GI

Question 1

Where is the A ring in the oesophagus ?

Answer 1

Above the vestibule (muscular)

Question 2

Where is the B ring in the oesophagus?

Answer 2

Below vestibule, mucosal
Is called a Schatzki ring if narrowed (<13mm)

Question 3

Barretts

Answer 3

Precursor to Adenocarcinoma 2° to reflux
Shown as high stricture with associated hiatal hernia
Reticular mucosal pattern

Question 4

Oesophagus Ca buzzwords

Answer 4

Irregular contour
Abrupt/shouldered edges

Question 5

Squamous oesophageal Ca

Answer 5

Stricture/ulcer/ mass is mid oesophagus

Question 6

Oesophageal adenocarcinoma

Answer 6

Previous barretts
Stricture/ulcer/mass is in the lower oesophagus

Question 7

Turcot syndrome

Answer 7

Autosomal recessive
Colonic polyposis and CNS tumours - supratentorial glioblastoma and medulloblastomas

Question 8

Right sided colitis causes

Answer 8

Shigella
Salmonella

Question 9

Haemochromatosis mri findings

Answer 9

Low T2
Hepatomegaly

Question 10

Duodenum

Answer 10

4 parts :
D1 superior
D2 descending
D3 horizontal/transverse
D4 ascending

Ligament of treitz at junction of duodenum and jejenum
Bleed proximal to this is an upper GI bleed.

Question 11

Signs of bowel ischaemia ( or impending ischaemia )

Answer 11

Engorged mesenteric vessels
Mesenteric oedema
Ascites
Wall thickening
Lack of bowel wall enhancement
Pneumatosis

Question 12

Indirect inguinal hernia

Answer 12

Lateral to inferior epigastric vessels
Travels with spermatic cord and often into the scrotum

Question 13

Direct inguinal hernia

Answer 13

Medial to inferior epigastric vessels
Contents do not go into the scrotum

Question 14

Amyand hernia

Answer 14

Inguinal hernia containing appendix

Question 15

Littre hernia

Answer 15

Inguinal hernia containing Meckel’s diverticulum

Question 16

Obturator hernia

Answer 16

Usually In elderly due to weak pelvic floor muscles
Bowel located between pectineus and obturator muscles

Question 17

Femoral hernia

Answer 17

Posterior and inferior to inguinal ligament.
If contains appendix is called De Gaarengeot hernia
Compresses femoral vein

Question 18

Aneurysmal dilatation of the small bowel wall with no obstruction

Answer 18

Think lymphoma

Question 19

Intussusception

Answer 19

Transient small bowel - short segment without wall thickening
Malignant - longer segments with associated thickening and upstream obstruction

Question 20

Chrons

Answer 20

Affects mouth to anus
Usually terminal ileum
Discontinuous skip lesions
Early changes - aphthous ulcers

Question 21

Chrons active inflammation

Answer 21

Mural hyperenhancement
Intramural oedema
Mural ulcerations

Question 22

Chrons stricturing disease

Answer 22

Luminal narrowing with upstream dilatation

Question 23

Chrons penetrating disease

Answer 23

Sinus tracts, simple fistula,complex fistula, inflammatory mass, abscess

Question 24

Celiac disease

Answer 24

Reversal of jejunal and ideal fold patterns.
Featureless jejunum due to villous atrophy.

Mesenteric adenopathy
Engorgement of mesenteric vessels

Complication - small bowel t cell lymphoma

Question 25

Terminal ileum infectious enteritis

Answer 25

Yersinia and TB

Question 26

Segmental distal small bowel thickening and thickened folds due to infection

Answer 26

Salmonella

Question 27

Low attenuation mesenteric adenopathy

Answer 27

Whipples disease Celiac - cavitating mesenteric lymph node syndrome

Question 28

Radiation enteritis

Answer 28

Mural thickening Mucosal hyperenhancement and luminal narrowing later on.

Question 29

Hidebound bowel

Answer 29

In scleroderma Thin, straight bowel folds stacked together due to replacement of muscular layers with collagen

Question 30

Most common primary appendiceal neoplasm

Answer 30

Carcinoid

Question 31

Ischaemic colitis

Answer 31

Splenic flexure most susceptible as it is a watershed area Segmental thickening

Question 32

Infectious colitis

Answer 32

Pericolonic stranding Ascites Colonic wall thickening Yersinia and salmonella - right colon E.coli,cmv and c diff. Cause pancolitis

Question 33

Accordian sign

Answer 33

Severe Colonic wall thickening and enhancing inner mucosa.can be seen in pseudomembranous colitis

Question 34

Ulcerative colitis

Answer 34

Begins distally in rectum and spreads proximally. Increased risk of PSC, cholangiocarcinoma and colon cancer. Assoc. Sacroiliitis, iritis, erythema nodosum, pyoderma gangrenosum. Can have backwash ileitis. Circumferential wall thickening with granular mucosal pattern. Featureless and foreshortened lead pipe colon. Toxic mega colon - >6cm, risk of perforation.

Question 35

Typhlitis

Answer 35

Necrotising inflammatory colitis seen in right colon/ terminal ileum in neutropenic patients.

Question 36

Stercoral colitis

Answer 36

Focal inflammatory colitis due to increased bowel wall pressure from impacted faeces . Can lead to bowel wall ischaemia, pressure ulceration and perforation.

Question 37

FAP

Answer 37

Autosomal dominant Innumerable pre-malignant polyps. Prophylactic colectomy Gardner syndrome is a variant with Desmoid tumours, osteomas, papillary thyroid cancer and epidermoid cysts. Turcot syndrome is another variant with CNS tumours - glioma and medulloblastoma

Question 38

Most common tumour involving mesentry

Answer 38

Non-Hodgkin lymphoma Also causes bulky adenopathy

Question 39

Peritoneal carcinomatosis

Answer 39

Disseminated Mets to peritoneal surface. Most commonly caused by mucinous adenocarcinoma

Question 40

Pseudomyxoma peritonei

Answer 40

Due to mucin producing adenoma or adenocarcinoma of appendix Also seen in ovarian, gallbladder and pancreatic ca

Question 41

Necrotising panc imaging

Answer 41

Cg 72-96 hrs after onset of symptoms

Question 42

Retroperitoneal

Answer 42

Descending and ascending colon

Question 43

Hyperechoic liver lesion

Answer 43

Mets Cholangio Some HCCs

Question 44

Acute UC presentation

Answer 44

AXR as 1st line

Question 45

CI to liver biopsy

Answer 45

Echinococcus / hydatid cyst

Question 46

Abnormal uptake on mibg scan

Answer 46

Pancreas (Mibg goes into cells metabolically active for adrenaline )

Question 47

Detect spleen/splenules

Answer 47

RBCs

Question 48

Zollinger ellison

Answer 48

Multiple gastrinomas Octreotide scan

Question 49

Mass obstructing smv that calcifies

Answer 49

Neuroendocrine tumour

Question 50

Heamachromatosis

Answer 50

In and out of phase reversal of signal GRE to quantify degree