GI Flashcards by p h

biggest predictor of local recurrence and survival in rectal cancer?

radial margin
(more than longitudinal involvement and T category)

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bugs that gives terminal ileitis and right colon

yersinia
campylobacter
salmonella

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1 and #2 visceral aneurysms

spleen

2. renal

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sign that there’s abN flow in liver

hepatic artery and portal vein are opposite

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most common benign esophageal neoplasm

leiomyoma

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side effect of gastrografin in upper GI

pulmonary edema

H2O soluble, but hyperosmolar

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isoosmolar h2o soluble contrast

omnipaque

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side effect of barium in upper GI

mediastinitis

if ?perf, do H2O soluble first

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ingestion of sushi

anisakis
roundworms
invade stomach or intestinal wall causing edema and ulcers

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rectal prolapse

trichuris
whipworm
invades colonic mucosa, bleeding, anemia
intussusception and rectal prolapse

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iron deficiency anemia

hookworms

invade colonic mucosa

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bug causing cholangitis or pancreatitis

ascaris
largest nematode
can cause bowel obstruction, or pancreatic/biliary duct

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causes gastric fold thickening

h pylori gastritis
menetriers disease
zollinger ellison

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gastrinoma triangle

medial: pancreatic neck/body junction
inferior: 2nd-3rd junction duodenum
superior: junction cystic duct and CBD

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most common inflammatory disease esophagus

reflux

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most common malignant primary hepatic malignancy

HCC

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diverticula occurring at killian dehiscence

zenker

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most common benign splenic lesion

hemangioma

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most common location of tear in Boerhaave syndrome

left posterolateral wall of the distal esophagus, 3-6 cm above the esophageal hiatus of the diaphragm

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treatment for achalasia

Heller myotomy:

- longitudinal excision through lower esophageal sphincter

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bouveret syndrome

gastric outlet obstruction secondary to impacted gallstone

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right & left paraduodenal internal hernias go through what? what % do they each make up?

right: fossa of Waldeyer; 25%

2. left: fossa of Landzert; 75%

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critical stage esophageal cancer

T3 adventitia vs T4 invasion into adjacent structures

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plummer vinson syndrome

iron deficiency anemia
dysphagia
thyroid issues
spoon shaped nails
esophageal web

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GIST most common location? | nodal involvement?

- stomach MC (then duodenum) - LNs NOT enlarged - goes to liver & drop mets ass'd w. carney triad & NFI

Carneys triad

Carneys Eat Garbage Chondroma (pulmonary) Extra adrenal pheo GIST

most common extra nodal site for nonhodgkin lymphoma

stomach

organoaxial vs mesenteroaxial gastric volvulus

organo - greater curve over lesser, old ladies, hernias mesentero - over mesentery, risk ischemia, obstruction, kids

bug in whipples

Tropheryma Whipplei

riglers triad

gallstone ileus: 1. pneumobilia 2. obstruction 3. ectopic gallstone NOT riglers sign of free air on either side of bowel

hernia with appendix in it | " with meckels in it

amyand appendix | littre meckels

findings entamoeba histolytica gi

- cecum & ascending colon - normal terminal ileum - coned cecum - toxic megacolon - liver, spleen, brain abscesses - bloody diarrhea - flask shaped ulcer in endoscopy

infections that like duodenum | infections that like terminal ileum

duodenum: giardia, strongyloides terminal ileum: Tb, yersinia, campylo

critical stage rectal cancer

T3 - tumor breaks into perirectal fat | - get chemo/rads prior to surgery

mckittrick wheelock syndrome

villous adenoma mucous diarrhea severe electrolyte disturbances and depletion

most common spot peritoneal carcinomatosis

retrovesical space | most dependent portion peritoneal cavity

advanced imaging for FNH

mri w. hepatocyte agent | sulfur colloid

nuc med agent for fibrolemellar HCC

gallium remember scar does not enhance & is T2 dark

CEA & CA 19-9 in cholangio pancreatic ca colon ca

cholangio: CEA up, CA19-9 up pancreatic ca: CA19-9 up colon ca: CEA up

amebic abscess left lobe

emergent drainage | can rupture into pericardium

primary vs secondary hemochromatosis

primary inherited = pancreas involved, spleen spared (thyroid, heart, pituitary) secondary chronic inflamm'n/++transfusions, eat iron w/ reticuloendothelial system = spleen involved, pancreas spared

causes nutmeg liver

- budd chiari - hepatic veno occlusive disease - right heart failure (hepatic congestion) - constrictive pericarditis

massive caudate lobe hypertrophy

- budd chiari - primary sclerosing cholangitis - primary biliary cirrhosis

cavernous transformation after portal vein thrombosis means what?

chronic, takes 12 months to develop

complications of carolis disease

- auto recessive, central dot sign, ass'd w. polycystic kidney dz & medullary sponge kidney - cholangiocarcinoma - cirrhosis - cholangitis - intraductal stones

mirizzi syndrome association

5x risk co-incident gallbladder cancer

resistive index RI calculation

PSV - EDV/PSV

acceleration time corresponding to 50% stenosis of renal artery

acceleration time >0.07 sec | acc'n time = time from end diastole to 1st systolic peak

causes for increased and decreased HV pulsatility

increased: tricuspid regurg'n, right sided CHF decreased: cirrhosis, hepatic venous outflow obstruction

causes of portal vein: 1. pulsatility 2. reversed flow 3. slow flow 4. absent

1. pulsatility: right sided CHF, tricuspid regurg, cirrhosis, vascular AP shunting 2. portal htn 3. <15 cm/s, portal htn (pre, intra, post) 4. thrombosis, tumor invasion, stagnant flow bad portal htn

echogenicity of pancreas on uss

greater than normal liver

hereditary pancreatitis gene

SPINK 1

hereditary syndromes associated with pancreatic cancer

HNPCC BRCA ataxia telangiectasia peutz jegers

advanced imaging for intrapancreatic splenule

heat treated rbc scan | sulfur colloid

anastamoses in whipples

1. gastrojejunal 2. choledochojejunal/hepaticojejunal 3. pancreaticojejunal

why is pancreatic RI not helpful?

no capsule

most common bugs in splenic abscess

immunocompetent: salmonella immunocompromised: fungi, tb, MAI, pcp (multiple microabscess)

antibodies in hashimotos

antiTPO | anti thyroglobulin

common appearance of hashimotos

- giraffe skin | - white knights

origin of parathyroid glands

top 2: 4th branchial pouch | bottom 2: 3rd branchial pouch

#1 small bowel cancer

metastases

increased risk small bowel (duodenal) adenocarcinoma

FAP | Gardner

most common location small bowel adenocarcinoma

jejunum

most common location small bowel neuroendocrine/carcinoid

ileum

c difficile bacteria type

gram positive anaerobe | endotoxin B

HNPCC (Lynch Syndrome) - screening

colonic & endometrial

% LBO from cancer

60-80% volvulus 10-15% diverticulitis 5-10%

anal cancer staging?

based on SIZE | inguinal lymph nodes = independent prognostic factor

low rectal cancer spread?

can go straight to lungs (mid/inf hemorrhoidal veins) | higher = liver 2/2 drainage to portal vein via sup hemorrhoidal