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WlwG Abdo Organs (excl liver) Flashcards

1
Q

Gallbladder wall calcs ++

A

Porcelain

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2
Q

GB stones

A

Cholelithiasis

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3
Q

CBD stones

A

Choledocholithiasis

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4
Q

Cystic duct stones

A

Mirizzi

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5
Q

Narrow biliary sphincter after trauma

A

Papillary stenosis

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6
Q

Causes of only extra-hepatic biliary dilatation

A

Cholecystectomy, choledochocyst, cholecystitis (“Choles”)

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7
Q

Cause of intra-hepatic dilatation, raised AMA

A

PBC (“ABC = AhMa AMA for Biliary Cirrhosis”)

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8
Q

Cause of intra-hepatic dilatation, cystic, polycystic kidneys

A

Carolis (“Caroline CCC = Congenital, Cholelithiasis, Cholangitis, Cystic-dilatation of Intra-hepatic Ducts”)

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9
Q

Cause of intra+extra hepatic dilatation, acute infection

A

E.coli/Kleb Cholangitis

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10
Q

Cause of intra+extra hepatic dilatation, string of beads appearance, ulcerative colitis

A

PSC (“ScleroSING = String of beads”)

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11
Q

Cause of intra+extra hepatic dilatation, narrowed CBD

A

Biliary stricture

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12
Q

Cause of extra-hepatic biliary dilatation with CT-hypo GB wall nodules

A

XanthoGranulomatous cholecystitis

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13
Q

Cause of intra+extra hepatic dilatation, recurrent infection, numerous stones

A

Clonorchis/Ascaris recurrent pyogenic cholangitis

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14
Q

Cause of intra+extra hepatic dilatation, long segment extra-hepatic strictures

A

AIDS cholangiopathy

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15
Q

GB Neoplastic: US comet-tail artefact in GB

A

AdenoMyomatosis

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16
Q

GB Neoplastic: Ring-down artefact in bile duct

A

Biliary adenoma/Hamartoma

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17
Q

GB Neoplastic: Fatty/strawberry apperance

A

Cholesterolosis

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18
Q

GB Neoplastic: Single GB mass

A

AdenoCa

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19
Q

GB Neoplastic: Multiple polyps

A

FAP or Peutz Jeghers

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20
Q

GB Neoplastic: Bile duct mass and obstruction in adult

A

CholangioCa

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21
Q

GB Neoplastic: Bile duct mass with obstruction in child

A

RhabdoMyoSarcoma

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22
Q

GB Neoplastic: Large cyst in biliary tree/CBD

A

Choledochal cyst

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23
Q

GB Neoplastic: Large biliary cyst in duodenum

A

CholedoChocele (Type 3 choledochal cyst)

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24
Q

GB Neoplastic: Multiple biliary tree cysts

A

Carolis (Type 5 choledochal cyst)

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25
Choledochal Cysts: Types 1-6 locations?
Type 1: CBD/extra-hepatic dilation (commonest type) Type 2: CBD/extra-hepatic DIVERTICULUM Type 3: Dilated extra-hepatic duct within duodenum (CHOLEDOCHOCELE) Type 4: INTRA & EXTRA-HEPATIC duct dilation/cysts Type 5: INTRA-HEPATIC duct dilation/cysts (i.e. Caroli disease with central dot sign) Type 6: CYSTIC DUCT dilation
26
GB Polyp Management?
1-5mm = 1 point 6-9mm = 2 points 1+cm = 3 points Increase by 2mm at follow up = 3 points Risk factors (50+ year old, PSC, Indian, Sessile polyp) = +1 point Disappeared at follow up = 0 points Summary: 0 points = 0 follow up 1 point = 1x per year f/u (first year), then 2-yearly 2 points = 2x per year f/u (first year), then yearly 3 points = surgery
27
Pancreas: Acute swollen pancreas
Acute pancreatitis
28
Pancreas: Chronic swelling with T1-hyper, T2-hypo
Cystic fibrosis
29
Pancreas: Child with pancreatic insufficiency
Schwachman-Diamond ("Short man PAEDS = Pancreatic insufficiency, Anaemia, Eczema, Diarrhoea, Short")
30
Pancreas: Small pancreas, PD dilatation, calcs
Chronic pancreatitis
31
Pancreas: Large pancreas, PD narrowing, no calcs
Auto-immune pancreatitis (increased IgG4 and ANA)
32
Pancreas: Pancreas located in unusual location
Heterotopic pancreas
33
Pancreas Neoplastic: Cystic, Involves PD > 1 cm
Main branch IPMN
34
Pancreas Neoplastic: HEAD, small grapes cystic, NO PD communication, +/- scar/calcs
Serous cystadenoma
35
Pancreas Neoplastic: HEAD/UNCINATE, PD communication, small grapes cystic
Side branch IPMN
36
Pancreas Neoplastic: Cystic, Body/Tail, no PD communication
Mucinous cystic
37
Pancreas Neoplastic: Tail, solid-cystic, enhancing, teen girl
SPEN
38
Pancreas Neoplastic: Cyst from recent pancreatitis/pancreas trauma
Pseudocyst
39
Pancreas Neoplastic: Solid <10 year old
PancreatoBlastoma
40
Pancreas Neoplastic: Solid in adult, hypo-enhancing
PDAC = Raised CA 19-9 + jaundice + weight loss + Courvoisier sign (enlarged non-tender GB). Head > body/tail. CT HYPO-enhancement, US double duct sign (from both PD/CBD obstruction).
41
Pancreas Neoplastic: Solid in adult, hyper-enhancing
Islet cell (neuroendocrine tumour, eg insulinoma/gastrinoma)
42
Spleen: Causes of splenomegaly?
Leukaemia/Lymphoma, AIDS, Infectious mono, Gauchers, portal HTN, Felty's, acute sickle cell
43
Spleen: Causes of small spleen
Chronic sickle cell, radiotherapy
44
Spleen: Splenic artery aneurysm, what size to treat?
Coils/stent if >2.5 cm
45
Spleen: Splenic abscess causes
Salmonella in normal, TB/fungus in immunocompromised ("Spleen salmonella, compare kidney candi")
46
Spleen: Focal US-hypo
Cyst
47
Spleen: Focal US-hyper, CT-hypo, enhancing with delayed washout
Haemangioma
48
Spleen: Focal US-hyper, CT-hypo, heterogeneous enhancing
Hamartoma
49
Spleen: CT-hypo, poor enhancement
Angiosarcoma
50
Spleen: CT-hypo, PET-avid
Lymphoma
51
Spleen: Sickle cell signs
<5 year old = sequestration (blood pooling) causing splenomegaly, thus hypotension/cardiovascular collapse >5 year old = Splenic infarcts with autosplenectomy thus small calcified spleen Systemic: Hepatomegaly from iron deposition Gallstones from calcium deposition Anaemia, bone infarcts, extramedullary haematopoiesis Cardiomegaly and sickle chest (consolidations)
52
Adrenal CT: Formula for absolute washout and percentage?
>60%, (“AEDEP”): (Enhanced – Delayed) / (Enhanced – Plain)
53
Adrenal CT: Formula for Relative washout and percentage?
>40% (“REDE”): (Enhanced – Delayed) / Enhanced
54
Adrenal CT: <1cm mx?
No further imaging
55
Adrenal CT: 1+cm, <-10 HU on plain
Myelolipoma (mostly fat, thus low density)
56
Adrenal CT: 1+cm, <10HU on plain
Lipid-rich adenoma (high fat, low solid)
57
Adrenal CT: 1+cm, >10HU on plain, high washout, Dx and management
Lipid-poor adenoma (NFU)
58
Adrenal CT: 1-4 cm, >10 HU on plain, low washout, Dx and management
Indeterminate (consider biopsy/PET-CT)
59
Adrenal CT: 4+ cm, no cancer hx, Dx and management
Adreno-Cortical Ca, surgery
60
Adrenal CT: 4+cm, cancer hx, Dx and management
Mets, Biopsy/PET-CT
61
Adrenal CT: HU >120
Pheochromocytoma
62
Adrenal Neoplastic: Pre-natal
Neuroblastoma
63
Adrenal Neoplastic: T1-hyper
Myelolipoma (fatty)
64
Adrenal Neoplastic: Anechoic foci with enlarged spleen
Haemorrhagic (from trauma/sepsis/hypoxia) If with meningitis = Waterhouse-Fridericksen
65
Adrenal Neoplastic: Calcifications
TB
66
Adrenal Neoplastic: MEN 1 vs 2A vs 2B?
(“1 man PPP no pheo/friends, 2A is pheo/friends with thyroid & PTH, 2B is too big/marfans”) MEN 1: “PPP” = parathyroid hyperplasia, pituitary adenoma, pancreatic gastrinoma (no pheo) MEN 2A: “PPM” = parathyroid hyperplasia, pheochromocytoma, medullary thyroid ca MEN 2B: “PMM” = pheochromocytoma, medullary thyroid ca, marfans
67
Adrenal Neoplastic: Pheochromocytoma with haemangioma and pancreas/liver cysts
Von Hippel Lindau “HiPPEL = Haemangioma, Pheo, Pancreatic cysts, Eye haemangioblastoma, Liver cysts”
68
Adrenal Functional: Increased ACTH
Cushing
69
Adrenal Functional: Low potassium with HTN
Conns/Hyper-aldosteronism
70
Adrenal Functional: Hyper-pigmentation
Addison's disease
71
Adrenal Functional: Genital ambiguity
Congenital adrenal hyperplasia
72
Peritoneum: Male cancer
Peritoneal mesothelioma
73
Peritoneum: Female cancer
Peritoneal Ca
74
Peritoneum: Peritoneal thickening, liver scalloping
Pseudo-Myxoma peritonei
75
Peritoneum: Thickened omentum (anterior peritoneum), bowel displaced posteriorly
Omental seeding from mets (Compare mesentery: "Me Sen = Deep, thus posterior peritoneum")
76
Peritoneum: Thickened mesentery (posterior peritoneum), bowels displaced anteriorly
Sclerosing mesenteritis/mesenteric panniculitis ("Me Sen = Deep, thus posterior peritoneum")
77
Peritoneum: Thick peritoneum from peritoneal dialysis
Sclerosing peritonitis (“affects in and out since dialysis, thus peritoneum”)
78
Peritoneum: Inflammation/infarction in LEFT lower quadrant of peritoneum, no bowel wall thickening
Epiploic Appendagitis ("Epiploic = Epic Left Lower Infarct")
79
Peritoneum: Hypodense mass in RIGHT lower quadrant of peritoneum, no bowel wall thickening
Omental infarct
80
Peritoneum: SMA occlusion with intra-mural gas
Mesenteric ischaemia
81
Peritoneum: Progression of mesenteric ischaemia and which is most worrying sign
Most worrying sign = Pneumoperitoneum/sepsis SMA thrombus → bowel necrosis → Pneumatosis intestinalis/intra-mural bowel gas → Portal vein gas → Sepsis/Pneumoperitoneum → Death
82
Peritoneum: Ureteric obstruction
Retro-peritoneal fibrosis
83
Abdo Hernias: Child
Diaphragmatic (Anterior morgagni, Back bochdalek)
84
Abdo Hernias: Male
Inguinal
85
Abdo Hernias: Female, inferio-lateral to pubic tubercle
Femoral
86
Abdo Hernias: Female
Femoral or Obturator
87
Abdo Hernias: Superio-medial to pubic tubercle, medial to inferior epigastric vessels
Direct inguinal
88
Abdo Hernias: Superio-medial to pubic tubercle, lateral to inferior epigastric vessels
Indirect inguinal ("LIE")
89
Abdo Hernias: Lateral to rectus abdominis
Spigelian
90
Spleen Trauma: Laceration vs haematoma vs haemorrhage vs pseudoaneurysm/AVF
CT PV phase (not arterial phase) Laceration (linear hypodensity) Haematoma (low-density fluid) Haemorrhage (high-density fluid increasing on delay) Pseudoaneurysm/AVF high-density fluid NOT increasing on delay).
91
Spleen Trauma: Management
Mx conservative of haemodynamically-stable, Splenic artery embolisation if unstable.
92
Spleen Trauma: AAST Grade 1-5
AAST Grade 1-3 (small/moderate/large haematoma/laceration), Grade 4 (active bleed/vascular injury), Grade 5 (shattered spleen)

WlwG Old (22 decks)

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