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Radiology oral boards review > GI > Flashcards

GI Flashcards

1
Q

posterior impression on esophagus

A

aberrant subclavian
vascular ring (double aortic arch)
(if high, DISHphagia)

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2
Q

what’s the liver disease associated with ulcerative colitis? What are the risks?

A

Primary sclerosing cholangitis. May lead to cirrhosis, increased risk of cholangiocarcinoma.

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3
Q

What’s the anatomy of Bilroth I? Bilroth II? What are complications?

A

Bilroth 1: antrectomy anastomosis to duodenum
Bilroth 2: antrectomy anastomosis to jejunum, risk for aferent loop syndrome
Done for gastric carcinoma

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4
Q

What’s afferent loop syndrome?

A

uncommon complication following a Billroth II
Most are mechanical obstruction of the afferent loop from adhesions, kinking at the anastomosis, internal hernia, stomal stenosis, malignancy, or inflammation surrounding the anastomosis
Obstruction -> back pressure from dilated -> bil dil and acute pancreatitis.
Dx: hepatobiliary nucs study

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5
Q

Ddx of desmoplastic reaction in mesentary

A

Retractile mesenteritis
desmoid tumor
(desmoplastic) carcinoid (met)

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6
Q

Ascites with scalloping of organs (liver, spleen, etc.)

A

Pseudomyxoma peritonei: intraperitoneal accumulation of a gelatinous ascites secondary to rupture of a mucinous tumour. The most common cause is a ruptured mucinous tumour of the appendix / appendiceal mucocoele

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7
Q

Ddx hypervascular splenic lesions

A 
Mets: Melanoma, RCC, endometrial, carcinoid
Lymphoma
angiosarcoma
hemangioma, hamartoma, sarcoid
Fungal infxn
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8
Q

Ddx hepatic lesion with central scar

A 
FNH (benign hamartomarous - central scar is AVM)
Hepatic adenoma
Giant cavernous hemangioma
Fibrolamellar HCC
Mets
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9
Q

Causes of pneumatosis intestinalis

A

primary (15%)
ischemia, trauma, infection, pulmonary (COPD), colonic obstruction, artificial ventilation, collagen disease, steroid therapy

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10
Q

Portal venous gas in adult Ddx

A

mesenteric ischemia (eg occlusion), diabetes, mesenteric vein thrombosis, hemorrhagic pancreatitis, diverticulitis, pelvic abscess, perforated gastric ulcer, necrotic colon cancer, ingestion of corrosive substances

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11
Q

Ddx for solid pancreatic masses

A 
adenocarcinoma
islet cell tumor
SPEN (young women)
lymphoma
microcystic (serous) adenoma
mets
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12
Q

Ddx echogenic liver masses

A

Hemangioma (70%)
mets
HCC
fatty change

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13
Q

What liver mass is associated with hormonal contraceptives? What do we do when it’s diagnosed?

A

Hepatic adenoma
common in young women
remove them - risk of rupture

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14
Q

Ddx hepatic cysts

A 
simple cyst
traumatic cyst
echinococcal
abscess
biliary cystadenoma (septa may calcify)
(cystadenoma, mesenchymal hamartoma, emryonal sarcoma)
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15
Q

Ddx cystic pancreatic masses

A 
pseudocyst
abscess
congenital (PCKD, VHL)
microcystic adenoma (grandmother)
mucinous cystic adenoma/carcinoma (mother)
SPEN (daughter)
IPMT (grandfather)
islet cell
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16
Q

what MRI contrast agent to look for FNH

A

eovist

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17
Q

Ddx Gastric mass: intramural/extramucosal

A

GIST, leiomyoma/sarcoma, neurogenic tumor, heterotopic pancreas, carcinoid, fibrous tumor, granuloma

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18
Q

Ddx thickened gastric folds

A 
Gastritis-Hypertrophic, H. Pylori
Menetrier’s disease
Zollinger Ellison syndrome
Varices
Lymphoma
(post-radiation, Crohn, sarcoid, gastric, mets, eosinophilic gastritis, amyloid)
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19
Q

What’s Zollinger-Ellison?

What syndrome is it associated with?

A

Gastrinoma with excessive secretion of acid into the stomach, initial manifestations is with peptic ulcer disease (PUD) with multiple recurrent and intractable ulcers, often in unusual locations
Also get diarrhea
assoc. with MEN I

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20
Q

What’s menetrier disease?

A

a form of rare idiopathic hypertrophic gastropathy, most commonly affecting fundus with massively thickened folds -
it causes protein loss
*increased risk of gastric cancer

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21
Q

Ddx pancreatic lipomatosis

A

CF, obesity, malnutrition, steroids/Cushing syndrome

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22
Q

Gastric polyps - what types and what would each be associated with?

A

adenomatous (usually antral)
Hyperplastic (gastritis)
Hamartomatous (Peutz-Jeghers)
Fundic Gland (FAP)

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23
Q

What’s Peutz–Jeghers syndrome?

A

multiple hamartomatous polyps, most commonly involving the small intestine, but also colon and stomach
mucocutaneous pigmentation involving the mouth, fingers and toes

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24
Q

Ddx for mid-esophageal stricture

A 
caustic injestion
reflux esophagitis
radiation
prolonged tube
eosinophilic esophagitis
carcinoma (primary or mets)
pill esophagitis
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25
Q

Ddx thickened bowel wall / bowel wall thickening

A

enteritis, radiation, ischemia (including shock bowel), hemorrhage, ACE angioedema

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26
Q

Ddx for aneurysmal dilatation prior to small bowel stricture

A

lymphoma, Crohn’s dz, TB

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27
Q

Ddx gastric antral stenosis

A

TB, sarcoid, caustic, gastric cancer, mets, lymphoma, eosinophilic gastroenteritis, radiation

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28
Q

Ddx multiple gastric antral ulcers

A

erosive gastritis (meds, H. pylori), mets (melanoma, breast, Kaposi’s, lymphoma), Crohn’s dz

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29
Q

Ddx colonic “thumbprinting”

A

C. diff colitis, Crohn’s, UC, ischemic bowel, (if also in small bowel, graft-vs-host)

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30
Q

Organs involved in primary hemachromatosis:

A

Liver, pancreas, heart

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31
Q

GE junction polyps are associated with what?

A

reflux

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32
Q

Ddx for large gas-filled cyst in the lower abdomen on plain film:

A

cecal or sigmoid volvulus

giant sigmoid diverticulum

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33
Q

What are the types of groin hernias? How do you distinguish them?

A

Inguinal hernia - anterior to pubic tubercle
Indirect is lateral to the inferior epigastric vessels and congenital
direct is medial and found in adults
Lateral to pubic tubercle:
Femoral hernia - anterior to pectineus
Obturator hernia - posterior to pectineus (characteristic in old ladies)

34
Q

What hernia are gastric bypass patients prone to?

A

internal hernia through the mesocolic window created during surgery

35
Q

Small bowel tapeworm is called

A

Ascaris lumbricoides

36
Q

Ddx small esophageal ulcers

A

Herpes, Crohn’s, medication

37
Q

Ddx large esophageal ulcers

A

CMV (late HIV), HIV (at seroconversion)

38
Q

Ddx for multiple calcifications in the liver and spleen

A

Treated systemic PCP, treated granulomatous disease

39
Q

Ddx “target” lesions in small bowel

A

Mets (melanoma, breast, lung)

Immunocompromised: Kaposi, lymphoma

40
Q

What’s a “carpet lesion” in the colon?

A

Villous adenoma

41
Q

Posterior esophageal diverticulum =

A

Zenker’s

42
Q

Lateral esophageal diverticulum =

A

Killian-Jamieson

43
Q

Pseudopolyps in the colon indicate

A

Chronic IBD/colitis (look at distribution for Crohns vs UC)

44
Q

Ddx for intramural bowel fistula

A

Crohns (especially if long), diverticulitis, cancer

45
Q

Ddx numerous small esophageal outpouchings

A

Esophageal pseudodiverticulosis (Aunt Minnie)

46
Q

Describe flouro findings of Barrett’s esophagus

A

may be normal
ulcer
stricture
reticular mucosa

47
Q

Ddx large / mega esophagus

A

achalasia, scleroderma, Chagas disease (Tripanosoma cruzi), pseudoachalasia (ca/mets)

48
Q

Esophageal ulcers tracking longitudinally into the wall

A

TB

49
Q

What’s Hampton’s line (relating to the stomach)?

A

Line of intact mucosa around a benign ulcer

50
Q

Ddx for double pyloric channel

A

Ulcer/peptic ulcer disease
Crohns
Cancer with ulceration

51
Q

Duodenal adenoca - what should you think of/look for?

A

FAP - look for a stoma or absence of colon from prior total colectomy

52
Q

Reduced/absent gastric folds:

A

Atrophic gastritis: causes vitamin B12 deficiency, and megaloblastic anemia
can be caused by persistent infection with Helicobacter pylori, or can be autoimmune in origin

53
Q

What’s Cowden syndrome?

A

multiple hamartoma syndrome
large and small bowel hamartomatous polyps
associated with Lhermitte-Duclos (hamartoma in cerebellum)
increased risk of breast cancer

54
Q

Imaging features of cholangiocarcinoma

A

Central (Klatskin) or peripheral, masslike or infiltrating
slow enhancement, retains contrast
capsular retraction
distal bile duct dilatation

55
Q

Imaging features of recurrent pyogenic cholangitis

A

Infection with chlonorchis (“Oriental”)
strictures, especially (98%) in LEFT lobe with atropy
Ducts get strictures and *stones, sludge
increased risk for cholangioca

56
Q

What are the types of bile duct cysts? What’s the classification called?

A 
Todani classification
1 - CBD - fusiform
2 - CBD diverticulum
3 - choledochocele
4 - multiple extrahepatic +/- intrahepatic (type A)
5 - Caroli's disease
57
Q

Features of Crohn’s dz

A 
ulcers - apthous or deep
cobble stone mucosa
comb sign
wall thickening and enhancement
strictures
LAN
fat separating bowel loops ("fat halo")
pseudodiverticula ("omega sign") on anti-mesenteric border
fistula and abscess formation
ram's horn sign (antrum-duodenum)
58
Q

Features of Scleroderma in the small bowel:

A

hidebound/saran-wrapped: crowded, sharp folds
pseudosacculations along the mesenteric border with more folds along the antimesenteric border
(check lung bases for fibrosis and esophagus for dilatation)

59
Q

Features of celiac disease

A

reversal of jejunal and ileal fold pattern
delayed transit
duodenitis
mesenteric LAN

60
Q

Features of small bowel lymphoma

A

aneurysmal dilatation - no obstruction!
wall thickening without luminal narrowing
splenomegaly
LAN

61
Q

Ddx small bowel stricture

A

NSAID enterocolitis, Crohn’s, ischemia, radiation, lymphoma, TB, eosinophilic enteritis

62
Q

Ddx for fatty/low density LAN

A

Whipple disease, TB or fungal, mets (incl lymphoma)

63
Q

Ddx for pancolitis

A

Infectious, IBD

not ischemic

64
Q

Ddx for proctitis

A

Herpes, CMV, Crohn’s, UC, chlamydia (lymphogranuloma venereum)

65
Q

Locations in the colon prone to ischemia:

A

Splenic flexure, sigmoid

66
Q

What are filiform colonic polyps and what are they caused by?

A

Small islands of residual mucosa which appear as thin, worm-like structures
UC, Crohn’s, TB

67
Q

What’s the term for colitis caused by fecal impaction?

A

Stercoral colitis

can rupture

68
Q

What are some things to consider if the patient has no colon?

A

Total colectomy:
UC (look for liver lesion eg missed metastatic lesion from colon ca, PSC and/or cholangioca)
FAP - look for duodenal mass or desmoid in mesentery
Occasionally 2/2 Crohn’s or C. diff colitis

69
Q

What’s a tail gut duplication cyst?

A

aka retrorectal cystic hamartoma
seen in adults (~30-60 yo)
discrete, well-marginated, pre-sacral mass with water or soft-tissue density, depending on the contents of the cyst. Calcifications may be seen

70
Q

What’s a Spigelian hernia?

A

Lateral to the rectus femoris m.

tends to cause bowel strangulation

71
Q

What other issue is associated with wandering spleen?

A

Gastric volvulus

72
Q

Describe the types of gastric volvulus

A

organoaxial - along long axis, so greater curvature is now superior and to the right
mesenteroaxial - across short axis, so GE jctn on right and pylorus on left - more severe
both can cause ischemia

73
Q

What is a waterlily sign and what does it mean? What are other features of this disease?

A 
detachment of the endocyst membrane which results in floating membranes within the pericyst
Hydatid cyst (Echinococcal infection)
Daughter cysts are also diagnostic
74
Q

Ddx dense liver

A

defined as >70 HU

Amiodarone, hemosiderosis, hemochromatosis, Wilson’s

75
Q

Liver lesions that can contain calcium:

A

Mets (mucinous GI, osteosarcoma, treated lymphoma)

76
Q

Low density lesions in the spleen

A

Fungal infxn, lymphoma, mets, TB, hemangioma (fills in post contrast)

77
Q

What’s the name for complications resulting from foreign objects / material left inside a patient’s body, usually following surgery

A

Gossypiboma

78
Q

Ddx varioliform gastric ulcers

A

NSAIDS, Crohns, EtOH, infxn (CMV, candida)

Note - these are smaller than target lesions, which are >1 cm

79
Q

What are Gamna gandy bodies? What do they look like? What organ? What does it mean?

A 
aka siderotic nodules = microhemorrhages + fibroblastic rxn in the spleen
Dark on T2 / heterogeneous on US
Portal HTN (rarely other causes)
80
Q

What’s cavernous transformation of the portal vein?

A

portal vein thrombosis and is the replacement of the normal single channel portal vein with numerous tortuous venous channels. (there’s portal HTN)

81
Q

Ddx massive gallbladder wall thickening

A

(acute cholecystitis)
hepatitis
hypoproteinuria
CHF

Radiology oral boards review (10 decks)

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