Module 3: GI Flashcards
What is the A ring
muscular ring above the vestibule
What is the B ring
Mucosal ring
Below the vestiuble
If B ring is narrowed its called
Schatzki
schatskBi ring
What is the Z line
squamocolumnar junction
between esophageal and gastric epithelium
in which part of the oesophagus is Zenker Diverticulum found
Hypopharynx
What is the cricopharyngeas
muscle is the border between pharynx and caervical oesophagus
c5
Reflux oesophagitis
what is the oprocess that then leads to cancer
thin folds
thick folds
strictures
Cancer
What is Barretts
precursor to adenocarcinoma
(shown as a high stricture with hiatal hernia)
Reticular mucosal pattern in the oesophagus think
Barretts oesophagus
Ringed oesophagus in a young man with long standing dysphagia
Eosinophilic oesophagitis
Treatment for eosinophilic oesophagitis
steroids
PPI dont work
Nissen fundoplication is what
wrapping the fundus around the GOJ to support it
Nissen
complication
obstructing due to being too tight
peak at 2 weeks
Post nissen
recurrent reflux - cause
slipped nissen
common cause of a slipped nissen
short oesophagus
- fixed 5cm hiatal hernia
after a fundoplication what can you no longer do?
vomit
buzzwords for cancer on brium swallow
irregular contour
abrupt shoulder edges
Esophageal cancer. - CT is used to differentiate what
stae 3 ( adventitia)
from
stage 4 (invasion to nearby structures)
Candidiasis will appear as what?
plaques
ax motility disorders
nodularity/granularity
shagy with irregular luminal surface
Glycogen acanthosis
mimic of candidiasis
asymptomatic elderly patient
Ulcers
Herpes Ulcer has
a halo of oedema
small and multiple
CMV and HIV ulcers appears as
large flat
varices appearance onbarium
linear, serpentine
calloped contour from filling defects
How to differentiate uphill varices from downhill?
Uphill - portal hypertension
- confined to bottom half of oesophagus
Downhill - svc obstruction
- cofined to top half of oesophagus
Esophageal enteric duplication cyst exist where
posterior mediasitnum
most common enteric duplcation yst location
ileum
Zenker diverticulum located at the
back
Z back of alphabet
Zenker protrudes through
killian Dehiscence
Killian Jamieson diverticulum
location
anterior and lateral
cervical oesophagus
Killiam Jamieson diverticulum
protrudes through
weakness below cricopharyngeas muscle
what is traction diverticulum and where does it occur
mid oesophagus
- triangular in shape
occur in scarring (think from granulomatous disease or TB)
epiphrenic diverticula
location
next to the diaphragm on the RIGHT normally
Osophageal pseudodiverticulosis
what are they
how do they happen
dilated submucosal glands cause small outpouchings
due to chronic reflux oesophagitis
what is the difference between a traction vs pulsion
diverticulum
traction
- triangular and will empty
pulsion
- round and will not empty, no muscle in the wall
what is the most common benign mucosal lesion of the esophagus
papilloma
its just hyperplastic squamous epithelium
Sliding hernia
GE junction above the diaphragm
Rolling hernia
GOJ below the diaphragm , bit of stomach above.
Manometric findings in Nutcracker oesophagus
180mmHg
common location for oesophageal web
Cricopharyngeus.
oesophageal web risk factor for
oesophageal and hypopharyngeal carcinoma
Oesophageal web ax with
Plummer Vinson Syndrome
What are the features of plumer vinson syndrome
iron def anaemia
dysphagia
spoon shaped nails
which vascular ring goes BETWEEN the trachea and oesophagus
Pulmonary sling
Pulmonary sling associated with
trachea stenosis
cardiopulmonary and systemic anomalies
- hypoplastic right lung
- horseshoe lung
-TO fistulas
- imperforate anus
- tracheal rings
what is the most common symptomatic vascular ring anomaly
double aortic arch
most common vascular ring anomaly
not always symptomatic
left arch with aberrant right subclavian
what is the diverticulum of Kommerell
pouch dilatation of the proximal portion to the aberrant right subclavian artery
feature of achalasia
dialted oesophagus but brids beak at the end
risk of achalsia
candida
achalasia vs chagas
look the same, chagas from jungle parasite
real achalasia vs pseudoachalasia (cancer)
real achalasia will eventually relax
scleroderma will cause what in oesophagus and what in lungs
Lungs. - NSIP
LOS is incompetent and so get reflux scarring ect
H Pylori gastritis is found in the
Antrum
Zollinger Ellison are what
ulcers in the stomach
- jeujenal ulcer
common in the duodenal bulb
Does Crohns go to the stomach ?
Not really
but antrum if it does
Menetriers is found where in the stomach
fundus and body
lymphoma in the stomach can be described as crossing which structure
crosses the pylorus
FAP (hyperplastic somtach, adneomatous bowel polyps)
+
Desmoid tumours, osteomas, papillary thyroid cancer
Gardner Syndrome
FAP + Gliomas and Medulloblastomas
Turcots
SNA mismatch repairpolyposis syndrome
Lynch
Mucocutaenous pigmentation
small and alrge bowel Ca, pancreatic CA, gynae Ca
Peutz-Jeghers
Hameartomas
Breast Ca, thyroid Ca, lhermitte-Dulcose
cowdens
what is Lhermitte Dulcose
posterior fossa noncancerous brain tumour
What is cronkite Canada
haemartoma
stomach, small bowel, colon
ectodermal stuff
loose stool, skin pigmentation, alopciai
Diverticula by the cricopharyngeaus
Zenker Diverticula.
most common mesnechymal tumour of the GI tract
GIST
Appearance of GIST if malignancy
big >10cm with ulceration
necrotic
ulceration
GIST has an association with which triad
and which other condition
Carneys
extra renal phaeo
GIST
pulmonary chordoma
also NF1
types of gastric cancer
carcinoma 95%
lymphoma 5%
What is Krukenberg Tumour
when the gastric carcinoma has mets to the ovary
swollen left supracalvicular node is called
Virchow node
Gastric lymphoma can be primary or secondary to what
systemic lymphoma
primary is just MALT
Commonest extra nodal site for nonHodkin lymphoma is
stomach
Gastric ulcers occur from
altered mucosal resistane
Duodenal ulcers occur due to
increased peptic acid
if multiple duodenal ulcers think
ZE
Leather bottle stomach
Linitis Plastica
result of…
scirrhous adenocarcinoma with diffuse infiltration. Can be from breast or lung mets
What is menetriers disease
idiopathic gastropathy
rugal thickening
fundus and spares the antrum
bimodal age distribution
Pseudo billroth1 is also called
Rams HOrn Deformity
what is Rams horn deformity
tapering of the antrum causes the appearance.
can be seen from peptic ulcers, granulomatous disease (Crohns, Sarcoid, TB, Syphilis) or Scirrhous carcinoma
Where in the GI tract is sarcoid favoured to go
stomach
what are the tpes of gastric volvulus
Organo axial
Mesenteroaxial
Organoaxial gastric volvulus
greater flips over the lesser curvature
Mesenteroaxial gastric volvulus
twisting over the mesentery. Causes ischaemia and obstruction.
more common in kids
gastric diverticulum needs to be distinguished from
adrenal gland. easy to mistake
Gastric varcies can be assocaited with conditions
conditions that cause splenic vein thrombus like pancreatititis and pancreatic cancer
Areae Gastricae
when does it enlarge
normal fine reticular pattern seen on double contrast.
can enlarge in elderly and H Pylori
Chronic aspirin therapy can cause
multiple gastric ulcers
Uncommon complication post billroth 2
Afferent loop syndrome
obstruction is the cause
build up into gallbladder can cause pancreatitis
Jejunogastric intussusception
complication of gastroenterostomy
jej herniates back into the stomach and cause obstruction
bile reflex gastritis.
fold thickening and filling defects seen in the stomach after Billroth 1 or 2.
bile acid reflux
Gastro-gastric fistula
seen in roux en Y who gain weight years later.
anastomotic breakdown is a chronic process and often is not painful
post old peptic ulcer surgeries what can happen to the remnant of somtach
3-6 times increased risk of adneocarincoma
small bowel filling defects
uniform 2 - 4mm nodules
lymphoid hyperplasia
small bowel filling defects
nodules of larger or varying sizes
cancer
Who gets squamous cancer of the osesophagus
Black
drinks and smokes
Lye ingestion
mid oesophagus
Adeno of the oesophagus affects who?
white dude
stress
chronic reflux
clover leaf sign on barium imaginging
healed duodenal ulcer
Barium small bowel
target sign
single
GIST, primary adenocarincoma, lymphoma, ectopic pancreatic rest, mets
Multiple target signs on small bowel pathology
Lymphoma
Mets
What is a cause of low density enlarged lymph nodes in the small bowel
Whipples infection
Tropheryma wipplei
but also Coeliac, crohns
What is pseduo wipples and who does it affect
MAI infection
AIDS patient with CD4 less than 100.
what do people with pseudo wipples get?
nodules in the jej like regular wiples infection
but also a big spleen and retroperitoneal lymph nodes
Celiac Sprue - what is it?
Small bowel absdopriton of gluten
Celiac is ax with what skin condiiton
Dermatitis Herpetiformis
Celiac on CT/ Barium
Fold reversal
moulage sign
low density cavitary lymph nodes
Splenic atrophy
what is fold reversal
Jej like ileum and ileum like jej
what causes intestinal lymphangiectasia?
obstructed lymph from the small intestine to the mesentry
SMA syndrome
obstruction of 3rd part duodenum by the SMA
Ribbon bowel is ax with …..
Graft vs host
What is meckels diverticulum
congenital true diverticulum of the distal ileum
Persistent pice of Omphalomeseneric duct
Meckels
Meckels divertiuclum rule of 2s
2% population
2 types of tissue (gastric and pancreatic)
2 feet from IC valve
kids before 2
meckels that bleed have what tissue type
gastric
if gastric it will pick up what kind of nuc med scan
Tc-pertechnetate
Duodenal inflammatory disease can be caused by what?
INternal and external organ inflammation
eg gallbladder and pancreas
Jejenal diverticulosis occur along which border
mesenteric
where is small bowel adneocarincoma normally found
duodenum
does a duodenal web increase the risk of adneocaricnoma
no
small bowel lymphoma is normally what type?
non-hodkin flavor
Patient groups / conditons that risk small bowel lymphoma
celiac
crohns
aids
sle
does small bowel lymphoma obstruct
no
classic carcinoid appearance
starburst
Is the starburst the cancer itself ?
no
the desmoplastic reaction
common primary location of carcinoid tumour
distal appendix.
then terminal ileum
what does systemic serotonin do to body
degrade heart valves and cause tricuspid regugitation
which cancer mets to the small bowel
melanoma
most common abdominal wall hernia
inguinal
which is more common type of unguinal hernia
indirect
cause of indirect hernia is
failure of the processus vaginalis to close
who gets femoral hernias
old ladies
who gets obturator hernia
old ladies
increased abdominal pressures
What is a superior lumbar hernia called
inferior called
Grynfeltt-Lesshaft
petit
spigelian hernias happen where
along the semilunar line
through the transversus abdominus aponeurosis close to the level of the arcuate line
What is a Littre hernia
hernia with a meckel diverticulum in it
Amyand Hernia is what
hernia with an appendix in it
Richter hernia is what
contains only one wall of bowel so doesnt obstruct
though at higher risk of strangulation
why are people at risk of internal hernias post roux en Y
laproscopic - no adesions, more mobile
more weight loss- more mobility
sites of internal hernias
defect in the transverse mesocolon
defect in the eneteroenterostomy
behind the roux limb mesenery placed in a retrocolic or antecolic position