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FRCR 2a Flashcards > GI > Flashcards

GI Flashcards

1
Q

What is the Whipple triad?

A

Insulinoma

Fasting hypoglycemia
Symptoms of hypoglycaemia
Immediate release of symptoms after IV glucose administration

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2
Q

What is Zolliger Ellison syndrome?

A

Gastrinoma - gastrin secretion tumour.

Fluoroscopy shows:
- thickened rugal folds
- multinodular stomach + duodenum
- erosions and ulcers in atypical locations

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3
Q

What is 4D syndrome?

A

Symptoms of glucagonoma

Diabetes mellitus
Deep vein thrombosis
Dermatitis
Depression

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4
Q

Common radiological findings in Wilson’s disease?

A

Liver - Cirrhosis due to copper deposition
Brain - high T2 in basal ganglia (panda sign)
Bones - Chondrocalcinosis

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5
Q

Acute and chronic GI manifestations of epidermolysis bullosa?

A

GI tract submucosal bullae acutely and oesophageal webs chronically

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6
Q

What is Plummer Vinson syndrome?

A

DOI

Triad of:
- Dysphagia
- Oesophageal webs
- Iron deficiency anaemia

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7
Q

What is linitis plastica?

A

Submucosal infiltration of the stomach with scirrhous adenocarcinoma.
Causes gastric thickening, stiffening, and nodularity, with loss of rugal folds.

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8
Q

Most common distant metastasis to the oesophagus?

A

Breast

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9
Q

Most common cancer that can have direct invasion to oesophagus?

A

Bronchial carcinoma

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10
Q

Barium swallow shows narrow tubular stomach with loss of rugal folds.

A

Atrophic gastritis.

Linitis plastica is usually nodular.

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11
Q

Most common finding for coeliac disease on small bowel enema?

A

Reversal of jejunal and ileal fold pattern

Moulage sign - dilated jejunum with loss of folds
Intussusception

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12
Q

What is the moulage sign?

A

Sign of coeliac disease on small bowel enterography.
Dilated jejunum with complete loss of jejunal folds

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13
Q

What are the 4 types of anal fistula?

A

EX I T S

EXtra-sphincteric
Inter-sphincteric
Trans-sphincteric
Supra-sphincteric

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14
Q

What is Turcot syndrome?

A

Multiple intestinal polyps and CNS tumours (glioblastomas)

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15
Q

Most common causative organism causing left colon infectious colitis?

A

Shigella, or schistosomiasis. Thought to be due to worms entering the inferior mesenteric vein.

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16
Q

Most common causative organism causing rectosigmoid infectious colitis?

A

Gonorrhoea, herpes

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17
Q

What feature differentiates C Diff colitis from other forms of colitis?

A

Ascites. 40% of C Diff cases have ascites.

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18
Q

What are the radiological features of haemochromatosis?

A

Iron deposition in predominantly liver. Also in spleen, pancreas, brain, heart.

  • Hepatomegaly (90%)
  • CT - Increased liver density. MR - Low liver signal on T2
  • Hook like osteophytes 2nd+3rd metacarpals. Chondrocalcinosis.
  • Restrictive cardiomyopathy
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19
Q

What are the grades for liver laceration?

A

Grade 1 - <1cm deep, <10% surface area
Grade 2 - 1-3cm deep, 10-50% surface area
Grade 3 - >3cm deep, >50% surface area

Grade 4 - involving 25-75% of lobe
Grade 5 - >75% of lobe

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20
Q

Classic hepatic and splenic appearance of Schistosomiasis?

A

Turtle back appearance - Echogenic calcified septa outlining polygonal areas of normal liver
Fibrosis

Gamna gandy bodies

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21
Q

Most common primary metastases to the spleen?

A

Malignant melanoma

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22
Q

What diseases are associated with primary biliary cholangitis?

A

Autoimmune disease that causes cirrhosis

Sjogrens syndrome
Rheumatoid
Hashimotos thyroiditis

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23
Q

What pancreatic features are associated with cystic fibrosis?

A

Fatty replacement
Pancreatitis

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24
Q

Lymphatic drainage of the anal canal?

A

Above the dentate line - internal iliac nodes
Below the dentate line - superficial inguinal nodes

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25
Q

How do you prove an adrenal lesion is an adenoma?

A

Non contrast <10 HU
Contrast - Relative washout >40
Contrast - Absolute washout >60

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26
Q

What is the Carney Triad?

A

GIST

Extra adrenal pheochromocytoma

Pulmonary chondroma

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27
Q

Abnormal posterior indentation of the oesophagus?

A

Aberrant right subclavian artery

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28
Q

Abnormal anterior indentation of the oesophagus?

A

Aberrant left pulmonary artery

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29
Q

Classic imaging features of Barret’s oesophagus?

A

Reticular mucosal pattern on contrast study

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30
Q

Classic imaging appearance of feline oesophagus?

A

Transient fine transverse folds that go away with swallowing

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31
Q

Classic imaging appearance if herpes esophagitis

A

Small multiple ulcers with halo of oedema

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32
Q

Classic imaging appearance if candidiasis oesophagus?

A

Discrete plaque like lesions, with mucosal fold thickening.

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33
Q

What is the difference between Zenker diverticulum and Killian James diverticulum?

A

Zenker is posterior (Z is at the back of the alphabet), at the midline, above cricopharyngeus

Killian James is anterior, lateral, below cricopharyngeus

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34
Q

What is esophageal pseudo diverticulosis?

A

Multiple tiny outpouchings in the oesophagus, due to reflex.

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35
Q

What is the difference between achalasia and pseudo-achalasia?

A

Pseudo-achalasia is due to tumour. Pseudo-achalasia the gastro esophageal junction doesn’t eventually relax.

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36
Q

What is the most common tumour of the gastrointestinal tract?

A

GIST tumour

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37
Q

What tumour is Virchow’s node associated with?

A

Gastric adenocarcinoma.

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38
Q

What is the difference between organoaxial and mesenteroaxial gastric volvulus?

A

Organoaxial - gastric antrum lies below the fundus as normal. Twisted on the axis of the stomach.

Mesenteroaxial - Gastric antrum is at the level of the fundus. Stomach twists in half along the perpendicular axis.

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39
Q

What does sand like nodules indicate on a small bowel follow through?

A

Whipple’s disease (Tropheryma whipplei infection)

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40
Q

What is cobblestoning Indicate on a small bowl follow through?

A

Crohn’s disease

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41
Q

What does the cloverleaf sign indicate on a small bowel follow through?

A

Healed peptic ulcer

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42
Q

What does small bowel carcinoid look like?

A

Mass with desmoplastic stranding and calcifications.

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43
Q

What is Carcinoid syndrome?

A

Flushing and diarrhoea with carcinoid cancer metastases to the liver

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44
Q

How can you differentiate femoral hernia from inguinal hernia?

A

Femoral hernia occurs lateral to the pubic tubercle.
Femoral hernias compress the femoral vein.

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45
Q

What is Typhilitis?

A

Neutropenic colitis usually limited to the caecum

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46
Q

Classic enhancement pattern of a hepatic haemangioma?

A

Peripheral discontinuous nodular enhancement.
Progressive filling in.

47
Q

What is the difference between FNH and fibrolamellar HCC?

A

Both have a central scar.
FNH scar is T2 bright and enhances.
Fibrolamellar HCC scar is T2 dark and does not enhance

48
Q

Classic imaging findings for cholangiocarcinoma.

A

Capsular retraction.
Dilated billiary ducts.
Delayed persistent enhancement.

49
Q

How to differentiate HCC from Cholangiocarcinoma?

A

HCC invades the portal vein.
Cholangiocarcinoma encases the portal vein

50
Q

Classic scenario for a hepatic adenoma?

A

Female on OCP.
Male on anabolic steroids.

51
Q

What is pseudo cirrhosis of the liver?

A

Treated breast cancer metastases to the liver can look like cirrhosis

52
Q

Classic imaging features of Primary Sclerosing Cholangitis, and what is its association?

A

Multifocal strictures of the intra and extra hepatic bile ducts.
Cirrhosis with central regenerate hypertrophy.

Associated with UC.

53
Q

Classic imaging features of Primary Biliary Cholangitis?

A

Autoimmune disease that destroys the INTRA hepatic bile ducts.

Lace like pattern of fibrosis
Periportal halo sign
Intrahepatic duct dilatation
Increased risk of HCC

54
Q

What are the 5 types of choledochal cyst?

A

1 - focal dilatation of the CBD
2 - Bile duct diverticulum
3 - dilation of CBD within the duodenal wall (choledochocele)
4 - focal intra and extra hepatic dilatation
5 - Carolis disease (intrahepatic only)

55
Q

What is associated with Caroli’s disease?

A

Polycystic kidney disease.
Medullary sponge kidney.

56
Q

What is Mirizzi syndrome?

A

Cystic duct stone causes external compression of the CBD

57
Q

What is the USS sign for Adenomyomatosis of the gallbladder?

A

Comet tail artifact

58
Q

Classic imaging features of serous cystadenoma of the pancreas?

A

Old women.
Head of pancreas.
Bunch of grapes appearance.
Can have central classification.
Associated with Von Hipple Lindau.

59
Q

Classic imaging appearance of mucinous cystic neoplasm?

A

Mother lesion.
Found in body and tail of pancreas.
Uni/multilocular cyst.
Peripheral calcification.

[Serous = “sentral” (central) calc]

60
Q

Classic imaging appearance of solid pseudo papillary epithelial neoplasm of the pancreas?

A

Daughter lesion.
Tail of pancreas.
Large mixed solid cystic mass.

61
Q

Which type of IPMN has the highest malignancy potential?

A

Main branch IPMN.
Side branch IPMN is more common.

62
Q

What are gamna gandy bodies and what are they associated with?

A

Small focal hemorrhage in the spleen parenchyma.

Portal hypertension
Schistosomiasis

63
Q

Risk factors for acute acalculus cholecystitis?

A

Diabetes
Vasculitis
Viral infections (HIV, EBV, CMV)

64
Q

What does hepatosplenic candidiasis look like on USS?

A

Bulls eye sign - inner hyperechoic ring + outer hypoechoic ring.

65
Q

What is the classical imaging appearance of glycogenic acanthosis?

A

Looks like candida, i.e. discrete oesophageal plaques, but is asymptomatic

66
Q

Classic imaging appearance for Cowdens syndrome?

A

GI hamartoma polyps
Breast cancer

67
Q

Typical features of GI tract TB?

A

Affects ileocaecal junction

Narrowing of terminal ileum
Thickening and incompetence of ileocaecal valve
Thickening of caecum

68
Q

Most common causative organism causing right colon infectious colitis?

A

Salmonella

69
Q

Most common location for pancreatic trauma?

A

Body of pancreas

70
Q

How do VIPomas present?
(vasoactive intestinal peptide tumours)

A

Watery diarrhoea that persists with fasting
Hypokalaemia
Hypochlorhydria

71
Q

Most common site of bowel injury following blunt trauma?

A

Jejunum

72
Q

What is Menetrier’s disease?

A

Giant hypertrophic gastritis

Enlarged, tortuous folds in the body and fundus.
Sparing of the antrum.

Impaired mucosal coating of barium due to mucus hypersecretion.

73
Q

How does Cronkhite Canada syndrome present?

A

Skin pigmentation, alopecia, and watery diarrhea.

74
Q

How does Juvenile Polyposis present?

A

Typically age 10-20.
Rectal bleeding, bowel obstruction and intussusception.

75
Q

How does GI angiodysplasia present?

A

GI Bleeding.

Focal area of contrast enhancment.
Enlargment of feeding artery.
Early filling of draining vein.

76
Q

Typical imaging features of chronic Budd Chiari syndrome?

A

Caudate lobe hypertrophy
Regenerative nodules
Nutmeg liver - mottled contrast enhancment
Ascites

77
Q

Associations with polysplenia?

A

Left isomorism:
- Bi lobed lungs bilaterally
- Non cyanotic heart disease
- Gut malrotation

78
Q

Associations with asplenia?

A

Right isomerism:
- Tri lobed lungs bilaterally
- Cyanotic heart disease
- Gut malrotation

79
Q

What is a choledochocele?

A

Type 3 choledochal cyst - Dilated intraduodenal portion of CBD.

80
Q

Most common organism causing cholangitis?

A

E Coli

81
Q

What does a Whipples procedure involve?

A

Complete resection of the duodenum and head of pancreas (pancreatic surgery)

Reattach the stomach, bile ducts, and the remaining pancreas to jejenum.

Gastrojejunostomy
Choledochojejunostomy
Pancreaticojejunostomy

82
Q

“Stepladder” Oesophagus

A

Oesophagitis
- Reflux oesophagitis
- Eosinophilic oesophagitis

83
Q

What is Hamptons line?

A

Radiolucent line seen at the neck of a gastric ulcer indicating benign nature.

84
Q

How does erosive gastritic typically present?

A

Erosive (haemorrhagic) gastritis

Epigastric pain
Malaena
NSAID use

85
Q

How do small bowel leiomyomas typically present?

A

Typically found in jejunum

Abdominal pain
Bleeding and anaemia secondary to ulceration

86
Q

Peutz Jeghers syndrome

A

Bowel polyps
Melanin pigmentation of the mouth, fingers and toes.

Seminoma - boys
Adenoma malignum - girls

87
Q

Hereditary non-polyposis colorectal cancer associations?

A

Genitourinary tract malignancies
- endometrial
- prostate
- urinary tract

Small bowel cancer

88
Q

Beningn causes of pneumotosis intestinalis?

A

PSI

Pulmonary disease
Scleroderma
Inflammation

89
Q

What is a pseudo polyp?

A

Apparant polyp caused by surrounding deep ulceration, creating a mucosal island. The “polyp” is the healthy tissue.

90
Q

Most common site of peripancreatic pseudoaneurysm?

A

Splenic artery
GDA

91
Q

Large spherical pancreatitic calcifications in childhood

A

Hereditary pancreatitis
Autosomal dominant

92
Q

How does acute Budd chiari present?

A

Rapid onset ascites

93
Q

What features suggest malignant Vs benign gastric ulcer on barium swallow?

A

Malignant - Carmen meniscus sign
Benign - Hamptons line

Carmen - carcinoma
Hamptons - harmless

94
Q

Where do the rectal veins drain into?

A

Superior rectal veins - IMV into portal system
Middle and inferior rectal veins - internal iliac vein into IVC

95
Q

Imaging appearances of thalassemia?

A

ThalaSSSSemia
(Skull, Sinus, Spine, Spleen)

Skull:
- Skull hair on end appearance
- Sinus hypopneumatisation

Spine:
- Scoliosis
- Expansion of ribs, with rib within a rib appearance

Spleen:
- Splenomegaly

96
Q

Stages of renal TB?

A

Early - papillary necrosis
Progressive - strictures and hydronephrosis
Late - thinned cortex, dystrophic calc (Putty kidney)

97
Q

MRI findings for phaeochromocytoma?

A

T1 - low
T2 - high
Gd - heterogenous enhancement
Out of phase - no signal loss

98
Q

What is the Child Pugh score?

A

Higher score indicate worsening liver function which gives the medical or surgical teams an idea of liver comorbidity.

Perioperative mortality:
- Child Pugh score A: 5% - up to 50% of liver resected
- Child Pugh score B: 10-15% - up to 25% of liver score resected
- Child Pugh score C: >25% - liver resection contraindicated

99
Q

How do oesophageal duplication cysts typically present?

A

Childhood symptoms of dysphagia, cough, stridor.

Occasionally present with haemorrhage due to islands of gastric/pancreatic mucosa

100
Q

What does scleroderma look like on barium swallow?

A

Dilation of distal two thirds.
Absent or reduced peristalsis of the lower oesophagus.

101
Q

Caused of REDUCED liver attenuation on CT.

A

Fatty liver
Amyloidosis
Diffuse malignancy

102
Q

Imaging appearance of xanthogranulomatous cholecystitis?

A

Thickened gallbladder wall.
Multiple hypodense nodules in the wall.

(Similar appearance to xanthogranulomatous pyelonephritis)

103
Q

Associations with Peutz-Jeger syndrome

A

Boys - Sertoli cell tumour
Girls - Adenoma malignum (cervix)

104
Q

Associations with Cowden syndrome?

A

BELT

Breast cancer
Endometrial cancer
Lhermitte-Duclos disease (Dysplastic cerebellar gangliocytoma)
Thyroid cancer

105
Q

Classic imaging findings of medullary sponge kidney?

A

Paintbrush appearance - pyramidal medullary calcification

Bouquet of flowers appearance on IVU.

106
Q

Normal liver MRI appearance Vs spleen?

A

T1 - Liver > Spleen
T2 - Liver < Spleen
In/out - No change

107
Q

Typical MRI findings of hepatic adenoma

A

T1 - iso to bright
T2 - brightish
Gd - early arterial enhancement, iso on delayed
Primovist - dark

108
Q

CF liver manifestations

A

Fatty liver
Focal biliary cirrhosis

109
Q

Imaging appearance of HCC?

A

Raised AFP
Typically with cirrhosis

T1 - iso
T2 - bright
Gd - arterial enhancement, quick washout to lower than background

110
Q

How to differentiate primary Vs secondary haemochromatosis?

A

PRIMARY - Liver and PANCREAS are dense

SECONDARY - Liver and SPLEEN are dense

111
Q

How can you tell the difference between direct Vs indirect inguinal hernia?

A

Direct - Medial to inferior epigastric artery, compresses the inguinal canal (lateral crescent sign)

Indirect - Lateral to the inferior epigastric artery

112
Q

CEA and CA 19-9 ratios for cholangio, colon, and pancreatic cancer?

A

Cholangio - CEA high, CA 19-9 high

Colon - CEA high, CA 19-9 low

Pancreatic - CEA low, CA 19-9 high

113
Q

Obturator hernia?

A

Lateral to pubic tubercle
Deep to pectineus muscle

FRCR 2a Flashcards (11 decks)

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