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HomeStretch/Numbers > HomeStretch CRACK vol 1. GI > Flashcards

HomeStretch CRACK vol 1. GI Flashcards

1
Q

Esophageal anatomy

A ring and B ring and Z line

bonus - what esophagitis shows concentric rings?

A

A: muscular ring above the vestibule

B: mucosal ring Below the vestibule; thin constriction at the GE junction - ShatzB ring

Z line: squamoclumnar junction

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2
Q

High stricture + hiatal hernia = ?

What’s the buzzword for this entity?

A

Barrett

buzzword = reticular mucosal pattern

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3
Q

candidiasis appearence on barium swallow

What else looks like that exactly?

A

discrete plaque-like lesions, nodularity, fold thickening and shaggy appearence

Glycogenic ancothosis looks exactly the same in an asymptomatic elderly patient.

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4
Q

Herpes, CMV and HSV esophageal barium

A

Herpers has a halo - small and multiple ulcers with halo

CMV = HIV = large, flat ovoid ulcer

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5
Q

Esophageal diverticulum

A
  • Zenker - (posterosuperior - above cricopharyngeus) pulsion divirticulum posteriorly via site of weakness called Killian dehisence in the hypopharynx
  • Killian-Jamieson - anterolateral and more inferior (below cricopharygneus), this one is in the cervical esophagus; least common
    • Pulsion diverticulum are Pseudodiverticuli (i.e. don’t have all three layers of esophagus and therefore won’t empty).
  • Traction diverticulum - mid esophagus, triangular in shape, TB, will empty since it is a true diverticulum
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6
Q

Carny’s Triad

A

Carney’s Eat Garbage

  • Chondroma (pulmonary)
  • Extra adrenal pheo
  • GIST
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7
Q

Hidebound bowel or stack of coins

A

Scleroderma

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8
Q

Fold reversal

A

CeliaC

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9
Q

clover leaf sign

A

healed peptic ulcer

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10
Q

Ribbon bowel

A

GVHD

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11
Q

Lane Hamilton Syndrome

A

Idiopathic pulmonary Hemosiderosis, which is associated with celec sprue

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12
Q

Rigler’s Triad

A

pneuobilia, obstruction and ectopic location of glasstone

Note that rigler’s sign (pneumoperitoneum) is not included here

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13
Q

Spigelian Hernia

A

Lateral ventral hernia

Hernia along the Semilunar line (S for S)

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14
Q

Grynfelt-Lesshaft Hernia

Petit Hernia

Littre Hernia

Amyand Hernia

Richter Hernia

A
  • Grynfelt-Lesshaft Hernia = super lumbar hernia (more common)
  • Petit Hernia = inferior lumbat hernia
  • Littre Hernia = hernia with meckel diverticulum in it!
  • Amyand Hernia = hernia with Appendinx in it!
  • Richter Hernia = contains only one wall of bowel and does not obstruct but can strangulate. . .
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15
Q

Howship-Romberg Sign

A

Obturator hernia causing characteristic paresthesia along inner though down to knee

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16
Q

Femoral v Direct Inguinal v Indirect Inguinal Hernias

(also obturator)

A
  • Femoral: seen in old ladies, infeior to the inferior epigastric and medial to common femoral vein, below the pubic tubercle; compression of the femoral vein can cause distal collateral venous engorgement; obstruction is common
    • obturator will have bowel herniating between obturator and pectineus muscle).
  • Direct = medial and anterior to inferior epigastric - goes through Hesselbach’s triangle, not covered by spermatic
  • Indirect goes Into the Inguinal canal/lateral to the inferior epigastric artery and into a patent processus vaginalis.
17
Q

Most common types of internal hernias

A

Paraduodenal hernia in the left occurs through a defect via the fossa of Lanzert (L for L) this one is more common

right sided - goes through fossa of waldeyer

18
Q

What do you think of when you have an enlarged lymph node in the setting of ulcerative colitis

A

cancer/metastatses

19
Q

Behcet’s

A

ulcers of penis and mouth

can hit GI and look like crohn’s

cause of pulmonary artery aneursyms

20
Q

What syndromes are associated with rectal cavernous hemangiomas?

A

Klippel-Trenaunay-Weber and Blue Rubber Bleb syndrome

21
Q

McKittrick-Wheelock Syndrome

A

Villous andeoma in the rectum with mucous diarrhea (usually in an old lady causing electrolyte imbalances/dehydration).

22
Q

retroperitoneal structures

A
  • Duodenum (2nd and 3rd part)
  • Pancreas (except tail)
  • Colon (ascending and descending)
  • Rectum (proximal 1/3)
    • distal 1/3 if the rectum is intraperitoneal
23
Q

Mesenteric mass algorithm

A
  1. Cystic versus Solid
  2. Single versus multiple
    1. If single - does it have fat?
    2. If it doesn’t have fat what do the margins look like?
24
Q

Fissure for the ligamentum venosum

Fissure for the ligamentum teres

A
  • Fissure for the ligamentum venosum: Fibrous remnant of the ductus venosus fetal circululation (closer one to the IVC - relative tot the ligamentum teres). An artery in this fissure is a replaced left hepatic artery.
  • Fissure for the ligamentum teres - ligamentum teres (which is found within the falciform ligament) = round ligament of the liver, which is the remnant of the left umbilical vein. . the left hepatic vein also courses here and slits the caunaid system (4a/2 and 4b/3)
25
Q

Cantlie’s Line

A

Liver lobe line. . . divides the liver into functional left and right hepatic lobes (8/4a and 5/4b)

26
Q

Couinaud System Testable Trivia

Left hepatic vein / Fissure for Ligamentum Teres (falciform) divides what segments?

Middle hepatic vein divides what segments?

Right hepatic vein divides what segments?

Portal vein devides what?

What segment is the caudate lobe? where does it drain?

A
  • Left hepatic vein / Fissure for Ligamentum Teres (falciform) divides 2 from 4a and 3 from 4b)
  • Middle hepatic vein divides 4a from 8 and 4b from 5 (Cantlie’s line)
  • Right hepatic vein divides 8 from 7 and 5 from 6
  • Portal vein divides liver from upper and lower segments
  • What segment is the caudate lobe = 1 and drains directly into IVC
27
Q

Most common hepatic vascular variant?

Most common biliary variant?

A
  • Most common hepatic vascular variant = replaced right hepatic originating from SMA
  • Most common biliary variant = right posterior segmental into the left hepatic duct
28
Q

Hepatic adenoma subtypes

A
  • Inflammatory = most common; highest bleeding rate
  • HNF-1 alpha mutated - 2nd most common; multiple masses
  • Beta-catenin mutated = least common; anabolic steroids and glycogen storage disorders and FAP.
29
Q

Hepatic Angiosarcoma

A

Most common primary liver sarcoma

assocaited with toxic exposures like arsenic, polyvynil chloride and thoratrast

Can see in hemochromatosis and NF1 patients

usually multifocal and likes to bleed

30
Q

Osler-Weber-Rendu Syndrome

A

Hereditary Hemorrhagic Telangiectasia

AD disorder characterized by muliple AVMs in liver and lungs

Leads to cirrhosis and massively dilated hepatic artery

lung avms set you up for brain abscesses

31
Q

Fitz-Hugh-Curtis Syndrome

A

PID complication with enhancement of the anterior liver capsule, perihepatic ascites and peritoneal septations

32
Q

Choledocal cyst classification

A
  • Type 1: Focal dilation of the CBD and most common form
  • Type 2: rare - diverticulum of bile duct
  • Type 3: rare - choledococele - focally dilated distal common bile duct protruding into the duodenum
  • Type 4: both intra and extra
  • Type 5: intra only = caroli’s disease
33
Q

Caroli’s disease

A

Type 5 choledocal cysts (which communicate with ducts!)

Central dot sign

Associated with polycystic kidney disease, medullary sponge kidney and cholangioCA.

34
Q

Mirizzi syndrome

A

Cystic duct stone obstructing CBD

increased co-incidence of gallbladder CA

35
Q

Peripancreatic fluid collections

A
  • NO necrosis
    • < 4 weeks = acute peripancreatic fluid collections
    • > 4 weeks = pseudocyst
  • Necrosis
    • < 4 weeks = acute necrotic collection
    • > 4 weeks = walled off necrosis
36
Q

Hereditary syndromes with pancreatic CA

A

HNPCC (Lynch Syndrome), BRCA mutation, Ataxia-telangiectasia, Peutz-Jeger

37
Q

Felty’s syndrome

A

Abnormality of Granulocytes with triad of:

Splenomegaly, RA and neuropenia

38
Q

Caplan syndrome

A

rhematoid pneumoconiosis

HomeStretch/Numbers (24 decks)

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