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Abdominal Radiology > Stomach and Duodenum > Flashcards

Stomach and Duodenum Flashcards

1
Q

provides excellent evaluation of stomach and duodenum and remains part of radiologic armamentarium

A

UGI

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2
Q

technique that entails using small amounts of barium to coat the mucosa without distending the bowel to demonstrate abnormalities such as varices

A

mucosal relief technique

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3
Q

essentially a hollow tube consisting of four concentric layers of tissue

A

GI tract

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4
Q

innermost layer of the GI tract exposed to the lumen is the

A

mucosa

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5
Q

GI mucosa consists of epithelium supported by loose connective tissue of the lamina propria and a thin band of smooth muscle called the

A

muscularis mucosae

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6
Q

layer of GI wall lining that contains the primary vascular and lymphatic channels, lymphoid follicles and autonomic nerve plexuses

A

submucosa

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7
Q

major muscular structure of the bowel wall is

A

muscularis propria

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8
Q

muscularis propria consist of

A

inner circular and outer longitudinal layers

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9
Q

outer covering of the bowel

A

serosa or adventitia

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10
Q

layer of GI tract that contains the lymphoid tissue

A

mucosa (epithelium and lamina propria), submucosa, and the mesenteric lymph nodes

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11
Q

major component of GI lymphoid tissue that plays a major role in host defense and is a site of significant disease

A

mucosa-associated lymphoid tissue (MALT)

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12
Q

refers to region of GEJ

A

cardia

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13
Q

portion of stomach above the level of GEJ

A

fundus

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14
Q

central 2/3 portions from cardia to incisura angularis

A

body of stomach

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15
Q

acute angle formed on the lesser curvature that marks the boundary between the body and antrum

A

incisura angularis

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16
Q

gastric cells which produce hydrochloric acid and chief cells, which produce pepsin precursors and located in the fundus and body

A

parietal cells

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17
Q

distal 1/3 of stomach and contains gastrin-producing cells but no acid-secreting cells

A

antrum

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18
Q

junction of the stomach with the duodenum and the pyloric canal

A

pylorus

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19
Q

pyramidal first portion of the duodenum

A

duodenal bulb or cap

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20
Q

duodenal bulb like the stomach is covered on call surfaces by

A

visceral peritoneum

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21
Q

remainder of the duodenum is located where

A

retroperitoneal and within the anterior pararenal compartment.

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22
Q

part of duodenum that is lateral to the head of pancreas

A

second or descending portion of duodenum

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23
Q

common bile duct and pancreatic duct pierce the medial aspect of the descending duodenum at the

A

ampulla of Vater

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24
Q

part of duodenum that passes to the left between the SMV and IVC and aorta

A

3rd or horizontal portion

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25
Q

part of duodenum that ascends on the left side of aorta to the level of L2 and ligament of Treitz, where it turns abruptly ventrally to form the duodenal-jejunal flexure

A

fourth or ascending portion

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26
Q

this term refers to the detailed pattern of gastric mucosa as demonstrated by double-contrast technique. it varies from a fine reticular pattern to a course nodular pattern

A

areae gastricae

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27
Q

refers to gastric mucosal folds that produce distinct radiolucent ridges when the stomach is partially distended

A

rugae

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28
Q

rugae are composed of

A

mucosa, lamina propria, muscular mucosae and portions of submucosa

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29
Q

rugal folds are most prominent in what part of stomach

A

fundus and proximal gastric body

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30
Q

rugal folds are usually absent in

A

antrum

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31
Q

lesser curvature of the stomach is attached to the liver by the

A

lesser omentum

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32
Q

attaches the greater curvature of stomach

A

greater omentum

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33
Q

an intraperitoneal space posterior to the stomach and anterior to the pancreas

A

lesser sac

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34
Q

normal gastric wall on ct when well distended in the antrum measures ___ and in the body ___

A

5-7 mm thick and 2-3 mm

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35
Q

wall of normal duodenum measures

A

less than 3 mm

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36
Q

major cause of chronic gastritis, duodenitis, benign gastric and duodenal ulcers, gastric adenocarcinoma and MALT lyphoma

A

H. Pylori

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37
Q

H.pylori will only infect what cell-type and is usually located where

A

gastric-like epithelium, gastric antrum

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38
Q

H.pylori survives in gastric acid by

A

using a powerful urease enzyme to break down urea into ammonia and bicarbonate, creating a more alkaline environment for itself

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39
Q

double contrast technique demonstrates ____ in 50% of patients with H.pylori infection

A

enlarged areae gastricae

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40
Q

diagnosis of H.pylori infection is made by

A

serology, urease breath tests and endoscopic biopsy

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41
Q

tx for H.pylori

A

combination of 2 or more drugs, including one or more antibiotics, H2 blockers to decrease acid secretion, and occasionally a bismuth compound

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42
Q

third most common GI malignancy, following colon and pancreatic CA

A

gastric carcinoma

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43
Q

most (95%) gastric carcinomas are of what cell type

A

adenocarcinoma

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44
Q

remaining 5% of gastric carcinomas are of what cell type

A

diffuse anaplastic (signet ring) carcinoma, squamous cell carcinoma or rare cell types

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45
Q

predisposing factors for gastric carcinoma

A

smoking, pernicious anemia, atrophic gastritis and gastrojejunostomy

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46
Q

cause of half of gastric adenocarcinoma

A

H.pylori

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47
Q

peak age and gender predilection of gastric adenocarcinoma

A

50-70 y.o with males predominating 2:1

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48
Q

4 common morphologic growth pattern of gastric carcinoma

A

polypoid, broad-based and papillary, ulcerative, infiltrating tumors

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49
Q

type of morphologic growth pattern of gastric carcinoma that present as filling defects within the gastric lumen

A

polypoid

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50
Q

type of morphologic growth pattern of gastric carcinoma that present as focal plaque-like lesions with central ulcer or diffusely infiltrating with poorly differentiated carcinomatous cells producing bizarre thickened folds and thickened rigid stomach wall, so-called scirrhous carcinomas

A

infiltrating

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51
Q

term that may be applied to describe the resulting stiff narrowed stomach

A

linitis plastica, water bottle stomach

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52
Q

lymphatic spread of gastric carcinoma

A

perigastric nodes along the lesser curvature, celiac axis, hepatoduodenal, retropancreatic, mesenteric, and para-aortic nodes

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53
Q

hematogeneous spread of gastric carcinoma

A

liver, adrenal glands, ovaries and rarely, bone and lung

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54
Q

intraperitoneal seeding of gastric carcinoma presents as

A

carcinomatosis or Krukenberg ovarian tumors

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55
Q

early gastric cancers appear on barium studies as

A

gastric polyps with risk of malignancy increased for lesions than 1 cm, superficial plaque-like lesions or nodular mucosa, shallow irregular ulcers with nodular adjacent mucosa

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56
Q

what GI organ is the most common site of involvement of primary GI lymphoma, accounting for approximately 50% of cases

A

stomach

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57
Q

risk factors for gastric lymphoma

A

chronic infection with H. Pylori, Epstein-Barr virus, Hepa B virus or campylobacter jejuni, celiac disease, atrophic gastritis and IBD

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58
Q

most of gastric lymphomas are of what cell type

A

B-cell type especially MALT type

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59
Q

4 morphologic patterns of gastric lymphoma

A

polypoid solitary mass, ulcerative mass, multiple submucosal nodules and diffuse infiltration

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60
Q

UGI findings in gastric lymphoma

A

polypoid lesions, irregular ulcers with nodular thickened folds, bulky tumors with large cavities, multiple submucosal nodules that commonly ulcerate and create a target or”bull’s eye” appearance, diffuse but pliable wall and fold thickening and rarely, linitis plastical appearance of diffuse, stiff narrowing

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61
Q

Multiplicity of gastric lesions favors what malignancy

A

MALT lymphoma

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62
Q

imaging features of gastric adenocarcinoma

A

focal wall thickening (> 1 cm), diffuse wall thickening (linitis plastica), large mass, ulcerated mass that is predominantly intraluminal, soft tissue stranding from mass into perigastric fat, adenopathy, peritoneal implants, distal metastasis

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63
Q

imaging features of gastric lymphoma

A

marked wall thickening (4-5 cm), circumferential wall thickening without luminal narrowing, homogeneous attenuation of tumor, multiple polyps with ulceration, extensive adenopathy, especially if below the renal hila, transpyloric tumor spreads to duodenum

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64
Q

imaging features of malignant GIST

A

large, heterogeneous exophytoc mass (> 5cm), extensive ulceration of the mass, prominent necrosis, hemorrhage, liquefaction, calcification within the tumor

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65
Q

imaging features of metastases to stomach

A

wall thickening, similar to primary carcinoma, focal intramural mass, ulcerated mural nodule, direct invasion of the stomach from adjacent tumor

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66
Q

most common mesenchymal tumor to arise from the GI tract. most, but not all tumors previously classified as leiomyomas, leiomyosarcomas and leiomyoblastomas are now classified as this entity

A

GISTs

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67
Q

approximately 60 to 70% of GISTs arise from

A

stomach

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68
Q

true or false: ture leiomyomas and leiomyosarcomas are very rare in the stomach

A

true

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69
Q

characteristic of GIST

A

long term growth to a large size

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70
Q

CT imaging characteristics of benign GIST

A

smaller (4 to 5 cm), homogeneous in density, show uniform diffuse enhancement

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71
Q

CT imaging features of malignant GIST

A

larger tumor (> 10 cm) with central zones of low density caused by hemorrhage and necrosis and show irregular patterns of enhancement

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72
Q

common primary tumors that metastasize in the stomach are

A

melanoma, breast and lung ca

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73
Q

breast cancer metastasis to stomach produce

A

linitis plastica

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74
Q

common symptom of Kaposi sarcoma in the stomach

A

bleeding

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75
Q

adenomatous polypoid masses that produce multiple frond-like projections. most are solitary and 3 to 9 cm in size although giant tumors may be as large as 15 cm. malignant potential is high and varies with size of lesion. barium trapped in clefts between fronds produces a characteristic soap bubble appearance. tumors are mobile and deform with compression

A

villous tumors

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76
Q

malignant potential is high in villous tumors, __% in 2-4 cm lesions and ___% for lesions > 4cm

A

50% and 80%

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77
Q

this sign is produced by the acute angle of attachment of the polyp to the mucosa

A

bowler hat sign

78
Q

this sign consists of two concentric rings and is produced by visualizing a pedunculated polyp end on. Polyps are commonly multiple

A

mexican hat sign

79
Q

accounts for 80% of gastric polyps

A

hyperplastic polyps

80
Q

true or false: hyperplastic polyps are not neoplasms, but rather hyperplastic responses to mucosal injury, especially gastritis, have no malignant potential but are indicative of chronic gastritis

A

hyperplastic polyps

81
Q

accounts for 15% of gastric polyps

A

adenomatous polyps

82
Q

most adenomatous polyps are seen in what part of stomach

A

antrum

83
Q

polyps that are larger than ___ cm and appears ____ should have biopsies taken of them because of risk of malignancy

A

larger than 1 cm, lobulated or pedunculated

84
Q

polyps that occur in Peutz-Jeghers syndrome. they have no malignant potential

A

Hamartomatous polyps

85
Q

true or false: gastric lipomas are submucal neoplasms composed of mature benign fatty tissue. UGI reveals a smooth, well-defined submucosal lesion that occasionally ulcerates

A

true

86
Q

ectopic pancreas in the stomach is usually seen at what part

A

antrum

87
Q

appearance of ectopic pancreas in the stomach

A

up to 5 cm in size, are covered by gastric mucosa, most are nipple- or cone-shaped with small central orifices

88
Q

refers to an intraluminal gastric mass consisting of accumulated undigested material

A

bezoar

89
Q

normal gastric folds are thicker and more undulated in what part of the stomach

A

proximal stomach and along the greater curvature

90
Q

irregular, focal (<5 cm length), asymmetric bowel wall thickening suggests

A

malignancy

91
Q

Regular, homogeneous, symmetric bowel wall thickening suggests a

A

benign process

92
Q

diffuse bowel wall thickening (> 6 cm in length) is usually caused by a

A

benign, inflammatory, ischemic or infectious diseases

93
Q

following IV contrast administration, bowel thickening that shows alternating densities of high or low attenuation (target appearance) indicates _____. the low-density layer is indicative of bowel wall edema

A

nearly always benign and secondary to inflammation or ischemia

94
Q

perigastric fat stranding, disproportionately more severe than the degree of wall thickening suggests a

A

an inflammatory process

95
Q

convenient label used to describe a wide variety of diseases affecting the gastric mucosa

A

gastritis

96
Q

hallmarks of gastritis

A

thickened folds and superficial mucosal ulcerations (erosions)

97
Q

defined as defects in the mucosa that do not penetrate beyond the muscularis mucosae

A

erosions

98
Q

also called varioliform erosions, are complete erosions that appear as tiny central flecks of barium surrounded by a radiolucent halo of edema

A

aphthous ulcers

99
Q

true or false: erosion heals without scarring

A

true

100
Q

gastritis is commonly associated with

A

duodenitis

101
Q

most common form of gastritis and is the most common cause of thickened gastric folds

A

H pylori gastritis

102
Q

erosive gastritis is most often caused by

A

alcohol, aspirin and other NSAIDs or steroids

103
Q

crohn gastritis characteristically involves the

A

gastric antrum and proximal duodenum

104
Q

a chronic autoimmune disease that destroys the fundic mucosa but spares the antral mucosa

A

atrophic gastritis

105
Q

destruction of parietal cells results in

A

decreased acid and intrinsic factor production that lead to vitamin B12 deficiency and pernicious anemia

106
Q

UGI findings in this disease entity include decreased or absent folds in the fundus and body (“bald fundus”), narrowed, tube-shaped stomach (fundal diameter <8cm) and small (1 to 2 mm) or absent gastricae

A

atrophic gastritis

107
Q

type of gastritis that is acute, often fatal bacterial infection of the stomach . alpha hemolytic streptococci are the most common cause, but a variety of other bacteria has also been identified

A

Phlegmonous gastritis

108
Q

phlegmonous gastritis may arise as a complication of

A

septicemia, gastric surgery or gastric ulcers

109
Q

in this type of gastritis, multiple abscesses are formed in the gastric wall, which is markedly thickened. rugae are swollen. barium may penetrate into abscess crypts in the gastric wall. peritonitis develops in 70% of cases. healing usually results in a severely contracted stomach

A

phlegmonous gastritis

110
Q

form of phlegmonous gastritis caused by gas-producing organisms, usually E.coli, clostidium welchiii, or mixed infectious with S. aureus. most cases are caused by caustic ingestion, alcohol abuse, surgery, trauma or ischemia. multiple gas bubbles are apparent within the wall of stomach. gastric folds are thickened and edematous

A

emphysematous gastritis

111
Q

rare type of gastritis characterized by diffuse infiltration of the wall of stomach and small bowel by eosinophilar and perihilar areaseos

A

eosinophilic gastroenteritis

112
Q

in eosinophilic gastroenteritis, what part of the abdomen is narrowed with a nodular “cobblestone” mucosal pattern

A

antrum

113
Q

also called giant hypertrophic gastritis is a rare condition characterized by excessive mucus production, giant rugal hypertrophy, hypoproteinemia and hypochlorhydria

A

Menetrier disease

114
Q

UGI findings of menetrier disease include

A

markedly enlarged (> 10 mm in the fundus) and tortuous but pliable folds in the fundus and body, especially along the greater curvature, with sparing of the antrum, and hypersecretion but has diluted the barium and impaired mucosal coating. CT demonstrates nodular markedly thickened folds with smooth serosal surface and normal gastric wall thickness between folds

115
Q

gastric varices are common in

A

fundus

116
Q

isolated gastric varices occur with

A

splenic vein occlusion

117
Q

what part of the stomach is the most common location for neoplasms

A

distal stomach

118
Q

defined as full-thickness defect in the mucosa. it frequently extends to the deeper layers of the stomach, including the submucosa and muscularis propria.

A

ulcer

119
Q

true or false: 95% of ulcerating gastric lesions are benign

A

true

120
Q

diagnostic method of choice for gastric ulcers

A

gastroduodenal endoscopy

121
Q

ulcers that are usually associated with increased production of acid

A

duodenal ulcers

122
Q

ulcers that occur with normal or even decreased acid levels

A

gastric ulcers

123
Q

this must be present for peptic ulceration to occur

A

hydrochloric acid

124
Q

major complications of peptic ulcer disease are

A

bleeding, obstruction and perforation

125
Q

hallmark of benign ulcers

A

mucosa is intact to the very edge of an undermining ulcer crater

126
Q

reliable radiographic evidence of benign ulcer

A

complete and sustained healing

127
Q

edematous ulcer collar with overhanging mucosal edge is a sign of benign or malignant ulcer?

A

benign

128
Q

ulcer projecting beyond the expected lumen is a sign of benign or malignant ulcer?

A

benign

129
Q

radiating folds extending into the crater is a sign of benign or malignant ulcer?

A

benign

130
Q

depth of ulcer that is greater than width is a sign of benign or malignant ulcer?

A

benign

131
Q

presence of hampton line, best demonstrated on spot films obtained with compression, is caused by an overhanging gastric mucosa in an undermined ulcer is a sign of benign or malignant ulcer?

A

benign

132
Q

wall thickening usually involving both antrum and duodenum is a sign of benign or malignant ulcer?

A

benign

133
Q

edema and edematous stranding extending into periantral and periduodenal fat or involving adjacent organs is a sign of benign or malignant ulcer?

A

benign

134
Q

deep ulcers that may show focal discontinuity of mucosal enhancement and/or outpouching of the lumen is a sign of benign or malignant ulcer?

A

benign

135
Q

true or false: the size, depth, and location of the ulcer and the contour of the ulcer base are of no diagnostic value in differentiating benign from malignant ulcers

A

true

136
Q

differential diagnosis for benign ulcers include

A

H.pylori peptic disease, gastritis, hyperparathyroidism, radiotherapy and Zollinger-elison syndrome

137
Q

irregular tumor mass or infiltration of the surrounding mucosa is a sign of benign or malignant ulcer?

A

malignant

138
Q

ulcer within the lumen of the stomach and an ulcer eccentrically located within the tumor mound is a sign of benign or malignant ulcer?

A

malignant

139
Q

shallow ulcer with width greater than its depth is a sign of benign or malignant ulcer?

A

malignant

140
Q

an ulcer with nodular, rolled, irregular or shouldered edges is a sign of benign or malignant ulcer?

A

malignant

141
Q

presence of carmen meniscus sign is a sign of benign or malignant ulcer?

A

malignant

142
Q

sign that appears as a large flat-based ulcer with heaped-up edges that fold inward to trap a lens-shaped barium collection that is convex toward the lumen is called

A

carmen meniscus sign

143
Q

differential diagnosis of malignant ulcer include

A

gastric adenocarcinoma, lymphoma, leiomyoma, leiomyosarcoma

144
Q

equivocal ulcers may show these characteristics

A

coarse areae gastricae abutting the ulcer, nodular ulcer collar, mildly irregular folds extending into the ulcer edge

145
Q

90% of tumors in the duodenal bulb are benign or malignant

A

benign

146
Q

most tumors in this portion of the duodenum are malignant

A

4th portion

147
Q

signs of malignant duodenal tumor include

A

central necrosis, ulceration or excavation, exophytic or intramural mass, evidence of tumor beyond the duodenum

148
Q

duodenal adenocarcinoma are most common in the

A

periampullary region

149
Q

this duodenal malignancy appears on CT and MR as an enhancing intramural or exophytic soft tissue mass with frequently bilobed “dumbbell” shape

A

duodenal adenocarcinoma

150
Q

metastases to the duodenum may occur in what part of duodenum

A

wall or subserosa of the duodenum presenting with wall thickness

151
Q

most common primary malignancies that metastasise to duodenum

A

breast, lung, GI

152
Q

presents as polypoid lesion that may be pedunculated or sessile. this accounts for about half of the neoplasms in the duodenum

A

duodenal adenoma

153
Q

these duodenal adenomas have a high incidence of malignant degeneration and a characteristic “cauliflower” appearance on double contrast UGI serires

A

villous adenomas

154
Q

GISTs in duodenum are common in what part

A

second or third portion

155
Q

second most common primary malignant tumor of duodenum

A

malignant GIST

156
Q

presents as small (1 to 3 mm) polypoid nodules diffusely throughout the duodenum. it is associated with immunodeficiency states in some adults

A

lymphoid hyperplasia

157
Q

true or false: there is no evidence that supports the concept that lymphoid hyperplasia is a precursor to lymphoma

A

true

158
Q

this disease entity may prolapse through the pylorus during peristalsis and cause a lobulated mass at the base of the duodenal bulb. diagnosis is suggested by characteristic location and change in the configuration with peristalsis, which may be observed on UGI

A

gastric mucosal prolapse/heterotopic gastric mucosa

159
Q

this lesion has the appearance of areae gastricae in the duodenal bulb, or as clusters of 1-3 mm plaques on the smooth duodenal bulb mucosa

A

gastric mucosal prolapse/heterotopic gastric mucosa

160
Q

located in the submucosa of proximal 2/3 of duodenum and secrete an alkaline substance that buffers gastric acid

A

brunner gland hyperplasia/hamartoma

161
Q

hyperplasia has size of

A

multiple and smaller than 5 mm

162
Q

hamartomas has size of

A

> 5 mm

163
Q

true or false: brunner gland hamartomas are benign and without cellular atypia

A

true

164
Q

common cause of multiple nodules, often with a cobblestone appearance

A

diffuse nodular gland hyperplasia

165
Q

usually presents as solitary nodule and is identical in appearance to other benign duodenal nodules

A

Brunner gland hamartoma

166
Q

True or false: Brunner glands are located deep in the wall of duodenum that may be overlooked on endoscopy

A

true

167
Q

ectopic pancreas in duodenum occurs in what part

A

proximal descending portion

168
Q

most characteristic for ectopic pancreas in the duodenum

A

solitary mass with central dimple

169
Q

valvulae conniventes is also known as

A

Kerckring folds

170
Q

valvulae conniventes begin at what portion of duodenum

A

secondary to suboptimal inspiration

171
Q

they are permanent circular folds of mucosa supported by a core of fibrovascular submucosa

A

valvulae conniventes

172
Q

thickened valvulae conniventes measures

A

greater than 2-3 mm wide

173
Q

refers to inflammation of duodenum without discrete ulcer formation

A

duodenitis

174
Q

major cause of duodenitis

A

H.pylori

175
Q

UGI findings in duodenitis include

A

thickening (>4 mm) of proximal duodenal folds, nodules or nodular folds (enlarged Brunner glands), deformity of duodenal bulb and erosions

176
Q

Crohn disease of duodenum involve what portion

A

first and second portions

177
Q

most commonly involved part of the duodenum in duodenal ulcers

A

duodenal bulb, anterior wall

178
Q

en face appearance of ulcer crater

A

persistent collection of barium or air

179
Q

appearance of ulcers in profile

A

project beyond the normal lumen

180
Q

duodenal ulcer size are mostly

A

smaller than 1 cm diameter

181
Q

caused by gastrin-secreting neuroendocrine tumor (gastrinoma)

A

Zollinger-Ellison syndrome

182
Q

gastrinomas are found in the

A

pancreas, duodenum and extraintestinal sites (liver, lymph nodes, ovary)

183
Q

multiple peptic ulcers in Zollinger-Ellison syndrome are most characteristic in what part of duodenum

A

postbulbar duodenum

184
Q

duodenal diverticula are most commonly seen along the

A

inner aspect of descending duodenum

185
Q

diverticula are differentiated from ulcers on a UGI series by demonstration of

A

mucosal folds entering the neck of diverticulum and change in appearance with peristalsis

186
Q

these are duodenal diverticula that are caused by thin, incomplete, congenital diaphragm that is stretched by moving intraluminal contents to form a “windsock” configuration within the duodenum

A

intraluminal diverticula

187
Q

most common congenital anomaly of pancreas

A

annular pancreas

188
Q

portion of duodenum that is encircled and narrowed by annular pancreas

A

descending portion

189
Q

congenital abnormality that occurs when the bilobed ventral component of pancreas fuses with the dorsal pancreas on both sides of duodenum

A

annular pancreas

190
Q

annular pancreas is associated with high incidence of what abnormality in the duodenum

A

postbulbar peptic ulceration in adults

191
Q

postbulbar duodenal ulcer is commonly associated with

A

narrowing of the lumen of second and third portions of duodenum

192
Q

common cause of upper GI bleeding

A

duodenal ulcer

Abdominal Radiology (14 decks)

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