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Flashcards in GI Deck (81)
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1

posterior impression on esophagus

aberrant subclavian
vascular ring (double aortic arch)
(if high, DISHphagia)

2

what's the liver disease associated with ulcerative colitis? What are the risks?

Primary sclerosing cholangitis. May lead to cirrhosis, increased risk of cholangiocarcinoma.

3

What's the anatomy of Bilroth I? Bilroth II? What are complications?

Bilroth 1: antrectomy anastomosis to duodenum
Bilroth 2: antrectomy anastomosis to jejunum, risk for aferent loop syndrome
Done for gastric carcinoma

4

What's afferent loop syndrome?

uncommon complication following a Billroth II
Most are mechanical obstruction of the afferent loop from adhesions, kinking at the anastomosis, internal hernia, stomal stenosis, malignancy, or inflammation surrounding the anastomosis
Obstruction -> back pressure from dilated -> bil dil and acute pancreatitis.
Dx: hepatobiliary nucs study

5

Ddx of desmoplastic reaction in mesentary

Retractile mesenteritis
desmoid tumor
(desmoplastic) carcinoid (met)

6

Ascites with scalloping of organs (liver, spleen, etc.)

Pseudomyxoma peritonei: intraperitoneal accumulation of a gelatinous ascites secondary to rupture of a mucinous tumour. The most common cause is a ruptured mucinous tumour of the appendix / appendiceal mucocoele

7

Ddx hypervascular splenic lesions

Mets: Melanoma, RCC, endometrial, carcinoid
Lymphoma
angiosarcoma
hemangioma, hamartoma, sarcoid
Fungal infxn

8

Ddx hepatic lesion with central scar

FNH (benign hamartomarous - central scar is AVM)
Hepatic adenoma
Giant cavernous hemangioma
Fibrolamellar HCC
Mets

9

Causes of pneumatosis intestinalis

primary (15%)
ischemia, trauma, infection, pulmonary (COPD), colonic obstruction, artificial ventilation, collagen disease, steroid therapy

10

Portal venous gas in adult Ddx

mesenteric ischemia (eg occlusion), diabetes, mesenteric vein thrombosis, hemorrhagic pancreatitis, diverticulitis, pelvic abscess, perforated gastric ulcer, necrotic colon cancer, ingestion of corrosive substances

11

Ddx for solid pancreatic masses

adenocarcinoma
islet cell tumor
SPEN (young women)
lymphoma
microcystic (serous) adenoma
mets

12

Ddx echogenic liver masses

Hemangioma (70%)
mets
HCC
fatty change

13

What liver mass is associated with hormonal contraceptives? What do we do when it's diagnosed?

Hepatic adenoma
common in young women
remove them - risk of rupture

14

Ddx hepatic cysts

simple cyst
traumatic cyst
echinococcal
abscess
biliary cystadenoma (septa may calcify)
(cystadenoma, mesenchymal hamartoma, emryonal sarcoma)

15

Ddx cystic pancreatic masses

pseudocyst
abscess
congenital (PCKD, VHL)
microcystic adenoma (grandmother)
mucinous cystic adenoma/carcinoma (mother)
SPEN (daughter)
IPMT (grandfather)
islet cell

16

what MRI contrast agent to look for FNH

eovist

17

Ddx Gastric mass: intramural/extramucosal

GIST, leiomyoma/sarcoma, neurogenic tumor, heterotopic pancreas, carcinoid, fibrous tumor, granuloma

18

Ddx thickened gastric folds

Gastritis-Hypertrophic, H. Pylori
Menetrier’s disease
Zollinger Ellison syndrome
Varices
Lymphoma
(post-radiation, Crohn, sarcoid, gastric, mets, eosinophilic gastritis, amyloid)

19

What's Zollinger-Ellison?
What syndrome is it associated with?

Gastrinoma with excessive secretion of acid into the stomach, initial manifestations is with peptic ulcer disease (PUD) with multiple recurrent and intractable ulcers, often in unusual locations
Also get diarrhea
assoc. with MEN I

20

What's menetrier disease?

a form of rare idiopathic hypertrophic gastropathy, most commonly affecting fundus with massively thickened folds -
it causes protein loss
*increased risk of gastric cancer

21

Ddx pancreatic lipomatosis

CF, obesity, malnutrition, steroids/Cushing syndrome

22

Gastric polyps - what types and what would each be associated with?

adenomatous (usually antral)
Hyperplastic (gastritis)
Hamartomatous (Peutz-Jeghers)
Fundic Gland (FAP)

23

What's Peutz–Jeghers syndrome?

multiple hamartomatous polyps, most commonly involving the small intestine, but also colon and stomach
mucocutaneous pigmentation involving the mouth, fingers and toes

24

Ddx for mid-esophageal stricture

caustic injestion
reflux esophagitis
radiation
prolonged tube
eosinophilic esophagitis
carcinoma (primary or mets)
pill esophagitis

25

Ddx thickened bowel wall / bowel wall thickening

enteritis, radiation, ischemia (including shock bowel), hemorrhage, ACE angioedema

26

Ddx for aneurysmal dilatation prior to small bowel stricture

lymphoma, Crohn's dz, TB

27

Ddx gastric antral stenosis

TB, sarcoid, caustic, gastric cancer, mets, lymphoma, eosinophilic gastroenteritis, radiation

28

Ddx multiple gastric antral ulcers

erosive gastritis (meds, H. pylori), mets (melanoma, breast, Kaposi's, lymphoma), Crohn's dz

29

Ddx colonic "thumbprinting"

C. diff colitis, Crohn's, UC, ischemic bowel, (if also in small bowel, graft-vs-host)

30

Organs involved in primary hemachromatosis:

Liver, pancreas, heart