GI Flashcards
1
Q
Barretts-buzzword, typical appearance, dx, rx
A
- buzzword: Reticular mucosal pattern
- appearance: mucosal ulceration several centimeters above the gastroesophageal junction
- diagnosis- muc bx
- rx: Aggressive medical treatment for gastroesophageal reflux is mandatory along with close monitoring to detect possible transition into adenocarcinoma of the esophagus.
2
Q
feline esophagus vs esuinophilic esophagitis
A
feline= thin TRANSIENT folds, lower 2/3, normal but also high ass with reflux esophagitis
3
Q
Critical staging for Es CA
A
T3 (Adventitia) vs T4 (invasion into adjacent structures. Need CT (others staged by endoscopy)
4
Q
Name for fundoplication 360˚ and < 360˚
A
nissen=360. Toupe = <360
5
Q
Ivor lewis
A
transthoracic esophagectomy usually through right intercostal approach (Ivor lewis)
6
Q
“short esophagus”
A
hiatal hernia that is fixed/non-reducible and >5cm
7
Q
MCC recurrent reflex s/p fundoplication
A
Slipped Nissen
8
Q
MCC slipped Nissen
A
short es
9
Q
earliest mc complication fundoplication. when does it peak?
A
obstruction (edema or too tight). peak at 2wks.
10
Q
Treatment for short esophagus
A
Collis gastroplasty
11
Q
Diagnosis slipped nissen
A
narrowed esophagus >2 cm
12
Q
odynophagia + immunocompromised
A
esophageal candidiasis
13
Q
elevated benign esophageal nodules + elderly
A
glycogenic acanthosis (asymptomatic.)
14
Q
When do you see esophageal involvement with Crohn’s? What is the buzzword?
A
Severe disease. Apthous ulcer.
15
Q
clusters of nodules on esophagram
A
hpv squamous papillomatosis
16
Q
MC location esophageal duplication cyst
A
ileum
17
Q
Killian Dehiscence
A
between thyropharyngeus and cricopharyngeus muscles
18
Q
ddx epiphrenic diverticula
A
- paraesophageal hernia (MC left)
- traction-mc mid es, tented/triangular
- fluid collection-history, less well defined.
19
Q
Epiphrenic diverticula
A
pulsion diverticula in distal es, mc on right. Ass with dysmotility
20
Q
Plummer-vinson syndrome
A
Fe def anemia, dysphagia (es web), thyroid issues, “spoon-shaped nails”, glossitis
21
Q
esophageal webs are a RF for what?
A
hypoph and es CA
22
Q
long esophageal stricture
A
radiation, NGT, caustic
23
Q
medication induced esophagitis-mcc & loc
A
- sites of es narr (AA, LMB, retrocardiac, distal es)
- abx (tetracycline), anti-inflamm, cardiac (quinidine, K), BisP
24
Q
glycogenic acanthosis
A
asymptomatic benign esophageal nodules in elderly. Look like candidiasis
25
buzzword eosinophilic esophagitis
ringed esophagus
26
"vigorous achalasia"
early/less sev form. repetitive simultaneous non=propulsive contractions. MC in women, 2˚ CA MC in men
27
achalasia vs pseudoachalasia
GEJ will eventually relax with achalasia
28
increased risks of achalasia
SCC, candidiasis
29
increased risks of scleroderma
chronic reflux, scarring, barretts, adenoCA, (also candidiasis?)
30
how will scleroderma appear on exam?
dilated es with birds beak (ID to achalasia) + lung changes (NSIP)
31
Hampton's Line
Benign gastric ulcer AM. Thin radiolucent line separating barium in gastric lumen from barium in crater
32
Carmen meniscus sign
Malignant gastric ulcer AM. Ulcer crater and radiolucent elevated border
33
GIST location frequency
stomach (70%), duo, colon
34
Carney's triad
Carney's Eat Garbage: chondroma (pulmonary), extra adrenal pheo, GIST.
35
where do GIST usually met?
They don't. But if so, to liver
| Sarcoma-spreads hematogenously, rarely to LNs
36
what syndromes are GIST ass with?
Carney's triad & NF1
37
Areae gastricae-what is it, when does it enlarge and when is it obliterated
normal fine reticular pattern on double contrast. Enlarges in elderly, H pylori and focally next to ulcer. Obliterated by cancer.
38
Types of gastric volvulus
organoaxial (gastric antrum below GEJ) & mesenteroaxial (gastric antrum above GEJ.)
39
Menetrier's disease
idiopathic hypoproteinemic gastropathy with rural thickening. Fundus, spares antrum. Protein loss (low alb). Ass with CMV in kids?
40
MC GI tract loc for sarcoid?
stomach
41
Ram's Horn Deformity
aka Pseudobillroth 1. tapering of antrum. Ddx= peptic ulcer scarring, granulomatous dx, scirrhous carcinoma.
42
in what setting does splenic v thrombus occur?
isolated gastric varices (which can be ass with pancreatic cancer, pancreatitis)
43
gastric band-1) MC complication 2) MC comp to be tested
1) stomal stenosis 2) slippage
44
billroth 1 vs 2
1) Pylorus removed, remaining stom att to duo. (-) post op gastritis, (+) early compl
2) Partial gastrectomy, remaining stom att to jej.
45
risks billroth 2
1) dumping syndrome
2) afferent loop syndrome
3) gastric CA 10-20 yrs
46
Afferent loop syndrome
- Obstr of afferent limb --> dil loop, BD dil, chole/pancreatitis.
- Pot compl of billroth 2, REY, Whipple.
47
dumping syndrome
-classically billroth 2. also REY
48
what is suspected cause of gastric fold thickening and filling defects s/p Billroth?
bile reflux gastritis
49
jejunogastric intussusception
post-op compl w/ jejunal herniation into stom. High mortality when acute.
50
mcc sbo s/p REY
open=adhesions. laparoscopic= less ads --> more mobility --> closed loop.
51
3 potential sites for internal hernia s/p REY
1) transverse mesocol 2) JJ anast mesentery 3) behind roux limb mesentery
52
buzzword: ribbon bowel
graft vs host. Featureeless, atrophic, fold thickening
| -vascular granulation tissue replacing destroyed mucosa
53
buzzword: hidebound
scleroderma-narrow sep of normal folds w/ mild bowel dil
54
buzzword: moulage sign (tube of wax)
Celiac-dilated jejunal loop w/ compl loss of jejunal folds. opacified like a tube of wax
55
buzzword: fold reversal
Celiac-jejunum loses folds to look more like ileum, ileum gains folds (in RLQ) to look like jej. Ie: atrophied jej, thickened ileum
56
buzzword: thread-like defect in barium column
ascaris suun worm
57
clover leaf sign
AM: healed peptic ulcer of duodenal bulb
58
which bug is responsible for whipples?
Tropheryma Whipplei
59
Buzzword: sand-like nodules
Whipple (and MAC "pseudo-whipples")
60
SMA syndrome
compression 3rd pt duo by SMA. 2/2 sudden wt loss
61
other diseases ass w. celiac
- idiopathic pulmonary hemosiderosis (Lane Hamilton syndrome)
- Dermatitis herpetiformis
- bowel lymphoma
62
Meckel's diverticulum
True diverticulum, remnant of omphalomesenteric duct
63
Complications of Meckel's
- diverticulitis
- bleed (30% syx)
- intuss
- obstr
64
chronic dialysis its suscp to which bowel path?
thickened duo folds
65
jejunal diverticulosis
occ along mesenteric border, ass w/ bacterial overgrowth & Malays. V rare.
66
Riglers sign vs triad
Riglers sign- free air
| Riglers triad- pneumobilia, obstruction, ectopic gallstone
67
Dir & indir sgx's bowel trauma
- direct=spilled oral contrast, active mesenteric bleed
| - indir=mes fat stranding fluid layering along bowel
68
MC type of small bowel lymphoma
non-hodgkin
69
sm bowel tumors ass w/ desmoplastic rxn
carcinoid (classically), HL
70
spigelian hernia
AKA lateral ventral hernia. Loc along Semilunar line (lat border RA) --> MC above arcuate line (caudal to umbilicus)
- defect in the aponeurosis of the internal oblique and transverse abdominal
- It is often covered by external oblique muscle and aponeurosis, as seen here, which helps to distinguish it from an incisional hernia.
71
lumbar hernia
- superior lumbar (grynfeltt-Lesshaft)-12th rib (super), int obl (inf), quadratus lumborum (med)
- inferior lumbar (petit)- latissimus dorsi, iliac crest, external obl (lat)
72
litter hernia
contains MD
73
amyand hernia
contains appendix
74
Howship-Romberg Sign
inner thigh paresthesia 2/2 obturator hernia
75
Richter hernia
only 1 bowel wall herniates, (+) strangulation
76
mc type of internal hernia
paraduodenal (through song defect)
77
paraduodenal internal hernias-2 types
1) Fossa of Lanzert-on Left (desc colon mesentery/LUQ). Sac-like cluster dil loops in left ant pararenal space behind IMV & asc L colic a
2) Fossa of Waldeyer- Right (asc colon, RLQ). ass w/ malrotation (non rotated small bowel, normally rotated large bowel). Occ below 3rd pt duo, behind SMA
78
What is the most common imaging finding in adult CF?
fatty replacement
79
Pancreatic agenesis vs lipomatosis
Agenesis: no duct. Lipomatosis: duct.
80
How does annular pancreas present differently in adult vs child?
Adult-pancreatitis.
| Child-obstruction
81
CF buzzword
lipomatous pseudohypertrophy of the pancreas (enlarged w/ fatty replacement.)
82
imaging pancreatic CF
1) fibrosis 2) fatty replacement 3) small 1-3 mm cysts
83
Fibrosing colonopathy in CF
2/2 enzyme replacement
84
causes of pancreatic lipomatosis
CF, Cushing syndrome, chronic steroid, HLD, Shwachman-Diamond Syndrome
85
Shwachman-Diamond Syndrome
diarrhea, short stature (metaphysical achondroplasia), eczema, lipomatous pseudohypertrophy of pancreas (2nd MCC pancreatic insufficiency in children (CF=#1))
86
key imaging finding annular pancreas
annular duct encircling descending duodenum
87
What matters the most in pancreatic trauma? Next step if suspected?
- duct integrity-surgical EM.
| - MRCP or ERCP if suspected
88
MC complications pancreatic trauma?
fistula (MC), abscess
89
Causes pancreatitis
GS, EtOH, ERCP (milder course), mx (VA), trauma (kids), H hyperTG, hyperCa, AI pancreatitis, pancreatic divisum, groove (para-duodenal), tropic, parasite (Ascaris)
90
How to score pancreatitis
Balthazar
91
Biphasic course acute pancreatitis
1-2wks=inflammatory (SIRS/ARDS)
| 3-4wk=anti-inflamm --> (+) susp infection
92
most common anatomic variant of pancreas
pancreatic divisum
93
MCC chronic pancreatitis
EtOH
94
early & late findings chronic pancreatitis
- early- 1) loss of T1 signal 2) delayed enh 3) dilated side branches
- late- 1) atrophic 2) chain of lakes (dilation/beading duct + Ca) 3) pseudocyst (30%)
- fibrotic inflammatory pseudotumor-diff from cancer
95
most char finding chr pancr
chain of lakes
96
compl chr pancr
cancer (20 yrs chr pancr = 6% increased risk)
97
chr pancreas vs malignancy
CP-duct dil=irreg & <50%
| -fibrotic inflamm pseudotumor
98
IgG4
- AI pancreatitis
- retroperitoneal fibrosis
- sclerosing cholangitis
- inflammatory pseudotumor
- riedel's thyroiditis
99
What gene is related to hereditary pancreatitis?
SPINK-1 gene
100
Trousseau's syndrome
enlarged GB, painless jaundice, migratory thrombophlebitis
101
imp staging elements of pancreatic adenoCA
SMA/celiac axis involvement-unresectable
102
pancreatic adenoCA on small bowel follow-through
reverse impression on duodenum (frostburg's inverted 3 sign or wide duo sweep)
103
Frostburg's inverted 3 sign
reverse impression on duo in setting of pancreatic adenoCA seen on sm bowel follow through
104
Periampullary tumor
within 2 cm of major papilla arising from pancr, duo or CBD
105
What syndrome is associated with increased incidence of periampullary tumor?
Gardner's syndrome
106
buzzword jejunal ulcer
Zollinger-Ellison syndrome
107
complications whipple
1) delayed gastric emptying 2) pancreatic fistula 3) wound inf
108
complications pancreatic transplant
1) acute rejection 2) donor splenic vein thrombosis 3) pancreatitis (<4 wks) 4) chronic rejection (shrinking transplant)
109
buzzword: shrinking transplant
pancreatic transplant chronic rejection, graft progressively gets smaller
110
Felty's syndrome
SMG, RA, NP. Abn of granulocytes
111
Littoral cell angioma
benign vascular tumor of littoral cells lining venous sinusoids of red pulp
112
MC met to spleen
melanoma
113
Lane Hamilton syndrome
Celiac dx + Idiopathic pulmonary hemosiderosis (IPH)
IPH is an uncommon form of pulmonary hemosiderosis. It is characterized by the triad of
hemoptysis
iron deficiency anemia
diffuse pulmonary infiltrates, usually represented by diffuse pulmonary hemorrhage
The diagnosis is usually made by exclusion 1.
114
signs of GIST malignancy?
- mets (most reliable sign)
- size >5m
- irregular enh
- ulceration, cavitation
115
3 components of levator ani
1) pubococcygeus (pubovisceral ) m
2) iliococcygeus m
3) puborectalis m
116
inguinal LN pathology
- perineum
- anal canal
- anorectal junction
117
internal & external iliac LN pathology
- rectal
- urinary bladder
- prostate, cervical CA
118
obturator LN pathology
early prostate
119
rectus sheath mets
melanoma
120
inferior epigastric vessels course through rectus sheath
btw rectus abd and pst layer of rectus sheath
121
rectus sheath
strong fibrous compartment enveloping rectus m's, formed by aponeuroses of 3 flat m's
- contains sup and inf epigastric vess'
- ant: apon EO and ant IO
- pst=pst IO and TA
- below arcuate line (halfway btw umbilicus and pubic symphysis)--> no pst wall!
122
which liver tumors rupture spon't
hcc
| angiosarcoma
123
abd wall hernias with highest risk strangulation
femoral=highest
124
how often does serous cyst adenoma have central enhancing scar and Ca?
30%
| 10%
125
when to resect serous cystadenoma vs other cystic pancreatic neos
- 4cm (growth accelerates)
| - 3 cm
126
serpiginous filling defects in esophagus
-varices
-varicoid carcinoma
lymphoma
127
varicose carcinoma of esophagus
mural metastasis of SCC of es
128
when to treat pancreatic fluid colls
```
4 wks
intractable pain
biliary ob
suspecting inf
con't growth
```
129
Myochosis/"cogwheel"
hypertrophy of the colonic circular muscle layer and shortening of the longitudinal layer (taenia) cause irregular narrowing of the colonic lumen.
130
Non hodgkin lymphoma
Immunosuppressed patients (e.g., those with AIDS or transplant recipients) are at markedly increased risk for developing NHL. Almost any focal abdominal visceral or nodal mass should be considered worrisome for involvement by NHL and evaluated appropriately.
131
anal cancer-who, ass w/ which virus, mets
- homosexual men, AIDS
- papilloma viral inf
- can spread systemically w/o liver mets due to dual (portal & systemic) venous drainage of rectum
132
CT criteria for acute appendicitis
thickened wall and/or dilated lumen & periappendiceal inflamm
133
Brunner gland hyperplasia/hamartoma
- Nonneoplastic hyperplasia of duodenal submucosal glands
- common cause for polypoid filling defects
- ass w. duodenitis, hyperacidity
- Strawberry or cobblestone appearance in proximal duodenum on barium study
134
Rx GIST
imatinib (Gleevec), tyrosine-kinase inhibitor
135
mesenteric adenitis-what is it?
inf of distal sm bowel
136
pancreatic pseudocyst mx
- typically resolve on own in weeks. Decompr into pancreatic duct or stomach/duo
- drain if inf, syx (usually via obstr of bowel or bd)
137
gastric ulcer vs avm/vascular ectasia on CT
- The term "ulcer" implies erosion into the submucosa or even through the wall of stomach. CT might show extraluminal gas, fluid, or enteric contrast medium, not evident in this case.
- Arteriovenous malformations or vascular ectatic lesions occur throughout the gastrointestinal (GI) tract and are a common cause of GI bleeding. These cannot be diagnosed by imaging, except indirectly as a source of active hemorrhage.
138
Bochdalek hernia
left post hemidiaph defect
139
pancreatitis fluid collections-encapsulated vs non
non= <4 wks (acute necrotic collection, acute peripancreatic fluid colelction.)
encaps: >4 wks (walled off necrotic collection, pseudocyst.)
140
common causes splenic v thrombosis
- acute & chr pancreatitis
- pancreatic malignancy
- aneurysms of celiac/splenic arteries
141
how does pancreatitis cause gastric varices?
splenic v thrombosis
142
vascular compl of pancreatitis-what, pathophys, which ones
- enzymes --> erosion --> hemorrhage and pseudoaneurysm via erosion
- splenic > GD > PD arteries
143
-Vessels we care about in panacreatic adenocarcinoma
- *common hepatic a's --> GDA --> SPDA
- *celiac a + branches (LGA, SA)
- *SMA --> IPDA
*PV, splenic v
144
vessel encasement vs abutment
- encasement= > 180
| - abutment = <180
145
benign vs malignant: serous cystadenoCA, mucinous cystic tumor
- serous=benign
| - mucinous= low grade mal
146
small bowel target sign-app, causes
- water or hemorrhage in submuc
- pancreatic rests, GIST, lymphoma, melanoma, primary bowel adenoCA
* if mult: think lymphoma, melanoma
147
How does afferent loop syndrome cause pancreatitis?
obstruction of afferent limb s/p billroth2 --> obstruction of biliary and pancreatic drainage
148
img mucinous cystic pancreatic tumor
- large, loculated, thick walled cystic masses
- mural nodules, papillary projections
- TAIL
149
annular pancreas-pathophys
Failure of ventral pancr bud to rotate (clockwise) with duodenum
150
annular pancreas-types
- complete-complete encasement of duo
- incomplete-
- extramural: pancreatic tissue from ventral bud drains into main PD
- intramural-VB drains via own small ducts into duo
