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WlwG Old > WlwG Abdo Organs (excl liver) > Flashcards

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
Q

Choledochal Cysts: Types 1-6 locations?

A

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

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26
Q

GB Polyp Management?

A

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

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27
Q

Pancreas: Acute swollen pancreas

A

Acute pancreatitis

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28
Q

Pancreas: Chronic swelling with T1-hyper, T2-hypo

A

Cystic fibrosis

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29
Q

Pancreas: Child with pancreatic insufficiency

A

Schwachman-Diamond (“Short man PAEDS = Pancreatic insufficiency, Anaemia, Eczema, Diarrhoea, Short”)

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30
Q

Pancreas: Small pancreas, PD dilatation, calcs

A

Chronic pancreatitis

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31
Q

Pancreas: Large pancreas, PD narrowing, no calcs

A

Auto-immune pancreatitis (increased IgG4 and ANA)

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32
Q

Pancreas: Pancreas located in unusual location

A

Heterotopic pancreas

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33
Q

Pancreas Neoplastic: Cystic, Involves PD > 1 cm

A

Main branch IPMN

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34
Q

Pancreas Neoplastic: HEAD, small grapes cystic, NO PD communication, +/- scar/calcs

A

Serous cystadenoma

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35
Q

Pancreas Neoplastic: HEAD/UNCINATE, PD communication, small grapes cystic

A

Side branch IPMN

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36
Q

Pancreas Neoplastic: Cystic, Body/Tail, no PD communication

A

Mucinous cystic

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37
Q

Pancreas Neoplastic: Tail, solid-cystic, enhancing, teen girl

A

SPEN

38
Q

Pancreas Neoplastic: Cyst from recent pancreatitis/pancreas trauma

A

Pseudocyst

39
Q

Pancreas Neoplastic: Solid <10 year old

A

PancreatoBlastoma

40
Q

Pancreas Neoplastic: Solid in adult, hypo-enhancing

A

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
Q

Pancreas Neoplastic: Solid in adult, hyper-enhancing

A

Islet cell (neuroendocrine tumour, eg insulinoma/gastrinoma)

42
Q

Spleen: Causes of splenomegaly?

A

Leukaemia/Lymphoma, AIDS, Infectious mono, Gauchers, portal HTN, Felty’s, acute sickle cell

43
Q

Spleen: Causes of small spleen

A

Chronic sickle cell, radiotherapy

44
Q

Spleen: Splenic artery aneurysm, what size to treat?

A

Coils/stent if >2.5 cm

45
Q

Spleen: Splenic abscess causes

A

Salmonella in normal, TB/fungus in immunocompromised
(“Spleen salmonella, compare kidney candi”)

46
Q

Spleen: Focal US-hypo

A

Cyst

47
Q

Spleen: Focal US-hyper, CT-hypo, enhancing with delayed washout

A

Haemangioma

48
Q

Spleen: Focal US-hyper, CT-hypo, heterogeneous enhancing

A

Hamartoma

49
Q

Spleen: CT-hypo, poor enhancement

A

Angiosarcoma

50
Q

Spleen: CT-hypo, PET-avid

A

Lymphoma

51
Q

Spleen: Sickle cell signs

A

<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
Q

Adrenal CT: Formula for absolute washout and percentage?

A

> 60%, (“AEDEP”): (Enhanced – Delayed) / (Enhanced – Plain)

53
Q

Adrenal CT: Formula for Relative washout and percentage?

A

> 40% (“REDE”): (Enhanced – Delayed) / Enhanced

54
Q

Adrenal CT: <1cm mx?

A

No further imaging

55
Q

Adrenal CT: 1+cm, <-10 HU on plain

A

Myelolipoma (mostly fat, thus low density)

56
Q

Adrenal CT: 1+cm, <10HU on plain

A

Lipid-rich adenoma (high fat, low solid)

57
Q

Adrenal CT: 1+cm, >10HU on plain, high washout, Dx and management

A

Lipid-poor adenoma (NFU)

58
Q

Adrenal CT: 1-4 cm, >10 HU on plain, low washout, Dx and management

A

Indeterminate (consider biopsy/PET-CT)

59
Q

Adrenal CT: 4+ cm, no cancer hx, Dx and management

A

Adreno-Cortical Ca, surgery

60
Q

Adrenal CT: 4+cm, cancer hx, Dx and management

A

Mets, Biopsy/PET-CT

61
Q

Adrenal CT: HU >120

A

Pheochromocytoma

62
Q

Adrenal Neoplastic: Pre-natal

A

Neuroblastoma

63
Q

Adrenal Neoplastic: T1-hyper

A

Myelolipoma (fatty)

64
Q

Adrenal Neoplastic: Anechoic foci with enlarged spleen

A

Haemorrhagic (from trauma/sepsis/hypoxia)

If with meningitis = Waterhouse-Fridericksen

65
Q

Adrenal Neoplastic: Calcifications

A

TB

66
Q

Adrenal Neoplastic: MEN 1 vs 2A vs 2B?

A

(“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
Q

Adrenal Neoplastic: Pheochromocytoma with haemangioma and pancreas/liver cysts

A

Von Hippel Lindau
“HiPPEL = Haemangioma, Pheo, Pancreatic cysts, Eye haemangioblastoma, Liver cysts”

68
Q

Adrenal Functional: Increased ACTH

A

Cushing

69
Q

Adrenal Functional: Low potassium with HTN

A

Conns/Hyper-aldosteronism

70
Q

Adrenal Functional: Hyper-pigmentation

A

Addison’s disease

71
Q

Adrenal Functional: Genital ambiguity

A

Congenital adrenal hyperplasia

72
Q

Peritoneum: Male cancer

A

Peritoneal mesothelioma

73
Q

Peritoneum: Female cancer

A

Peritoneal Ca

74
Q

Peritoneum: Peritoneal thickening, liver scalloping

A

Pseudo-Myxoma peritonei

75
Q

Peritoneum: Thickened omentum (anterior peritoneum), bowel displaced posteriorly

A

Omental seeding from mets
(Compare mesentery: “Me Sen = Deep, thus posterior peritoneum”)

76
Q

Peritoneum: Thickened mesentery (posterior peritoneum), bowels displaced anteriorly

A

Sclerosing mesenteritis/mesenteric panniculitis
(“Me Sen = Deep, thus posterior peritoneum”)

77
Q

Peritoneum: Thick peritoneum from peritoneal dialysis

A

Sclerosing peritonitis (“affects in and out since dialysis, thus peritoneum”)

78
Q

Peritoneum: Inflammation/infarction in LEFT lower quadrant of peritoneum, no bowel wall thickening

A

Epiploic Appendagitis (“Epiploic = Epic Left Lower Infarct”)

79
Q

Peritoneum: Hypodense mass in RIGHT lower quadrant of peritoneum, no bowel wall thickening

A

Omental infarct

80
Q

Peritoneum: SMA occlusion with intra-mural gas

A

Mesenteric ischaemia

81
Q

Peritoneum: Progression of mesenteric ischaemia and which is most worrying sign

A

Most worrying sign = Pneumoperitoneum/sepsis

SMA thrombus → bowel necrosis → Pneumatosis intestinalis/intra-mural bowel gas → Portal vein gas → Sepsis/Pneumoperitoneum → Death

82
Q

Peritoneum: Ureteric obstruction

A

Retro-peritoneal fibrosis

83
Q

Abdo Hernias: Child

A

Diaphragmatic (Anterior morgagni, Back bochdalek)

84
Q

Abdo Hernias: Male

A

Inguinal

85
Q

Abdo Hernias: Female, inferio-lateral to pubic tubercle

A

Femoral

86
Q

Abdo Hernias: Female

A

Femoral or Obturator

87
Q

Abdo Hernias: Superio-medial to pubic tubercle, medial to inferior epigastric vessels

A

Direct inguinal

88
Q

Abdo Hernias: Superio-medial to pubic tubercle, lateral to inferior epigastric vessels

A

Indirect inguinal (“LIE”)

89
Q

Abdo Hernias: Lateral to rectus abdominis

A

Spigelian

90
Q

Spleen Trauma: Laceration vs haematoma vs haemorrhage vs pseudoaneurysm/AVF

A

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
Q

Spleen Trauma: Management

A

Mx conservative of haemodynamically-stable, Splenic artery embolisation if unstable.

92
Q

Spleen Trauma: AAST Grade 1-5

A

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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