass –> no duct dil –> ddx? (8)
- autoimmune pancreatitis
- groove pancreatitis
- cystic panc tumor
- neuroendocrine tumor
- duodenal GIST
- peripanc LN
- panc mets
- lymphoma
double duct sign –> no panc mass –> ddx? (1)
panc adenoCA
pancreas –> what is acinar cell CA?
panc adenoCA variant –> rare, aggressive
acinar cell CA –> clinical triad? MOA?
malig cells –> lipase –> lipase hypersecretion synd:
- subQ fat necrosis
- bone infarct –> polyarthralgia
- eosinophilia
pancreas –> serous cystadenoma –> benign or malig?
benign
pancreas –> serous cystadenoma –> imaging features? (3)
- many small cysts –> >6 cysts –> <2cm –> may appear solid
- hypervasc
- central stellate calc
pancreas –> mucinous cystic neoplasm –> benign or malig?
benign
pancreas –> mucinous cystic neoplasm –> tx? why?
resect –> malig potential
pancreas –> mucinous cystic neoplasm –> imaging feature? (1)
1 or few lrg cysts –> <6 cysts –> >2cm
pancreas tumor –> capsule –> ddx? (2)
- mucinous cystic
- SPEN
solid & papillary epithelial neoplasm (SPEN) –> imaging feature? (2)
- lrg heterogeneous solid & cystic mass
- hemorrhage
pancreas –> intraductal papillary mucinous neoplasm (IPMN) –> benign or malig?
variable:
- benign
- indolent
- agg
pancreas –> intraductal papillary mucinous neoplasm (IPMN) –> main panc duct vs sidebranch –> which is more malig potential?
main
pancreas –> intraductal papillary mucinous neoplasm (IPMN) –> classic imaging appearance?
intra-pancreas –> cystic lesion –> comm w panc duct or sidebranch
pancreas –> intraductal papillary mucinous neoplasm (IPMN) –> resect –> indication? (3)
- > 3cm
- mural nodule
- panc duct >10mm
hypervasc liver mass + assoc pancreatic mass –> ddx? (1)
panc endocrine neoplasm –> liver mets
panc endocrine tumor –> hypo- or hypervasc?
hyper
panc endocrine tumor –> small vs lrg –> density?
- small –> solid
- lrg –> central necrosis & calc
MC panc endocrine tumor?
insulinoma
insulinoma –> clinical triad?
Whipple triad:
- hypoglycemia
- hypoglycemia ssx
- improve w glucose admin
2nd MC panc endocrine tumor?
gastrinoma