CORE - GI Flashcards
1
Q
Normal liver attenuation
A
40-60 HU; >75 HU = hyperattenuating; hypoattenuating = less than spleen on NECT or 25 HU less than spleen on CECT
2
Q
Hot quadrate sign
A
SVC occlusion
3
Q
Empty gallbladder fossa sign
A
Hepatic parenchyma surrounding GB replaced by fat in early cirrhosis
4
Q
Criteria for distended GB
A
> 4 cm
5
Q
Porcelain GB
A
- Calcified GB wall
- Increased risk of gallbladder cancer
6
Q
Criteria for GB wall thickening
A
> 3 mm
7
Q
Thoratrast complications (liver)
A
- Angiosarcoma
- HCC
- Cholangiocarcinoma
8
Q
Indications for gallbladder polyp removal
A
> 10 mm
or
> 6 mm + suspicious features
9
Q
Most common type of gallbladder polyp
A
Cholesterol polyps
10
Q
Transplant type with highest incidence of PTLD
A
small bowel > pancreas > heart & lung
11
Q
Most common organ involved in PTLD
A
Liver
12
Q
Multiple hepatic adenomas
A
Von Gierke disease or adenomatosis
13
Q
Most common hepatitis virus to cause HCC worldwide
A
Hepatitis B (can occur in acute or chronic HepB infection)
14
Q
Light bulb sign
A
Hemangioma - appears very T2 bright
15
Q
Micronodular cirrhosis
A
Nodules are < 3 mm
Associated with alcoholism
16
Q
Macronodular cirrhosis
A
Nodules are >3 mm
Associated with viral hepatitis
17
Q
Starry sky pattern
A
Periportal edema in the setting of hepatitis
18
Q
Hydatid sand
A
Echinococcal cyst
Fine sediment caused by separation of membranes
Can occur in liver or spleen
19
Q
Water lily sign
A
Echinococcal cyst
Undulating membrane
Can occur in liver or spleen
20
Q
Daughter cysts
A
Echinococcal cyst within a larger cyst
Can occur in liver or spleen
21
Q
Hepatic candidiasis
A
Multipe small “targetoid” or “bull’s eye” lesions
22
Q
Hepatic PCP
A
Punctate echogenic foci in liver +/- spleen
After inhaled pentamidine
23
Q
Amebic abscess
A
Entamoeba histolytica
Characteristic location is near dome of right lobe
24
Q
Most common complication of amebic abscess
A
Pleuropulmonary amebiasis (20-35%) > peritoneal, pericardial or renal amebiasis
25
Amebic abscess in the left hepatic lobe
May rupture into pericardium, therefore, emergent drainage needed
26
Primary hemochromatosis
Liver + pancreas
Long term complications: cirrhosis, diabetes, cardiomyopathy, arthritis, bronze skin
Inherited (genetic)
Tx = phlebotomy
27
Secondary hemochromatosis
Liver, spleen, and bone marrow
Due to chronic illness or multiple transfusions
Tx = chelation
28
Scalloping of the liver
Pseudomyxoma peritonei
29
Periportal hypoechoic infiltration
Kaposi's sarcoma (in AIDS patient)
30
Increased liver signal on out-of-phase
Hemochromatosis
Liver is very T2 dark
31
Anti-mitochondrial antibodies
primary biliary cirrhosis
32
Mirizzi syndrome
stone in cystic duct causing obstruction of CHD; assoc. with GB carcinoma
33
Injury to bare area of the liver
retroperitoneal bleed
34
Falciform ligament location
divides segments 2/3 and 4; ligamentum teres runs within
35
Cantlie's line
divides the liver into the functional left and right hepatic lobes; between segments 5/8 and 4
36
Most common hepatic vascular variant
replaced RHA
37
Most common biliary ductal variant
right posterior segmental branch draining into the left hepatic duct
38
T1 characteristics of liver-pancreas-spleen
pancreas (brightest) \> liver \> spleen (darkest)
39
Regenerative and dysplastic nodules
T2 iso/dark, no arterial enhancement; high grade dysplastic nodules may demonstrate arterial enhancement
40
Nodule within a nodule
HCC (T2 bright) within a regenerative/dysplastic nodule (T2 dark); suggests malignant transformation
41
Well-differentiated HCC
enhances during hepatobiliary phase with Eovist (normal HCC does not)
42
Massively dilated hepatic artery
HHT; multiple hepatic and pulmonic AVMs
43
Solitary pyogenic hepatic abscess
Klebsiella
44
Multiple pyogenic hepatic abscesses
E. coli
45
Gas in a hepatic abscess
suggests pyogenic etiology
46
Tortoise shell appearance of the liver
schistosomiasis
47
Hemangioma ultrasound characteristics (liver)
hyperechoic (unless liver is fatty), no internal flow, posterior acoustic enhancement
48
Most common benign liver neoplasm
hemangioma \> FNH
49
T1 hyper- or isointense liver lesion DDx
HCC, FNH, hepatic adenoma
50
Threshold for hepatic adenoma resection
\>5 cm
51
Liver lesion with intralesional (microscopic) fat
HCC, hepatic adenoma
52
Non-enhancing T2 dark central scar
fibrolamellar HCC (gallium avid)
53
Late-enhancing T2 bright central scar
FNH (sulfur colloid avid, visible on HIDA)
54
Most common location for a hepatic adenoma
right hepatic lobe
55
Alternate name for Eovist
Gd-EOB-DTPA
56
Risk factors for cholangiocarcinoma
PSC, choledochal cysts, recurrent pyogenic cholangitis (chlonorchis senesis), FAP, thorotrast
57
Cholangiocarcinoma
delayed enhancement, ductal dilatation, capsular retraction
58
Risk factors for hepatic angiosarcoma
arsenic (25 year latent period), polyvinyl chloride exposure, radiation, thorotrast, hemochromatosis, NF1
59
Calcified liver mets
mucinous neoplasms (stomach, colon, ovary, breast)
60
Hypervascular liver mets
hemorrhagic mets + carcinoid, PNET
61
NASH
hepatic steatosis + abnormal LFTs
62
Budd-Chiari
most commonly: hypercoagulable state =\> hepatic vein thrombosis =\> nutmeg liver +/- multiple regenerative nodules
63
Nutmeg liver DDx
Budd-Chiari, hepatic veno-occlusive disease, right heart failure, constrictive pericarditis
64
Caudate lobe hypertrophy DDx
cirrhosis, Budd-Chiari, PSC, PBC
65
Causes of hepatic veno-occlusive disease
post-BMT, chemotherapy, Jamaican bush tea (alkaloids); occlusion of post-sinusoidal venules with patent hepatic veins; caudate lobe is NOT spared
66
Pseudocirrhosis
treated breast cancer mets; causes capsular retraction
67
Donor liver segments
right lobe (segments 5-8) in adults; segments 2/3 in peds
68
Indications for liver transplant
hepatitis C, alcoholic cirrhosis, HCC, PSC, cryptogenic cirrhosis (NASH)
69
Contraindications to liver transplant
extrahepatic malignancy, advanced cardiac or pulmonary disease, active substance abuse
70
Impending thrombosis post-liver transplant
days 3-10; normal waveform =\> loss of diastolic flow =\> tardus parvus arterial waveform + RI \<0.5 =\> loss of hepatic artery waveform
71
"Central regenerative hypertrophy"
pattern in cirrhosis due to PSC
72
Dilated intrahepatic bile ducts in the setting of cirrhosis
PSC
73
Withered tree on MRCP
PSC
74
AIDS cholangiopathy
findings of PSC + papillary stenosis; classically due to cryptospordium infection (or CMV)
75
Malignant biliary strictures
long with shouldering (vs. benign strictures which are short and abrupt)
76
Charcot triad
fever, jaundice, RUQ pain; in ascending cholangitis
77
Recurrent pyogenic cholangitis
left lobe predominant disease burden
78
Primary biliary cirrhosis
autoimmune, middle-aged women, irregular intrahepatic ducts, normal extrahepatic ducts; increased risk of HCC
79
Most common type of choledochal cyst
type 1
80
Caroli's disease associations
polycystic kidney disease, medullary sponge kidney
81
Complications of choledochal cysts
cholangiocarcinoma, bile duct stones, cirrhosis, cholangitis; Tx is resection
82
Duct of Luschka
accessory cystic duct; may cause bile leak after cholecystectomy
83
Multiple "halo" or "targetoid" liver masses
epitheloid hemangioendothelioma
84
Lace-like hepatic fibrosis
primary biliary cirrhosis
85
Cholesterolosis
cholesterol deposition within the gallbladder lamina propria; similar appearance to adenomyosis
86
Diffuse hepatic hypoattenuation
steatosis, amyloidosis (may also be focal)
87
Diffuse hepatic hyperattenuation
hemochromatosis, hemosiderosis, Wilson's disease, amiodarone, methotrexate, gold, glycogen excess
88
Wilson's disease
AR; hyperattenuating liver with multiple nodules; progresses to cirrhosis
89
Caudate-to-right lobe size ratio suggesting cirrhosis
\>0.65
90
von Meyenburg complexes
biliary hamartomas; small, irregular, non-communicating
91
Caroli syndrome
Caroli disease + hepatic fibrosis
92
Central dot sign (liver)
Caroli disease
93
Gallbladder wall thickening with intraluminal membranes
gangrenous cholecystitis; Tx emergent cholecystectomy (or -ostomy)
94
Most common islet cell tumor
insulinoma (almost always benign) \> gastrinoma \> glucagonoma
95
Gastrinoma
Zollinger-Ellison syndrome; assoc. with MEN1
96
Gastrinoma triangle
typical location; bounded by junction of cystic duct, CBD and duodenum inferiorly, and pancreas medially
97
Serous cystadenoma
grandmother tumor; benign; hypervascular, head most commonly, peripheral calcifications; assoc. with VHL; resection only if symptoms related to mass effect
98
Mucinous cystadenoma
mother tumor; pre-malignant; body and tail most commonly; Tx resection
99
Solid and papillary epithelial neoplasm (SPEN)
daughter tumor; tail most commonly; heterogenous, prone to hemorrhage; Tx resection (malignant potential)
100
Intraductal papillary mucinous neoplasm (IPMN)
grandfather tumor; main branch has higher malignant potential
101
Indications for IPMN resection
\>3 cm, mural nodularity, or ductal dilatation \>10 mm
102
Lipase hypersecretion syndrome
syndrome related to acinar cell carcinoma (rare, aggressive, elderly males); subcutaneous fat necrosis, eosinophilia, bone infarcts=\>polyarthralgias
103
Whipple triad
clinical symptoms of insulinoma: hypoglycemia, symptoms of hypoglycemia, alleviation with glucose administration
104
Crossing duct sign
pancreas divisum; CBD crosses the main pancreatic duct (which drains via minor papilla)
105
VHL associations (pancreas)
pancreatic cysts; increased risk of serous cystadenoma and PNETs
106
Sausage pancreas + associations
autoimmune pancreatitis; assoc. with IgG-4 and Sjogren's
107
Wide duodenal sweep (fluoro)
mass effect from pancreatic cancer
108
Dorsal pancreatic agenesis
increased risk of diabetes; assoc. with polysplenia
109
Pancreatic lipomatosis DDx
CF, Schwachmann-Diamond, obesity, Cushing's, chronic steroids, hyperlipidemia
110
Pancreatic agenesis
no duct present (vs. lipomatosis which still has a duct)
111
Next step in suspected pancreatic duct injury
MRCP or ERCP
112
Pancreas in CF
fibrosis, lipomatosis, or cystosis
113
Causes of acute pancreatitis
gallstones, EtOH, scorpion bite, ERCP, valproic acid, trauma, ascariasis
114
Pancreas hypoechoic relative to the liver
inflammation/edema
115
Most common anatomic variant of the pancreas
pancreas divisum; increased risk of pancreatitis
116
Complication(s) of chronic pancreatitis
increased risk of pancreatic cancer
117
Loss of T1 signal in the pancreas
suggests fibrosis (normally very T1 bright); chronic pancreatitis, CF
118
Capsule surrounding the pancreas
autoimmune pancreatitis; capsule may demonstrate delayed enhancement
119
Cause of groove pancreatitis
duodenal or biliary obstruction (stenosis or stricture)
120
Cystic change of duodenal wall
groove pancreatitis
121
Large pancreatic calcifications with ductal dilation
tropical pancreatitis; younger patients, assoc. with malnutrition; increased risk of pancreatic cancer
122
Most common cause of pancreatic pseudocyst
acute or chronic pancreatitis (inflammatory pseudocyst)
123
DDx for true pancreatic cysts (non-pseudocysts)
ADPKD, VHL, CF
124
Atrophic pancreas with dystrophic calcifications
chronic pancreatitis, IPMN
125
Strongest risk factor for pancreatic adenocarcinoma
smoking
126
Elevated CA-19-9
pancreatic adenocarcinoma
127
Syndromes assoc. with increased risk of pancreatic adenocarcinoma
HNPCC, BRCA, ataxia-telangiectasia, Peutz-Jeghers
128
Periampullary pancreatic cancer
originates within 2 cm of major papilla; increased incidence in Gardner syndrome
129
Unresectable pancreatic cancer
involvement of SMA or celiac axis
130
Large hyperenhancing pancreatic mass with calcifications
non-functional PNET; +/- necrosis
131
Whipple procedure
resection of pancreatic head, adjacent duodenum, and gastric antrum =\> attach CBD and pancreatic remnant to distal duodenum + gastrojejunostomy
132
Causes of pancreatic transplant failure
acute rejection \> donor splenic vein thrombosis (usually within 6 weeks); both may demonstrate reversal of diastolic flow
133
Shrinking pancreas transplant
chronic rejection
134
Santorinicele
occurs in pancreas divisum; may cause obstruction =\> pancreatitis
135
Enhancing pancreatic mass
PNET, splenule, met (RCC most commonly), serous cystadenoma
136
Common channel syndrome
absent septum between distal CBD and pancreatic allowing reflux
137
Splenomegaly size criteria
\>14 cm; remember mono can cause this; volume \>500 cc
138
Gamna-gandy bodies
splenic microhemorrhages (increased susceptibility); secondary sign of portal hypertension
139
Splenic hemangioma
assoc. with Kasabach-Merritt and Kllippel-Trenaunay-Weber
140
Splenic hamartoma
assoc. with tuberous sclerosis
141
Wheel within a wheel or bull's eye appearance (spleen)
pyogenic abscess
142
Most common splenic mets
breast, lung, melanoma; same as adrenal gland
143
Tigroid spleen
normal striated appearance of spleen in the arterial phase
144
Wandering spleen + association
predisposed to torsion; assoc. with abnormalties of intestinal rotation
145
Gaucher disease
glucocerebrosidase deficiency; splenomegaly +/- multiple nodules
146
Multiple hypodense splenic nodules DDx
sarcoidosis, pelosis, Gaucher's, splenic PCP
147
Massive splenomegaly
myelofibrosis
148
Peliosis
blood-filled cystic spaces in the liver and/or spleen; related to OCPs, anabolic steroids, AIDS, renal transplant, lymphoma
149
Most common visceral artery aneurysm
splenic artery aneurysm; most commonly in the setting of trauma or pancreatitis
150
Indication for splenic artery aneurysm repair
size \>2 cm
151
Splenic infarction
sickle cell disease
152
Splenic vein thrombosis
may lead to gastric varices; most commonly due to pancreatitis, also diverticulitis or Crohn's
153
Multiple round splenic calcifications
histoplasmosis, TB; a.k.a. "prior granulomatous disease"
154
Splenic abscess in a trauma or sickle cell patient
consider Salmonella
155
Most common cystic lesion in the spleen
pseudocyst (post-traumatic); no epithelial lining, may have mural calcifications
156
Felty syndrome
splenomegaly, rheumatoid arthritis, neutropenia
157
Epidermoid cyst (spleen)
2nd most common cystic lesion of spleen; "true" cyst (epithelial lining), may have septations
158
Most common benign neoplasm of the spleen
hemangioma
159
Littoral cell angioma (spleen)
multiple hypoattenuating lesions, hemosiderin (low T1/T2)
160
Malignant masses of the spleen
angiosarcoma, lymphoma, mets
161
Multilocular cyst with enhancing septations (spleen)
splenic lymphangioma
162
Cystic lesion with internal flow on US (spleen)
lymphoma; not truly cystic, but appears so on ultrasound
163
Benign splenic cystic lesions
true cyst (epidermoid cyst), pseudocyst, lymphangioma, intrasplenic pancreatic pseudocyst
164
Splenomegaly DDx
passive congestion, AIDS, lymphoma, leukemia, Gaucher's, myelofibrosis, mononucleosis
165
Splenic cyst with mural calcifications
pseudocyst; true splenic cysts rarely have mural calcifications
166
Esophageal fold thickening
esophagitis (non-specific)
167
Cricopharyngeus muscle
at C5-6; border between the pharynx and cervical esophagus; UES
168
A ring
muscular ring
169
B ring
mucosal ring a.k.a. lower esophageal ring
170
C ring
diaphragmatic impression
171
Schatzki ring
narrowing of B ring (\<13 mm) causing dysphagia; almost always assoc. with a hiatal hernia
172
Zollinger-Ellison syndrome
peptic esophagitis from increased acid from gastrin
173
Scleroderma (esophagus)
sphincter fibrosis =\> incompetence =\> reflux =\> esophagitis +/- stricture/Barrett's/cancer
174
Shaggy or foamy esophagus
candidiasis; immunocompromised or motility disorders; painful
175
Candidiasis-like appearance in an asymptomatic elderly woman
glycogen acanthosis; painless
176
Large flat ulcers
CMV or HIV esophagitis
177
Small randomly distributed ulcers
HSV esophagitis; may have "halo of edema"
178
Medication esophagitis
ulcer at the arotic arch or distal esophagus (sites of narrowing)
179
Numerous small esophageal outpouchings
pseudodiverticulosis; dilated submucosal glands due to chronic reflux esophagitis
180
Long, smooth, narrow stricture
caustic, radiation induced (\>50 Gy), or NGT stricture; caustic strictures assoc. with increased risk of cancer
181
Peptic stricture
at or just above GEJ; fibrosis may lead to esophageal shortening
182
Barrett stricture
mid esophageal, above metaplastic adenomatous transition (adenomatous tissue is acid-resistant)
183
Barrett esophagus
shown as a high stricture + hiatal hernia; precursor to adenocarcinoma
184
Regurgitation of fleshy mass
fibrovascular polyp (pedunculated mass usually occuring in cervical esophagus); intralesional fat
185
Uphill varices
seen in portal hypertension; lower half of esophagus
186
Downhill varices
seen in SVC obstruction; upper half of esophagus
187
Bird's beak (esophagus)
achalasia ('A' for Auerbach's plexus)
188
Corkscrew or shish-kebab esophagus
diffuse esophageal spasm
189
Zenker diverticulum
in the hypopharnx (above cricopharyngeus); posterior (through Killian's dehiscence)
190
Killian-Jameson diverticulum
in the cervical esophagus (below cricopharyngeus); lateral, often bilateral
191
Dysphagia lusoria
most commonly due to aberrant right SCA
192
Esophageal concentric rings
eosinophilic esophagitis; Tx steroids
193
Fine transverse folds in lower esophagus
feline esophagus; transient, assoc. with reflux; not seen during swallowing
194
Most common benign mucosal lesion of esophagus
papilloma
195
Achalasia
increased risk of carcinoma and candidiasis; sphincter will relax eventually (vs. malignancy)
196
Pseudoachalasia
causes include Chagas, reflux esophagitis, prior vagotomy, malignancy; a.k.a. secondary achalasia
197
Fundoplication
for reflux or hiatal hernia; complications include slipping and obstruction
198
Esophageal cancer - stage 3 vs. 4
stage 3 = limited to adventitia; stage 4 = invasion into adjacent structures
199
Most common location of esophageal duplication cyst
ileum \> esophagus
200
Traction diverticulum
triangular shape; due to TB or granulomatosis disease =\> mediastinal scarring; will empty
201
Pulsion diverticulum
round shape; due to increase intra-esophageal pressure; do not empty
202
Epiphrenic diverticulum vs. paraesophageal hernia
epiphrenic diverticulum occurs on the right (medial); paraesophageal hernia occurs on the left (lateral)
203
Esophageal web + associations
anterior impression; most commonly in cervical esophagus; increased risk of hypopharyngeal/esophageal carcinoma; assoc. with Plummer-Vinson syndrome (anemia)
204
Large dilated esophagus DDx
achalasia, pseudoachalasia, scleroderma
205
Boerhaave's syndrome
transmural tear, typically 2-3 cm proximal to GEJ; assoc. wtih left-sided pleural effusion
206
Hypopharynx (boundaries)
hyoid bone to cricopharyngeus muscle
207
Oropharynx (boundaries)
uvula to hyoid bone
208
Esophageal contraction waves
primary = initiated by swallowing; secondary = initiated by food/liquid bolus; tertiary = abnormal, but not clinically significant
209
Umbilicated submucosal nodule (stomach)
ectopic pancreatic rest
210
Krukenberg tumor
GI met to ovary (gastric or colon most commonly)
211
Hampton line sign
benign ulcer; line of non-ulcerated acid resistant mucosa surrounding the ulcer crater
212
Carmen meniscus sign
malignant ulcer; splaying of large flat malignant ulcer when compression is applied; pathognomonic for gastric carcinoma
213
Menetrier's disease
idiopathic rugal thickening usually involving the fundus; spares antrum
214
Gastric lymphoma
classically crosses the pylorus, but does not cause obstruction
215
Most common location for sarcoid in the GI tract
stomach
216
History of BilIroth II
increased risk of gastric cancer
217
Gardner syndrome
FAP + Desmoid tumors, Osteomas, Papillary thyroid cancer, Epidermoid cysts ("DOPE Gardner")
218
Turcot syndrome
FAP + gliomas, medulloblastomas
219
Risk factors for gastric cancer
polycyclic hydrocarbons and nitrosamines (processed meats), atrophic gastritis, pernicious anemia, prior subtotal gastrectomy, H. pylori
220
Most common mesenchymal tumor of GI tract
GIST
221
Most common location for GIST + associations
stomach most commonly, rare before 40 y/o; assoc. with Carney's triad and NF1
222
Carney's triad
pulmonary chondroma, extra-adrenal pheochromocytoma, GIST
223
Virchow node
gastric met to left supraclavicular node
224
Sister Mary Joseph node
GI met to umbilical node
225
Most common extra-nodal site for NHL
stomach
226
Linitis plastica
scirrhous adenocarcinoma with diffuse submucosal infiltration; diffusely thickened stomach on CT
227
Organoaxial gastric volvulus
old ladies with paraesophageal hernias; Tx surgical repair
228
Mesenteroaxial gastric volvulus
peds, may cause ischemia and/or obstruction; Tx surgical repair
229
Gastric diverticulum
most commonly arises posteriorly from the fundus
230
Enlargement of the areae gastricae
H. pylori gastritis; typically in elderly patients
231
Multiple gastric ulcers
chronic aspirin use or ZES; if duodenal ulcers also =\> ZES
232
Roux-en-Y patient with weight gain years later
gastro-gastric fistula
233
Jejunogastric intussusception
occurs at the gastrojejunostomy (Roux-en-Y or Billroth); may cause gastric obstruction
234
H. pylori gastritis
assoc. with MALT lymphoma (low grade) and increased risk of gastric adenocarcinoma
235
Gastric carcinoid association
high gastrin levels (gastrinoma); carcinoid may regress after gastrinoma resection
236
Paradoxical increase in gastrin level after secretin administration
ZES
237
Hyperplastic polyp (stomach)
benign, due to chronic inflammation (gastritis)
238
Fundic gland polyp (stomach)
sporadic or FAP
239
Adenomatous polyp (stomach)
neoplastic polyp with malignant potential, especially if \>2 cm; Tx polypectomy
240
Hamartomatous polyp (stomach)
benign; assoc. with Peutz-Jeghers, juvenile polyposis, Cronkhite-Canada, Cowden
241
Retrocolic Roux limb
increased risk of internal hernia
242
Upper limit of normal small bowel diameter
3 cm
243
Whirl sign (swirling mesentery)
closed loop obstruction; surgical emergency
244
Fossa of Landzert
mesenteric defect through which paraduodenal hernias occur; behind the 4th segment of the duodenum
245
Foramen of Winslow
communication between lesser sac and greater peritoneal cavity; potential space for internal hernia
246
Aneurysmal expansion of the small bowel
lymphoma; could also be melanoma mets or GIST (but classically lymphoma)
247
Rigler triad
seen with gallstone ileus; pneumobilia (from cholecystoduodenal fistula), SBO, ectopic gallstone in small bowel lumen
248
Cobblestone appearance on endoscopy and fluoroscopy (small bowel)
Crohn disease; result of criss-crossing ulcerations
249
Creeping fat
Crohn disease; fibrofatty mesenteric change seen as a result of Crohn disease
250
String sign
Crohn disease; segment of narrowed bowel lumen due to wall thickening in Crohn disease
251
Hidebound bowel
scleroderma; thin, straight bowel folds stacked together; due to fibrosis
252
Enteritis involving the terminal ileum
TB, yersinia, Crohn's, campylobacter, salmonella
253
Whipple disease
arthralgias, increased skin pigmentation, malabsorption, abdominal pain; low density lymph nodes
254
Ribbon bowel
GVHD (after BMT); bowel may appear hyperenhancing
255
Celiac sprue associations
iron deficiency anemia, idiopathic pulmonary hemosiderosis, dermatitis herpetiformis; increased risk of small bowel lymphoma and adenocarcinoma
256
Infections with duodenal predilection
Giardia, Strongyloides
257
Sand-like nodules in jejunum
Whipple disease; with thickened mucosal folds
258
Sand-like nodules in jejunum and low CD4 count
MAI (pseudo-Whipple disease); with splenomegaly and retroperitoneal lymphadenopathy
259
Moulage pattern
Celiac disease - supposedly looks like a tube into which wax has been poured
260
Fold pattern reversal of jejunum and ileum
Celiac disease
261
Duodenal obstruction after recent weight loss
SMA syndrome
262
Jejunal ulcer
think ZES; especially if also ulcers in stomach and/or duodenal bulb
263
Cloverleaf sign
healed ulcer of the duodenal bulb
264
Numerous small filling defects (small bowel)
lymphoid hyperplasia
265
Low density mesenteric lymph nodes
TB/MAI, treated lymphoma, CMLNS (occurs in celiac sprue), Whipple disease
266
Jejunal diverticulosis associations
occur along mesenteric border; association with bacterial overgrowth and malabsorption
267
Increased risk of small bowel lymphoma
celiac disease, Crohn's, AIDS, SLE
268
Most common malignant tumor of the small bowel
adenocarcinoma \> carcinoid; most common benign tumor is a leiomyoma
269
Most common location for carcinoid
appendix \> small bowel
270
Femoral hernia
medial to femoral vein; likely to obstruct
271
Littre hernia
hernia containing a Meckel diverticulum
272
Spigelian hernia
along the semilunar line through the transversus abdominus aponeurosis
273
Richter hernia
contains one wall of bowel; does not obstruct, but may strangulate
274
Increased risk of internal hernia after gastric bypass
laproscopic over open; extensive weight loss (less protective mesenteric fat)
275
Most common type of internal hernia
paraduodenal hernia (between stomach and pancreas)
276
Most common complication of internal hernia
closed-loop obstruction +/- strangulation
277
Paraduodenal hernia
small bowel between stomach and pancreas; often contains IMV and left colic artery
278
Small bowel met that causes intussusception
melanoma mets
279
Complications of celiac disease
intussusception, pneumatosis intestinalis, splenic atrophy, CMLNS; increased risk of venous thromboembolism
280
Typhlitis
neutropenic colitis; limited to cecum
281
Accordion sign
pseudomembranous colitis (C. difficile); after antibiotics
282
Thumbprinting
colonic edema seen on fluoroscopy; non-specific, but classically in C. diff
283
Collar-button ulcer
ulcerative colitis; represents mucosal ulceration undermined by submucosal extension
284
Lead pipe colon
ulcerative colitis; featureless and foreshortened colon
285
Upper limit of normal appendiceal diameter
6 mm
286
Cone-shaped cecum
amebiasis (spares TI), TB (involves TI)
287
"Fat gran and an old crone skipping down the cobblestone street away from the wreck"
Crohn's with granulomas, creeping fat, skip lesions, cobblestoning, and rectal sparing
288
Ulcerative colitis associations
colon cancer, PSC, cholangiocarcinoma
289
Epiploic appendigitis vs. omental infarct
EA smaller and on the left; OI larger and on the right (ROI)
290
Appendiceal mucocele
mural calcifications; may occur with or without an associated neoplasm
291
Pseudomyxoma peritonei
due to rupture of an appendiceal mucocele or mucin-producing neoplasm (ovary, appendix, colon, pancreas)
292
Coffee bean sign
sigmoid volvulus (adults)
293
Cecal volvulus
young patients, points to LUQ, less common than sigmoid volvulus
294
Toxic megacolon
seen in UC, Crohn's, C. diff, amebiasis, Hirschsprung's; lack of haustral markings; colonoscopy is contraindicated
295
Behcet's (GI tract)
ileocecal ulcers; look for oral/genital ulcers and pulmonary artery aneurysms
296
Ogilvie syndrome
a.k.a. colonic ileus or colonic pseudobstruction
297
Rectal cavernous hemangioma
enhancing with phleboliths (venous malformation); assoc. with Klippel-Trenaunay-Weber and blue rubber bleb syndromes
298
Mucous diarrhea
villous adenoma; may lead to severe fluid/electrolyte depletion (McKittrick-Wheelock syndrome)
299
Colonic polyp with highest risk for malignancy
adenomatous (includes villous polyps)
300
Rectal cancer staging
T3 = invasion beyond muscularis into mesorectal fat; indication for neoadjuvant chemoradiation
301
Most important sequence for rectal cancer staging
T2
302
Causes of ischemic colitis
acute arterial thromboembolism, chronic arterial stenosis, venous thrombosis, low-flow states
303
Rectal sparing
Crohn's, ischemic colitis
304
Syndromes associated with adenomatous colonic polyps
FAP, HNPCC; both are AD
305
Indications for surgery in diverticulitis
fistula, 2 prior episodes treated conservatively
306
Syndromes associated with hamartomatous colonic polyps
Peutz-Jeghers (AD), Cowden syndrome (AD), Cronkhite-Canada
307
True mesenteries
transverse mesocolon, small bowel mesentery, sigmoid mesentery; greater and lesser omentum are not "true"
308
Misty mesentery
mesenteric panniculitis, but can also be seen with infiltrating neoplasm
309
Malignancy involving mesentery
Relatively common site of metastaseas - NHL, carcinoid (80% of GI carcinoids spread to mesentery), pancreatic, biliary, colon, breast, GIST, mesothelioma, melanoma. Primaries are less common than mets - desmoid a/w Gardner's syndrome being one.
310
Sandwich sign
mesenteric lymphoma - mesenteric fat and vessles engulffed by bulky lymphomatous masses
311
Most common location for peritoneal carcinomatosis
retrovesicle space; natural flow of ascites dictates distribution
312
Barium peritonitis
inflammatory reaction =\> hypovolemic shock; give IV fluids
313
Calcified mesenteric mass
carcinoid
314
Upstream stenosis findings
tardus parvus waveform, RI \<0.5
315
Downstream stenosis findings
RI \>0.7
316
At level of stenosis findings
elevated PSV, spectral broadening
317
Hepatic venous waveform
above line = away from heart; below line = towards heart; A, S, and D waves
318
Absent hepatic venous waveform
Budd-Chiari (hepatic vein occlusion/thrombosis)
319
Increased hepatic vein pulsatility
right heart failure or tricuspid regurgitation (D-wave is Deeper in Drug users); both have accentuated A-wave
320
Decreased hepatic vein pulsatility
cirrhosis, Budd-Chiari, veno-occlusive disease, IVC thrombosis
321
Slow flow in the PV (number)
\<16 cm/s
322
Causes of slow flow in the PV
portal hypertension (any cause), PV thrombosis, right heart failure, tricuspid regurgitation, Budd-Chiari
323
Causes of increased PV pulsatility
right heart failure, tricuspid regurgitation, HHT (from shunting), cirrhosis with arterioportal shunting
324
Normal PV velocity
16-40 cm/s
325
Obturator hernia
between obturator and pectineus muscles
326
Foramen of Winslow hernia
small bowel between PV and IVC
327
MRCP technique
fast spin echo, heavily T2-weighted
328
Complications of BMT (4)
PTLD, GVHD, veno-occlusive disease, typhlitis
329
Peritoneal inclusion cyst
h/o prior surgery or inflammatory disease; closely assoc. with an ovary; may be septated
330
Lymphocele (peritoneum)
h/o prior lymph node dissection or renal transplant; along pelvic sidewall
331
Complication of post-transplant hepatic arterial stenosis
biliary ischemia =\> biloma
332
Treatment for biliary cystadenoma
resection (risk of malignant transformation)
333
MR findings of confluent hepatic fibrosis
low T1, mildly T2 hyperintense, delayed enhancement; may be diffuse, focal, or ill-defined; usually in setting of cirrhosis
334
Hypervascular masses (liver)
HCC, FNH, adenoma, hypervascular mets, flash-filling hemangioma
335
Ligamentum teres
a.k.a. round ligament; runs within falciform ligament; represents obliterated umbilical vein
336
Small bowel polyps
Peutz-Jeghers
337
Multiple target lesions (small bowel)
mets (especially melanoma)
338
Position of GDA relative to CBD
GDA is anterior to the CBD (could be shown on US in the region of pancreatic head)
339
Colon cancer screening guidelines (average risk patient)
ACR/ACS recommends colonoscopy q10, flex sig q5, double contrast BE q5, or virtual colonoscopy q5; starting at age 50
340
Lane Hamilton syndrome
celiac disease + idiopathic pulmonary hemosiderosis
341
Liver window and level
W 200, L 100
342
Fissure separating the left and right hepatic lobes
interlobar fissure (fissure of the gallbladder)
343
Nodular small bowel fold thickening
Whipple disease, Crohn's, lymphoma, infection, mets (melanoma)
344
Location: valeculla vs. pyriform sinuses
vallecula are above the epiglottis and pyriform sinuses
345
Foamy esophagus (fluoro)
achalasia, scleroderma
346
Glucagonoma
diabetes, dermatitis, DVT, depression, death
347
Increased risk of small bowel adenocarcinoma
FAP, HNPCC, Peutz-Jegher, celiac disease, Crohn's
