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PBR 2 and 3 > Page 22 > Flashcards

Page 22 Flashcards

1
Q

Most dependent portion of the abdominal cavity in a supine px

A

Morison pouch (right hepatorenal fossa/ right posterior subhepatic space)

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2
Q

Most dependent portion of the peritoneal cavity in the upright patient

A

Pelvis

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2
Q

The lesser sac communicates with the greater sac through?

A

Foramen of Winslow

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3
Q

Most dependent portion of the peritoneal cavity

A

Cul-de-sac

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4
Q

Left subphrenic space and left subhepatic space communicate freely but separated from
right subphrenic space by?

A

Falciform ligament

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4
Q

Right subphrenic and subhepatic spaces communicate freely with the pelvic peritoneal cavity via?

A

Right paracolic gutter

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5
Q

Left subphrenic/subhepatic space separated from left paracolic gutter by?

A

Phrenicocolic ligament

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6
Q

This is the remnant of the obliterated umbilical VEIN

A

Ligamentum teres

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6
Q

Xray dx of ascites requires how many __ml of fluid to be seen?

A

500ml

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7
Q

Xray technique/position most sensitive for free air

A

Upright chest xray

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7
Q

Pseudomyxoma peritonei may result from?

A

1) Rupture of appendiceal mucocele 2) intraperitoneal spread of of benign or mucinous cysts of the ovary 3) mucinous adeno CA of the colon/rectum

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8
Q

Popcorn calcification

A

Uterine leiyomyoma

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8
Q

What are the signs of pneumoperitoneum on supine radiograph?

A

1) Rigler sign - gas on both sides of bowel wall; 2) gas outlining the falciform ligament, 3) football sign - gas outlining peritoneal cavity, 4) triangual or linear localized extraluminal gas in the RUQ

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8
Q

Post-operative pneumoperitoneum resolves in how many days?

A

3-4 days

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9
Q

Rice-grain calcifications

A

Cysticercosis in muscles

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9
Q

Tooth-like/bone calcification

A

Benign cystic teratoma

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10
Q

Post-operative ileus resolves in how many days?

A

4-7 days

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10
Q

Dilated bowels

A

small bowel >2.5-3 days; colon >5 cm; cecum >8 cm

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10
Q

Air-fluid levels

A

normal = stomach; often = small bowel; NEVER = colon distal to hepatic flexure

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11
Q

How many hours before radiograph can confirm the presence of bowel obstruction?

A

6-12 hrs

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11
Q

What is the most striking finding of toxic megacolon?

A

dilatation of transverse colon up to 15 cm

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12
Q

What is the imaging method of choic to confirm small bowel obstruction?

A

CT (small bowel feces sign)

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12
Q

What is the most specific sign for strangulation obstruction?

A

lack of enhancement of the bowel wall

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12
Q

Low-density nodal metastases are commonly seen with

A

Nonseminomatous testicular ca, TB, and lymphoma (occasionally)

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13
Q

Upper limits of normal lymph node size

A

6mm = retrocrural and porta hepatis; 8mm = gastrohepatic ligament; 10mm = retroperitoneal, celiac and SMA, pancreaticoduodenal, perisplenic, and mesenteric; 15mm = pelvic

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13
Q

What is the hallmark of retroperitoneal fibrosis?

A

smooth extrinsic narrowing of one or both ureters in the region of L4-L5

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13
Q

Portal venous flow may be altered by?

A

1) portal blockade by tumor or thrombus, 2) extrinsic compression by ribs or diaphragmatic slips, or tumors on the liver capsule, 3) third inflow from systemic veins - pericholecystic, parabiliary, and epigastric-paraumbilical venous systems

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14
Q

How to differentiate lymphoma from retroperitoneal fibrosis?

A

Lymphoma extends behind the vessels and displaces them anteriorly, retroperitoneal fibrosis does not

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14
Q

Hepatic arterial flow may be increased by?

A

1) focal hypervascular lesion, 2) inflammation of adjacent organs (cholecystitis, pancreatitis), 3) aberrant hepatic arterial supply

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15
Q

What is the primary role of imaging patients with chronic hepatitis?

A

to detect HCC

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16
Q

Diffentiation b/w regenerative and dysplastic nodules

A

regenerative (no atypia)/low grade nodules (minimal atypia)- portal venous supply = NO arterial enhancement; High grade dysplastic (moderate atypia)- hepatic artery supply = SHOW arterial enhancement, PREMALIGNANT, secrete AFP

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17
Q

How to differentiate HCC from other arterially enhancing lesions (pseudolesion, THAD)?

A

On delayed imaging, HCC becomes hypointense to surrounding liver, whereas other non-specific lesions are isointense

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17
Q

How to differentiate acute from chronic fibrosis of the liver?

A

On T1 = hypointense to liver (both); T2 = HIGH due to increase fluid content (acute), T2 LOW (Chronic)

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17
Q

Differentiation b/w dysplastic nodule and small HCC

A

Dysplastic nodules are almost NEVER hyperintense on T2W compared with HCC

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18
Q

What is the hepatic parenchymal attenuation to suggest hemochromatosis?

A

> 72 HU

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18
Q

Causes of T1 HYPERintensity in focal liver lesions

A

fat deposits, blood, pretein, copper, melanin, contrast, ghosting artifact, iron, and edema

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18
Q

How to differentiate portal venous gas vs pneumobilia?

A

Gas in portal vein extending to liver capsule, while in pneumobilia gas is more central and does not extend to 2 cm of the the liver capsule

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19
Q

Long standing hemochromatosis patients are at risk for?

A

cirrhosis, HCC, and colorectal ca

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19
Q

Where can you find pseudocirrhosis?

A

HHT

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20
Q

Causes of T2 HYPOintensity in focal liver lesions

A

fibrous capsule (HCC, hep adenoma, FNH); fibrous central scar (FNH, fibrolamellar hepatocellular ca)

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21
Q

Hallmark finding in HCC

A

heterogeneous arterial enhancement with rapis wash out of contrast on venous phase; hypointense on delayed phase

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22
Q

What are the fat containing lesions in the liver?

A

Hepatic adenoma, HCC, focal fatty deposition, lipoma, teratoma, liposarcoma, postop packing material (omentum), and foacl intrahepatic extramedullary hematopoiesis

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22
Q

How to differentiate HCC from regenerative or dysplastic nodules?

A

Hypointense on delayed postcontrast phase a feature of HCC, not seen with regenerative or dysplastic nodules on MR

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22
Q

What is Peliosis hepatis?

A

rare, assoc with chronic wasting from cancer or TB; cystic dilatation of hepatic sinusoids and multiple small blood-filled spaces

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23
Q

How to differentiate amebic from pyogenic abscess?

A

indistinguishable by imaging; diff is made by history, serology, or aspiration; amebic = most RIGHT lobe with elevation of R hemidiaphragm

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24
Q

What is the normal size of intrahepatic ducts?

A

does not exceed 40% of diameter of adjacent portal vein, or 2mm in central liver, or 1.8mm in peripheral liver

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25
Q

What is the normal size of extrahepatic ducts?

A

not exceed 6-7mm in internal diameter

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26
Q

Difference between benign and malignant bile duct strictures

A

gradual tapering of dilated common duct and minimal wall enhancmenet= BENIGN; abrupt termination of dilated common duct and hyperenhancement on PV phase = MALIGNANT

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27
Q

MRCP may still miss stones of what size?

A

smaller than 3 cm because they are lost within high signal fluid

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28
Q

What are the diseases that may complicate/cause Cholangiocarcinoma?

A

Primary sclerosing cholangitis, recurrent pyogenic cholangitis (oriental cholangiohepatitis), Caroli disease

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29
Q

What is the size of the gallbladder when contracted and enlarged?

A

contracted = <2 cm; enlarged (hydropic) = >5 cm

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30
Q

Adenomyomatosis has no malignant potential. T or F?

A

TRUE

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30
Q

Adenomatous polyps are potentially premalignant. T or F?

A

TRUE

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30
Q

Size of polyp that needs to be resected because of risk of cancer

A

> 10 mm

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31
Q

Normal size of pancreas

A

3 x 2.5 x 2 cm (head, body, tail)

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32
Q

Normal pancreatic duct size

A

3-4 mm diameter in the head and tapers toward the tail

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32
Q

What are the signs of resectability of panc ca?

A

isolated mass, no extrapancreatic dse, no encasement of celiac, SMA

33
Q

What are the signs of potential resectability of panc ca?

A

no involvement of celiac, SMA, regional nodes may be involved, limited peripanc extention

33
Q

What are the signs of unresectability of panc ca?

A

encasement of celiac/SMA, occlusion of SMV/portal vein, distant mets

34
Q

How do you define encasement of vessel?

A

Tumor abutting more than 180deg, focal narrowing, or occlusion

35
Q

Highest malignant potential among the functioning NET?

A

80% glucagonoma, 60% gastrinoma, 10% insulinoma

35
Q

How do you differentiate functioning from non-functioning NET?

A

Non-functioning usually mas pangit, 80% malignant, larger in size than the functioning NET

36
Q

What are the 3 imaging appearances of serous cystadenoma?

A

microcystic (MC), macrocystic, innumerable tiny cysts that appear solid

36
Q

What type of IPMN carries higher risk of carcinoma?

A

Main duct IPMN 65%, branch duct IPMN 15%

37
Q

What is a highly diagnostic feature of serous cystadenoma?

A

central stellate scar that may calcify

37
Q

How to differentiate pseudocyst from serous cystadenoma?

A

septations and lobulated contours are more often associated with serous cystadenoma; pseudocysts = usually shows involution on serial imaging

38
Q

Normal size

A

12 x 7 x 3-4 cm (length, width, thickness)

38
Q

How do you differentiate mass from chronic panc vs adenoca?

A

Chronic panc - beaded dilatation of panc duct, adenoca - smooth dilatation of panc duc

39
Q

Cysts found in Cystic fibrosis are true cysts. T or F?

A

TRUE (pancreatic cystosis - macrocysts of varying size developing from functional remnants of pancreatic ducts

40
Q

Largest lymphoid organ?

A

spleen

41
Q

Cysts found in posttraumatic spleen are true cysts. T or F?

A

FALSE; usually calcify

42
Q

Cysts in epidermoid cysts of the spleen are true cysts. T or F?

A

TRUE

42
Q

How do you define splenomegaly?

A

> 14cm, lower edge lower than liver or kidney, extends ventral to ant axillary line

43
Q

What are the 4 major categories of causes of splenomegaly?

A

Congestive, myeloproliferative, infectious, infiltrative

43
Q

Early sign of dysmotility or esophagitis

A

(transverse folds of the esophageal mucosa from contraction of longitudinal fibersFeline esophagus)

44
Q

normal thickness of the wall of the distended esophagus

A

not >3mm

44
Q

A radiographic marker of GEJ seen on single-contrast barium study

A

B ring

45
Q

A radiographic marker of GEJ seen on double-contrast barium study

A

Z line

46
Q

How to differentiate primary and secondary achalasia?

A

Primary = short length of narrowed segment; secondary (cancer) = longer segment >3.5cm

46
Q

Most sensitve means of diagnosing abnormal GERD in ambulatory patient

A

Monitoring of esophageal pH for 24hrs

47
Q

Most patients with hiatus hernia do not have GERD, while most GERD patients have

A

TRUE

48
Q

What is the upper limit of normal hiatal width?

A

15mm

49
Q

Difference b/w Zenker and Killiam-Jamieson diverticula

A

(Both upper esophagus) Zenker = hypopharynx, posterior midline, small neck; Killian-Jamieson = below cricopharyngeus, lateral (left), wide neck

50
Q

Difference b/w pulsion and traction diverticula

A

(both midesophagus) Pulsion = mucosa and submucosa herniate thru muscularis; Traction = contain all esophageal layers

50
Q

EPiphrenic diverticula?

A

lower esophagus, usually on the right side

51
Q

Least common portion of the GIT to be involved by TB

A

esophagus

51
Q

Characterictic radiographic appearance of Barrett esophagus?

A

high (midesophageal) stricture or deep ulcer in px with GERD

52
Q

Causes of upper and middle esophageal strictures?

A

Barrett esopahgus, mediastinal radiation, caustic ingestion, and skin diseases (pemphigoid, erythema multiforme, epidermolysis bullosa)

52
Q

Causes of distal esophagitis?

A

GERD, scleroderma, prolonged NGT

53
Q

Difference b/w pharyngeal and esophageal webs?

A

Pharyngeal = anterior wall of hypoharynx; Esophageal = anywhere MC in cervical esophagus just distal to cricopharyngeus imppression

53
Q

Difference b/w benign and malignant strictures?

A

Benign = smooth tapering concentric narrowing; Malignant = abrupt, asymmetri, eccentri narrowing with irregular nodular mucosa

53
Q

Hallmark finding of esophagitis

A

Ulcers

53
Q

Difference b/w Boerhaave syndrome and Mallory-Weiss tear?

A

Boerhaave = full-thickness tear in left posterior wall near left crus of diaphragm; MWT = only mucosa torn, longitudinal oriented in distal esophagus

53
Q

4 common morphologic growth patterns of gastric carcinoma

A
  1. polypoid masses
  2. ulcerative masses
  3. focal infiltrating tumors (plaque-like lesion w/ central ulcer)
  4. diffuse infiltrative (scirrhous ca)
53
Q

Normal gastric wall thickness when distended

A

antrum = 5-7mm, body = 2-3 mm (duodenum <3mm)

53
Q

Major cause of chronic gastritis, duodenitis, benign gastric and duodenal ulcers, gastric

A

H. pylori

54
Q

4 morphologic patterns of gastric lymphoma

A
  1. polypoid solitary mass
  2. ulcerative mass
  3. multiple submucosal nodules
  4. diffuse infiltration
54
Q

CT findings differentiating gastric LYMPHOMA from carcinoma

A
  1. marked wall thickening (>3 cm)
  2. involvement of additional areas of GI tract
  3. no invasion of perigastric fat
  4. no luminal narrowing and obstruction despite extensive involvement
  5. widespread and bulkier adenopathy
55
Q

Hallmarks of gastritis

A
  1. thickened folds
  2. superficial mucosal ulcerations (erosions)
56
Q

Hallmark of benign ulcers

A

mucosa that is intact to the very edge of an undermining ulcer crater; depth of ulcer greater than width

56
Q

Gastritis with sparing of the antrum

A
  1. Atrophic gastritis
  2. Menetrier disease
57
Q

Most of gastric ulcers are benign. T or F?

A

TRUE

57
Q

Evidence of malignant ulcers

A

irregular tumor mass or infiltration of surrounding mucosa; shallow ulcer with width greater than depth

58
Q

Duodenal tumors

A

bulb = 90% benign, 2nd and 3rd portion = 50% benign/malignant, 4th portion = most are malignant

59
Q

Brunner glang hyperplasia vs hamartoma

A

Hamartoma = >5 mm

59
Q

Barium studies should be avoided in patients with acute stages of UGI hemorrhage. T or F?

A

TRUE

60
Q

Location of Chron disease of duodenum

A

1st and 2nd portions

60
Q

Disease/syndrome that have Increased risk for small bowel carcinoma

A

Adult celiac disease, Crohn dse, and Peutz-jeghers syndrome

61
Q

Differentials for annular constricting lesions of the small bowel

A

small bowel adenocarcinoma, annular mets, intraperitoneal adhesions, malignant GIST, lymphoma (rare)

62
Q

Differentiating finding in lymphoma in comparison w/ GIST and adenocarcinoma?

A

lymphoma enhances little

63
Q

Hallmark of mechanical bowel obstruction

A

point of transition b/w dilated and nondilated bowel

64
Q

Ddx of annular constricting lesions of the small bowel

A

adenoca, annular mets, intraperitoneal adhesions, malignant GISTs, lymphoma (rare)

65
Q

Differentiate exophytic lymphoma vs GIST and adenoca

A

exophytic lymphoma - enhances little, if any; GIST and adenoca - enhance prominently

66
Q

Differentiate carcinoid tumors and small bowel adenoca vs melanoma in terms of their mesenteric metastases

A

carcinoid and SI adenoca - prominent desmoplastic reaction in the mesentery; melanoma - no mesenteric retraction

67
Q

Patient condition that have increased risk for colon ca

A

ulcerative colitis, crohn disease, Peutz-Jeghers syndrome, familial adenomatous polyposis

67
Q

Filling defects seen on barium enema include the ff considerations

A

polyps, tumor, plaques, air bubbles, feces, mucus, or foreign objects

68
Q

Syndrome/diseases associated with Hamartomatous polyposis syndrome

A

Peutz-Jeghers syndrome, Cowden syndrome, Chronkhite-Canada syndrome

68
Q

“Rules of thumb” for colonic polyps

A

<5mm = hyperplastic with <5% risk of malignancy; 5-10mm = 90% adenoma w/ 1% malignancy risk; 10-20 mm = adenomas w/ 10% malignancy risk; >20 mm = 50% malignant

68
Q

Common cause of rectal bleeding in children

A

Hamartomatous polyps (Juvenile polyps)

69
Q

Patients with Peutz-Jeghers syndrome have increased risk for what malignancy?

A

Colon ca, breast ca, uterine and ovarian ca, and early age pancreatic ca

69
Q

Patients with Cowden disease have increased risk for what malignancy?

A

breast ca, transitional cell ca (urinary tract)

69
Q

Difference b/w lymphoma and lymphoid hyperplasia

A

lymhoma nodules vary in size. lymhoid hyperplasia nodules are uniform in size.

70
Q

GI metastases often cannot be differentiated from primary tumors by imaging. T or F

A

TRUE

70
Q

Crohn disease and metastatic disease may also look exactly alike radiographically. T or F

A

TRUE

71
Q

Radiographic hallmarks of Ulcerative disease

A

granular mucosa, confluent shallow ulcerations, symmetry of disease around lumen, continuous confluent diffuse involvement

72
Q

CT findings of Ulcerative colitis

A

1)wall thickening w/ low density submucosal edema 2) narrowing of lumen 3) pseudopolyps and pneumatosis coli with megacolon

73
Q

Assoc extraintestinal diseases of Ulcerative colitis

A

sacroiliitis, eye lesions, cholangitis, thromboembolic dse

73
Q

Complications of ulcerative colitis

A

1) strictures in transverse colon and rectum 2) colorectal adenoca 3) toxic megacolon 4) massive hemorrhage

74
Q

Barium studies should be avoided in patients with toxic megacolon. T or F

A

TRUE

74
Q

Hallmarks of Crohn disease

A

early aphthous ulcers, later confluent deep ulcers, predominant right colon, discontinuous involvement, assymetric, strictures, fistulas, sinus formation

74
Q

Bleedin rate detection of scintigraphy vs angiography

A

scintigraphy = below 0.1ml/min; angiography = 0.5 ml/min or greater

74
Q

Radiographic findings of Toxic megacolon

A

1) marked dilatation >6cm transverse colon with abscence of haustra 2) colonic wall edema and thickening 3) pneumatosis coli 4) evidence of perforation

75
Q

watershed areas of the colon that are most susceptible to ischemic colitis

A

splenic flexure and descending colon

75
Q

CT findings of Pseudomembranous colitis

A

1) marked wall thickening 2) accordion sign 3) mild pericolonic inflammation 4) ascites

76
Q

What are the usual locations of the appendix?

A

Posteromedial aspect of the cecum, may also be pelvic, retrocecal, retrocolic, intraperitoneal, extraperitoneal

77
Q

What is one reliable way of locating the appendix?

A

The appendix always arises from the cecum on the same side as teh ileocecal valve

78
Q

What is the most common cause of acute abdomen?

A

Acute appendicitis

79
Q

What are mimickers of AP in women of childbearing age?

A

Ruptured ovarian cysts, PID

80
Q

What findings of AP can you see in a radiograph?

A

Appendiceal calculus (14%), appendiceal abscess or periappendiceal inflammation as soft tissue mass in RLQ, deformed lumen of cecum in RLQ, localized ileus

81
Q

What is the imaging technique of choice in women of childbearing age and children in
the diagnosis of AP?

A

US, although MRI competes with US as diagnostic method of choice

82
Q

the diagnosis of AP? US, although MRI competes with US as diagnostic method of choice What ultrasound scanning technique is quite accurate in providing a definitive diagnosis of AP?

A

Graded compression technique - slow graded compression applied to area of max tenderness

83
Q

What are the US signs of appendicitis? (4)

A

1 non-compressible appendix >6mm diam (outer wall to outer wall), 2 shadowing appendicolith, 3 inflamed periappendiceal fat, 4 increased vascularity of wall

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