Stomach and Bowel Flashcards
Where do drugs cause gastritis?
Distally or near the greater curve.
Name 8 causes of gastritis?
Gut Bacteria Alcohol, allergy Stress Trauma Radiation Ischaemia, Infection Corrosives, Bile
H pylori is a/w what % of gastric and duodenal ulcers?
60% of gastric ulcers
80% of duodenal ulcers
T/F H pylori is a/w cancer?
True
4 features of gastritis on barium?
- Thickened folds
- Inflammatory nodules
- Coarse area gastricae
- Erosions
Name 3 other types of gastritis?
- Phlegmonous (a/w bacteria)
- Emphysematous
- Corrosive
9 risk factors for gastric cancer?
Gatrojejunostomy and partial gastrectomy Adenomatous and villous polyps Smoking H pylori Menetriers Atrophi gastritis Nitrites, nitrates Pickled vegetables Pernicious anemia
T/F 60% of gastric cancer along lesser curve?
True
5 year survival gastric cancer?
5-18%
T Staging gastric cancer?
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.
Blumer’s shelf?
Peritoneal seeding to rectal wall
T/F normal stomach does not contain lymphoid follicles?
True- they can develop following infection with H pylori. Persistent antigenic stimulation by H pylori is thought to lead to neoplastic transformation.
T/F MALT is usually locally contained at time of dx?
True - better prognosis than NHL
Commonest site of MALT?
Antrum
T/F Perforation common with MALT?
False- rare
MALT on Barium?
Can be focal and infiltrative or diffuse
T/F Ulceration common with MALT?
False- rare
4 Res for PUD?
- H Pylori
- Analgesia
- Smoking
- Zollinger Ellison
T/F GIST a/w NF1?
True and Carney’s triad
Causes of thickened mucosal folds?
- Inflammatory causes
- gastritis
- ZE syndrome
- acute pancreatitis
- Crohn’s - Infiltrative and neoplastic causes
- lymphoma
- carcinoma
- eosinophilic gastroenteritis - Other causes
- Menetrier’s
- Varices
Causes of Linitis Plastica?
- Neopalsia
- gastric carcinoma
- lymphoma
- metastases
- local invasion from pancreatic cancer - Inflammatory causes
- corrosives
- radiotherapy
- granulomas
- eosinophilic enteritis
Causes of target lesions in the stomach?
- Submucosal metastases
- melanoma
- lymphoma
- carcinoma/carcinoid - Leiomyoma
- Ectopic pancreatic tissue
- Neurofibroma
Commonest site of small bowel injury following blunt trauma?
Jejunum- distal to ligament of Trietz
T/F Bowel wall thickening is a sensitive sign of injury?
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.
T/F With bowel injury, mesenteric stranding is seen on the mesenteric side?
True
Other signs of bowel injury?
- Free fluid
- Interloop fluid
- 5% of hepatic and splenic lacerations are a/w bowel injury
- intramural haematoma
- mesenteric haematoma
Cause of malrotation?
- arrest in embryological development of rotation and fixation.
- abnormal gut position due to narrow mesenteric attachment.
In what % of cases of malrotation is the SMV to the left of the SMA?
80%
Name 2 lumbar hernias?
- Grynfelt
2. Petit lumbar
Where does obturator hernia occur?
Between pectineus and obturator externus.
Direct inguinal hernia?
- Defect in Hesselbachs triangle
- medial to inferior epigastric vessels
Indirect inguinal hernia?
- passes through the inguinal canal lateral to the inferior epigastric vessels
Paraduodenal hernias are due to a defect in what?
Descending mesocolon
Where do duodenal hernias usually occur?
1st part of duodenum
Complications of duodenal diverticulum?
- perforation
- obstruction
- biliary obstruction
- bleeding
- diverticulitis
Ddx Duodenal cap BIG cobblestones?
- Hypertrophy of Brunner’s glands
- Oedema
- Crohn’s
- Varices
- Carcinoma
- Lymphoma
Ddx Duodenal cap SMALL cobblestones?
- Food residue
- Duodenitis
- Nodular lymphoid hyperplasia
- Hypertrophic gastric mucosa
5 causes of absent or decreased duodenal folds?
- Amyloid
- Crohn’s
- CF
- Scleroderma
- Strongyloides
Ddx thickened duodenal folds?
- Inflammatory
- Crohns
- Duodenitis
- Pancreatitis
- ZE syndrome - Neoplasia
- Mets
- Lymphoma
- Infiltrations
- Eosinophilic
- Amyloid
- Mastocytosis
- Whipples - Oedema
- Hypoproteinemia
- Venous obstruction
- Lymphatic obstruction
- Angioneurotic oedema - Infestation
- worms
- giardiasis
Causes of dilated duodenum?
Mechanical Obstruction
- Bands
- Atresia/web/stenosis
- Annular pancreas
- SMA syndrome
Paralytic ileus
Scleroderma
What is the most common small bowel malignant tumour?
Lymphoma
Res for intestinal lymphoma?
- Coeliac
- AIDS
- SLE
- Crohns
- Chemotherapy
Imaging features of SI lymphoma?
- large, cavitating ulcerative mass
- aneurysmal dilatation
Types of SI lymphoma?
Hodgekins or NHL
What type of tumours are MALTomas?
Low grade B cell
Staging of GI lymphoma?
- Confined to SI
- Local LNs
- Widespread LNs
- Disseminated to liver, marrow and other sites
T/F SI lymphoma is the commonest cause of intussusception?
True- 51% ileum, 47% jejunum, 2% duodenum
What does SI lymphoma arise from?
Peyer’s patches?
Describe the 4 types of SI lymphoma?
- Single or multiple polypoid masses, cobblestoning. A/w ulceration and intussusception.
- Infiltrating lymphoma involving <5cm of the bowel wall- a/w desmoplastic response, thickened valvulae and aneurysmal dilatation.
- 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.
- Endoexoenteric lymphoma- a large mass with small intramural component which can cause fistulas.
Most common site of lymphoma in large bowel?
Caecum (85%)
What is the most common primary malignant tumour of small bowel?
Carcinoid- 33% in small bowel (81% ileum), 45% appendix
What % of ppl with small bowel carcinoid have another primary malignancy?
33%
What % of gastric carcinoid have mets at presentation?
50-70%
Hairpin turn?
Seen in small bowel carcinoid if there is fibrosis in the tissues, there may be a kink in the small bowel.
T/F 2% of carcinoids < 1cm metastasise, 85% > 2cm metastasise?
True
T/F Mets are more common in carcinoid of the ileum than appendix?
True
T/F adenocarcinoma more common in distal small bowel?
False- proximal small bowel
Imaging features adenocarcinoma of small bowel?
- ulceration
- annular constriction with shouldering
- desmoplastic reaction
- polyps
What causes fold reversal in coeliacs?
Jejunal atrophy results in hypertrophy of the ileum
Hyposplenism/atrophy in what % of coeliacs?
30-50%
T/F coeliac a/w SCC of oesophagus?
True
What % of coeliacs have endocrine disease?
10%- autoimmune thyroiditis and Sjogrens
Imaging features Coeliac?
- 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)
T/F Whipples seen in immunocompromised ppl?
True m:f, 9:1
Whipples clinical presentation?
- muscle wasting
- arthralgia
- fever
- diarrhoea
- pericarditis
Whipples barium?
THIckening of duodenal or jejunal folds
Mechanism of injury in radiation enteritis?
- 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
8 causes of SBO?
- Adhesions
- Hernia
- Intussusception
- Crohns
- Gallstone ileus
- Ileus
- Tumour
- Foreign body
4 causes LBO?
- Faeces
- Sigmoid/caecal volvulus
- Tumour
- Diverticulitis
Causes of dilated small bowel with thick folds? CLAIREE
Crohns Lymphoma Amyloid Ischaemia Radiation Ellison Zollinger Extensive SB resection
What is a Meckel’s diverticulum?
Persistence of the omphalomesenteric duct on the anti-mesenteric border of the ileum.
T/F Meckel’s diverticulum is commonest congenital anomaly of GIT?
True
Complications of Meckel’s?
Bleeding
Diverticulitis
Bowel obstruction secondary to intussusception
Malignancy
T/F Meckel’s- ectopic mucosa in 50%?
True- gastric, pancreatic and colonic
S and S of Tc Pertech for Meckels?
85% sensitive and >95% specific but sensitivity drops after adolescence because less likely to contain gastric mucosa
Meckels on angio- what is pathognommic?
Identification of Vitelline artery
Cause of primary epiploic appendigitis?
Torsion or venous thrombosis. 50% in RLQ
Causes of small bowel strictures? CLAIRE
Crohns Lymphoma (and other tumours) Adhesions Ischaemia Radiation Enteric coated potassium tablets
Causes of small bowel nodules?
Inflammatory
- Nodular lymphoid hyperplasia
- Crohns
Infiltrative
- Whipples
- Waldenstrom’s macroglobulinemia
- Mastocytosis
Neoplasia
- Lymphoma
- Polyposis
- MEts
Infective causes
- Typhoid
- Yersiinia
Lesions in TI?
Inflammatory
- Radiation
- Crohns
- UC
Infective causes
- TB
- Actinomycosis
- Yersiinia
- Histoplasmosis
Neoplasia
- Lymphoma
- Carcinoid
- Mets
3 causes of small bowel pathos ulceration?
- Crohns
- PAN
- Yersinia
Bowel ischaemia- Griffith’s point?
80% of cases- splenic flexure
Bowel ischaemia- Sudeck’s point?
Rectosigmoid junction
Bowel ischaemia- left colon more often than right?
True
Complications of diverticulitis?
- Abscess
- Intestinal fistula (14%)
- Perforation
- Obstruction
- Peritonitis
- Sepsis and shock
- Bleeding
2 different types of polyp?
- Hyperplastic (90%)
- most commonly rectosigmoid
- some malig potential (hyper plastic polyposis syndrome) - Tubular
- 10% risk malig >1.5cm
What % of large polyps does CT colonoscopy detect?
80%
Modified Duke’s staging?
A- Limited to mucosa
B- Involvement of muscularis propria
C- LN mets
D- Distant mets
Most common sites colon cancer?
Rectum 30%
Sigmoid 30%
T/F Sigmoid volvulus twists on mesenteric axis?
True
5 causes of secondary pneumatosis intestinalis?
- NEC
- Colitis and enteritis
- Collagen disorders
- Leukaemia
- Steroids and other immunosuppressive tx
Causes of widened pre sacral space?
Neoplasia
- Rectal Ca
- Rectal mets
- Sacral tumour
Inflammatory causes
- Crohns/UC
- Abscess
- Radiotherapy
- Diverticulitis
Pelvic lipoma
Anterior sacral meningocele
Enteric duplication cyst
3 Res for Crohn’s?
- family hx
- smoking
- OCP
4 complications of Crohn’s?
- Sinus tracks
- Bowel obstruction
- Fistula (50%)
- Malignant transformation
T/F in UC, risk of malignant transformation increases by 0.5-1% per year after 10 years of the disease?
True, toxic megacolon in 2%
UC mucosa?
- Mucosal oedema- fine granular pattern
- Collar button ulcers
- confluent ulceration as a coarse granular appearance
Thumb printing?
Haustral thickening from oedema
Pseudopolyps?
Result from normal mucosa adjacent to areas of ulceration
T/F submucosal fat deposition seen in UC more than Crohn’s?
True
