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GI Fair Game Flashcards

1
Q

Case 61

DDx for fibrotic mesenteric mass?

A

Desmoid: typically a round mass
Lymphoma
Carcinoid
Peritoneal Carcinomatosis

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2
Q

Case 61

Which polyposis syndrome is associated with mesenteric fibrosis?

A

Familial adenomatous polyposis (Gardner syndrome)

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3
Q

Case 62
What is massive distention of GB also known as?

What is the preceding pathology of this condition?

A

Gallbladder hydrops

Untreated Acute Cholecystitis

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4
Q

Case 62

What are potential complications of untreated acute cholecystitis?

A

Perforation
Bile Peritonitis
GB Hydrops

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5
Q

Case 63

What is an appendicolith composed of?

A

Inspissated fecal debris
Mucous
Calcium phosphate
Inorganic salts

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6
Q

Case 63
What is the accuracy rate of MDCT for the diagnosis of acute appendicitis?

US?

A

Approaches 100%

70 to 90% in current literature

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7
Q

Case 64

What is the MC disease associated with sclerosing cholangitis?

A

Ulcerative colitis

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8
Q

Case 64

What is the MC cause of recurrent biliary tract infection worldwide?

A

Ascariasis

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9
Q

Case 64
1. What percentage of patients with PSC have UC?

  1. What percentage of patients with UC develop PSC?
A
  1. 70% of pts with PSC have UC

2. Up to 10% of pts with UC will develop PSC

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10
Q

Case 64

What is a potential serious complication of longstanding sclerosing cholangitis?

A

Cholangiocarcinoma

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11
Q

Case 65
What is the most common pancreatic cystic tumor?

Avg age?

A

Mucinous Cystadenoma

50 yo

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12
Q

Case 65
Which pancreatic neoplasm is associated with VHL?

Malignant potential?

A

Microcystic adenoma

Not premalignant

  • Female
  • Older Patients
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13
Q

Case 65

Macrocystic pancreatic lesion with septations?

A

Mucinous cystadenoma
- Premalignant

Cystadenocarcinoma

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14
Q

Case 65

Mixed solid/cystic pancreatic neoplasm in young female is most likely?

A

Solid papillary endothelial neoplasm (SPEN)

- Low grade malignancy

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15
Q

Case 61

What is a rounded masslike area of mesenteric fibrosis called?

A

Desmoid tumor

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16
Q

Case 66
What is the MC histology of duodenal polyps?

What is their relative malignant potential?

A
  1. Adenomatous polyps
    - vs hyperplastic polyps in stomach
  2. More commonly malignant compared to colonic adenomas
    - Size directly correlates w malignant potential
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17
Q

Case 66

How is the location of a duodenal polyp clinically important?

A

Generally

  • the more distal the polyp
  • the more likely it is to be premalignant
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18
Q

Case 67

What is the anatomic space anterior to the superior rectum?

A

Pouch of Douglas

Cul-de-sac

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19
Q

Case 67

Lesion seen at anterior wall of rectum on double contrast BE. DDx?

A 
Primary carcinoma
Peritoneal metastatic disease
Primary gyn malignancy
Endometriosis
PID
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20
Q

Case 68

What underlying disease predisposes patients to emphysematous cholecystitis?

A

Diabetes

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21
Q

Case 68

Emphysematous Cholecystitis - causative organism?

A

Clostridium species

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22
Q

Case 68

What is the potential complication from emphysematous cholecystitis?

A

Perforation

- 5 x more likely

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23
Q

Case 69

What is the most important anatomic consideration in the setting of pancreatic trauma?

A

Ductal injury

-> Surgery

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24
Q

Case 69

What are the most common mechanisms of pancreatic injury?

A

MVA

Deceleration Injuries

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25
Q

Case 69

In the setting of pancreatic duct injury, which portion of the pancreas is removed?

A

Requires surgical resection of the pancreas proximal to the lesion

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26
Q

Case 70

What is a major predisposing factor to the development of splenic abscesses?

A

Immunocompromised state

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27
Q

Case 70

What is the MC source of septic emboli that result in splenic abscesses?

A

Endocarditis

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28
Q

Case 70

What local condition is most commonly associated with splenic abscess?

A

Pancreatitis

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29
Q

Case 70

What NM study can be helpful to diagnose a splenic abscess?

A

Gallium scan (although lymphoma would also take up gallium)

Tagged WBC scan would result in diffuse splenic uptake

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30
Q

Case 66

DDx for polypoid filling defect in the bulb

A
  • Adenoma
  • Pancreatic Rests
  • Prolapsed Gastric polyp
  • GIST
  • Brunner’s Gland Adenoma
  • Mets
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31
Q

Case 71

Term used to describe pancreatitis with significant bleeding

A

Hemorrhagic pancreatitis

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32
Q

Case 71

What features of the pancreas allow pancreatitis to have widespread impact?

A

Capsule
Location
Exocrine function (NOT Endocrine function)

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33
Q

Case 72
In adults, what is the MC retroperitoneal soft tissue sarcoma?
How is it treated?

A

Liposarcoma

XRT

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34
Q

Case 72

Features of liposarcoma

A
  • Rare
  • Can be almost purely lipomatous
  • Adult males
  • Rare in children
  • Difficult to excise
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35
Q

Case 72

Adult fatty retroperitoneal tumor - what is the likely diagnosis?

A

Liposarcoma

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36
Q

Case 73

What is the MC intra-abdominal site of involvement in sarcoidosis?

A

Liver

Hepatosplenomegaly

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37
Q

Case 73

Most common site of Sarcoid GI tract involvement?

A

Stomach

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38
Q

Case 71

What is the major cause of pancreatitis in the US?

A

Alcohol

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38
Q

Case 73
T/F
Biliary involvement by Sarcoid can result in strictures of the extra hepatic biliary ducts

A

True

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39
Q

Case 74

What is the MC primary tumor of the pharynx?

A

SCC

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40
Q

Case 74

What is the MC risk factor for pharyngeal cancer?

A

Tobacco

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41
Q

Case 74

A posterior pharyngeal tumor should suggest what etiology?

A

Lymphoma

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42
Q

Case 74

Cervical esophageal webs + anemia = ?

A

Plummer-Vinson syndrome

- questionable premalignant condition

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43
Q

Case 74
Cancers that metastasize to the pharynx?

Hypopharynx?

A

Breast and Lung

Melanoma and Kaposi’s

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44
Q

Case 75

What complication might a patient suffer from the colonic absorption of iodinated contrast media?

A

Anaphylaxis

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45
Q

Case 75

Vicarious excretion of colonically absorbed water-soluble contrast is seen how often?

A 
20% of normal patients
More common in
- Ischemic colon
- Colitis
- IBD
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46
Q

Case 76
What is the most common pathologic cause of papillary enlargement?

Other causes?

A

Choledocholithiasis

Pancreatitis
Choledochocele
Tumors

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47
Q

Case 76

What is Poppel’s sign?

A

Papillary enlargement due to edema and swelling from pancreatitis

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48
Q

Case 76

What polyposis syndrome is associated with tumors of the papilla?

A

Familial polyposis coli (Gardner syndrome)

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49
Q

Case 76

What is the term used to describe the region in and around the ampulla?

A

Perivaterian region

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50
Q

Case 77

What is the MC cause of gastroduodenal ulcers in Western society?

A

H. pylori

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51
Q

Case 77

What substance does the breath test for H. pylori detect?

A

Urease

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52
Q

Case 77

What is the treatment for H. pylori?

A

Triple therapy: PPI + 2 antibiotics

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53
Q

Case 78

What is the pathologic basis of Hirschsprung disease?

A

Segment of congenitally absent ganglion cells in the distal colon

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54
Q

Case 78

How often does Hirschsprung disease involve the entire colon?

A

Rarely (5%)

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55
Q

Case 78

What other condition is Hirschsprung disease most commonly associated with?

A

Trisomy 21

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56
Q

Case 79

What is the MC benign cause of gastric outlet obstruction?

A

Peptic ulcer disease

** Case review contradicts itself on case 79 p161 q2 and case 113 p229 q2. The information for the correct answers to these cases was therefore taken from Requisites 4th ed page 66.

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57
Q

Case 79

Which malignancies are most likely to cause gastric outlet obstruction?

A

Pancreatic CA

Gastric CA

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57
Q 
Case 79
Hirschsprung's 
- Boys vs girls
- Definitive diagnosis
- Treatment
A

Boys

Biopsy

Surgical resection

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58
Q

Case 79
T/F
1. Short history of Sxs is suspicious for malignancy
2. GO obstruction is the most common complication of Gastroduodenal TB
3. Gastrostomy tube migration can result in GO obstruction
4. Organoaxial gastric volvulus is more likely to result in GO obstruction

A
  1. T
  2. T
  3. T
  4. F
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59
Q

Case 80

What is the MC cause of hematogenous mets to the esophagus?

A

Breast cancer

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60
Q

Case 80

Which tumor is most likely to spread to the esophagus by direct extension?

A

Gastric cardia tumors

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62
Q

Case 80

What can metastasize to the esophagus?

A
  • Melanoma
  • Breast
  • Renal Cell
  • Kaposi’s sarcoma
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63
Q

Case 80

Metastatic spread to the esophagus occurs early or late in the disease?

A

Late

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64
Q

Case 81

What is the pathogenesis for the development of toxic megacolon?

A

Transmural inflammation

  • Damages ganglion cells
  • Results in atony
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65
Q

Case 81

What causes the thumbprinting sign?

A

Lobulated thickening of haustral folds

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66
Q

Case 81

Five causes of toxic megacolon

A 
Ulcerative Colitis
Crohn's
Pseudomembranous Colitis
Ischemia
Infectious Colitis
- esp in AIDS
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67
Q

Case 81

What imaging measurement is suggestive of Toxic Megacolon?

A

Transverse colon > 8 cm

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68
Q

Case 81

Once treated is there an increased risk of developing Toxic Megacolon in the future?

A

Yes

- may require colectomy

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69
Q

Case 82

What are some potential causes of pseudomyxoma peritonei?

A

Mucin Producing Neoplasms

  • Mucinous AdenoCA / Mucocele
  • Appendix
  • Ovaries
  • Pancreas

Less common

  • Stomach
  • Intestines
  • Bile ducts
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70
Q

Case 82

What is the treatment for Pseudomyxoma Peritonei?

A

Supportive

  • No definitive treatment
  • Material cannot be successfully removed surgically
  • Remaining cells will continue to produce material
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71
Q

Case 82

What is the most common presentation of Pseudomyxoma in women?

A

Increasing abdominal girth

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72
Q

Case 83

What is the appropriate initial diagnostic procedure in a hemodynamically stable patient s/p stab wound?

A

CT scan (although I’ve always been taught exploratory laparotomy)

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73
Q

Case 83

What is the most commonly injured viscus in stab injuries?

A

Colon

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74
Q

Case 83

What should one look for within the abdomen in penetrating injuries?

A
  • Air
  • Free fluid (blood)
  • Injury of the bowel wall itself
    (Even if not completely breeched)
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75
Q

Case 84

In what % of the general population is C. difficile found?

A
  • 20% is subclinically colonized
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77
Q

Case 84

What is the pathophysiology of pseudomembranous colitis?

A

C. difficile endotoxin

  • Inflammation/necrosis of the mucosa
  • Subsequent loss of fluid
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77
Q

Case 84
T/F
1. Pseudomembranous colitis can lead to Toxic Megacolon
2. Can involve the small bowel
3. Pseudomembranous colitis always involves the whole colon
4. Can be elicited by Chemotherapy

A
  1. T
  2. T
  3. F
  4. T
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78
Q

Case 84

How long after antibiotic therapy do symptoms of Pseudomembranous Colitis occur?

A

Typically less than 2 weeks
- can occur anywhere from a few days to 8 wks
Must change Antibiotics to treat!

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79
Q

Case 85

What is the physical cause of azygous continuation of the IVC?

A

Congenital absence of the IVC or acquired IVC occlusion

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80
Q

Case 85

Besides congenital, what other conditions may result in azygous continuation?

A

Hepatoma
Sickle cell
Leukemia

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81
Q

Case 86

What is the MC tumor of the inguinal canal?

A

Lipoma

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82
Q

Case 87

What is the hereditary pattern of neurofibromatosis?

A

Autosomal dominant

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83
Q

Case 86

What is the MC cause of small bowel obstruction?

A

Fibrous adhesions

SBO is best detected with CT

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84
Q

Case 87

What is the most common form of NF?

A

NF1 (von Recklinghausen’s disease) - 90%

1 in 4000

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84
Q

Case 88

What is the MC cause of a benign pancreatic duct stricture?

A

Chronic pancreatitis

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85
Q

Case 87

What part of the body is most commonly affected by NF?

A

Skin

In the small bowel, you get malabsorption

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86
Q

Case 88

What is the double duct sign?

A

Dilation of the CBD and pancreatic ducts

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87
Q

Case 89

What is the MC cause of abdominal ascites?

A

Cirrhosis and severe liver dz

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88
Q

Case 89

In a supine patient, what is the most dependent peritoneal space?

A

Rectouterine space (Pouch of Douglas)

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89
Q

Case 89

What is suggested by ‘centralization of bowel loops’?

A

Large volume ascites

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90
Q

Case 90

Nonfamilial polyposis syndrome with skin abnormalities, alopecia, onychodystrophy, hyperpigmentation?

A

Cronkhite-Canada syndrome

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91
Q

Case 89

What is the ‘dog ears’ sign of ascites?

A

Ovoid or triangular densities just above and lateral to the urinary bladder on supine abdominal film

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92
Q

Case 90

Patient with multiple gastric hamartomas, circumoral papillomatosis, thyroid abnormalities and skeletal abnormalities?

A

Cowden syndrome

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93
Q

Case 91

Which infections can produce fistulas?

A

TB

Actinomycosis

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94
Q

Case 90

Polyposis syndrome with multiple bowel hamartomatous polyps with no malignant potential?

A

Peutz-Jeghers

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95
Q

Case 90

Familial Polyposis syndrome with multiple adenomatous or hyperplastic gastric polyps?

A

Gardner’s Syndrome

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96
Q

Case 92

What is the vascular supply to FNH?

A

Arterial

  • usually central as compared to peripheral
  • there is no PV supply to FNH
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97
Q

Case 91
What is the MC cause of colonic fistulas to the urogenital tract?
What is the worldwide most common cause of rectovaginal fistula?

A

Diverticulitis

Trauma

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98
Q

Case 92

What is an MRI imaging feature helpful in determining FNH?

A

Scar

  • high T2
  • low T1
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99
Q

Case 93

What are predisposing factors to the development of hepatic adenoma?

A
  • Female predominance
  • Oral contraceptive use
  • Glycogen storage dz
  • Anabolic steroid use
    (not Catabolic steroids)
  • Propensity to bleed
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100
Q

Case 93

What is the appearance of hepatic adenoma on Tc-99m sulfur colloid scan?

A

Photopenic defect

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101
Q

Case 93

What would be the appearance of a hepatic adenoma on MRI C+ (Eovist)?

A
  • Bright on pre-contrast T1 due to glycogen and fat
  • Feeding vessels
  • Diffusely enhance
  • Typically hypointense to background liver on delayed hepatobiliary phase
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102
Q

Case 94

What is the best screening modality for AAA?

A

Ultrasound

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103
Q

Case 94
What is a major risk factor for AAA?

Most common presentation?

Gender predominance?

Other causes?

A

Smoking

Incidentally found on imaging

Men 7 times more often than women

Mycotic, Marfan’s, Ehler-Danlos

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104
Q

Case 95
What is the most specific CT finding for bowel strangulation?

What is the origin of the gas within dilated bowel in a patient with obstruction?

A

Abnormal enhancement

Swallowed air

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105
Q

Case 96

What are the best MR sequences for the detection of iron deposition?

A

Signal loss on T2 (long TE sequences), gradient echo

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106
Q

Case 96

Abnormally dense liver in a patient with history of arrhythmia?

A

Amiodarone toxicity

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107
Q

Case 96

How to distinguish between primary and secondary hemochromatosis on MRI?

A

In primary hemochromatosis, the bone marrow and spleen are typically spared (and pancreas is affected)

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108
Q

Case 96

Besides hemochromatosis, what is another cause of hyperdense liver parenchyma?

A

Wilson’s disease

- copper metabolism

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109
Q

Case 96

Describe Hemochromatosis

A

Inherited disorder

  • Increased iron absorption
  • Primarily males
  • Can cause
    - Cirrhosis
    - Diabetes
    - Arthropathy
    - Cardiac problems
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110
Q

Case 97

What is the significance of lymph node status in cervical cancer?

A

5-year survival rates:
N0 - 90%
N1 - 55%

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111
Q

Case 97

What is the best diagnostic test to evaluate for local spread of cervical cancer?

A

MRI

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112
Q

Case 97

What are the T2 imaging characteristics of cervical carcinoma?

A

High signal intensity mass on T2 weighted images

Stark contrast to low signal of normal cervical stroma

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113
Q

Case 92

Why does FNH take up sulfur colloid radiotracer?

A

Presence of Kupffer cells

- part of the reticuloendothelial system

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113
Q

Case 92

In what demographic is FNH typically seen?

A

Young women

113
Q

Case 97

How does cervical cancer spread locally?

A

Contiguous spread laterally to the parametrium and to the vagina

Fascial planes protect spread to rectum and bladder early in the disease

114
Q

Case 98

Incidentalomas

A

Incidental gallstones are of moderate importance

Never ignore an incidental Bosniak III renal cyst

115
Q

Case 99

What is the MC underlying condition seen with GB varices?

A

Alcholic cirrhosis

117
Q

Case 99
Term used for chronically occluded portal vein?

Dilated veins in the abdominal wall around the umbilicus?

A

Cavernous Transformation

Caput Medusa

118
Q

Case 101

What is the most common cause of UGI bleeding?

A

Peptic Ulcers

119
Q

Case 101

Where are downhill varices seen and what is their cause?

A

Proximal esophagus

SVC obstruction

120
Q

Case 99

7 Causes of portal hypertension

A
  • Alcoholic cirrhosis (The most common cause)
  • Splenic vein thrombosis
  • Schistosomiasis
  • Chronic Hepatitis
  • Hypervitaminosis A
  • Congenital absence of PV
  • Congenital Hep Fibrosis
121
Q

Case 101

What is the usual physiologic basis for uphill varices?

A

Portal hypertension

Cirrhosis

122
Q

Case 102

What is the hallmark sign of ascariasis on barium studies?

A

Ingested barium within the GI tract of the worm

123
Q

Case 102

Apart from the GI tract, what is the second most common viscera to be affected by ascariasis?

A

Biliary tract

  • cholangitis
  • pancreatitis
  • biliary strictures
124
Q

Case 103

What is a Mallory-Weiss tear?

A
  • Distal esophagus at the GE junction
  • Incomplete tear on the mucosal side
  • Secondary to retching or vomiting
  • Can bleed
  • Usually alcoholics
  • Very difficult to see on fluoro
  • Opposed to Boerhaave’s
  • > complete tear with extravasation
125
Q

Case 103

How are Mallory-Weiss tears usually treated?

A

Conservatively

- 95% of cases resolve spontaneously

126
Q

Case 104

Which caustic agent is typically more severe when ingested, acid or alkali?

A

Acid results in gastric injury more often

- Alkali can be somewhat neutralized by gastric acid

127
Q

Case 104

Caustic injury can lead to what long term complication?

A

Squamous cell carcinoma

128
Q

Case 105

Syndrome associated with hemangiomas and thrombocytopenia?

A

Kasabach-Merritt syndrome

129
Q

Case 105

T or F: Centrifugal enhancement is diagnostic of hepatic hemangioma.

A

F - centripetal enhancement with progressive filling is diagnostic

130
Q

Case 105

What are the T2 characteristics of hepatic hemangioma?

A

T2 hyperintense

131
Q

Case 105

What is the typical appearance of hepatic hemangioma on Tc-99m tagged RBC scan?

A

Early photopenia, with progressive uptake of tracer

132
Q

Case 107

What is the MC metastatic lesion in the liver to calcify?

A

Colorectal Mucinous Adenocarcinoma

133
Q

Case 107

What is the MC cause of calcified liver lesions in children?

A

Neuroblastoma

134
Q

Case 100

What can help distinguish secondary achalasia due to tumor from primary achalasia?

A

Mucosal irregularity
Proximal shouldering
Longer segment of narrowing
- malig narrowing > 3.5 cm

135
Q

Case 109

What is the 1st and 2nd MC sites of involvement in hydatid disease?

A

1st MC - Liver

2nd MC - Lung

136
Q

Case 109
What is the MC location of rupture in hydatid disease?

What are some potential complications?

A

Biliary

Anaphylaxis
Cholangitis

137
Q

Case 109

Apart from surgery, how can echinococcal cysts be treated?

A

Percutaneous catheter drainage with instillation of scolecidal agents

138
Q

Case 108

What is colitis cystica profunda?

A

Solitary rectal ulcer syndrome

  • Sequela of chronic anterior internal rectal wall prolapse
  • Chronic ulceration/healing
  • Results in trapped regenerating mucosa
  • Forms cystic structures filled w mucin
  • Produces a polypoid appearance
139
Q

Case 106

What are the potential pancreatic complications of cystic fibrosis?

A

Pancreatic endocrine insufficiency (DM)
Exocrine insuffiency
Pancreatitis
Pancreatic Atrophy

Not assoc w/ increased risk of cancer

140
Q

Case 110

What is the MC imaging appearance of GI lymphoma?

A

Infiltrating mass

141
Q

Case 110

What is the MC site for primary GI lymphoma?

A

Stomach

142
Q

Case 109

What is the 10 year mortality rate in untreated Echinococcal dz?

A

90%

143
Q

Case 110

What predisposing condition results in the greatest risk for the development of GI lymphoma?

A

Transplant

- followed by AIDS

144
Q

Case 111

What are the 4 major complications of duodenal PUD?

A

Hemorrhage
Obstruction
Perforation
Penetration

145
Q

Case 111

What is penetration in the setting of PUD?

A

Extension of an ulcer into an adjacent structure (pancreas) or hollow viscus. Penetration in to a vessel can lead to catastrophic hemorrhage

146
Q

Case 111

What is the most common site of perforation in the setting of PUD?

A

Duodenal

  • potentially lethal
  • more common in elderly and pts taking NSAIDs
  • absence of pneumoperitoneum does not exclude perforation
147
Q 
Case 111
Which of the following is associated with the highest prevalence of H. pylori infection?
A. Gastric ulcer
B. Gastric cancer
C. Duodenal ulcer
D. Chronic gastritis
A

C. Duodenal ulcer

148
Q

Case 112

What is the MC extracolonic malignancy seen in Lynch syndrome?

A

Endometrial carcinoma

150
Q

Case 112

What is Lynch Syndrome? What’s its genetic basis?

A

HNPCC

  • hereditary non-polyposis colorectal cancer
  • Defective DNA mismatch repair sequences
151
Q

Case 112

What cancers are associated with Lynch Syndrome?

A 
High risk - colon CA
Increased Risk
- Endometrial (most common)
- Ovarian
- Hepatobiliary
- Stomach
- SB cancers
152
Q

Case 115

What is Menetrier’s dz?

A

Protein Loss Enteropathy of unknown etiology

  • Characterized by rugal hypertrophy
  • Hypo-proteinemia
  • Hypo-chloremia
  • Pain, weight loss, vomiting, diarrhea
  • Responds poorly to Rx
  • May require gastric resection
153
Q

Case 113
What is the name of the syndrome where there is gastric outlet obstruction due to a lodged gallstone in the pyloric channel?

A

Bouveret’s Syndrome

154
Q

Case 115

What is Menetrier’s dz?

A

Protein Loss Enteropathy of unknown etiology

  • Characterized by rugal hypertrophy of the entire stomach
  • Hypo-proteinemia
  • Hypo-chloremia
  • Pain, weight loss, vomiting, diarrhea
  • Responds poorly to steroids or other treatments
  • May require gastric resection
155
Q

Case 115

DDx for thickened gastric folds

A

Menetrier’s dz
Eosinophilic Gastritis
Sarcoid
Gastric Varices

156
Q

Case 113
T/F
1. Caustic ingestion frequently leads to gastric outlet obstruction
2. Transpyloric prolapse of gastric mucosa is usually asymptomatic
3. Gastric outlet obstruction is the most common complication of gastroduodenal tuberculosis
4. Patients with gastroduodenal involvement by Crohn’s dz are usually symptomatic

A
  1. T
  2. T
  3. T
  4. F
157
Q

Case 113

What is the most common cause of gastric outlet obstruction?

A

Malignancy

  • Pancreatic AdenoCA
  • Primary Gastric CA
    • Scirrhous type

Both can infiltrate along the gastric wall causing antral constriction and outlet obstruction

** Case review contradicts itself on case 79 p161 q2 and case 113 p229 q2. The information for the correct answers to these cases was therefore taken from Requisites 4th ed page 66.

158
Q

Case 115

Features of gastric Sarcoidosis

A
  • There is always associated pulmonary involvement
  • Other parts of the GI tract may be involved
  • Responds well to steroids
159
Q

Case 116

What should you suspect when there is no etiologic basis for acute pancreatitis in a middle-aged or older adult?

A

Pancreatic Cancer

160
Q

Case 115

Gastric rugal hypertrophy with peripheral eosinophilia

A

Eosinophilic gastritis

- Rx is steroids

161
Q

Case 116

What is the most definitive means to diagnose benign focal pancreatitis from pancreatic carcinoma?

A

Follow up CT

163
Q

Case 116

What are the 2 leading causes of death in acute pancreatitis?

A

Necrosis (happens early in the course of disease)

Sepsis

164
Q

Case 117
What part of the colon is typically affected by amebiasis?

What is the classic appearanace?

A

Primarily the Cecum
Can also affect
- Liver
- Lungs

‘Coned cecum’

165
Q

Case 117

DDx for coned appearance of the cecum

A 
Amebiasis (E. Histolytica)
Crohn's
Ulcerative Colitis
TB
Cancer / Lymphoma
Yersinia
Blastomycosis
Anisakiasis
166
Q

Case 118

What is the typical treatment for typhlitis?

A

Aggressive antibiotic therapy
Surgery not indicated unless
- perforation
- abscess

167
Q

Case 118

In what demographic is typhlitis typically seen? What is the mortality rate?

A

Immunocompromised pediatric pts

  • typically undergoing chemo
  • can occur in adults
  • thick bowel wall +- pneumatosis
  • responds well to Abx
  • also called Neutropenic Colitis
  • 50% mortality rate
168
Q

Case 119

What is the classic physical exam finding indicating metastatic gastric carcinoma?

A

Virchow’s node

- left supraclavicular

169
Q

Case 117

What are the typical terminal ileal findings in UC?

A

Dilated gaping TI

- backwash ileitis

169
Q

Case 119

What is the anatomic structure that allows tumor to spread from the stomach to the transverse colon?

A

Gastro-colic Ligament

170
Q

Case 119

Most common tumor of the omentum?

A

Metastatic Ovarian Cancer

171
Q

Case 120

Most common GI site of involvement by Scleroderma?

A

Esophagus

172
Q

Case 120

List three common clinical complications of Scleroderma

A

Constipation
Incontinence
Rectal Prolapse

173
Q

Case 121

What embryologic portion of the pancreas becomes the uncinate process?

A

Ventral pancreatic bud

174
Q

Case 121

What percentage of patients with annular pancreas develop acute or chronic pancreatitis?

A

Up to 25%

175
Q

Case 120

What disease states can result in wide-mouth colonic sacculations?

A

Scleroderma
Crohn’s disease
Laxative abuse

Contain all 3 layers of bowel
Also termed
- "true" diverticula
- wide mouth diverticula
- pseudo-diverticula
176
Q

Case 121

What imaging features are diagnostic of annular pancreas?

A

Presence of visible pancreatic tissue posterior and lateral to the descending duodenum

177
Q

Case 121

What is the MC presentation of annular pancreas?

A

Duodenal obstruction

178
Q

Case 122

What is the most common primary malignancy of the duodenum?

A

Adenocarcinoma

179
Q 
Case 122
Which of the following conditions results in the highest risk of duodenal carcinoma?
A. Celiac disease
B. Crohn's disease
C. Neurofibromatosis
D. Gardner's syndrome
A

Gardner’s syndrome

180
Q

Case 122

What is the MC location of duodenal carcinoma?

A

Descending duodenum (D2)

181
Q

Case 123

What is the difference between T4a and T4b in esophageal cancer?

A

T4a = invades pleura, pericardium or diaphragm. RESECTABLE.

T4b = invades aorta, vertebral body, trachea, or bronchus. UNRESECTABLE.

182
Q

Case 124

What is the mechanism of Mirizzi’s syndrome?

A

Gallstone impacted in cystic duct resulting in compression of the common hepatic or common bile duct secondary to local inflammatory response

183
Q

Case 123

What is the definition of T4 disease in esophageal cancer?

A

T4 = invasion of local structures

- determines resectability

184
Q

Case 123

Historically, what is the MC type of esophageal carcinoma?

A

Squamous Cell Carcinoma

- AdenoCA increasing and now more equal

185
Q

Case 124

What is a potential surgical pitfall in Mirizzi’s syndrome?

A

Inadvertent ligation of the common hepatic duct

186
Q

Case 124

Most common cause of obstructive jaundice?

A

Choledocolithiasis

187
Q

Case 125

What is the MC source of hematogenous metastatic disease to the colon?

A

Breast cancer

188
Q

Case 125

What is the MC site of GI tract metastasis from breast cancer?

A

Stomach

189
Q

Case 125

What is the MC type of breast cancer histology to result in metastatic spread to the GI tract?

A

Lobular carcinoma

- vs ductal infiltrative

190
Q

Case 125

What is the most common morphology of GI mets from primary lobular breast carcinoma?

A

Linitis plastica

191
Q

Case 126

What percentage of Meckel’s diverticula contain gastric mucosa?

A

About 50%

192
Q

Case 126

What is the cause of Meckel’s?

A

Embryologically the incomplete obliteration of the vitelline duct (omphalomesenteric duct)

193
Q

Case 126
What nucs study is used for Meckel’s?

How reliable is it?

A

Tc99 pertechnetate
- to detect gastric mucosa

Not very

194
Q

Case 126
T/F
In scintigraphic evaluation of Meckel’s, pentagastrin and glucagon are useful

A

True

195
Q

Case 126

What are potential complications of Meckel’s diverticulum?

A 
Pain
Bleeding
SBO
Intussusception
Volvulus
Littre hernia
196
Q

Case 126

In Meckel’s diverticula, what other type of ectopic tissue may be found besides gastric mucosa?

A

Pancreatic tissue

197
Q

Case 126

On angiography, what is diagnostic of Meckel’s diverticula?

A

A persistent Vitelline artery

198
Q

Case 126

What potential appearance does Meckel’s have on CT?

A

Elongated ileal polyp

199
Q

Case 126

Plain film radiographs visualize about 50% of Meckel’s enteroliths

A

True

200
Q

Case 126
How common is a Meckel’s enterolith?

Potential complications?

A

10 %

Obstruction and bleeding

201
Q

Case 127

Which side is more common with traumatic diaphragmatic rupture?

A

Left sided

- 8 x more likely

202
Q

Case 127

What is the most common perception error in right sided diaphragmatic rupture?

A

Mistaken for elevation or eventration of the intact hemidiaphragm

203
Q

Case 127

What is the most common type of diaphragmatic tear in blunt trauma?

A

Posterolateral and radial

204
Q

Case 127

Most common visceral injury associated with left diaphragmatic injury?

A

Spleen

205
Q

Case 128

What is the MC technique for esophagectomy?

A

Ivor-Lewis esophagectomy

206
Q

Case 128

What is the MC intraoperative complication in esophagectomy?

A

Recurrent laryngeal nerve injury

207
Q

Case 128

What is the most common non-malignant reason for performing an esophagectomy in a pediatric patient?

A

Esophageal Atresia

208
Q

Case 128

In the setting of esophagectomy with jejunal interposition, what are the major long term complications?

A

Gastric acid reflux

TEF

209
Q

Case 129
What type of hepatoma occurs in young adults?

Sex predominance?

A

Fibrolamellar hepatoma

Males

210
Q

Case 129

What percentage of fibrolamellar hepatomas calcify?

A

50%

211
Q

Case 129

What is the appearance of the central scar of fibrolamellar HCC on MRI?

A

Typically hypointense on all sequences

212
Q

Case 129

What is the appearance of fibrolamellar hepatoma on Tc-99m sulfur colloid imaging?

A

Does not take up sulfur colloid

- does not contain Kupfer cells

213
Q

Case 129

In younger patients, what is an unusual variant of hepatocellular carcinoma?

A 
Fibrolamellar carcinoma
Not assoc w
- cirrhosis
- chronic hepatitis
Responds well to chemo
214
Q

Case 130

Most common gastric malignancy?

A

Adenocarcinoma

215
Q

Case 128

Which is the most common type of esophageal atresia often associated with tracheoesophageal fistula?

A

EA with distal TEF

216
Q

Case 130

List two complications of lesions in the pre-pyloric gastric antrum?

A

Gastric outlet obstruction

Transpyloric extension

217
Q

Case 130

What is the MC gross appearance of gastric adenocarcinoma?

A

Mass lesion

NOT: ulcer, linitis plastica, or thickened folds

218
Q

Case 131
What type of injury is MC associated with traumatic pancreatic injury?

What is the incidence pancreatic injury in the setting of blunt trauma?

A

Penetrating injury

10%

219
Q

Case 130

Most likely malignancy to cross the pylorus?

A

Adenocarcinoma

  • Lymphoma has a greater tendency but
  • AdenoCA is much more common (90%)
220
Q

Case 131

What is the most common site of pancreatic injury?

A

Body of the pancreas

221
Q

Case 131

What is the most important concern in suspected pancreatic injury?

A

Injury of the main pancreatic duct

222
Q

Case 132

What infectious dz of the small bowel typically involves the terminal ileum?

A

Yersinia enterocoliticus

223
Q

Case 133

What is the MC site of involvement with acute GVHD?

A

Skin

224
Q

Case 133

What are the major organs involved in graft v. host disease (GVHD)?

A

Skin
GI
Lungs
Liver

225
Q

Case 133

When does subacute GVHD occur?

A

Within 1-4 months of BMT

226
Q

Case 133

What is the MC site of GI tract chronic GVHD?

A

Oral cavity

227
Q

Case 133

How does GVHD manifest itself in the GI Tract?

A

Fold thickening
Effacement of folds
Luminal Narrowing
Separation of bowel loops

228
Q

Case 134

In mastocytosis, what is the skin condition called?

A

Urticaria Pigmentosa

229
Q

Case 134

What are the clinical and imaging manifestations of mastocytosis in the small bowel?

A 
Diarrhea
Tachycardia
Flushing
Thickened folds
Bowel wall thickening
PUD
230
Q

Case 134

After the skin, what is the MC site of involvement in mastocytosis?

A

Small bowel: Thickened folds and bowel wall thickening

231
Q

Case 135

What part of the GI tract does actinomycosis classically involve?

A

Ileocecal junction

232
Q

Case 135

What iatrogenic pelvic procedure has been associated with sigmoid actinomycosis?

A

IUD placement

233
Q

Case 135

What is the treatment of choice in Actinomycosis?

A

Penicillin

234
Q

Case 135

Characteristics of Actinomyces israelii

A

Gram-positive bacillus
Normal GI fluora
Can breach normal barriers
- like TB

235
Q

Case 136

What is the anatomic site of weakness in a Killian-Jameson diverticulum?

A
  • Below the level of the cricopharyngeus muscle

- Lateral to the longitudinal muscles of the esophagus

236
Q 
Case 136
Which of the following is a true diverticulum?
A. Traction diverticulum
B. Zenker's diverticulum
C. Killian-Jamieson diverticulum
D. Intramural pseudodiverticulum
A

A. Traction diverticulum

237
Q

Case 136

What is a potential surgical pitfall in resecting a Killian-Jamieson diverticulum?

A

Recurrent laryngeal nerve injury

238
Q

Case 136

Why is it important to distinguish betwen Killian-Jamieson and Zenker’s diverticulum?

A

Surgical management differs

  • KJ requires endoscopic management
  • Due to potential recurrent laryngeal nerve injury
239
Q

Case 134

Name two conditions that result in elevation of serum gastrin levels.

A
  1. Zollinger-Ellison syndrome
    - gastrin-secreting tumor
    - results in highest gastrin levels
  2. Mastocytosis
    - mast cells release histamine
    - increases gastrin levels
239
Q

Case 137

What is the MC cause of an appendiceal mucocele?

A

Mucinous cystadenoma

240
Q

Case 138

Most common cause of asymmetric ovoid intramural mass in the duodenum?

A

Duodenal hematoma

- Trauma

241
Q

Case 136
With regards to the cricopharyngeus muscle and position relative to midline, what are the differences between KJ and Zenker’s diverticula?

A

Cricopharyngeus Bar

  • Z is above
  • KJ is below

Midline

  • Z is midline
  • KJ is Lateral

A/P

  • Z is posterior
  • KJ is anterior
241
Q

Case 137

Most common malignant neoplasm of the appendix?

A

Mucinous Adenocarcinoma

242
Q

Case 138
T/F
In the setting of MVA and blunt abdominal trauma in children, abdominal wall bruising indicates significant intraabdominal injury in children

A

True

243
Q

Case 137

What is the MC neoplasm of the appendix?

A

Carcinoid

- Typically benign

245
Q

Case 139

What is the most consistently recognized CT finding of active Crohn’s disease?

A

Bowel wall thickening

246
Q

Case 139

What is the most common cause of small bowel obstruction in young adults?

A

Adhesions

247
Q

Case 140

What percentage of colonic adenomas at 1 to 2 cm in diameter contain carcinoma?

A

10%

248
Q

Case 139
T/F
A person with Crohn’s disease is more likely to have a relative with IBD

A

True

249
Q

Case 140

What is the MC site of colonic villous adenomas?

A

Rectum

250
Q

Case 141

Describe Zollinger-Ellison Syndrome

A

Excessive gastrin secretion

  • Secondary to non-islet cell tumors
  • > Gastrinomas predominantly pancreatic
    • 60 % are malignant
  • PUD from elevated gastrin levels
  • Associated with MEN I
  • -> Parathyroid, pituitary, adrenal
  • Hypervascular on CT (arterial phase)
251
Q

Case 140
T/F
Incidence of carcinoma in colonic adenomas increases with increasing size

A

True

252
Q

Case 140

Which imaging sign on barium enema is used to describe a pedunculated polyp?

A

Mexican hat sign

253
Q

Case 141

What other diseases are gastrinomas associated with?

A

MEN I

  • Parathyroid
  • Pituitary
  • Adrenal tumors
254
Q

Case 141
What is the typical clinical presentation of Zollinger-Ellison syndrome?

What typical appearance on UGI series?

A

Diarrhea

Thickened gastric rugal folds

255
Q

Case 141

What are the MC locations for gastrinoma?

A 
Pancreas - 75%
Duodenum - 15%
Para-aortic
Bladder
Ovaries
Liver
255
Q

Case 141

What is the typical appearance of a pancreatic gastrinoma on CT?

A

Hypervascular tumor

  • Enhances brightly on arterial phase
  • Typically in the pancreatic head
256
Q

Case 141

What serum levels of gastrin is indicative or suggestive of ZES?

A

Anything > 1000 pg/mL

257
Q

Case 142

What is the most important vascular finding in patients with GI malrotation?

A

SMA/SMV transposition

258
Q

Case 141

What is the best diagnostic test to localize a gastrinoma?

A

In-111 Octreotide scan

- Somatostatin receptor scintigraphy

259
Q

Case 142

In malrotation, what is the leading cause of death?

A

Congenital heart disease

  • heterotaxy
  • other congenital abnormalities
260
Q

Case 143

What operation can result in gastric fundal pseudotumor?

A

Fundoplication

261
Q

Case 143

What is the most serious complication of partial gastrectomy?

A

Cancer

262
Q

Case 142

What is the typical presentation of midgut malrotation?

A

Newborn

263
Q

Case 143

What is pseudo-lymphoma of the stomach?

A

Lymphoid tissue proliferation that simulates lymphoma

264
Q

Case 144

Most common foreign body seen in the upper esophagus?

A

Fish or chicken bone

- typically difficult to see radiographically

265
Q

Case 145

What is the MC tumor associated with dilation of the pancreatic duct?

A

Ductal adenocarcinoma of the pancreatic head

266
Q

Case 145

Dilated pancreatic duct containing signal poor filling defects on MRCP?

A

Calculi

267
Q

Case 144

What is the MC site of impaction of an ingested foreign body?

A

Pharynx

- Lateral radiograph gives the best chance to detect

268
Q

Case 145

Even though MRCP is superior to CT in the evaluation of the biliary tract, what advantage does CT have over MR?

A

CT has better spatial resolution

269
Q

Case 146

List five causes of fistula

A 
Diverticulitis
Crohn's
TB
Neoplasm
Radiation
271
Q

Case 146

What is the MC cause of lower urinary tract fistulas?

A

Gynecologic surgery

272
Q

Case 146

What is the most common etiology of colovesical fistula?

A

Diverticulitis

273
Q

Case 146

What is the most common type of fistula to the lower urinary tract?

A

Fistula to vagina

274
Q

Case 147

Name 4 infections that typically affect the ileocecal region

A

Tuberculosis
Amebiasis
Yersiniasis
Actinomycosis

275
Q

Case 147

Most common site of involvement of abdominal tuberculosis?

A

Lymph nodes

276
Q

Case 148
What is the triad of findings for gallstone ileus?

What is it called?

A

Ectopic gallstone in bowel
Small Bowel Obstruction
Pneumobilia

Rigler’s triad

277
Q

Case 148

In gallstone ileus, where does the gallstone typically become impacted?

A

Terminal ileum

278
Q

Case 147

What is the characteristic appearance of tuberculosis at the terminal ileum

A

Thickening of the lips of the ileocecal valve with gaping of the valve and narrowing of the terminal ileum

279
Q

Case 148

How often is Rigler’s triad seen on plain film radiography?

A

10%

280
Q

Case 149

Most common complication of colon cancer?

A

Obstruction

281
Q

Case 149
In the setting of colonic perforation, what features can help distinguish between malignancy and other benign causes of perforation?

A

Irregular thickening of the colonic wall

282
Q

Case 149

What finding can help distinguish colon carcinoma from diverticulitis?

A

Presence of pericolic lymph nodes

283
Q

Case 150

What MRI finding most reflects active pathologic inflammation of the bowel in Crohn’s dz?

A

Contrast enhancement

284
Q

Case 150

What is the advantage of MRI over CT for the evaluation of Crohn’s?

A

Lack of ionizing radiation

286
Q

Case 100
Most common cause of:
Primary Achalasia
Secondary Achalasia

A

Primary: Idiopathic
Secondary: Cancer

287
Q

Case 150

Name five causes of small bowel feces

A

Anything that delays SB transit time

  • Crohn’s
  • Obstruction
  • Ischemia
  • Adhesions
  • Cystic fibrosis

GI (3 decks)

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