GI Flashcards
biggest predictor of local recurrence and survival in rectal cancer?
radial margin (more than longitudinal involvement and T category)
bugs that gives terminal ileitis and right colon
yersinia
campylobacter
salmonella
1 and #2 visceral aneurysms
- spleen
2. renal
sign that there’s abN flow in liver
hepatic artery and portal vein are opposite
most common benign esophageal neoplasm
leiomyoma
side effect of gastrografin in upper GI
pulmonary edema
H2O soluble, but hyperosmolar
isoosmolar h2o soluble contrast
omnipaque
side effect of barium in upper GI
mediastinitis
if ?perf, do H2O soluble first
ingestion of sushi
anisakis
roundworms
invade stomach or intestinal wall causing edema and ulcers
rectal prolapse
trichuris
whipworm
invades colonic mucosa, bleeding, anemia
intussusception and rectal prolapse
iron deficiency anemia
hookworms
invade colonic mucosa
bug causing cholangitis or pancreatitis
ascaris
largest nematode
can cause bowel obstruction, or pancreatic/biliary duct
causes gastric fold thickening
h pylori gastritis
menetriers disease
zollinger ellison
gastrinoma triangle
medial: pancreatic neck/body junction
inferior: 2nd-3rd junction duodenum
superior: junction cystic duct and CBD
most common inflammatory disease esophagus
reflux
most common malignant primary hepatic malignancy
HCC
diverticula occurring at killian dehiscence
zenker
most common benign splenic lesion
hemangioma
most common location of tear in Boerhaave syndrome
left posterolateral wall of the distal esophagus, 3-6 cm above the esophageal hiatus of the diaphragm
treatment for achalasia
Heller myotomy:
- longitudinal excision through lower esophageal sphincter
bouveret syndrome
gastric outlet obstruction secondary to impacted gallstone
right & left paraduodenal internal hernias go through what? what % do they each make up?
- right: fossa of Waldeyer; 25%
2. left: fossa of Landzert; 75%
critical stage esophageal cancer
T3 adventitia vs T4 invasion into adjacent structures
plummer vinson syndrome
- iron deficiency anemia
- dysphagia
- thyroid issues
- spoon shaped nails
- esophageal web
GIST most common location?
nodal involvement?
- stomach MC (then duodenum)
- LNs NOT enlarged
- goes to liver & drop mets
ass’d w. carney triad & NFI
Carneys triad
Carneys Eat Garbage
Chondroma (pulmonary)
Extra adrenal pheo
GIST
most common extra nodal site for nonhodgkin lymphoma
stomach
organoaxial vs mesenteroaxial gastric volvulus
organo - greater curve over lesser, old ladies, hernias
mesentero - over mesentery, risk ischemia, obstruction, kids
bug in whipples
Tropheryma Whipplei
riglers triad
gallstone ileus:
- pneumobilia
- obstruction
- ectopic gallstone
NOT riglers sign of free air on either side of bowel
hernia with appendix in it
“ with meckels in it
amyand appendix
littre meckels
findings entamoeba histolytica gi
- cecum & ascending colon
- normal terminal ileum
- coned cecum
- toxic megacolon
- liver, spleen, brain abscesses
- bloody diarrhea
- flask shaped ulcer in endoscopy
infections that like duodenum
infections that like terminal ileum
duodenum: giardia, strongyloides
terminal ileum: Tb, yersinia, campylo
critical stage rectal cancer
T3 - tumor breaks into perirectal fat
- get chemo/rads prior to surgery
mckittrick wheelock syndrome
villous adenoma
mucous diarrhea
severe electrolyte disturbances and depletion
most common spot peritoneal carcinomatosis
retrovesical space
most dependent portion peritoneal cavity
advanced imaging for FNH
mri w. hepatocyte agent
sulfur colloid
nuc med agent for fibrolemellar HCC
gallium
remember scar does not enhance & is T2 dark
CEA & CA 19-9 in
cholangio
pancreatic ca
colon ca
cholangio: CEA up, CA19-9 up
pancreatic ca: CA19-9 up
colon ca: CEA up
amebic abscess left lobe
emergent drainage
can rupture into pericardium
primary vs secondary hemochromatosis
primary inherited = pancreas involved, spleen spared (thyroid, heart, pituitary)
secondary chronic inflamm’n/++transfusions, eat iron w/ reticuloendothelial system = spleen involved, pancreas spared
causes nutmeg liver
- budd chiari
- hepatic veno occlusive disease
- right heart failure (hepatic congestion)
- constrictive pericarditis
massive caudate lobe hypertrophy
- budd chiari
- primary sclerosing cholangitis
- primary biliary cirrhosis
cavernous transformation after portal vein thrombosis means what?
chronic, takes 12 months to develop
complications of carolis disease
- auto recessive, central dot sign, ass’d w. polycystic kidney dz & medullary sponge kidney
- cholangiocarcinoma
- cirrhosis
- cholangitis
- intraductal stones
mirizzi syndrome association
5x risk co-incident gallbladder cancer
resistive index RI calculation
PSV - EDV/PSV
acceleration time corresponding to 50% stenosis of renal artery
acceleration time >0.07 sec
acc’n time = time from end diastole to 1st systolic peak
causes for increased and decreased HV pulsatility
increased: tricuspid regurg’n, right sided CHF
decreased: cirrhosis, hepatic venous outflow obstruction
causes of portal vein:
- pulsatility
- reversed flow
- slow flow
- absent
- pulsatility: right sided CHF, tricuspid regurg, cirrhosis, vascular AP shunting
- portal htn
- <15 cm/s, portal htn (pre, intra, post)
- thrombosis, tumor invasion, stagnant flow bad portal htn
echogenicity of pancreas on uss
greater than normal liver
hereditary pancreatitis gene
SPINK 1
hereditary syndromes associated with pancreatic cancer
HNPCC
BRCA
ataxia telangiectasia
peutz jegers
advanced imaging for intrapancreatic splenule
heat treated rbc scan
sulfur colloid
anastamoses in whipples
- gastrojejunal
- choledochojejunal/hepaticojejunal
- pancreaticojejunal
why is pancreatic RI not helpful?
no capsule
most common bugs in splenic abscess
immunocompetent: salmonella
immunocompromised: fungi, tb, MAI, pcp (multiple microabscess)
antibodies in hashimotos
antiTPO
anti thyroglobulin
common appearance of hashimotos
- giraffe skin
- white knights
origin of parathyroid glands
top 2: 4th branchial pouch
bottom 2: 3rd branchial pouch
1 small bowel cancer
metastases
increased risk small bowel (duodenal) adenocarcinoma
FAP
Gardner
most common location small bowel adenocarcinoma
jejunum
most common location small bowel neuroendocrine/carcinoid
ileum
c difficile bacteria type
gram positive anaerobe
endotoxin B
HNPCC (Lynch Syndrome) - screening
colonic & endometrial
% LBO from cancer
60-80%
volvulus 10-15%
diverticulitis 5-10%
anal cancer staging?
based on SIZE
inguinal lymph nodes = independent prognostic factor
low rectal cancer spread?
can go straight to lungs (mid/inf hemorrhoidal veins)
higher = liver 2/2 drainage to portal vein via sup hemorrhoidal
