J. Mandell & D. Marchiori Flashcards
What is the most common cause of bladder calculi?
Bladder outlet obstruction from prostatic disease (seen in elderly men)
The presence of bladder stones is associated with an increased incidence of _____
Bladder carcinoma
80% of Wilms tumors occurs in children of what age range?
1-5 years old
Peak incidence: 3-4 years old
What is the most common abdominal malignancy in children?
Wilms tumor (aka nephroblastoma)
Intra-parenchymal calcifications within the kidney is known as what?
Nephrocalcinosis
cortical vs. medullary types
Calcifications within the pyelocalyceal lumina of the kidney is known as what?
Nephrolithiasis
What is the most common substance that makes up renal stones in the US?
Calcium oxalate (75%)
What percentage of renal stones are visible on radiographs?
90% are opaque enough to be seen on plain films
What is the most common germ cell neoplasm and the most common childhood ovarian tumor?
Mature teratoma (aka ovarian dermoid cysts)
What is the most common complication with a ovarian dermoid cyst?
Torsion
What percentage of ovarian tumors are benign?
80% (majority occur in patients of reproductive age)
Pheochromocytoma is a rare, potentially life-threatening neoplasm characterized by its marked production of what?
Catecholamines (epinephrine and norepinephrine)
Approximately 85-95% of pheochrormocytomas occur where?
Adrenal medulla
Renal cell carcinoma (RCC) accounts for what percentage of primary malignant renal neoplasms?
80-90%
Of all genitourinary malignancies, which is considered the most lethal?
Renal cell carcinoma
What is the most common benign renal neoplasm?
Angiomyolipoma
Approximately what percentage of angiomyolipomas occur in females?
80%
Multiple, bilateral, small angiomyolipomas that may be symptomatic are found in up to 80% of patients with what underlying disease?
Tuberous sclerosis
Angiomyolipoma often has a similar appearance to RCC on ultrasound, which modality is used to determine the diagnosis?
CT
Angiomyolipomas have a classical appearance of inhomogenous attenuation of what kind of tissue on CT?
Fatty tissue that does not enhance
What is the most common benign uterine tumor?
Leiomyoma (aka uterine fibroma)
A uterine fibroma is primarily affected by what when it comes to growth?
Estrogen
What genitourinary tumor has a classic “popcorn” or “cauliflower-like” appearance on plain film?
Uterine fibroid (leiomyoma)
What is the preferred imaging modality when imaging gallstones?
Ultrasound
What percentage of gallstones have enough calcification to be visualized on plain film?
10-15%
Porcelain gallbladder (aka calcifying cholecystitis) is extensive calcification of the _____ of the gallbladder
Wall of the gallbladder
A porcelain gallbladder is associated with a higher risk of which primary gallbladder malignancy?
Adenocarcinoma of the gallbladder
Describe gallstone ileus
A complication of gallstones, it is perforation of the duodenum/bowel by gallstone
What is the classic radiographic triad associated with gallstone ileus?
Small bowel obstruction
Biliary tract air
Opaque concretion seen in the small bowel
Describe limy bile syndrome (milk of calcium bile)
Radiopaque appearance of gallbladder on radiographs
Caused by calcium carbonate precipitation in the bile
In the setting of limy bile syndrome, what is a characteristic finding on upright radiographs?
An air-fluid level
A non-surgical technique that helps to break up gallstones is called _____
Lithotripsy (strong ultrasound waves)
Adenomatous colon polyps are considered a precursor to _____ cancer
Colorectal cancer
Why is colon polyp size critical for guiding clinical management?
As colon polyp size increases, so does the risk of malignancy
Chronic occult blood loss from polyps may lead to what kind of deficiency?
Iron deficiency
The following are high risk groups for colorectal carcinoma
Familial polyposis (100% risk if untreated)
Gardner syndrome
Ulcerative colitis (increased risk with chronic UC)
Crohns disease (risk is lower than UC)
Family history
What are characteristic findings of Peutz-Jeghers syndrome?
Multiple polyps (mostly at small intestines) Mucocutaneous melanin pigmentation at: Lips Buccal mucosa Fingers and toes
What lesions are associated with Gardner syndrome?
Multiple polyps
Osteomas
Fibromas
Desmoid tumors
A narrowed segment of bowel with markedly narrowed lumen, abrupt transition, and overhanging edges is known as a _____
“Napkin ring” or “apple core” lesion
The “napkin ring” or “apple core” lesion is associated with what pathology?
Colon carcinoma
Which part of bowel does Crohns disease predominantly affect?
Terminal ileum and proximal ascending colon
Small bowel only involvement (30-40%)
Colon only involvement (25%)
Which age range does Crohns disease typically affect?
Adolescents and young adults
“Rose thorn” ulcerations, “cobble stone” mucosal appearance, “skip lesions”, fissures, strictures, and fistulas are all associated with which inflammatory bowel disease?
Crohns disease
What are some clinical symptoms of Crohns disease?
Intermittent low-grade fever Non-bloody diarrhea Abdominal distention RLQ pain Iron deficiency anemia
Diverticulosis/diverticulitis is most common at which location?
Sigmoid colon (may occur anywhere in the colon)
What category of diseases can predispose a patient to diverticular disease?
Connective tissue diseases, reduces the integrity of the bowel wall:
Marfans syndome
Ehlers-Danlos
Scleroderma
What are some clinical symptoms of diverticular disease?
Diverticulitis (inflammation)
Hemorrhage
LLQ tenderness
Rectal bleeding (associated with right colon diverticulitis)
What is the most common type of hiatal hernia?
Sliding (95%):
A portion of gastric fundus herniates into chest
The following conditions may lead to pancreatic calcifications
Alcoholism: small concretions scattered through the gland
Pseudocysts: widely scattered or rim calcification
Pancreatic cancer: diffuse calcification (most do not calcify)
Hyperparathyroidism: causes pancreatic and renal calcification
Cystadenoma/cystadenocarcinoma: sunburst pattern calcification (pathognomonic but uncommon)
IN the setting of pancreatic calculi, what percentage of patients have a history of high alcohol intake?
90%
Calcifications of the pancreas usually develops after how many years of abdominal pain in patients with high alcohol intake?
5-10 years
Peptic ulcer disease (aka gastric ulcers) is the erosion of the _____ or _____ mucosa
Gastric or duodenal mucosa
What bacteria is thought to be a major cause of peptic ulcer disease?
H. pylori (present in 80-90% of patients with peptic ulcer disease)
What percentage of gastric ulcers are associated with malignancies?
5%
What percentage of duodenal ulcers are associated with malignancies?
Virtually none
Ulcerative colitis is an inflammatory condition affecting the mucosal surface of the colon. Which region is involved in approximately 50% off the patients?
Involves only the rectosimoid region in approximately 50% of patients
Epigastric pain is present in what percentage of patients with peptic ulcer disease?
Approximately 90%
What is the acceptable measurement of small bowel?
< 3cm
What is the acceptable measurement of large bowel?
< 6cm
What is the acceptable measurement of the cecum?
< 9cm
Image findings of ulcerative colitis includes the following
Loss of haustra
Coarse, granular appearance of mucosa
Differentiating ulcerative colitis from Crohns disease
UC: Colon involvement is continuous Pseudopolyps Decreased rectal distensibility No strictures, fissures, fistulas
A hallmark clinical symptoms that is present in ulcerative colitis and not Crohns disease is _____
Bloody diarrhea
Dilatation larger than _____cm indicates a possible abdominal aortic aneurysm
3cm
What is the most diagnostic imaging modality for detecting an abdominal aortic aneurysm?
Ultrasound
What is the most common cause of an acute abdomen?
Appendicitis
Tearing of the lower esophagus due to violent vomiting is called what?
Mallory-Weiss syndrome
What is the most frequently involved site for a hydatid cyst?
Liver Can also be seen at: Spleen Kidney Peritoneum
Which animals are hosts for echinococcus granulosus/echinococcus multilocularis?
Sheep Dogs Cattle Deer Hogs
Hydatid cysts represent infestation by which 2 organisms?
Echinococcus grranulosus
Echinococcus multilocularis
Describe characteristics of a concretion calcification within the abdomen
Varied shape (typically round/oval) Clearly defined border (usually smooth) Continuous border
Describe the characteristics of conduit wall calcification within the abdomen
Tubular, track-like appearance
Border may be indistinct
Margins may be discontinuous, irregular
Describe the characteristics of a cyst calcification within the abdomen
Round/oval in shape
May be compressed on one side
Smooth, curvilinear rim of opacification
Rim calcification may be continuous/interrupted
Describe the characteristics of a mass calcification within the abdomen
Varied shape
Irregular, calcified border
Interrupted margins
Vas deferens calcification is highly associated with what underlying systemic disease?
Diabetes mellitus
Which abdominal calcification is associated with current/future appendices perforation, especially in children?
Appendicolith
The presence of phleboliths outside of the pelvic bowl periphery usually indicates what?
Soft tissue hemangiomas
Concretions of variable sizes behind the pubic symphysis of male patients older than 40 most likely represents what?
Prostatic calculi
What is the most common location for conduit wall calcification?
Abdominal aorta
Renal artery calcification occurs primarily as a consequence of which systemic disease?
Diabetes mellitus
Splenic artery calcification is seen in which location of the abdomen?
LUQ
What is the characteristic appearance of splenic artery calcification?
Serpiginous
2/3 of splenic cysts are caused by what organism?
Echinococcus granulosis
Seeni n LUQ
What type of cysts are most likely to calcify at the adrenal glands?
Pseudocysts
What is the most common cause of calcification of the bladder?
Schistosomiasis
Thin, continuous curvilinear calcification
What is the most common cause of pneumoperitoneum?
Recent laparotomy (usually presents 3-7 days after)
What is the most common spontaneous causes of pneumoperitoneum?
Perforation of gastric/duodenal ulcer