HomeStretch CRACK vol 1. GI Flashcards
Esophageal anatomy
A ring and B ring and Z line
bonus - what esophagitis shows concentric rings?
A: muscular ring above the vestibule
B: mucosal ring Below the vestibule; thin constriction at the GE junction - ShatzB ring
Z line: squamoclumnar junction
High stricture + hiatal hernia = ?
What’s the buzzword for this entity?
Barrett
buzzword = reticular mucosal pattern
candidiasis appearence on barium swallow
What else looks like that exactly?
discrete plaque-like lesions, nodularity, fold thickening and shaggy appearence
Glycogenic ancothosis looks exactly the same in an asymptomatic elderly patient.
Herpes, CMV and HSV esophageal barium
Herpers has a halo - small and multiple ulcers with halo
CMV = HIV = large, flat ovoid ulcer
Esophageal diverticulum
- 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
Carny’s Triad
Carney’s Eat Garbage
- Chondroma (pulmonary)
- Extra adrenal pheo
- GIST
Hidebound bowel or stack of coins
Scleroderma
Fold reversal
CeliaC
clover leaf sign
healed peptic ulcer
Ribbon bowel
GVHD
Lane Hamilton Syndrome
Idiopathic pulmonary Hemosiderosis, which is associated with celec sprue
Rigler’s Triad
pneuobilia, obstruction and ectopic location of glasstone
Note that rigler’s sign (pneumoperitoneum) is not included here
Spigelian Hernia
Lateral ventral hernia
Hernia along the Semilunar line (S for S)
Grynfelt-Lesshaft Hernia
Petit Hernia
Littre Hernia
Amyand Hernia
Richter Hernia
- 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. . .
Howship-Romberg Sign
Obturator hernia causing characteristic paresthesia along inner though down to knee
Femoral v Direct Inguinal v Indirect Inguinal Hernias
(also obturator)
- 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.
Most common types of internal hernias
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
What do you think of when you have an enlarged lymph node in the setting of ulcerative colitis
cancer/metastatses
Behcet’s
ulcers of penis and mouth
can hit GI and look like crohn’s
cause of pulmonary artery aneursyms
What syndromes are associated with rectal cavernous hemangiomas?
Klippel-Trenaunay-Weber and Blue Rubber Bleb syndrome
McKittrick-Wheelock Syndrome
Villous andeoma in the rectum with mucous diarrhea (usually in an old lady causing electrolyte imbalances/dehydration).
retroperitoneal structures
- Duodenum (2nd and 3rd part)
- Pancreas (except tail)
- Colon (ascending and descending)
- Rectum (proximal 1/3)
- distal 1/3 if the rectum is intraperitoneal
Mesenteric mass algorithm
- Cystic versus Solid
- Single versus multiple
- If single - does it have fat?
- If it doesn’t have fat what do the margins look like?
Fissure for the ligamentum venosum
Fissure for the ligamentum teres
- 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)
Cantlie’s Line
Liver lobe line. . . divides the liver into functional left and right hepatic lobes (8/4a and 5/4b)
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?
- 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
Most common hepatic vascular variant?
Most common biliary variant?
- Most common hepatic vascular variant = replaced right hepatic originating from SMA
- Most common biliary variant = right posterior segmental into the left hepatic duct
Hepatic adenoma subtypes
- 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.
Hepatic Angiosarcoma
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
Osler-Weber-Rendu Syndrome
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
Fitz-Hugh-Curtis Syndrome
PID complication with enhancement of the anterior liver capsule, perihepatic ascites and peritoneal septations
Choledocal cyst classification
- 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
Caroli’s disease
Type 5 choledocal cysts (which communicate with ducts!)
Central dot sign
Associated with polycystic kidney disease, medullary sponge kidney and cholangioCA.
Mirizzi syndrome
Cystic duct stone obstructing CBD
increased co-incidence of gallbladder CA
Peripancreatic fluid collections
- NO necrosis
- < 4 weeks = acute peripancreatic fluid collections
- > 4 weeks = pseudocyst
- Necrosis
- < 4 weeks = acute necrotic collection
- > 4 weeks = walled off necrosis
Hereditary syndromes with pancreatic CA
HNPCC (Lynch Syndrome), BRCA mutation, Ataxia-telangiectasia, Peutz-Jeger
Felty’s syndrome
Abnormality of Granulocytes with triad of:
Splenomegaly, RA and neuropenia
Caplan syndrome
rhematoid pneumoconiosis
