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RANZCR Part 2 Exam > GIT 3 > Flashcards

GIT 3 Flashcards

1
Q

Gardner syndrome

A
  • hyperplastic stomach polyps - adenomatous bowel polyps - desmoid tumors - osteomas - papillary thyroid cancer
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2
Q

Turcot syndrome

A
  • hyper plastic stomach polyps - adenomatous bowel polyps - gliomas and medulloblastomas
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3
Q

Peutz Jegher’s syndrome

A
  • small and large bowel cancer - pancreatic cancer - GYN cancer - sertoli cell tumors - mucocutaneous pigmentation
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4
Q

Cowden

A
  • breast cancer - thyroid cancer - lhermitte-duclos
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5
Q

Carney’s traid

A
  • extra-adrenal pheochromocytoma - GIST - pulmonary chondroma
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6
Q

Bilroth 1 - complications?

A

pylorus removed, proximal stomach is sewed to the duodenum - less post -op gastritis compared to bilroth 2 - more early post-op complications

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7
Q

billroth 2 - complications?

A
  • partial gastrectomy, and stomach is attached to jejunum - dumping syndrome - afferent loop syndrome - increased risk of gastric cancer 10-20 years after surgery
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8
Q

Celiac sprue associations

A
  • iron deficiency anemia - idiopathic pulmonary hemosiderosis (Lane Hamilton syndrome) - dermatitis herpetiformis - increased risk of bowel lymphoma - fold reversal - Moulage sign - dilated bowel with effaced folds - cavitary lymph nodes (low density) - splenic atrophy
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9
Q

Grynfeltt-Lesshaft

A
  • hernia through superior lumbar triangle
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10
Q

Petit hernia

A

hernia through inferior lumbar triangle

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11
Q

3 sites for internal hernia after Roux-en Y gastric bypass

A
  • defect in transverse mesocolon, through which the Roux limb passes (if done in retrocolic position) - mesenteric defect at enteroenterostomy - behind roux limb mesentery placed in a retrocolic or antecolic position - Petersen type hernia
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12
Q
A

Paraduodenal hernia​

most common type of internal hernia;

  • 75% on the left (This case)
  • occurs at duodenojejunal junction (Foss of Landzert)
  • sac contains IMV and left colic artery
  • right sided occur just below transverse segment of duodenum
  • Fossa of Waldeyer and behind the SMA

Case courtesy of Dr Ryan Logan Webb, Radiopaedia.org, rID: 52006

Case Discussion

Abnormal location of small bowel loops within the left hemi-abdomen, lying in the left anterior pararenal space. The ectopic small bowel is contained within a hernia sac, which is outlined by ascites. Associated stretching and distortion of mesenteric vessels. Findings are consistent with left paraduodenal hernia.

Additionally, some of the small bowel loops demonstrate severe wall thickening and abnormal enhancement pattern consistent with ischaemia in the setting of elevated lactate.

At surgery, abnormal location of bowel was noted with the additional finding of twisting of the mesentery resulting in venous occlusion and bowel ischaemia. After devolvulizing, the bowel was deemed viable and no bowel was resected. Additionally, congenital bands were seen near the ligament of Treitz, which were lysed. Postoperative course was uncomplicated.

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13
Q

DDx Diverticular disease

Esophagus

6 ddx

2 mimicks

A
  • Pharyngocele:
    • usually lateral in hypopharynx
  • Zenker diverticulum:
    • pulsion diverticulum
  • Traction diverticula
    • all layers involved.
    • pulling usually by adhesions to mediastinal structures because of malignancy to TB
    • Typically at level of bifurcation
  • Pulsion
    • all layers, secondary to increased intraluminal pressure
  • Pseudodiverticula
    • small outpouchings caused by dilated mucus glands
    • a/w diabetes, alcoholism, candidiasis, obstruction, cancer
  • Epiphrenic diverticulum
  • Mimicks
    • paraesophageal hernia
    • oesophageal perforation with contrast extravasation
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14
Q

DDx Luminal Narrowing Esophagus

A
  • Webs
    • 2
  • rings
    • 2
  • stricture
    • 5
  • Extrinsic compression
    • 3
  • Webs
    • Idiopathic
    • Plummer-vinson syndrome
  • Rings
    • Congenital: Vascular or muscular rings
    • Schatzki ring
  • Stricture
    • Skin lesions
      • epideermolysis
      • pemphigoid
      • Proximal 1/3 of oesophagus
    • tumour
    • oesophagitis
      • lye
      • barrett
      • infection
      • radiation
      • oesosinophilic
    • Intubation
    • Achalasia, scleroderma, chagas disease
  • extrinsic compression
    • vascular aortic arch
      • arch anomalies
      • aneurysm
      • left atrium
    • left bronchus
    • mediastinal tumours
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15
Q

DDx Megaeosophagus

6 ddx’s

A
  • Achalasia
  • Scleroderma
  • dilatation 2ndary to distal narrowing
    • tumour
    • stricture
  • Chagas disease
  • diabetic or alcoholic neuropahty
  • Bulbar palsy
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16
Q

Ddx oesophageal tears

6

A
  1. Esophagitis
  2. Tumour
  3. Vomiting
    • Mallory-Weiss syndrome: only mucosa is disrupted. Longitudinal superficial tear. rarely visualised
    • Boerhaave syndrome: the entire wall is ruptured. Pneumomediastinum, extravasation of contrast
  4. Tracheoesophageal fistulas (paediatrics)
  5. Bronchopulmonary foregut malformations with communication to esophagus
    • bronchogenic cysts
    • extra lobar sequestration
  6. Endoscopy.
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17
Q

DDx Of oesophageal filling defects/mass lesions

A
  1. Neoplasm
  2. Extrinsic lesions
  3. Submucosal masses
  • Neoplasm
    • benign
      • leiomyoma - 50%
      • pedunculated fibrovascular polyp (esp. upper oesophagus) 25%
      • Cysts, papilloma, fibroma, hemangioma
    • Malignant
      • SCC - 95%
      • Adenocarcinoma - 5%
      • Carcinosarcoma
      • Lymphoma
      • Metastases
      • FB
      • Varices
  • Uphill varices
    • portal hypertension, predominantly inferior location
  • Downhill varices
    • SVC obstruction, predominantly superior location
  • Extrinsic lesions
    • LNs
    • Engorged vessels
    • aneurysms
    • cysts
  • Submucosal masses
    • GIST
    • Fibroma, neurofibroma, lipoma, hemangioma
    • Duplication cyst
    • Lymphoma
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18
Q

DDx thickened Oeophageal folds

3

A
  • Early form of oesophagitis
  • Neoplasm
    • lymphoma
    • Varicoid carcinoma
  • Varices
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19
Q

DDx Air Fluid Level

3

A
  • Hiatal hernia
  • Oesophageal diverticulum
  • Any oesophageal lesions caused by a motility disorder or a stricture
    • cancer
    • achalasia
    • scleroderma
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20
Q

DDx Gastritis

7

A
  1. Erosive
  2. Granulomatous
  3. Eosinophilic
  4. Hypertrophic
  5. Recurrent Gastric ulcer
  6. Misc
  7. Rare
  • Errosive
    • Corrosives
    • alcohol
    • stress
    • drugs
  • granulomatous
    • Crohns
    • sarcoid
    • suphilis
    • TB
    • Histoplasmosis
  • eosinophilic
    • peripheral eosinophilia - 60%
    • hypoalbuminemia
    • hypogammaglobulinemia
    • hyperplastic polyps
  • hypertrophic
    • menetrier disease
    • Zollinger-Ellison syndrome
    • Idiopathic
  • recurrent ulcer
    • Zollinger-ellison syndrome
    • PUD
    • Retained tastric antrum
    • Drugs
  • misc
    • radiation
    • ulcer
    • corrosives
  • rare
    • Pseudolymphoma
    • Suture line ulceration
    • Intraarterieal chemotherapy
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21
Q

DDx Target/Bull’s eye lesions

A
  • Ulcer surrounded by a radiolucent halo. Multiple
    • Gastritis (aphthoid type, tiny ulcer)
      • erosive
        • NSAID, Alcohol
      • Granulomatous
        • Crohn’s Disease
      • Infectious
        • Candidiasis
        • herpes
        • syphilis
        • CMV
    • Submucosal Metastasis (Large ulcer)
      • melanoma
      • kaposi sarcoma
      • Lymphoma
    • Solitary, giant bull’s eye (very large ulcer)
      • Leiomyoma
      • sarcoma
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22
Q

Ddx Stomach Filling Defect/mass lesion

4

A
  • Mobile filling defects
    • bezoar
      • phytobezoar
      • trichobezoar
      • phytotrichobezoar
  • Fixed filling defects
    • Neoplasm
      • adenocarcinoma
      • lymphoma
      • leiomyosarcoma
      • metastases
      • kaposi sarcoma
    • Other
      • endometriosis
      • carcinoid
      • benign tumours
        • Leiomyoma > lipoma, fibroma, schwannoma
      • Polyps
      • Varices
      • Extramedullary hematopoiesis
      • Ectopic pancreas
    • Extrinsic compression
      • Spleen
      • Pancreas
      • Liver
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23
Q

DDx Stomach submucosal lesions

4

A
  • GIST
  • Lipoma
  • ectopic pancreas
  • Lymphoma
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24
Q

DDx Stomach Giant rugal Folds

6

A
  • Tumour
    • Lymphoma​
  • Inflammation
    • Menetrier disease
    • ZES
    • Gastritis a/w pancreatitis
    • Bile Reflux Gastritis
    • Eosinophilic Gastroenteritis
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25
Q

DDx of this appearance

A
  • Ddx Stomach

Linitis Plastica

4 categories

11 ddx

AKA - Leather bottle stomach

* Marked thickening and irregularity of the gastric wall (diffuse infiltration)
* Rigidity, narrowing and nondistensibility
* peristalsis does not pass through linitis * DDx
* Tumour
* Inflammation
* Infiltrative disease
* Infection * DDx
* Tumour
    * Scirrhous cancer (most common cause)
    * Lymphoma
    * Metastases (most commonly breast cancer)
    * Pancreatic carcinoma
* Inflammation
    * Erosive gastritis
    * Radiation therapy
* Infiltrative disease
    * Sarcoid
    * Amyloid - rare
    * Intramural gastric hematoma (rare)
* Infection
    * TB
    * Syphylis

https://radiopaedia.org/cases/linitis-plastica-2

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26
Q

DDx stomach Antral Lesions

3 categories

10 ddx

A
  • Tumour
  • Inflammatory
  • Other
  • Tumour
    • Andromcarcinoma
    • mets
    • lymphoma
  • Inflammatory
    • Crohn’s disease
    • PUD
    • TB
    • Sarcoid
  • Other
    • Hypertrophic pyloric stenosis
    • Pulorospasm
    • Antral web
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27
Q

DDx Stomach Ram’s Horn Antrum

8

A
  • Blunting of antral fornices with progressive tapering from antrum to pylorus
    • DDX
      • Chronic PUD
      • Scirrhous carcinoma
      • Granulomatous Disease
        • Crohn’s disease
        • TB
        • Sarcoid
        • Eosinophilic gastroenteritis
      • Caustic ingestion
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28
Q

DDx stomach Intraperitoneal Air

6

A
  1. Surgery and laparoscopy and other radiologic interventions (most common cause
  2. Perforated gastric or duodenal ulcer (second most common cause)
  3. Cecal perforation from colonic obstruction
  4. pneumatosis coli
  5. air through genital trach in females
  6. perforated distal bowel (usually a/w abscess and lesser amounts of free air
    • IBD
    • Diverticulitis
    • Tumour
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29
Q

DDx Duodenum Filling defects

A
  • Neoplastic
    • benign
    • Malignant
  • Other
    • Bulb
    • Distal
  • Neoplastic
    • benign
      • often in first portion, asymptomatic
        • adenoma (usually <1cm)
        • Leiomyoma
        • Carcinoid
        • Villous Adenoma
          • Near Papilla, high malignant potential
    • Malignant
      • Often distal to first portion, symptomatic
        • adenocarcinoma at or distal to papilla - 90% of malignant tumors
        • Metastases
          • Direct invasion from stomach, pancreas, colon, kidney, or hematogenous such as melanoma
        • Lymphoma
  • Other
    • Bulb
      • ectopic gastric mucosa
      • prolapsed antral mucosa
      • Brunner gland hyperplasia
      • varices
    • Distal
      • Benign lymphoid hyperplasia
      • ectopic pancreas
      • Annular pancreas
      • papilla of vater
      • tumour
      • edema with impacted or passed gallstone
      • choledochocele
      • duplication cyst
      • intraluminal diverticulum
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30
Q

Malignancy of duodenal lesions depending on location

A
  • Duodenal Bulb
    • 90% are benign
  • 2nd and 3rd portions
    • 50% are malignant
  • 4th portion
    • 90% are malignant
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31
Q

ddx Duodenal luminal outpouchings

A
  • Ulcer
    • ulcer with contained perforation
    • malignant ulcer (rarely primary)
  • Diverticulum
    • pseudodiverticulum: ulcer scarring
    • Choledochoduodenal or cholecytoduodenal fistula
    • True diverticulum
      • medial
      • 2nd part duodenum
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32
Q

Ddx duodenal Post bulbar narrowing

A
  • Neoplastic
    • adenocarcinoma
    • lymphoma
    • metastases
      • direct invasion from colon, kidney, pancreas, GB
    • GIST
  • Inflammatory
    • Intrinsic
      • post bulbar ulcer
      • duodenitis
      • crohn’s disease
    • extrinsic
      • pancreatitis
    • annular pancreas
    • intramural diverticulum
    • duodenal duplication cyst
    • duodenal hematoma
    • aortic aneurysm (3rd portion)
    • SMA Syndrome
      • Supine position causes partial obstruction of the 3rd portion of the duodenum by SMA
      • may be exacerbatedby weight loss
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33
Q

DDx duodenal Fold thickening

9

A
  • H. Pylori
  • Crohn’s
  • Giardiasis
  • Sprue
  • Whipple disease
  • Brunner gland hyperplasia
  • Lymphoma
  • Hematoma/trauma
  • Pancreatitis
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34
Q

DDx duodenal Papillary enlargement

9

A
  • Normal variant
  • choledochocele
  • papillary edema
    • pancreatitis
    • acute duodenal ulcer
    • impacted stone
  • Ampullary tumour
    • adenomatous polyp
    • carcinoma
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35
Q

Findings of Small Bowel Obstruction

A
  • Disproportionate distribution of gas is the key finding
  • much more gas and fluid in SB compared with colon
  • much more gas in proximal; SB compared with distal SB
  • Fluid retention parallels gas distribution:
    • no fluid no obstruction
  • Closed-loop obstruction
    • lumen occluded at two adjacent sites
    • obstructed loops distend with fluid
    • loop may twist
    • the bowel may or may not be infarcted
  • Additional examinations in presumed acute SBO include
    • if very dilated or abundant fluid
      • CT - the fluid acts as an intrinsic contrast material
    • if mild dilatation
      • CT with oral contrast or SBFT
    • Enteroclysis:
      • need to decompress bowel before the study, best applied to nonacute situations
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36
Q

Colonic Obstruction

Key radiographic finding

A
  • cecal dilation is the key radiographic Finding
    • cecum is invariably most dilated in colonic obstruction. however it may also be very dilated in paralytic ileus
    • If the transverse colon is more dilated than the caecum, there is rarely an obstruction
      • exception: concomitant disease that intrinsically narrows the cecum (IBD)
    • Fluid retentiaion not necessarily seen in colonic obstruciton
  • A useful initial screening procedure to rule out distal colonic obstruction is a prone KUB. IF there is no obstruction, gas passes to the rectum.
  • BE is the definitive study.
  • Do not perform UGI series in a patient with possible colonic obstruction (contraindicated bc barium impacts in the colon.
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37
Q

DDx Paralytic Adynamic Ileus

A
  • post operative - Most common
  • Vascular
  • IBD
  • Inflammatory
    • often localised ileus -> sentinel loop
      • pancreatitis
      • appendicitis
      • cholecystitis
      • Diverticulitis
      • peritonitis
    • Metabolic
      • hypokalemia
      • hypocalcemia
      • Hypomagnesemia
    • medication
      • morphine
      • diphnoxylate (lomotil)
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38
Q

DDX Mechanical SBO

A
  • Adhesions
  • hernias
  • tumours
  • gallstones
  • inflammation with strictures
  • Gallstone ileus:
    • pneumobilia
    • SBO
    • Stone within bowel lumen (may obstruct ileocecal valve)
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39
Q

Signs of Malabsorption Patterns

A
  • Signs
    • dilution of barium (hypersecretion_
    • Flocculation of barium
    • moulage
    • segmentation of barium column
    • delay in transit
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40
Q

DDx of Malabsorption Patterns with Predominantly Thick/irregular folds

A
  • MNEMONIC: WAG CLEM
    • Whipple disease
    • Amyloid
    • Giardiasis (largely affects jejunum) GVH retraction, gammaglobulinopathy
    • Cryptosporidiosis (largely affects jejunum)
    • Lymphoma, lymphangiectasis, lactase deficiency
    • Eosinophilic gastroenteritis
    • Mycobacterium Avium complex, Mastocytosis
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41
Q

DDx of Malabsorption patterns with predominantly thick/Straight folds

A
  • Ischaemia
  • Intramural hemorrhage
  • Radiation
  • Hypoproteinema
  • Venous congestion
  • Cirrhosis

Pattern Approach for Diseases of Mesenteric Small Bowel on Barium Studies1

https://geiselmed.dartmouth.edu/radiology/wp-content/uploads/sites/47/2019/04/small_bowel.pdf

42
Q

DDx of Predominantly Dilated loops, Normal Folds

MNEMONIC

A
  • SOSO
    • Sprue is the single most important cause of true Malabsorption
    • Obstruction or ileus
    • Scleroderma
    • Other
      • Medication
        • Morphine
        • Lomotil
        • Atropine
        • Pro-Banthine
      • Vagotomy
43
Q

DDx of Thick folds without Malabsorption pattern

(oedema, Tumour, Hemorrage)

A
  • Criteria:
    • Folds >3mm
    • By CT, the edema in SB wall may appear as ring or halo sign
    • Two Types
      • DIFFUSE: uniformly thickened folds
      • FOCAL: nodular thickening (pinky printing).
        • Analogous to thumb printing in ischaemic colitis
        • stack of coins appearance
        • picket fence appearance
44
Q

DDX Causes of Thick folds without malabsorption

3 categories

10 ddx

A
  • Submucosal edema
    • ischemia
    • enteritis
      • infection
      • radiation
    • Hypoproteinemia
    • GVH reaction
  • Submucosal tumor
    • lymphoma, leukemia
    • infiltrating carcinoid causing venous stasis
  • Submucosal hemorrhage
    • Henoch-Schonlein disease
    • Hemolytic uremic syndrome
    • Coagulopathies (hemophilia, vit K, Anticoagulants)
    • Thrombocytopenia, disseminated intravascular coagulation
45
Q

DDx of Bowel Nodules

6

A
  • Mastocytosis
  • Lymphoid hyperplasia
  • Lymphoma
  • Mets
  • Polyps
  • Crohns disease
46
Q

DDx of Stack of Coins appearance

5

A
  • Anticoagulation
  • Vasculitis
  • Trauma
  • Ischemia
  • Carcinoid
47
Q

DDx of SB luminal Narrowing

A
  • Ischemia
  • Vasculitis
  • Hemorrhage
  • Radiation
  • Collagen vascular disease
  • inflammatory bowel disease
  • tumor
  • adhesions
48
Q

DDx of this sign

7

A
  • TARGET SIGN
    • Ischaemia
    • vasculitis
    • hemorrhage
    • IBD
    • Angioedema
      • ACE inhibitors
      • Hereditary
      • Allergic reaction
    • Portal Hypertension
    • NSAIDS

VERY GOOD ARTICLE:

https://radiologyassistant.nl/abdomen/bowel/bowel-wall-thickening-ct-pattern

VERY GOOD ARTICLE: https://radiologyassistant.nl/abdomen/bowel/bowel-wall-thickening-ct-pattern

49
Q

DDx Gracile SB

A
  • Tubular, “Toothpaste” appearance on SB Series
    • GVH disease
    • Cryptosporidium

https://link.springer.com/article/10.1007/s00247-010-1853-x/figures/1

Intestinal graft-versus-host disease

Sabah Servaes

Pediatric Radiology volume 40, page101 (2010)Cite this article

557 Accesses

Metricsdetails

A 17-month-old boy with acute lymphoblastic leukemia status 61 days post cord blood transplant presented with vomiting, diarrhea and feeding intolerance. Fluoroscopic examination with barium demonstrates diffuse narrowing of the small bowel lumen referred to as toothpaste- or ribbon-like (Fig. 1) and consistent with graft-versus-host disease (GVHD). Despite improvement of intestinal GVHD with immunosuppressive therapy, the boy developed respiratory failure and infection and died 4 months later.

50
Q

DDX of Small Bowel Tumours

A
  • Benign
    • Adenoma (most common)
    • Leiomyoma (second most common)
    • Lipoma
    • Hemangioma
    • Neurogenic tumours (usually in NF)
    • Other
      • brunner gland hyperplasia
      • Heterotopic pancreatic tissue
      • Duplication cyst
      • Inverted Meckel Diverticulum
  • Malignant Tumours
    • Mets
      • Melanoma
      • kidney
      • breast
      • kaposi Sarcoma
    • Lymphoma
    • Carcinoid (most common primary - 50% are malignant and have mets at time of diagnosis)
    • GIST
    • Sarcoma (Sarcomatous degeneration of benign tumours
      • eg leiomyosarcoma
      • lymphosarcoma
      • usually large ulcerating tumors
      • adenocarcinoma
  • Polyposis Syndromes
51
Q

DDx of Mesenteric Bowel Ischemia

A
  • Occlusive disease
    • emboli
      • (AF,
      • ventricular aneurysm)
    • Arterial Thrombosis
      • (atherosclerosis)
    • Venous thrombosis
      • (portal hypertension,
      • pancreatitis,
      • tumor)
  • Nonocclusive disease (ie low flow)
    • Hypotension
    • Hypovolemia
52
Q

DDx of Shortened Transit Time

4

A
  • Anxiety
  • Hyperthyroidism
  • Medication
    • Metoclopramide
    • Neostigmine
    • Quinidine
    • Methacholine
  • Partial SBO
    • Paradoxical rapid propulsion to point of obstruction
53
Q

DDx of Colon Mass lesions

A
  • Non-neoplastic Polypoid Abnormmalities
    • normal lymphofollicular pattern
    • Pneumatosis Coli
    • Colitis Cystitc profunda
    • Amyloidosis
    • Endometriosis
    • Ischaemic Colitis
  • Polyps
  • Polyposis syndromes
  • Benign neoplasms
    • Lipoma (common)
    • Leimyoma (rare)
  • Malignant Neoplasm
    • Adenocarcinoma
    • Mets
    • Lymphoma
54
Q

DDx of Colon Polyps

3

A
  • Hyperplastic polyps
    • 90% of colonic polyps
    • not true tumors
    • No malignant potential
  • Adenomatous polyps
    • Second Most common Type
    • 25% are multiple
      • True tumours
      • malignant transformation
      • Types
        • tubular
        • villous
        • tubulovillous
  • Hamartomatous Polyps
    • Rare
    • Peutz-jeghers
55
Q

DDx of Colon Aphthoid Ulcers (superficial)

4

A
  • Crohn disease (50% of patients)
  • amebiasis
  • Behcet syndrome
  • CMV
  • Herpes
56
Q

DDx of Deep colonic Ulcers

4 categories

12 things

A
  • Inflammatory Colitis
    • UC
    • Crohn’s
    • Behcet syndrome
  • infectious Colitis
    • Amebiasis
    • TB
    • Salmonella
    • Shigella
    • Histoplasmosis
    • AIDS
      • candida
      • herpes
      • CMV
  • Ischemic colitis
  • Radiation Colitis
57
Q

Ddx of Bowel Wall thickening

(thumb-printing)

A
  • Thumbprinting refers to luminal indentations the size of a thumb, bc of edema, tumor or hemorrhage.
  • Morphology of accompanying haustral folds may be a clue to underlying diagnosis
    • preserved haustral folds
      • infection
      • ischemia
    • effaced haustra folds
      • Tumour
      • IBD
  • DDX
    • Edema
      • Infectious Colitis
        • Pseudomembranous colitis (c diff)
        • CMV colitis
        • E. coli, shigella, salmonella amebiaisis
        • Neutropenic Colitis (typhlitis)
      • IBD
    • Tumour
      • Lymphoma
      • leukemia
    • Hemorrhage
      • ischemia
      • Henoch-schonlein disease, thrombocytopenia, DIC
      • Coagulopathies
        • hemophilia
        • Vit K
        • Anticoagulants
58
Q

DDx of Tumour Like Colonic Deformity

A
  • Deformities may be symmetric (circumferential, apple core) or asymmetric
    • Tumor
      • adenocarcinoma
    • Saddle shaped if asymmetric
    • Apple core shaped if circumferential
      • Mets (common serosal implants: gastric, ovarian)
  • Inflammation
    • diverticulitis
    • Focal inflammation
      • IBD: Crohn disease UC
      • Infectious
        • Ameboma,
        • TB
  • Other
    • endometriosis
    • Pelvic Abscess
    • epiploic appendagitis
59
Q

DDx of Long > 10cm colonic narrowing

A
  • Scirrhous adenocarcinoma
  • lymphoma
  • UC (with or without carcinoma)
  • Crohn disease
  • ischaemic stricture
  • Radiation
60
Q

DDx of Ahaustral Colon

A
  • Cathartic Abuse
    • often right colon
  • UC/CD
  • Amebiasis
  • Ageing (usually left colon)
61
Q

DDx of Colonic Obstruction

A
  • Carcinoma (65%)
  • diverticulitis (20%)
  • Volvulus (5%)
  • Other
    • impaction
    • hernia
62
Q

DDx of Megacolon

A
  • Descriptive term for abnormally distended transverse colon >6cm) most commonly used in conjunction with TMC.
    • TMC
      • Haustral deformity, pseudopolps, risk of perforatmion systemic signs
      • UC, CD
      • Infectious
        • amebiasis
        • shigellosisi
        • C. Diff
    • Acute colonic distention
      • risk of perforation with cecum >9cm)
        • Obstructive: cancer
        • Paralytic ileus
        • Volvulus
    • Chronic megacolon (no or small risk of performation)
      • Cathartic colon (chronic laxtive abuse)
      • Colonic pseudoobstuctionve (ogilvie syndrome, colonic ileus)
      • Psuchogenic)
      • Congenital Hirchsprung disease
      • chagas disease
      • Neuromuscular disease
        • Parkinsonisn
        • diabetes
        • scleroderma
        • Amyloid
      • Metabolic, drugs
        • Hypothrouidism
        • Electrolyte imbalances.
64
Q

Adult Intussusception

A
  • Ileoileal 40% > Ileocolic 15% > other locations
  • Tumours 35%
    • Polyps, lipoma 25%
    • Malignant umours 10%
      • Mets
      • lymphoma
      • Carcinoid
  • Idiopapthic 20%
  • Other
    • meckles
    • adhesions
    • Aberrant panceas
65
Q

Ddx Of Pneumatosis Coli

2 categories

8 ddx

A
  • Pneumatosis Cystoides (large, cyst like collection of air, few symptoms), associated with Benign causes
    • COP
    • Ventilated patients
    • Mucosal injury
      • rectal tube insertion
      • colonoscopy
      • surgery
      • Scleroderma
      • Chemotherapy
  • Pneumatosis Intestinalis (symptomatic). Ass/w serious causes.
    • infarcted bowel (tiny bubbles, lineal gas collections
    • necrotizing enterocolitis (neonates)
    • TMC
    • Typhlitis
66
Q

Ddx of Ileocecal Deformities/Coned caecum

A
  • Inflammation (coned cecum)
    • Typhlitis: Inflammatory changes of cecum and/or ascending colon in neutropenic (immunosuppressed, leukemia, lymohioma) patients. Caued by infection, bleeding, ischaema.
    • TB: narrow cecum (fleischner sign), narrow crohn may produce same appearance, terminal ileum (stierlin sign)
    • Amebiasis (predominantly effects the cecum, not terminal ileum)
    • UC: valve is wide open (gaping), labia are atrophied, terminal ileum is dilated
    • Crohn’s disease (apthous ulcers-> linear fissues -> nodules -> cobblestone -> stricture, spasm (string sign), fistua).
  • Tumour
    • Lymphoma
    • adenocarcinoma
    • Carcinoid of the ileum (desmoplastic response) or appendix
    • Intussusception
67
Q

Ddx of Proctitis

A
  • Condulomata acuminata (HPV)
  • Lymphogranuloma Venereum (chlamydia)
  • Gonococcal Proctitis
  • UC, CD
  • Herpes
  • CMV
68
Q

DDx of Solid Liver Masses

A
  • Solid Liver masses
    • Neoplasm
      • Benign: Hemangioma
      • Malignant:
        • Primary
        • Secondary
    • Focal Fatty liver (pseudotumour)
    • Regenerating nodules in Cirrhosis
69
Q

DDx of Cystic Liver masses

3 categories

a 3

b 7

c 4

A
  • Cystic Liver masses DDx
    • Infectious
    • Benign masses
    • Malignant
  • Cystic Liver masses DDx
    • Infectious
      • Echinococcosis
      • Amebiasisi
      • Other abscesses (often complex and have debris)
    • Benign masses
      • Simple liver cysts
      • Polysystic disease of the liver
      • Von Meyenburg Complexes
      • Peribilary cysts
      • Biliary cystadenoma
      • Obstructive intrahepatic GB
      • Biloma
    • Malignant
      • Cystadenocarcinoma
      • Cystic mets (ovarian)
      • Necrotic Tumours
      • Cholangiocarcinoma
70
Q

Ddx of iNcreased Liver density

5

A
  • Hemochromatosis
  • Glycogen storage disease
  • Wilsondisease
  • Drugs
    • amiodarone
    • Cisplatin
    • Gold
  • Apparent increased density of liver parenchyma in patients with anemia (relative decreased blood density)
71
Q

DDx of Decreased LIver denisity

A
  • Fatty liver (common)
    • CAUSES
      • Obesity/nutritional
      • Alcohol
      • diabetes
      • steroids
      • chemotherapy
72
Q

DDx of Hypervascular liver lesions

A
  • Hemangioma
  • hemangioendothelioma/hemangiopericytoma, angiosarcoma, intrahepatic cholangiocarcinoma
  • Mets
    • Islet cell
    • melanoma
    • carcinoid
    • RCC
    • Thyroid
    • Breast
    • Sarcoma
73
Q

Ddx of Fat Containing liver masses

6

A
  • Hepatic adenoma
  • HCC
  • Mets (liposarcoma, teratoma)
  • Focal fatty infiltration
  • Lipoma
  • AML
74
Q

DDx of Focal LIver lesions with capsular retraction

6

A
  • mets after rx
  • cholangiocarcinoma
  • Focal confluent firbosis
  • primary sclerosing cholangitis
  • epithelioid hemangioendothelioma
  • Hemangioma (rarely)
75
Q

DDx of Focal Liver lesions with a central scar

7

A
  • FNH
  • Fibrolamellar HCC
  • Large cavernous hemangioma
  • Cholangiocarcinoma
  • Adenoma
  • HCC (with central necrosis mimicking a scar)
  • Mets (with central necrosis mimicking a scar)
76
Q

DDx of Liver nodules in cirrhosis

A
  • Regenerative:
    • benign
    • proliferation of hepatocytes
    • Precursor to dysplastic nodule and HCC
    • Regenerative nodules with hemosiderine are termed siderotic nodules
    • They are isointense on CT, Hyperdense on NCT and hypointense on T1 and T2.
  • Dysplastic nodule
    • pre-malignant
    • hyperintense on T1 and hypointense on T2
    • When malignancies develop they often appear as a nodule within a nodule, where the inner nodule has a characteristic appearance
      • T1 hypo
      • T2 hyper
      • Arterial enhancement
  • HCC
77
Q

DDx of ROUND Hyperechoic liver lesions

5 cats

10 ddx

A
  • Hemangioma
  • Hyperecehoic mets
    • Hypervascular mets
    • sarcoma
    • Calcificed mets
  • Primary liver tumours (contain fat)
    • HCC
    • Fibrolamellar HCC
  • Focal Fat/lipoma/angiomyolipoma (TS)
  • Gaucher disease
78
Q

DDx of LINEAR hyperechoic Liver Lesions

A
  • Air in biliary tree
  • Air in PVs
  • Biliary Ascariasis
79
Q

Ddx of Mulitple Hypoechoic liver lesions

A
  • Tumour
    • mets
    • lymphoma
    • Multifocal HCC
  • Infection
    • Multiple pyogenic abscesses
    • Amebic abscresses
    • Echinococcus
    • Candidiasis
    • Schistosomiasis
  • Other
    • Regenerating nodules/cirrhosis
    • Sarcoid
    • Extramedullary hematopoiesis
    • Hematomas
    • Hemanioma
80
Q

DDx of Gas in liver

4

A
  • biliary gas (ercp, surgery)
  • PV gas (bowel necrosis, diverticulitis)
    • May produce short spikes on doppler wave form
  • Abscess
  • Emphysematous cholecystitis
81
Q

Levels of ESXTRAHEPATIC BILIARY OBSTRUCTION/DILATATION

A
  • Levels of Obstruction
    • Intrapancreartic (most common)
      • Pancreatic cancer
      • Calculus
      • Chronic pancreatitis
    • Suprapancreatic
      • Primary biliary ductal carcinoma
      • Metastatic LNs
    • Portal
      • invasive GB carcinoma
      • surgical strictures
      • hepatoma
      • choangiocarcinoma
82
Q

Types of Biliary Obstruction

A
  • Tumour
  • Pancreatitis
  • Lithiasis Related disease
  • Cholangitis
  • Caroli Disease
  • Intrahepatic biliary neopalsm (rare)
  • Tumour
    • Abrupt termination of a duct
    • mass adjacent to duct
  • Pancreatitis
    • smooth, long tapering
  • Lithiasis Related disease
    • calculus visible
    • meniscus sign (ERCP, CT), intrahepatic dilatation
    • Mirizzi Syndrome
  • Cholangitis
    • Sclerosing Cholangitis (50% have UC)
    • AIDS cholangitis
    • Intrahepatic biliary calculi (oriental cholangiohepatitis)
  • Caroli Disease
    • Congenital disorders comprising of multifocal cystic dilatation of segmental intrahepatic bile ducts.
  • Intrahepatic biliary neoplasm (rare)
    • Cystadenoma
    • Cystadenocarcinoma
83
Q

US Signs of Intrahepatic dilatation

A
  • Colour Doppler flow is absent in dilated ducts
  • acoustic enhancement behind dilated ducts,
    • blood in contrast attenuates acoustic beam secondary to high protein content
  • Double duct sign
    • dilated biliary vessel accompanies PV
  • Caliber irregularity and tortuosity of dilated bile ducts,
    • veins are always smooth and taper gradually
  • Spokewheel appearance at points of conversion of ducts
84
Q

DDx of Multifocal biliary duct narrowing

5

A
  • Primary sclerosing cholangitis
  • AIDS cholangiopathy
  • Mets
  • Chemotherapy
  • Post-transplant ischemia
85
Q

DDx of Filling defects within the biliary system

5

A
  • Calculi
  • Clot
  • papillomas
  • cholangiocarcinoma
  • Sludge balls
86
Q

DDx of Periportal enhancement

A
  • Thickened portal tracts with enhancement
    • ascending cholangitis
    • schistosomiasis, TB, Histoplasmosis
    • Primary sclerosing cholangitis
    • Primary biliary cirrhosis
    • Sarcoidosis
    • Cholangiocarcinoma
87
Q

DDx of GB wall thickening

8

A
  • GB wall thickening >3mm
  • Wall thickening typically appears as a hypoechoic region between two echogenic lines.
  • When measuring walll thickening by US, a 5-MHz transducer should be used.
  1. Nonfasting GB (GB is usually <2mm)
  2. Acute cholecystitis (50-75% of patients have thickening)
  3. Portal venous Hypertension
    • Cystic vein dilatation causes edema)
  4. Hypoalbuminemia (<2.5g/dL)
  5. Hepatitis
  6. AIDS
    • Cryptosporidiosis
    • CMV
    • MAI
  7. Vasculitis
    • Lupus
    • HSP
  8. Ascities
    • Benign ascites -> GB wall thickening
    • Malignant Ascities -> no GB wall thickening
88
Q

Ddx of Focal (Eccentric) Thickening

5

A
  • GB carcinoma
    • 40% present with focal thickening, mass typically fills the GB
  • Mets
    • Melanoma
    • Gastric
    • Pancreas
  • Benign tumours
    • polyps (cholesterol, adenomatous)
    • Adenomyomatosis
  • Tumefactive sludge adherent to GB wall
  • AIDS
89
Q

DDx of Hyperechoic Foci in GB Wall

5

A
  1. Calculus
  2. Polyp
  3. Cholesterol
  4. Emphysematous Cholecystitis
  5. Porcelain GB
90
Q

DDx of Dense GB CT

6

A
  • Hepatobiliary excretion of contrast material
  • Calculi
  • Milk of calcium bile
  • Reflux of oral contrast agent after surgery
  • oral cholecystogram
  • Hemorrhage (hematocrit effect)
91
Q

DDx of Focal pancreatic signal abnormality

A
  • Ie focal hypoechoic or hypodense pancreatic lesion
    • Tumour
    • focal pancreatitis
    • Adenopathy
92
Q

DDx of Paraduodenal pancreatitis

3

A
  • Groove pancreatitis
  • Cystic dystrophy of the duodenum
  • Paraductodenal wall cysts
93
Q

DDx of Cystic Pancreatic lesions

A
  • Unilocular
    • simple cyst
    • Pseudocyst post pancreatitis
  • muliple unilocular
    • VHL
    • CF
    • ADPKD
  • Microcystic lesions
    • serous cystadenoma
  • Macrocystic lesions
    • mucinous cystadenoma
  • Mural nodules
    • pancreatic adenocarcinoma
94
Q

DDx of Pancreatic Lesions by incidence

common

A
  • Common cystic neoplasms
    • mucinous cystic neoplasm
    • Serous cystadenoma
    • Intraductal papillary mucinous neoplasm (IPMN)
95
Q

ddx rare cystic neoplasms pancreas

A

Rare cystic neoplasms

  • Solid pseudopapillary epithelial neoplasm (SPEN)
  • Papillary cystic epithelial neoplasm
  • Acinar cell cystadenocarcinoma
  • Cystic teratoma
  • cystic choriocarcinoma
  • Angiomatous neoplasmas (Lymphangioma, hemangioma)
  • Paraganglioma
96
Q

Ddx of pancreatic solid tumours undergoing cystic change

2

and 4 other misc tumours

A
  • Solid tumors undergoing cystic change
    • cystic islet cell tumors
    • Cystic necrosis pf pancreatic adenocarcinoma
  • Others
    • lymphoma
    • Mets (ovarian clear cell)
    • Cystic teratoma
    • Sarcoma
97
Q

Ddx of Pancreatic Calcifications

A
  • Chronic pancreatitis
  • islet cell tumour
  • serous cystadenoma
  • mucinous cystic neoplasm
  • SPEN
  • Granulomatous disease
    • sarcoidosis
    • Histoplasmosis
98
Q

DDx of Fatty replacement of the pancreas

A
  • CF
  • Aging
  • DM
  • Obesity
  • Steroids
  • Shwachman-Diamond Syndrome (picture)
99
Q

DDx of Hyperechoic Pancreas

A
  • The normal pancrease appears slightly hyperechoic relative to the liver. Marked hyperechogenicity is seen in:
    • CF
    • Pancreatic lipomatosis
100
Q

DDx of Focal Splenic lesions

A
  • Tumour
  • Infection
  • Other
  • Tumour
    • mets
      • Usually in endstage disease
      • Lymphoma
      • melanoma
      • ovary
    • hemangioma (common benign lesion)
    • Lymphangioma
    • Hamartoma
    • Rare lesions
      • Myoma
      • chondroma
      • osteoma
      • hemangiosarcoma
      • fibrosarcoma
  • Infection
    • abscess
    • candidiasis (esp AIDS)
    • TB MAI
    • Schistosomiasis
      • Splenic nodules in 10%
      • Pneumocystis jiroveci
  • Other
    • infarcts
    • hematoma
    • cysts: simple, hydatid
    • Fatty nodules in Gaucher disease

RANZCR Part 2 Exam (64 decks)

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