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radiology > GI > Flashcards

GI Flashcards

1
Q

Barretts-buzzword, typical appearance, dx, rx

A
  • buzzword: Reticular mucosal pattern
  • appearance: mucosal ulceration several centimeters above the gastroesophageal junction
  • diagnosis- muc bx
  • rx: Aggressive medical treatment for gastroesophageal reflux is mandatory along with close monitoring to detect possible transition into adenocarcinoma of the esophagus.
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2
Q

feline esophagus vs esuinophilic esophagitis

A

feline= thin TRANSIENT folds, lower 2/3, normal but also high ass with reflux esophagitis

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3
Q

Critical staging for Es CA

A

T3 (Adventitia) vs T4 (invasion into adjacent structures. Need CT (others staged by endoscopy)

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4
Q

Name for fundoplication 360˚ and < 360˚

A

nissen=360. Toupe = <360

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5
Q

Ivor lewis

A

transthoracic esophagectomy usually through right intercostal approach (Ivor lewis)

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6
Q

“short esophagus”

A

hiatal hernia that is fixed/non-reducible and >5cm

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7
Q

MCC recurrent reflex s/p fundoplication

A

Slipped Nissen

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8
Q

MCC slipped Nissen

A

short es

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9
Q

earliest mc complication fundoplication. when does it peak?

A

obstruction (edema or too tight). peak at 2wks.

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10
Q

Treatment for short esophagus

A

Collis gastroplasty

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11
Q

Diagnosis slipped nissen

A

narrowed esophagus >2 cm

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12
Q

odynophagia + immunocompromised

A

esophageal candidiasis

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13
Q

elevated benign esophageal nodules + elderly

A

glycogenic acanthosis (asymptomatic.)

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14
Q

When do you see esophageal involvement with Crohn’s? What is the buzzword?

A

Severe disease. Apthous ulcer.

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15
Q

clusters of nodules on esophagram

A

hpv squamous papillomatosis

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16
Q

MC location esophageal duplication cyst

A

ileum

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17
Q

Killian Dehiscence

A

between thyropharyngeus and cricopharyngeus muscles

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18
Q

ddx epiphrenic diverticula

A
  • paraesophageal hernia (MC left)
  • traction-mc mid es, tented/triangular
  • fluid collection-history, less well defined.
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19
Q

Epiphrenic diverticula

A

pulsion diverticula in distal es, mc on right. Ass with dysmotility

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20
Q

Plummer-vinson syndrome

A

Fe def anemia, dysphagia (es web), thyroid issues, “spoon-shaped nails”, glossitis

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21
Q

esophageal webs are a RF for what?

A

hypoph and es CA

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22
Q

long esophageal stricture

A

radiation, NGT, caustic

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23
Q

medication induced esophagitis-mcc & loc

A
  • sites of es narr (AA, LMB, retrocardiac, distal es)

- abx (tetracycline), anti-inflamm, cardiac (quinidine, K), BisP

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24
Q

glycogenic acanthosis

A

asymptomatic benign esophageal nodules in elderly. Look like candidiasis

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25
Q

buzzword eosinophilic esophagitis

A

ringed esophagus

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26
Q

“vigorous achalasia”

A

early/less sev form. repetitive simultaneous non=propulsive contractions. MC in women, 2˚ CA MC in men

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27
Q

achalasia vs pseudoachalasia

A

GEJ will eventually relax with achalasia

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28
Q

increased risks of achalasia

A

SCC, candidiasis

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29
Q

increased risks of scleroderma

A

chronic reflux, scarring, barretts, adenoCA, (also candidiasis?)

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30
Q

how will scleroderma appear on exam?

A

dilated es with birds beak (ID to achalasia) + lung changes (NSIP)

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31
Q

Hampton’s Line

A

Benign gastric ulcer AM. Thin radiolucent line separating barium in gastric lumen from barium in crater

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32
Q

Carmen meniscus sign

A

Malignant gastric ulcer AM. Ulcer crater and radiolucent elevated border

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33
Q

GIST location frequency

A

stomach (70%), duo, colon

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34
Q

Carney’s triad

A

Carney’s Eat Garbage: chondroma (pulmonary), extra adrenal pheo, GIST.

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35
Q

where do GIST usually met?

A

They don’t. But if so, to liver

Sarcoma-spreads hematogenously, rarely to LNs

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36
Q

what syndromes are GIST ass with?

A

Carney’s triad & NF1

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37
Q

Areae gastricae-what is it, when does it enlarge and when is it obliterated

A

normal fine reticular pattern on double contrast. Enlarges in elderly, H pylori and focally next to ulcer. Obliterated by cancer.

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38
Q

Types of gastric volvulus

A

organoaxial (gastric antrum below GEJ) & mesenteroaxial (gastric antrum above GEJ.)

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39
Q

Menetrier’s disease

A

idiopathic hypoproteinemic gastropathy with rural thickening. Fundus, spares antrum. Protein loss (low alb). Ass with CMV in kids?

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40
Q

MC GI tract loc for sarcoid?

A

stomach

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41
Q

Ram’s Horn Deformity

A

aka Pseudobillroth 1. tapering of antrum. Ddx= peptic ulcer scarring, granulomatous dx, scirrhous carcinoma.

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42
Q

in what setting does splenic v thrombus occur?

A

isolated gastric varices (which can be ass with pancreatic cancer, pancreatitis)

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43
Q

gastric band-1) MC complication 2) MC comp to be tested

A

1) stomal stenosis 2) slippage

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44
Q

billroth 1 vs 2

A

1) Pylorus removed, remaining stom att to duo. (-) post op gastritis, (+) early compl
2) Partial gastrectomy, remaining stom att to jej.

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45
Q

risks billroth 2

A

1) dumping syndrome
2) afferent loop syndrome
3) gastric CA 10-20 yrs

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46
Q

Afferent loop syndrome

A
  • Obstr of afferent limb –> dil loop, BD dil, chole/pancreatitis.
  • Pot compl of billroth 2, REY, Whipple.
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47
Q

dumping syndrome

A

-classically billroth 2. also REY

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48
Q

what is suspected cause of gastric fold thickening and filling defects s/p Billroth?

A

bile reflux gastritis

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49
Q

jejunogastric intussusception

A

post-op compl w/ jejunal herniation into stom. High mortality when acute.

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50
Q

mcc sbo s/p REY

A

open=adhesions. laparoscopic= less ads –> more mobility –> closed loop.

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51
Q

3 potential sites for internal hernia s/p REY

A

1) transverse mesocol 2) JJ anast mesentery 3) behind roux limb mesentery

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52
Q

buzzword: ribbon bowel

A

graft vs host. Featureeless, atrophic, fold thickening

-vascular granulation tissue replacing destroyed mucosa

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53
Q

buzzword: hidebound

A

scleroderma-narrow sep of normal folds w/ mild bowel dil

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54
Q

buzzword: moulage sign (tube of wax)

A

Celiac-dilated jejunal loop w/ compl loss of jejunal folds. opacified like a tube of wax

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55
Q

buzzword: fold reversal

A

Celiac-jejunum loses folds to look more like ileum, ileum gains folds (in RLQ) to look like jej. Ie: atrophied jej, thickened ileum

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56
Q

buzzword: thread-like defect in barium column

A

ascaris suun worm

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57
Q

clover leaf sign

A

AM: healed peptic ulcer of duodenal bulb

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58
Q

which bug is responsible for whipples?

A

Tropheryma Whipplei

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59
Q

Buzzword: sand-like nodules

A

Whipple (and MAC “pseudo-whipples”)

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60
Q

SMA syndrome

A

compression 3rd pt duo by SMA. 2/2 sudden wt loss

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61
Q

other diseases ass w. celiac

A
  • idiopathic pulmonary hemosiderosis (Lane Hamilton syndrome)
  • Dermatitis herpetiformis
  • bowel lymphoma
62
Q

Meckel’s diverticulum

A

True diverticulum, remnant of omphalomesenteric duct

63
Q

Complications of Meckel’s

A
  • diverticulitis
  • bleed (30% syx)
  • intuss
  • obstr
64
Q

chronic dialysis its suscp to which bowel path?

A

thickened duo folds

65
Q

jejunal diverticulosis

A

occ along mesenteric border, ass w/ bacterial overgrowth & Malays. V rare.

66
Q

Riglers sign vs triad

A

Riglers sign- free air

Riglers triad- pneumobilia, obstruction, ectopic gallstone

67
Q

Dir & indir sgx’s bowel trauma

A
  • direct=spilled oral contrast, active mesenteric bleed

- indir=mes fat stranding fluid layering along bowel

68
Q

MC type of small bowel lymphoma

A

non-hodgkin

69
Q

sm bowel tumors ass w/ desmoplastic rxn

A

carcinoid (classically), HL

70
Q

spigelian hernia

A

AKA lateral ventral hernia. Loc along Semilunar line (lat border RA) –> MC above arcuate line (caudal to umbilicus)

  • defect in the aponeurosis of the internal oblique and transverse abdominal
  • It is often covered by external oblique muscle and aponeurosis, as seen here, which helps to distinguish it from an incisional hernia.
71
Q

lumbar hernia

A
  • superior lumbar (grynfeltt-Lesshaft)-12th rib (super), int obl (inf), quadratus lumborum (med)
  • inferior lumbar (petit)- latissimus dorsi, iliac crest, external obl (lat)
72
Q

litter hernia

A

contains MD

73
Q

amyand hernia

A

contains appendix

74
Q

Howship-Romberg Sign

A

inner thigh paresthesia 2/2 obturator hernia

75
Q

Richter hernia

A

only 1 bowel wall herniates, (+) strangulation

76
Q

mc type of internal hernia

A

paraduodenal (through song defect)

77
Q

paraduodenal internal hernias-2 types

A

1) Fossa of Lanzert-on Left (desc colon mesentery/LUQ). Sac-like cluster dil loops in left ant pararenal space behind IMV & asc L colic a
2) Fossa of Waldeyer- Right (asc colon, RLQ). ass w/ malrotation (non rotated small bowel, normally rotated large bowel). Occ below 3rd pt duo, behind SMA

78
Q

What is the most common imaging finding in adult CF?

A

fatty replacement

79
Q

Pancreatic agenesis vs lipomatosis

A

Agenesis: no duct. Lipomatosis: duct.

80
Q

How does annular pancreas present differently in adult vs child?

A

Adult-pancreatitis.

Child-obstruction

81
Q

CF buzzword

A

lipomatous pseudohypertrophy of the pancreas (enlarged w/ fatty replacement.)

82
Q

imaging pancreatic CF

A

1) fibrosis 2) fatty replacement 3) small 1-3 mm cysts

83
Q

Fibrosing colonopathy in CF

A

2/2 enzyme replacement

84
Q

causes of pancreatic lipomatosis

A

CF, Cushing syndrome, chronic steroid, HLD, Shwachman-Diamond Syndrome

85
Q

Shwachman-Diamond Syndrome

A

diarrhea, short stature (metaphysical achondroplasia), eczema, lipomatous pseudohypertrophy of pancreas (2nd MCC pancreatic insufficiency in children (CF=#1))

86
Q

key imaging finding annular pancreas

A

annular duct encircling descending duodenum

87
Q

What matters the most in pancreatic trauma? Next step if suspected?

A
  • duct integrity-surgical EM.

- MRCP or ERCP if suspected

88
Q

MC complications pancreatic trauma?

A

fistula (MC), abscess

89
Q

Causes pancreatitis

A

GS, EtOH, ERCP (milder course), mx (VA), trauma (kids), H hyperTG, hyperCa, AI pancreatitis, pancreatic divisum, groove (para-duodenal), tropic, parasite (Ascaris)

90
Q

How to score pancreatitis

A

Balthazar

91
Q

Biphasic course acute pancreatitis

A

1-2wks=inflammatory (SIRS/ARDS)

3-4wk=anti-inflamm –> (+) susp infection

92
Q

most common anatomic variant of pancreas

A

pancreatic divisum

93
Q

MCC chronic pancreatitis

A

EtOH

94
Q

early & late findings chronic pancreatitis

A
  • early- 1) loss of T1 signal 2) delayed enh 3) dilated side branches
  • late- 1) atrophic 2) chain of lakes (dilation/beading duct + Ca) 3) pseudocyst (30%)
  • fibrotic inflammatory pseudotumor-diff from cancer
95
Q

most char finding chr pancr

A

chain of lakes

96
Q

compl chr pancr

A

cancer (20 yrs chr pancr = 6% increased risk)

97
Q

chr pancreas vs malignancy

A

CP-duct dil=irreg & <50%

-fibrotic inflamm pseudotumor

98
Q

IgG4

A
  • AI pancreatitis
  • retroperitoneal fibrosis
  • sclerosing cholangitis
  • inflammatory pseudotumor
  • riedel’s thyroiditis
99
Q

What gene is related to hereditary pancreatitis?

A

SPINK-1 gene

100
Q

Trousseau’s syndrome

A

enlarged GB, painless jaundice, migratory thrombophlebitis

101
Q

imp staging elements of pancreatic adenoCA

A

SMA/celiac axis involvement-unresectable

102
Q

pancreatic adenoCA on small bowel follow-through

A

reverse impression on duodenum (frostburg’s inverted 3 sign or wide duo sweep)

103
Q

Frostburg’s inverted 3 sign

A

reverse impression on duo in setting of pancreatic adenoCA seen on sm bowel follow through

104
Q

Periampullary tumor

A

within 2 cm of major papilla arising from pancr, duo or CBD

105
Q

What syndrome is associated with increased incidence of periampullary tumor?

A

Gardner’s syndrome

106
Q

buzzword jejunal ulcer

A

Zollinger-Ellison syndrome

107
Q

complications whipple

A

1) delayed gastric emptying 2) pancreatic fistula 3) wound inf

108
Q

complications pancreatic transplant

A

1) acute rejection 2) donor splenic vein thrombosis 3) pancreatitis (<4 wks) 4) chronic rejection (shrinking transplant)

109
Q

buzzword: shrinking transplant

A

pancreatic transplant chronic rejection, graft progressively gets smaller

110
Q

Felty’s syndrome

A

SMG, RA, NP. Abn of granulocytes

111
Q

Littoral cell angioma

A

benign vascular tumor of littoral cells lining venous sinusoids of red pulp

112
Q

MC met to spleen

A

melanoma

113
Q

Lane Hamilton syndrome

A

Celiac dx + Idiopathic pulmonary hemosiderosis (IPH)

IPH is an uncommon form of pulmonary hemosiderosis. It is characterized by the triad of

hemoptysis
iron deficiency anemia
diffuse pulmonary infiltrates, usually represented by diffuse pulmonary hemorrhage
The diagnosis is usually made by exclusion 1.

114
Q

signs of GIST malignancy?

A
  • mets (most reliable sign)
  • size >5m
  • irregular enh
  • ulceration, cavitation
115
Q

3 components of levator ani

A

1) pubococcygeus (pubovisceral ) m
2) iliococcygeus m
3) puborectalis m

116
Q

inguinal LN pathology

A
  • perineum
  • anal canal
  • anorectal junction
117
Q

internal & external iliac LN pathology

A
  • rectal
  • urinary bladder
  • prostate, cervical CA
118
Q

obturator LN pathology

A

early prostate

119
Q

rectus sheath mets

A

melanoma

120
Q

inferior epigastric vessels course through rectus sheath

A

btw rectus abd and pst layer of rectus sheath

121
Q

rectus sheath

A

strong fibrous compartment enveloping rectus m’s, formed by aponeuroses of 3 flat m’s

  • contains sup and inf epigastric vess’
  • ant: apon EO and ant IO
  • pst=pst IO and TA
  • below arcuate line (halfway btw umbilicus and pubic symphysis)–> no pst wall!
122
Q

which liver tumors rupture spon’t

A

hcc

angiosarcoma

123
Q

abd wall hernias with highest risk strangulation

A

femoral=highest

124
Q

how often does serous cyst adenoma have central enhancing scar and Ca?

A

30%

10%

125
Q

when to resect serous cystadenoma vs other cystic pancreatic neos

A
  • 4cm (growth accelerates)

- 3 cm

126
Q

serpiginous filling defects in esophagus

A

-varices
-varicoid carcinoma
lymphoma

127
Q

varicose carcinoma of esophagus

A

mural metastasis of SCC of es

128
Q

when to treat pancreatic fluid colls

A 
4 wks
intractable pain
biliary ob
suspecting inf
con't growth
129
Q

Myochosis/”cogwheel”

A

hypertrophy of the colonic circular muscle layer and shortening of the longitudinal layer (taenia) cause irregular narrowing of the colonic lumen.

130
Q

Non hodgkin lymphoma

A

Immunosuppressed patients (e.g., those with AIDS or transplant recipients) are at markedly increased risk for developing NHL. Almost any focal abdominal visceral or nodal mass should be considered worrisome for involvement by NHL and evaluated appropriately.

131
Q

anal cancer-who, ass w/ which virus, mets

A
  • homosexual men, AIDS
  • papilloma viral inf
  • can spread systemically w/o liver mets due to dual (portal & systemic) venous drainage of rectum
132
Q

CT criteria for acute appendicitis

A

thickened wall and/or dilated lumen & periappendiceal inflamm

133
Q

Brunner gland hyperplasia/hamartoma

A
  • Nonneoplastic hyperplasia of duodenal submucosal glands
  • common cause for polypoid filling defects
  • ass w. duodenitis, hyperacidity
  • Strawberry or cobblestone appearance in proximal duodenum on barium study
134
Q

Rx GIST

A

imatinib (Gleevec), tyrosine-kinase inhibitor

135
Q

mesenteric adenitis-what is it?

A

inf of distal sm bowel

136
Q

pancreatic pseudocyst mx

A
  • typically resolve on own in weeks. Decompr into pancreatic duct or stomach/duo
  • drain if inf, syx (usually via obstr of bowel or bd)
137
Q

gastric ulcer vs avm/vascular ectasia on CT

A
  • The term “ulcer” implies erosion into the submucosa or even through the wall of stomach. CT might show extraluminal gas, fluid, or enteric contrast medium, not evident in this case.
  • Arteriovenous malformations or vascular ectatic lesions occur throughout the gastrointestinal (GI) tract and are a common cause of GI bleeding. These cannot be diagnosed by imaging, except indirectly as a source of active hemorrhage.
138
Q

Bochdalek hernia

A

left post hemidiaph defect

139
Q

pancreatitis fluid collections-encapsulated vs non

A

non= <4 wks (acute necrotic collection, acute peripancreatic fluid colelction.)

encaps: >4 wks (walled off necrotic collection, pseudocyst.)

140
Q

common causes splenic v thrombosis

A
  • acute & chr pancreatitis
  • pancreatic malignancy
  • aneurysms of celiac/splenic arteries
141
Q

how does pancreatitis cause gastric varices?

A

splenic v thrombosis

142
Q

vascular compl of pancreatitis-what, pathophys, which ones

A
  • enzymes –> erosion –> hemorrhage and pseudoaneurysm via erosion
  • splenic > GD > PD arteries
143
Q

-Vessels we care about in panacreatic adenocarcinoma

A
  • *common hepatic a’s –> GDA –> SPDA
  • *celiac a + branches (LGA, SA)
  • *SMA –> IPDA

*PV, splenic v

144
Q

vessel encasement vs abutment

A
  • encasement= > 180

- abutment = <180

145
Q

benign vs malignant: serous cystadenoCA, mucinous cystic tumor

A
  • serous=benign

- mucinous= low grade mal

146
Q

small bowel target sign-app, causes

A
  • water or hemorrhage in submuc
  • pancreatic rests, GIST, lymphoma, melanoma, primary bowel adenoCA
  • if mult: think lymphoma, melanoma
147
Q

How does afferent loop syndrome cause pancreatitis?

A

obstruction of afferent limb s/p billroth2 –> obstruction of biliary and pancreatic drainage

148
Q

img mucinous cystic pancreatic tumor

A
  • large, loculated, thick walled cystic masses
  • mural nodules, papillary projections
  • TAIL
149
Q

annular pancreas-pathophys

A

Failure of ventral pancr bud to rotate (clockwise) with duodenum

150
Q

annular pancreas-types

A
  • complete-complete encasement of duo
  • incomplete-
  • extramural: pancreatic tissue from ventral bud drains into main PD
  • intramural-VB drains via own small ducts into duo

radiology (31 decks)

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