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Gastrointestinal Imaging (Beri) > Stomach (for PBR 2) > Flashcards

Stomach (for PBR 2) Flashcards

1
Q

This is the major cause of chronic gastritis, duodenitis, benign gastric and duodenal ulcers, gastric adenocarcinoma, and MALT lymphoma

A

Helicobacter pylori infection

Infection is chronic and causes a superficial gastritis, which is most commonly asymptomatic

Approximately 70% of peptic gastric ulcers, 95% of duodenal ulcers, and 50% of gastric adenocarcinoma are caused by this infection

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2
Q

Imaging finding of H. pylori infection

A

Double-contrast technique demonstrates enlarged areae gastricae in 50% of patients

Diagnosis of H. pylori infection is made by serology, urease breath tests, and endoscopic biopsy

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3
Q

This is third most common GI malignancy, following colon and pancreatic carcinoma

Most (95%) are adenocarcinomas; the remainder is diffuse anaplastic (signet ring) carcinoma, squamous cell carcinoma, or rare cell types

Predisposing factors include smoking, pernicious anemia, atrophic gastritis, and gastrojejunostomy

A

Gastric carcinoma

H . pylori infection increases the risk of gastric carcinoma sixfold and is the cause of approximately half of gastric adenocarcinoma cases

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4
Q

Gastric carcinoma has four common morphologic growth patterns

What are these patterns?

A
  1. Polypoid masses (1/3)
  2. Ulcerative masses (1/3)

The remaining 1/3
3. Infiltrating tumors
4. Focal plaque-like lesions with central ulcers
5. Diffusely infiltrating
…with poorly differentiated carcinomatous cells producing bizarre thickened folds and thickened rigid stomach wall, so-called scirrhous carcinomas

*Creator’s notes: 4 pattern by 5 were mentioned (?)

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5
Q

This term may be applied to described the resulting stiff narrowed stomach.

A

“Linitis plastica” and “water bottle stomach”

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6
Q

Hematogeous metastases of gastric carcinoma involves what organs?

A

Liver
Adrenal glands
Ovaries
Rarely - Bone and lung

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7
Q

Intrapertineal seeding of gastric carcinoma presentas as what?

A

Carcinomatosis or Krukenberg ovarian tumors

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8
Q

Finding of early gastric cancer on barium study

A
  1. Gastric polyps (with risk of malignancy increased for lesions larger than 1 cm)
  2. Superficial plaque-like lesions or nodular mucosa
  3. Shallow, irregular ulcers with nodular adjacent mucosa

These lesions are most sensitively detected on double-contrast studies

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9
Q

Findings of gastric carcinoma on CT and MR

These modalities are used to determine the extent of tumor to facilitate preoperative planning

A
  1. Focal, often irregular, wall thickening (>1 cm)
  2. Diffuse wall thickening due to tumor infiltration (linitis plastica) (contrast enhancement is common)
  3. Intraluminal soft tissue mass
  4. Bulky mass with ulceration
  5. Rare, large, exophytic tumor resembling leiomyosarcoma
  6. Extension of tumor into perigastric fat
  7. Regional lymphadenopathy
  8. Metastases in the liver, adrenal, and peritoneal cavity
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10
Q

Mucinous adenocarcinomas frequently contain stippled calcifications

True or false

A

True

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11
Q

What gastric tumor has this imaging features:

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, distant metastases

A

Gastric adenocarcinoma

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12
Q

What gastric tumor has this imaging features:

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 the duodenum

A

Gastric lymphoma

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13
Q

What gastric tumor has this imaging features:

Large, heterogeneous exophytic mass (>5 cm)
Extensive ulceration of the mass
Prominent necrosis, hemorrhage, liquefaction
Calcification within the tumor

A

Malignant GIST

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14
Q

What gastric tumor has this imaging features:

Wall thickening similar to primary carcinoma
Focal intramural mass
Ulcerated mural nodule
Direct invasion of the stomach from adjacent tumor

A

Metastases to stomach

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15
Q

This findings limit treatment of gastric carcinoma to palliative surgery or chemotherapy

A

Transmural extension, intraperitoneal spread, or distant metastases

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16
Q

The stomach is the most common site of involvement of primary GI lymphoma

True or false

A

True

It accounts approximately 50% of cases

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17
Q

What are risk factors for gastric lymphoma?

A 
Chronic infection with H . pylori
Epstein–Barr virus
Hepatitis B virus,
Campylobacter jejuni
Celiac disease
Atrophic gastritis
Inflammatory bowel disease
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18
Q

What is the reason why gastric lymphoma has better prognosis than carcinoma?

A

Because lymphoma remains confined to the bowel wall for prolonged periods of time

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19
Q

What are the four morphologic patterns of gastric lymphoma?

A
  1. Polypoid solitary mass
  2. Ulcerative mass
  3. Multiple submucosal nodules
  4. Diffuse infiltration
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20
Q

UGI findings of gastric lymphoma

A
  1. Polypoid lesions
  2. Irregular ulcers with nodular thickened folds
  3. Bulky tumors with large cavities
  4. Multiple submucosal nodules that commonly ulcerate and create a target or “bull’s- eye” appearance
  5. Diffuse but pliable wall and fold thickening
  6. Rarely, linitis plastica appearance of diffuse, stiff narrowing
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21
Q

CT is the primary imaging modality used to stage lymphoma

What are helpful CT findings in differentiating gastric lymphoma from carcinoma?

A
  1. More marked thickening of the wall (may exceed 3 cm)
  2. Involvement of additional areas of the GI tract (transpyloric spread of lymphoma to the duodenum in 30%)
  3. Absence of invasion of the perigastric fat
  4. Absence of luminal narrowing and obstruction despite extensive involvement
  5. More widespread and bulkier adenopathy
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22
Q

These are most common mesenchymal tumor to arise from the GI tract

A

Gastrointestinal stromal tumors (GISTs)

Most, but not all, tumors previously classified as leiomyomas, leiomyosarcomas, and leiomyoblastomas are now classified as GISTs

Approximately 60% to 70% of GISTs arise in the stomach and 10% to 30% of these are malignant

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23
Q

Characteristics of gastrointestinal stroma tumors

A

Long-term silent growth to a large size

The overlying mucosa is commonly ulcerated

Dystrophic calcification is relatively common in both benign and malignant tumors (helps differentiate these lesions from other gastric tumors)

Predominantly extraluminal

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24
Q

in GIST - difference between benign and malignant

A

Benign tumors;
Smaller (4 to 5 cm, average size)
Homogeneous in density
Uniform diffuse enhancement

Malignant tumors:
Larger (>10 cm) with central zones of low density caused by hemorrhage and necrosis and show irregular patterns of enhancement

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25
Q

Presentation of metastasis in the stomach

A

May present as submucosal nodules or ulcerated masses

Most are hematogenous metastases

Rich blood supply results in common involvement of the stomach and small bowel

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26
Q

What are common primary tumors that metastasize to the stomach?

A

Common primary tumors are melanoma and breast and lung carcinoma

Breast cancer metastases may cause linitis plastica

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27
Q

Kaposi sarcoma involves the GI tract in 50% of patients with what disease?

A

Patients with disseminated AIDS

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28
Q

Imaging finding of GI Kaposi sarcoma

A

Double-contrast studies:
Flat masses with or without ulceration, polypoid masses, irregularly thickened folds, multiple submucosal masses, and linitis plastica

CT:
Enhancing adenopathy in the porta hepatis, mesentery, and retroperitoneum

*Creator’s note: Not very specific

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29
Q

These are adenomatous polypoid masses that produce multiple frond-like projections

A

Villous tumors

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 the lesion
(50% for 2- to 4-cm lesions, 80% for lesions >4 cm)

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30
Q

These are lesions that protrude into the lumen as sessile or pedunculated masses

Their appearance on double-contrast UGI series depends on whether they are on the dependent or nondependent surface

A

Polyps

A polyp on the dependent surface appears as a radiolucent filling defect in the barium pool

A polyp on the nondependent surface is covered with a thin coat of barium

Polyps are commonly multiple

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31
Q

In gastric polyps

The x-ray beam catches its margin in tangent, resulting in a lesion whose margins are etched in white.

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

A

Bowler hat

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32
Q

Sign that consist of two concentric rings and is produced by visualizing a pendiculated polyp end on

A

Mexican hat sign

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33
Q

What are the different types of gastric polyps?

A

Hyperplastic polyps
Adenomatous polyps
Hamartous polyps

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34
Q

These account for 80% of gastric polyps

Most are less than 15 mm in diameter

They are not neoplasms, but rather hyperplastic responses to mucosal injury, especially gastritis

A

Hyperplastic polyps

They may be located anywhere in the stomach, are frequently multiple, have no malignant potential, but are indicative of chronic gastritis

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35
Q

These account for 15% of gastric polyps and are true neoplasms with malignant potential

A

Adenomatous polyps

Most are solitary, located in the antrum, and are larger than 2 cm in diameter

36
Q

Characteristic of a polyp what have risk of malignancy

A

Larger than 1 cm
Lobulated
Pedunculated

Should be biopsied

37
Q

Polyps that occur in Peutz-Jeghers syndrome

A

Hamartomatous polyps

Have no malignant potential

38
Q

This is a common intramural lesion, usually found in the antrum

Lobules of heterotopic pancreatic tissue, up to 5 cm in size, are covered by gastric mucosa

Most are nipple- or cone-shaped with small central orifices

A

Ectopic pancreas

39
Q

This refers to an intraluminal gastric mass consisting of accumulated undigested material

A

Bezoar

Stones may be ingested or form with the bezoar

Any ingested foreign body may produce an intraluminal filling defect

40
Q

Bezoars may be composed of a wide variety of substances

This bezoar is composed of hair

A

Trichobezoars

41
Q

Bezoars may be composed of a wide variety of substances

This bezoar is composed of fruit or vegetable products

A

Phytobezoars

42
Q

Bezoars may be composed of a wide variety of substances

This bezoar consist of tablets and semi-solid mass of drugs

A

Pharmacobezoars

43
Q

Causes of multiple gastric filling defects

A
  1. Hyperplastic polyps
  2. Adenomatous polyps (especially with polyposis syndromes)
  3. Metastases
  4. Lymphoma
  5. Varices
44
Q

Key points in thickened gastric folds/ thickened wall

Irregular, focal (< 5m length), asymmetric bowel wall thickening suggest:

a. Benignancy
b. Malignancy

A

b. Malignancy

Regular, homogeneous, symmetric bowel wall thickening suggests a benign process

45
Q

Key points in thickened gastric folds/ thickened wall

Diffuse bowel wall thickening (>6 cm in length) is usually caused by:

a. benign process
b. malignant process

A

A. benign process

Caused by benign inflammatory, ischemic, or infectious diseases

46
Q

Key points in thickened gastric folds/ thickened wall

Following intravenous contrast administration, bowel wall thickening that shows alternating densities of high and low attenuation (target appearance) is nearly always:

a. benign
b. malignant

A

a. benign

Nearly always benign and secondary to inflammation or ischemia

The low-density layer is indicative of bowel wall edema

47
Q

Key points in thickened gastric folds/ thickened wall

Perigastric fat stranding disproportionally more severe than the degree of wall thickening suggests what process?

A

Inflammatory process

*Creator’s note: does not specify if benign or malignant process

48
Q

Hallmarks of gastritis

A

Thickened folds and superficial mucosal ulcerations (erosions)

Thethickened folds are usually caused by mucosal edema and superficial inflammatory infiltrate

49
Q

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

A

Erosions

Erosions heal without scarring

50
Q

These are also called as varioliform erosions

These are complete erosions that appear as tiny central flecks of barium surrounded by a radiolucent halo of edema

A

Aphthous ulcers

51
Q

These may mimic erosions, appearing as distinct punctate barium spots but without the distinctive radiolucent halo of a true erosion

A

Barium precipitates

52
Q

Gastritis is commonly accompanied by duodenitis

True or false

A

True

53
Q

CT findings of gastritis

A
  1. Wall thickening of the distal stomach and duodenum, often with target appearance indicating wall edema
  2. Involved mucosa may enhance avidly
  3. Edematous stranding in the perigastric and periduodenal fat
54
Q

Different types of gastritis

A 
H. pylori gastritis
Erosive gastritis
Crohn gastritis
Atrophic gastritis
Phlegmonous gastritis
Emphysematous gastritis
Eosinophilic gastroenteritis
Menetrier disease
55
Q

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

A

Helicobacter pylori gastritis

Almost all patients with benign gastric and duodenal ulcers have H. pylori gastritis

56
Q

UGI findings of H. pylori gastritis

A
  1. Thickening (<5 mm) of gastric folds
  2. Nodular folds
  3. Erosions
  4. Antral narrowing
    5, Inflammatory polyps
  5. Antral narrowing
  6. Enlarged areae gastricae
57
Q

This gastritis is most often caused by alcohol, aspirin, and other nonsteroidal anti-inflammatory agents, or steroids

A

Erosive gastritis

58
Q

UGI findings of erosive gastritis

A
  1. Erosions (aphthous ulcers)
  2. Thickened, nodular folds in the antrum
  3. Limited distensibility of the antrum
  4. Wall stiffness and limited peristalsis
59
Q

This gastritis characteristically involves the gastric antrum and proximal duodenum

Early-stage disease manifests as aphthous ulcers identical to those seen with erosive gastritis

More advanced disease shows antral narrowing, wall thickening, and fistulas

A

Crohn gastritis

60
Q

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

Destruction of parietal cells results in decreased acid and intrinsic factor production that lead to vitamin B12 deficiency and pernicious anemia

A

Atrophic gastritis

61
Q

UGI findings of atrophic gastritis

A
  1. Decreased or absent folds in the fundus and body (“bald fundus”)
  2. Narrowed, tube-shaped stomach (fundal diameter <8 cm)
  3. Small (1 to 2 mm) or absent areae gastricae
62
Q

This is an acute, often fatal, bacterial infection of the stomach

α-Hemolytic streptococci are the most common cause, but a variety of other bacteria have also been identified

It may arise as a complication of septicemia, gastric surgery, or gastric ulcers

A

Phlegmonous gastritis

63
Q

Findings of phelgmonous gastritis

A

Multiple abscesses are formed in the gastric wall, which is markedly thickened

The 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

64
Q

This is a form of phlegmonous gastritis caused by gas- producing organisms, usually Escherichia coli, Clostridium welchii, or mixed infections with Staphylococcus aureus

Most cases are caused by caustic ingestion, alcohol abuse, surgery, trauma, or ischemia

A

Emphysematous gastritis

Multiple gas bubbles are apparent within the wall of the stomach

Gastric folds are thickened and edematous

65
Q

This is a rare disease characterized by diffuse infiltration of the wall of the stomach and small bowel by eosinophils

Any or all layers of the wall may be involved

A

Eosinophilic gastroenteritis

The condition is associated with a peripheral eosinophilia as high as 60%

66
Q

Findings of eosinopholic gastroenteritis

A

Initially, the folds are markedly thickened and nodular, especially in the antrum

When chronic, the antrum is narrowed with a nodular “cobblestone” mucosal pattern

Ascites and pleural effusions may be present

67
Q

This is also called as giant hypertrophic gastritis

Condition characterized by excessive mucus production, giant rugal hypertrophy, hypoproteinemia, and hypochlorhydria

A

Menetrier disease

Pathologically patients have mucosa thickened by hyperplasia of epithelial cells

68
Q

UGI findings of Menetrier disease

A
  1. 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
  2. Hypersecretion that has diluted the barium and impaired mucosal coating
69
Q

CT finding of Menetrier disease

A

Demonstrates nodular markedly thickened folds with smooth serosal surface and normal gastric wall thickness between folds

70
Q

Varices are most common in what area?

A

Fundus and usually accompany esophageal varices

Isolated gastric varices occur with splenic vein occlusion

71
Q

MDCT with bolus contrast enhancement is an excellent method for confirming the presence of gastric varices as well as demonstrating their cause

CT findings of varices

A

CT shows well-defined clusters of rounded and tubular enhancing vessels

Additional findings of portal hypertension may be evident

72
Q

Most common location for gastric neoplasm

A

Distal stomach

Lymphoma and superficial spreading gastric carcinoma may produce distorted rigid gastric folds that are commonly ulcerated and appear nodular

73
Q

Definition of gastric ulcer

A

Full-thickness defect in the mucosa

About 95% of ulcerating gastric lesions are benign

74
Q

Diagnostic method of choice for gastric ulcer

A

Gastroduodenal endoscopy

75
Q

Signs of ulcers on UGI

A
  1. Barium-filled crater on the dependent wall
  2. A ring shadow caused by barium coating the edge of the crater on the nondependent wall
  3. A double ring shadow if the base of the ulcer is broader than the neck
  4. A crescentic or semilunar line when the ulcer is seen on tangent oblique view
76
Q

Causes of benign gastric ulcers

A

H. pylori infection
Chronic use of NSAIDs

The effects of the two conditions are additive for development of peptic disease

Alcohol and smoking are other exacerbating factors

77
Q

Major complications of peptic ulcer disease

A

Bleeding
Perforation
Obstruction

78
Q

Most gastric ulcers are:

a. benign
b. malignant

A

Benign

79
Q

What is the hallmark of benign ulcers and the basis of radiographic signs of benignancy

A

Mucosa that is intact to the very edge of an undermining ulcer

80
Q

Sign of benignancy in gastric ulcer

A
  1. Smooth ulcer mound with tapering edges
  2. An edematous ulcer collar with overhanging mucosal edge
  3. An ulcer projecting beyond the expected lumen
  4. Radiating folds extending into the crater
  5. Depth of ulcer greater than width
  6. Sharply marginated contour
  7. Hampton line (a thin, sharp, lucent line that traverses the orifice of the ulcer)
81
Q

This is caused by an overhanging gastric mucosa in an undermined ulcer

A

Hampton’s line

Best demonstrated on spot films obtained with compression

82
Q

CT scan finding of benign gastric ulcer

A
  1. Wall thickening usually involving both the antrum and duodenum
  2. Edema and edematous stranding extending into periantral and periduodenal fat or involving adjacent organs
  3. Deep ulcers that may show
    focal discontinuity of mucosal enhancement and/or outpouching of the lumen
83
Q

Differential diagnosis for benign ulcers

A 
H . pylori peptic disease
Gastritis
Hyperparathyroidism
Radiotherapy
Zollinger–Ellison syndrome
84
Q

Sign of malignancy in gastric ulcer

A
  1. An ulcer within the lumen of the stomach
  2. An ulcer eccentrically located within the tumor mound
  3. A shallow ulcer with a width greater than its depth
  4. Nodular, rolled, irregular, or shouldered edges
  5. Carmen meniscus sign
85
Q

This sign describes 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

A

Carmen meniscus sign

86
Q

Differential diagnosis of malignant ulcer

A
  1. Gastric adenocarcinoma
  2. Lymphoma
  3. Leiomyoma
  4. Leiomyosarcoma
87
Q

Equivocal ulcers may show the following finding

A
  1. Coarse areae gastricae abutting the ulcer
  2. Nodular ulcer collar
  3. Mildly irregular folds extending to the ulcer edge

Gastrointestinal Imaging (Beri) (26 decks)

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