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GI Flashcards

1
Q

Islet cell tumour

A

Hyper-echoic metastases in liver Could be:

  1. a gastrinoma, most commonly found in head of pancreas and is malignant on 60%. It is asso with PUD. Rare
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2
Q

what is the classification of endocrine tumours of the pancreas?

A
  • functional tumours: 85%, presents earlier insulinoma: most common, whipple’s triad,
  • 10% malignant Gastrinoma- Zollinger Ellison Syndrome,
  • 60% malignant Glucagonoma,
  • 80% malignant VIPoma,
  • 75% malignant somatostatinoma (some of these can be non functional),
  • 75% malignnat non-functional tumours: 15%, 85-100% malignant
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3
Q

What is MEN1 lesions?

A

triad of :

  1. parathyroid,
  2. pituitary, and
  3. pancreatic lesions.
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4
Q

What is the Whipple’s triad in insulinoma?

A
  1. Fasting hypoglycemia
  2. symptoms of hypoglycemia
  3. immediate relief of symptoms after the administration of IV glucose
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5
Q

What % of insulinoma are malignant?

A

10% and 10% are multiple

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6
Q

What are the CT features of insulinoma/

A

they are hyperattenuating on arterial phase.

some may show calcification.

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7
Q

What MRI sequence is best suitable for detecting insulinoma?

A

Dynamic MRI with fast gradient echo sequence following bolus injection of contrast medium.

T1 post Gd- shows enhancement. although contrast enhancement may not improve tumour visualisation compared with non-contrast images

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8
Q

what % of carcinoids are malignnat?

A

carcinoid is the 33% tumour.

  • 33% malignant, 33% in small bowel, 33% multiple and 33% associated with a second malignancy
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9
Q

what % of carcioid are appendiceal?

What % of small bowel are at terminal ileum?

what is the relationship between the size and risk of metastatic spread?

A

appendiceal carcinoid accounts for 50% of all carcinoid

the terminal ileum accounts for ~90% of all small bowel carcinoid tumours

67% are asymptomatic at presentation

only account for 7% of metastatic disease with small bowel causing the 75%

the size of the tumour at diagnosis is related to the risk of metastatic spread:

2% if the lesion is <1cm but 85% if the lesion is over 2 cm

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10
Q

what markers are used in diagnosis of carcinoid tumours?

A

5-HIAA (5-hydroxyindoleaceticacid): usually suggests functioning carcinoid tumour

chromogranin A (CgA): considered valuable tool in the diagnosis of neuroendocrine neoplasia in general

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11
Q

what nuclear scan can be used for diagnosis of GI carcinoid and liver mets?

A

In111 octreotide (Octreoscan) generally specific for gastrointestinal tract carcinoid tumours as well as liver metastases.

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12
Q

this line represents undermining of the mucosaby the more vulnerable submucosa.

A

Hampton’s line

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13
Q

this line is diagnostic of benign ulcer when present

A

Hampton’s line

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14
Q

what features suggest benign gastric ulcer?

A
  • outpouching of ulcer crater beyond the gastric contour (exoluminal)
  • smooth rounded and deep ulcer crater
  • smooth ulcer mound
  • smooth gastric folds that reach the margin of ulcer
  • Hampton’s line
  • Usually seen on the lesser curve.
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15
Q

what features suggest malignant gastric ulcer?

A
  • does not protrude beyond the gastric contour (endoluminal)
  • irregular and shallow ulcer crater
  • nodular and angular ulcer mound
  • nodular gastric folds that do not reach the ulcer margin
  • Carman meniscus sign

-Usually seen on the lesser curve.

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16
Q

What is The American Association for the Surgery of Trauma (AAST) splenic injury grading system

A

grade 1: subcapsular haematoma <10% of surface area
capsular laceration <1 cm depth

grade 2:

subcapsular haematoma 10-50% of surface area
intraparenchymal haematoma <5 cm in diameter
laceration 1-3 cm depth not involving trabecular vessels

grade 3:

subcapsular haematoma >50% of surface area or expanding
intraparenchymal haematoma >5 cm or expanding
laceration >3 cm depth or involving trabecular vessels
ruptured subcapsular or parenchymal haematoma

grade 4:

laceration involving segmental or hilar vessels with major devascularisation (>25% of spleen)

grade 5:

shattered spleen
hilar vascular injury with devascularised spleen

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17
Q

what grade of splenic laceration is this?

A

grade 1

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18
Q

what grade of splenic laceration?

A

grade 4

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19
Q

what is the pathology in scleroderma?

A

Smooth muscle atrophy and fibrosis is thought to be the chief underlying mechanism which leads to luminal dilatation, reduced motility and reduced sphincter tone.

20
Q

Gastrointestinal manifestations of scleroderma can occur in up to…… of patients with scleroderma, with the commonest site of GI involvement being the ….

A

Gastrointestinal manifestations of scleroderma can occur in up to 90% of patients with scleroderma, with the commonest site of GI involvement being the oesophagus.

21
Q

what are the radiographic features of slcroderma affecting the oesophagus?

A
  • dilatation of distal 2/3 of the oesophagus
  • apparent shortening of length due to fibrosis
  • dysmotility of lower oesophagus (normal peristalsis above aortic arch)
  • gastro-oesophageal reflux due to reduced sphincter tone
  • air-fluid level in oesophagus when supine (CT)
22
Q

what are the complications of scleroderma affecting the oesophagus?

A
  • aspiration
  • oesophagitis:

mucosal erosion
fusiform stricture ~4-5cm above gastro-oesophageal junction
progression to Barrett oesophagus
higher risk of development of oesophageal cancer (adenocarcinoma)

23
Q

what might happen in scleroderma of stomach?

A

Gastric vascular antral ectasia (dilated submucosal capillaries), often known as watermelon stomach,

24
Q

what % of patients with scleroderma, have small bowel involvement? what is the most common site affected?

A

The small bowel is affected in more than 60% of scleroderma patients, the duodenum most frequently. Patients may be asymptomatic or may present with bloating or malabsorption due to bacterial overgrowth.

25
Q

what are the radiographic features of small bowel scleroderma?

A

luminal dilatation (can be massive)- (mega duodenum- abrupts at level of SMA)
reduced peristalsis / delayed contrast transit
mucosal folds appear relatively normal despite dilatation
hidebound bowel sign (crowding of valvulae conniventes): thought to be pathognomonic of scleroderma
accordian sign: well seen evenly spaced mucosal folds in duodenum
sacculation (antimesenteric border, focal dilatations, pseudo-diverticula)

pseudo-diverticula 10-40% are seen on the mesenteric side of the bowel unlike colonic diverticulae.

26
Q

what is the name of this sign?

A

hidebound bowel sign (crowding of valvulae conniventes): thought to be pathognomonic of scleroderma

27
Q

what % of scleroderma affects the large bowel?

How do they present?

A

The large bowel is affected in ~40% of patients and may cause constipation or diarrhoea. Reduced anal sphinter tone can result in faecal incontinence.

28
Q

What are the radiographic features of large bowel scleroderma?

A
  • pseudosacculation
  • loss of haustration
  • colonic dilatation
  • reduced colonic transit time
29
Q

where would you see the stack coin appearance/

A

in intramural haemorrhage

30
Q

which organs are involved in abdominal sarcoid?

A

Organs involved:

  • liver and spleen are the most frequently involved viscera, with granulomata noted in 40-70% of patients.
  • renal involvement is seen in 8-19% of patients
  • pancreatic, intestinal, and testicular sarcoidosis have been found in 5% or less of patients at autopsy
31
Q
A
32
Q

what enzyme is most commonly affected in liver sarcoid?

A

Laboratory evidence of liver dysfunction is seen in 2-60% of patients, with the alkaline phosphatase level being most commonly affected

33
Q

what are the USS findings in liver sarcoidosis?

A
  • pattern of either diffuse increased homogeneous or heterogeneous echogenicity
  • nodules are usually hypoechoic relative to the background liver
34
Q

What are the CT and MRI findings of liver sarcoid/

A
  • in most patients the liver appears homogeneous
  • ~10-15% of patients show hypoattenuating/hypointense liver and/or spleen nodules ranging in size from 5-20 mm that correspond with coalescing granulomas 1
  • the nodules become more confluent with increasing size 3
  • on contrast-enhanced CT liver nodules appear as hypoattenuating masses relative to adjacent normal parenchyma
  • on MRI the lesions are hypointense on all sequences and hypoenhancing relative to the background parenchyma
35
Q

What is the involvement of pancreas in sarcoid?

A

It is uncommon.
the imaging manifestations of pancreatitis resulting from sarcoidosis are indistinguishable from those of pancreatitis caused by other conditions

36
Q

What is the GI manifestation of sarcoid?

What is the most common site affected?

A
  • It is rare and when present it is usually associated with pulmonary disease
  • the stomach is the most common site of involvement and the radiological signs of the disease are very nonspecific, ranging from mucosal thickening (mimicking Menetrier disease) to lesions mimicking gastric ulcers or linitis plastica 1
37
Q

What is the renal manifestation of sarcoid?

A
  • renal involvement is seen in 7-22% of patients 1
  • in male patients the epididymis and the testis can be involved
  • CECT scan may show signs of interstitial nephritis or less frequently multiple hypoattenuating nodules that resemble lymphoma or metastases 1
  • when the epididymis is involved, MRI shows heterogeneous and nodular enlargement with a slight increase in signal intensity on the T2-weighted images
  • sonographically, the resultant masses are homogeneously hypoechoic 1
  • hydronephrosis may be caused by compression of the ureters by enlarged retroperitoneal nodes 1
38
Q

what are the abdominal wall manifestation of sarcoid?

A
  • sarcoidosis can involve the muscles and produce either a nodular, myopathic or myositic appearance
  • radiographic changes include nodules extending along the muscle fibers
  • the atrophic myopathic form is characterized by muscular atrophy and fatty infiltration
39
Q

What are the DDx of GI sarcoid?

A
  1. metastases:

simultaneous involvement of liver and spleen makes metastatic disease less likely and favours the diagnosis of sarcoidosis and lymphoma

  1. lymphoma:
  • lymph node enlargement is more pronounced
  • conglomeration of lymph nodes is more frequent in lymphoma
  • retrocrural lymph nodes are more frequently involved
  1. infectious disease:
    * liver lesions may simulate disseminated hepatic microabscesses such as those seen in Candida, Staphylococcus and Aspergillus infections
40
Q
A
41
Q

35M, H/O abdominal pain and polyps

A

Gardner:

  • FAP
  • Osteomas
  • Desmoid
  • Papillary thyroid cancer
42
Q

Turcot

A
  1. FAP
  2. Glioblastoma
  3. Medulloblastoma
43
Q

75M, Acute ataxia, Cowden’s syndrome.

A

Lhermitte-Duclos-

Also at risk of breast ca and thyroid ca

44
Q

Carney triad

A
  1. GIST
  2. Extra adrnal paraganglioma
  3. Chondroma (hamartoma) pulm
45
Q

65m, Epigastric pain and weight loss.

A

Linitis plastica:

  1. scirrhous gastric adenocarcinoma
  2. Mets:
    1. Lung
    2. Breast

GI (3 decks)

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