GI from CTC Flashcards
Esophageal 1-4
critical = 3 vs 4
1 vs 2 endoscopic dx
Stage 3 = adventitia
Stage 4 = invasion in to adjacent structures
4a resectable (pleura, pericardium diphragm)
4b NOT (trachea, aorta)
esoph candida
early vs late
old person mimic
MC = discrete plaque like lesions
later shaggy
older person mimic with multiple elevated nodules = glycogenic acanthosis
esoph ulcers
herp vs HIV/CMV
herp small and multiple with halo
HIV/CMV large and flat
MC sites for dup cysts
1 ileum
2 gus
scleroderma small bowel
hidebound, stack of coins, narrowly separated valvulae conniventes
achalasia cancer risk type
squam
ZE ulcers MC spot
bulb
Gardner syndrome
(FAP)
multiple osteomas especially of the mandible, skull and long bones
desmoid tumours of mesentery and anterior abdominal wall
Cowden’s
HAMARTOMAS
Breast cancer
Lhermitte Duclos
GIST
where and who
70% stomach
over 40y
benign ulcer features
deeper than wide
lesser curvature
folds radiate to ulcer
gastric vs duodenal ulcers
duey
never cancer
“increased peptic acid”
solitary
stomach
“altered mucosal resistance”
5% cancer, 2/2 h pylori
MC extranodal site for NON hodgkin lymphoma
Stomach
vs primary stomach lymphoma, MALT
Linitus plastica primary and mets
Primary = scirrhous adenocarcinoma
or breast or lung mets
ram’s horn ddx
ulcer scarring
Granulomatous
Crohns
Sarcoid
Scirrhous Cancer
“Isolated gastric varices”
Splenic vein thrombosis
(panc cancer or itis —> splenic thrombus —> isolated gastric varices)
area gastricea enlarged by?
obliterated by?
elarged in elderly and H pylori, enlarges next to an ulcer
obliterated cancer or atrophic gastritis
fold density jej vs il
jejunum more packed (4-7 per inch)
2-4 per inch in ileum
contrast % weight by vol
CT
smal bowel
double barium
CT = 2% wt/vol
Small bowel = 20-30% wt/vol
double barium = 98% wt/vol
Whipples
strippers - old men in 50’s
thickened folds and nodules
Duoy and Jej
MC small bowel adeno
duoy
which side
epiploic append
omental infarct
ROI
RIGHT = omental infarct
Epiploic appendagitis on LEFT
appendix mucocele
MC mucinous tumor of the appendix
gets big, looks like cystadenoma
rupture = pseudomyxoma peritoneii
“onion sign”
toxic megacolon causes and must
UC, Crohns (less) and Cdiff
NO haustra
rectal phleboliths
rectal cavernous hemangioma
klippel trenaunay weber
Blue Rubber Bleb
entamoeba histolytica site
cecum and ascending colon MC
“coned cecum”
spares TI
colonic TB
INVOLVES TI
also coned cecum
ulcers and areas of narrowing
pseudomyxoma peritoneii causes
ruptured mucocele MC = appendix
mucinous neoplasm (ovary, colon, appendix and panc)
leads to obstructions
cause of atrophy hypertrophy in cirrhosis
Right portal vein takes a longer course
placenta circulation
PULI
PUDI
splits. placenta umb LIVER IVC
placenta umb DUCTUS IVC
regenerative vs dysplastic vs hcc
regen T1 and T2 dark
dysplastic T1 bright
HCC T2 bright and enhancing
Liver window
Center = 100
Width = 200
OWR liver
cirrhosis with massively enlarged hepatic artery
Single liver abscess =
multiple =
single = kleb
multiple = e coli
ddx for CT enhancement patterns
washout -
iso -
persist-
washout = HCC, mets, adenoma, abscess
iso = FNH
persists = hemangioma
FNH trivia
scar looks like
nucs study
Scar has delayed enhancement (fibrolamellar HCC doesn’t)
Sulfur colloid
FNH is MRI stealth, T1 and T2 iso
Hepatic adenoma on MRI feature
microscopic fat
drop out on out of phase (out of phase has india ink)
Fibrolamellar scar and nucs stuff
T2 dark scar that doesn’t enhance
HOT ON GALLIUM
MRI liver phase timing
CT
arterial = 30 seconds
PV = 70 seconds
hep vein = 90 sec - 5 mins
CT
30sec
80 sec
3-5 minutes
Cholangio T4 =?
main vein/artery
secondary biliary radicles
lead to desmo reaction and delayed enhancement
hepatic angiosarc a/w?
toxic exposure - arsenic, PVC, radiation, thorotrast
multifocal, bleeds
cystic liver lesion in middle aged female
biliary cystadenoma
can’t distinguish from carcinoma
calcified liver mets
colon, ovary, pancreatic (mucinous tumors)
Gallium hot liver thing
HCC or abscess
T1/T2 bright liver thing, gross fat on CT
liver AML (TS)
Budd chiari look
large regenerative nodules in a dysmorphic liver (huge caudate)
acute flip flop with high attenuation peripherally
massive caudate ddx
Budd
PSC
PBC
pseudocirrhosis
treated breast (or colon) mets can mimic with retraction and caudate enlargement
liver transplant US
normal HA velocity
<200
bil dil rare in all types of cirrhosis except?
PSC
multifocal strictures/ PSC mimic in HIV
AIDS cholangiopathy
CRYPTO
left dominant, recurrent dilated ducts full of stones
Oriental/recurrent pyogenic cholangitis
Caroli’s a/w
PcKD
medullary sponge
% with synchronous polyps
(ie chance someone with an adenomatous polyp cut out has another one)
30-50%
normal PV vel
20-40 cm/s
complication of enzyme replacement therapy in CF
fibrosing colonopathy
wall thickening of proximal colon
young pancreatitis with dilated, stone filled duct
hereditary or tropical
increased adenoCa risk
IPMN a/w malig = ?
MAIN BRANCH
all considered malignant and should be resected
diffuse dilatation, calcs, atrophy (mimics chronic itis)
SPEN b9 or malig?
low grade malignant tumor
thick capsule
may have progressive fill in
unresectable panc cancer = ?
involvement of SMA/celiac axis
GDA comes out anyway
Panc NET
MC overall
MC with MEN
Highest malig potential
MC overall = insulinoma
MC with MEN = Gastrinoma
Highest malig potential = glucagonoma
nonfunctional = big, malignant, metastatic
T2 dark things in spleen
GG bodies, foci of hemorrhage
a/w portal HTN
MC GI sites for sarcoid
antrum MC in GI tract
spleen in 50-80% (usually just big)
splenic aneurysms
who gets more
when to treat
preggos
2-3 cm
classic bug and setting for splenic abscess
salmonella
