Esophageal cancer: Name the type - Mid esophagus? Lower esophagus? - Smoker/drinker? - H/o caustic/alkaloid ingestion - Barretts? - H/o chronic reflux despite PPI use?

- Squamous = mid esophagus, drinker/smoker, caustic ingestion - Adeno = Lower esophagus, reflux/PPI use, Barretts

Cricopharyngeus - What is it? - Separates what two structures?

- Cricopharyngeus = “true upper esophageal sphincter” - Separates “hypopharynx” and “cervical esophagus”

Cause of achalasia: - General mechanism - Underlying pathophysiology

- Caused by failure of LES to relax - Loss/destruction of neurons in the AUERBACH/myenteric plexus

"Ringed esophagus" on esophagram - Young person, long standing dysphagia... dx? - Treatment?

- Eosinophilic esophagitis - PPIs will have failed; treat with steroids

- What is Zollinger-Ellison? - Who gets it?

- Peptic ulcer dz due to gastrinomas (gastrin causes hypersecretion of acid) - MEN 1 3 P's = - Pancreatic islet cell tumors (like gastrinomas) - Pituitary adenomas - hyper-Parathyroidism)

DNA mismatch repair... - Name the syndrome - This causes?

- Lynch syndrome or Hereditary Non-Polyposis Syndrome (HNPCC) - Colon cancer, endometrial cancer, others

Gastrointestinal Flashcards by Matt Mader

Fluoro: Esophagus

Reticulated mucosal pattern
Lace-like pattern associated with a stricture

Barrett’s esophagus

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Fluoro: Esophagus

Plaque-like lesions
Linear or irregular filling defects, longitudinally oriented
Shaggy

Candidiasis

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Who gets candidiasis (esophagus)

Immunocompromised - HIV, transplant

- Motility disorder - achalasia, scleroderma

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Looks like candidiasis (esophagus), but asymptomatic elderly person

Glycogenic acanthosis

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Esophageal cancer: Name the type

Mid esophagus? Lower esophagus?
Smoker/drinker?
H/o caustic/alkaloid ingestion
Barretts?
H/o chronic reflux despite PPI use?

Squamous = mid esophagus, drinker/smoker, caustic ingestion
Adeno = Lower esophagus, reflux/PPI use, Barretts

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Types of Hiatal Hernia?

Type 1 = sliding
Type 2 = GE stays in place, fundus herniates
Type 3 = GE and fundus herniate
Type 4 = Type 3 + other organ (eg bowel)

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Cricopharyngeus

What is it?
Separates what two structures?

Cricopharyngeus = “true upper esophageal sphincter”

- Separates “hypopharynx” and “cervical esophagus”

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Pulsion vs traction diverticulum

Shape?
Which empties? And why?

Traction = triangular; usually related to scarring, fixing part of the esophagus in place; this will still empty because it has muscle

Pulsion = round; will NOT empty, because it contains no muscle in the walls

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Esophageal diverticula:
Zenker vs Killian-Jamieson
- Location?

Posterior wall, above cricopharyngeus (ie hypopharynx)

- Anterior and lateral wall, below cricopharyngeus (ie cervical esophagus)

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Epiphrenic diverticulum vs para-esophageal hernia:

- laterality (LEFT vs RIGHT)?

Tic = Right
Hernia = Left (fundus lies to the left)

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DDX: dilated esophagus (3 dx?)

Achalasia (primary/idiopathic or Chagas) - BIRD BEAK
Pseudoachalasia - ie cancer at GE junction
Scleroderma

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Differentiate achalasia from pseudoachalasia on imaging?

Achalasia will eventually relax;

Pseudo WON’T relax - FIXED OBSTRUCTION

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Lungs show GGO with subpleural sparing
Esophagus is dilated

dx?
descriptor for lung pattern…

Scleroderma

NSIP

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3 complications/sequelae of achalasia

Cancer (usually mid esophagus, usually squamous cell)
Candida
Aspiration

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Fluoro: Esophagus

Dilated submucosal glands in the setting of chronic reflux esophagitis

Pseudodiverticulosis

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Types of motility disorders?

Primary vs secondary

Primary = achalasia or idiopathic

- Secondary = systemic disease (scleroderma is most common); related to reflux

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Cause of achalasia:

General mechanism
Underlying pathophysiology

Caused by failure of LES to relax

- Loss/destruction of neurons in the AUERBACH/myenteric plexus

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Dilated submucosal glands causing hairlike projections on esophagram:

dx/name?
underlying path?

Pseudodiverticulosis

- Chronic reflux esophagitis

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“Ringed esophagus” on esophagram

Young person, long standing dysphagia… dx?
Treatment?

Eosinophilic esophagitis

- PPIs will have failed; treat with steroids

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I say jejunal ulcer, you say??

Zollinger-Ellison

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What is Zollinger-Ellison?

- Who gets it?

Peptic ulcer dz due to gastrinomas (gastrin causes hypersecretion of acid)
MEN 1

3 P’s =

Pancreatic islet cell tumors (like gastrinomas)
Pituitary adenomas
hyper-Parathyroidism)

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Young pt s/p total colectomy develops locally invasive tumor… wtf?

FAP, desmoid

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DNA mismatch repair…

Name the syndrome
This causes?

Study These Flashcards

Lynch syndrome or Hereditary Non-Polyposis Syndrome (HNPCC)
Colon cancer, endometrial cancer, others

Carney’s triad?

Study These Flashcards

Carney Eats Garbage

Chondromas (pulmonary)
Extra-adrenal pheos
GIST

Who gets GISTs... - What age group? - What syndromes?

- Old people; rare before 40's | - NF-1 and Carney Triad

Diffuse infiltration of the stomach with contracted desmoplastic appearance... - Name? - Cause?

- Linitis plastica | - Think breast or lung cancer

Giant mucosal folds involving the fundus, sparing the antrum...?

Menetrier's disease | - Bimodal disease (linked to CMV in kids)

Immediate postprandial abdominal pain, tachycardia, faintness, nausea... patient had "stomach surgery"... - What surgery did they have? - How do you treat?

- Billroth 2 | - Low carb diet and/or conversion to Roux-en-Y

- Markedly dilated small bowel + absent pancreas in an adult... dx? - What if it's a baby?

- DIOS = distal intestinal obstruction syndrome - Cystic fibrosis (hence pancreas) with distal obstruction from inspissated material - Meconium ileus in a baby

Absent/fatty replaced pancreas (with pancreatic insufficiency) + short stature (NOT CF)

Schwachman-Diamond

What is gleevac? - Mechanism? - Treats?

- tyrosine kinase inhibitor | - tx for GIST

Jejunal-ileal fold reversal + intussusception

Celiac sprue

Cystic pancreatic lesion: MACROcystic with thick wall septations + PERIPHERAL calcifications - dx? - demographic? - benign or malignant?

- Mucinous cystic neoplasm - Middle aged women... Mucinous = mother = MACRO (big MOTHER fucker) - Premalignant --> mucinous cystadenocarcinoma

Cystic pancreatic lesion: MICROcystic/HONEYCOMBED cyst with CENTRAL scar and calcifications - dx? - demographic? - benign or malignant?

- Serous cystic neoplasm - OLD women... serous = silly old fart (grammy) - Benign, but can grow and cause issues

- What cystic pancreatic lesion do daughters (20s-30s) get? - Where? - What does it look like?

- Solid pseudopapillary epithelial neoplasm - Pancreatic head - Solid tumor with cystic/necrotic components

Pancreas: - Where are the CALCIFICATIONS in a MUCINOUS cystic neoplasm? - SEROUS cystic neoplasm?

- Mucinous = peripheral (big "MOTHER" F'ing MACROcysts with peripheral calcs) - Serous = central (SENTRAL scar/calc with SMALL microcysts)

GI findings look like Crohns, but CT chest shows pulmonary artery aneurysms... - Dx? - Other classic findings?

- Behcet's disease (vasculitis) | - Oral and genital ulcers

Cecum is folded anteromedially (NOT rotated), resulting in marked distention of the cecum...

Cecal BASCULE

Large hepatic mass with central scar: | - Classic differential?

FNH vs fibrolamellar HCC

FNH vs fibrolamellar HCC - Scar characteristics? - Which has calcification? - Helpful nuclear medicine scans?

FNH: T2 BRIGHT scar, delayed enhancement (scars enhance); NO calcs; SULFUR COLLOID uptake FL HCC: T2 DARK scar (black hole of death), NO ENHANCEMENT; +/- CALCS; GALLIUM uptake

- Hepatic adenoma in male+steroids or glycogen storage disease? - Risks?

- BETA CATENIN (CTNNB1 mutation) - GREATEST risk of malignant degeneration (HCC) - Can bleed (like inflammatory adenomas)

- What type of adenoma demonstrates signal dropout on opposed phase imaging? - Risks?

- HNF1-alpha mutated (mutation causes lipogenesis/fat deposit) - Generally low risk of bleeding/malignant degeneration

Why to FNHs take up SULFUR COLLOID??

Kupffer cells (reticuloendothelial cells lining hepatic sinusoids)

Types of hemochromatosis - extrahepatic sites of involvement?

``` “P”rimary = “P”ancreas involved (signal dropout on in phase) “S”econdary = “S”pleen involved (signal dropout on in phase) ``` Primary also involves... heart, thyroid, pituitary

Hemochromatosis which involves the heart...?

Primary

Infant with thrombocytopenia (+/- anemia) and a big vascular lesion... dx?

Kasabach-Merritt | Platelet sequestration in a hemangioma (or maybe a Kaposiform hemangioendothelioma)

Cancer by tumor markers: - CEA(+)? - CA19-9(+)? - CEA(+) and CA19-9(+)?

- CEA(+) = colon - CA19-9(+) = pancreas - CEA(+) and CA19-9(+) = cholangiocarcinoma

“Double rim sign” - Describe - Classic dx?

- Fluid collection with rim enhancement surrounded by halo of hypodensity/edema - Pyogenic liver abscess

Important pressures (mmHg) for portal hypertension

Hepatic venous pressure gradient (HVPG) - HVPG >10 mm Hg = clinically significant PHTN (dx of PHTN at 6-8 mm Hg) - HVPG >12 mm Hg = increased risk for variceal bleeding + ascites

Femoral vs inguinal hernia

- Femoral is ENTIRELY LATERAL to the pubic tubercle | - Medial to femoral vein with compression of femoral vein

Ddx: HYPER-enhancing hepatic mets?

``` Neuroendocrine Renal cell Thyroid Melanoma Sarcoma ```

Scattered hepatic cysts with central enhancing vessel

aka "Central dot sign" - Caroli disease - Dilated biliary cystic spaces surround portal vessels

Types of choledochal cysts?

``` 1 = focal dilatation of CBD 2 = CBD diverticulum 3 = choledochocele 4 = both intra/extra bil dil 5 = ONLY intra bil dil (Caroli disease) ```

What is a choledochocele?

Cystic dilatation of the distal CBD within the duodenal wall

Early hyperenhancement of hepatic segment 4... - name of sign? - what causes this?

- Hot quadrate sign (classically Tc99m sulfur colloid scan; CTs as well) - SVC obstruction; portosystemic shunting through the "superior vein of Sappey"

Hilar cholangiocarcinoma = aka?

Klatskin tumor

Gastrointestinal Flashcards

(56 cards)