GI Flashcards
What is the Whipple triad?
Insulinoma
Fasting hypoglycemia
Symptoms of hypoglycaemia
Immediate release of symptoms after IV glucose administration
What is Zolliger Ellison syndrome?
Gastrinoma - gastrin secretion tumour.
Fluoroscopy shows:
- thickened rugal folds
- multinodular stomach + duodenum
- erosions and ulcers in atypical locations
What is 4D syndrome?
Symptoms of glucagonoma
Diabetes mellitus
Deep vein thrombosis
Dermatitis
Depression
Common radiological findings in Wilson’s disease?
Liver - Cirrhosis due to copper deposition
Brain - high T2 in basal ganglia (panda sign)
Bones - Chondrocalcinosis
Acute and chronic GI manifestations of epidermolysis bullosa?
GI tract submucosal bullae acutely and oesophageal webs chronically
What is Plummer Vinson syndrome?
DOI
Triad of:
- Dysphagia
- Oesophageal webs
- Iron deficiency anaemia
What is linitis plastica?
Submucosal infiltration of the stomach with scirrhous adenocarcinoma.
Causes gastric thickening, stiffening, and nodularity, with loss of rugal folds.
Most common distant metastasis to the oesophagus?
Breast
Most common cancer that can have direct invasion to oesophagus?
Bronchial carcinoma
Barium swallow shows narrow tubular stomach with loss of rugal folds.
Atrophic gastritis.
Linitis plastica is usually nodular.
Most common finding for coeliac disease on small bowel enema?
Reversal of jejunal and ileal fold pattern
Moulage sign - dilated jejunum with loss of folds
Intussusception
What is the moulage sign?
Sign of coeliac disease on small bowel enterography.
Dilated jejunum with complete loss of jejunal folds
What are the 4 types of anal fistula?
EX I T S
EXtra-sphincteric
Inter-sphincteric
Trans-sphincteric
Supra-sphincteric
What is Turcot syndrome?
Multiple intestinal polyps and CNS tumours (glioblastomas)
Most common causative organism causing left colon infectious colitis?
Shigella, or schistosomiasis. Thought to be due to worms entering the inferior mesenteric vein.
Most common causative organism causing rectosigmoid infectious colitis?
Gonorrhoea, herpes
What feature differentiates C Diff colitis from other forms of colitis?
Ascites. 40% of C Diff cases have ascites.
What are the radiological features of haemochromatosis?
Iron deposition in predominantly liver. Also in spleen, pancreas, brain, heart.
- Hepatomegaly (90%)
- CT - Increased liver density. MR - Low liver signal on T2
- Hook like osteophytes 2nd+3rd metacarpals. Chondrocalcinosis.
- Restrictive cardiomyopathy
What are the grades for liver laceration?
Grade 1 - <1cm deep, <10% surface area
Grade 2 - 1-3cm deep, 10-50% surface area
Grade 3 - >3cm deep, >50% surface area
Grade 4 - involving 25-75% of lobe
Grade 5 - >75% of lobe
Classic hepatic and splenic appearance of Schistosomiasis?
Turtle back appearance - Echogenic calcified septa outlining polygonal areas of normal liver
Fibrosis
Gamna gandy bodies
Most common primary metastases to the spleen?
Malignant melanoma
What diseases are associated with primary biliary cholangitis?
Autoimmune disease that causes cirrhosis
Sjogrens syndrome
Rheumatoid
Hashimotos thyroiditis
What pancreatic features are associated with cystic fibrosis?
Fatty replacement
Pancreatitis
Lymphatic drainage of the anal canal?
Above the dentate line - internal iliac nodes
Below the dentate line - superficial inguinal nodes
How do you prove an adrenal lesion is an adenoma?
Non contrast <10 HU
Contrast - Relative washout >40
Contrast - Absolute washout >60
What is the Carney Triad?
GIST
Extra adrenal pheochromocytoma
Pulmonary chondroma
Abnormal posterior indentation of the oesophagus?
Aberrant right subclavian artery
Abnormal anterior indentation of the oesophagus?
Aberrant left pulmonary artery
Classic imaging features of Barret’s oesophagus?
Reticular mucosal pattern on contrast study
Classic imaging appearance of feline oesophagus?
Transient fine transverse folds that go away with swallowing
Classic imaging appearance if herpes esophagitis
Small multiple ulcers with halo of oedema
Classic imaging appearance if candidiasis oesophagus?
Discrete plaque like lesions, with mucosal fold thickening.
What is the difference between Zenker diverticulum and Killian James diverticulum?
Zenker is posterior (Z is at the back of the alphabet), at the midline, above cricopharyngeus
Killian James is anterior, lateral, below cricopharyngeus
What is esophageal pseudo diverticulosis?
Multiple tiny outpouchings in the oesophagus, due to reflex.
What is the difference between achalasia and pseudo-achalasia?
Pseudo-achalasia is due to tumour. Pseudo-achalasia the gastro esophageal junction doesn’t eventually relax.
What is the most common tumour of the gastrointestinal tract?
GIST tumour
What tumour is Virchow’s node associated with?
Gastric adenocarcinoma.
What is the difference between organoaxial and mesenteroaxial gastric volvulus?
Organoaxial - gastric antrum lies below the fundus as normal. Twisted on the axis of the stomach.
Mesenteroaxial - Gastric antrum is at the level of the fundus. Stomach twists in half along the perpendicular axis.
What does sand like nodules indicate on a small bowel follow througqh?
Whipple’s disease (Tropheryma whipplei infection)
What is cobblestoning Indicate on a small bowl follow through?
Crohn’s disease
What does the cloverleaf sign indicate on a small bowel follow through?
Healed peptic ulcer
What does small bowel carcinoid look like?
Mass with desmoplastic stranding and calcifications.
What is Carcinoid syndrome?
Flushing and diarrhoea with carcinoid cancer metastases to the liver
How can you differentiate femoral hernia from inguinal hernia?
Femoral hernia occurs lateral to the pubic tubercle.
Femoral hernias compress the femoral vein.
What is Typhilitis?
Neutropenic colitis usually limited to the caecum
Classic enhancement pattern of a hepatic haemangioma?
Peripheral discontinuous nodular enhancement.
Progressive filling in.
What is the difference between FNH and fibrolamellar HCC?
Both have a central scar.
FNH scar is T2 bright and enhances.
Fibrolamellar HCC scar is T2 dark and does not enhance
Classic imaging findings for cholangiocarcinoma.
Capsular retraction.
Dilated billiary ducts.
Delayed persistent enhancement.
How to differentiate HCC from Cholangiocarcinoma?
HCC invades the portal vein.
Cholangiocarcinoma encases the portal vein
Classic scenario for a hepatic adenoma?
Female on OCP.
Male on anabolic steroids.
What is pseudo cirrhosis of the liver?
Treated breast cancer metastases to the liver can look like cirrhosis
Classic imaging features of Primary Sclerosing Cholangitis, and what is its association?
Multifocal strictures of the intra and extra hepatic bile ducts.
Cirrhosis with central regenerate hypertrophy.
Associated with UC.
Classic imaging features of Primary Biliary Cholangitis?
Autoimmune disease that destroys the INTRA hepatic bile ducts.
Lace like pattern of fibrosis
Periportal halo sign
Intrahepatic duct dilatation
Increased risk of HCC
What are the 5 types of choledochal cyst?
1 - focal dilatation of the CBD
2 - Bile duct diverticulum
3 - dilation of CBD within the duodenal wall (choledochocele)
4 - focal intra and extra hepatic dilatation
5 - Carolis disease (intrahepatic only)
What is associated with Caroli’s disease?
Polycystic kidney disease.
Medullary sponge kidney.
What is Mirizzi syndrome?
Cystic duct stone causes external compression of the CBD
What is the USS sign for Adenomyomatosis of the gallbladder?
Comet tail artifact
Classic imaging features of serous cystadenoma of the pancreas?
Old women.
Head of pancreas.
Bunch of grapes appearance.
Can have central classification.
Associated with Von Hipple Lindau.
Classic imaging appearance of mucinous cystic neoplasm?
Mother lesion.
Found in body and tail of pancreas.
Uni/multilocular cyst.
Peripheral calcification.
[Serous = “sentral” (central) calc]
Classic imaging appearance of solid pseudo papillary epithelial neoplasm of the pancreas?
Daughter lesion.
Tail of pancreas.
Large mixed solid cystic mass.
Which type of IPMN has the highest malignancy potential?
Main branch IPMN.
Side branch IPMN is more common.
What are gamna gandy bodies and what are they associated with?
Small focal hemorrhage in the spleen parenchyma.
Portal hypertension
Schistosomiasis
Risk factors for acute acalculus cholecystitis?
Diabetes
Vasculitis
Viral infections (HIV, EBV, CMV)
What does hepatosplenic candidiasis look like on USS?
Bulls eye sign - inner hyperechoic ring + outer hypoechoic ring.
What is the classical imaging appearance of glycogenic acanthosis?
Looks like candida, i.e. discrete oesophageal plaques, but is asymptomatic
Classic imaging appearance for Cowdens syndrome?
GI hamartoma polyps
Breast cancer
Typical features of GI tract TB?
Affects ileocaecal junction
Narrowing of terminal ileum
Thickening and incompetence of ileocaecal valve
Thickening of caecum
Most common causative organism causing right colon infectious colitis?
Salmonella
Most common location for pancreatic trauma?
Body of pancreas
How do VIPomas present?
(vasoactive intestinal peptide tumours)
Watery diarrhoea that persists with fasting
Hypokalaemia
Hypochlorhydria
Most common site of bowel injury following blunt trauma?
Jejunum
What is Menetrier’s disease?
Giant hypertrophic gastritis
Enlarged, tortuous folds in the body and fundus.
Sparing of the antrum.
Impaired mucosal coating of barium due to mucus hypersecretion.
How does Cronkhite Canada syndrome present?
Skin pigmentation, alopecia, and watery diarrhea.
How does Juvenile Polyposis present?
Typically age 10-20.
Rectal bleeding, bowel obstruction and intussusception.
How does GI angiodysplasia present?
GI Bleeding.
Focal area of contrast enhancment.
Enlargment of feeding artery.
Early filling of draining vein.
Typical imaging features of chronic Budd Chiari syndrome?
Caudate lobe hypertrophy
Regenerative nodules
Nutmeg liver - mottled contrast enhancment
Ascites
Associations with polysplenia?
Left isomorism:
- Bi lobed lungs bilaterally
- Non cyanotic heart disease
- Gut malrotation
Associations with asplenia?
Right isomerism:
- Tri lobed lungs bilaterally
- Cyanotic heart disease
- Gut malrotation
What is a choledochocele?
Type 3 choledochal cyst - Dilated intraduodenal portion of CBD.
Most common organism causing cholangitis?
E Coli
What does a Whipples procedure involve?
Complete resection of the duodenum and head of pancreas (pancreatic surgery)
Reattach the stomach, bile ducts, and the remaining pancreas to jejenum.
Gastrojejunostomy
Choledochojejunostomy
Pancreaticojejunostomy
“Stepladder” Oesophagus
Oesophagitis
- Reflux oesophagitis
- Eosinophilic oesophagitis
What is Hamptons line?
Radiolucent line seen at the neck of a gastric ulcer indicating benign nature.
How does erosive gastritis typically present?
Erosive (haemorrhagic) gastritis
Epigastric pain
Malaena
NSAID use
How do small bowel leiomyomas typically present?
Typically found in jejunum
Abdominal pain
Bleeding and anaemia secondary to ulceration
Peutz Jeghers syndrome
Bowel polyps
Melanin pigmentation of the mouth, fingers and toes.
Seminoma - boys
Adenoma malignum - girls
Hereditary non-polyposis colorectal cancer associations?
Genitourinary tract malignancies
- endometrial
- prostate
- urinary tract
Small bowel cancer
Beningn causes of pneumotosis intestinalis?
PSI
Pulmonary disease
Scleroderma
Inflammation
What is a pseudo polyp?
Apparant polyp caused by surrounding deep ulceration, creating a mucosal island. The “polyp” is the healthy tissue.
Most common site of peripancreatic pseudoaneurysm?
Splenic artery
GDA
Large spherical pancreatitic calcifications in childhood
Hereditary pancreatitis
Autosomal dominant
How does acute Budd chiari present?
Rapid onset ascites
What features suggest malignant Vs benign gastric ulcer on barium swallow?
Malignant - Carmen meniscus sign
Benign - Hamptons line
Carmen - carcinoma
Hamptons - harmless
Where do the rectal veins drain into?
Superior rectal veins - IMV into portal system
Middle and inferior rectal veins - internal iliac vein into IVC
Imaging appearances of thalassemia?
ThalaSSSSemia
(Skull, Sinus, Spine, Spleen)
Skull:
- Skull hair on end appearance
- Sinus hypopneumatisation
Spine:
- Scoliosis
- Expansion of ribs, with rib within a rib appearance
Spleen:
- Splenomegaly
Stages of renal TB?
Early - papillary necrosis
Progressive - strictures and hydronephrosis
Late - thinned cortex, dystrophic calc (Putty kidney)
MRI findings for phaeochromocytoma?
T1 - low
T2 - high
Gd - heterogenous enhancement
Out of phase - no signal loss
What is the Child Pugh score?
Higher score indicate worsening liver function which gives the medical or surgical teams an idea of liver comorbidity.
Perioperative mortality:
- Child Pugh score A: 5% - up to 50% of liver resected
- Child Pugh score B: 10-15% - up to 25% of liver score resected
- Child Pugh score C: >25% - liver resection contraindicated
How do oesophageal duplication cysts typically present?
Childhood symptoms of dysphagia, cough, stridor.
Occasionally present with haemorrhage due to islands of gastric/pancreatic mucosa
What does scleroderma look like on barium swallow?
Dilation of distal two thirds.
Absent or reduced peristalsis of the lower oesophagus.
Caused of REDUCED liver attenuation on CT.
Fatty liver
Amyloidosis
Diffuse malignancy
Imaging appearance of xanthogranulomatous cholecystitis?
Thickened gallbladder wall.
Multiple hypodense nodules in the wall.
(Similar appearance to xanthogranulomatous pyelonephritis)
Associations with Peutz-Jeger syndrome
Boys - Sertoli cell tumour
Girls - Adenoma malignum (cervix)
Associations with Cowden syndrome?
BELT
Breast cancer
Endometrial cancer
Lhermitte-Duclos disease (Dysplastic cerebellar gangliocytoma)
Thyroid cancer
Classic imaging findings of medullary sponge kidney?
Paintbrush appearance - pyramidal medullary calcification
Bouquet of flowers appearance on IVU.
Normal liver MRI appearance Vs spleen?
T1 - Liver > Spleen
T2 - Liver < Spleen
In/out - No change
Typical MRI findings of hepatic adenoma
T1 - iso to bright
T2 - brightish
Gd - early arterial enhancement, iso on delayed
Primovist - dark
CF liver manifestations
Fatty liver
Focal biliary cirrhosis
Imaging appearance of HCC?
Raised AFP
Typically with cirrhosis
T1 - iso
T2 - bright
Gd - arterial enhancement, quick washout to lower than background
How to differentiate primary Vs secondary haemochromatosis?
PRIMARY - Liver and PANCREAS are dense
SECONDARY - Liver and SPLEEN are dense
How can you tell the difference between direct Vs indirect inguinal hernia?
Direct - Medial to inferior epigastric artery, compresses the inguinal canal (lateral crescent sign)
Indirect - Lateral to the inferior epigastric artery
CEA and CA 19-9 ratios for cholangio, colon, and pancreatic cancer?
Cholangio - CEA high, CA 19-9 high
Colon - CEA high, CA 19-9 low
Pancreatic - CEA low, CA 19-9 high
Obturator hernia?
Lateral to pubic tubercle
Deep to pectineus muscle
