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Green Book GI > Stomach and Bowel > Flashcards

Stomach and Bowel Flashcards

1
Q

Where do drugs cause gastritis?

A

Distally or near the greater curve.

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2
Q

Name 8 causes of gastritis?

A 
Gut Bacteria
Alcohol, allergy
Stress
Trauma
Radiation
Ischaemia, Infection
Corrosives, Bile
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3
Q

H pylori is a/w what % of gastric and duodenal ulcers?

A

60% of gastric ulcers

80% of duodenal ulcers

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4
Q

T/F H pylori is a/w cancer?

A

True

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5
Q

4 features of gastritis on barium?

A
  1. Thickened folds
  2. Inflammatory nodules
  3. Coarse area gastricae
  4. Erosions
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6
Q

Name 3 other types of gastritis?

A
  1. Phlegmonous (a/w bacteria)
  2. Emphysematous
  3. Corrosive
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7
Q

9 risk factors for gastric cancer?

A 
Gatrojejunostomy and partial gastrectomy
Adenomatous and villous polyps
Smoking
H pylori
Menetriers
Atrophi gastritis
Nitrites, nitrates
Pickled vegetables
Pernicious anemia
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8
Q

T/F 60% of gastric cancer along lesser curve?

A

True

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9
Q

5 year survival gastric cancer?

A

5-18%

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10
Q

T Staging gastric cancer?

A

T1: mucosa/submucosa
T2: muscle or serosa
T3: through serosa
T4a: invasion of adjacent contiguous tissues
T4b: invasion of adjacent organs, diaphragm or abdominal wall.

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11
Q

Blumer’s shelf?

A

Peritoneal seeding to rectal wall

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12
Q

T/F normal stomach does not contain lymphoid follicles?

A

True- they can develop following infection with H pylori. Persistent antigenic stimulation by H pylori is thought to lead to neoplastic transformation.

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13
Q

T/F MALT is usually locally contained at time of dx?

A

True - better prognosis than NHL

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14
Q

Commonest site of MALT?

A

Antrum

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15
Q

T/F Perforation common with MALT?

A

False- rare

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16
Q

MALT on Barium?

A

Can be focal and infiltrative or diffuse

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17
Q

T/F Ulceration common with MALT?

A

False- rare

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18
Q

4 Res for PUD?

A
  1. H Pylori
  2. Analgesia
  3. Smoking
  4. Zollinger Ellison
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19
Q

T/F GIST a/w NF1?

A

True and Carney’s triad

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20
Q

Causes of thickened mucosal folds?

A
  1. Inflammatory causes
    - gastritis
    - ZE syndrome
    - acute pancreatitis
    - Crohn’s
  2. Infiltrative and neoplastic causes
    - lymphoma
    - carcinoma
    - eosinophilic gastroenteritis
  3. Other causes
    - Menetrier’s
    - Varices
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21
Q

Causes of Linitis Plastica?

A
  1. Neopalsia
    - gastric carcinoma
    - lymphoma
    - metastases
    - local invasion from pancreatic cancer
  2. Inflammatory causes
    - corrosives
    - radiotherapy
    - granulomas
    - eosinophilic enteritis
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22
Q

Causes of target lesions in the stomach?

A
  1. Submucosal metastases
    - melanoma
    - lymphoma
    - carcinoma/carcinoid
  2. Leiomyoma
  3. Ectopic pancreatic tissue
  4. Neurofibroma
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23
Q

Commonest site of small bowel injury following blunt trauma?

A

Jejunum- distal to ligament of Trietz

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24
Q

T/F Bowel wall thickening is a sensitive sign of injury?

A

True- Seen in 75% of transmural injuries. Isolated mesenteric lacerations may also give this sign.

Bowel wall enhancement more than the posts with thickening adds specificity.

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25
Q

T/F With bowel injury, mesenteric stranding is seen on the mesenteric side?

A

True

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26
Q

Other signs of bowel injury?

A
  • Free fluid
  • Interloop fluid
  • 5% of hepatic and splenic lacerations are a/w bowel injury
  • intramural haematoma
  • mesenteric haematoma
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27
Q

Cause of malrotation?

A
  • arrest in embryological development of rotation and fixation.
  • abnormal gut position due to narrow mesenteric attachment.
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28
Q

In what % of cases of malrotation is the SMV to the left of the SMA?

A

80%

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29
Q

Name 2 lumbar hernias?

A
  1. Grynfelt

2. Petit lumbar

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30
Q

Where does obturator hernia occur?

A

Between pectineus and obturator externus.

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31
Q

Direct inguinal hernia?

A
  • Defect in Hesselbachs triangle

- medial to inferior epigastric vessels

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32
Q

Indirect inguinal hernia?

A
  • passes through the inguinal canal lateral to the inferior epigastric vessels
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33
Q

Paraduodenal hernias are due to a defect in what?

A

Descending mesocolon

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34
Q

Where do duodenal hernias usually occur?

A

1st part of duodenum

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35
Q

Complications of duodenal diverticulum?

A
  • perforation
  • obstruction
  • biliary obstruction
  • bleeding
  • diverticulitis
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36
Q

Ddx Duodenal cap BIG cobblestones?

A
  1. Hypertrophy of Brunner’s glands
  2. Oedema
  3. Crohn’s
  4. Varices
  5. Carcinoma
  6. Lymphoma
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37
Q

Ddx Duodenal cap SMALL cobblestones?

A
  1. Food residue
  2. Duodenitis
  3. Nodular lymphoid hyperplasia
  4. Hypertrophic gastric mucosa
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38
Q

5 causes of absent or decreased duodenal folds?

A
  1. Amyloid
  2. Crohn’s
  3. CF
  4. Scleroderma
  5. Strongyloides
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39
Q

Ddx thickened duodenal folds?

A
  1. Inflammatory
    - Crohns
    - Duodenitis
    - Pancreatitis
    - ZE syndrome
  2. Neoplasia
    - Mets
    - Lymphoma
    - Infiltrations
    - Eosinophilic
    - Amyloid
    - Mastocytosis
    - Whipples
  3. Oedema
    - Hypoproteinemia
    - Venous obstruction
    - Lymphatic obstruction
    - Angioneurotic oedema
  4. Infestation
    - worms
    - giardiasis
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40
Q

Causes of dilated duodenum?

A

Mechanical Obstruction

  1. Bands
  2. Atresia/web/stenosis
  3. Annular pancreas
  4. SMA syndrome

Paralytic ileus
Scleroderma

41
Q

What is the most common small bowel malignant tumour?

A

Lymphoma

42
Q

Res for intestinal lymphoma?

A
  1. Coeliac
  2. AIDS
  3. SLE
  4. Crohns
  5. Chemotherapy
43
Q

Imaging features of SI lymphoma?

A
  • large, cavitating ulcerative mass

- aneurysmal dilatation

44
Q

Types of SI lymphoma?

A

Hodgekins or NHL

45
Q

What type of tumours are MALTomas?

A

Low grade B cell

46
Q

Staging of GI lymphoma?

A
  1. Confined to SI
  2. Local LNs
  3. Widespread LNs
  4. Disseminated to liver, marrow and other sites
47
Q

T/F SI lymphoma is the commonest cause of intussusception?

A

True- 51% ileum, 47% jejunum, 2% duodenum

48
Q

What does SI lymphoma arise from?

A

Peyer’s patches?

49
Q

Describe the 4 types of SI lymphoma?

A
  1. Single or multiple polypoid masses, cobblestoning. A/w ulceration and intussusception.
  2. Infiltrating lymphoma involving <5cm of the bowel wall- a/w desmoplastic response, thickened valvulae and aneurysmal dilatation.
  3. Mesenteric or retroperitoneal lymphoma- may be single or multiple extra-luminal masses, in a ‘cake’ configuration engulfing multiple small bowel loops or a ‘sandwich’ configuration in which a mass surrounds mesenteric vessels that are separated by perivascular fat. Can also occur as a mesenteric and retroperitoneal mass.
  4. Endoexoenteric lymphoma- a large mass with small intramural component which can cause fistulas.
50
Q

Most common site of lymphoma in large bowel?

A

Caecum (85%)

51
Q

What is the most common primary malignant tumour of small bowel?

A

Carcinoid- 33% in small bowel (81% ileum), 45% appendix

52
Q

What % of ppl with small bowel carcinoid have another primary malignancy?

A

33%

53
Q

What % of gastric carcinoid have mets at presentation?

A

50-70%

54
Q

Hairpin turn?

A

Seen in small bowel carcinoid if there is fibrosis in the tissues, there may be a kink in the small bowel.

55
Q

T/F 2% of carcinoids < 1cm metastasise, 85% > 2cm metastasise?

A

True

56
Q

T/F Mets are more common in carcinoid of the ileum than appendix?

A

True

57
Q

T/F adenocarcinoma more common in distal small bowel?

A

False- proximal small bowel

58
Q

Imaging features adenocarcinoma of small bowel?

A
  • ulceration
  • annular constriction with shouldering
  • desmoplastic reaction
  • polyps
59
Q

What causes fold reversal in coeliacs?

A

Jejunal atrophy results in hypertrophy of the ileum

60
Q

Hyposplenism/atrophy in what % of coeliacs?

A

30-50%

61
Q

T/F coeliac a/w SCC of oesophagus?

A

True

62
Q

What % of coeliacs have endocrine disease?

A

10%- autoimmune thyroiditis and Sjogrens

63
Q

Imaging features Coeliac?

A
  • Jejunal atrophy (3 folds or fewer per 2.5cm jejunum)
  • Fold reversal
  • Fold thickening
  • Mosaic pattern of mucosa in jejunum 10%
  • bowel dilatation
  • barium flocculation (hyper secretion and malabsorption)
  • jejunisation of ileum (hypertrophy of ileum with thickening of folds)
  • gastric metaplasia in the duodenum can give rise to mucosal nodules (bubbly bulb sign)
64
Q

T/F Whipples seen in immunocompromised ppl?

A

True m:f, 9:1

65
Q

Whipples clinical presentation?

A
  • muscle wasting
  • arthralgia
  • fever
  • diarrhoea
  • pericarditis
66
Q

Whipples barium?

A

THIckening of duodenal or jejunal folds

67
Q

Mechanism of injury in radiation enteritis?

A
  • inability to repopulate the surface epithelium
  • collagen deposition and fibrosis
  • leads to bowel wall thickening, obliterative endarteritis and neural injury all of which lead to impaired mucosal and motor function
68
Q

8 causes of SBO?

A
  1. Adhesions
  2. Hernia
  3. Intussusception
  4. Crohns
  5. Gallstone ileus
  6. Ileus
  7. Tumour
  8. Foreign body
69
Q

4 causes LBO?

A
  1. Faeces
  2. Sigmoid/caecal volvulus
  3. Tumour
  4. Diverticulitis
70
Q

Causes of dilated small bowel with thick folds? CLAIREE

A 
Crohns
Lymphoma
Amyloid
Ischaemia
Radiation
Ellison Zollinger
Extensive SB resection
71
Q

What is a Meckel’s diverticulum?

A

Persistence of the omphalomesenteric duct on the anti-mesenteric border of the ileum.

72
Q

T/F Meckel’s diverticulum is commonest congenital anomaly of GIT?

A

True

73
Q

Complications of Meckel’s?

A

Bleeding
Diverticulitis
Bowel obstruction secondary to intussusception
Malignancy

74
Q

T/F Meckel’s- ectopic mucosa in 50%?

A

True- gastric, pancreatic and colonic

75
Q

S and S of Tc Pertech for Meckels?

A

85% sensitive and >95% specific but sensitivity drops after adolescence because less likely to contain gastric mucosa

76
Q

Meckels on angio- what is pathognommic?

A

Identification of Vitelline artery

77
Q

Cause of primary epiploic appendigitis?

A

Torsion or venous thrombosis. 50% in RLQ

78
Q

Causes of small bowel strictures? CLAIRE

A 
Crohns
Lymphoma (and other tumours)
Adhesions
Ischaemia
Radiation
Enteric coated potassium tablets
79
Q

Causes of small bowel nodules?

A

Inflammatory

  • Nodular lymphoid hyperplasia
  • Crohns

Infiltrative

  • Whipples
  • Waldenstrom’s macroglobulinemia
  • Mastocytosis

Neoplasia

  • Lymphoma
  • Polyposis
  • MEts

Infective causes

  • Typhoid
  • Yersiinia
80
Q

Lesions in TI?

A

Inflammatory

  • Radiation
  • Crohns
  • UC

Infective causes

  • TB
  • Actinomycosis
  • Yersiinia
  • Histoplasmosis

Neoplasia

  • Lymphoma
  • Carcinoid
  • Mets
81
Q

3 causes of small bowel pathos ulceration?

A
  1. Crohns
  2. PAN
  3. Yersinia
82
Q

Bowel ischaemia- Griffith’s point?

A

80% of cases- splenic flexure

83
Q

Bowel ischaemia- Sudeck’s point?

A

Rectosigmoid junction

84
Q

Bowel ischaemia- left colon more often than right?

A

True

85
Q

Complications of diverticulitis?

A
  1. Abscess
  2. Intestinal fistula (14%)
  3. Perforation
  4. Obstruction
  5. Peritonitis
  6. Sepsis and shock
  7. Bleeding
86
Q

2 different types of polyp?

A
  1. Hyperplastic (90%)
    - most commonly rectosigmoid
    - some malig potential (hyper plastic polyposis syndrome)
  2. Tubular
    - 10% risk malig >1.5cm
87
Q

What % of large polyps does CT colonoscopy detect?

A

80%

88
Q

Modified Duke’s staging?

A

A- Limited to mucosa
B- Involvement of muscularis propria
C- LN mets
D- Distant mets

89
Q

Most common sites colon cancer?

A

Rectum 30%

Sigmoid 30%

90
Q

T/F Sigmoid volvulus twists on mesenteric axis?

A

True

91
Q

5 causes of secondary pneumatosis intestinalis?

A
  • NEC
  • Colitis and enteritis
  • Collagen disorders
  • Leukaemia
  • Steroids and other immunosuppressive tx
92
Q

Causes of widened pre sacral space?

A

Neoplasia

  • Rectal Ca
  • Rectal mets
  • Sacral tumour

Inflammatory causes

  • Crohns/UC
  • Abscess
  • Radiotherapy
  • Diverticulitis

Pelvic lipoma
Anterior sacral meningocele
Enteric duplication cyst

93
Q

3 Res for Crohn’s?

A
  • family hx
  • smoking
  • OCP
94
Q

4 complications of Crohn’s?

A
  1. Sinus tracks
  2. Bowel obstruction
  3. Fistula (50%)
  4. Malignant transformation
95
Q

T/F in UC, risk of malignant transformation increases by 0.5-1% per year after 10 years of the disease?

A

True, toxic megacolon in 2%

96
Q

UC mucosa?

A
  • Mucosal oedema- fine granular pattern
  • Collar button ulcers
  • confluent ulceration as a coarse granular appearance
97
Q

Thumb printing?

A

Haustral thickening from oedema

98
Q

Pseudopolyps?

A

Result from normal mucosa adjacent to areas of ulceration

99
Q

T/F submucosal fat deposition seen in UC more than Crohn’s?

A

True

Green Book GI (3 decks)

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