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Prometheus Qs > Module 3: GI > Flashcards

Module 3: GI Flashcards

1
Q

What is the A ring

A

muscular ring above the vestibule

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2
Q

What is the B ring

A

Mucosal ring

Below the vestiuble

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3
Q

If B ring is narrowed its called

A

Schatzki

schatskBi ring

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4
Q

What is the Z line

A

squamocolumnar junction

between esophageal and gastric epithelium

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5
Q

in which part of the oesophagus is Zenker Diverticulum found

A

Hypopharynx

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6
Q

What is the cricopharyngeas

A

muscle is the border between pharynx and caervical oesophagus

c5

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7
Q

Reflux oesophagitis

what is the oprocess that then leads to cancer

A

thin folds
thick folds
strictures
Cancer

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8
Q

What is Barretts

A

precursor to adenocarcinoma

(shown as a high stricture with hiatal hernia)

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9
Q

Reticular mucosal pattern in the oesophagus think

A

Barretts oesophagus

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10
Q

Ringed oesophagus in a young man with long standing dysphagia

A

Eosinophilic oesophagitis

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11
Q

Treatment for eosinophilic oesophagitis

A

steroids

PPI dont work

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12
Q

Nissen fundoplication is what

A

wrapping the fundus around the GOJ to support it

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13
Q

Nissen

complication

A

obstructing due to being too tight

peak at 2 weeks

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14
Q

Post nissen

recurrent reflux - cause

A

slipped nissen

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15
Q

common cause of a slipped nissen

A

short oesophagus

  • fixed 5cm hiatal hernia
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16
Q

after a fundoplication what can you no longer do?

A

vomit

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17
Q

buzzwords for cancer on brium swallow

A

irregular contour
abrupt shoulder edges

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18
Q

Esophageal cancer. - CT is used to differentiate what

A

stae 3 ( adventitia)

from

stage 4 (invasion to nearby structures)

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19
Q

Candidiasis will appear as what?

A

plaques
ax motility disorders

nodularity/granularity

shagy with irregular luminal surface

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20
Q

Glycogen acanthosis

A

mimic of candidiasis

asymptomatic elderly patient

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21
Q

Ulcers

Herpes Ulcer has

A

a halo of oedema

small and multiple

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22
Q

CMV and HIV ulcers appears as

A

large flat

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23
Q

varices appearance onbarium

A

linear, serpentine

calloped contour from filling defects

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24
Q

How to differentiate uphill varices from downhill?

A

Uphill - portal hypertension
- confined to bottom half of oesophagus

Downhill - svc obstruction
- cofined to top half of oesophagus

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25
Q

Esophageal enteric duplication cyst exist where

A

posterior mediasitnum

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26
Q

most common enteric duplcation yst location

A

ileum

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27
Q

Zenker diverticulum located at the

A

back

Z back of alphabet

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28
Q

Zenker protrudes through

A

killian Dehiscence

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29
Q

Killian Jamieson diverticulum

location

A

anterior and lateral

cervical oesophagus

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30
Q

Killiam Jamieson diverticulum

protrudes through

A

weakness below cricopharyngeas muscle

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31
Q

what is traction diverticulum and where does it occur

A

mid oesophagus
- triangular in shape

occur in scarring (think from granulomatous disease or TB)

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32
Q

epiphrenic diverticula

location

A

next to the diaphragm on the RIGHT normally

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33
Q

Osophageal pseudodiverticulosis

what are they
how do they happen

A

dilated submucosal glands cause small outpouchings

due to chronic reflux oesophagitis

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34
Q

what is the difference between a traction vs pulsion

diverticulum

A

traction
- triangular and will empty

pulsion
- round and will not empty, no muscle in the wall

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35
Q

what is the most common benign mucosal lesion of the esophagus

A

papilloma

its just hyperplastic squamous epithelium

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36
Q

Sliding hernia

A

GE junction above the diaphragm

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37
Q

Rolling hernia

A

GOJ below the diaphragm , bit of stomach above.

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38
Q

Manometric findings in Nutcracker oesophagus

A

180mmHg

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39
Q

common location for oesophageal web

A

Cricopharyngeus.

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40
Q

oesophageal web risk factor for

A

oesophageal and hypopharyngeal carcinoma

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41
Q

Oesophageal web ax with

A

Plummer Vinson Syndrome

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42
Q

What are the features of plumer vinson syndrome

A

iron def anaemia
dysphagia
spoon shaped nails

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43
Q

which vascular ring goes BETWEEN the trachea and oesophagus

A

Pulmonary sling

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44
Q

Pulmonary sling associated with

A

trachea stenosis

cardiopulmonary and systemic anomalies
- hypoplastic right lung
- horseshoe lung
-TO fistulas
- imperforate anus
- tracheal rings

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45
Q

what is the most common symptomatic vascular ring anomaly

A

double aortic arch

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46
Q

most common vascular ring anomaly

not always symptomatic

A

left arch with aberrant right subclavian

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47
Q

what is the diverticulum of Kommerell

A

pouch dilatation of the proximal portion to the aberrant right subclavian artery

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48
Q

feature of achalasia

A

dialted oesophagus but brids beak at the end

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49
Q

risk of achalsia

A

candida

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50
Q

achalasia vs chagas

A

look the same, chagas from jungle parasite

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51
Q

real achalasia vs pseudoachalasia (cancer)

A

real achalasia will eventually relax

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52
Q

scleroderma will cause what in oesophagus and what in lungs

A

Lungs. - NSIP

LOS is incompetent and so get reflux scarring ect

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53
Q

H Pylori gastritis is found in the

A

Antrum

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54
Q

Zollinger Ellison are what

A

ulcers in the stomach
- jeujenal ulcer
common in the duodenal bulb

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55
Q

Does Crohns go to the stomach ?

A

Not really

but antrum if it does

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56
Q

Menetriers is found where in the stomach

A

fundus and body

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57
Q

lymphoma in the stomach can be described as crossing which structure

A

crosses the pylorus

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58
Q

FAP (hyperplastic somtach, adneomatous bowel polyps)
+
Desmoid tumours, osteomas, papillary thyroid cancer

A

Gardner Syndrome

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59
Q

FAP + Gliomas and Medulloblastomas

A

Turcots

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60
Q

SNA mismatch repairpolyposis syndrome

A

Lynch

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61
Q

Mucocutaenous pigmentation

small and alrge bowel Ca, pancreatic CA, gynae Ca

A

Peutz-Jeghers

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62
Q

Hameartomas
Breast Ca, thyroid Ca, lhermitte-Dulcose

A

cowdens

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63
Q

what is Lhermitte Dulcose

A

posterior fossa noncancerous brain tumour

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64
Q

What is cronkite Canada

A

haemartoma
stomach, small bowel, colon
ectodermal stuff

loose stool, skin pigmentation, alopciai

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65
Q

Diverticula by the cricopharyngeaus

A

Zenker Diverticula.

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66
Q

most common mesnechymal tumour of the GI tract

A

GIST

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67
Q

Appearance of GIST if malignancy

A

big >10cm with ulceration
necrotic
ulceration

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68
Q

GIST has an association with which triad

and which other condition

A

Carneys

extra renal phaeo
GIST
pulmonary chordoma

also NF1

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69
Q

types of gastric cancer

A

carcinoma 95%
lymphoma 5%

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70
Q

What is Krukenberg Tumour

A

when the gastric carcinoma has mets to the ovary

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71
Q

swollen left supracalvicular node is called

A

Virchow node

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72
Q

Gastric lymphoma can be primary or secondary to what

A

systemic lymphoma

primary is just MALT

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73
Q

Commonest extra nodal site for nonHodkin lymphoma is

A

stomach

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74
Q

Gastric ulcers occur from

A

altered mucosal resistane

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75
Q

Duodenal ulcers occur due to

A

increased peptic acid

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76
Q

if multiple duodenal ulcers think

A

ZE

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77
Q

Leather bottle stomach

Linitis Plastica

result of…

A

scirrhous adenocarcinoma with diffuse infiltration. Can be from breast or lung mets

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78
Q

What is menetriers disease

A

idiopathic gastropathy

rugal thickening

fundus and spares the antrum
bimodal age distribution

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79
Q

Pseudo billroth1 is also called

A

Rams HOrn Deformity

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80
Q

what is Rams horn deformity

A

tapering of the antrum causes the appearance.

can be seen from peptic ulcers, granulomatous disease (Crohns, Sarcoid, TB, Syphilis) or Scirrhous carcinoma

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81
Q

Where in the GI tract is sarcoid favoured to go

A

stomach

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82
Q

what are the tpes of gastric volvulus

A

Organo axial

Mesenteroaxial

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83
Q

Organoaxial gastric volvulus

A

greater flips over the lesser curvature

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84
Q

Mesenteroaxial gastric volvulus

A

twisting over the mesentery. Causes ischaemia and obstruction.

more common in kids

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85
Q

gastric diverticulum needs to be distinguished from

A

adrenal gland. easy to mistake

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86
Q

Gastric varcies can be assocaited with conditions

A

conditions that cause splenic vein thrombus like pancreatititis and pancreatic cancer

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87
Q

Areae Gastricae

when does it enlarge

A

normal fine reticular pattern seen on double contrast.

can enlarge in elderly and H Pylori

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88
Q

Chronic aspirin therapy can cause

A

multiple gastric ulcers

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89
Q

Uncommon complication post billroth 2

A

Afferent loop syndrome

obstruction is the cause
build up into gallbladder can cause pancreatitis

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90
Q

Jejunogastric intussusception

A

complication of gastroenterostomy

jej herniates back into the stomach and cause obstruction

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91
Q

bile reflex gastritis.

A

fold thickening and filling defects seen in the stomach after Billroth 1 or 2.

bile acid reflux

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92
Q

Gastro-gastric fistula

A

seen in roux en Y who gain weight years later.

anastomotic breakdown is a chronic process and often is not painful

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93
Q

post old peptic ulcer surgeries what can happen to the remnant of somtach

A

3-6 times increased risk of adneocarincoma

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94
Q

small bowel filling defects

uniform 2 - 4mm nodules

A

lymphoid hyperplasia

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95
Q

small bowel filling defects
nodules of larger or varying sizes

A

cancer

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96
Q

Who gets squamous cancer of the osesophagus

A

Black
drinks and smokes
Lye ingestion

mid oesophagus

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97
Q

Adeno of the oesophagus affects who?

A

white dude
stress
chronic reflux

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98
Q

clover leaf sign on barium imaginging

A

healed duodenal ulcer

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99
Q

Barium small bowel

target sign

single

A

GIST, primary adenocarincoma, lymphoma, ectopic pancreatic rest, mets

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100
Q

Multiple target signs on small bowel pathology

A

Lymphoma
Mets

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101
Q

What is a cause of low density enlarged lymph nodes in the small bowel

A

Whipples infection

Tropheryma wipplei

but also Coeliac, crohns

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102
Q

What is pseduo wipples and who does it affect

A

MAI infection

AIDS patient with CD4 less than 100.

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103
Q

what do people with pseudo wipples get?

A

nodules in the jej like regular wiples infection

but also a big spleen and retroperitoneal lymph nodes

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104
Q

Celiac Sprue - what is it?

A

Small bowel absdopriton of gluten

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105
Q

Celiac is ax with what skin condiiton

A

Dermatitis Herpetiformis

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106
Q

Celiac on CT/ Barium

A

Fold reversal
moulage sign
low density cavitary lymph nodes
Splenic atrophy

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107
Q

what is fold reversal

A

Jej like ileum and ileum like jej

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108
Q

what causes intestinal lymphangiectasia?

A

obstructed lymph from the small intestine to the mesentry

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109
Q

SMA syndrome

A

obstruction of 3rd part duodenum by the SMA

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110
Q

Ribbon bowel is ax with …..

A

Graft vs host

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111
Q

What is meckels diverticulum

A

congenital true diverticulum of the distal ileum

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112
Q

Persistent pice of Omphalomeseneric duct

A

Meckels

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113
Q

Meckels divertiuclum rule of 2s

A

2% population
2 types of tissue (gastric and pancreatic)
2 feet from IC valve
kids before 2

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114
Q

meckels that bleed have what tissue type

A

gastric

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115
Q

if gastric it will pick up what kind of nuc med scan

A

Tc-pertechnetate

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116
Q

Duodenal inflammatory disease can be caused by what?

A

INternal and external organ inflammation

eg gallbladder and pancreas

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117
Q

Jejenal diverticulosis occur along which border

A

mesenteric

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118
Q

where is small bowel adneocarincoma normally found

A

duodenum

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119
Q

does a duodenal web increase the risk of adneocaricnoma

A

no

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120
Q

small bowel lymphoma is normally what type?

A

non-hodkin flavor

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121
Q

Patient groups / conditons that risk small bowel lymphoma

A

celiac
crohns
aids
sle

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122
Q

does small bowel lymphoma obstruct

A

no

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123
Q

classic carcinoid appearance

A

starburst

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124
Q

Is the starburst the cancer itself ?

A

no

the desmoplastic reaction

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125
Q

common primary location of carcinoid tumour

A

distal appendix.

then terminal ileum

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126
Q

what does systemic serotonin do to body

A

degrade heart valves and cause tricuspid regugitation

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127
Q

which cancer mets to the small bowel

A

melanoma

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128
Q

most common abdominal wall hernia

A

inguinal

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129
Q

which is more common type of unguinal hernia

A

indirect

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130
Q

cause of indirect hernia is

A

failure of the processus vaginalis to close

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131
Q

who gets femoral hernias

A

old ladies

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132
Q

who gets obturator hernia

A

old ladies
increased abdominal pressures

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133
Q

What is a superior lumbar hernia called

inferior called

A

Grynfeltt-Lesshaft

petit

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134
Q

spigelian hernias happen where

A

along the semilunar line

through the transversus abdominus aponeurosis close to the level of the arcuate line

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135
Q

What is a Littre hernia

A

hernia with a meckel diverticulum in it

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136
Q

Amyand Hernia is what

A

hernia with an appendix in it

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137
Q

Richter hernia is what

A

contains only one wall of bowel so doesnt obstruct

though at higher risk of strangulation

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138
Q

why are people at risk of internal hernias post roux en Y

A

laproscopic - no adesions, more mobile

more weight loss- more mobility

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139
Q

sites of internal hernias

A

defect in the transverse mesocolon

defect in the eneteroenterostomy

behind the roux limb mesenery placed in a retrocolic or antecolic position

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140
Q

Petersonæs hernia, through the

A

posterior aspect of the mesentery of the Roux limb.

also ante version of Peterson

141
Q

How does internal hernia manifest

A

closed lop obstruction

142
Q

How many types of internal hernia are there

A

9

143
Q

Paraduodenal hernia msot common

A

left

144
Q

Paraduodenal hernia locationis the

A

DJ junction,

Fossa of landzert

sac of bowel between sotmtach and pancreas left of ligament of TREITZ

145
Q

Complications ax with corhns

A

fistula
abscess
gallstones
fatty liver
sacroiliitis

146
Q

cobblestone appearance is caused by

A

irregular appearnce of bowel wall, ulcers with areas of edema between them

147
Q

what are pseduopolyps

A

islands of hyperplastic mucosa

148
Q

What filiform

A

post inflammatory polyps - long and worm like

149
Q

How are pseduodivertucla created

A

bulging area of normal wall opposite side of scarring from disease

exist on antimesenteric border

150
Q

what is string sign when ax with crohns

A

narrowing of TI from oedema, spasm and fibrosis

151
Q

what is UC ax with

A

colon cancer
PSC
arthritis

152
Q

Crohns vs UC

Hpeatic avscess and pancreatitis are more common

A

Crohns

153
Q

Crohns vs UC

lymph node enalrgement

A

Crohns

154
Q

most common mucinous tumour of the appendix

A

mucinous cystadenoma

155
Q

IF a mucinsou cystadenoma perforates what can it cause

A

pseudomiyxoma peritonei

156
Q

causes of toxic megacolon

A

C diff and UC

157
Q

how does Behcets present

A

uclers of mouth and penis

also ileocaecal region
can cause pulmonary artery aneurysm

158
Q

Colonic pseudoobstruction seen in

A

nursing home
post serious illness

159
Q

Appearance of colonc pseduoobstruction

A

marked diffuse dilation of the large bowel. No discrete transition point

160
Q

what is diverison colitis /

A

get bacterial overgrowth in a blind loop through which stool does not pass.

161
Q

Rectal cacernous hamengioma appears as

A

multiple phleobliths down there

162
Q

Rectal cavernous haemangiomas

associated with

A

Klippel Trenaunay Weber

Blue Rubber Bled

163
Q

parasite that causes bloody diarrohea. liver abscess. spleen abscess.

Flask shaped ulcers on endscopy

A

Entamoieba Histolytica

164
Q

Entamoeba Histolytica spares the

A

terminal ileum

165
Q

Fleishchner sign and stierlin sign

A

COlONIC TB

widely gaping, thickened, patulous ileocecal valve and a narrowed, ulcerated terminal ileum associated with tuberculous involvement of the ileocecum.

166
Q

WHo gets colon CMV

A

immunosupressed

167
Q

cowdry Type A intranuclear inclusion bodies think

A

CMV

168
Q

accodion sign

A

C diff

169
Q

infections affecting the duodenum

A

Giardia
Strongyloides

170
Q

infections affecting the T I

A

TB

Yersinia

171
Q

Adencarinoma of colon

left vs right symptoms/presentaiton

A

right side bleeds

left side obstructs

172
Q

where might squamous cc arise in large bowel

A

Anus

HPV

173
Q

Second commonest tumour of the large bowel

A

Lipomas

174
Q

which type of large bowel adenoma has risk of malignancy

A

Villous adeonoma

175
Q

McKittrick - Wheelock syndrome

what is it

A

Villous adenoma

mucous diarrhea - fluid and electrolyte depletion

176
Q

Rectal cancer standard excision

A

Total mesorectal excision

177
Q

rectal cancer - highest recurrance rate

A

0-5cm from the anorectal angle

178
Q

change in rectal cancer managemant at what staging

A

T3
- break out

need sradio and chemo ahead of surgery

179
Q

peritoneal cavity

what is pseudomyxoma peritonei

A

gelatinous ascites from rupured mucocele

intraperitoneal spread of mucinous neoplasm

180
Q

scalloped appearance of the liver

A

buzzword for pseudomyxoma peritonei

181
Q

Peritoneal cartinotmatosis

implants are dictated by the

A

natural flow of ascites.

retroperitoneal is most common as most dependant

182
Q

Omental caking

catch phrase

A

psoterior displacement of bowel from the anterior abdominal wall

183
Q

Primary periotneal mesothelioma

happens how long after asbestos exposure

A

its super rare

30 - 40 years

184
Q

Cystic peritoneal mesothelioma

A

even more rare

benign

not associated with prior asbestos exposure

185
Q

mesenteric lymphoma is normally what type

A

non hodkin lymphoma

186
Q

What is sandwich sign

A

lobukated confluent soft tissue mass encasing the mesenteric vessles

187
Q

complications of barium

A

peritonitis and intravasation

use water soluble contrast for concern of leak

188
Q

how does barium intravasation

A

PE

189
Q

liver is covered by visceral perionteum except at the

A

porta hepatis, bare area and gallbladder fundus

190
Q

why does the right liver shrink and left expand in cirrhotic morphology

A

right portal vein has a longer portal vein course

191
Q

two ways blood can get to the IVC from the umbilical vein

A

Liver

ductus venosus

192
Q

liver contrast - what is the central peripheral phenomenon

A

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

193
Q

A HCC is formed from what

A

a regenerative nodule that has turned dysplastic

194
Q

HCC are bright on arterial phase because of what

A

they derive a blood supply from arterial

195
Q

regenerative nodules are dark on arterial phase because

A

they derive a portal blood supply

196
Q

regenerative nodule has what in it

A

Iron

197
Q

due to iron in regenerative nodules - what are MRI features

A

T1 adnT2 dark

198
Q

dysplastic nodule contains waht

A

fat and glycoprotein

199
Q

MRI of dysplastic nodule

A

T1 bright, T2 dark

doesn’t enhance

200
Q

HCC MRI

A

T2 bright

Does arterially enhance

201
Q

A lession in a cirrhotic liver is treated with greater suspiciion

why

A

cirrhosis will push out haemangiomas and cysts.

So highly likely a lesion may be malignant

202
Q

ADPCKD or ARPCKD will have liver lesions

A

DOMINANT

203
Q

ADPCKD or ARPCKD will have liver fibrosis

A

RECESSVIE

204
Q

Hereditory Haemorrhagic Telengiestasia also called

A

Osler Weber Rendu

massive dilated hepatic artery

205
Q

single hepatic abscess think of causative organism as

A

Klebsiella

206
Q

multiple hepatic abscess, think of causative organism as

A

E Coli

207
Q

hepatic infection buzzwords

starry sky

A

Viral hepatitis

208
Q

hepatic infection buzzwords

double target

A

pyogenic abscess

209
Q

bulls eye

hepatic infection buzzwords

A

candida

210
Q

hepatic infection buzzwords

extra hepatic extension:
pleural effusion

perihepatic fluid collection

gastric or colonic involvement

retroperitoneal extension

A

amoebic abscess from entamoeba hisolitica

211
Q

hepatic infection buzzwords

water lilly
sandstorm

A

hydatid

212
Q

hepatic infection buzzwords

tortoise shell

A

schistosomiasis

213
Q

what can cause Haemangiomas to increase in size

A

pregnancy

214
Q

blood flow of haemangiomas on US

A

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

215
Q

blood flow of haemangiomas on CT/ MRI

A

should match the aorta

216
Q

FNH enhances where

A

delayed central scar enhacenement

217
Q

Hepatic adenomas, grow due to

A

steroids - exogenous or endogenous

218
Q

if multiple hepatic adenomas think of

A

glycogen storage disease

liver adenomatosis

219
Q

HCC doubling time is

A

variable

but 300 is the midground

220
Q

Fibromellar HCC has what

A

central scar

DOESN”T enhance

221
Q

HCC vs Fibromellar HCC

A

Fibromellar, no cirrhosis, young, can calcify, Normal AFP

222
Q

FNH scar

A

T2 Bright
Enhances on delayed
Sulfur Colloid avid

223
Q

FL HCC scar features

A

T2 dark
does not enhance
Mass is Gallium avid

224
Q

Extracellular MRI contrast causes bright T1 by

A

shorterning the T1 time

225
Q

cholangiocarincoma risk factor

A

PSC
pyogenic cholangitis
clonorchis senesis
hiv
hep b/c
etOH

226
Q

how does cholangiocarcinoma spread and enhancement

A

delayed enhancement and infiltrative

227
Q

cholangiocarinoma buzzword

A

capsular retraction

228
Q

what is a klatskin tumour?

A

type of cholangiocarcinoma

occurs at the bifurcation of the right and left hepatic ducts

229
Q

which patients might you seem haemangiosarcoma of the liver in

A

Haemachromatosis and NF

230
Q

what is biliary cystadenoma

A

uncommon

bengin cystic neoplasm in liver

231
Q

who gets biliarycystadenoma

A

middle age women

232
Q

calcified mets in the liver are usualy from

A

mucinous neoplasm

colon
ovary
pancreas

233
Q

Hyperechoic liver mets are normally what typ

A

vascular

234
Q

Hypoechoic mets are normall what type

A

avascular

colon, lung, pancreas

235
Q

Benign liver lesions

raw out the large table on page 274 of the book

A

Gonna have to look that one up!

236
Q

HU for CT fatty liver

A

40

237
Q

Fattty liver on US

hepatosteatosis

A

brighter than right kidney

238
Q

in and out phase imaging for Fat and Iron

for haemachromatosis

A

Iron - drop out on IN phase

Fat - drop out on OUT phase

239
Q

Type 1 haemochromatosis

A

hereditory
pancreas involved

240
Q

Secondary haemachromatosis

A

response to ifnlmmation.

Pancreas spared

spleen involved

241
Q

chiari syndrome causes

A

hepatic vein thrombosis

242
Q

who gets masive caudate lobe hypertrophy?

A

budd chiari
PSC
PBC

243
Q

what happens if portal vein is chronically occluded?

A

serpiginous vessels in the porta hepatis may reconstitute with the protal veins

244
Q

pseudo cirrhosis can affect who?

A

Treated breast cancer mets

multifocal liver retraction

245
Q

contraindications to liver transplant

A

extrahepatic malignancy

advanced cardiac disease or pulmonary
substance abuse

246
Q

Normal Transplant US features

A

RAPID systolic upstroke

RI 0.5 to 0.7

Hepatic artery peak veolcity should be < 200cm / sec

247
Q

which blood vessel is the major player in transplanted livers

A

hetapic artery

248
Q

most common cause of obstructive jaundice

A

benign stricture

249
Q

PSC features

A

multifocal strictures from prolonged inflammaiton

can lead to cholangiocarcinoma.

cirrhotic pattern is central regenerative hypertropy

ax UC

250
Q

features of AIDS cholangiopathy

A

focal strictures extrahaptic >2cm

251
Q

recurrent pyogenic cholangitis will be seen on imaging as

A

dilated ducts full of pigmneted stones

252
Q

PBC
caused by

A

automimmune

253
Q

Blood test for PBC

A

Aantimitochondrial bodies

254
Q

what are choledocal cysts?

A

congenital dlatation of the bile ducts

255
Q

gallbladder wall thickness should be

A

<3mm

256
Q

what is a galbladder duct of Lushka

A

accessory bile duct from liver to gallbladder

257
Q

choledochal cysts

most common type

A

T1

focal dilatation of the CBD

258
Q

how many choledochal cysts types are there

A

5

259
Q

what type is a choledochal diverticulum,

A

2

260
Q

choledochocele is what type

A

3

261
Q

Type 4 choledochal is what

A

intra and extra hepatic

262
Q

t5 choledochal is

A

intrahepatic only

263
Q

complications of choledochal cysts

A

cholangiocarinoma

corrhosis
cholagnitits
intraductal stones

264
Q

Gallbladder wall echo shadow

3 cuases

A

stones
porceilain gb
emphysematous cholecystitis

265
Q

Porcelain gb causes increased risk of

A

GB cancer

266
Q

GB polyps are what

A

lipid filled papillary fonds are the cholestrol ones

non cholestrol can be adenom as or papillomas - 1cm they are of interest

267
Q

Adenomyomatosis

results from

A

hyperplasia of the wall with formation of intramural mucosal diverticula

comet tail artefact

268
Q

3 flavours of adenmyomatosis

A

Generalized (diffuse)
segmental (annualr)
fundal (localized/adenomyoma)

269
Q

what is mirizzi syndrome

A

obstructed common hepatic duct due to gallstone imacpted in the cystic duct

270
Q

what is tardus

A

slow systolic upstroke

> 0.07 considred 50% stenosis

271
Q

what is parvus

A

decreased systolic velocity

acc index. <3m/s considred 50% stenosis

272
Q

normal liver RI

A

0.5 - 0.7

273
Q

low liver RI caused by

A

proximal stenosis or distal vacsular shunting

274
Q

why is RI not useful for fibrosis

A

shunts that develop decrease RI but fibrosis that develops increase it.

So no benefit

275
Q

direct signs of stenosis

A

found at stenosis
elevated peak systolic velocity
spectral broadening

276
Q

Indirect sign of stenosis

A

downstream
tardus parvus

high RI upstream to overcome the stenses.

277
Q

flow in portal vein should always be

A

antegrade

278
Q

patterns that can be seen in portal vein and cuases

A

normal

pulsatile
- right HF, tri cusp regurg, cirrhosis with vascular AP shunting.

reversed
- portal HTN

279
Q

for blood the doppler angle should be

A

less than 60

280
Q

US pancreas schogenicity should WHAT compared to liver

A

BRIGHTER

281
Q

pancreas changes in CF patients

A

Fibrosis (low T1 and T2)
Fatty replacement (increased T1)

caused by duct obstruction

282
Q

why get fibrosing colonopathy in CF patients

A

complication of enzyme replacement therapy

283
Q

schwachman-diamond syndrome

A

The 2nd most common cause of pancreatic insufficiency in kids.

get pseudohypertrophy

loose stool , short and eczema

284
Q

dorsal pancreatic agenesis ax with

A

diabetes

polysplenia

285
Q

annualar pancreas

A

encases duodenum

annualar duct encircles D2

286
Q

pancreatic trauma look at the

A

duct. if damaged wil need theatre

287
Q

suspected pancreatic duct injury next step

A

MRCP or ERCP

288
Q

in what time frame does acute peripancreatic fluid collection move to a pseudocyst

A

> 4 weeks

both of these are NO necrosis

289
Q

what time frame does acute necrotic collection more to walled off necrosis

A

4 week

290
Q

how frequently is gas seen in an infected abscess

A

20%

291
Q

on US inflamed apncreas will be

A

hypoechoic compared to liver

292
Q

pancreatic ducts

A

small santorini is superior

Wirsprung is major

293
Q

Pancreatic divisum is what and increases the risk of what

A

drains via the minor duct .

increased pancreatitits

294
Q

chronic pancreatitis image findings seperated by time frame

which are

A

early and late

295
Q

early imaging findings of Chronic Pancreatitis

A

loss of T1 intensity

delayed enhancement

dilated side branches

296
Q

late CP fnidings

A

small atrophied
pseudocyst formed 30%

dilatation and beading of pancreatic duct with calc

297
Q

how to discern malignant duct dilatation vs CP duct dilatation

A

irregular in CP
duct is <50% of the AP gland diameter in CP

298
Q

which Ig is automimmune pancreatitis ax with

A

IgG4

299
Q

autoimmune pancreatitis repsonds to

A

steroids

300
Q

type of attack in auto pancreatitis

A

absence of symptoms

301
Q

groove pancreatitis - what is it

A

biliary and duodenal obstruction

sx overlap with pancreatic cancer

302
Q

Tropic pancreatitis affect who

A

young age

risks of adenocarcinoma

large calculi in dilated duct

303
Q

Hereditary pancreatitis is what gene

A

SPINK 1

304
Q

what is the most common parasite ax with pnacereatitis

A

ascaris induced

worm can be seen in bile ducts

305
Q

igG4 is ax with what

A

auto pancreatitis

retroperitonela fibrosis
sclerosing cholangitis
inflammatory pseudotumour
riedels thyroiditis

306
Q

common cause of a pseduocyst

A

acute or chronic pancreatitis

307
Q

what conditons are true, epithelial lined, cysts of pancreas found

A

vHL
PKD
CF

308
Q

Serous cystadenoma found in

A

old ladies

309
Q

Describe serous cystadenoma

A

multiple small cysts in pancreatic head

No communciation to the duct

310
Q

Serous cystadenoma is ax to q

A

vHL

311
Q

Mucinous cystic neoplasm found in

A

Women in 50s.

312
Q

what to do with MCN.

A

pre-malingnat - excised

313
Q

mcn are found in the

A

body and tail

314
Q

mcn

calcification are cnetral or peripheral

A

perihperal

315
Q

location of IPMN

A

main branch
side branch

both

316
Q

side branch IPMN

A

small cystic mass in head or uncinate process

benign compared to main branch

317
Q

main branch IPMN

A

diffuse dilated duct
atrophy gland, dystrophic calc
higher % malignant therefore considered malignant

318
Q

features concerning for IPMN malignancny

A

duct > 1cm.
diffuse / multifocal involvement
enhancing nodules
solid hypovascular mass

319
Q

solid pseudopapillary tu mour of the pancreas affectsa who

A

young women 30s
large at presentation
likes the tail

thick capsule

320
Q

with adencarcinoma what features are important to comment on CT

A

SMA and coeliac involvement. If they are then unresectable

GDA is removed in whipples regardless

321
Q

hereditaory syndromes with pancreatic Ca

A

Peutz-Jeghers
Ataxia - Telangiectasia
BRCA mutation
HNPCC

322
Q

Islet cell / neuroednocrine tumours

A

insulinoma

gastrinoma

non-functional

323
Q

things in the spleen are benign except for

A

lymphoma

rare primary sarcoma

324
Q

MRI and spleen treat as

A

lymph node

325
Q

MRI spleen on demonstrate what diffusion

A

restriciton

326
Q

right sided heterotaxia

A

mirrored right sided features

two fissures in left lung
asplenia
caridac malformation
reversed aorta and IVC

327
Q

Left sided hetertaxia

A

polysplenia
biliary atresia
one fissure to right lung
azygous continuation of IVC

328
Q

how to know if something is spleen tissue vs mass/lymph node

A

heat treated rbc

Tc Sulfur Colloid

329
Q

what are gamma gandy bodies

siderotic nodule

A

small foci of haemorrhage ax with portal htn

t2 dark

330
Q

peliosis

A

mutliple blood filled cysts in a solid organ

331
Q

sarcoid in spleen will show as

A

splenomegaly

332
Q

sarcoid in GI common location is

A

gastric antrum

333
Q

who gets peliosis

A

OCPs
anabolic steroid men
AIDS
renal trx
hodkin lymphoma

334
Q

don’t mistake a splenic aneurysm for a….

A

hypervascular pancreatic islet cell mass

335
Q

Splenic vein thrombosis can occur in

A

pancreatitis

but also diverticulitis and crohns

336
Q

which condition commonly infarcts the spleen

A

Sickle cell

337
Q

Most common splenic infection detected radiologically

A

histoplasmosis (multiple round calc)
typeof fungal

338
Q

Causes of calcified grnauloma in spleen

A

TB

Large over 2cm solitary think brucellosis

339
Q

splenic abscess in immunocompromised

bug is

A

salmonella

340
Q

small spleen differentials

A

sickle
post radiation
post thorotrast

malabasorption syndrome

341
Q

big spleen differentials

A

congestion (HG, portal HTN)
lymphoma
leukaemia
gauchers

342
Q

What is feltys syndrome triad

A

splenomegaly
rheumatoid arthritis
neutropenia

343
Q

why are post traumatic splenic cysts called

pseudo- cyst

A

no epithelial lining

344
Q

Epidermoid cysts in spleen

A

congenital
10cm when found
symptoms if large enough

345
Q

Hydatid cysts in spleen
]
caused by what parasite

A

Echinoccus Granulosus

346
Q

How will a haemangioma in the spleen behave?

A

smooth
well marginated

contrast uptake and delayed washout.

(won’t be like peripheral nodular discontinuous enhacnement seen in liver)

347
Q

Hamartomas in spleen will show as

A

hypodense or isodense,

moderate heterogenous enhancement

hyperdesne if hemosiderin deposition

348
Q

spleen lymphoma on imaging

CT
MRI
PET

A

low on CT
T1 dark
PET hot

349
Q

common mets to the spleen

A

Melanoma

otherwise breast lung

Prometheus Qs (9 decks)

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