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Flashcards in duodenum Deck (34):
1

Differential for thickened and nodular folds in the first and second portions of the duodenum

Duodenitis
Brunner gland hyperplasia - cobblestone appearance
Crohns

2

What is brunner gland hyperplasia

Edema causes multiple enlarged discrete nodules that form a cobblestone appearance

3

Differentiate a pyloric channel ulcer from a torus defect

Ulcer shape will not change

Torus defect is usually diamond or triangular in shape

4

How does a duodenal ulcer present radiographically

Persistent collection of barium in the duodenal bulb that doesnt change shape with compression or peristalsis

5

How common are multiple duodenal ulcers? What do multiple ulcers suggest?

10-15%

Zollinger ellison

6

Perforation is more common in gastric or duodenal ulcers?

Duodenal

7

What is giant duodenal ulcer

Ulcer of the bulb >2.5cm, prone to more complications

8

What is the most common cause of perforated viscus in a nontraumatic patient

Perforated duodenal ulcer, most perforate anteriorly

9

What gives a "cloverleaf" appearance?

Duodenal bulb ulcer/scar

10

Differentiate acute from chronic duodenal bulb scarring?

Active ulceration is a fixed abnormality

Chronic will change shape with peristalsis

11

What is the differential for a multichannel pylorus

Congenital deformity vs. Fistulous channel from PUD

12

Postbulbar ulcers - benign or malignant? Should prompt search for what?

Malignancy, zollinger ellison

13

Why are postbulbar ulcerations rare?

Acid is usually neutralized by pancreatic secretions by that point

14

What differentiates mass effect on the duodenum (eg pancreatitis) vs carcinoma induced narrowing?

Intact mucosa is seen with adjacent inflammation

15

What do tethered folds suggest?

Adjacent inflammation (pancreatitis, cholecystitis)

16

Give a DDx for multiple flat ulcerations in the duodenum

PUD
Crohns
Viral
Medication induced
Zollinger Ellison

17

Thickened and nodular duodenal folds

duodenal erosions and luminal dilation

Small angular filling defects with w mosaic/bubbly appearance of the duodenal bulb

Celiac sprue

18

Short segmental narrowing with abrupt edges in the duodenum

Duodenal adenocarcinoma

19

Where is duodenal adenocarcinoma most common

Distal to the ampulla

20

Ampullary mass lesion Ddx

Ampullary adenocarcinoma
Edematous papilla due to impacted distal stone
Large duodenal polyp

21

What type of tumors chracteristically have intratumoral calcification

Smooth muscle tumor

22

Enhancing mass with brisk washout

bulky lesion and central necrosis

Malignant GIST

23

Small, multiple, hyperenhacing lesions in the proximal duodenum

Gastrinomas (ZES)

24

What is the reverse 3, or Epsilon, sign?

Narrowing and distortion of the medial second duodenal portion border due to pancreatic cancer

25

Villous adenoma is suggested by what kind of appearance

Raspberry or cauliflower

26

Do GI polyps enhance?

Yes, most do

27

What is the difference between gastric and duodenal polyps in FAP?

Gastric - hyperplastic
Duodenal - adenomatous

28

What is the Ddx for multiple tiny filling defects in the duodenum?

Variable size vs same size

Heterotopic gastric mucosa - raised, angular configuration, confined to the duodenal bulb

Effervescent granules - change in size and shape

Brunner gland hyperplasia - larger, less numerous, variable in size

Lymphoid nodules - small and UNIFORM, evenly distributed

29

Polypoid filling defect in the junction of the first and second portions of the duodenum suggest what?

Flexural pseudopolyp

30

Most common location of duodenal diverticulum?

Medial wall of the second portion

31

A radiolucent band surrounding a polypoid intraluminal mass?

Intraluminal duodenal diverticulum

32

Dilation of the first and second portions of the duodenum with a stricture/narrowing at the third portion?

Tx?

SMA syndrome, turning patient will relieve constriction

33

Most common GI site for hemorrhage

Small bowel

34

Loss of the fat plane between the aorta and duodenum suggests what? What is the cause?

Aortoenteric fistula

Infection