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
Petersonæs hernia, through the
posterior aspect of the mesentery of the Roux limb.
also ante version of Peterson
How does internal hernia manifest
closed lop obstruction
How many types of internal hernia are there
9
Paraduodenal hernia msot common
left
Paraduodenal hernia locationis the
DJ junction,
Fossa of landzert
sac of bowel between sotmtach and pancreas left of ligament of TREITZ
Complications ax with corhns
fistula
abscess
gallstones
fatty liver
sacroiliitis
cobblestone appearance is caused by
irregular appearnce of bowel wall, ulcers with areas of edema between them
what are pseduopolyps
islands of hyperplastic mucosa
What filiform
post inflammatory polyps - long and worm like
How are pseduodivertucla created
bulging area of normal wall opposite side of scarring from disease
exist on antimesenteric border
what is string sign when ax with crohns
narrowing of TI from oedema, spasm and fibrosis
what is UC ax with
colon cancer
PSC
arthritis
Crohns vs UC
Hpeatic avscess and pancreatitis are more common
Crohns
Crohns vs UC
lymph node enalrgement
Crohns
most common mucinous tumour of the appendix
mucinous cystadenoma
IF a mucinsou cystadenoma perforates what can it cause
pseudomiyxoma peritonei
causes of toxic megacolon
C diff and UC
how does Behcets present
uclers of mouth and penis
also ileocaecal region
can cause pulmonary artery aneurysm
Colonic pseudoobstruction seen in
nursing home
post serious illness
Appearance of colonc pseduoobstruction
marked diffuse dilation of the large bowel. No discrete transition point
what is diverison colitis /
get bacterial overgrowth in a blind loop through which stool does not pass.
Rectal cacernous hamengioma appears as
multiple phleobliths down there
Rectal cavernous haemangiomas
associated with
Klippel Trenaunay Weber
Blue Rubber Bled
parasite that causes bloody diarrohea. liver abscess. spleen abscess.
Flask shaped ulcers on endscopy
Entamoieba Histolytica
Entamoeba Histolytica spares the
terminal ileum
Fleishchner sign and stierlin sign
COlONIC TB
widely gaping, thickened, patulous ileocecal valve and a narrowed, ulcerated terminal ileum associated with tuberculous involvement of the ileocecum.
WHo gets colon CMV
immunosupressed
cowdry Type A intranuclear inclusion bodies think
CMV
accodion sign
C diff
infections affecting the duodenum
Giardia
Strongyloides
infections affecting the T I
TB
Yersinia
Adencarinoma of colon
left vs right symptoms/presentaiton
right side bleeds
left side obstructs
where might squamous cc arise in large bowel
Anus
HPV
Second commonest tumour of the large bowel
Lipomas
which type of large bowel adenoma has risk of malignancy
Villous adeonoma
McKittrick - Wheelock syndrome
what is it
Villous adenoma
mucous diarrhea - fluid and electrolyte depletion
Rectal cancer standard excision
Total mesorectal excision
rectal cancer - highest recurrance rate
0-5cm from the anorectal angle
change in rectal cancer managemant at what staging
T3
- break out
need sradio and chemo ahead of surgery
peritoneal cavity
what is pseudomyxoma peritonei
gelatinous ascites from rupured mucocele
intraperitoneal spread of mucinous neoplasm
scalloped appearance of the liver
buzzword for pseudomyxoma peritonei
Peritoneal cartinotmatosis
implants are dictated by the
natural flow of ascites.
retroperitoneal is most common as most dependant
Omental caking
catch phrase
psoterior displacement of bowel from the anterior abdominal wall
Primary periotneal mesothelioma
happens how long after asbestos exposure
its super rare
30 - 40 years
Cystic peritoneal mesothelioma
even more rare
benign
not associated with prior asbestos exposure
mesenteric lymphoma is normally what type
non hodkin lymphoma
What is sandwich sign
lobukated confluent soft tissue mass encasing the mesenteric vessles
complications of barium
peritonitis and intravasation
use water soluble contrast for concern of leak
how does barium intravasation
PE
liver is covered by visceral perionteum except at the
porta hepatis, bare area and gallbladder fundus
why does the right liver shrink and left expand in cirrhotic morphology
right portal vein has a longer portal vein course
two ways blood can get to the IVC from the umbilical vein
Liver
ductus venosus
liver contrast - what is the central peripheral phenomenon
Fibrosis blockade of blood takes place a the central lobular vein.
- blood flow is poor in the peripheral areas of fibrosis.
enhanced subcapsular hepatic parenchyma
A HCC is formed from what
a regenerative nodule that has turned dysplastic
HCC are bright on arterial phase because of what
they derive a blood supply from arterial
regenerative nodules are dark on arterial phase because
they derive a portal blood supply
regenerative nodule has what in it
Iron
due to iron in regenerative nodules - what are MRI features
T1 adnT2 dark
dysplastic nodule contains waht
fat and glycoprotein
MRI of dysplastic nodule
T1 bright, T2 dark
doesn’t enhance
HCC MRI
T2 bright
Does arterially enhance
A lession in a cirrhotic liver is treated with greater suspiciion
why
cirrhosis will push out haemangiomas and cysts.
So highly likely a lesion may be malignant
ADPCKD or ARPCKD will have liver lesions
DOMINANT
ADPCKD or ARPCKD will have liver fibrosis
RECESSVIE
Hereditory Haemorrhagic Telengiestasia also called
Osler Weber Rendu
massive dilated hepatic artery
single hepatic abscess think of causative organism as
Klebsiella
multiple hepatic abscess, think of causative organism as
E Coli
hepatic infection buzzwords
starry sky
Viral hepatitis
hepatic infection buzzwords
double target
pyogenic abscess
bulls eye
hepatic infection buzzwords
candida
hepatic infection buzzwords
extra hepatic extension:
pleural effusion
perihepatic fluid collection
gastric or colonic involvement
retroperitoneal extension
amoebic abscess from entamoeba hisolitica
hepatic infection buzzwords
water lilly
sandstorm
hydatid
hepatic infection buzzwords
tortoise shell
schistosomiasis
what can cause Haemangiomas to increase in size
pregnancy
blood flow of haemangiomas on US
seen in vessels adjacent to the lesion but NOT in the lesion
No doppler flow of the lesion itself
but on contrast US get gradual filling in
blood flow of haemangiomas on CT/ MRI
should match the aorta
FNH enhances where
delayed central scar enhacenement
Hepatic adenomas, grow due to
steroids - exogenous or endogenous
if multiple hepatic adenomas think of
glycogen storage disease
liver adenomatosis
HCC doubling time is
variable
but 300 is the midground
Fibromellar HCC has what
central scar
DOESN”T enhance
HCC vs Fibromellar HCC
Fibromellar, no cirrhosis, young, can calcify, Normal AFP
FNH scar
T2 Bright
Enhances on delayed
Sulfur Colloid avid
FL HCC scar features
T2 dark
does not enhance
Mass is Gallium avid
Extracellular MRI contrast causes bright T1 by
shorterning the T1 time
cholangiocarincoma risk factor
PSC
pyogenic cholangitis
clonorchis senesis
hiv
hep b/c
etOH
how does cholangiocarcinoma spread and enhancement
delayed enhancement and infiltrative
cholangiocarinoma buzzword
capsular retraction
what is a klatskin tumour?
type of cholangiocarcinoma
occurs at the bifurcation of the right and left hepatic ducts
which patients might you seem haemangiosarcoma of the liver in
Haemachromatosis and NF
what is biliary cystadenoma
uncommon
bengin cystic neoplasm in liver
who gets biliarycystadenoma
middle age women
calcified mets in the liver are usualy from
mucinous neoplasm
colon
ovary
pancreas
Hyperechoic liver mets are normally what typ
vascular
Hypoechoic mets are normall what type
avascular
colon, lung, pancreas
Benign liver lesions
raw out the large table on page 274 of the book
Gonna have to look that one up!
HU for CT fatty liver
40
Fattty liver on US
hepatosteatosis
brighter than right kidney
in and out phase imaging for Fat and Iron
for haemachromatosis
Iron - drop out on IN phase
Fat - drop out on OUT phase
Type 1 haemochromatosis
hereditory
pancreas involved
Secondary haemachromatosis
response to ifnlmmation.
Pancreas spared
spleen involved
chiari syndrome causes
hepatic vein thrombosis
who gets masive caudate lobe hypertrophy?
budd chiari
PSC
PBC
what happens if portal vein is chronically occluded?
serpiginous vessels in the porta hepatis may reconstitute with the protal veins
pseudo cirrhosis can affect who?
Treated breast cancer mets
multifocal liver retraction
contraindications to liver transplant
extrahepatic malignancy
advanced cardiac disease or pulmonary
substance abuse
Normal Transplant US features
RAPID systolic upstroke
RI 0.5 to 0.7
Hepatic artery peak veolcity should be < 200cm / sec
which blood vessel is the major player in transplanted livers
hetapic artery
most common cause of obstructive jaundice
benign stricture
PSC features
multifocal strictures from prolonged inflammaiton
can lead to cholangiocarcinoma.
cirrhotic pattern is central regenerative hypertropy
ax UC
features of AIDS cholangiopathy
focal strictures extrahaptic >2cm
recurrent pyogenic cholangitis will be seen on imaging as
dilated ducts full of pigmneted stones
PBC
caused by
automimmune
Blood test for PBC
Aantimitochondrial bodies
what are choledocal cysts?
congenital dlatation of the bile ducts
gallbladder wall thickness should be
<3mm
what is a galbladder duct of Lushka
accessory bile duct from liver to gallbladder
choledochal cysts
most common type
T1
focal dilatation of the CBD
how many choledochal cysts types are there
5
what type is a choledochal diverticulum,
2
choledochocele is what type
3
Type 4 choledochal is what
intra and extra hepatic
t5 choledochal is
intrahepatic only
complications of choledochal cysts
cholangiocarinoma
corrhosis
cholagnitits
intraductal stones
Gallbladder wall echo shadow
3 cuases
stones
porceilain gb
emphysematous cholecystitis
Porcelain gb causes increased risk of
GB cancer
GB polyps are what
lipid filled papillary fonds are the cholestrol ones
non cholestrol can be adenom as or papillomas - 1cm they are of interest
Adenomyomatosis
results from
hyperplasia of the wall with formation of intramural mucosal diverticula
comet tail artefact
3 flavours of adenmyomatosis
Generalized (diffuse)
segmental (annualr)
fundal (localized/adenomyoma)
what is mirizzi syndrome
obstructed common hepatic duct due to gallstone imacpted in the cystic duct
what is tardus
slow systolic upstroke
> 0.07 considred 50% stenosis
what is parvus
decreased systolic velocity
acc index. <3m/s considred 50% stenosis
normal liver RI
0.5 - 0.7
low liver RI caused by
proximal stenosis or distal vacsular shunting
why is RI not useful for fibrosis
shunts that develop decrease RI but fibrosis that develops increase it.
So no benefit
direct signs of stenosis
found at stenosis
elevated peak systolic velocity
spectral broadening
Indirect sign of stenosis
downstream
tardus parvus
high RI upstream to overcome the stenses.
flow in portal vein should always be
antegrade
patterns that can be seen in portal vein and cuases
normal
pulsatile
- right HF, tri cusp regurg, cirrhosis with vascular AP shunting.
reversed
- portal HTN
for blood the doppler angle should be
less than 60
US pancreas schogenicity should WHAT compared to liver
BRIGHTER
pancreas changes in CF patients
Fibrosis (low T1 and T2)
Fatty replacement (increased T1)
caused by duct obstruction
why get fibrosing colonopathy in CF patients
complication of enzyme replacement therapy
schwachman-diamond syndrome
The 2nd most common cause of pancreatic insufficiency in kids.
get pseudohypertrophy
loose stool , short and eczema
dorsal pancreatic agenesis ax with
diabetes
polysplenia
annualar pancreas
encases duodenum
annualar duct encircles D2
pancreatic trauma look at the
duct. if damaged wil need theatre
suspected pancreatic duct injury next step
MRCP or ERCP
in what time frame does acute peripancreatic fluid collection move to a pseudocyst
> 4 weeks
both of these are NO necrosis
what time frame does acute necrotic collection more to walled off necrosis
4 week
how frequently is gas seen in an infected abscess
20%
on US inflamed apncreas will be
hypoechoic compared to liver
pancreatic ducts
small santorini is superior
Wirsprung is major
Pancreatic divisum is what and increases the risk of what
drains via the minor duct .
increased pancreatitits
chronic pancreatitis image findings seperated by time frame
which are
early and late
early imaging findings of Chronic Pancreatitis
loss of T1 intensity
delayed enhancement
dilated side branches
late CP fnidings
small atrophied
pseudocyst formed 30%
dilatation and beading of pancreatic duct with calc
how to discern malignant duct dilatation vs CP duct dilatation
irregular in CP
duct is <50% of the AP gland diameter in CP
which Ig is automimmune pancreatitis ax with
IgG4
autoimmune pancreatitis repsonds to
steroids
type of attack in auto pancreatitis
absence of symptoms
groove pancreatitis - what is it
biliary and duodenal obstruction
sx overlap with pancreatic cancer
Tropic pancreatitis affect who
young age
risks of adenocarcinoma
large calculi in dilated duct
Hereditary pancreatitis is what gene
SPINK 1
what is the most common parasite ax with pnacereatitis
ascaris induced
worm can be seen in bile ducts
igG4 is ax with what
auto pancreatitis
retroperitonela fibrosis
sclerosing cholangitis
inflammatory pseudotumour
riedels thyroiditis
common cause of a pseduocyst
acute or chronic pancreatitis
what conditons are true, epithelial lined, cysts of pancreas found
vHL
PKD
CF
Serous cystadenoma found in
old ladies
Describe serous cystadenoma
multiple small cysts in pancreatic head
No communciation to the duct
Serous cystadenoma is ax to q
vHL
Mucinous cystic neoplasm found in
Women in 50s.
what to do with MCN.
pre-malingnat - excised
mcn are found in the
body and tail
mcn
calcification are cnetral or peripheral
perihperal
location of IPMN
main branch
side branch
both
side branch IPMN
small cystic mass in head or uncinate process
benign compared to main branch
main branch IPMN
diffuse dilated duct
atrophy gland, dystrophic calc
higher % malignant therefore considered malignant
features concerning for IPMN malignancny
duct > 1cm.
diffuse / multifocal involvement
enhancing nodules
solid hypovascular mass
solid pseudopapillary tu mour of the pancreas affectsa who
young women 30s
large at presentation
likes the tail
thick capsule
with adencarcinoma what features are important to comment on CT
SMA and coeliac involvement. If they are then unresectable
GDA is removed in whipples regardless
hereditaory syndromes with pancreatic Ca
Peutz-Jeghers
Ataxia - Telangiectasia
BRCA mutation
HNPCC
Islet cell / neuroednocrine tumours
insulinoma
gastrinoma
non-functional
things in the spleen are benign except for
lymphoma
rare primary sarcoma
MRI and spleen treat as
lymph node
MRI spleen on demonstrate what diffusion
restriciton
right sided heterotaxia
mirrored right sided features
two fissures in left lung
asplenia
caridac malformation
reversed aorta and IVC
Left sided hetertaxia
polysplenia
biliary atresia
one fissure to right lung
azygous continuation of IVC
how to know if something is spleen tissue vs mass/lymph node
heat treated rbc
Tc Sulfur Colloid
what are gamma gandy bodies
siderotic nodule
small foci of haemorrhage ax with portal htn
t2 dark
peliosis
mutliple blood filled cysts in a solid organ
sarcoid in spleen will show as
splenomegaly
sarcoid in GI common location is
gastric antrum
who gets peliosis
OCPs
anabolic steroid men
AIDS
renal trx
hodkin lymphoma
don’t mistake a splenic aneurysm for a….
hypervascular pancreatic islet cell mass
Splenic vein thrombosis can occur in
pancreatitis
but also diverticulitis and crohns
which condition commonly infarcts the spleen
Sickle cell
Most common splenic infection detected radiologically
histoplasmosis (multiple round calc)
typeof fungal
Causes of calcified grnauloma in spleen
TB
Large over 2cm solitary think brucellosis
splenic abscess in immunocompromised
bug is
salmonella
small spleen differentials
sickle
post radiation
post thorotrast
malabasorption syndrome
big spleen differentials
congestion (HG, portal HTN)
lymphoma
leukaemia
gauchers
What is feltys syndrome triad
splenomegaly
rheumatoid arthritis
neutropenia
why are post traumatic splenic cysts called
pseudo- cyst
no epithelial lining
Epidermoid cysts in spleen
congenital
10cm when found
symptoms if large enough
Hydatid cysts in spleen
]
caused by what parasite
Echinoccus Granulosus
How will a haemangioma in the spleen behave?
smooth
well marginated
contrast uptake and delayed washout.
(won’t be like peripheral nodular discontinuous enhacnement seen in liver)
Hamartomas in spleen will show as
hypodense or isodense,
moderate heterogenous enhancement
hyperdesne if hemosiderin deposition
spleen lymphoma on imaging
CT
MRI
PET
low on CT
T1 dark
PET hot
common mets to the spleen
Melanoma
otherwise breast lung
