Flashcards in GI Deck (81)
posterior impression on esophagus
vascular ring (double aortic arch)
(if high, DISHphagia)
what's the liver disease associated with ulcerative colitis? What are the risks?
Primary sclerosing cholangitis. May lead to cirrhosis, increased risk of cholangiocarcinoma.
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
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
Ddx of desmoplastic reaction in mesentary
(desmoplastic) carcinoid (met)
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
Ddx hypervascular splenic lesions
Mets: Melanoma, RCC, endometrial, carcinoid
hemangioma, hamartoma, sarcoid
Ddx hepatic lesion with central scar
FNH (benign hamartomarous - central scar is AVM)
Giant cavernous hemangioma
Causes of pneumatosis intestinalis
ischemia, trauma, infection, pulmonary (COPD), colonic obstruction, artificial ventilation, collagen disease, steroid therapy
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
Ddx for solid pancreatic masses
islet cell tumor
SPEN (young women)
microcystic (serous) adenoma
Ddx echogenic liver masses
What liver mass is associated with hormonal contraceptives? What do we do when it's diagnosed?
common in young women
remove them - risk of rupture
Ddx hepatic cysts
biliary cystadenoma (septa may calcify)
(cystadenoma, mesenchymal hamartoma, emryonal sarcoma)
Ddx cystic pancreatic masses
congenital (PCKD, VHL)
microcystic adenoma (grandmother)
mucinous cystic adenoma/carcinoma (mother)
what MRI contrast agent to look for FNH
Ddx Gastric mass: intramural/extramucosal
GIST, leiomyoma/sarcoma, neurogenic tumor, heterotopic pancreas, carcinoid, fibrous tumor, granuloma
Ddx thickened gastric folds
Gastritis-Hypertrophic, H. Pylori
Zollinger Ellison syndrome
(post-radiation, Crohn, sarcoid, gastric, mets, eosinophilic gastritis, amyloid)
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
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
Ddx pancreatic lipomatosis
CF, obesity, malnutrition, steroids/Cushing syndrome
Gastric polyps - what types and what would each be associated with?
adenomatous (usually antral)
Fundic Gland (FAP)
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
Ddx for mid-esophageal stricture
carcinoma (primary or mets)
Ddx thickened bowel wall / bowel wall thickening
enteritis, radiation, ischemia (including shock bowel), hemorrhage, ACE angioedema
Ddx for aneurysmal dilatation prior to small bowel stricture
lymphoma, Crohn's dz, TB
Ddx gastric antral stenosis
TB, sarcoid, caustic, gastric cancer, mets, lymphoma, eosinophilic gastroenteritis, radiation
Ddx multiple gastric antral ulcers
erosive gastritis (meds, H. pylori), mets (melanoma, breast, Kaposi's, lymphoma), Crohn's dz
Ddx colonic "thumbprinting"
C. diff colitis, Crohn's, UC, ischemic bowel, (if also in small bowel, graft-vs-host)