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GI Opening Round Flashcards

1
Q

Case 1
In ischemia, bowel wall may be hyperdense on non-contrast CT
T/F

A

True

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2
Q

Case 1

What is the best initial study for SBO?

A

Plain film

Air-fluid levels are typically seen within 48-72 hrs of obstruction

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3
Q

Case 2

What is the best initial study for the diagnosis of appendicitis in children and pregnant women?

A

Ultrasound

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4
Q

Case 2

Pericolic stranding of the right colon with sparing of the cecal pole is suggestive of what?

A

Cecal diverticulitis

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5
Q

Case 3

What is the most common type of colonic volvulus?

A

Sigmoid volvulus (50-75%) is most common

Cecal volvulus is 2nd MC (20-40%)

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6
Q

Case 3
Subtype of cecal volvulus where the cecum flips up and over an adhesion across the ascending colon and presents as an air filled subhepatic structure

A

Cecal bascule

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7
Q

Case 3

Sign of cecal volvulus on CT

A

Bird beak sign

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8
Q

Case 3

Purpose of CT in the setting of cecal volvulus

A

Influence treatment by detecting complications of volvulus

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9
Q

Case 4

What type of diaphragmatic hernia is most associated with GERD?

A

Sliding-type

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10
Q

Case 4
T/F
1. Bulimia patients are at an increased risk for GERD

  1. Episodic insomnia is a manifestation of chronic GERD
A
  1. True

2. True

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11
Q

Case 4

Four fluoroscopic findings of chronic GERD

A

Fold Thickening
Granular Appearance
Superficial Ulcerations
Luminal Narrowing

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12
Q

Case 4

Three complications of chronic GERD

A

Barrett’s Metaplasia
-precursor of AdenoCA
Stricture
Ulceration

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13
Q

Case 5
Which of the following is true regarding colonic diverticulitis?
A. Colonic diverticula are true diverticula
B. Diverticulitis is the MC cause of colovesical fistula
C. Diverticular hemorrhage usu. ensues if diverticulitis is untreated
D. Diverticulitis of the right colon is more likely to progress rapidly to complications

A

B. Diverticulitis is the MC cause of colovesical fistula

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14
Q

Case 5

What is the role of BE for diverticular disease?

A

Useful in chronic diverticulosis. Can be helpful for operative planning.

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15
Q

Case 5

What is the finding on BE of acute diverticulitis?

A

Appearance of an intramural tract

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16
Q

Case 6

What is the MC type of enteric cyst?

A

Esophageal duplication cyst (25%)

They are most commonly asymptomatic

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17
Q

Case 6

What nucs study can be helpful for the diagnosis of esophageal duplication cysts?

A

Tc-99m perctechnetate is positive in up to 50% of cases

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18
Q

Case 6

Name three Foregut Congenital Cysts

A

Neurogenic
Bronchogenic
Enteric duplication

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19
Q

Case 7

What is the MC malignancy of distal small bowel?

A

Carcinoid

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19
Q

Case 6

Most common symptom of esophageal duplication cyst

A
  • None
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20
Q

Case 7

What is the MC tumor of small bowel?

A

GIST

Second MC - Lipoma

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20
Q 
Case 7
What polyposis syndrome is associated with increased risk of small bowel cancer?
A. Lynch syndrome
B. Peutz-Jeghers
C. Cronkhite-Canada
D. Cowden syndrome
A

B. Peutz-Jeghers

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21
Q

Case 7
What is the MC location for intussusception in adults?
MC etiology?

In Children?

A

Location - ileoileal
Etiology - polyp / tumor

Location - ileocolonic
Etiology - lymphoid hyperplasia

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22
Q

Case 7

Typical manifestations of small bowel tumors

A 
Bleeding
Bowel Obstruction
Intussusception (5-15% in adults)
- mainly in children 2o to Lymphoid hyperplasia
- most are transient
SB tumors are typically asymptomatic
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23
Q

Case 8

What is the BE sign at the site of torsion with sigmoid volvulus?

A

Bird’s beak

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24
Q

Case 8
T/F
1. Volvulus is the 3rd most common cause of colonic obstruction, sigmoid is the most common type of volvulus.
2. Laparotomy and sigmoidopexy are the therapy of choice for sigmoid volvulus
3. A redundant sigmoid colon is a predisposing factor to sigmoid volvulus
4. The development of gangrene is suggested by clinical signs of peritonism or imaging signs of pneumoperitoneum or pneumatosis

A
  1. T
  2. F
  3. T
  4. T
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25
Q 
Case 9
Which of the following features is most suggestive of a malignant gastric ulcer?
A. Gastric antrum location
B. Ulcer projects outside gastric lumen
C. Clubbed surrounding rugal folds
D. Associated duodenal ulcer
E. Hampton's line present
A

C. Clubbed surrounding rugal folds.

B and E are suggestive of benign ulcer

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26
Q

Case 9

Describe clubbing of gastric folds

A

The termination of a fold swells into a clublike configuration

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28
Q 
Case 9
Yes / No
Associated with gastric malignancy
1. AIDS
2. Benign gastric ulcer
3. H. Pylori
4. Nitrites and nitrates
5. Partial gastrectomy
A
  1. Yes
  2. No
  3. Yes
  4. Yes
  5. Yes
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29
Q

Case 9

Best imaging study for gastric cancer staging

A

CT

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31
Q

Case 10

DDx for widening of the presacral space

A

Rectal perforation - abscess
Sacral chordoma - other sacral bony process (metastasis)
Anorectal carcinoma
Pelvic lipomatosis

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31
Q

Case 9

Define Hampton’s line

A
  • Well-defined thin lucency at the base of the ulcer
  • Ulcer collar
  • Characteristic of benign ulcer
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32
Q

Case 9

What is clubbing?

A
  • Indicative of malignant gastric ulcer

- The termination of a fold swells into a club-like configuration

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33
Q

Case 10

What is the most common retrorectal tumor

A

Ependymoma

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34
Q

Case 11
Cause of duodenal obstruction in young female with h/o weight loss that is worsened in supine position compared to upright?

A

SMA syndrome

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35
Q

Case 11

What is the abnormal SMA angle in SMA syndrome?

A

Aortomesenteric angle of less than 25 degrees

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36
Q

Case 11

Four predisposing conditions to SMA syndrome

A

Young women with eating disorders
Burn patients
Patients in body casts
Severe illness and sudden weight loss

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37
Q

Case 11

What is the surgical intervention for SMA syndrome?

A

Gastrojejunostomy

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38
Q

Case 12

What is the MC type of solid organ injury in blunt trauma?

A

Splenic injury (25%)

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39
Q

Case 12

What is a potential latent complication in patients who have undergone splenectomy

A

Encapsulated bacterial sepsis

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40
Q

Case 12
What is a grade 1 splenic injury?

What is a grade 5 splenic injury?

A

Grade 1: Subcapsular hematoma less than 10% of surface area and /or capsular tear of less than 1 cm, non-expanding and not actively bleeding

Grade 5: Shattered spleen with involvement of vascular pedicle

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41
Q

Case 13

What is the Borchardt triad and what is it diagnostic of?

A

Pain
Nonproductive retching
Inability to pass NGT

Diagnostic of gastric volvulus
Present 70% of the time

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42
Q

Case 13

What subtype of gastric volvulus results in the antrum being displaced toward the fundus?

A

Mesenteroaxial volvulus

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43
Q

Case 14

What is the MC histologic subtype of colonic adenomatous polyp

A 
Tubular adenoma (80%)
 - Very little risk for malignant degeneration
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44
Q

Case 13
What type of gastric volvulus is most common?
Which type is most serious?
What is the typical anatomic defect?

A

Most common: organoaxial
Most serious: mesenteroaxial (due to increased risk of strangulation)
Abnormal laxity of the gastric ligaments

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45
Q

Case 14

What type of colonic polyp is associated with malignancy?

A

Villous adenoma

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46
Q

Case 14
What is the malignant potential of a colonic villous adenoma based on size?
1-2 cm
>2 cm

A
  • 10% risk

- 30-40% risk

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47
Q 
Case 15
Which of the following is an iatrogenic cause of pneumatosis intestinalis?
A. O2 therapy
B. Hyperbaric oxygen
C. Chemotherapy
D. Dialysis
A

C. Chemotherapy

Also, ischemia, C diff colitis, NEC, steroids, obstruction, trauma, endoscopy, malignancy, Crohn’s dz

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48
Q

Case 15

What is pneumatosis intestinalis cystica?

A

Benign condition with subserosal blebs in the distal bowel.

Caused by migration of air along bronchovascular pathways to mesentery (Macklin’s pathway)

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49
Q

Case 16

What is the minimal volume for free air to be visible on upright film?

A

1-2 cc

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50
Q

Case 16

How long does it take for free air to reabsorb following surgery?

A

Usually 3-10 days.

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51
Q

Case 16

What can affect the reabsorption of pneumoperitoneum?

A

Body habitus - thin patients taking longer

Postoperative ileus or peritonitis - can prolong

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52
Q

Case 17

What can occur in the duodenum as a result of hyperacidity?

A

Brunner gland hypertrophy

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53
Q

Case 17

DDx for multiple small filling defects in the duodenal bulb?

A

Heterotopic Gastric Mucosa
Benign Lymphoid Hyperplasia
Brunners Gland Hyperplasia
Pancreatic Rests

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54
Q

Case 17

Name 4 polyposis syndromes

A

Familial Adenomatous Polyposis
Peutz-Jeghers Syndrome
Cronkhite-Canada Syndrome
Filiform Polyposis

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55
Q

Case 17

Which polyposis syndrome does not involve the duodenum?

A

Filiform polyposis

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56
Q

Case 17
Name 4 benign tumors of the duodenum?

What is the MC benign tumor of the duodenum?

A

Adenoma
Neurofibroma
Leiomyoma (GIST)
Mesenchymal tumors

Mesenchymal tumors

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57
Q

Case 18
Which of these viscera are not related to the descending duodenum?
Aorta, Gallbladder, Common bile duct, Right Kidney, Pancreas

A

Aorta

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58
Q

Case 18

What adjacent organs bear a close relationship with the duodenum and may result in thickened duodenal folds?

A

Pancreas
Right Kidney

  • Duodenal folds may also be thickened due to spasm from pancreatitis
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59
Q

Case 18

MC cause of duodenal inflammation?

A

Hyperacidity and peptic ulcer dz

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60
Q

Case 18

Other causes of thickened duodenal folds?

A

Zollinger-Ellison synd
Eosinophilic Enteritis
Crohn’s disease

Whipple’s disease
Amyloid
Malignancies

Hypoproteinemia
Intramural bleeding

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61
Q

Case 18

What is the MC malignancy of the duodenum?

A

Adenocarcinoma (64%)

Followed by carcinoid (21%), lymphoma (10%), sarcoma (4%)

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62
Q

Case 19
What is the MC cause of acute pancreatitis in Western society?

Other causes?

A

Alcohol

  • mainly younger patients
  • oder patients -> billiary
                      Trauma
                  Drugs    Iatrogenic - ERCP
            Idiopathic
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63
Q

Case 19
Cullen sign?

Grey Turner sign?

A

Bluish discoloration around umbilicus

Discoloration along the flanks

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64
Q

Case 19

Nearly all cases of pancreatitis result in some change in which lung base?

A

Left

  • atelectasis
  • effusion
  • airspace disease
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65
Q

Case 20

What is the MC primary lymphoma of the stomach?

A

MALT

Mucosa-associated Lymphoid Tissue

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66
Q

Case 20

Name 4 known risk factors for gastrointestinal lymphoma

A

AIDS
H. Pylori
Celiac Dz
Epstein Bar Virus

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67
Q

Case 20

What is the most common area of the GI tract affected by lymphoma?

A

Stomach
- half primary and half generalized dz

Lymphoma accounts for only 5% of gastric malignancies
Most are Non-Hodgkins
Primarily affects men and older age groups

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68
Q

Case 21

T or F: Arterial obstruction is the MC cause of ischemic colitis

A

False
Most commonly caused by low-flow states
- Hypotension
- Heart failure

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69
Q

Case 21

Prognosis of ischemic colitis?

A

Most patients improve and fully recover

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70
Q

Case 22

What are the MC type of splenic cyst?

A

Post-traumatic cysts

Congenital epidermoid cysts

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71
Q

Case 22

What is the MC benign neoplasm of the spleen?

A

Hemangioma

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72
Q

Case 22

What is the MC splenic malignancy?

A

Lymphoma

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73
Q

Case 23

What are the normal extrinsic impressions of the esophagus on barium swallow?

A
  1. Aortic arch
  2. Left mainstem bronchus
  3. Left atrium
  4. Diaphragmatic Hiatus
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74
Q

Case 23

What can produce an anterior esophageal impression on barium swallow?

A

Pulmonary sling

75
Q

Case 23

What is dysphagia lusoria?

A

Impression on the esophagus by any vascular structure

76
Q

Case 24

What abdominal neoplasms are seen in VHL?

A 
RCC (clear cell)
Pheochromocytoma
Pancreas
 - Cystic
 - Islet cell
77
Q

Case 24

Describe von Hippel-Lindau dz

A

AD inheritance

  • Capillary angiomatous hamartomas
  • CNS involvement of brain and retina
  • Typically hemangioblastoma of posterior fossa
  • Abd tumors - RCC, pheo, cystic islet cell pancreas
  • Mult panc cysts of various sizes
    • -> suspect VHL
78
Q

Case 25

What is the most likely lesion to cause large masses in the gut without obstruction?

79
Q

Case 25

What small bowel lesion results in eleveated 5-HIAA in the URINE?

80
Q

Case 25

Describe aneurysmal dilation of small bowel

A

Large mass encasing the small bowel, in which the gut lumen is channeled through the lesion, leaving a false channel surrounded by tumor but without obstruction
- This is a particular characteristic of NH Lymphoma in the SB

81
Q

Case 26

What is the MC herniated organ in patients with traumatic diaphragmatic rupture?

82
Q

Case 27

What is the MC type of GB polyp?

A

Cholesterol
Followed by
- Adenoma
- Papilloma

83
Q

Case 27

Although uncommon, what can metastasize to the gallbladder

A

Melanoma
Breast CA
Lymphoma

84
Q

Case 28

What conditions are associated with emphysematous gastritis?

A

Pulmonary dz
Peptic Ulcer dz
Gastric Outlet Obstruction
Endoscopy (esp w intervention)

85
Q

Case 28

What is the MC location for intramural gas to occur in the GI tract?

86
Q

Case 28

What infectious processes can result in emphysematous gastritis?

A

Hemolytic Strep
Clostridium species
Coliform bacteria

87
Q

Case 28

Ingestion of what substances can cause emphysematous gastritis?

A

Ingestion of corrosive substances

- such as in suicide attempts

88
Q

Case 29

What is the MC malignancy at the GE junction?

A

Adenocarcinoma

89
Q

Case 29

What inflammatory condition predisposes to Adeno CA of the GE junction?

A

Barrett’s metaplasia

90
Q

Case 30
What is the Carmen meniscus sign and what does it indicate?

How is CMS best seen?

A

Large semi-lunar or lenticular shaped hypodense zone

  • Seen in ulcerating gastric adenoCAs
  • Flattened polypoid mass with a broad central ulceration
  • Gastric mucosa adjacent to the polyp forms a smooth inner margin
  • Must be located along lesser curvature or antrum to see this sign

Single-contrast or biphasic studies

91
Q

Case 30

What is the Kirkland (Kirklin’s) complex?

A
  • Seen in ulcerated gastric cancer

- Concave lucent margin around the ulceration

92
Q

Case 31

Which type of inflammatory bowel disease is associated with higher risk of malignancy?

A

Ulcerative colitis

93
Q

Case 31

Is the terminal ileum involved with UC?

94
Q

Case 31

Which is most likely to cause fistulas - UC vs Crohn’s?

95
Q

Case 31

Which IBD has the greatest risk for malignancy?

96
Q

Case 32

How can you distinguish portal venous gas from pneumobilia?

A

Portal venous gas is more peripheral

97
Q

Case 32

What are some benign causes of portal venous gas?

A

Bowel obstruction
Instrumentation
Bowel surgery

98
Q

Case 32

In the setting of portal venous gas - what must be excluded?

A

Catastrophic bowel necrosis

99
Q

Case 33

How is a malignant gastric stromal tumor distinguished from a benign one on imaging?

A

Presence of metastasis

- No other imaging characteristics are specific

100
Q

Case 33

Most common benign submucosal tumor of the stomach?

A

Stromal tumor (leiomyoma)

Ectopic pancreatic rest is a congenital abnormality that mimics leiomyoma

101
Q 
Case 34
Which of the following is a predisposing factor to the development of cholangiocarcinoma?
A. Postviral hepatic fibrosis
B. Recurrent bacterial infection
C. Echinococcal cyst
D. Sclerosing cholangitis
A

D. Sclerosing cholangitis

102
Q

Case 34

What is a Klatskin’s tumor

A

Cholangiocarcinoma that arises from the confluence of the right and left bile ducts

  • Typically scirrhous cholangiocarcinoma
  • Grows along the ducts
  • Can result in a central mass with focal lobar atrophy
102
Q

Case 35

What is the MC complication of ovarian dermoids?

A

Torsion

- Malignant degeneration is rare

102
Q

Case 34

What are the different forms in which cholangiocarcinoma can present?

A

Biliary Stricture
Biliary Polyp
Liver Mass

102
Q

Case 35

What sign is pathogmonic of ovarian dermoid?

A

Fat-fluid level on imaging

102
Q

Case 35

What variety of tissues are recognized within ovarian dermoids?

A

Fat
Skin
Teeth
Hair

103
Q

Case 36

What is glycogenic acanthosis?

A

Benign condition of the esophagus

  • Nodular esophageal epithelium
  • Occurs in elderly
  • Not clinically important
103
Q

Case 36

Most common cause of infectious esophagitis?

A

Candida albicans

104
Q

Case 36

Esophageal papillomatosis is associated with which skin condition?

A

Acanthosis nigricans

105
Q

Case 35

How often are ovarian dermoids bilateral?

107
Q

Case 36

What imaging feature distinguishes esophageal Candida infection in immunocompromised vs immunocompetent patient?

A

Immunocompromised
- shaggy esophagus

Immunocompetent
- nodular esophagus

107
Q

Case 36

Name three skin conditions that are associated with multiple tiny esophageal nodular lesions

A

Acanthosis nigricans
Bullous pemphigoid
Pyoderma gangrenosum

108
Q

Case 37

What is the definitive treatment for acalculous cholecystitis?

A

Cholecystectomy

Drainage of any associated abscess

108
Q

Case 37

What conditions are associated with acalculous cholecystitis?

A 
Surgery
Trauma
Shock
Ischemia
Mechanical Ventilation
AIDS
Burns
Vasculitis
Parenteral Nutrition
109
Q

Case 38

What is the MC source of hematogenous mets to stomach?

110
Q

Case 38

What is the MC site of melanoma mets to GI tract?

A

Small bowel

116
Q

Case 38

In recent decades, what is the most common cause of bull’s eye lesions in the stomach?

A

Kaposi’s sarcoma

- AIDS

117
Q

Case 38

Name five sources of metastasis to the stomach

A 
Melanoma
Lung
Breast
Kaposi's Sarcoma
Lymphoma
118
Q

Case 38

Define the classic bull’s eye lesion

A

Rounded filling defect with a barium collection at its center (ulceration)

119
Q

Case 39

What polyposis syndrome is assoc with osteomas and cortical hyperostosis?

A

Familial Adenomatous Polyposis

  • Gardner syndrome
  • Now a part of FAPS
120
Q

Case 39

Which polyposis syndrome is autosomal recessive inhertiance?

A

Cronkhite-Canada

All others are AD

  • FAP / Gardner’s
  • Peutz-Jegher’s Syn
  • Cowden’s Syn
122
Q

Case 39

What are clinical features of Cronkhite-Canada syn?

A

Rash
Alopecia
Diarrhea

123
Q

Case 39

What are the two most common malignancies associated with polyposis syndromes?

A

Colon is most common
Periampullary carcinoma

  • Thyroid increased in women
124
Q

Case 39

Which polyposis syndrome is associated with CNS tumors such as glioblastomas and medulloblastomas?

A

Turcot’s Syndrome

125
Q

Case 40

What is the most common etiology of colorectal carcinoma?

126
Q

Case 40

Name 4 risk factors associated with colon cancer

A

Adenomatous polyp
Ulcerative colitis
Patient Diet
Family history

127
Q

Case 40

How common is colon CA relative to other malignancies?

A

Fourth

Lung
Breast
Prostate
Colon

128
Q

Case 41

What is the likely cause of GB wall calcification (porcelain GB)?

A

Chronic cystic duct obstruction with subacute inflammation

128
Q

Case 40

What is the correlation between polyp size in the colon and chance of malignancy?

A

Less than 1 cm 1 %
1 to 2 cm 10 %
Over 2 cm 40%

129
Q

Case 41

What is the MC complication of porcelain GB?

A

GB carcinoma (up to 30%)

130
Q

Case 42

What conditions are associated with esophageal intramural pseudodiverticulosis?

A
  • Strictures
  • Candida esophagitis
  • Other inflammatory conditions
131
Q

Case 42

Describe Esophageal Intramural Pseudodiverticulosis

A
  • Barium filling of exretory ducts of the mucous glands
  • Normal anatomic structures
  • Dilate due to underlying inflammatory process
    • –> Fill with barium
  • Commonly mistaken for ulcers
  • Candida organisms commonly found in pts w/ this condition
  • May result in benign strictures
  • Slightly increased risk of adenocarcinoma
132
Q

Case 43

How do malignant and benign pelvic lesions affect bowel differently?

A

Benign masses
- obstruct

Malignant masses
- invade adjacent serosal surface

133
Q

Case 44

What fungal infection is known to be locally aggressive and breach fascial barriers?

A

Actinomycosis

134
Q

Case 44

What would be the MC cause of psoas abscess worldwide?

A

Tuberculosis

135
Q

Case 45

What is the MC specific histologic subtype of pancreatic malignancy

A

Ductal epithelial adenocarcinoma

136
Q

Case 45

What is the most common clinical presentation of pancreatic cancer?

137
Q

Case 45

Where are most pancreatic cancers located?

138
Q

Case 46

What is the best imaging modality to assess for local spread of gastric cancer?

A

Endoscopic ultrasound

139
Q

Case 46

What percentage of gastric cancers are linitis plastica type?

140
Q

Case 46

What is the name of the association of gastric cancer metastatic to the left axilla?

A

Irish node

142
Q

Case 47

What is the 2nd MC solid organ injured in blunt trauma?

143
Q

Case 48

What is the moulage sign and what is it associated with?

A

Seen on SBFT. Barium forms smooth, featureless elongated columns or clumps in the jejunum.

Associated with celiac dz.

144
Q

Case 49

What is the cause of feline esophagus?

A

Transient spasm of longitudinal muscularis mucosa

145
Q

Case 48

What is the MC finding seen on SBFT in pts with celiac disease?

A
  1. Diffuse dilation of distal small bowel

2. Jejunization of ileum

146
Q

Case 49

What is the MC symptom of eosinophilic esophagitis?

A

Solid dysphagia

146
Q

Case 50

In diverticular hemorrhage, where is the diverticulum typically located?

A

Right colon

147
Q

Case 49

What is the ‘ringed esophagus’ and what is it associated with?

A

A segment of fixed transverse folds

Eosinophilic esophagitis

148
Q

Case 50
Are colonic diverticula true diverticula?

What is thought to be the pathogenesis of diverticulitis?

A

No

Infection secondary to impacted fecal matter

150
Q

Case 50

What percentage of patients older than 60 in the U.S. have colonic diverticula?

151
Q

Case 51

Through what anatomic area does the hernia sac pass in a spigelian hernia?

A

Linea semilunaris

  • Fibrous band of tissue joining the rectus with the oblique muscles
  • Probably a result of weakness or congenital defect
151
Q

Case 51

What is a Littre hernia?

A

A hernia containing a Meckel diverticulum

152
Q

Case 52

What is the MC clinical manifestation of Crohn’s disease?

153
Q

Case 51

What is the unusual hernia which contains only a portion of the bowel loop and not the entire lumen?

A

Richter’s hernia!!

Important b/c it can incarcerate without obstruction

154
Q

Case 52

DDx for wall thickening of the terminal ileum

A

Crohn’s
TB
Yersinia
UC -never involves TI but can appear patulous from backwash ileitis

155
Q

Case 52

Cardinal presentation of Crohn’s

A

Diarrhea
Abdominal pain
Weight Loss

156
Q

Case 52

What is the MC part of the GI tract involved in Crohn’s disease?

A

Small bowel

Commonly a string sign of the TI on a SBS

157
Q

Case 53

What is filiform polyposis of the colon?

A

Diffuse colonic polyps in the colon secondary to chronic ‘burned out’ ulcerative colitis

158
Q

Case 53

Most common acute complication of severe UC?

A

Toxic Megacolon

159
Q

Case 54

What neoplasm most commonly produces thickened gastric folds?

160
Q

Case 54

What causes isolated gastric fundal varices?

A

Splenic vein thrombosis

161
Q

Case 54

What is the MC infectious cause of thickened gastric folds?

162
Q

Case 54

DDx for gastric fold thickening

A

Gastritis
- EtOH
- Eosinophilic
H. Pylori

Sarcoid
Amyloid
Crohn’s

Menetrier’s dz
Mets
Adeno CA
Zollinger- Ellison Syn

163
Q

Case 54

What is Menetrier’s disease?

A

Rare disease characterized by gastric mucosal hypertrophy (giant rugal folds)

Achlorhydria, hypoproteinemia, and edema

164
Q

Case 55

What lobe is typically spared in hepatic cirrhosis?

A

Caudate lobe

-derives blood supply from IVC

165
Q

Case 56

How can radiating folds help determine whether a gastric ulcer is benign or malignant?

A

If the radiating fold extends to the center of the edge of the crater - it is most likely benign.

If it stops short, could be benign or malignant.

167
Q

Case 57

What is required for GI carcinoid tumor to produce carcinoid syndrome?

A

Liver metastases

167
Q

Case 56
Most common cause of benign gastric ulcer?
Does the size of an ulcer have any bearing on malignant potential?

A

H. Pylori

No

168
Q

Case 57

How often are carcinoid tumors multiple?

169
Q

Case 56

What is a Hampton line sign and is the ulcer benign or malignant?

A

Thin lucent line at the base or neck of an ulcer

Indicates that the ulcer is benign

170
Q

Case 57

What substance is produced by carcinoid tumors?

171
Q

Case 57

What non-imaging test can be used to confirm the diagnosis of carcinoid?

A

Urine test for 5-HIAA

172
Q

Case 57

What is the most common site from which carcinoid tumor arises?

173
Q

Case 58
What part of the bowel is typically affected with TB?
Viral infections?

A

TB - ileocecal area

Viral - colon

174
Q

Case 58

What is the most common cause of viral colitis?

175
Q

Case 59

What type of ulcer suggest Crohn’s dz rather than UC?

A

Aphthous ulcers

176
Q

Case 59

What diseases produce bowel fistulae?

A

Crohn’s disease, diverticulitis (and rarely, TB)

178
Q

Case 59

DDx for colonic fistula formation

A

Crohn’s
TB: Deep ulcers that progress to fistulae
Diverticulitis (colovesical)

  • Fistulas are never seen w UC
178
Q

Case 60

What are the tiny diverticula called in adenomyomatosis?

A

Rokitansky-Aschoff Sinuses

179
Q

Case 59

What diseases are associated with long, linear mucosal ulcers?

A

Crohn’s
TB
Diverticulitis (colovesical)

  • Fistulas are never seen w UC
180
Q

Case 59

What diseases are associated with long, linear mucosal ulcers?

A

Crohn’s disease

TB rarely

181
Q

Case 56

How can location of gastric ulcers help predict benignity?

A

Lesser curvature - tend to be benign

Fundus - tend to be malignant

181
Q

Case 57

What is the MC site in the GI tract for carcinoid?

181
Q

Case 60

What is the clinical significance of GB adenomyomatosis?

GI (3 decks)

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