GI Flashcards
Most common cystic neoplasm of the pancreas?
mucinous cystic pancreatic tumor
Findings associated with Gardener syndrome?
multiple GI tract neoplasms
osteomas of the facial bones
cystic pancreatic mass with honeycomb appearance
serous cystadenoma
Zenker diverticulum is located where?
hypopharynx. superior to cricopharyngeus muscles (c5-6)
Location of killian-jamieson diverticulum?
cervical esophagus- below cricopharyngeus
Reticular mucosal pattern in esophagram?
Barretts
Esophagram with concentric rings
young patient
atopia
ringed esophagus
Eosinophilic esophagitis
Esophageal carcinoma assoc with alc, tobacco, alkaloid ingestion, mid esoph
squamous
esophageal cancer related to chronic reflux
adeno
What is the difference between stage 3 and stage 4 esophageal malignancy?
adventitia vs. invasion into adjacent structures. (CT)
UGI demonstrates plaque-like lesions or granularity in esophagus
candidiasis.
patient will be immunocompromised
severe form looks shaggy with irregular luminal surface
esophageal ulcer with halo of edema
Herpes
Ð herpes has a halo
asymptomatic version of esophageal candidiasis (mult elevated nodules, elderly)
glycogen acanthosis
large flat ulcer of esophagus
CMV or HIV
they are not distinguishable
Water density mass in posterior mediastinum
esophageal (enteric) duplication cysts
How do you distinguish between an epiphrenic diverticula and para-esophageal hernia?
Epiphrenic will be on right and hernia on left
epiphren considered a pulson type diverticulum
multiple small outpouchings of the esophagus
esophageal pseudodiverticulosis
2/2 chronic gerd
Liver lesion
young woman
large
well-circ
solitary
peripherally draped vascular supply
Hepatic adenoma
MC cause of linitis plastica?
Scirrhous cardcinoma
2nd most common: lymphoma
ribbon-like bowel (barium)
graft vs. host
Irregular, nodular fold thickening, adenopathy, and diarrhea
Mycobacterium avium-intracellulare (MAl) infection
soft-tissue thickening centered at the superior mesenteric root, with central calcifications extending outward to produce mass effect on the small bowel.
retractile mesenteritis
ddx: Carcinoid: spoked wheel or star burst pattern of mesenteric thickening and retraction with central calcifications. Hypervascular metastases to liver would suggest this. less dense than retractile mesenteritis.
nutcracker esophagus
esophageal spasm
manometric findings >180 mmHg
iron deficiency anemia, dysphagia, thyroid issues, spoon shaped nails
Plummer-Vinson Syndrome
esophageal web
risk factor for esophogeal and hypopharyngeal carcinoma
dysphagia 2/2 compression by aberrant R SCA
dysphagia lusoria
what lung problem occurs with scleroderma?
NSIP
H pylori gastritis occurs where in the stomach?
antrum
“jejunal ulcer”
also ulcerations in the stomach and duodenal bulb
Zollinger Ellison
ZE is from gastrinoma- could test MEN syndromes this way
where in the stomach does Menetriers disease occur?
fundus
massive gastric folds
which gastric wall problem “crosses the pylorus”?
lymphoma
adenocarcinoma does it too
FAP+ Desmoid tumors, osteomas, papillary thyroid cancers
Gardener Syndrom
FAP + gliomas and medulloblastomas
Turcots
cancer everywhere in everything (early colon) and DNA mismatch repair
Lynch Syndrome
aka Hereditary nonpolyposis syndrome
hamartomas, mucocutaneous pigmentation, small and large bowel CA, panc CA, and GYN CA
Peutz-Jeghers
hamartomas, breast CA, thyroid CA, lhermitte-duclose (posterior fossa noncanerous brain tumor)
Cowden’s
***likely to be asked
hamartomas with stomach, small bowel, colon, and ectodermal stuff (skin, hair, nails)
Conkite-Canada
Hamartomas + nada
Juvenile polyps
MC mesenchymal tumor of the GI tract
GIST
70% in the stomach.
rare before age 40
** no LN involvement, malignant can be huge, NF-1 association
Carney’s Triad
chordoma
extra adrenal pheo
GIST
carney’s eat garbage
features of malignant stomach ulcers
wider than tall
located within lumen
nodular/irreg edges
folds adjacent to ulcer
can be anywhere
features of benign stomach ulcers
deeper than wide
project beyond lumen
sharp contour
folds radiate to ulcer
lesser curvature
risk factor associated with gastric carcinoma
H pylori
median age 70
metastatic spread of gastric carcinoma to the ovary
Krukenberg tumor
MC location for sarcoid in the GI tract
stomach
sand like nodules and thickened irregular mucosal folds of duodenum and prox jejunum
Whipples
“like a stripper”
look for near-fat LNs
findings of whipples (sand like nodules in jejunum with mucosal fold thickening) + big spleen and RP LNs
Pseudo Whipples/ MAI infection
Clinical stuff related to celiac’s
malabsorption of iron
idiopathic pulmonary hemosidrosis (Lane Hamilton Syndrome)
increased risk of bowel wall lymphoma
Gold standard is bx
dermatitis herpetiformis
fold reversal (feathery jejunum looks like ileum and vice versa)
cavitary LNs
splenic atrophy
Celiac sprue
intestinal lymphangiectasia
obstruction of the flow of lymph from the small intestine into the mesentery
SMA syndrome
obstruction of 3rd portion of the duodeum by the SMA
recent weight loss
Meckel’s Diverticulum
- Rule of 2’s
- NM scan
- 2 feet from IC valve, 2 inches long, 2cm in diameter, symptoms before age 2
- Tc-Pertechnetate
MC primary location of carcinoid
distal appendix
and terminal ileum
Epidemiology of SPEN?
solid psuedopapillar epithelial neoplasm.
They are extremely rare and thought to account for 1-2% of exocrine pancreatic tumours. They tend to present in young non-Caucasian females around the 2nd and 3rddecades of life.
venous drainage of the adrenal glands
R: IVC
L: L renal vein
Where is aldosterone made?
Zona glomerulosa
regulator of Na, K and HTN
Where is cortisol made?
zona fasiculata
where are androgrens made (in regards to adrenal gland)?
zona reticularis
Where are catecholamines made?
Medulla of adrenal gland
You are shown an thickened adrenal gland with loss of the central hperechoic stripe.
21-Hydroxylase Deficiency/ Congenital adrenal hypertrophy
in girls, genital ambiguity
in boys, salt loosing pathology which can be lethal
Bilateral adrenal gland hyperplasia in a patient with small cell lung cancer
Cushing syndrome= too much cortisol. ectopic production from small cell.
cushings can also be from pituitary adenoma (75%) and adrenal adenoma (20%)
What are some of the causes of adrenal hemorrhage?
Stress: breech, fetal distress, calcs as end result, should be avascular. (neuroblastoma will not get smaller)
Trauma: more common on R
Waterhouse-Friderichesen Syndrome: in the setting of fulminantn meningitis from Neisseria Meningitidis
Heterogenous adrenal mass that is T2 bright.
pheochromocytoma
usually larger than 3cm on presentation
MIBG>octreotide
also organ of Zuckerkandl
Rule of 10s with pheo?
10% are:
extra adrenal
bilateral
in children
hereditary
NOT active (no HTN)
Syndromes associated with pheochromocytoma?
Von Hippel Lindau
MEN IIa, IIb
less likely: NF-1, Sturge Weber, TS
Carney Triad? (not carney complex)
Extra-adrenal pheo, GIST, pulmonary chondroma (hamartoma)
Adrenal tumor that contains bulk fat?
Myelolipoma
B9
if bigger than 4cm, can bleed
If a pt has a known primary and an adrenal lesion that looks like lipid poor adenoma?
Adrenal met. (esp lung, breast, melanoma)
LARGE adrenal mass, 20% have calcs and met everywhere with direct extension first
Adrenal cortical carcinoma
Absolute equation for adrenal washout? what value = adenoma?
(enahnced CT-Delayed CT)/(enhanced CT- unenhanced CT) x 100
Greater than 60%=Adenoma
ÐAbsolute Vodka is clear (unenhanced) and 60 proof
What is the equation for relative washout for adrenal adenoma? What value = adenoma?
(Enhanced CT- Delayed CT)/Enahnced CT x 100
Greater than 40% = Adenoma
Your relatives drink brandy, which is not clear (unenhanced) and it is 40 proof
Which syndrome = too much aldosterone?
Conn. most commonly caused by benign adenoma.
what are some of the causes of adrenal calcs?
prior trauma
prior infxn (TB)
cortical carcinoma, neuroblastoma, melanoma
bialteral enlarged calcified adrenals (peds)
Wolman disease
fat metabolism error that kills in 6 mos
Can you think of a way to remember the MEN syndromes?
MEN 1: parathyroid hyperplasia, pituitary adeno, pancreatic tumor (gastrinoma)
MEN 2a: medullary thyroid, parathyoid hyperplasia, pheo
MEN 2b: medullary thyroid, pheo, mucosal neuroma, marfanoid body habitus. (Lincoln had this? he is a Man2Be)
microcalcifications in a thyroid nodule
papillary thyroid cancer
what do you do with a cold nodule on thyroid scan?
usually B9, but cancer 15% of the time- deserve futher workup
why care about thyroglossal duct cyst?
can get infected, can rarely have papillary thyroid cancer
most common location for ectopic thyroid?
base of the tongue- will look hyperdense because of iodine (just like thyroid)
most common cause of goiter?
North America: multi-nodular goiter/graves
Africa: low iodine
What is Grave’s dz?
autoimmune dz -> HYPERthyroid ism, antibody directed at TSH receptor
I-123 scan value indicateing Graves?
usually 50-80% uptake
What is Hashimotos?
autoimmune dz -> hyper and hypo thyroid MC cause of goitrous hypo
Abs against TPO and anti-thyroglobulin
U/S appearance of Hashimotos?
Giraffe skin heterogenous appearance
white knights (hyperechoic regenerative nodules)
Solid, asymptomatic pancreatic tumor.
Pancreatic neuroendocrine tumors are usually solid and hypoechoic or isoechoic in appearance.
jejunal ulcer
buzzword for ZE.
ZE is from gastrinoma, could test MEN syndromes this way
duodenal bulb is actually MC location for ulcers in ZE
menetriers dz
enalrgement gastric folds of fundus
diff bw Gardner and Turcots?
both have FAP, but Gardener has desmoids, osteomas, and papillary thyroid CA while Turcots has gliomas and medulloblastomas
Cowden’s syndrome
hamartomas
Breast CA
Thyroid CA
Lhermitte-Dulcose (posterior fossa non-CA brain tumor)
What defines stage T3 rectal cancer?
breaking out of the rectum and into the perirectal fat- changes managment to neoadjuvant
Nuc Med studies: which liver lesions are hot (with what tracer) and just plain cold?
- Hepatic adenoma
- FNH
- Cavernous Hemangioma
- HCC
- Cholangiocarcinoma
- Mets
- Abscess
- Focal Fat
- cold
- Sulfur colloid hot- 40%
- RBC hot
- Gallium hot
- cold
- cold
- gallium hot
- xenon hot
High liver signal on in phase imaging
hemachromatosis
Pancreatic lesions with subtle mutliple cysts, septa, and central scar
microcystic adenoma
