GI Challenge Flashcards by Michael Richter

Case 151

What heterotaxy syndrome is associated with a high risk of congenital heart disease?

Situs ambiguous with asplenia (85-95% have CHD)

Situs ambiguous with polysplenia have a lower chance of CHD

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Case 151

Right lower lobe bronchiectasis with dextrocardia = ?

Kartagener’s syndrome

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Case 151

What is the incidence of congenital heart disease in patients with situs inversus?

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Case 152

What is the MC congenital abnormality of the pancreas?

Pancreatic divisum (4-10% of the population)

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Case 152

What is the MC clinical scenario associated with pancreas divisum?

Most are asymptomatic, although there is a higher incidence of pancreatitis

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Case 152

What is the other name of the accessory pancreatic duct?

Duct of Santorini

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Case 153

What is the MC viscus used for esophageal interposition surgery?

Stomach

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Case 153

Tumor recurrence is common following esophagectomy for esophageal cancer. Where is the MC site for recurrence?

Distant metastases

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Case 154

What is the peritoneal space posterior to the stomach and anterior to the pancreas?

Lesser sac

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Case 154

Which viscus most commonly herniates through the foramen of Winslow?

Small bowel

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Case 154

What is the MC type of internal hernia?

Paraduodenal

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Case 155

In what age group is mesenteric volvulus typically seen?

Infancy, and is usually associated with congenital abnormalities.

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Case 156

Which imaging modality is best for preoperative or pre-interventional planning for uterine fibroids?

MRI

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Case 157

What postoperative complication is more common following Billroth II compared to Billroth I?

Afferent loop syndrome (also seen with Roux-en-Y gastric bypass and pancreaticoduodenectomy)

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Case 157

What are some potential causes of gastric bezoar?

Hair (trichobezoars)
Persimmon fruit or psyllium fiber taken with too little water (phytobezoar)
Post-gastric surgery (incidence of 5-12%)

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Case 158

What histologic component seen in other parts of the GI tract is absent in the esophagus?

Serosa

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Case 158

Worldwide, what is the MC cause of portal hypertension and varices?

Schistosomiasis

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Case 158

What are ‘jump’ metastases in esophageal cancer and why do they occur?

Mets that spread throughout the length of the esophagus.

Due to extensive lymphatic network in the esophagus.

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Case 159

What is the MC surgical complication of lap cholecystectomy?

Retained stone

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Case 160

In patients with Crohn’s disease, which portion of the stomach is typically involved?

Antrum

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Case 160

In longstanding Crohn’s disease, what is the name given to a featureless antrum and duodenum?

Ram’s horn sign

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Case 161

What is the MC pancreatic islet cell tumor?

Nonfunctioning islet cell tumor (50% of all pancreatic neuroendocrine tumors)

Conflicting info see on Radiopaedia. They say that 15% are nonfunctional. MC functional pancreatic NET is insulinoma

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Case 161

Which pancreatic islet cell tumor would be associated with palpitations, sweating, and headache?

Insulinoma

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Case 162

What is the MC cause of cirrhosis in caucasians? In Asians?

Caucasians - alcohol

Asians - viral hepatitis

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Case 162 | What serum marker is often used in HCC?

Alpha-fetoprotein (AFP), although it is nonspecific

Case 163 | What is the definition of a giant duodenal ulcer?

A mucosal defect replacing 2/3 of the duodenal bulb

Case 163 | Where do perforating duodenal ulcers most commonly occur?

Duodenal bulb

Case 163 | What is the only duodenal tumor that can specifically diagnosed with CT?

Lipoma

Case 164 | From where does most of the air come from seen within the GI tract?

Swallowed air

Case 164 | T or F: Pneumoretroperitoneum is never benign.

True. Most commonly represents performation of colon or duodenum.

Case 165 In the setting of a nutmeg liver, what imaging characteristic would be suggestive of Budd-Chiari over right heart failure?

Caudate lobe hypertrophy

Case 166 | What is the pathophysiology of epiploic appendagitis?

Torsion of the epiploic appendage

Case 166 | What is the treatment for epiploic appendagitis?

Conservative therapy

Case 167 | What is the MC presentation of a thyroglossal duct cyst?

Palpable mass

Case 167 | What is the MC complication of a thyroglossal duct cyst?

Infection

Case 167 | What is the definitive treatment for a thyroglossal duct cyst?

Surgery

Case 168 | An abscess due to a retained surgical foreign body is known as what?

Gossypiboma

Case 169 | What is the MC cause of portal vein thrombosis in adults?

Cirrhosis

Case 170 | Multiple rim enhancing soft tissue lesions in the liver in a patient without known primary tumor?

I would still think metastatic disease first, until proven otherwise. Epithelioid hemangioendothelioma (EHE) is also a consideration.

Case 170 | What is the MC site of involvement for epithelioid hemangioendothelioma (EHE)?

Soft tissues

Case 170 | Histologically, what is epithelioid hemangioendothelioma (EHE)?

Rare vascular tumor that is clinically and histologically intermediate between angiosarcoma and hemangioma. Now thought of as a low grade epithelioid angiosarcoma.

Case 171 | Where in the esophagus are strictures most commonly seen?

Distal esophagus

Case 171 | What is the treatment for esophageal webs?

Endoscopy

Case 172 | What is the clinical significance of colon cancer presenting with perforation?

Elevated risk of peritoneal carcinomatosis

Case 173 | What is the MC predisposing factor in esophageal bolus impaction?

There is typically an underlying stricture

Case 174 | What is the MC predisposing factor in hepatic microabscesses?

Immunocompromised state

Case 174 | What is the MC causative organism in hepatic microabscesses?

Candida

Case 175 | What is the MC benign cause of linitis plastica?

Caustic ingestion

Case 176 | What are the normal lymphoid aggregates in the ileum called?

Peyer's patches

Case 176 | What disease is most commonly associated with nodular lymphoid hyperplasia of the distal ileum?

Viral infection

Case 176 | What is a potential complication of nodular lymphoid hyperplasia in pediatric patients?

Ileocolic intussusception

Case 177 | What is the underlying pathophysiologic defect in achalasia?

Aganglionosis

Case 177 | What is tylosis and why is it important?

Genetic disorder characterized by palmar/plantar hyperkeratosis, oral leukoplakia, and esophageal cancer. Only genetic syndrome known to predispose to SCC of the esophagus.

Case 178 | On what CT phase is RCC typically the most conspicuous?

Nephrographic phase

Case 179 | What is the MC causative organism for AIDS-related enteritis?

Cryptosporidium parvum

Case 179 | What is the MC cause of dysphagia/odynophagia in AIDS patients?

Candida esophagitis

Case 179 | What disease occurs in immunocompromised patients following bone marrow transplant but not AIDS patients?

GVHD

Case 180 | What is the CT fat halo sign and what does it suggest?

Ring of fat tissue in the submucosa of bowel. Seen in inflammatory bowel disease.

Case 181 | What is the MC cause of large bowel obstruction?

Tumor

Case 181 | What is the MC type of colonic volvulus?

Sigmoid

Case 182 | What is the MC finding of bowel ischemia?

Bowel wall thickening

Case 183 | What is the MC malignancy of the biliary tract?

GB adenocarcinoma

Case 183 | What is the prognosis for GB adenocarcinoma?

Mean survival time of 6 months

Case 184 | What is the MC site of GI tract involvement in Burkitt's lymphoma?

Terminal ileum

Case 184 | What is the MC site of presentation in Burkitt's lymphoma?

Facial and mandibular

Case 184 | What virus is specifically associated with Burkitt's lymphoma?

Epstein-Barr virus

Case 185 | T or F. Traumatic diaphragmatic injury is typically evident at presentation.

False. It is commonly missed at presentation, even with cross-sectional imaging.

Case 186 | What is the MC systemic disorder that may be associated with esophageal dysmotility?

Diabetes mellitus

Case 186 | What is the most common GI manifestation of a paraneoplastic syndrome?

Diarrhea

Case 186 | What is the MC malignancy to give rise to a paraneoplastic syndrome?

Bronchogenic carcinoma

Case 187 | What is the MC cause of perfusion defects in the spleen?

Infarcts

Case 187 | How common are splenic hematogenous metastases?

Rare.

Case 187 | What is the MC primary splenic neoplasm?

Hemangioma

Case 188 | Bleeding colonic polyps in someone who recently went 'swimming in the Nile"

Colonic schistosomiasis

Case 189 | What is the MC clinical manifestation of a lymphangioma?

Cystic hygroma

Case 189 | What syndrome is associated with lymphangiomas?

CRS says fetal alcohol syndrome Also, aneuploidy syndromes (Trisomies, Turner syndrome), Noonan syndrome, Cornelia de Lange, among others

Case 190 | What finding suggests pancreatic lymphoma over adenocarcinoma?

Absence of pancreatic ductal dilation

Case 191 | What is the MC type of esophageal polyp

Leiomyoma (stromal cell tumor)

Case 191 What is the MC location of an esophageal fibrovascular polyp? How do they typically present?

Proximal esophagus. Typically present with dysphagia.

Case 192 | What is the MC complication of peptic ulceration?

Bleeding

Case 192 What is the eponym of a penetrating ulcer that extends from the gastric antrum to the duodenum (paralleling the pyloric channel)?

Dragstedt ulcer (could hardly find anything online about this)

Case 193 | What is the MC cause of small bowel hemorrhage?

Anticoagulant therapy

Case 193 | What is the 'stack of coins' sign on SBFT and what does it suggest?

Thickening small bowel folds that remain straight and parallel. Associated with small bowel hemorrhage.

Case 194 | What are the underlying pathologic changes seen in the bowel as a result of scleroderma?

Small vessel vasculitis and fibrosis

Case 194 | What is meant by 'hidebound' appearance of bowel and what does it suggest?

Dilated small bowel with crowding of normal thickness valvulae conniventes. Seen in scleroderma.

Case 195 | What is the MC cause of hepatic infarction secondary to hepatic arterial occlusion?

Hepatic transplantation

Case 195 | What can develop as a result of hepatic arterial occlusion and infarction?

Bile lakes

Case 196 | What is the MC underlying cause of SMV thrombosis?

Prothrombotic state

Case 196 | What part of the GI tract would you expect to be affected with SMV thrombosis?

Small bowel and right colon

Case 197 | Oral and ileocecal aphthous ulcers, skin lesions, uveitis, and genital ulcers. Diagnosis?

Behcet's disease

Case 198 | What is the typical first line therapy for splenic artery pseudoaneurysm?

Endovascular intervention

Case 199 | What is the typical appearance of gastric GIST?

Exophytic mass with extragastric extension

Case 199 | What is the MC cause of a bulky gastric tumor?

Carcinoma

Case 200 | What imaging finding would suggest biliary cystic neoplasm over a simple hepatic cyst?

Ductal dilation

Case 200 | Do biliary cystadenomas have any malignant potential?

Yes.

GI Challenge Flashcards

(95 cards)