Gastrointestinal Flashcards by Tonia Forjoe

Narrowing of which oesophageal ring is called a Shatzki?
Where is it found?

B ring

Mucosal ring below the vestibule, GOJ

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Which oesophageal diverticulum is found in the hypopharynx?

Zenker Diverticulum

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Which oesophageal diverticulum is found in the cervical oesophagus?

Killian Jameison diverticulum

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What abnormality in the oesophagus does this describe?
High stricture with an associated hiatal hernia + Reticular mucosal pattern

Barretts oesophagus

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What oesophageal abnormality does this describe?
Transient fine transverse folds coursing mid and lower oesophagus

Feline oesophagus

May be normal or associated with reflux and oesophagitis

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What oesophageal abnormality does this describe?
Irregular contour, abrupt shouldered edges, mass in mid oesophagus

Squamous cell carcinoma of oesophagus

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What oesophageal abnormality does this describe?
Chronic reflux Hx, irregular contour mass with abrupt shouldered edges
Stricture/ulcer in lower oesophagus

Adenocarcinoma of the oesophagus

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What type is the following hiatus hernia?
GEJ above the diaphragm

Type 1 sliding hiatus hernia

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What type is the following hiatus hernia?
GEJ below the diaphragm + to the left

Type 2 Rolling paraoesophageal hernia

Increased risk of incarceration

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What procedure is this?
Gastric fundus is wrapped around the lower end of the oesophagus and stitched in place, to reinforce the lower oesophageal sphincter

Fundoplication

Nissen = 360º wrap

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Following a fundoplication if a barium swallow shows total or near obstruction of the oesophagus, what does this denote?

Oesophageal obstruction/narrowing, if there is oedema or the warp is too tight

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What is the most common reason for recurrent reflux with a Nissen fundoplication?

What is the most common reason for this complication?

Slipped Nissen (>2cm of narrowed oesophagus)

Short oesophagus (Fixed/non-reducible hiatal hernia >5cm)

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What is the treatment for a short oesophagus with a Nissen fundoplication?

Colis gastroplasty - lengthening & fundoplication

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What oesophageal abnormality does this describe?
Immunocompromised patient, discrete plaque like lesions, nodularity/granularity/fold thickening due to mucosal oedema
Upper oesophagus

Candidiasis

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What oesophageal abnormality does this describe?
Immunocompromised patient with shaggy irregular luminal surface

Candidiasis

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What oesophageal abnormality does this describe?
Multiple elevated benign nodules in asymptomatic elderly patient

Glycogen acanthosis

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What oesophageal abnormality does this describe?
Small multiple ulcers with halo of oedema

Herpes

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What oesophageal abnormality does this describe?
Large flat ovoid ulcer
Distal oesophagus

CMV or HIV

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What oesophageal abnormality does this describe?
Discrete ulcers surrounded by mounds of oedema

Crohns (Aphthous ulcers)

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What oesophageal abnormality does this describe? On CT
Posterior mediastinum, water density focus abutting the oesophagus
May have Hx of dysphagia

Enteric duplication cyst

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What is the most common location for an enteric duplication cyst?

Ileum then Oesophagus

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What oesophageal abnormality does this describe?
Posterior diverticulum arising from the hypopharynx + Does not empty

Where is the site of weakness?

Zenker diverticulum

Killian dehiscence/triangle

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What oesophageal abnormality does this describe?
Anterior & Lateral diverticulum in the cervical oesophagus + Does not empty

Where is the site of weakness

Kilian Jameison diverticulum

Area of weakness below C5/6 at cricophayngeus

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What oesophageal abnormality does this describe?
Mid oesophageal triangular shape diverticulum + empties

Traction diverticulum

From scarring - TB/Granulomatous disease

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What oesophageal abnormality does this describe? Above the diaphragm usually on right

Epiphrenic diverticulum

What oesophageal abnormality does this describe? Dilated submucosal glands causing multiple small outpouchings

Oesophageal pseudodiverticulosis (Due to chronic reflux oesophagitis)

What oesophageal abnormality does this describe? small sessile polyp with a smooth or slightly lobulated contour

Papiloma (Benign - hyperplastic squamous epithelium)

What oesophageal abnormality does this describe? Cervical oesophagus, circumferential out pouching (Anteiror & Posterior)

Oesophageal web

The following describes which syndrome? Iron deficiency anaemia Dysphagia Thyroid issues Spoon shaped nails

Plummer Vinson syndrome

What oesophageal abnormality does this describe? Young man with history of dysphagia, atopy & eosinophilia + Concentric rings on swallow

Eosinophilic oesophagitis

What oesophageal abnormality does this describe? Corkscrew tertiary contractions in the distal oesophagus

Oesophageal spasm - normal

What oesophageal abnormality does this describe? Dilated distal 2/3 of oesophagus, smooth stricture at GEJ (Birds beak) What causes it?

Achalasia Failure of lower oesophageal sphincter to relax

What disease has a similar appearance to Achalasia but is not idiopathic?

Chagas disease

What oesophageal abnormality does this describe? Dilated distal 2/3 of oesophagus, smooth stricture at GEJ (Birds beak) + GEJ won't relax

Pseudoachalasia/Secondary achalasia due to malignancy

What oesophageal abnormality does this describe? Lower 2/3 of oesophagus + LES incompetent + NSIP in lungs + Closely spaced valvulae conniventes

Scleroderma

What oesophageal abnormality does this describe? Linear/serpentine + filling defects causing scalloped contour

Oesophageal varices

What oesophageal abnormality does this describe? Caused by portal HTN Confined to bottom half of oesophagus Linear filling defects

Uphill varices

What oesophageal abnormality does this describe? Caused by SVC obstruction Confined to top half of oesophagus Linear filling defects

Downhill varices

What oesophageal abnormality does this describe? Ulcers at level of the arch or distal oesophagus

Medication induced oesophagitis

What oesophageal abnormality does this describe? Long oesophageal stricture

Stricture due to caustic ingestion, radiation or long term NG tube use

What do the following features of stomach ulcers suggest? Width > Depth Located within lumen Nodular, irregular edges Folds adjacent to ulcer Carmen meniscus sign Can be anywhere

Malignant

What do the following features of stomach ulcers suggest? Depth > Width Project beyond the expected lumen Sharp contour Folds radiate to ulcer Hamptons line Mostly on lesser curvature

Benign

What is the most common location of a GIST?

Stomach Duodenum Colon

In a GIST the absence of perigastric lymphadenopathy favours a benign or malignant GIST/Adenocarcinoma?

Absence of perigastric lymphadenopathy favours a benign GIST

Where do GIST Tumours typically metastasise to?

Liver

What is Carneys triad?

Chondroma (Pulmonary) Extra-adrenal phaeochromocytoma GIST

What is the most common cause of gastric cancer?

Adenocarcinoma (95%) Lymphoma Malignant GIST

What do the following stomach changes suggest? Obstruction of antrum Large, ulcerated heterogenous mass Asymmetric wall thickening - focal/nodular >12 mm

Gastric adenocarcinoma

What do the following stomach changes suggest? Smoothly marginated Exophytic mass

Gastric GIST

What do the following stomach changes suggest? Diffuse stratified gastric wall thickening

Benign gastritis

What do the following stomach changes suggest? No Gastric outlet obstruction Crossing the pylorus May be variable size, polypoid/ulcerative Diffuse wall thickening >1cm

Gastric lymphoma MALT (Primary) or Systemic lymphoma (Secondary)

What is the most common extra-nodal site for NHL?

Stomach

The following features suggest gastric cancer or lymphoma? More likely to cause GOO Distal stomach location Extend beyond serosa and obliterate adjacent fat planes Focal mass

Gastric adenocarcinoma

What is the most likely primary to metastasise to the stomach? What does it look like?

Melanoma Multiple button type soft tissue nodules

Which cancers can metastasise to the stomach?

Melanoma Breast - Lobular carcinoma Lung

What is Linitis plastica? Which cancers cause this?

Diffuse infiltration and contracted desmoplastic deformity (Stiff leather bottle) Breast, Lung, Lymphoma

What do the following stomach changes suggest? Multiple gastric ulcers

Chronic aspirin use

What do the following duodenal changes suggest? Multiple duodenal ulcers

Zollinger Ellison

What do the following stomach changes suggest? Fine reticular pattern on double contrast When do they enlarge? When are they obliterated?

Normal gastric pattern Enlarge - H.pylori or elderly Obliterated - Cancer/Atrophic gastritis

What do the following stomach changes suggest? Regular rugal thickening Involves the fundus Spares the antrum Bimodal age distribution Low albumin

Menetriers disease (Idiopathic gastropathy)

What do the following stomach changes suggest? Tubular, conical shape of the distal stomach What causes it?

Rams horn deformity Peptic ulcer scarring or Granulomatous disease (Crohn's, Sarcoid, TB)

What is the most common GIT location for sarcoid?

Stomach

What do the following stomach changes suggest? Gastric antrum below the GEJ Old woman with paraoesophageal hernia

Organoaxial gastric volvulus Greater curvature flips over lesser curvature

What do the following stomach changes suggest? Gastric antrum above GEJ Usually children

Mesenteroaxial gastric volvulus Twisting over mesentery, causes ischaemia and obstruction

What do the following stomach changes suggest? Posterior fundus sof tissue mass Normal adrenal

Gastric diverticulum

What is the cause of isolated gastric varices?

Splenic vein thrombus (Pancreatitis/Pancreatic cancer)

What is a gastric band?

Inflatable silicone band around the upper part of the stomach which creates a restrictive pouch

What do the following stomach changes suggest? Post gastric band Dilated proximal pouch Vomiting

Stomal stenosis

What do the following stomach changes suggest? Gastric band On CT band is within the lumen of the stomach

Gastric band erosion

What do the following stomach changes suggest? Gastric band Band should be at 2 o'clock but is more flat

Gastric band slippage

The following describes which surgery? Pylorus removed Proximal stomach sewn directly to duodenum Due to gastric cancer, pyloric dysfunction or ulcers

Bilroth 1

The following describes which surgery? Partial gastrectomy Stomach attached to jejunum - Afferent (Bilio-pancreatic limb) + Efferent (Gastro-jejunal limb) Due to gastric cancer or distal stomach ulcers

Bilroth 2

The following describes which surgery? Stomach divided to make a pouch 1. Gastric pouch to Jejunum (Gastrojejunal/Efferent) 2. Excluded stomach attached to duodenum (Bilio-pancreatic/Afferent) 3. Jejunum attached to other Jejunum (Jejunojeunal)

Roux en Y bypass

What causes afferent loop syndrome?

Something extrinsic (Adhesions or internal hernia) or Intrinsic (Scarring from radiation or oedema from ulcer) obstructs Afferent loop Leads to secretions, bile and pancreatic enzyme build up

What do the following changes suggest? Fluid filled U loop of bowel adjacent to pancreas CBD entering the loop +/- dilated bile ducts May have pancreatitis

Afferent loop syndrome

What is dumping syndrome?

Rapid transit of undigested food from the stomach

When does Roux en Y anastomotic leak typically occur? Where is most common?

Within 10 days post op Anastamosis of stomach and small bowel (Gastrojejunal anastomosis)

What do the following stomach changes suggest? Roux en Y bypass Oral contrast going into the excluded stomach Weight gain post op

Gastro-gastric fistula

What do the following stomach changes suggest? Roux en Y bypass Solitary ulcer near the gastrojejunal anastomosis

Marginal ulcer Due to small bowel not being used to gastric acid exposure

What do the following stomach changes suggest? Post roux en Y bypass Multiple giant >2.5 cm ulcers in same region

Chronic jejunal ischaemia

The following small bowel changes suggest what? Single transition point Accumulation of gas upstream from the obstacle (Initial) Dilated loops of fluid filled small bowel = air fluid levels

Single transition point mechanical small bowel obstruction

The following small bowel changes suggest what? 2 transition points No gas, distension due to secretions & venous stasis

Closed loop bowel obstruction

Which component of a closed loop obstruction will have air/fluid levels, if it has had time to develop?

Supralesional component (Above the obstruction) Due to slower distension

The following are features of what? 3 beak sign Radial layout - vessels & loops converging to single point Pneumatosis coli

Closed loop small bowel obstruction

What is the 3 beak sign?

3 beak sign - beak 1 + 2 are found proximal and adjacent to each other, beak 3 is more distal and has downstream decompressed bowel

What do the following stomach changes suggest? Dilated gastric pouch & jejunal roux limb Decompressed stomach & duodenum

Obstruction of Roux limb (Gastrojejunal limb)

What do the following stomach changes post roux en Y suggest? Dilated stomach and duodenum Decompressed gastric pouch and jejunal roux limb

Obstruction of the biliopancreatic limb Acts as closed loop obstruction as stomach is sewn shut proximally

What do the following stomach changes post roux en Y suggest? Dilatation above jejunal jejunal limb

Obstruction below JJ limb

What is meant by ante colic v retrocolic roux limb?

Anteocolic - Roux limb passes in front of the transverse colon Retrocolic - Roux limb passes behind the transverse colon (Defect in transverse mesocolon is created)

What are the 3 sites of internal hernia?

1. Defect in transverse mesocolon - for retrocolic roux en y 2. Mesenteric defect at enteroenterostomy - hole in mesentery near JJ anastomosis 3. Behind roux limb mesentery (Peterson)

What does the following small bowel follow through suggest? Loop seperation Without tethering

Ascites Wall thickening (Crohn's, Lymphoma) Adenopathy Mesenteric tumours

What does the following small bowel follow through suggest? Loop seperation With tethering

Carcinoid

What does the following small bowel follow through suggest? Sand like nodules - diffuse micronodules in the jejunum

Whipples Pseudo Whipples (MAC infection)

What does the following small bowel follow through suggest? Uniform 2-4 mm nodules

Lymphoid hyperplasia

What does the following small bowel follow through suggest? Nodules of larger or varying sizes

Cancer - consider melanoma mets

What does the following small bowel follow through suggest? Cobblestoning - Islands of mucosa separated by linear streaks perpendicular to bowel lumen Areas of stricture Loop separation from fat proliferation

Crohns Cobblestones are ulceration

What does the following small bowel follow through suggest? Ribbon bowel - featureless atrophic, fold thickening

GvH disease Post bone marrow transplant

What does the following small bowel follow through suggest? Hidebound bowel - Narrow separation of normal folds with mild bowel dilatation

Scleroderma

What does the following small bowel follow through suggest? Moulage sign - dilated jejunal loop with complete loss of jejunal folds, like tube of wax

Coeliac disease

What does the following small bowel follow through suggest? Fold reversal - jejunum loses folds to look like ileum, ileum gains folds to look like jejunum

Coeliac disease

What does the following small bowel follow through suggest? Tubular/thread like defect in barium column

Ascaris worm

What does the following small bowel follow through suggest? Target sign - Single target

GIST, Primary adenocarcinoma, Lymphoma, Ectopic pancreatic rest, Melanoma met

The following have what appearance in the small bowel? GIST, Primary adenocarcinoma, Lymphoma, Ectopic pancreatic rest, Melanoma met

Target sign

What does the following small bowel follow through suggest? Clover leaf sign at duodenal bulb

Healed peptic ulcer of the duodenal bulb

What does the following small bowel follow through suggest? Thickened irregular mucosal folds in duodenum and proximal jejunum Sand like nodules - micronodules in jejunum Low density enlarged lymph nodes

Whipples disease (Tropheryma Whipplei)

What does the following small bowel follow through suggest? Immunocompromised patients Nodules in jejunum Retroperitoneal nodes

Pseudo Whipples - MAC infection Confirmed with AFB staining not imaging

What does the following small bowel follow through suggest? Loss of normal mesenteric fat under SMA Weight loss Dilated stomach & D1 + D2

SMA syndrome - compression of D3 by SMA

What does the following small bowel follow through suggest? IDA Idiopathic pulmonary haemosiderosis Fold reversal Moulage sign Cavitary lymph nodes - low density Splenic atrophy

Coeliac disease - confirmed with biopsy

What do the following small bowel features suggest? 2 types of heterotypic mucosa - Gastric & Pancreatic 2 feet from IC valve 2 inches long

Meckels diverticulum

What is Meckels diverticulum?

Congenital true diverticulum of the distal ileum, persistent omphalomesenteric duct

What nuclear medicine scan is used to diagnose Meckels?

Tc99m Pertechnate (Due to gastric mucosa)

What do the following small bowel features suggest? Duodenal fold thickening Pancreatitis/Cholecystitis

Duodenal inflammatory disease

Where is jejunal diverticulosis typically found?

Mesenteric border of the jejunum Associated with bacterial overgrowth and malabsorption

What do the following small bowel features suggest? Pneumobilia SBO Ectopic gallstone

Gallstone ileus

What are the direct signs of bowel trauma?

Spilled oral contrast Active mesenteric bleed

What are the indirect signs of bowel trauma?

Fat stranding Fluid layering along the bowel

What do the following bowel features suggest? Diffuse intense bowel mucosal enhancement & thickening Flat IVC Bowel loops denser than psoas on unenhanced

Hypovolemic shocked bowel

What do the following abdominal findings on CT suggest? Thickened enhancing bowel loops Collapsed IVC Hypoenhancement of liver & spleen Bilateral delayed nephrograms Hyper-enhancement of adrenals

Hypovolaemic shock

What do the following small bowel features suggest? Focal circumferential wall thickening in proximal small bowel May have SBO

Small bowel adenocarcinoma

What do the following small bowel features suggest? Non-obstructing Circumferential wall thickening in small bowel Favours ileum

Lymphoma

Which lymphoma is more common in the small bowel? Which lymphoma is more likely to have a desmoplastic reaction?

NHL HL

What do the following small bowel features suggest? Desmoplastic stranding Mesenteric mass with calcifications Hypervascular liver mets Distal ileum - most common

Carcinoid

What does carcinoid syndrome cause?

Serotonin degrades the heart valves (Right side) causing tricuspid regurgitation

Which nuclear medicine scans are used to diagnose carcinoid?

MIBG Octreotide studies or Ga68 Dotate PET

What is the most common primary cancer to metastasise to the small bowel?

Melanoma

What type of hernia is being described here? Muscle defect at the lateral border of the rectus muscle Along semilunar line

Spigelian hernia/Lateral ventral hernia

What type of hernia is being described here? Superior hernia around the 12th rib, quadratus lumborum and internal oblique

Superior lumbar hernia More common

What type of hernia is being described here? Inferior hernia around latissimus dorsi, external oblique, and iliac crest

Inferior lumbar hernia

What is a Littre hernia? Amyand hernia?

Littre - Hernia with Meckels diverticulum within Amyand - Hernia with appendix within

What type of hernia is being described here? Muscle defect containing only one wall of bowel, no obstruction

Richter hernia High risk for strangulation

What type of hernia is being described here? BG: COPD, Ascites, Pregnancy Bowel herniating between obturator and pectineus muscles

Obturator hernia

What type of hernia is being described here? Inferior to inferior epigastric vessels Medial to common femoral vein Below pubic tubercle

Femoral hernia Compression of the femoral vein is common

What type of hernia is being described here? Medial and anterior to inferior epigastric artery Defect in Hesselbachs triangle Above pubic tubercle

Direct inguinal hernia Compresses inguinal canal, not covered by internal spermatic fascia

What type of hernia is being described here? Lateral and superior to inferior epigastric artery Processus vaginalis open Above pubic tubercle

Indirect inguinal hernia No compression of inguinal canal contents, covered by internal spermatic fascia

What type of hernia is being described here? Most common Defect through descending colon mesentery (LUQ) Cluster of small bowel loops in left anterior pararnal space, behind IMV & Ascending left colic artery

Left sided paraduodenal hernia

What type of hernia is being described here? Defect through ascending colon mesentery (RLQ) Dilated small bowel loops on right, below D3 + Behind SMA displaced anteriorly

Right sided paraduodenal hernia

What do the following small bowel changes suggest? Large and small bowel air filled but not dilated May have air fluid levels but these are few and small

Small bowel ileus

What do the following bowel changes suggest? Dilated loops with air fluid levels

Small bowel obstruction

What is a sentinel loop?

Segment of bowel that is dilated in response to adjacent infection/inflammatory process

What is the most commonly involved segment in Crohn's disease?

Terminal ileum

The following are suggestive of which condition? Squaring of folds Skip lesions Separation of loops due to infiltration of mesentery Cobblestoning Creeping fat sign - mesenteric fat increased String sign - Marked narrowing of terminal ileum with oedema, spasm and fibrosis

Crohns disease

The following bowel changes are suggest what? Favours rectum - retrograde progression Ahaustral colon Diffuse granular appearing mucosa Continuous Ileocaecal valve open Perirectal fat increased

Ulcerative colitis

The following are associated with which bowel disease? Colon cancer Primary sclerosing cholangitis Arthritis

Ulcerative colitis

Ulcerative colitis with enlarged lymph nodes is suggestive of what?

Colon cancer

The following are suggestive of UC or Crohn's? Gallstones Hepatic abscess Pancreatitis

Crohn's disease

The following are suggestive of UC or crohns? Primary sclerosing cholangitis

Ulcerative colitis

The following bowel changes are suggest what? Gaseous dilatation usually transverse colon Lack of haustra Hx of: Crohns, UC, or C.difficile

Toxic megacolon

The following bowel changes are suggest what? Ulcers in penis and mouth GIT - ulcers Pulmonary artery aneurysms

Behcets

The following bowel changes are suggest what? Left sided - Rectosigmoid junction Serosal surface Concentric bowel wall thickening

Epiploic appendagitis

The following bowel changes are suggest what? Right sided Larger mass Oval shape + Central low density

Omental infarct

The following bowel changes are suggest what? Onion sign - layering within cystic mass Region of appendix

Appendix mucocele

What are the causes of pseudomyxoma peritonei?

Mucinous cystadenoma Ruptured mucocele Mucinous neoplasm (Ovary, colon, appendix, pancreas)

The following bowel changes are suggest what? Coffee bean sign - inverted 3 sign Points to RUQ Haustra lost Ascending & transverse colon dilated

Sigmoid volvulus

The following bowel changes are suggest what? Points to LUQ Haustra maintained Small bowel dilated

Caecal volvulus

The following bowel changes are suggest what? Seen in unwell patient or nursing home patients Marked diffuse dilatation of the large bowel, no discrete transition point

Colonic pseudo-obstruction Can progress to bowel necrosis and perforation

The following bowel changes are suggest what? Small or large cysts in the entire colon

Colitis cystica

The following bowel changes are suggest what? Retracted caecum - change in normal bulbous appearance of caecum Involves caecum and ascending colon Spares terminal ileum concurrent liver/spleen or brain abscess

Entamoeba Histolytica

The following bowel changes are suggest what? Affects terminal ileum - narrowed Retracted caecum Caecum pulled up via scarring out of the RLQ Ulcers & areas of narrowing Large necrotic nodes

Colonic TB

The following bowel changes are suggest what? Immunosuppressed patient Deep ulceration

Colonic CMV

Which infections favour the duodenum?

Giardia Strongyloides

Which bowel infections favour the terminal ileum?

TB Yersinia

The following bowel changes are suggest what? Accordion sign - enhancing oedematous mucosa, contrast trapped inside mucosal folds Thumb printing Ulceration & Irregularity

C-Difficile

The following bowel changes are suggest what? Bowel thickening Limited to the caecum Severe neutropenia

Neutropenic colitis (Typhilitis)

What are the causes of colon cancer?

Adenocarcinoma - Most common Squamous cell carcinoma - HPV

What is used to stage rectal cancer?

MRI T2 specifically

What is the most common benign tumour of the colon & rectum?

Adenoma

What is the following describing? Villous adenoma causing mucous diarrhoea Severe fluid and electrolyte depletion Mass in rectum/bowel

McKittrick-Wheelock syndrome

Which structures are retroperitoneal?

D2 & D3 Pancreas except tail Ascending & Descending colon Proximal 1/3 rectum

What is the conduit between the greater and lesser sac called?

Epiploic foramen of winslow

The following peritoneal ligaments allow spread to which organs? Gastrohepatic ligament Gastrosplenic ligament Duodenocolic ligament

Gastrohepatic ligament - Spread from stomach, oesophagus and liver Gastrosplenic ligament - Spread from stomach to splenic hilum Duodenocolic ligament - Spread from right colon to nodes around duodenum/pancreas

The following description suggests which condition? Scalloped appearance of liver Proteinacious ascites

Pseudomyxoma peritonei

What is the most common location of peritoneal carcinomatosis?

Retrovesical space

The following is a sign of what: Posterior displacement of bowel from anterior abdominal wall

Omental caking/seeding

What is the following describing? Mesenteric mass - Cystic unilocular Bowel association

Duplication cyst

What is the following describing? Mesenteric mass - cystic unilocular Surgical site

Lymphocele

What is the following describing? Mesenteric mass - Unilocular Hx of pancreatitis

Pseudocyst

What is the following describing? Mesenteric mass - cystic multilocular

Lymphangioma

What is the following describing? Mesenteric mass - solid + many lesions

Mets, lymphoma, mesothelioma

What is the following describing? Mesenteric mass - Solid single lesion Fat containing

Liposarcoma

What is the following describing? Mesenteric mass - solid single lesion No fat Smooth margins

GIST, Solitary fibrous tumour

What is the following describing? Mesenteric mass - solid single lesion No fat Infiltrative margins Ileum location + Arterial enhancement

Carcinoid

What is the following describing? Mesenteric mass - solid single lesion No fat Infiltrative margins Distorting margins Delayed hyper-enhancement

Desmoid Sclerosing mesenteritis

What does the following bowel appearance suggest? Sandwich sign - lobulated confluent soft tissue mass encasing mesenteric vessels

Mesenteric lymphoma - NHL most common

What does the following bowel appearance suggest? Increased mesenteric fat density entered around jejunal root Few small nodes

Misty mesentery - Mesenteric panniculitis most common Follow up in 6 months to ensure resolution

Which hepatic segment is described here: Left of falciform ligament Left of left hepatic vein Above portal vein Below portal vein

Above PV = Segment 2 Below PV = segment 3

Which hepatic segment is described here: Left of middle hepatic vein Above portal vein Below portal vein

Above PV = 4a Below PV = 4b

Which hepatic segment is described here: Between middle hepatic vein and right hepatic vein Above PV Below PV

Above PV = Segment 8 Below PV = Segment 5

Which hepatic segment is described here: To right of right hepatic vein Above PV Below PV

Above PV = Segment 7 Below PV = Segment 6

Where does the caudate lobe drain into?

IVC directly

What is the most common vascular variant in the liver? What is the most common biliary variant in the liver?

Vascular = Replaced right hepatic artery (Origin from SMA) Biliary = Right posterior segmental into left hepatic duct

What are the MR signal characteristics of the following organs Spleen Pancreas Liver

Spleen = T1 dark, T2 bright Pancreas = T1 brightest structure Liver = T1 bright but less than pancreas

What are the components of fetal circulation?

Placenta Umbilical vein to Liver & Ductus venosus IVC

What is the normal flow of the portal vein?

Hepatopetal flow - directed towards the liver

The following liver lesion findings suggest what? T1 variable T2 dark Does not enhance

Regenerative nodule

What is the process of HCC formation?

Regenerative nodule Dysplastic nodule HCC

The following liver lesion findings suggest what? T1 bright T2 iso to dark Arterial enhancement but no washout

Dysplastic nodule (Pre-malignant)

The following liver lesion findings suggest what? T2 bright Enhancement - Arterial enhancement + rapid washout on PV phase Dark on delayed phase May contain fat

Hepatocellular carcinoma

Why is HCC dark on delayed phase?

Loss of the bile uptake transporter which moves biliary contrast agents into the cells In normal cells = bright

Which type of HCC is bright on delayed phase and why?

Well differentiated HCC Retention of bile uptake transporter function

In an arterial phase study, where is the contrast?

Contrast in hepatic artery + Portal vein NO hepatic vein contrast

In a portal venous phase contrast, where is the contrast?

Hepatic artery Portal vein Hepatic veins

In delayed phase imaging of the liver, where is the contrast?

Hepatocellular contrast, so normal hepatocytes are enhancing - Abnormal cells are dark

What are the contrast phases on MR liver?

Late hepatic arterial phase Portal venous phase Hepatic venous phase

The following liver lesion findings suggest what? Hyperechoic, Posterior enhancement on US Doppler flow in vessels adjacent to lesion but not within Peripheral nodular discontinuous enhancement T2 bright Progressive fill in by 15 mins (Centripetal)

Haemangioma

The following liver lesion findings suggest what? >5 cm Hyperechoic on US Doppler flow in vessels adjacent to lesion Peripheral nodular discontinuous enhancement Progressive fill in by 15 mins

Giant haemangioma

The following liver lesion findings suggest what? <2 cm Rapid flash filling on arterial phase Retain contrast - isodense to blood pool No washout

Flash filling haemangioma

The following liver lesion findings suggest what? Spoke wheel on US doppler Marked arterial enhancement, isointense on PV phase Retains HPB specific contrast T1 & T2 isointense Central scar - delayed enhancement

Focal nodular hyperplasia

What nuclear medicine test can be used to diagnose haemangioma?

Tc 99m RBCs

What nuclear medicine test can be used to diagnose FNH?

Sulfur colloid (Normal or increased uptake) Tc99m HIDA scan (Immediate uptake & delayed clearance)

The following liver lesion findings suggest what? Female on OCP/Male on anabolic steroids Right lobe of liver most common Drop out with in out and out of phase - used to show fat

Hepatic adenoma

The following liver lesion findings suggest what? Cirrhosis Older >50 No calcification Elevated AFP

HCC

The following liver lesion findings suggest what? Younger patient <35 No cirrhosis, normal AFP Central scar, no enhancement + T2 dark Tumour enhancement, calcification

Fibrolamellar subtype of HCC

Of the two liver lesions with central scars, which is being described here? T2 bright Enhancement on delayed phase Mass is sulfur colloid avid

Focal nodular hyperplasia

Of the two liver lesions with central scars, which is being described here? T2 dark No enhancement Mass is gallium avid

Fibrolamellar HCC

What is Cholangiocarcinoma?

Cancer of the bile duct

The following are risk factors for which GI malignancy? PSC, Pyogenic cholangitis, Carol disease, Hepatitis, HIV, Hx of cholangitis, Clonorchis (Liver worms)

Cholangiocarcinoma

The following liver lesion findings suggest what? Mass that enhances on delayed imaging Rim arterial enhancement with patchy progressive enhancement - centripetal filling Liver capsular retraction Biliary ductal dilatation (Unliateral and peripheral, unless central lesion) No tumour capsule

Cholangiocarcinoma

What do HCC v Cholangiocarcinoma do to the portal vein?

HCC = Invades the portal vein Cholangiocarcinoma = Encases the portal vein

What is a Klatskin tumour?

Cholangiocarcinoma that occurs at bifurcation of right and left hepatic ducts

The following liver lesion findings suggest what? Biliary obstruction - shouldering/abrupt tapering on MRCP Hilar mass at confluence of R/L Hepatic ducts

Klatskin tumour

Which cancers are denoted by the following tumour markers: Elevated CEA + CA 199 Elevated CA 199 only Elevated CEA only

Elevated CEA + CA 199 = Cholangiocarcinoma Elevated CEA 199 only = Pancreatic cancer Elevated CEA only = Colon cancer

The following liver lesion findings suggest what? Mulifocal Propensity to bleed Exposure to toxin

Hepatic angiosarcoma

The following liver lesion findings suggest what? Middle aged woman Unilocular/multilocular cystic mass Solid and nodular enhancing component

Biliary Cystadenocarcinoma

The following liver lesion findings suggest what? Middle aged woman Unilocular/Multilocular cystic mass

Biliary cystadenoma or cystadenocarcinoma

What most commonly metastasises to the liver? What causes calcified mets?

Colon cancer Calcified mets = Mucinous neoplasms (Colon, ovary, pancreas)

The following liver lesion findings suggest what? US - Hyperechoic metastases

Hypervascular -- Melanoma, renal, carcinoid, thyroid, choriocarcinoma, islet cell

The following liver lesion findings suggest what? US - Hypoechoic mets

Hypovascular -- Colon, lung, pancreas

The following liver lesion findings suggest what? CT - Low density masses with continuous rim of enhancement US - Multiple lesions + Halo (Target sign)

Hepatic metastases

The following liver lesion findings suggest what? Diffuse periportal hypoechoic infiltration AIDS patient

Kaposi sarcoma

The following liver lesion findings suggest what? US - Anechoic with well defined thin walls Single or multiple <2cm

Simple liver cyst

The following liver lesion findings suggest what? Hypoechoic >2cm Presence of membranes - Water lily Abundant sediment in cysts Daughter cysts Sand storm appearance

Hydatid cyst

The following liver lesion findings suggest what? Young woman Isoechoic to liver Bulging the liver Central scar or spoke wheel on doppler

Focal nodular hyperplasia

The following liver lesion findings suggest what? Round mass with well defined borders Hypoechoic halo of fatty sparing May have haemorrhage, calcification, necrosis Perilesional increased flow

Hepatic adenoma

The following liver lesion findings suggest what? Internal doppler flow or peripheral flow Thin peripheral halo of hypoechogenicity (Capsule)

HCC

The following liver lesion findings suggest what? Hyperechoic on US CT Fat density T1/T2 bright on MR

Hepatic angiomyolipoma

What happens to the liver with the following conditions? ARPKD ADPKD

ARPKD - Fibrosis ADPKD - Cysts

Which condition is associated with the following findings: Multiple AVMs in liver and lungs Cirrhosis Massively dilated hepatic artery

HHT (Osler-Weber-Rendu)

The following liver lesion findings suggest what? Starry sky appearance on US

Hepatitis Due to liver oedema causing fat surrounding portal triads to look brighter than normal

The following liver lesion findings suggest what? Double target sign - central low density, rim enhancement, surrounded by low density - CT.

Pyogenic abscess

What is the most likely cause of: Single liver abscess Multiple liver abscess

Single = Klebsiella Multiple = E.Coli

What is the risk of a left sided amoebic abscess?

Emergency drainage as risk of rupture into pericardium

The following liver lesion findings suggest what? Tortoise shell Irregular nodular liver margins Dystrophic calcifications with fibrous septa in polygonal shape

Schistosomiasis

The following liver lesion findings suggest what? Known PID, RUQ pain Enhancement of anterior liver capsule Perihepatic ascites Peritoneal septations

Fitz Hugh Curtis syndrome

What does the following suggest on CT of the liver? Portal venous phase - HU <100 or 25 HU less than the spleen

Hepatic steatosis

The following in the liver are signs of what condition? US - Liver more hyper echoic than right kidney Drop out on out of phase images on MRI

Hepatosteatosis

What is the difference between hepatosteatosis v NASH

Hepatosteatosis = Fatty liver NASH = Abnormal LFTs and fatty liver

The following in the liver are signs of what condition? Liver & Spleen T1 and T2 dark Liver is darker than muscle on T2 Low signal on in phase, high signal on out of phase

Heamochromatosis

The following suggest primary or secondary haemochromatosis? Genetic Liver & Pancreas Heart, thyroid and pituitary Acquired Liver & Spleen

Primary = Genetic + Liver & Pancreas Heart, thyroid and pituitary Secondary = Acquired + Liver & Spleen

The following in the liver are signs of what condition? Hepatic venous outflow obstruction Intrahepatic & systemic collateral veins Regenerative nodules in dysmorphic liver Caudate lobe enlarged Flip flop pattern - portal phase low attenuation centrally, high peripherally

Budd Chiari

What is Nutmeg liver?

Inhomogenous mottled appearance of liver with delayed enhancement of the periphery of the liver

What is the flip flop pattern?

Arterial - central enhancement, peripheral enhancement is minimal Portal venous - Central washout, peripheral enhancement

The following conditions have which appearance on US? Budd Chiari Hepatic Veno-occlusive disease Hepatic congestion (RHF) Constrictive pericarditis

Nutmeg liver (Inhomogenous mottled appearance of liver with delayed enhancement of the periphery of the liver)

Who gets massive caudate lobe hypertrophy?

Budd Chiari Primary Sclerosing cholangitis Primary biliary cirrhosis

The following in the liver are signs of what condition? Main hepatic veins and IVC patent Portal waveforms abnormal (Slow, reversed)

Budd chiari with occlusion of small hepatic venules

The following in the liver are signs of what condition? Elevated CVP Refluxed contrast into hepatic veins Increased portal venous pulsatility Nutmeg liver

Passive congestion Due to stasis of blood within the liver due to compromise of hepatic drainage, complication of CHF or constrictive pericarditis

What do the following liver findings suggest? Filling defect in the portal vein Development of serpiginous vessels in porta hepatis - reconstitute right and left portal veins

Portal vein thrombosis

What is the distribution of gas in the following: Portal venous gas Pneumobilia

Portal venous gas = Peripheral Pneumobilia = Central

What do the following liver findings suggest? Intra and/or extra hepatic bile duct strictures & focal dilation - Beaded appearance Cirrhosis Central regenerative hypertrophy Withered tree - on MRCP from abrupt narrowing of branches

Primary sclerosing cholangitis

What do the following liver findings suggest? Intrahepatic and/or extra hepatic multifocal strictures Papillary stenosis

AIDS Cholangiopathy

What do the following liver findings suggest? Dilated biliary ducts full of pigmented stones Straight rigid intrahepatic ducts

Recurrent pyogenic cholangitis

What do the following liver findings suggest? Middle aged woman Destruction of small/medium intrahepatic bile ducts Normal extra hepatic ducts Lace like pattern of fibrosis

Primary biliary cirrhosis

What do the following liver findings suggest? CBD and pancreatic duct fuse prematurely at level of pancreatic head Associated with focal dilatation of CBD (Type I Choledococysts)

Long common channel

What are choledochal cysts?

Congenital dilatations of the bile ducts, classified into 5 types

Which type of choledochal cyst is most common?

Type 1 - focal dilatation of the CBD

The following describe which biliary disease? Diverticulum of the bile duct Choledochocele Focal dilatation of the CBD Both intra and extra-hepatic focal dilatation Intrahepatic duct dilatation

Type 1 - Focal dilatation of the CBD Type 2 - Diverticulum of the bile duct Type 3 - Choledochocele Type 4 - Both intra and extra-hepatic focal dilatation Type 5/Caroli's - Intrahepatic duct dilatation

What do the following liver findings suggest? Associated with PKD & Medullary sponge kidney Intrahepatic duct dilatation, large and saccular Central dot sign - portal vein with surrounding dilated bile ducts

Carolis disease Type 5

What are the complications of Carolis disease?

Cholangiocarcinoma Cirrhosis Cholangitis Intraductal stones

What do the following GB findings suggest? Clean US posterior acoustic shadow Hyperechoic focus within the GB

Gallstone

What is the common cause of gallstones in children?

Sickle cell disease

What do the following GB findings suggest? Sonographic murphy sign Dilatation of the GB >4cm width Increased wall thickness

Acute cholecystitis

What do the following GB findings suggest? Sloughed membrane/cobwebs Impacted gallastone

Gangrenous cholecystitis Necrosis of the GB wall

What do the following GB findings suggest? Elderly diabetic patient Dirty shadowing

Emphysematous cholecystitis - Gas forming organisms in GB wall & Lumen

What do the following GB findings suggest? Thick GB wall Adjacent fluid Unwell patient

Acute calculus cholecystitis

What does the following describe Common hepatic duct obstructed secondary to impacted cystic duct stone Increased incidence of GB cancer

Mirizzi

What is Bouveret syndrome?

Gastric outlet obstruction due to impaction of gallstone in the pylorus or proximal duodenum

What do the following GB findings suggest? Hypertrophied mucosa & muscularis Cholesterol crystals deposited in intraluminal location - with rokitansky aschoff diverticulae Comet tail artifact

Gallbladder Adenomyomatosis

What do the following GB findings suggest? Cholesterol and triglyceride deposition within the substance of the lamina, associated formation of cholesterol polyps

Gallbladder cholesterolosis

What do the following GB findings suggest? Extensive wall calcification Increased risk of GB Cancer

Porcelain gallbladder

What do the following GB findings suggest? <5 mm Pedunculated & Multiple Comet tail artifact on US

Benign Gallbladder polyps

What do the following GB findings suggest? >1cm Sessile & Solitary Enhancement on CT/MR Flow on doppler

Malignant gallbladder polyp

What is the following describing? Slowed systolic upstroke Decreased systolic velocity

Tardus parvus

The following are signs of what? Elevated PSV Spectral broadening

Direct signs of stenosis

The following are signs of what? Tardus parvus downstream RI upstream elevated

Indirect signs of stenosis

The following cause what in the liver? Tricuspid regurgitation Right sided CHF

Hepatic vein pulsatility

What causes hepatic vein pulsatility?

Cirrhosis Hepatic venous outflow obstruction

The following cause what in the liver? Right sided CHF Tricuspid regurgitation Cirrhosis with vascular AP shunting

Portal vein pulsatility

What are the causes of portal vein reversed flow?

Portal HTN

The following cause what in the portal vein? Thrombosis Tumour invasion Stagnant flow from terrible portal HTN

Absent portal vein flow?

What are the causes of slow portal vein flow? Pre- Intra- Post

Pre - Portal vein thrombosis Intra - Cirrhosis Post - R CHF, Tricuspid regurgitation, Budd-Chiari

How does the pancreas appear on: US MR

US - Echogenicity > than normal liver MR - Brightest organ on T1

What do the following pancreas findings suggest? Pancreatic fibrosis - Low T1 & T2 Fatty replacement increased T1

Cystic fibrosis Due to inspissated secretions causes proximal duct obstruction

What do the following findings suggest? Complete fatty replacement of pancreas (Pseudohypertrophy of pancreas) Fibrosing colonopathy (Wall thickening of proximal colon)

Cystic fibrosis

What do the following findings suggest? Pancreatic insufficiency in child Short stature (Metaphyseal achondroplasia) Eczema Lipomatous pseudo hypertrophy of the pancreas

Schwachman-Diamond syndrome

What is the following pancreatic finding describing? Fat density pancreas Does not have a pancreatic duct

Pancreatic agenesis

What is the following pancreatic finding describing? Fat density pancreas Pancreatic duct present

Pancreatic lipomatosis

The following are causes of what condition? Cushing syndrome Chronic steroid use Hyperlipidemia Schwachman-Diamond Syndrome

Pancreatic lipomatosis

What do the following pancreas findings suggest? Absent dorsal pancreas (Tail & Body) Polysplenia Diabetes

Dorsal pancreatic agenesis

What do the following pancreas findings suggest? Pancreas encases the duodenum - annular duct Duodenal obstruction

Annular pancreas

What is the next stage if a pancreatic duct injury is suspected?

MRCP ERCP

What are the possibilities in a non-necrotic pancreatitis?

Acute peripancreatic fluid collection Psuedocyst

What are the possibilities in necrotic pancreatitis?

Acute necrotic collection Walled off necrosis

What are the vascular complications of pancreatitis?

Splenic vein & Portal vein thrombosis Pseudoaneurysm of GDA & Splenic artery

What are the non-vascular complications of pancreatitis?

Abscess, infection

What is the normal course of the pancreatic ducts?

2 ducts (Major & Minor) Major duct drains into the inferior of the 2 duodenal papilla (Major papilla) Minor duct drains into superior of 2 duodenal papilla (Minor papilla)

What does the following describe? Main portion of the pancreas is drained by the minor or accessory papilla

Pancreatic divisum

What do the following pancreas findings suggest? Loss of T1 pancreas signal Delayed pancreatic enhancement Dilated side branches

Early chronic pancreatitis

What do the following pancreas findings suggest? Small uniformly atrophic, may have focal enlargement Pseudocyst formation Dilatation and beading of pancreatic duct with calcifications

Late chronic pancreatitis (>4 weeks)

What do the following pancreas findings suggest? Older female Heterogenous, mixed density lesion made up of multiple small cysts Pancreatic head No communication with pancreatic duct May have central scar +/- central calcifications

Serous cystadenoma (Benign)

What syndrome are serous cyst adenomas associated with?

VHL

What do the following pancreas findings suggest? Middle age woman Body and tail No communication with pancreatic duct Unilocular or septated

Mucinous cystic neoplasm (Pre-malignant)

What do the following pancreas findings suggest? Young female Large thick capsule Tail of pancreas Progressive fill in of solid portions

Solid Pseudopapillary tumour of the pancreas (SPEN)

What do the following pancreas findings suggest? Elevated IgG4 Sausage shaped pancreas Loss of pancreatic high T1 signal Capsule with delayed rim enhancement around gland No duct dilatation No calcifications

Autoimmune pancreatitis (IgG4)

What do the following pancreas findings suggest? Soft tissue within the pancreaticoduodenal groove with/without delayed enhancement Duodenal stenosis and/or structures of CBD Little/No biliary obstruction

Groove pancreatitis

What do the following pancreas findings suggest? Young age at onset Multiple large calculi within a dilated pancreatic duct

Tropic pancreatitis or Hereditary pancreatitis

The following findings are suggestive of which - Autoimmune pancreatitis v Chronic pancreatitis No ductal dilatation No calcifications Ductal dilatation Ductal calcifications

Autoimmune pancreatitis = No ductal dilatation No calcifications Chronic pancreatitis = Ductal dilatation Ductal calcifications

What do the following pancreas findings suggest? Small cystic mass in head/uncinate process May have main duct enlargement if large amounts of mucin

Side branch IPMN

What do the following pancreas findings suggest? Produces diffuse dilatation of the main duct Atrophy of gland & dystrophic calcifications Fish mouth ampulla on endoscopy

Main branch IPMN

Are the following benign or malignant features of IPMN: Main duct >10 mm Diffuse or multifocal involvement Enhancing nodules Solid hypovascular mass

Malignant IPMN

Which type of IPMN is most likely to be malignant?

Main brain IPMN

Which of the following are hypo vascular v hyper vascular? Pancreatic ductal adenocarcinoma Islet cell/Neuroendocrine pancreatic cancer

Pancreatic ductal adenocarcinoma - Hypovascular Islet cell/Neuroendocrine pancreatic cancer - Hypervascular

What do the following pancreas findings suggest? Double duct sign Hypoenhancing mass with poorly demarcated borders Low T1 signal mass

Pancreatic adenocarcinoma

What do the following pancreas findings suggest? Origin within 2 cm of major papilla Hypoenhancing mass with poorly demarcated borders

Periampullary tumour

What do the following pancreas findings suggest? Hyperenhancing - Brisk early arterial enhancement Mass in the pancreas

Islet cell/Neuroendocrine tumour

Which type of Neuroendocrine tumour is associated with MEN1?

Gastrinoma

What do the following pancreas findings suggest? Solitary, small <2cm Benign Hyperenhancing - Brisk early arterial enhancement Mass in the pancreas

Insulinoma

What do the following pancreas findings suggest? Hyperenhancing - Brisk early arterial enhancement Mass in the pancreas Increased gastric output and ulcer formation

Gastrinoma

What do the following pancreas findings suggest? Mass in the pancreas Follows spleen (Dark on T1, Bright on T2 - relative to the liver) Restrict diffusion Tiger striped mass on arterial phase

Intrapancreatic accessory spleen

Which nuclear medicine scan is used to assess intrapancreatic accessory spleen?

Heat treated RBCs - tracer uptake Sulfur Colloid - tracer uptake

The following are removed as part of what procedure? Resection of pancreatic head, duodenum, gastric antrum, gallbladder - Jejunal loop brought to RUQ for connection with stomach, CBD/Liver, and Pancreas

Whipples

Where does the blood supply for a pancreatic transplant come from?

Arterial: - Donor SMA - Donor splenic artery Venous: - Donor portal vein - Recipient SMV

What are the common complications of pancreatic transplant?

Acute rejection within 6 weeks Donor splenic vein thrombosis***

What do the following pancreatic findings suggest: Pancreatic transplant Reversed diastolic flow

Venous thrombosis and acute rejection

What does the following suggest in a pancreatic transplant patient? Shrinking transplant

Chronic rejection - graft progressively gets smaller in size

What do the following spleen findings suggest: Bright on T2 relative to liver Dark on T1 relative to liver Restricted diffusion

Normal spleen

What is a wandering spleen?

Spleen that is an unexpected location, due to laxity in peritoneal ligaments holding the spleen

What are the complications of a wandering spleen?

Torsion + Infarction Chronic partial torsion can lead to gastric varices

What is the most common solid organ injured in trauma?

Spleen

What do the following spleen findings suggest: Post trauma Multiple spherical nodules in peritoneal cavity

Splenosis

What do the following spleen findings suggest: Splenomegaly Numerous discrete 1-2cm hypodense nodules

Sarcoidosis

What do the following spleen findings suggest: T2 dark multiple small foci in the splenic parenchyma Portal HTN

Gamma Candy bodies - small foci of haemorrhage (Siderotic nodules)

What do the following spleen findings suggest: Multiple blood filled cyst like spaces May also be in the liver Women on OCP, or men on anabolic steroids

Peliosis

What do the following spleen findings suggest: Dilatation of the splenic artery - saccular Mid-distal artery

Splenic artery aneurysm

What do the following spleen findings suggest: Wedge shaped Peripheral Low attenuation defects

Infarction Associated with sickle cell disease

What do the following spleen findings suggest: Multiple round calcifications

Histoplasmosis

The following cause what in the spleen? Histoplasmosis TB Brucellosis

Multiple round calcifications

What do the following spleen findings suggest: Solitary >2cm round calcifications Low density centre encircled by calcification (Bullseye)

Brucellosis

What is the most common cause of splenic abscess?

Salmonella

What is the splenic size in these conditions? Sickle cell Post radiation Malabsorption syndromes

Small spleen

What is the splenic size in these conditions? Passive congestion (Heart failure, portal HTN, Splenic vein thrombosis) Lymphoma Leukemia Gauchers Feltys syndrome

Splenomegaly

The following indicate which syndrome? Splenomegaly Rheumatoid arthritis Neutropenia

Feltys syndrome

What do the following spleen findings suggest: Cystic focus in spleen No epithelial lining Thick wall Prominent peripheral calcifications

Post traumatic cyst (Pseudocyst)

What do the following spleen findings suggest: Epithelial lining Cystic focus in spleen Solitary & Peripheral calcifications

Epidermoid cyst

What do the following spleen findings suggest: Smooth well marginated lesion Contrast uptake and delayed washout Peripheral nodular discontinuous enhancement

Haemangioma

What do the following spleen findings suggest: Hypodense/Isodense Moderate heterogenous enhancement Hyperdense if haemosiderin deposition

Hamartoma

What do the following spleen findings suggest: Multiple small foci Hypoattenuating on late portal phase MR - T1 & T2 low signal

Littoral cell angioma

Which is the most common malignant mass in the spleen?

Angiosarcoma

What do the following spleen findings suggest: Poorly defined area of heterogeneity Low density in enlarged spleen Necrosis Poor contrast enhancement

Angiosarcoma

What do the following spleen findings suggest: Splenomegaly Low density on CT T1 dark PET Hot

Lymphoma

What is the most common primary that mets to the spleen?

Melanoma

What is the following describing? Treat oesophageal varices Shunt to divert blood around the liver Improves oesophageal varices and ascites

TIPS (Transjugular intrahepatic portosystemic shunt)

What is the following describing? Treat gastric varices with gastro-renal shunt Embolise collaterals to drive blood into river Improves hepatic encephalopathy

BRTO (Balloon occluded retrograde transverse obliteration)

What is the following describing? Post ablation Low grade fever and body aches post ablation

Normal post ablation syndrome - no infection

What is the following describing? Post ablation 2-3 weeks prior Persistent fever

Infection

What is the puncture location for a nephrostomy?

Lower pole of a posteriorly oriented calyx - to go through Brodels avascular zone

The following is an indication for what procedure: CBD obstruction (Failed ERCP), cholangitis, bile duct/injury

Percutaneous biliary drainage

The following is an indication for what procedure: Cholecystitis in patients who are not surgical candidates. Septic

Percutaneous Cholecystostomy

The following is an indication for what procedure: Performed prior to percutaneous biliary intervention, liver transplant patients with suspected obstruction

Percutaneous trans hepatic cholangiography (PTC)

What do the following findings suggest? contrast-enhanced CT liver nodules appear as hypoattenuating masses on MRI the lesions are hypointense on all sequences and hypoenhancing relative to the background parenchyma Elevated ACE + ALP Liver lesions

Liver sarcoid

What is the best MRI sequence for anal fistula

T1 post contrast or STIR

What does the following describe? Ultrasound Cavernous transformation of the portal vein and the dilatation of bile ducts MRI biliary stenosis wavy appearance of the bile ducts angulation of the CBD upstream dilatation of the bile ducts

Portal biliopathy

What do the following findings suggest? Liver lesions CT - Hypoattenuation with no enhancement, may have enhancing nodule/rim MRI - T1 low T2 High No contrast enhancement No diffusion restriction

Biliary Hamartoma

What do the following findings suggest? Multiple osteomas - mandible/maxilla/skull GI polyps

Gardner syndrome (Variant of FAP)

What does the following describe? Fistula crosses intersphinteric space and does not cross the external sphincter

Intersphincteric rectal/anal fistula (Most common)

What does the following describe? Fistula crosses intersphincteric space, through external sphincter into the ischiorectal fossa

Transsphincteric rectal/anal fistula

What does the following describe? Fistula passes superiorly into the intersphincteric space, over top of puborectalis muscle, through illiococcygeus to skin

Suprasphincteric rectal/anal fistula

What does the following describe? Fistula crosses from perineal skin through ischiorectal fossa and levator ani muscle complex into rectum

Extrasphincteric rectal/anal fistula

What type of contrast agents are the following? Gadovist + Dotarem + Prohance Primovist + Multihance

Gadovist + Dotarem + Prohance (Extracellular contrast agents) Primovist + Multihance (HPB Contrast agents)

What does the following describe? Peripheral arterial nodular enhancement with centripetal filling

Haemangioma

What do the following features describe? Hx of recent travel Large solitary lesion Thick nodular walls

Amoebic abscess

What does the following describe? Lower/Middle 1/3 oesophagus Calcification

Oesophageal Leiomyoma

What type of gastric cancer is H.Pylori associated with? And has larger nodes than gastric cancer

MALT Lymphoma

Which of the following are not included in the BCSP CT colonography protocol? Gas insufflation Faecal tagging Buscopan >2 patient positions IV Contrast

IV Contrast

When is IV contrast used for CT Colonography?

For symptomatic CT Colonography

The following favour which presentation diverticular disease or colon cancer? Long segment >10 cm Diverticulae not obscured/obliterated Tapered margins Wall thickening (Milder) Vascular engorgement

Diverticular disease

The following favour which presentation diverticular disease or colon cancer? Shorter segment involvement Diverticulae adjacent to but not in affected segment Shouldering Wall thickening +++

Colon cancer

What is the following describing Pancolitis Haustral thickening Accordion sign

Pseudomembranous colitis

What is the difference between Mallory Weiss tear v Boerhaave syndrome?

Boerhaave = transmural disruption of oesophageal wall with blood into mediastinum/pleural space Mallory Weiss tear = Mucosal & Submucosal tear of oesophagus - Haematemesis

What are the conditions which cause pneumatosis intestinalis?

C - COPD I - Ischaemia P - Pneumatosis cystoides intestinalis S - Scleroderma/Steroids

What causes the stacked coin appearance in the bowel?

Intra-mural bleeding Vasculitis HSP

What is the most specific v sensitive finding for appendiceal perforation?

Sensitive = Wall defect Specific = Abscess formation

What is the staging used for oesophageal cancer?

Endoscopy or barium swallow if unfit CT thorax/abdomen with contrast; PET-CT if curative intent

The following are regional lymph nodes for which cancer? Coeliac axis Paraoesophageal LN

Oesophageal cancer

What are the distant mets for oesophageal cancer?

Supraclavicular + Retroperitoneal nodes

What is the staging imaging for stomach cancer?

CT thorax/abdomen/pelvis

The following are regional LN for which cancer? Peri-gastric Coeliac axis

Stomach cancer

Gastrointestinal Flashcards

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