GI trivia Flashcards
Type I HH
GEJ above the diaphragm, no paraesophageal componet
Type II HH
anterolateral phrenoesophageal membrane defect
Gastric cardia and GEJ remain subdiaphragmatic
Fundus usually first part herniated
Type III HH
MCC of paraesophageal with Type I and II features
gastric rotation
usually large
Type IV HH
Marked widening of the diaphragmatic hiatus that contains other organs
GERD findings
abn motility mucosal filling defects Ulceration Sacculations thick logitudinal folds Transverse folds Intramural pseudodiverticula Inflammatory polyp Stricture
Chagas Disease can look like what on esophagram
Achalasia
Epiphrenic diverticulum of esophagus assoc with what
motility disorders like achalasia
pulsion type
MCL for esophageal tear from Boerhaave
left posterior lateral distal esophagus
Long esophageal strictures
severe GERD
NG tube
ZE syndrome
Caustic ingestion = liquifactive necrosis
Downhill varicies
SVC obstruction
Multiple short concentric rings in esophagus (not feline)
Eosinophilic esphagitis (usually upper and mid) hx of asthma/atopy
Major risk factors for esophageal adenocarcinoma
Obesity
GERD
smoking
Benign stomach ulcer findings
Extends beyond stomach contour
regular ovoid shape
folds radiating to the edge of the crater
smooth ulcer collar
more common in antrum and lesser curvature
Organoaxial rotation of stomach
stomach rotates along the long axis with the greater curvature located cephalad to the lesser
Mesenteroaxial rotation of the stomach
rotates around the short axis
displacement of the antrum above the GEJ (stomach looks upside down with the antrum and pylorus superior to the fundus)
Right paraduodenal hernia (25% of PDH)
through fossa of Waldeyer (1st part of jejunal mesentery)
bowel goes behind the SMA and diplaced anterior and inferior to transverse duodenum
Left paraduodenal hernia (75%)
fossa of Landzert
between pancreas and stomach
IMV displaced superiorly and anteriorly
Duodenal hematoma/injury with blunt trauma as usually have what injuires
Pancreatic trauma
Left hepatic lobe
spleen
direct inguinal hernia
medial to inferior epigastrics
indirect inguinal hernia
lateral to inferior epigastrics
femoral hernia
medial to inferior epigastrics and compress the femoral vein (medial to the vein)
median arcuate ligaments compresses what artery
Celiac
Colonic diverticula form where
weakness area where the vasa recta penetrate the bowel wall
pulsion type
Griffiths point
watershed area near splenic flexure
coffee bean appearance of colon
sigmoid volvulous (look for normal right colon)
Colonic pseudoobstruction (Ogilve Syndrome)
Chronic form shows decreased intramural ganglion cells
MCL of epiploic appendagitis
sigmoid and descending colon
can see central vessel (thrombosed vein)
Omental infarct
MCL anterior transverse colon or anteromedial to ascending colon
no central thrombosed vein
MCL for perforation due to sigmoid colonic neoplasm
Cecum (if ileocecal valve is competent)
greater risk if cecum >/= 10 cm
Right sided colon infections
salmonella
yersinia
TB
amebiasis
Left sided colon infections
Shigella
Lymphogranuloma venereum
Gonorrhea
Schistosomiasis
Diffuse colon infections
E. coli
CMV
Amyand Hernia
appendicitis in an inguinal hernia
Littre hernia
meckels in an inguinal hernia
Richter hernia
antimesenteric portion of bowel wall goes through abdominal defect
MEN 1
PPP
parathyroid
pancreatic NETs
Pituitary adenoma
MEN 2a
MPP
Medullary thyroid
pheo
parathyroid
MEN 2b
MNP
Medullary thyroid
neuromas
pheo
Insulinoma
Whipple triad
hypoglycemia
low glucose that symptoms resolve when corrected
Gastrinoma
ZE syndrome
Glucagonoma
4D Syndrome Dermatitis Diabetes DVT Depression
VIPoma
WDHA Syndrome
watery diarrhea
hypokalemia
achlorhydria
Somatostatinoma
Inhibitory Syndrome Diabetes steatorrhea diarrhea cholelithiasis
Pancreas is usually T1 bright
Pathology typically is T1 hypo
Duodenal diverticulum
oral contrast and gas with connection to duodenum
Change in size and shape from study to study
Serous microcystic cystadenoma (pancreas)
numerous small cysts clustered together with multilobulated margins
Mucinous cystic neoplasm (pancreas)
large encapsulated cyst with thick irregular internal septations and mural
90% in body or tail of pancreas
Intraductal papillary mucinous neoplasm (pancreas)
lobulated cystic mass communicating with pancreatic duct (either directly or on side branches)
> 3 cm and main ductal dilation and nodularity = bad
Complete fatty replacement of the pancreas
CF
Solid pseudopapillary tumor
Cystic mass with solid enhancing parts and hemorrhage in young woman
Interstitial edematous pancreatitis
< 4 weeks Acute peripancreatic fluid collection
> 4 weeks pancreatic pseudocyst
Necrotizing pancreatitis
< 4 weeks Acute necrotic collection (parenchymal necrosis alone, peripancreatic necrosis alone, pancreatic and peripancreatic necrosis)
> 4 weeks Walled-off necrosis
MC mets to pancreas
RCC
usually appears as a hypervascular mass
Budd-Chiari on CT
heterogeneous liver with macronodular contour
enlargement and increased enhancement of the caudate lobe
hepatic veins not seen (venogram has spider web of collaterals)
Biliary cystadenoma
encapsulated, multiloculated cystic mass in the liver with enhancing septations (possible nodules)
biliary ductal dilation
+/- calcs
More than 10 liver cysts are seen
consider fibropolycystic liver disease
Von Meyenburg Complex
AKA - biliary hamartomas
numerous sub cm T2 hyperintense lesions scattered throughout the liver
Signs of cirrhosis
Micronodular regenerating nodules
segmental atrophy (right lobe and medial left lobe)
Segmental hypertrophy (caudate and lateral left)
Right posterior hepatic notch sign
Expanded GB fossa sign (increased fat in the pericholecystic area)
Primary hemochromatosis
pancreas (bronzing DM)
Secondary Hemochromatosis
spleen
THID (MRI) and THAD (CT)
wedge-shaped or geographic area of enhancement representing altered perfusion
usually only seen on one phase (MC arterial)
Cavernous transformation of the portal vein
main portal vein not seen, numerous tortuous collaterals = chronic portal vein occlusion
Washout of hepatic lesions
have to be hypodense to surrounding liver , NOT isodense
MC benign hepatic tumor
Hemangioma
Timing of arterial phase for hypervascular liver lesions
Late arterial phase when there is heterogeneous blush in the main portal vein
Hypervascular METs (also most likely to bleed)
"MR CT" Melanoma Renal Cell carcinoma Carcinoid (neuroendocrine tumors)/ Choriocarcinoma Thyroid Carcinoma
Pseudocirrhosis after liver mets treatment
MCC breast ca
Giant cavnerous hemangioma of the liver assoc with what syndrome
Kasabach-Merritt syndrome
thrombocytopenia = sequestration/destruction of platelets
Peliosis hepatis
benign vascular disorder with dialted sinusoids and blood filled cavities
fills in central to peripheral (opposite hemangiomas)
delayed enhancement over surrounding liver (mets less likely)
assoc with Bartonella species
Type I Choledolchal cyst
single fusiform of part or entire extrahepatic duct
Type II Choledolchal cyst
true diverticulum with narrow stalk from extrahepatic duct
Type III Choledolchal cyst
Dilation of the extrahepatic bile duct within duodenal wall
Type IV choledochal cyst
IVa - both intra and extra hepatic cysts
IVb - multiple dilatations of extrahepatic ducts only
Type V Caroli disease
multiple dilatations of intrahepatic ducts only
Bouveret’s Syndrome
subtype of gallstone ileus with gallstone stuck in duodenum = gastric outlet obstruction
Rigler triad
pneumobilia, bowel distention, and ectopic gallstones = gallstone ileus
causes of pneumobilia
Iatrogenic
Trauma
Biliary-enteric fistula
gas forming infection
Periportal edema
fluid resuscitation CHF acute hepatitis trauma liver transplant
Portovenous gas
bowel ischemia/obstruction IBD hepatic abscess necrotizing pancreatitis trauma caustic ingestion
Intrahepatic stones with extensive diease
think recurrent pyogenic cholangitis
AIDS cholangiopathy
looks like PSC with papillary stenosis, MCC = cryptosporidium
Lobulated mas with dense calcs and spiculated margins tethering the ileal mesentery
Carcinoid tumor or retractile (fibrosing) mesenterities
Whipple disease
arthralgias and abdominal ss
nodular bowel wall thickening and low-density adenopathy
Pseudomyxoma peritonei
look for scalloping of the liver and spleen
fluid can return as no malignant cells
MCC of mortality in VHL
RCC
