Gastrointestinal Flashcards
(215 cards)
1
Q
What is a Schatzki?
A
When B ring (mucosal ring below vestibule) is narrowed (<13mm) AND symptomatic (dysphagia)
2
Q
Level of upper oesophageal sphincter
A
C5-6
3
Q
Muscle which makes up the upper oesophageal sphincter
A
Cricopharyngeus
4
Q
Barrett’s is a precursor to what malignancy?
A
Adenocarcinoma
5
Q
Reticular mucosal pattern is found in what?
A
Barrett’s oesophagus
6
Q
High stricture with an associated hiatal hernia
A
Barrett’s oesophagus
7
Q
Young patient with atopia and eosinophilia with long history of dysphagia
A
Eosinophilic oesophagitis
8
Q
Ringed oesophagus is feature of what?
A
Eosinophilic oesophagitis
9
Q
Treatment for eosinophilic oesophagitis
A
Steroids
10
Q
Concentric rings in oesophagus on barium?
A
Eosinophilic oesophagitis
11
Q
Where is the most common location of oesophageal squamous cell carcinoma?
A
Middle third oesophagus
Arises from mucosa
(More common in afro-Caribbean males)
12
Q
What are the risk factors for squamous cell carcinoma of the oesophagus?
A
Drinking
Smoking
Radiotherapy
Alkaloid ingestion
13
Q
Where is the most common location for an oesophageal adenocarcinoma?
A
Majority in lower third of the oesophagus and arises from columnar epithelium or submucosal glands
14
Q
What are the risk factors for oesophageal adenocarcinoma?
A
Reflux
Scleroderma
Drinking
Smoking
15
Q
What is the difference between T3 and T4 cancer of oesophagus?
A
T3 is invasion of adventitia
T4 is invasion to adjacent structures
16
Q
What are the risk factors for oesophageal candidiasis?
A
Immunocompromised (HIV/ transplant)
Achalasia
Scleroderma
17
Q
What are the barium findings of oesophageal candidiasis?
A
Discrete plaque-like lesions.
Muscosal inflammation and oedema (nodularity, granularity, fold thickening).
Looks “shaggy” when severe.
18
Q
What is the diagnosis in an asymptomatic elderly patient with imaging findings similar to that of oesophageal candidiasis?
A
Glycogen acanthosis
19
Q
What are the barium findings in oesophageal herpes ulcer?
A
Small/ multiple punctate or linear ulcers with surrounding radiolucent halo
20
Q
What are the risk factor(s) for herpes oesophagitis?
A
Immunocompromised patients, particularly those with AIDS
21
Q
What are the cause(s) of uphill varices?
A
Portal hypertension
(confined to bottom half of oesophagus)
22
Q
What are the cause(s) of downhill varices?
A
SVC obstruction (catheter related or tumour related)
Confined to top half of oesophagus
23
Q
How can you differentiate between varices and varicoid carcinoma on imaging?
A
Varices will flatten out with a large barium bolus.
24
Q
What are the appearances of varices on barium?
A
Linear, serpentine filling defects causing scalloped contour.
25
Water density posterior mediastinal cyst. Diagnosis?
Oesophageal duplication cyst
| (Most common location is ileum)
26
What is the name given to a posterior hypopharyngeal diverticulum at the site of Killian dehiscence?
Zenker diverticulum
27
Dilated submucosal glands that cause multiple small out-pouchings usually due to chronic reflux. Diagnosis?
Oesophageal pseudodiverticulosis
28
What is the difference between traction and pulsion diverticulum?
Traction- triangular and will empty.
Pulsion- round and will not empty (contain no muscle in their walls).
29
What is a “feline oesophagus”?
Fine transverse folds coursing the oesophagus
Can be normal or associated with oesophagitis
30
Oesophageal web is a risk factor for what?
Oesophageal and hypopharyngeal carcinoma
31
What are the features of Plummer-Vinson syndrome?
Oesophageal web
Dysphagia
Weight loss
Thyroid issues
Iron deficiency anaemia
32
What is achalasia?
Motor disorder of distal 2/3 of the oesophagus where the lower oesophageal sphincter won't relax.
33
What is the differential for a dilated oesophagus with smooth stricture at the GOJ junction?
Achalasia
Chagas disease
Pseudoachalasia
Scleroderma
34
Dilated oesophagus with signs of reflux and lung changes (NSIP). Diagnosis?
Scleroderma
35
What are the causes of a long stricture?
NG tube in too long
Radiation
Caustic ingestion
36
Dilated oesophagus due to cancer at GOJ junction is called what?
Pseudoachalasia
37
Name the three variants of familial adenomatous polyposis (FAP)?
Gardner syndrome
Attenuated familial adenomatous polyposis
Familial polyposis coli
38
Syndrome characterised by multiple colonic polyps and increased risk of colon and CNS tumours (glioblastoma/ medulloblastoma).
Turcot syndrome
39
Autosomal dominant polyposis syndrome resulting in cancer pretty much everywhere.
Lynch syndrome
(hereditary non-polyposis colorectal cancer)
40
What is the most common benign tumour of the stomach?
Leiomyoma
| (can be calcified)
41
A patient undergoes a double-contrast barium meal examination which demonstrates multiple filling defects. On endoscopy, the filling defects were confirmed as multiple gastric polyps.
What is the most likely histological pattern?
A. Adenomatous polyps
B. Metastases
C. Hyperplastic polyps
D. Leiomyoma
E. Hamartomatous polyps
Hyperplastic polyps.
(*Occur mainly in the body and fundus, measure less than 1cm, make up around 80-90% of gastric polyps and are a recognised complication of long term PPI use*)
42
A gastric ulcer was visible during a double-contrast barium meal examination.
Which of the features below favour a benign aetiology?
A. Irregular modular folds
B. Shallow
C. Hamptons line
D. No protrusion beyond the stomach
E. Asymmetry
Hamptons line
(thin translucent line at the edge of an ulcer)
43
What is the most common benign tumour of the duodenum?
Adenoma
44
“Hide bound pattern” is seen in which condition?
Scleroderma
45
What cancers are people with achalasia more at risk of?
Squamous cell carcinoma
46
Oesophageal stricture with dilated submucosal gland. Diagnosis?
Pseudodiverticulosis.
Usually due to chronic reflux oesophagitis
47
What is the most common mesenchymal tumour of the GI tract?
Gastrointestinal stromal tumour (GIST)
48
“Jejunal ulcers” is buzzword for which syndrome?
Zollinger-Ellison syndrome
49
What is Carney's triad?
Chondroma
Extra-adrenal pheochromocytoma
GIST
50
Which cancers most frequently metastasise to liver?
Colorectal, lung, breast
Less frequently:
Thyroid, Ewing's sarcoma, neuroendocrine, renal cell, prostate
51
What are the CT findings in focal nodular hyperplasia (FNH)?
Arterial phase-low attenuation "scar" in centre of large hypervascular mass
No wash out
Venous phase-same scar "fills in"- as it contains central veins
52
What is the most common type of hypervascular liver metastasis?
Neuroendocrine
53
What are Aphthoid ulcers?
Shallow puncate "spot" with mucosal oedema
54
Aphthoid ulceration is found in which disorders?
Crohn's disease
Yersinia enterocolitis
CMV enterocolitis
Amoebic enterocolitis
Polyarteritis nodosa (PAN)
Ischaemic colitis
Behçet's disease
55
What are the causes of pseudosacculations?
Scleroderma
Crohn's disease
56
What is Mirizzi syndrome?
When the hepatic duct is obstructed secondary to an impacted cystic duct stone. The stone can eventually erode into the CHD or GI tract.
57
Mirizzi syndrome occurs more in patients with which anatomical variant?
Low insertion of the cystic duct
58
What are the 5 types of choledochal cysts?
Type 1 : focal dilation of CBD (most common)
Type 2 : diverticulum of bile duct
Type 3 : choledochocele
Type 4 : intra + extra-hepatic
Type 5 : Caroli's - intrahepatic only
59
“Comet-tail” artefact in the gallbladder is specific for what?
Adenomyomatosis
60
What other conditions are associated with Caroli disease?
Hepatic fibrosis (Caroli syndrome)
Polycystic kidney disease (AD and AR)
Medullary sponge kidney
61
Southeast Asian patient with dilated biliary ducts full of pigmented stones.
Ducts were described as “straight rigid intrahepatic ducts”
What is the diagnosis?
Recurrent pyogenic cholangitis
62
Which antibodies are present in primary biliary cirrhosis?
Antimitochondrial antibodies
| (in 95%)
63
How can you differentiate between AIDs cholangiopathy and primary sclerosing cholangitis (PSC)?
Both have intrahepatic and extrahepatic strictures, AIDS is also associated with papillary stenosis
Extrahepatic strictures in AIDs \> 2cm, whereas they are rarely \> 5mm in PSC.
PSC has saccular deformities of the ducts.
64
What are the _normal_ vascular US findings following liver transplant?
Rapid systolic upstroke (diastolic → systolic in less than 0.08s)
Resistive index 0.5 - 0.7
Hepatic artery peak velocity \< 200 cm/sec
65
The liver and which other organ is involved in primary haemochromatosis?
(genetic increased gastrointestinal uptake of iron)
Primary = pancreas
66
The liver and which other organ is involved in secondary haemochromatosis?
(chronic inflammation/ multiple transfusions)
Secondary = spleen
67
What are the causes of massive caudate lobe hypertrophy?
Budd Chiari
Primary sclerosing cholangitis
Primary biliary sclerosis
68
What is the differential for decreased early enhancement of the periphery of the liver with delayed enhancement of the periphery, also called “nutmeg liver”?
Budd Chiari
Hepatic veno-occlusive disease
Congenstive hepatopathy(right heart failure, constrictive pericarditis, pulmonary hypertension)
69
What are the imaging features of the liver in haemochromatosis?
Liver is T1 and T2 dark
Drop out on _IN_ phase imaging (opposite of fat)
Iron = in
70
What are the causes of hypervascular liver metastases?
Renal
Melanoma
Carcinoid
Choriocarcinoma
Thyroid
Islet cell
71
What are the risk factors for hepatic angiosarcoma?
Polyvinyl chloride
Arsenic
Radiation
Thorotrast
Associated with haemochromotosis and neurofibromatosis type 1
72
What are the risk factors for cholangiocarcinoma?
Primary sclerosing cholangitis
Recurrent pyogenic cholangitis
Clonorchis sinensis (East China)
HIV, Hep B&C
Alcohol
Thorotrast
73
What are the imaging features of a fibrolamellar HCC (subtype seen in younger patients \<35)?
T2 dark with a non-enhancing central scar
Gallium avid
Calcifies more than conventional HCC
Not associated with elevated AFP or cirrhosis
74
In which situations would you find a hepatic adenoma?
Oral contraceptive use
Anabolic steroids
Glycogen storage disease
Obesity
Metabolic syndrome
Diabetes
75
What is the only hepatic lesion that is avid on sulfur colloid scan?
Focal nodular hyperplasia (FNH)
76
What is the difference between the central scar of focal nodular hyperplasia vs central scar of fibrolamellar HCC?
The central scar of FNH is T2 bright and enhances on delayed scans
The central scar of fibrolamellar HCC is usually T2 dark with no enhancement.
77
What are the imaging features of focal nodular hyperplasia (FNH)?
Well defined with a central scar
On arterial phase there is centrifugal filling (opposite to haemangioma/adenoma)
On portal venous phase the lesion will be isointense to background liver
Central scar can be high on T2 and can enhance on delayed scans
78
What are the imaging features of a hepatic haemangioma?
Bright on ultrasound with no internal doppler signal
CT/MRI : peripheral discontinuous nodular enhancement with progressive filling in
T2 bright
79
Patient with massively dilated hepatic artery and multiple AVMs in liver and lungs.
Diagnosis?
Hereditary haemorrhagic telangiectasia
| (Osler-Weber-Rendu syndrome)
80
What are the MRI characteristics of regenerative hepatic nodules?
T1 & T2 dark with no enhancement
81
What are the MRI features of dysplastic hepatic nodules?
T2 dark, T1 bright, usually no enhancement.
82
What are the prehepatic, hepatic and post-hepatic causes of portal hypertension?
Pre-hepatic : portal vein thrombosis, tumour compression
Hepatic : cirrhosis, schistosomiasis
Post-hepatic : Budd-Chiari
83
What is McKittrick-Wheelock syndrome?
Villous adenoma which causes a mucous diarrhoea leading to severe fluid and electrolyte depletion.
84
Cowdry type A intranuclear inclusion bodies can be seen on pathology in which colitis?
Colonic CMV
85
What are the ultrasound features of an appendix mucocele?
Layering within a cystic mass “onion sign”.
86
What are the common associations with ulcerative colitis?
Primary sclerosing cholangitis
Ankylosing spondylitis
Colorectal carcinoma
Moyamoya phenomenon.
87
What are the barium appearances of ulcerative colitis?
Colon “ahaustral” with a diffuse granular appearing mucosal
“Lead pipe”
88
Pseudodiverticula in Crohns is typically found where?
Anti-mesenteric border of the colon
89
The hernial sac of a left paraduodenal internal hernia typically contains which vessels?
IMV and left colic artery
90
A _right_ paraduodenal hernia results from bowel herniating through which fossa?
Fossa of Waldeyer
91
Lesser sac hernias result in herniation of abdominal contents through which foramen?
Foramen of Winslow
92
A _left_ paraduodenal internal hernia results from bowel herniating through which fossa?
Fossa of Landzert
93
Which factors during a Roux-en-Y gastric bypass increase the risk of subsequent internal hernia?
Laparoscopic approach
Greater degrees of weight loss following procedure
94
What are the 3 potential sites for an internal hernia following Roux-en-Y gastric bypass?
Defect in the transverse mesocolon through which the Roux limb passes (if retrocolic)
Mesenteric defect at the enteroenterostomy
Behind the Roux limb mesentery (retrocolic/anterocolic Peterson types)
95
Which abdominal wall hernia is located lateral to the inferior epigastric artery + passes through deep inguinal ring.
Indirect inguinal hernia
96
Which abdominal wall hernia is located medial to the inferior epigastric artery and passes through a defect in Hesselbach triangle?
Direct inguinal hernia
97
What are the features of a femoral hernia?
Medial to the femoral vein
Posterior to the inguinal ligament
(most common in elderly ladies)
98
Which conditions increase the risk of small bowel lymphoma?
Coeliac disease
Crohn's disease
AIDs
SLE
99
Coeliac disease is associated with which conditions?
Idiopathic pulmonary haemosiderosis (Lane Hamilton syndrome)
Dermatitis herpetiformis
IgA deficiency
Small bowel lymphoma
CEC syndrome (coeliac, epilepsy, cerebral calcification)
100
What is the difference between SMA syndrome and nutcracker syndrome?
SMA syndrome is where the SMA compresses the 3rd part of duodenum (normally following severe weight loss)
Nutcracker syndrome is compression of the left renal vein, usually between the SMA and aorta
101
What are the imaging features of coeliac disease?
Fold reversal
Dilated bowel with effaced folds
Coiled spring appearance (intussusceptions)
Low density lymphadenopathy
Splenic atrophy
102
What is the differential for loop separation on fluoroscopy without tethering?
Ascites
Wall thickening (Crohns, lymphoma)
Adenopathy
Mesenteric tumours
103
A 54 year old man has imaging which finds diffuse “sand-like” micronodules in the jejunum with enlarged low density nodes. What is the diagnosis?
Whipple's (Tropheryma Whipplei)
104
What is the diagnosis for loop separation on fluoroscopy _with_ tethering?
Carcinoid
105
What is the differential for diffuse thick small bowel folds \> 3 mm on fluoroscopy?
Low protein
Venous congestion
Cirrhosis
106
Multiple uniform discrete nodules along the mucosal surface of the terminal ileum.
What is the diagnosis?
Gastrointestinal nodular lymphoid hyperplasia.
107
What is the differential for segmental fold thickening of the small bowel on fluoroscopy?
Ischaemia
Radiation
Haemorrhage
Adjacent inflammation
108
Which medication can cause multiple gastric ulcers?
Chronic aspirin therapy
| (doesn't cause duodenal ulcers)
109
Describe mesenteroaxial gastric volvulus.
Rotation around short axis perpendicular to the cardiopyloric line
Displacement of antrum above GOJ
Stomach “upside down” with antrum + pylorus above fundus
110
Describe organoaxial gastric volvulus.
Stomach is rotated along its long axis
Antrum rotates anterosuperiorly
Fundus rotates posteroinferiorly
111
Gastric volvulus seen in old ladies with paraoesophageal hernias?
Organoaxial volvulus
112
Which gastric volvulus type is more common in children?
Mensentero-axial volvulus
113
What is the most common extra-nodal site for non-Hodgkins lymphoma?
Stomach
114
Linitis plastica tends to result from adenocarcinoma of which two primaries?
Breast
Lung
115
Where would you find a Virchow node?
Left supraclavicular region
(sign of metastatic abdominal malignancy)
116
Name two associations with gastrointestinal stromal tumours (GIST)
Carneys triad (chordoma, extraadrenal pheochromocytoma, GIST)
NF-1
117
Which malignancies are associated with Cowden syndrome?
Breast
Thyroid (usually follicular)
Dysplastic cerebellar gangliocytoma (AKA Lhermitte-Duclos disease)
118
Which polyposis syndromes are associated with multiple hamartomatous polyps?
Peutz-Jeghers (mucocutaneous hyperpigmentated macules of nose, buccal, axilla, genetalia)
Cowden's (breast cancer_)_
Cronkhite - Canada (rash, alopecia + watery diarrhoea)
119
Hereditary nonpolyposis colorectal cancer (HNPCC), AKA Lynch syndrome is associated with which malignancies?
Colorectal cancer
Small bowel (most commonly duodenum)
Gastric
Genitourinary (endometrial, ovarian, urothelial)
Hepatobiliary
Pancreatic
CNS (most often gliomas)
120
Gardner syndrome is characterised by what?
Familial adenopolyposis
Multiple osteomas (skull and mandible)
Desmoid tumours of mesentry + abdominal wall
Supernumerary teeth
Papillary thyroid carcinoma
121
Which gastric malignancy tends to cross the pyloris and **_NOT_** result in gastric outlet obstruction despite extensive involvement?
Lymphoma
122
Mucosa-associated lymphoid tissue (MALT) lymphoma is associated with what?
Helicobacter pylori (and may regress following treatment of this)
123
Menetrier's disease (AKA giant hypertrophic gastritis) classically affects and spares which parts of the stomach?
Usually affects the fundus (enlarged and tortuous folds esp. along greater curvature)
Classically spares the antrum
124
What is the classic triad of Menetrier's disease?
Achlorhydria
Hypoproteinameia (ascites + pleural effusions)
Oedema
(Also characterised by excessive mucus production)
125
MEN 1 is an autosomal dominant condition characterised by what?
Pituitary adenomas
Pancreatic islet cell tumours (gastrinoma/glucagonoma)
Parathyroid disease (hyperplasia, adenoma, carcinoma)
126
Zollinger-Ellison syndrome is associated with which other syndrome?
Multiple endocrine neoplasia type 1
| (Wermer syndrome)
127
What are the imaging features in the pancreas in patients with cystic fibrosis?
Complete fatty replacement (lipomatous pseudohypertrophy)
Small 1-3mm pancreatic cysts
Pancreatic duct strictures
128
Progressive submucosal fibrosis of the proximal colon (fibrosing colonopathy) is associated with what?
High dose lipase supplementation used to treat exocrine insufficiency of the pancreas (e.g. in CF)
129
What are the features of Shwachman-Diamond syndrome?
Exocrine pancreatic insufficiency (lipomatous pseudohypertrophy)
Metaphyseal chondroplasia (short stature)
Eczema
130
How do you differentiate between pancreatic agenesis and pancreatic lipomatosis?
Lipomatosis will have a duct, agenesis will not
131
What is pancreatic divisum and why is this important?
Anatomical variant where the main portion of the pancreas is drained by the minor/ accessory papilla
Importance: increased risk of pancreatitis
132
What are the imaging characteristics of late chronic pancreatitis?
Small atrophic pancreas - may have focal enlargement
Pseudocyst formation
Dilation and beading of the pancreatic duct with calcifications
133
Autoimmune pancreatitis is associated with elevation of what?
IgG4
134
What are the imaging findings of autoimmune pancreatitis?
Sausage shaped pancreas
Capsule like delayed rim enhancement around pancreas
135
What are the imaging features of tropical pancreatitis?
Multiple large calculi within a dilated pancreatic duct
136
Which conditions are associated with IgG4?
Autoimmune pancreatitis
Retroperitoneal fibrosis
Sclerosing cholangitis
Inflammatory pseudotumour
Riedels thyroiditis
137
Serous cystadenoma is associated with what?
Von Hippel Lindau
138
What are the imaging features of a serous cystadenoma?
Located in the pancreatic head
Heterogenous mixed density lesion made up of multiple small cysts
Do NOT communicate with the pancreatic duct
Can have a central scar
If calcification present, will be central
139
Mucinous cystic neoplasm of the pancreas is a pre-malignant lesion found in woman in their 50s.
What are the typical imaging features?
Located in the pancreatic body/ tail
No communication with the pancreatic duct
Typically unilocular
If calcification present, tend to be peripheral
140
What are the imaging features of a solid pseudopapillary tumour of the pancreas?
Large solid lesion with cystic parts in the tail of the pancreas
Thick capsule
Progressive fill in of the solid component
141
Migratory thrombophlebitis is associated with malignancy is which syndrome?
Trousseau's syndrome
142
Which hereditary syndromes are associated with pancreatic cancer?
HNPCC
BRCA mutation
Peutz-Jeghers sydrome
143
There is an increased risk of ampullary carcinoma in which polyposis syndrome?
Gardner syndrome
144
Islet cell/ neuroendocrine pancreatic tumours are associated with which conditions?
MEN 1
Von Hippel Lindau
145
"Shrinking transplant" in regards to the pancreas is a buzzword for what?
Chronic rejection
146
What are the features of LEFT isomerism?
Bilateral bilobed lungs
Bilateral hyparterial bronchi
Bilateral left atria
Multiple splenules (without parent spleen)
Midline/ transverse liver
Intestinal malrotation
147
What are the features of RIGHT isomerism?
Bilateral trilobed lungs
Bilateral eparterial bronchi
Bilateral right atria
Absent spleen
Severe congenital heart disease
Midline/ transverse liver
Intestinal malrotation
148
A wandering spleen is associated with what?
Splenic torsion/ infarction
Intestinal malrotation
149
Gamma gandy bodies (siderotic nodules) are small foci of haemorrhage in the splenic parenchyma.
They are associated with what?
Portal hypertension
150
Splenic abscess in the immunocompetent patient, normally in the setting of underlying splenic damage (trauma/ sickle cell) is caused by which infection?
Salmonella
151
Feltys syndrome consists of which triad?
Splenomegaly
Rheumatoid arthritis
Neutropenia
152
What is the most common primary neoplasm to metastasise to the spleen?
Melanoma
153
Small bowel dilatation without increase in fold thickness is the pattern seen in which condition?
Coeliac disease
154
Small bowel dilatation without loss of the valvulae conniventes and prolonged transit time is the pattern seen in which condition?
Scleroderma
155
Dilatation of the proximal small bowel due to hypersecretion is seen in what syndrome?
Zollinger-Ellison syndrome
156
Small bowel fold thickening and lymph node enlargement is the pattern seen in what condition?
Lymphoma
157
Nodular small bowel fold thickening with sclerotic bone lesions is a pattern seen in what condition?
Mastocytosis
158
Thickened small bowel folds with or without nodularity, with NO dilatation and normal transit time is a pattern seen in which condition?
Whipple disease
159
Which infections cause diffuse involvement of the whole colon?
CMV
E. coli
160
Which infections affect the right colon?
Salmonella
Shigella
161
Which infections affect the left colon?
Schistosomiasis
162
Which infections affect the rectosigmoid colon?
Gonorrhoea
Herpes
Chlamydia
163
What are the features of familial adenomatous polyposis?
Colonic carpet of polyps
Stomach hamartomas
Duodenal adenomas
Periampullary carcinoma
Desmoid tumours
164
What are the features of Turcot syndrome?
Diarrhoea (colonic polyps)
Seizures (glioblastoma)
165
What are the features of Cowden syndrome?
Rectosigmoid polyps
Fibrocystic breast disease
Dysplastic cerebellar gangliocytoma
Trichilemmomas
166
What are the features of Peutz-Jegher syndrome?
Hamartomatous polyps
Mucocutaneous pigmentation
Increased risk of multiple cancers
167
Clinical syndrome which occurs secondary to functional gastrinoma resulting in GORD and peptic ulcer disease
Zollinger-Ellison syndrome
168
What are the causes of achalasia?
Idiopathic
Chagas disease (parasite in the jungle)
Allgrove syndrome
169
What are the fluoroscopic findings of a double aortic arch?
Frontal: “reverse S” sign. Upper indentation from right aortic arch. Lower indentation from left arch.
Lateral: posterior indentation (mostly right arch)
170
What are the fluoroscopic findings in pulmonary sling/ aberrant left pulmonary artery?
Mass between trachea + oesophagus just above the level of the carina
Indentation on anterior oesophagus
171
What are the fluoroscopic findings of an aberrant right subclavian artery?
“Bayonet sign”
Obliquely orientated posterior indentation of the oesophagus
172
What is the most common symptomatic vascular ring?
Double aortic arch
173
Which is the only vascular ring to pass between the oesophagus and the trachea?
Pulmonary sling
AKA aberrant left pulmonary artery
174
What are the two types of hiatal hernia and how do you differentiate them?
Sliding (axial) where the GOJ will be above the diaphragm
Rolling (paraoesophageal) with the GOJ below the diaphragm and piece of stomach above it
175
Pulmonary sling is associated with which other cardiopulmonary and systemic anomalies?
Tracheal stenosis
Complete tracheal rings
Tracheo-oesophageal fistula
Hypoplastic right lung
Imperforate anus
176
Which type of hiatus hernia has a higher rate of incarceration?
Rolling (paraoesophageal)
177
What is the most common benign mucosal lesion of the oesophagus?
Papilloma
178
Lower oesophageal pulsion diverticula with a strong association with oesophageal dysmotility. What is it and which side does it usually occur?
Epiphrenic diverticula
Usually on the right
179
Where does a Killian-Jamieson diverticulum arise?
Anterolateral cervical oesophagus
Below attachment of cricopharyngeus
Lateral to ligaments that help suspend the oesophagus on the cricoid cartilage
180
What is a traction diverticulum (oesophagus)?
True diverticulum occurring secondary to pulling forces on the outer aspect of the oesophagus.
181
What is the barium findings of CMV oesophagitis?
Large approx 2cm superficial mid-oesophageal ulcers (characteristic)
Small well-circumscribed ulcers with normal mucosal between them
182
CMV infection of the GI tract can be seen in HIV patients with what CD4 count?
CD4 \< 100
183
What are the common infective causes of oesophagitis in a patient with HIV?
CMV
Herpes
Candida
184
“Corkscrew” oesophagus appearance is seen in what?
Diffuse oesophageal spasm
185
Severe forms of glycogen acanthosis can be seen in what syndrome?
Cowden syndrome
186
Multiple small nodules and plaques in the upper to mid oesophagus in asymptomatic elderly patient. What is the diagnosis?
Glycogen acanthosis
187
What is the most common reason for recurrent reflux following nissen fundoplication?
Slipped nissen wrap which is seen as narrowed oesophagus over a length of \>2cm
188
“Ribbon like” bowel is a buzzword for what condition?
Graft vs host disease
189
What is the likely diagnosis of multifocal peripheral portal nodules with variable attenuation in a patient with AIDS?
Kaposi sarcoma
190
What is the most common islet cell tumour?
Insulinoma
191
What is the most common islet cell tumour associated with MEN?
Gastrinoma
192
Which cystic pancreatic lesion has an elevated CEA?
Mucinous cystadenoma
| (serous cystadenoma does not)
193
What are the imaging features of a flash haemangioma?
Immediate and uniform enhancement which persists on delayed sequences
194
Lymph from the bare area of the liver drain into which lymph node group?
Mediastinal
195
What are the imaging features of angiodysplasia?
Most common in the caecum and ascending colon
Cluster of arterially enhancing vessels on the anti-mesenteric border
Early opacification of the draining ileocolic vein
196
What conditions may cause low T2 signal in the spleen?
Haemochromotosis
Spherocytosis
Sickle cell disease
MRI safe prosthetic heart valve
197
What is the diagnosis in an immunosupressed patient with thickened and markedly oedematous caecum?
Neutropenic colitis
| (typhlitis)
198
Liver cirrhosis and a grossly dilated hepatic artery are suggestive of what diagnosis?
HHT
| (Osler-Weber-Rendu syndrome)
199
What is the syndrome associated with hamartomatous polyps in the stomach and colon as well as alopecia and nail atrophy?
Cronkhite-Canada syndrome
200
What are the causes of Budd-Chiari syndrome?
Thrombocytosis
OCP
Pregnancy
Polycythaemia rubra vera
Right atrial myxoma
Mechanical compression by a tumour
Constrictive pericarditis
201
In which types of oesophageal atresia will have no gas in the bowel?
Type A: pure oesophageal atresia with no fistula
Type B: oesophageal atresia with fistula between proximal pouch and tracheal
202
What is the most common type of oesophageal atresia?
Type C: oesophageal atresia with fistula from the trachea or main bronchus to the distal oesophageal segment
203
What is a type D oesophageal atresia?
Oesophageal atresia with both proximal and distal fistulas
204
Which conditions increase the risk of duodenal cancer?
Crohns
Coeliac
205
What are the predisposing factors of gastric malignancy?
H.pylori
Pernicious anaemia
Gastric polyps
Atrophic gastritis
Diet
Partial gastrectomy
206
What are the fluoroscopy features of gastric lymphoma?
Diffusely thickened irregular mucosal folds
Multiple ulcers associated with a mass and polypoid lesions
207
Which condition causes small evenly distributed filling defects throughout the duodenal cap on fluoroscopy?
Lymphoid hyperplasia
208
Which condition causes irregular filling defects within the duodenum, spreading from the pylorus and referred to as “crazy pavement”?
Gastric metaplasia
209
Which condition causes a cobblestone appearance of the duodenal cap with large nodules which are not effaced with distension?
Brunner's gland hyperplasia
(duodenitis causes similar appearance but will be effaced with distension)
210
Simple hepatic cysts are associated with which conditions?
Polycystic liver disease
Polycystic kidney disease
Tuberous sclerosis
Von Hippel-Lindau
211
What are the imaging features of a benign hepatic cystadenoma?
Arise from bile ducts, often in the right lobe
Multi-locular with internal septa (which can enhance)
Mural papillary projections (characteristic)
212
What are the imaging appearances of a hepatic adenoma?
Well defined and mixed echogenicity on US
High on T2, low in T1 (can be mixed if haemorrhage/ fat)
Rapid homogenous arterial enhancement that becomes isointense on later phase imaging
Cold on sulphur colloid scans (unlike FNH)
213
Conventional hepatocellular carcinomas are hyper-enhancing in the arterial phase and washout in the portal-venous. What is the reason for this?
They are supplied by the hepatic arteries not the portal system
214
What is the difference between adenoma and FNH when using hepatocyte specific contrast?
FNH will have enhancement which persists into the delayed phases due to the presence of hepatocytes
Hepatic adenomas do not retain hepatocyte specific contrast on the delayed phase as they do not have hepatocytes
215
Which nodal groups are deemed “local nodes” in regards to gastric cancer?
Perigastric, lesser and greater curve, common hepatic, splenic, left gastric and coeliac nodes
