GI Challenge Flashcards
Case 151
What heterotaxy syndrome is associated with a high risk of congenital heart disease?
Situs ambiguous with asplenia (85-95% have CHD)
Situs ambiguous with polysplenia have a lower chance of CHD
Case 151
Right lower lobe bronchiectasis with dextrocardia = ?
Kartagener’s syndrome
Case 151
What is the incidence of congenital heart disease in patients with situs inversus?
5%
Case 152
What is the MC congenital abnormality of the pancreas?
Pancreatic divisum (4-10% of the population)
Case 152
What is the MC clinical scenario associated with pancreas divisum?
Most are asymptomatic, although there is a higher incidence of pancreatitis
Case 152
What is the other name of the accessory pancreatic duct?
Duct of Santorini
Case 153
What is the MC viscus used for esophageal interposition surgery?
Stomach
Case 153
Tumor recurrence is common following esophagectomy for esophageal cancer. Where is the MC site for recurrence?
Distant metastases
Case 154
What is the peritoneal space posterior to the stomach and anterior to the pancreas?
Lesser sac
Case 154
Which viscus most commonly herniates through the foramen of Winslow?
Small bowel
Case 154
What is the MC type of internal hernia?
Paraduodenal
Case 155
In what age group is mesenteric volvulus typically seen?
Infancy, and is usually associated with congenital abnormalities.
Case 156
Which imaging modality is best for preoperative or pre-interventional planning for uterine fibroids?
MRI
Case 157
What postoperative complication is more common following Billroth II compared to Billroth I?
Afferent loop syndrome (also seen with Roux-en-Y gastric bypass and pancreaticoduodenectomy)
Case 157
What are some potential causes of gastric bezoar?
- Hair (trichobezoars)
- Persimmon fruit or psyllium fiber taken with too little water (phytobezoar)
- Post-gastric surgery (incidence of 5-12%)
Case 158
What histologic component seen in other parts of the GI tract is absent in the esophagus?
Serosa
Case 158
Worldwide, what is the MC cause of portal hypertension and varices?
Schistosomiasis
Case 158
What are ‘jump’ metastases in esophageal cancer and why do they occur?
Mets that spread throughout the length of the esophagus.
Due to extensive lymphatic network in the esophagus.
Case 159
What is the MC surgical complication of lap cholecystectomy?
Retained stone
Case 160
In patients with Crohn’s disease, which portion of the stomach is typically involved?
Antrum
Case 160
In longstanding Crohn’s disease, what is the name given to a featureless antrum and duodenum?
Ram’s horn sign
Case 161
What is the MC pancreatic islet cell tumor?
Nonfunctioning islet cell tumor (50% of all pancreatic neuroendocrine tumors)
Conflicting info see on Radiopaedia. They say that 15% are nonfunctional. MC functional pancreatic NET is insulinoma
Case 161
Which pancreatic islet cell tumor would be associated with palpitations, sweating, and headache?
Insulinoma
Case 162
What is the MC cause of cirrhosis in caucasians? In Asians?
Caucasians - alcohol
Asians - viral hepatitis
Case 162
What serum marker is often used in HCC?
Alpha-fetoprotein (AFP), although it is nonspecific
Case 163
What is the definition of a giant duodenal ulcer?
A mucosal defect replacing 2/3 of the duodenal bulb
Case 163
Where do perforating duodenal ulcers most commonly occur?
Duodenal bulb
Case 163
What is the only duodenal tumor that can specifically diagnosed with CT?
Lipoma
Case 164
From where does most of the air come from seen within the GI tract?
Swallowed air
Case 164
T or F: Pneumoretroperitoneum is never benign.
True. Most commonly represents performation of colon or duodenum.
Case 165
In the setting of a nutmeg liver, what imaging characteristic would be suggestive of Budd-Chiari over right heart failure?
Caudate lobe hypertrophy
Case 166
What is the pathophysiology of epiploic appendagitis?
Torsion of the epiploic appendage
Case 166
What is the treatment for epiploic appendagitis?
Conservative therapy
Case 167
What is the MC presentation of a thyroglossal duct cyst?
Palpable mass
Case 167
What is the MC complication of a thyroglossal duct cyst?
Infection
Case 167
What is the definitive treatment for a thyroglossal duct cyst?
Surgery
Case 168
An abscess due to a retained surgical foreign body is known as what?
Gossypiboma
Case 169
What is the MC cause of portal vein thrombosis in adults?
Cirrhosis
Case 170
Multiple rim enhancing soft tissue lesions in the liver in a patient without known primary tumor?
I would still think metastatic disease first, until proven otherwise.
Epithelioid hemangioendothelioma (EHE) is also a consideration.
Case 170
What is the MC site of involvement for epithelioid hemangioendothelioma (EHE)?
Soft tissues
Case 170
Histologically, what is epithelioid hemangioendothelioma (EHE)?
Rare vascular tumor that is clinically and histologically intermediate between angiosarcoma and hemangioma.
Now thought of as a low grade epithelioid angiosarcoma.
Case 171
Where in the esophagus are strictures most commonly seen?
Distal esophagus
Case 171
What is the treatment for esophageal webs?
Endoscopy
Case 172
What is the clinical significance of colon cancer presenting with perforation?
Elevated risk of peritoneal carcinomatosis
Case 173
What is the MC predisposing factor in esophageal bolus impaction?
There is typically an underlying stricture
Case 174
What is the MC predisposing factor in hepatic microabscesses?
Immunocompromised state
Case 174
What is the MC causative organism in hepatic microabscesses?
Candida
Case 175
What is the MC benign cause of linitis plastica?
Caustic ingestion
Case 176
What are the normal lymphoid aggregates in the ileum called?
Peyer’s patches
Case 176
What disease is most commonly associated with nodular lymphoid hyperplasia of the distal ileum?
Viral infection
Case 176
What is a potential complication of nodular lymphoid hyperplasia in pediatric patients?
Ileocolic intussusception
Case 177
What is the underlying pathophysiologic defect in achalasia?
Aganglionosis
Case 177
What is tylosis and why is it important?
Genetic disorder characterized by palmar/plantar hyperkeratosis, oral leukoplakia, and esophageal cancer.
Only genetic syndrome known to predispose to SCC of the esophagus.
Case 178
On what CT phase is RCC typically the most conspicuous?
Nephrographic phase
Case 179
What is the MC causative organism for AIDS-related enteritis?
Cryptosporidium parvum
Case 179
What is the MC cause of dysphagia/odynophagia in AIDS patients?
Candida esophagitis
Case 179
What disease occurs in immunocompromised patients following bone marrow transplant but not AIDS patients?
GVHD
Case 180
What is the CT fat halo sign and what does it suggest?
Ring of fat tissue in the submucosa of bowel. Seen in inflammatory bowel disease.
Case 181
What is the MC cause of large bowel obstruction?
Tumor
Case 181
What is the MC type of colonic volvulus?
Sigmoid
Case 182
What is the MC finding of bowel ischemia?
Bowel wall thickening
Case 183
What is the MC malignancy of the biliary tract?
GB adenocarcinoma
Case 183
What is the prognosis for GB adenocarcinoma?
Mean survival time of 6 months
Case 184
What is the MC site of GI tract involvement in Burkitt’s lymphoma?
Terminal ileum
Case 184
What is the MC site of presentation in Burkitt’s lymphoma?
Facial and mandibular
Case 184
What virus is specifically associated with Burkitt’s lymphoma?
Epstein-Barr virus
Case 185
T or F. Traumatic diaphragmatic injury is typically evident at presentation.
False. It is commonly missed at presentation, even with cross-sectional imaging.
Case 186
What is the MC systemic disorder that may be associated with esophageal dysmotility?
Diabetes mellitus
Case 186
What is the most common GI manifestation of a paraneoplastic syndrome?
Diarrhea
Case 186
What is the MC malignancy to give rise to a paraneoplastic syndrome?
Bronchogenic carcinoma
Case 187
What is the MC cause of perfusion defects in the spleen?
Infarcts
Case 187
How common are splenic hematogenous metastases?
Rare.
Case 187
What is the MC primary splenic neoplasm?
Hemangioma
Case 188
Bleeding colonic polyps in someone who recently went ‘swimming in the Nile”
Colonic schistosomiasis
Case 189
What is the MC clinical manifestation of a lymphangioma?
Cystic hygroma
Case 189
What syndrome is associated with lymphangiomas?
CRS says fetal alcohol syndrome
Also, aneuploidy syndromes (Trisomies, Turner syndrome), Noonan syndrome, Cornelia de Lange, among others
Case 190
What finding suggests pancreatic lymphoma over adenocarcinoma?
Absence of pancreatic ductal dilation
Case 191
What is the MC type of esophageal polyp
Leiomyoma (stromal cell tumor)
Case 191
What is the MC location of an esophageal fibrovascular polyp?
How do they typically present?
Proximal esophagus.
Typically present with dysphagia.
Case 192
What is the MC complication of peptic ulceration?
Bleeding
Case 192
What is the eponym of a penetrating ulcer that extends from the gastric antrum to the duodenum (paralleling the pyloric channel)?
Dragstedt ulcer (could hardly find anything online about this)
Case 193
What is the MC cause of small bowel hemorrhage?
Anticoagulant therapy
Case 193
What is the ‘stack of coins’ sign on SBFT and what does it suggest?
Thickening small bowel folds that remain straight and parallel. Associated with small bowel hemorrhage.
Case 194
What are the underlying pathologic changes seen in the bowel as a result of scleroderma?
Small vessel vasculitis and fibrosis
Case 194
What is meant by ‘hidebound’ appearance of bowel and what does it suggest?
Dilated small bowel with crowding of normal thickness valvulae conniventes. Seen in scleroderma.
Case 195
What is the MC cause of hepatic infarction secondary to hepatic arterial occlusion?
Hepatic transplantation
Case 195
What can develop as a result of hepatic arterial occlusion and infarction?
Bile lakes
Case 196
What is the MC underlying cause of SMV thrombosis?
Prothrombotic state
Case 196
What part of the GI tract would you expect to be affected with SMV thrombosis?
Small bowel and right colon
Case 197
Oral and ileocecal aphthous ulcers, skin lesions, uveitis, and genital ulcers. Diagnosis?
Behcet’s disease
Case 198
What is the typical first line therapy for splenic artery pseudoaneurysm?
Endovascular intervention
Case 199
What is the typical appearance of gastric GIST?
Exophytic mass with extragastric extension
Case 199
What is the MC cause of a bulky gastric tumor?
Carcinoma
Case 200
What imaging finding would suggest biliary cystic neoplasm over a simple hepatic cyst?
Ductal dilation
Case 200
Do biliary cystadenomas have any malignant potential?
Yes.