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Gastrointestinal > peritoneum and mesentery > Flashcards

peritoneum and mesentery Flashcards

1
Q

Most common bug in SBP?

A

E coli

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2
Q

With regards to bowel displacement, what processes moves them medial? posterior?

A

Medial - ascites

Posterior - intraperitoneal abscess

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3
Q

What is pseudomyxoma peritonei? What are the causes?

A

Gelatinous ascites from ruptured appendiceal mucinous tumor or other mucinous tumors

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4
Q

What are the differentiating features of pseudomyxoma compared to simple ascites

A

Pseudomyxoma will have a scalloped liver margin due to mass effect from mucinous implants. There will also be high attenuating septa and punctate “ring and arc” calcifications

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5
Q

Where are the most common sites of peritoneal carcinomatosis? why?

A

Due to the flow of ascites

Pelvic cul de sac
Right paracolic gutter
Mesenteric root at ileocecal junction
Sigmoid mesocolon

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6
Q

DDx for enhancing nodules along peritoneal surface with marked nodular thickening of the omentum

A

Peritoneal carcinomatosis
Mesothelioma
Tuberculous peritonitis

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7
Q

DDx for peripherally enhancing centrally necrotic masses intraperitoneally?

A

Colon cancer
Invasive peritoneal mets
Primary peritoneal tumor
Peritoneal abscess

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8
Q

How does primary peritoneal mesothelioma present?

A

Multiple enhancing soft tissue masses present along peritoneum IN CONTACT with peritoneum with large volume ascites

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9
Q

How does cystic peritoneal mesothelioma differ from primary? Who gets it?

A

Young women

Benign

Low attenuation/anechoic multiloculated cystic mass filling peritoneal cavity

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10
Q

Most common primary tumor of small bowel?

A

Caricinoid

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11
Q

What cells does carcinoid arise from?

A

Enterochromaffin cells of kulchitsky in crypts of lieberkuhn

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12
Q

DDx for calcified mesenteric mass with radiating strands and adjacent bowel wall thickening

A

Carcinoid

Retractile mesenteritis

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13
Q

Where do most small bowel carcinoid tumors arise?

A

Terminal ileum

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14
Q

How does one differentiate carcinoid from mesenteric mets?

A

Mets wont have desmoplastic reaction, will be multiple

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15
Q

What causes the desmoplastic reaction in carcinoid?

A

Thickening along neurovascular bundles

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16
Q

What is the cardiac complication with carcinoid? Why

A

Tricuspid valve insufficiency due to direct release of serotonin into the hepatic veins by metastatic carcinoid

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17
Q

What is retractile mesenteritis?

A

Idiopathic mesenteric mass with dense calcifications and bowel tethering and obstruction.

Similar to carcinoid, but wont have spokewheel thickening and small bowel wall thickening

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18
Q

DDx for a solitary, ill defined mass at root of small bowel mesentery with marked associated calcification and bowel tethering

A

Retractile mesenteritis

Carcinoid

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19
Q

Most common primary mesenteric tumor

A

Desmoid

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20
Q

Which lymphoma more commonly affects the mesentery?

A

NHL

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21
Q

Lobulated confluent soft tissue mass encasing superior mesenteric vessels
What is the sign? Dx?

A

Hamburger/sandwich sign

Mesenteric lymphoma

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22
Q

DDx for low attenuation mesenteric LN with perihperal enhancement?

A

Treated lymphoma
Infection (fungal, MAI)
Whipples
testicular mets

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23
Q

Which nodes does abdominal TB affect most often?

A

Mesenteric and peripancreatic

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24
Q

HIV patient with centrally low attenuating LN

A

TB

25
Q

What clues help differentiate MAI vs TB when considering them for centrally necrotic LN

A

TB more often has focal hepatic or splenic abnormalities and peritoneal involvement

26
Q

What make up the nodes in CMLNS?

A

Chylous fluid surrounded by a thin rim of fibrous tissue

27
Q

Cystic mesenteric adenopathy in a patient with celiac disease?

A

Cavitary mesenteric lymph node syndrome

28
Q

What are the two responses with a retained surgical sponge?

A

Fibrinous - foreign body granuloma

Exudative - abscess formation

29
Q

What is a gossypiboma?

A

Masslike inflammatory response surrounding a surgical sponge

30
Q

Where do spilled gallstones accumulate?

A

Subdiaphragmatic or hepatorenal recess

31
Q

When do complications most often occur with spilled gallstones?

A

4 months, but can be 1month-20years

32
Q

What are the three types of abdominal hernia?

A

External, internal, diaphragmatic

33
Q

Which hernia is most common?

A

Indirect

34
Q

Which inguinal hernia goes medial/lateral to the inferior epigastric vessels? How can you quickly tell the difference?

A

MD - medial, direct
Lateral, indirect

Direct will NOT extend to the scrotum

35
Q

What are the defects in the inguinal hernia types?

A

Direct - directly protrudes through abdominal wall defect

Indirect - protrudes through inguinal canal and emerges at the external ring

36
Q

What is an incarcerated hernia?

A

One that cannot be manually reduced

37
Q

Femoral hernias are more common in which sex?

A

Female

38
Q

Where does a femoral hernia extend?

A

ALWAYS below the inguinal ligament and lateral to the pubic tubercle

Immediately medial to the femoral vein

39
Q

Which hernia is more common to strangulate?

A

Femoral (10x) more than inguinal

40
Q

Obstruction with pain radiating down medial thigh suggest what kind of hernia?

A

Obturator (impingement on obturator nerve)

41
Q

Which hernia has the highest rate of mortality if strangulated?

A

Obturator

42
Q

What is a richter hernia?

A

Hernia with only a portion of the circumference of a bowel loop

43
Q

What is a spigelian hernia?

A

Abdominal wall defect involving the linea semilunaris

44
Q

What is the most frequent internal hernia?

A

Paraduodenal

45
Q

Where do most paraduodenal hernias occur and why?

A

Left side, as a result of bowel herniating through a peritoneal reflection created by the inferior mesenteric artery. Bowel resides lateral to the ascending limb of the duodenum

46
Q

How do paraduodenal hernias appear?

A

Mass of small bowel loops in LUQ appearing to be encapsulated

47
Q

What is a foramen of winslow hernia? Which part of bowel is more commonly herniated through it?

A

Herniation into the lesser sac

Small bowel (70%)
Ascending colon/cecum (30%)
48
Q

What is the cause of infantile bochdalek hernia?

A

Failure of closure of the pleuroperitoneal canal

49
Q

Which side do bochdalek usually occur?

A

Left, always posterior

50
Q

What is a morgagni hernia?

A

Midline defect where right and left pleuoroperitoneal folds do not join. Substernal herniation often involving omentum

51
Q

Which organ most commonly herniates through a traumatic diaphragmatic hernia?

A

Stomach!

52
Q

Which side do most traumatic hernias usually occur?

A

Left

due to protective effect of liver

53
Q

Which side do morgagni hernias usually occur?

A

Right, and anterior

54
Q

What is the progression of infantile umbilical hernia?

A

Spontaneous closure

55
Q

What is the differential for misty mesentery?

A

Fluid - CHF, portal hypertension, hypoalbuminemia, mesenteric arterial or venous thrombosis

Inflammation - pancreatitis, IBD, diverticulitis

Neoplasm - NHL

Retractile mesenteritis

56
Q

Soft tissue stranding with the epicenter distinct from the colon wall or appendix along the antimesenteric border?

A

Epiploic appendigitis

57
Q

Which side are omental infarcts more common?

A

Right side, due to longer length of right omentum

58
Q

What is the key feature in differentiating diverticulitis/appendicitis and omental infarct?

A

Omental infarct will have a normal adjacent colon

Gastrointestinal (13 decks)

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