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GI Flashcards

1
Q

Unresectable pancreatic cancer factors?

A

Vascular encasement (SMA). Direct invasion of adjacent organs. Liver metastasis. Adenopathy. Ascites (peritoneal spread).

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2
Q

Paraneoplastic condition in pancreatic adenocarcinoma?

A

Trousseau’s sign (spontaneous venous thrombosis).

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3
Q

Normal size of duodenal papilla?

A

Less than 1.5 cm.

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4
Q

Perivaterian neoplasms?

A

Carcinoma. Polyps. Leiomyoma. (Familial polyposis syndrome and associated Gardner’s syndrome)

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5
Q

Two types of gastric volvulus?

A

Organoaxial. Mesenteroaxial.

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6
Q

Small bowel folds in Celiac disease and Scleroderma?

A

Celiac: Jejunum decreased folds, ileum increased folds. Scleroderma: Increased folds throughout. 5 folds per inch is normal.

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7
Q

Ileocecal valve upper limits of normal size?

A

3 cm, certainly abnormal if > 4 cm.

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8
Q

Most common cause of enlarged ileocecal valve?

A

Lipomatous infiltration.

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9
Q

Diseases that can enlarged the ileocecal valve?

A

Lipoma. Crohn’s disease. Lymphoma. Prolapsing ileal neoplasms.

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10
Q

2 conditions that can cause eccentric sacculations of the small bowel?

A

Crohn’s disease. Scleroderma.

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11
Q

What vitamin deficiency may occur with small bowel diverticula?

A

Vitamin B12 from bacterial overgrowth.

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12
Q

Causes of toxic megacolon?

A

Ulcerative colitis. Crohn disease. Infectious colitis (especially in AIDS). Ischemia. Pseudomembranous colitis.

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13
Q

Which colon segment is most commonly involved in toxic megacolon?.

A

Transverse colon (most non-dependent).

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14
Q

What causes the colonic dilation in toxic megacolon?

A

Transmural inflamation with destruction of ganglion cells (myenteric plexus).

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15
Q

3 causes of intramural tracking?

A

Diverticulitis. Crohn’s disease. Malignancy.

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16
Q

What disorders cause wide-mouth diverticula (pseudosacculations) in the colon?

A

Scleroderma. Crohn’s disease. Ischemia.

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17
Q

In what patient population does right-sided diverticulitis occur?

A

Young adults. Asians.

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18
Q

Main differential feature of diffuse esophageal spasms and presbyesophagus?

A

Diffuse esophageal spasm presents with chest pain. Presbyesophagus is asymptomatic.

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19
Q

Does emphysematous cholecystitis result in air in the biliary system outside of the gallbladder?

A

No, because the cystic duct is obstructed.

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20
Q

What tumors of the appendix can product pseudomyxoma peritonei?

A

Mucocele. Mucinous cystadenoma. Myoglobulosis.

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21
Q

What are the two categories of cecal volvulus?

A

Axial torsion. Bascule (folding of cecum on right colon without significant twisting).

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22
Q

What underlying condition do patients with emphysematous cholecystitis most likely have?

A

Diabetes.

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23
Q

What conditions can lead to superior mesenteric artery syndrome?

A

Rapid weight loss. Immobilization. Wearing a body cast. Decreased peristalsis. Drugs.

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24
Q

What’s the Bourne test?

A

In suspected enterovesical fistula, urine is collected, spun, and radiographed for dectection of barium.

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25
Q

What’s the difference between a fistula and a sinus tract?

A

Fistula tract connects two mucosal lined structures. Sinus tract ends blindly or in a cavity without normal mucosa.

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26
Q

What drug is associated with pneumatosis of the bowel?

A

Steroids.

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27
Q

What pulmonary and collagen vascular diseases can cause pneumatosis of the bowel?

A

Scleroderma. SLE. Dermatomyositis. Asthma. COPD. CF.

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28
Q

Factors that distinguish a pancreatic abscess from pseudocyst?

A

Abscess (forms earlier after pancreatitis, days to weeks, high HU 20-50, may contain air).

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29
Q

Gallstone ileus triad?

A

Air in biliary system. Radiopaque stone. Bowel obstruction. All 3 present probably only 30% of the time.

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30
Q

Causes of nodular filling defects in duodenal bulb and proximal duodenum?

A

Heterotopic gastric mucosa. Benign lymphoid hyperplasia. Brunner’s gland hyperplasia (large nodules).

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31
Q

What conditions may result in loss of haustral folds?

A

Most types of colitis. Laxative abuse. Scleroderma.

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32
Q

Most common location in stomach for a malignant ulcer?

A

Antrum (most common area for benign ulcers, too). Fundus ulcers, though uncommon, are more likely to be malignant.

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33
Q

What liver lesion exhibitis cetripetal opacification?

A

Hemangioma, peripheral to central enhancement over time.

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34
Q

Spigelian, Richter’s, and Littre’s hernias?

A

Spigelian: lower quadrant through semilunar line. Richter’s: only one wall of bowel involved. Littre’s: Meckel’s diverticulum hernia.

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35
Q

Disorder that causes thyroid and breast abnormalities, hyperkeratosis, and harmartomas of the small bowel?

A

Cowden disease.

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36
Q

Features of Cronkhite-Canada syndrome?

A

Weight loss. Anorexia. Alopecia. Multiple intestinal hamartomas.

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37
Q

Cutaneous masses and small bowel tumors?

A

Neurofibromatosis.

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38
Q

What conditions may cause focal strictures of the small bowel?

A

Crohn’s disease. Certain infections. Radiation therapy. Ischemia.

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39
Q

What neoplasms of the stomach grow exophytically?

A

Spindle cell tumors (GISTs, leiomyoma, leiomyosarcoma, leiomyoblastoma). Neurofibromas. Lymphomas.

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40
Q

Bony abnormalities in patients with adenomatous polyposis syndrome?

A

Osteomas. Cortical hyperostosis.

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41
Q

Possible extraintestinal neoplasms of FAPS?

A

Osteomas. Glioblastomas. Medulloblastomas. Thyroid carcinoma.

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42
Q

Congenital condition that may cause diffuse bowel edema?

A

Lymphangiectasia.

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43
Q

Complications of Caroli’s disease (Type V Choledochal Cyst or communicating cavernous ectasia of the bile ducts)?

A

Cholangitis. Fibrosis. Portal hypertension. Cholangiocarcinoma.

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44
Q

Most common cause of portal hypertension and varices worldwide (parasite)?

A

Shistosomiasis.

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45
Q

Unusual variant of esophageal carcinoma that spreads submucosally producing thickened folds?

A

Varicoid carcinoma of the esophagus.

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46
Q

Most common internal hernia?

A

Paraduodenal hernia.

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47
Q

A left paraduodenal hernia extends through the fossa of?

A

Landzert.

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48
Q

A right paraduodenal hernia etends through the fossa of?

A

Waldeyer.

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49
Q

Paraduodenal hernia is due to a congenital defect in the?

A

Transverse mesocolon.

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50
Q

Causes of rectal varices (not internal hemorrhoids)?

A

Portal hypertension. IVC obstruction. Severe abdominal adhesions.

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51
Q

Amyloidosis most commonly affects what part of the GI tract?

A

Small intestine, with valvulae thickening and mucosal granularity.

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52
Q

Causes of Booerrhaave’s syndrome?

A

Endoscopy. Seizures. Coughing. Asthma. Childbirth. Severe straining. Blunt trauma.

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53
Q

Pancreatic phlegmon (massive enlargement of the pancreas by inflammation tissue) complications?

A

Necrosis. Hemorrhage. Infection.

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54
Q

CREST?

A

Subcutaneous Calcinosis. Raynaud’s phenomenon. Esophageal dysfunction. Sclerodactyly. Telangiectasia.

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55
Q

Crowding of the valvulae by fibrosis (scleroderma) term?

A

Hidebound.

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56
Q

What age groups are symptomatic in annulary pancreas?

A

50% present as children. 50% present as adults.

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57
Q

Annular pancreas complications?

A

Duodenal obstruction. Increased susceptibility to pancreaatitis.

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58
Q

The substance secreted by this tumor causes an intense desmoplastic response, producing mesentery fibrosis, with tethering and kinging of small bowel?

A

Carcinoid tumor secreting serotonin.

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59
Q

Insulinoma facts?

A

90% benign. small less than 2 cm. Most difficult to detect on imaging.

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60
Q

Gastrinoma facts?

A

Major cause of Zollinger-Ellison syndrome. MEN-1 syndrome. 60% Malignant. Ectopic locations outside pancreas.

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61
Q

Glucagonoma facts?

A

Secrete glucagon. Produce Diabetes Mellitus. 80% Malignant.

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62
Q

VIPoma facts?

A

Secrete vasoactive intestinal peptide. WDHA (Watery Diarrhea, Hypokalemia, Achlorhydria). Variable malignancy.

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63
Q

Somatostatinoma facts?

A

Rare. Cause diarrhea.

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64
Q

Nonfunctioning islet cell tumor facts?

A

3rd most common islet cell tumor. Generally malignant. Larger. Necrotic on imaging studies.

65
Q

Causes of ischemic bowel?

A

Low flow states (shock, major surgery, cardiac abnormality). Atherosclerosis (chronic). Embolism (acute). Venous occlusion (mesenteric venous occlusive disease).

66
Q

Major inflammatory processes that affect the terminal ileum?

A

Crohn’s disease. Tuberculosis. Yersiniosis.

67
Q

Distinguishing features between Crohn’s disease and Yersiniosis?

A

Yersiniosis: lacks lumen narrowing, lacks deep ulceration, short, self-limited course, heals without scarring.

68
Q

Benign splenic tumors and CT characteristics?

A

Hemangioma and lymphangioma (hypodense to splenic tissue, may calcify). Hamartoma (isodense to splenic tissue).

69
Q

Syndrome of generalized angiomatosis?

A

Klippel-Trenaunay-Weber syndrome.

70
Q

Define pseudopolyp, cobblestoning, and post-inflammatory polyp?

A

Pseudopolyp: island of normal or edematous mucosa surrounded by ulcerated or denuded mocusa. Cobblestoning: normal mucosa surrounded by linear ulceration (Crohn’s disease). Postinflammatory polyp: regenerating normal mucosa.

71
Q

FAPS (Gardner’s type) effect on the mesentery?

A

Mesenteric fibromatosis.

72
Q

When mesenteric fibromatosis occurs in a round shape this is called?

A

Desmoid.

73
Q

Causes of portal venous gas?

A

Infarcted bowel. Ulcers. Acute bowel dilation. Endoscopy. Necrotizing enterocolitis.

74
Q

Through what does a Zenker’s diverticulum protrude?

A

Killian’s dehisence.

75
Q

What are lateral diverticula of the pharyngoesophageal junction termed?

A

Killian-Jamieson diverticula.

76
Q

Colon watershed regions?

A

Splenic fleXure (SMA, IMA junction). Rectosigmoid.

77
Q

Appearance of the liver with enhancing lobules of hepatocytes and areas of edema that do not enhance?

A

Nutmeg liver (can be seen in patients with passive venous congestion of liver and early stages of Budd-Chiari syndrome).

78
Q

3 types of anal canal malignant neoplasms?

A

Adenocarcinoma. Squamous cell carcinoma. Cloacogenic carcinoma (women, worse prognosis).

79
Q

Storage disease associated with splenomegaly?

A

Gaucher’s disease. Amyloidosis. Hemochromatosis. Niemann-Pick disease.

80
Q

Pancreatic cystic neoplasm associated with von-Hippel Lindau disease?

A

Microcystic adenoma.

81
Q

What liver malignancies may calcify?

A

Fibrolamellar HCC. Hepatoblastoma. Intrahepatic cholangiocarcinoma. Metastases.

82
Q

Nuclear scanning distinction of FNH from fibrolamellar HCC?

A

FNH is hot (has Kupffer cells). Fibrolamellar HCC is cold (No Kupffer cells).

83
Q

Pathognomonic finding for cavernous hemangiomas of the colon?

A

Phleboliths.

84
Q

What is the most common location of Burkitt’s lymphoma in North America?

A

Distal ileum.

85
Q

Longitudinal dimension of the spleen should not eceed?

A

12 - 14 cm

86
Q

Heterogeneous spleen in early arterial phase?

A

Moire spleen.

87
Q

Congenital splenic cysts which contain an epithelial lining?

A

Epidermoid cysts.

88
Q

Accessory spleen versus splenosis?

A

Accessory (supernumerary) splenic tissue at hilum not post-traumatic (splenosis).

89
Q

Granulomatous disease of the spleen, major finding and common causes?

A

Multiple punctate calcifications. Histoplasmosis. Tuberculosis. Sarcoidosis.

90
Q

Fungal infections of the spleen, most common finding?

A

Microabscesses, multiple small low densities.

91
Q

Benign splenic neoplasms (2)?

A

Lymphangioma. Hemangioma.

92
Q

Malignant splenic neoplasms?

A

Hemangiosarcoma. Angiosarcoma (thorotrast 1950s). Kaposi sarcoma. Lymphoma (AIDS and non-AIDS). Leukemia.

93
Q

Normal splenic finding may mimic a splenic laceration?

A

Splenic cleft.

94
Q

Splenic artery aneurysm demographics?.

A

Women (medial dysplasia) rupture risk at pregnancy. Men (atherosclerosis).

95
Q

Sicke cell disease’s eventual effect on spleen?

A

Autosplenectomy, small, densely calcified splenic remnant.

96
Q

Longitudinal dimension of the spleen should not exceed?

A

12 - 14 cm.

97
Q

Maximal size of pancreatic duct in adults and elderly?

A

3 mm and 5 mm.

98
Q

Common sites of ectopic pancreatic tissue?

A

walls of stomach, duodenum, and Meckel diverticulum.

99
Q

Fatty replacement of the pancreas is common in?

A

diabetes. obesity. elderly. Cystic fibrosis.

100
Q

Pancreatitis complications?

A

Necrotizing pancreatitis. Hemorrhagic pancreatitis. Thrombosis (splenic, portal, mesenteric veins). Pseudoaneurysms. Pseudocysts. Ascites. Abscess.

101
Q

Pancreatic endocrine neoplasms?

A

Insulinomas. Gastrinomas. VIPomas. Somatostatinomas. Glucagonomas.

102
Q

Pancreatic exocrine neoplasms?

A

Adenocarcinoma. Cystic pancreatic neoplasms (microcystic adenoma, mucinous cystic neoplasms). Cystic teratomas.

103
Q

Low attenuation pancreatic mass with dilated loops of bowel?

A

VIPoma.

104
Q

Interposition of the hepatic fleure between the dome of the liver and the right hemidiaphragm?

A

Chilaiditi sign.

105
Q

Extracolonic sequelae of ulcerative colitis?

A

Hepatitis. Sclerosing cholangitis. Cholangiocarcinoma. Sacroilitis. Ankylosing spondylitis.

106
Q

Neutropenic colitis (pericecal)?

A

Typhlitis.

107
Q

Gardner syndrome?

A

Intestinal adenomatous polyps with osteomas of the skull or long bones. Epidermoid cysts. Fibromatosis.

108
Q

Turcot syndrome?

A

Medulloblastoma. Glioblastoma multiforme. Family polyposis.

109
Q

Most common appendiceal tumor?

A

Carcinoid tumor.

110
Q

Pneumatosis cystoides coli?

A

Asymptomatic, large round air collections in colon wall (iatrogenic mucosal injury).

111
Q

Pneumatosis intestinalis causes?

A

Infectious colitis. Necrotizing colitis. Bowel infarction. Typhlitis. Toxic megacolon.

112
Q

Most common site for intussusception in colon?

A

Ileocecal.

113
Q

Rare condition with mucinous cysts in colon wall?

A

Colitis cystica profunda.

114
Q

Term for sensation of a lump in the throat?

A

Globus.

115
Q

Nasopharyngeal reflux is prevented by the soft palate apposing the posterior pharyngeal wall, known as the?

A

Passavant cushion or pad.

116
Q

Functional abnormalities of the pharynx in barium swallows?

A

Nasopharyngeal reflux. Laryngeal penetration. Tracheal aspiration. Cricopharyngeal achalasia. Cricopharyngeal hypertrophy.

117
Q

Major structural abnormalities of the pharynx on barium swallow?

A

Strictures. Webs. Diverticula (Zenker [pharygoesophageal]). Lateral pharyngeal pouches. Lateral pharyngeal diverticula.

118
Q

For an esophagram, if esophageal rupture is suspected what contrast should be used?

A

Water-soluble contrast.

119
Q

For an esophagram, if aspiration or a tracheo-esophageal fistula is suspected what contrast should be used?

A

Barium. water-soluble contrast should be avoided for it can cause pulmonary edema.

120
Q

What does the Z-line represent?

A

Zigzagging transition zone between squamous epithilium to columnar.

121
Q

Describe proximal escape in esophagography?

A

Occurs when a primary contraction wave pushes barium caudally but at the mid third of the esophagus it breaks with regression of the bolus proximally

122
Q

Tertiary contraction waves?

A

Nonpropulsive contractions of muscularis propria seen as indentations at the margins of the esophagus which occur locally or over large segments.

123
Q

Feline esophagus differential?

A

Normal variant. Scleroderma. GER.

124
Q

Incomplete relaxation of the LES because of neuronal degeneration?

A

Achalasia.

125
Q

Diffuse esophageal spasm characteristics?

A

Severe tertiary contractions following 30% of swallows. Corckscrew appearance at -ray.

126
Q

Primary versus secondary achalasia?

A

Primary, no known source. Secondary, known source (neoplasm, Chagas disease).

127
Q

Chagas disease?

A

South American Trypanosoma cruzi destroys myenteric plexus of esophagus and colon. Causes myocarditis and cardiac aneurysms.

128
Q

Progressive systemic sclerosis’ effect on esophagus?

A

Muscular atrophy and collagen deposition of distal 2/3 of esophagus resulting in reflux.

129
Q

VACTERL congenital anomaly mnemonic?

A

Vertebral. Anal atresia. Cardiac. Tracheoesaphageal fistula/esophageal atresia. Renal agenesis/dysplasia. Limb.

130
Q

2 most common vascular rings to effect to the esophagus?

A

Double aortic arch. Aberrant left subclavian artery.

131
Q

Describe course of aberrant left subclavian artery?

A

Last branch of right aortic arch that usually passes behind the esophagus to ascend on the left.

132
Q

Describe course of aberrant right subclavian artery?

A

Last branch of left aortic arch that usually passes behind the esophagus to ascend on the right.

133
Q

Describe course of pulmonary sling?

A

Left pulmonary artery arises from right pulmonary artery and courses between the trachea and esophagus.

134
Q

2 types of hiatal hernias?

A

Sliding hiatal hernia (GE j moves). Paraesophageal hernia (GE j stable, cardia moves).

135
Q

A-ring?

A

Muscular/contractile ring at the tubulovestibular junction.

136
Q

B-ring?

A

Mucosal ring, ridge of tissue at the squamosal-columnar junction of the distal esophagus.

137
Q

Schatzki ring?

A

Pathologic B-ring that can result in dysphagia (inflamed B-ring from reflux).

138
Q

Barrett esophagus?

A

Metaplastic replacement of squamous epithelium with columnar above normal Z-line secondary to longstanding reflux.

139
Q

Common esophagitides?

A

Esophageal candidiasis (shaggy mucosa). Herpes esophagitis (discrete ulcers). Cytomegalovirus esophagitis (larger ulcers). HIV esophagitis (largest ulcers).

140
Q

Benign esophageal neoplasms?

A

Leiomyoma. Fibrovascular polyp. Squamous papilloma.

141
Q

Malignant esophageal neoplasms?

A

SCC. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Spindle-cell carcinoma. Leiomyosarcoma. Metastases.

142
Q

Common location for Booerhave esophagus perforation?

A

Left posterior lateral wall of distal esophagus just proximal to the gastroesophageal junction.

143
Q

Esophageal bypass surgical techniques?

A

Gastric pull-through (esophagogastrectomy). Colonic interposition.

144
Q

Structural abnormalities of the small intestine?

A

Atresia (jejunum, ileum > duodenum). Jejunoileal stenosis. Enteric duplication cyst. Malrotation. Meckel diverticula. Diverticula. Small bowel obstruction. Small bowel hernias. Adhesions. Adynamic ileus.

145
Q

Common causes of small bowel obstruction?

A

Adhesions. Hernias. Neoplasms. Intussusception. Volvulus. Foreign bodies. Inflammatory process.

146
Q

Prestenotic phase of Crohn disease, findings?

A

Blunting, flattening, distortion, straightening, and thickening of mucosal folds.

147
Q

Other prestenotic changes of Crohn disease?

A

Apthous erosions. Cobblestoning. Inflammatory pseudopolyps. Postinflammatory polyps. Skip lesions. Pseudodiverticula.

148
Q

Small bowel infection that can mimick appendicitis clinically and Crohn disease radiographically?

A

Yersiniosis at terminal ileum.

149
Q

Small bowel infection of middle aged men with malabsorption, fever, weight loss, chronic uveitis, endocardiits, arthralgia, lymphadenpathy, and skin pigmentation?

A

Whipple disease.

150
Q

Diffuse intestinal disease?

A

Menetrier disease. Intestinal lymphangiectasia. Mastocytosis. Radiation enteritis. Progressive systemic sclerosis. Celiac disease. Graft-versus-host disease. Ischemic enteritis.

151
Q

Benign small bowel neoplasms?

A

Adenomas. Leimyomas. Lipoma. Peutz-Jeghers syndrome. Cowden disease. Familial polyposis.

152
Q

Malignant small bowel neoplasms?

A

Carcinoid tumors. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Leiomyosarcoma. Metastases.

153
Q

Sharp angulation in the lesser curvature that demarcates the junction of the body and antrum?

A

Angular notch.

154
Q

Two common causes of gastroparesis?

A

Diabetes. Progressive systemic sclerosis.

155
Q

Focal loss of superficial epithelium?

A

Erosion.

156
Q

Middle-aged men, enlargement of gastric rugal folds?

A

Menetrier disease (protein-losing enteropathy).

157
Q

Benign gastric neoplasms?

A

Hyperplastic polyp (sessile, less than 1cm). Adenomatous polyps (>1cm). Leiomyoma.

158
Q

Malignant gastric neoplasms?

A

Gastric adenocarcinoma. Gastric lymphoma. Kaposi sarcoma.

159
Q

Billroth I versus Billroth II?

A

I: partial gastrectomy with gastroduodenoscopy. II: partial gastrectomy with gastrojejunoscopy.

HeadNeckSpineCards (10 decks)

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