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Flashcards in gastrointenstinalradiologyflash Deck (159):
1

Unresectable pancreatic cancer factors?

Vascular encasement (SMA). Direct invasion of adjacent organs. Liver metastasis. Adenopathy. Ascites (peritoneal spread).

2

Paraneoplastic condition in pancreatic adenocarcinoma?

Trousseau's sign (spontaneous venous thrombosis).

3

Normal size of duodenal papilla?

Less than 1.5 cm.

4

Perivaterian neoplasms?

Carcinoma. Polyps. Leiomyoma. (Familial polyposis syndrome and associated Gardner's syndrome)

5

Two types of gastric volvulus?

Organoaxial. Mesenteroaxial.

6

Small bowel folds in Celiac disease and Scleroderma?

Celiac: Jejunum decreased folds, ileum increased folds. Scleroderma: Increased folds throughout. 5 folds per inch is normal.

7

Ileocecal valve upper limits of normal size?

3 cm, certainly abnormal if > 4 cm.

8

Most common cause of enlarged ileocecal valve?

Lipomatous infiltration.

9

Diseases that can enlarged the ileocecal valve?

Lipoma. Crohn's disease. Lymphoma. Prolapsing ileal neoplasms.

10

2 conditions that can cause eccentric sacculations of the small bowel?

Crohn's disease. Scleroderma.

11

What vitamin deficiency may occur with small bowel diverticula?

Vitamin B12 from bacterial overgrowth.

12

Causes of toxic megacolon?

Ulcerative colitis. Crohn disease. Infectious colitis (especially in AIDS). Ischemia. Pseudomembranous colitis.

13

Which colon segment is most commonly involved in toxic megacolon?.

Transverse colon (most non-dependent).

14

What causes the colonic dilation in toxic megacolon?

Transmural inflamation with destruction of ganglion cells (myenteric plexus).

15

3 causes of intramural tracking?

Diverticulitis. Crohn's disease. Malignancy.

16

What disorders cause wide-mouth diverticula (pseudosacculations) in the colon?

Scleroderma. Crohn's disease. Ischemia.

17

In what patient population does right-sided diverticulitis occur?

Young adults. Asians.

18

Main differential feature of diffuse esophageal spasms and presbyesophagus?

Diffuse esophageal spasm presents with chest pain. Presbyesophagus is asymptomatic.

19

Does emphysematous cholecystitis result in air in the biliary system outside of the gallbladder?

No, because the cystic duct is obstructed.

20

What tumors of the appendix can product pseudomyxoma peritonei?

Mucocele. Mucinous cystadenoma. Myoglobulosis.

21

What are the two categories of cecal volvulus?

Axial torsion. Bascule (folding of cecum on right colon without significant twisting).

22

What underlying condition do patients with emphysematous cholecystitis most likely have?

Diabetes.

23

What conditions can lead to superior mesenteric artery syndrome?

Rapid weight loss. Immobilization. Wearing a body cast. Decreased peristalsis. Drugs.

24

What's the Bourne test?

In suspected enterovesical fistula, urine is collected, spun, and radiographed for dectection of barium.

25

What's the difference between a fistula and a sinus tract?

Fistula tract connects two mucosal lined structures. Sinus tract ends blindly or in a cavity without normal mucosa.

26

What drug is associated with pneumatosis of the bowel?

Steroids.

27

What pulmonary and collagen vascular diseases can cause pneumatosis of the bowel?

Scleroderma. SLE. Dermatomyositis. Asthma. COPD. CF.

28

Factors that distinguish a pancreatic abscess from pseudocyst?

Abscess (forms earlier after pancreatitis, days to weeks, high HU 20-50, may contain air).

29

Gallstone ileus triad?

Air in biliary system. Radiopaque stone. Bowel obstruction. All 3 present probably only 30% of the time.

30

Causes of nodular filling defects in duodenal bulb and proximal duodenum?

Heterotopic gastric mucosa. Benign lymphoid hyperplasia. Brunner's gland hyperplasia (large nodules).

31

What conditions may result in loss of haustral folds?

Most types of colitis. Laxative abuse. Scleroderma.

32

Most common location in stomach for a malignant ulcer?

Antrum (most common area for benign ulcers, too). Fundus ulcers, though uncommon, are more likely to be malignant.

33

What liver lesion exhibitis cetripetal opacification?

Hemangioma, peripheral to central enhancement over time.

34

Spigelian, Richter's, and Littre's hernias?

Spigelian: lower quadrant through semilunar line. Richter's: only one wall of bowel involved. Littre's: Meckel's diverticulum hernia.

35

Disorder that causes thyroid and breast abnormalities, hyperkeratosis, and harmartomas of the small bowel?

Cowden disease.

36

Features of Cronkhite-Canada syndrome?

Weight loss. Anorexia. Alopecia. Multiple intestinal hamartomas.

37

Cutaneous masses and small bowel tumors?

Neurofibromatosis.

38

What conditions may cause focal strictures of the small bowel?

Crohn's disease. Certain infections. Radiation therapy. Ischemia.

39

What neoplasms of the stomach grow exophytically?

Spindle cell tumors (GISTs, leiomyoma, leiomyosarcoma, leiomyoblastoma). Neurofibromas. Lymphomas.

40

Bony abnormalities in patients with adenomatous polyposis syndrome?

Osteomas. Cortical hyperostosis.

41

Possible extraintestinal neoplasms of FAPS?

Osteomas. Glioblastomas. Medulloblastomas. Thyroid carcinoma.

42

Congenital condition that may cause diffuse bowel edema?

Lymphangiectasia.

43

Complications of Caroli's disease (Type V Choledochal Cyst or communicating cavernous ectasia of the bile ducts)?

Cholangitis. Fibrosis. Portal hypertension. Cholangiocarcinoma.

44

Most common cause of portal hypertension and varices worldwide (parasite)?

Shistosomiasis.

45

Unusual variant of esophageal carcinoma that spreads submucosally producing thickened folds?

Varicoid carcinoma of the esophagus.

46

Most common internal hernia?

Paraduodenal hernia.

47

A left paraduodenal hernia extends through the fossa of?

Landzert.

48

A right paraduodenal hernia etends through the fossa of?

Waldeyer.

49

Paraduodenal hernia is due to a congenital defect in the?

Transverse mesocolon.

50

Causes of rectal varices (not internal hemorrhoids)?

Portal hypertension. IVC obstruction. Severe abdominal adhesions.

51

Amyloidosis most commonly affects what part of the GI tract?

Small intestine, with valvulae thickening and mucosal granularity.

52

Causes of Booerrhaave's syndrome?

Endoscopy. Seizures. Coughing. Asthma. Childbirth. Severe straining. Blunt trauma.

53

Pancreatic phlegmon (massive enlargement of the pancreas by inflammation tissue) complications?

Necrosis. Hemorrhage. Infection.

54

CREST?

Subcutaneous Calcinosis. Raynaud's phenomenon. Esophageal dysfunction. Sclerodactyly. Telangiectasia.

55

Crowding of the valvulae by fibrosis (scleroderma) term?

Hidebound.

56

What age groups are symptomatic in annulary pancreas?

50% present as children. 50% present as adults.

57

Annular pancreas complications?

Duodenal obstruction. Increased susceptibility to pancreaatitis.

58

The substance secreted by this tumor causes an intense desmoplastic response, producing mesentery fibrosis, with tethering and kinging of small bowel?

Carcinoid tumor secreting serotonin.

59

Insulinoma facts?

90% benign. small less than 2 cm. Most difficult to detect on imaging.

60

Gastrinoma facts?

Major cause of Zollinger-Ellison syndrome. MEN-1 syndrome. 60% Malignant. Ectopic locations outside pancreas.

61

Glucagonoma facts?

Secrete glucagon. Produce Diabetes Mellitus. 80% Malignant.

62

VIPoma facts?

Secrete vasoactive intestinal peptide. WDHA (Watery Diarrhea, Hypokalemia, Achlorhydria). Variable malignancy.

63

Somatostatinoma facts?

Rare. Cause diarrhea.

64

Nonfunctioning islet cell tumor facts?

3rd most common islet cell tumor. Generally malignant. Larger. Necrotic on imaging studies.

65

Causes of ischemic bowel?

Low flow states (shock, major surgery, cardiac abnormality). Atherosclerosis (chronic). Embolism (acute). Venous occlusion (mesenteric venous occlusive disease).

66

Major inflammatory processes that affect the terminal ileum?

Crohn's disease. Tuberculosis. Yersiniosis.

67

Distinguishing features between Crohn's disease and Yersiniosis?

Yersiniosis: lacks lumen narrowing, lacks deep ulceration, short, self-limited course, heals without scarring.

68

Benign splenic tumors and CT characteristics?

Hemangioma and lymphangioma (hypodense to splenic tissue, may calcify). Hamartoma (isodense to splenic tissue).

69

Syndrome of generalized angiomatosis?

Klippel-Trenaunay-Weber syndrome.

70

Define pseudopolyp, cobblestoning, and post-inflammatory polyp?

Pseudopolyp: island of normal or edematous mucosa surrounded by ulcerated or denuded mocusa. Cobblestoning: normal mucosa surrounded by linear ulceration (Crohn's disease). Postinflammatory polyp: regenerating normal mucosa.

71

FAPS (Gardner's type) effect on the mesentery?

Mesenteric fibromatosis.

72

When mesenteric fibromatosis occurs in a round shape this is called?

Desmoid.

73

Causes of portal venous gas?

Infarcted bowel. Ulcers. Acute bowel dilation. Endoscopy. Necrotizing enterocolitis.

74

Through what does a Zenker's diverticulum protrude?

Killian's dehisence.

75

What are lateral diverticula of the pharyngoesophageal junction termed?

Killian-Jamieson diverticula.

76

Colon watershed regions?

Splenic fleXure (SMA, IMA junction). Rectosigmoid.

77

Appearance of the liver with enhancing lobules of hepatocytes and areas of edema that do not enhance?

Nutmeg liver (can be seen in patients with passive venous congestion of liver and early stages of Budd-Chiari syndrome).

78

3 types of anal canal malignant neoplasms?

Adenocarcinoma. Squamous cell carcinoma. Cloacogenic carcinoma (women, worse prognosis).

79

Storage disease associated with splenomegaly?

Gaucher's disease. Amyloidosis. Hemochromatosis. Niemann-Pick disease.

80

Pancreatic cystic neoplasm associated with von-Hippel Lindau disease?

Microcystic adenoma.

81

What liver malignancies may calcify?

Fibrolamellar HCC. Hepatoblastoma. Intrahepatic cholangiocarcinoma. Metastases.

82

Nuclear scanning distinction of FNH from fibrolamellar HCC?

FNH is hot (has Kupffer cells). Fibrolamellar HCC is cold (No Kupffer cells).

83

Pathognomonic finding for cavernous hemangiomas of the colon?

Phleboliths.

84

What is the most common location of Burkitt's lymphoma in North America?

Distal ileum.

85

Longitudinal dimension of the spleen should not eceed?

12 - 14 cm

86

Heterogeneous spleen in early arterial phase?

Moire spleen.

87

Congenital splenic cysts which contain an epithelial lining?

Epidermoid cysts.

88

Accessory spleen versus splenosis?

Accessory (supernumerary) splenic tissue at hilum not post-traumatic (splenosis).

89

Granulomatous disease of the spleen, major finding and common causes?

Multiple punctate calcifications. Histoplasmosis. Tuberculosis. Sarcoidosis.

90

Fungal infections of the spleen, most common finding?

Microabscesses, multiple small low densities.

91

Benign splenic neoplasms (2)?

Lymphangioma. Hemangioma.

92

Malignant splenic neoplasms?

Hemangiosarcoma. Angiosarcoma (thorotrast 1950s). Kaposi sarcoma. Lymphoma (AIDS and non-AIDS). Leukemia.

93

Normal splenic finding may mimic a splenic laceration?

Splenic cleft.

94

Splenic artery aneurysm demographics?.

Women (medial dysplasia) rupture risk at pregnancy. Men (atherosclerosis).

95

Sicke cell disease's eventual effect on spleen?

Autosplenectomy, small, densely calcified splenic remnant.

96

Longitudinal dimension of the spleen should not exceed?

12 - 14 cm.

97

Maximal size of pancreatic duct in adults and elderly?

3 mm and 5 mm.

98

Common sites of ectopic pancreatic tissue?

walls of stomach, duodenum, and Meckel diverticulum.

99

Fatty replacement of the pancreas is common in?

diabetes. obesity. elderly. Cystic fibrosis.

100

Pancreatitis complications?

Necrotizing pancreatitis. Hemorrhagic pancreatitis. Thrombosis (splenic, portal, mesenteric veins). Pseudoaneurysms. Pseudocysts. Ascites. Abscess.

101

Pancreatic endocrine neoplasms?

Insulinomas. Gastrinomas. VIPomas. Somatostatinomas. Glucagonomas.

102

Pancreatic exocrine neoplasms?

Adenocarcinoma. Cystic pancreatic neoplasms (microcystic adenoma, mucinous cystic neoplasms). Cystic teratomas.

103

Low attenuation pancreatic mass with dilated loops of bowel?

VIPoma.

104

Interposition of the hepatic fleure between the dome of the liver and the right hemidiaphragm?

Chilaiditi sign.

105

Extracolonic sequelae of ulcerative colitis?

Hepatitis. Sclerosing cholangitis. Cholangiocarcinoma. Sacroilitis. Ankylosing spondylitis.

106

Neutropenic colitis (pericecal)?

Typhlitis.

107

Gardner syndrome?

Intestinal adenomatous polyps with osteomas of the skull or long bones. Epidermoid cysts. Fibromatosis.

108

Turcot syndrome?

Medulloblastoma. Glioblastoma multiforme. Family polyposis.

109

Most common appendiceal tumor?

Carcinoid tumor.

110

Pneumatosis cystoides coli?

Asymptomatic, large round air collections in colon wall (iatrogenic mucosal injury).

111

Pneumatosis intestinalis causes?

Infectious colitis. Necrotizing colitis. Bowel infarction. Typhlitis. Toxic megacolon.

112

Most common site for intussusception in colon?

Ileocecal.

113

Rare condition with mucinous cysts in colon wall?

Colitis cystica profunda.

114

Term for sensation of a lump in the throat?

Globus.

115

Nasopharyngeal reflux is prevented by the soft palate apposing the posterior pharyngeal wall, known as the?

Passavant cushion or pad.

116

Functional abnormalities of the pharynx in barium swallows?

Nasopharyngeal reflux. Laryngeal penetration. Tracheal aspiration. Cricopharyngeal achalasia. Cricopharyngeal hypertrophy.

117

Major structural abnormalities of the pharynx on barium swallow?

Strictures. Webs. Diverticula (Zenker [pharygoesophageal]). Lateral pharyngeal pouches. Lateral pharyngeal diverticula.

118

For an esophagram, if esophageal rupture is suspected what contrast should be used?

Water-soluble contrast.

119

For an esophagram, if aspiration or a tracheo-esophageal fistula is suspected what contrast should be used?

Barium. water-soluble contrast should be avoided for it can cause pulmonary edema.

120

What does the Z-line represent?

Zigzagging transition zone between squamous epithilium to columnar.

121

Describe proximal escape in esophagography?

Occurs when a primary contraction wave pushes barium caudally but at the mid third of the esophagus it breaks with regression of the bolus proximally

122

Tertiary contraction waves?

Nonpropulsive contractions of muscularis propria seen as indentations at the margins of the esophagus which occur locally or over large segments.

123

Feline esophagus differential?

Normal variant. Scleroderma. GER.

124

Incomplete relaxation of the LES because of neuronal degeneration?

Achalasia.

125

Diffuse esophageal spasm characteristics?

Severe tertiary contractions following 30% of swallows. Corckscrew appearance at -ray.

126

Primary versus secondary achalasia?

Primary, no known source. Secondary, known source (neoplasm, Chagas disease).

127

Chagas disease?

South American Trypanosoma cruzi destroys myenteric plexus of esophagus and colon. Causes myocarditis and cardiac aneurysms.

128

Progressive systemic sclerosis' effect on esophagus?

Muscular atrophy and collagen deposition of distal 2/3 of esophagus resulting in reflux.

129

VACTERL congenital anomaly mnemonic?

Vertebral. Anal atresia. Cardiac. Tracheoesaphageal fistula/esophageal atresia. Renal agenesis/dysplasia. Limb.

130

2 most common vascular rings to effect to the esophagus?

Double aortic arch. Aberrant left subclavian artery.

131

Describe course of aberrant left subclavian artery?

Last branch of right aortic arch that usually passes behind the esophagus to ascend on the left.

132

Describe course of aberrant right subclavian artery?

Last branch of left aortic arch that usually passes behind the esophagus to ascend on the right.

133

Describe course of pulmonary sling?

Left pulmonary artery arises from right pulmonary artery and courses between the trachea and esophagus.

134

2 types of hiatal hernias?

Sliding hiatal hernia (GE j moves). Paraesophageal hernia (GE j stable, cardia moves).

135

A-ring?

Muscular/contractile ring at the tubulovestibular junction.

136

B-ring?

Mucosal ring, ridge of tissue at the squamosal-columnar junction of the distal esophagus.

137

Schatzki ring?

Pathologic B-ring that can result in dysphagia (inflamed B-ring from reflux).

138

Barrett esophagus?

Metaplastic replacement of squamous epithelium with columnar above normal Z-line secondary to longstanding reflux.

139

Common esophagitides?

Esophageal candidiasis (shaggy mucosa). Herpes esophagitis (discrete ulcers). Cytomegalovirus esophagitis (larger ulcers). HIV esophagitis (largest ulcers).

140

Benign esophageal neoplasms?

Leiomyoma. Fibrovascular polyp. Squamous papilloma.

141

Malignant esophageal neoplasms?

SCC. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Spindle-cell carcinoma. Leiomyosarcoma. Metastases.

142

Common location for Booerhave esophagus perforation?

Left posterior lateral wall of distal esophagus just proximal to the gastroesophageal junction.

143

Esophageal bypass surgical techniques?

Gastric pull-through (esophagogastrectomy). Colonic interposition.

144

Structural abnormalities of the small intestine?

Atresia (jejunum, ileum > duodenum). Jejunoileal stenosis. Enteric duplication cyst. Malrotation. Meckel diverticula. Diverticula. Small bowel obstruction. Small bowel hernias. Adhesions. Adynamic ileus.

145

Common causes of small bowel obstruction?

Adhesions. Hernias. Neoplasms. Intussusception. Volvulus. Foreign bodies. Inflammatory process.

146

Prestenotic phase of Crohn disease, findings?

Blunting, flattening, distortion, straightening, and thickening of mucosal folds.

147

Other prestenotic changes of Crohn disease?

Apthous erosions. Cobblestoning. Inflammatory pseudopolyps. Postinflammatory polyps. Skip lesions. Pseudodiverticula.

148

Small bowel infection that can mimick appendicitis clinically and Crohn disease radiographically?

Yersiniosis at terminal ileum.

149

Small bowel infection of middle aged men with malabsorption, fever, weight loss, chronic uveitis, endocardiits, arthralgia, lymphadenpathy, and skin pigmentation?

Whipple disease.

150

Diffuse intestinal disease?

Menetrier disease. Intestinal lymphangiectasia. Mastocytosis. Radiation enteritis. Progressive systemic sclerosis. Celiac disease. Graft-versus-host disease. Ischemic enteritis.

151

Benign small bowel neoplasms?

Adenomas. Leimyomas. Lipoma. Peutz-Jeghers syndrome. Cowden disease. Familial polyposis.

152

Malignant small bowel neoplasms?

Carcinoid tumors. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Leiomyosarcoma. Metastases.

153

Sharp angulation in the lesser curvature that demarcates the junction of the body and antrum?

Angular notch.

154

Two common causes of gastroparesis?

Diabetes. Progressive systemic sclerosis.

155

Focal loss of superficial epithelium?

Erosion.

156

Middle-aged men, enlargement of gastric rugal folds?

Menetrier disease (protein-losing enteropathy).

157

Benign gastric neoplasms?

Hyperplastic polyp (sessile, less than 1cm). Adenomatous polyps (>1cm). Leiomyoma.

158

Malignant gastric neoplasms?

Gastric adenocarcinoma. Gastric lymphoma. Kaposi sarcoma.

159

Billroth I versus Billroth II?

I: partial gastrectomy with gastroduodenoscopy. II: partial gastrectomy with gastrojejunoscopy.