Lecture 18: IBD Cancers Radiology Flashcards
What is intussusceptum?
Prolapsing/invaginating inner loop
Narrow barium filled or coated lumen
Lead point polypoid lesion
What is the intussuscipiens?
The receiving or outer loop
Dilated bowel loop
What are the radiographic findings of ulcerative colitis?
- Granular mucosa (little dots)
- Small nodules, pseudopolyps (inflamed resideual mucosa)
- Ulcers on background mucosal granularly
- Tubular configuration colon
- Backwash ileitis
- Collar buttons (see slide 11)
What are the complications of ulcerative colitis?
- Steatosis (50%)
- Pericholangitis (35%)
- Sclerosing cholangitis (1-4%)
- Nephrolithiasis
What does UC look like radiographicaly?
Loss of haustrations and sacculations
What are the radiographic findings of Crohn’s?
- Asymmetric
- Right sided
- Discontinous
- Lymphoid distribution
What are aphthoid ulcers?
A blister on the mucous membranes of the lips, mouth or GI tract
Histologically, what does aphthoid ulcer look like?
Focal loss of villi over a round area of inflammation
Adjacent villi are enlarged by inflammation in the
Lamina propria
What is pathognomonic for CD?
Linear ulcers on the mesenteric border
Means villi is gone
What is cobblestoning?
Transverse or knife like clefts that span the colon
Pathognomonic of Crohn’s
How do strictures form in CD?
Results from transmural inflammatory process
Focal, tapered narrowing with slit-like lumen
Upstream bowel is dilated
What is “String sign” in CD?
When there is bowel wall narrowing due to
i. spasm ii. edema iii. inflammation iv. fibrosis
What are suprasphincteric fistulae?
When fissures arise in the distal rectum just above the anorectal junction
Therefore, there is a 2cm perirectal collection
What are valculae conniventes?
AKA plicae circulares
Circular folds
Large valvular flaps projecting into the lumen of the bowel
Serves to increase surface area
What does ischemia to the small intestine look like?
Thumb printing
The dark shit is a lot THICKER (the white part is a lot thinner in CT)
The dark shit is what should look like a thumb
Where do adenoma or adenocarcinoma usually present in small intestine?
2nd and 4th portion duodenum, proximal jejunum
Where do carcinoid tumors arise?
Distal ileum
Extension beyond bowel wall
30% multifocal
What is a desmoplastic reaction?
The growth of fibrous or connective tissue
Secondary to an insult
May occur around a neoplasm, causing dense fibrosis around the tumor
Where is the most common area of small bowel lymphoma?
The ileo-cecal region
What happens in small bowel lymphoma?
Degradation of circular longitudinal muscle
Therefore there is an EXPANSION of the lumen
Whereas crohn’s theres stricture of the lumen
What is a diverticulum?
A sac
What are the characteristics of diverticular disease of the colon?
- Multiple Small sacs
-herniations of mucosa/submucosa at sites of penetrating arterioles - Alteration of circular and longitudinal muscle layers (myochosis)
0elastin deposits result in short, thick taeniae coli with “bunching” of circular muscle and mucosa
What is the pathogenesis of diverticular bleeding?
Diverticulum (sac) expands against the vessels lining the outside of the lumen
Expansion will lesion the vessels, causing bleeding into the lumen
If you have rectal bleeding, what are the two most common causes
- hemorrhoids
2. Diverticular bleeding
What is the difference between diverticulosis and diverticulitis?
Diverticulosis = sacs Diverticulitis = inflammation of the mucosa? Submucosa?
What is the risk of a hyperplastic polyp of developing into a cancer?
99% that it will NOT turn into a tumor
How can you tell the likelihood of malignancy for adenoma?
The bigger the polyp, the more likely it is to be malignant
The more of a villous component, the more chance of malignancy as well
What are lipomas?
Most common submucosa lesion aside from hemorrhoids
Fat in the submucosa (all the white stuff in H&E)
Which of the following small bowel tumors forms a calcified, speculated mesenteric metastasis?
Which of the following small bowel tumors forms a calcified, speculated mesenteric metastasis? A. LYMPHOMA B. Adenocarcinoma C. Carcinoid tumor D. Metastatic melanoma
The most common cause of a jejunal intussusception in an adult is which of the following?
A. Lipoma
B. Adenoma
C. Metastatic melanoma
D. Idiopathic/No lead point polyp
