GI Fair Game Flashcards
(289 cards)
1
Q
Case 61
DDx for fibrotic mesenteric mass?
A
Desmoid: typically a round mass
Lymphoma
Carcinoid
Peritoneal Carcinomatosis
2
Q
Case 61
Which polyposis syndrome is associated with mesenteric fibrosis?
A
Familial adenomatous polyposis (Gardner syndrome)
3
Q
Case 62
What is massive distention of GB also known as?
What is the preceding pathology of this condition?
A
Gallbladder hydrops
Untreated Acute Cholecystitis
4
Q
Case 62
What are potential complications of untreated acute cholecystitis?
A
Perforation
Bile Peritonitis
GB Hydrops
5
Q
Case 63
What is an appendicolith composed of?
A
Inspissated fecal debris
Mucous
Calcium phosphate
Inorganic salts
6
Q
Case 63
What is the accuracy rate of MDCT for the diagnosis of acute appendicitis?
US?
A
Approaches 100%
70 to 90% in current literature
7
Q
Case 64
What is the MC disease associated with sclerosing cholangitis?
A
Ulcerative colitis
8
Q
Case 64
What is the MC cause of recurrent biliary tract infection worldwide?
A
Ascariasis
9
Q
Case 64
1. What percentage of patients with PSC have UC?
- What percentage of patients with UC develop PSC?
A
- 70% of pts with PSC have UC
2. Up to 10% of pts with UC will develop PSC
10
Q
Case 64
What is a potential serious complication of longstanding sclerosing cholangitis?
A
Cholangiocarcinoma
11
Q
Case 65
What is the most common pancreatic cystic tumor?
Avg age?
A
Mucinous Cystadenoma
50 yo
12
Q
Case 65
Which pancreatic neoplasm is associated with VHL?
Malignant potential?
A
Microcystic adenoma
Not premalignant
- Female
- Older Patients
13
Q
Case 65
Macrocystic pancreatic lesion with septations?
A
Mucinous cystadenoma
- Premalignant
Cystadenocarcinoma
14
Q
Case 65
Mixed solid/cystic pancreatic neoplasm in young female is most likely?
A
Solid papillary endothelial neoplasm (SPEN)
- Low grade malignancy
15
Q
Case 61
What is a rounded masslike area of mesenteric fibrosis called?
A
Desmoid tumor
16
Q
Case 66
What is the MC histology of duodenal polyps?
What is their relative malignant potential?
A
- Adenomatous polyps
- vs hyperplastic polyps in stomach - More commonly malignant compared to colonic adenomas
- Size directly correlates w malignant potential
17
Q
Case 66
How is the location of a duodenal polyp clinically important?
A
Generally
- the more distal the polyp
- the more likely it is to be premalignant
18
Q
Case 67
What is the anatomic space anterior to the superior rectum?
A
Pouch of Douglas
Cul-de-sac
19
Q
Case 67
Lesion seen at anterior wall of rectum on double contrast BE. DDx?
A
Primary carcinoma Peritoneal metastatic disease Primary gyn malignancy Endometriosis PID
20
Q
Case 68
What underlying disease predisposes patients to emphysematous cholecystitis?
A
Diabetes
21
Q
Case 68
Emphysematous Cholecystitis - causative organism?
A
Clostridium species
22
Q
Case 68
What is the potential complication from emphysematous cholecystitis?
A
Perforation
- 5 x more likely
23
Q
Case 69
What is the most important anatomic consideration in the setting of pancreatic trauma?
A
Ductal injury
-> Surgery
24
Q
Case 69
What are the most common mechanisms of pancreatic injury?
A
MVA
Deceleration Injuries
25
Case 69
| In the setting of pancreatic duct injury, which portion of the pancreas is removed?
Requires surgical resection of the pancreas proximal to the lesion
26
Case 70
| What is a major predisposing factor to the development of splenic abscesses?
Immunocompromised state
27
Case 70
| What is the MC source of septic emboli that result in splenic abscesses?
Endocarditis
28
Case 70
| What local condition is most commonly associated with splenic abscess?
Pancreatitis
29
Case 70
| What NM study can be helpful to diagnose a splenic abscess?
Gallium scan (although lymphoma would also take up gallium)
Tagged WBC scan would result in diffuse splenic uptake
30
Case 66
| DDx for polypoid filling defect in the bulb
- Adenoma
- Pancreatic Rests
- Prolapsed Gastric polyp
- GIST
- Brunner's Gland Adenoma
- Mets
31
Case 71
| Term used to describe pancreatitis with significant bleeding
Hemorrhagic pancreatitis
32
Case 71
| What features of the pancreas allow pancreatitis to have widespread impact?
Capsule
Location
Exocrine function (NOT Endocrine function)
33
Case 72
In adults, what is the MC retroperitoneal soft tissue sarcoma?
How is it treated?
Liposarcoma
XRT
34
Case 72
| Features of liposarcoma
- Rare
- Can be almost purely lipomatous
- Adult males
- Rare in children
- Difficult to excise
35
Case 72
| Adult fatty retroperitoneal tumor - what is the likely diagnosis?
Liposarcoma
36
Case 73
| What is the MC intra-abdominal site of involvement in sarcoidosis?
Liver
| Hepatosplenomegaly
37
Case 73
| Most common site of Sarcoid GI tract involvement?
Stomach
38
Case 71
| What is the major cause of pancreatitis in the US?
Alcohol
38
Case 73
T/F
Biliary involvement by Sarcoid can result in strictures of the extra hepatic biliary ducts
True
39
Case 74
| What is the MC primary tumor of the pharynx?
SCC
40
Case 74
| What is the MC risk factor for pharyngeal cancer?
Tobacco
41
Case 74
| A posterior pharyngeal tumor should suggest what etiology?
Lymphoma
42
Case 74
| Cervical esophageal webs + anemia = ?
Plummer-Vinson syndrome
| - questionable premalignant condition
43
Case 74
Cancers that metastasize to the pharynx?
Hypopharynx?
Breast and Lung
Melanoma and Kaposi's
44
Case 75
| What complication might a patient suffer from the colonic absorption of iodinated contrast media?
Anaphylaxis
45
Case 75
| Vicarious excretion of colonically absorbed water-soluble contrast is seen how often?
```
20% of normal patients
More common in
- Ischemic colon
- Colitis
- IBD
```
46
Case 76
What is the most common pathologic cause of papillary enlargement?
Other causes?
Choledocholithiasis
Pancreatitis
Choledochocele
Tumors
47
Case 76
| What is Poppel's sign?
Papillary enlargement due to edema and swelling from pancreatitis
48
Case 76
| What polyposis syndrome is associated with tumors of the papilla?
Familial polyposis coli (Gardner syndrome)
49
Case 76
| What is the term used to describe the region in and around the ampulla?
Perivaterian region
50
Case 77
| What is the MC cause of gastroduodenal ulcers in Western society?
H. pylori
51
Case 77
| What substance does the breath test for H. pylori detect?
Urease
52
Case 77
| What is the treatment for H. pylori?
Triple therapy: PPI + 2 antibiotics
53
Case 78
| What is the pathologic basis of Hirschsprung disease?
Segment of congenitally absent ganglion cells in the distal colon
54
Case 78
| How often does Hirschsprung disease involve the entire colon?
Rarely (5%)
55
Case 78
| What other condition is Hirschsprung disease most commonly associated with?
Trisomy 21
56
Case 79
| What is the MC benign cause of gastric outlet obstruction?
Peptic ulcer disease
** Case review contradicts itself on case 79 p161 q2 and case 113 p229 q2. The information for the correct answers to these cases was therefore taken from Requisites 4th ed page 66.
57
Case 79
| Which malignancies are most likely to cause gastric outlet obstruction?
Pancreatic CA
| Gastric CA
57
```
Case 79
Hirschsprung's
- Boys vs girls
- Definitive diagnosis
- Treatment
```
Boys
Biopsy
Surgical resection
58
Case 79
T/F
1. Short history of Sxs is suspicious for malignancy
2. GO obstruction is the most common complication of Gastroduodenal TB
3. Gastrostomy tube migration can result in GO obstruction
4. Organoaxial gastric volvulus is more likely to result in GO obstruction
1. T
2. T
3. T
4. F
59
Case 80
| What is the MC cause of hematogenous mets to the esophagus?
Breast cancer
60
Case 80
| Which tumor is most likely to spread to the esophagus by direct extension?
Gastric cardia tumors
62
Case 80
| What can metastasize to the esophagus?
- Melanoma
- Breast
- Renal Cell
- Kaposi's sarcoma
63
Case 80
| Metastatic spread to the esophagus occurs early or late in the disease?
Late
64
Case 81
| What is the pathogenesis for the development of toxic megacolon?
Transmural inflammation
- Damages ganglion cells
- Results in atony
65
Case 81
| What causes the thumbprinting sign?
Lobulated thickening of haustral folds
66
Case 81
| Five causes of toxic megacolon
```
Ulcerative Colitis
Crohn's
Pseudomembranous Colitis
Ischemia
Infectious Colitis
- esp in AIDS
```
67
Case 81
| What imaging measurement is suggestive of Toxic Megacolon?
Transverse colon > 8 cm
68
Case 81
| Once treated is there an increased risk of developing Toxic Megacolon in the future?
Yes
| - may require colectomy
69
Case 82
| What are some potential causes of pseudomyxoma peritonei?
Mucin Producing Neoplasms
- Mucinous AdenoCA / Mucocele
- Appendix
- Ovaries
- Pancreas
Less common
- Stomach
- Intestines
- Bile ducts
70
Case 82
| What is the treatment for Pseudomyxoma Peritonei?
Supportive
- No definitive treatment
- Material cannot be successfully removed surgically
- Remaining cells will continue to produce material
71
Case 82
| What is the most common presentation of Pseudomyxoma in women?
Increasing abdominal girth
72
Case 83
| What is the appropriate initial diagnostic procedure in a hemodynamically stable patient s/p stab wound?
CT scan (although I've always been taught exploratory laparotomy)
73
Case 83
| What is the most commonly injured viscus in stab injuries?
Colon
74
Case 83
| What should one look for within the abdomen in penetrating injuries?
- Air
- Free fluid (blood)
- Injury of the bowel wall itself
(Even if not completely breeched)
75
Case 84
| In what % of the general population is C. difficile found?
- 20% is subclinically colonized
77
Case 84
| What is the pathophysiology of pseudomembranous colitis?
C. difficile endotoxin
- Inflammation/necrosis of the mucosa
- Subsequent loss of fluid
77
Case 84
T/F
1. Pseudomembranous colitis can lead to Toxic Megacolon
2. Can involve the small bowel
3. Pseudomembranous colitis always involves the whole colon
4. Can be elicited by Chemotherapy
1. T
2. T
3. F
4. T
78
Case 84
| How long after antibiotic therapy do symptoms of Pseudomembranous Colitis occur?
Typically less than 2 weeks
- can occur anywhere from a few days to 8 wks
Must change Antibiotics to treat!
79
Case 85
| What is the physical cause of azygous continuation of the IVC?
Congenital absence of the IVC or acquired IVC occlusion
80
Case 85
| Besides congenital, what other conditions may result in azygous continuation?
Hepatoma
Sickle cell
Leukemia
81
Case 86
| What is the MC tumor of the inguinal canal?
Lipoma
82
Case 87
| What is the hereditary pattern of neurofibromatosis?
Autosomal dominant
83
Case 86
| What is the MC cause of small bowel obstruction?
Fibrous adhesions
| SBO is best detected with CT
84
Case 87
| What is the most common form of NF?
NF1 (von Recklinghausen's disease) - 90%
1 in 4000
84
Case 88
| What is the MC cause of a benign pancreatic duct stricture?
Chronic pancreatitis
85
Case 87
| What part of the body is most commonly affected by NF?
Skin
| In the small bowel, you get malabsorption
86
Case 88
| What is the double duct sign?
Dilation of the CBD and pancreatic ducts
87
Case 89
| What is the MC cause of abdominal ascites?
Cirrhosis and severe liver dz
88
Case 89
| In a supine patient, what is the most dependent peritoneal space?
Rectouterine space (Pouch of Douglas)
89
Case 89
| What is suggested by 'centralization of bowel loops'?
Large volume ascites
90
Case 90
| Nonfamilial polyposis syndrome with skin abnormalities, alopecia, onychodystrophy, hyperpigmentation?
Cronkhite-Canada syndrome
91
Case 89
| What is the 'dog ears' sign of ascites?
Ovoid or triangular densities just above and lateral to the urinary bladder on supine abdominal film
92
Case 90
| Patient with multiple gastric hamartomas, circumoral papillomatosis, thyroid abnormalities and skeletal abnormalities?
Cowden syndrome
93
Case 91
| Which infections can produce fistulas?
TB
| Actinomycosis
94
Case 90
| Polyposis syndrome with multiple bowel hamartomatous polyps with no malignant potential?
Peutz-Jeghers
95
Case 90
| Familial Polyposis syndrome with multiple adenomatous or hyperplastic gastric polyps?
Gardner's Syndrome
96
Case 92
| What is the vascular supply to FNH?
Arterial
- usually central as compared to peripheral
- there is no PV supply to FNH
97
Case 91
What is the MC cause of colonic fistulas to the urogenital tract?
What is the worldwide most common cause of rectovaginal fistula?
Diverticulitis
Trauma
98
Case 92
| What is an MRI imaging feature helpful in determining FNH?
Scar
- high T2
- low T1
99
Case 93
| What are predisposing factors to the development of hepatic adenoma?
- Female predominance
- Oral contraceptive use
- Glycogen storage dz
- Anabolic steroid use
(not Catabolic steroids)
- Propensity to bleed
100
Case 93
| What is the appearance of hepatic adenoma on Tc-99m sulfur colloid scan?
Photopenic defect
101
Case 93
| What would be the appearance of a hepatic adenoma on MRI C+ (Eovist)?
- Bright on pre-contrast T1 due to glycogen and fat
- Feeding vessels
- Diffusely enhance
- Typically hypointense to background liver on delayed hepatobiliary phase
102
Case 94
| What is the best screening modality for AAA?
Ultrasound
103
Case 94
What is a major risk factor for AAA?
Most common presentation?
Gender predominance?
Other causes?
Smoking
Incidentally found on imaging
Men 7 times more often than women
Mycotic, Marfan's, Ehler-Danlos
104
Case 95
What is the most specific CT finding for bowel strangulation?
What is the origin of the gas within dilated bowel in a patient with obstruction?
Abnormal enhancement
Swallowed air
105
Case 96
| What are the best MR sequences for the detection of iron deposition?
Signal loss on T2 (long TE sequences), gradient echo
106
Case 96
| Abnormally dense liver in a patient with history of arrhythmia?
Amiodarone toxicity
107
Case 96
| How to distinguish between primary and secondary hemochromatosis on MRI?
In primary hemochromatosis, the bone marrow and spleen are typically spared (and pancreas is affected)
108
Case 96
| Besides hemochromatosis, what is another cause of hyperdense liver parenchyma?
Wilson's disease
| - copper metabolism
109
Case 96
| Describe Hemochromatosis
Inherited disorder
- Increased iron absorption
- Primarily males
- Can cause
- Cirrhosis
- Diabetes
- Arthropathy
- Cardiac problems
110
Case 97
| What is the significance of lymph node status in cervical cancer?
5-year survival rates:
N0 - 90%
N1 - 55%
111
Case 97
| What is the best diagnostic test to evaluate for local spread of cervical cancer?
MRI
112
Case 97
| What are the T2 imaging characteristics of cervical carcinoma?
High signal intensity mass on T2 weighted images
Stark contrast to low signal of normal cervical stroma
113
Case 92
| Why does FNH take up sulfur colloid radiotracer?
Presence of Kupffer cells
| - part of the reticuloendothelial system
113
Case 92
| In what demographic is FNH typically seen?
Young women
113
Case 97
| How does cervical cancer spread locally?
Contiguous spread laterally to the parametrium and to the vagina
Fascial planes protect spread to rectum and bladder early in the disease
114
Case 98
| Incidentalomas
Incidental gallstones are of moderate importance
Never ignore an incidental Bosniak III renal cyst
115
Case 99
| What is the MC underlying condition seen with GB varices?
Alcholic cirrhosis
117
Case 99
Term used for chronically occluded portal vein?
Dilated veins in the abdominal wall around the umbilicus?
Cavernous Transformation
Caput Medusa
118
Case 101
| What is the most common cause of UGI bleeding?
Peptic Ulcers
119
Case 101
| Where are downhill varices seen and what is their cause?
Proximal esophagus
| SVC obstruction
120
Case 99
| 7 Causes of portal hypertension
- Alcoholic cirrhosis (The most common cause)
- Splenic vein thrombosis
- Schistosomiasis
- Chronic Hepatitis
- Hypervitaminosis A
- Congenital absence of PV
- Congenital Hep Fibrosis
121
Case 101
| What is the usual physiologic basis for uphill varices?
Portal hypertension
| Cirrhosis
122
Case 102
| What is the hallmark sign of ascariasis on barium studies?
Ingested barium within the GI tract of the worm
123
Case 102
| Apart from the GI tract, what is the second most common viscera to be affected by ascariasis?
Biliary tract
- cholangitis
- pancreatitis
- biliary strictures
124
Case 103
| What is a Mallory-Weiss tear?
- Distal esophagus at the GE junction
- Incomplete tear on the mucosal side
- Secondary to retching or vomiting
- Can bleed
- Usually alcoholics
- Very difficult to see on fluoro
- Opposed to Boerhaave's
- > complete tear with extravasation
125
Case 103
| How are Mallory-Weiss tears usually treated?
Conservatively
| - 95% of cases resolve spontaneously
126
Case 104
| Which caustic agent is typically more severe when ingested, acid or alkali?
Acid results in gastric injury more often
| - Alkali can be somewhat neutralized by gastric acid
127
Case 104
| Caustic injury can lead to what long term complication?
Squamous cell carcinoma
128
Case 105
| Syndrome associated with hemangiomas and thrombocytopenia?
Kasabach-Merritt syndrome
129
Case 105
| T or F: Centrifugal enhancement is diagnostic of hepatic hemangioma.
F - centripetal enhancement with progressive filling is diagnostic
130
Case 105
| What are the T2 characteristics of hepatic hemangioma?
T2 hyperintense
131
Case 105
| What is the typical appearance of hepatic hemangioma on Tc-99m tagged RBC scan?
Early photopenia, with progressive uptake of tracer
132
Case 107
| What is the MC metastatic lesion in the liver to calcify?
Colorectal Mucinous Adenocarcinoma
133
Case 107
| What is the MC cause of calcified liver lesions in children?
Neuroblastoma
134
Case 100
| What can help distinguish secondary achalasia due to tumor from primary achalasia?
Mucosal irregularity
Proximal shouldering
Longer segment of narrowing
- malig narrowing > 3.5 cm
135
Case 109
| What is the 1st and 2nd MC sites of involvement in hydatid disease?
1st MC - Liver
| 2nd MC - Lung
136
Case 109
What is the MC location of rupture in hydatid disease?
What are some potential complications?
Biliary
Anaphylaxis
Cholangitis
137
Case 109
| Apart from surgery, how can echinococcal cysts be treated?
Percutaneous catheter drainage with instillation of scolecidal agents
138
Case 108
| What is colitis cystica profunda?
Solitary rectal ulcer syndrome
- Sequela of chronic anterior internal rectal wall prolapse
- Chronic ulceration/healing
- Results in trapped regenerating mucosa
- Forms cystic structures filled w mucin
- Produces a polypoid appearance
139
Case 106
| What are the potential pancreatic complications of cystic fibrosis?
Pancreatic endocrine insufficiency (DM)
Exocrine insuffiency
Pancreatitis
Pancreatic Atrophy
Not assoc w/ increased risk of cancer
140
Case 110
| What is the MC imaging appearance of GI lymphoma?
Infiltrating mass
141
Case 110
| What is the MC site for primary GI lymphoma?
Stomach
142
Case 109
| What is the 10 year mortality rate in untreated Echinococcal dz?
90%
143
Case 110
| What predisposing condition results in the greatest risk for the development of GI lymphoma?
Transplant
| - followed by AIDS
144
Case 111
| What are the 4 major complications of duodenal PUD?
Hemorrhage
Obstruction
Perforation
Penetration
145
Case 111
| What is penetration in the setting of PUD?
Extension of an ulcer into an adjacent structure (pancreas) or hollow viscus. Penetration in to a vessel can lead to catastrophic hemorrhage
146
Case 111
| What is the most common site of perforation in the setting of PUD?
Duodenal
- potentially lethal
- more common in elderly and pts taking NSAIDs
- absence of pneumoperitoneum does not exclude perforation
147
```
Case 111
Which of the following is associated with the highest prevalence of H. pylori infection?
A. Gastric ulcer
B. Gastric cancer
C. Duodenal ulcer
D. Chronic gastritis
```
C. Duodenal ulcer
148
Case 112
| What is the MC extracolonic malignancy seen in Lynch syndrome?
Endometrial carcinoma
150
Case 112
| What is Lynch Syndrome? What's its genetic basis?
HNPCC
- hereditary non-polyposis colorectal cancer
- Defective DNA mismatch repair sequences
151
Case 112
| What cancers are associated with Lynch Syndrome?
```
High risk - colon CA
Increased Risk
- Endometrial (most common)
- Ovarian
- Hepatobiliary
- Stomach
- SB cancers
```
152
Case 115
| What is Menetrier's dz?
Protein Loss Enteropathy of unknown etiology
- Characterized by rugal hypertrophy
- Hypo-proteinemia
- Hypo-chloremia
- Pain, weight loss, vomiting, diarrhea
- Responds poorly to Rx
- May require gastric resection
153
Case 113
What is the name of the syndrome where there is gastric outlet obstruction due to a lodged gallstone in the pyloric channel?
Bouveret's Syndrome
154
Case 115
| What is Menetrier's dz?
Protein Loss Enteropathy of unknown etiology
- Characterized by rugal hypertrophy of the entire stomach
- Hypo-proteinemia
- Hypo-chloremia
- Pain, weight loss, vomiting, diarrhea
- Responds poorly to steroids or other treatments
- May require gastric resection
155
Case 115
| DDx for thickened gastric folds
Menetrier's dz
Eosinophilic Gastritis
Sarcoid
Gastric Varices
156
Case 113
T/F
1. Caustic ingestion frequently leads to gastric outlet obstruction
2. Transpyloric prolapse of gastric mucosa is usually asymptomatic
3. Gastric outlet obstruction is the most common complication of gastroduodenal tuberculosis
4. Patients with gastroduodenal involvement by Crohn's dz are usually symptomatic
1. T
2. T
3. T
4. F
157
Case 113
| What is the most common cause of gastric outlet obstruction?
Malignancy
- Pancreatic AdenoCA
- Primary Gastric CA
- Scirrhous type
Both can infiltrate along the gastric wall causing antral constriction and outlet obstruction
** Case review contradicts itself on case 79 p161 q2 and case 113 p229 q2. The information for the correct answers to these cases was therefore taken from Requisites 4th ed page 66.
158
Case 115
| Features of gastric Sarcoidosis
- There is always associated pulmonary involvement
- Other parts of the GI tract may be involved
- Responds well to steroids
159
Case 116
| What should you suspect when there is no etiologic basis for acute pancreatitis in a middle-aged or older adult?
Pancreatic Cancer
160
Case 115
| Gastric rugal hypertrophy with peripheral eosinophilia
Eosinophilic gastritis
| - Rx is steroids
161
Case 116
| What is the most definitive means to diagnose benign focal pancreatitis from pancreatic carcinoma?
Follow up CT
163
Case 116
| What are the 2 leading causes of death in acute pancreatitis?
Necrosis (happens early in the course of disease)
| Sepsis
164
Case 117
What part of the colon is typically affected by amebiasis?
What is the classic appearanace?
Primarily the Cecum
Can also affect
- Liver
- Lungs
'Coned cecum'
165
Case 117
| DDx for coned appearance of the cecum
```
Amebiasis (E. Histolytica)
Crohn's
Ulcerative Colitis
TB
Cancer / Lymphoma
Yersinia
Blastomycosis
Anisakiasis
```
166
Case 118
| What is the typical treatment for typhlitis?
Aggressive antibiotic therapy
Surgery not indicated unless
- perforation
- abscess
167
Case 118
| In what demographic is typhlitis typically seen? What is the mortality rate?
Immunocompromised pediatric pts
- typically undergoing chemo
- can occur in adults
- thick bowel wall +\- pneumatosis
- responds well to Abx
- also called Neutropenic Colitis
- 50% mortality rate
168
Case 119
| What is the classic physical exam finding indicating metastatic gastric carcinoma?
Virchow's node
| - left supraclavicular
169
Case 117
| What are the typical terminal ileal findings in UC?
Dilated gaping TI
| - backwash ileitis
169
Case 119
| What is the anatomic structure that allows tumor to spread from the stomach to the transverse colon?
Gastro-colic Ligament
170
Case 119
| Most common tumor of the omentum?
Metastatic Ovarian Cancer
171
Case 120
| Most common GI site of involvement by Scleroderma?
Esophagus
172
Case 120
| List three common clinical complications of Scleroderma
Constipation
Incontinence
Rectal Prolapse
173
Case 121
| What embryologic portion of the pancreas becomes the uncinate process?
Ventral pancreatic bud
174
Case 121
| What percentage of patients with annular pancreas develop acute or chronic pancreatitis?
Up to 25%
175
Case 120
| What disease states can result in wide-mouth colonic sacculations?
Scleroderma
Crohn's disease
Laxative abuse
```
Contain all 3 layers of bowel
Also termed
- "true" diverticula
- wide mouth diverticula
- pseudo-diverticula
```
176
Case 121
| What imaging features are diagnostic of annular pancreas?
Presence of visible pancreatic tissue posterior and lateral to the descending duodenum
177
Case 121
| What is the MC presentation of annular pancreas?
Duodenal obstruction
178
Case 122
| What is the most common primary malignancy of the duodenum?
Adenocarcinoma
179
```
Case 122
Which of the following conditions results in the highest risk of duodenal carcinoma?
A. Celiac disease
B. Crohn's disease
C. Neurofibromatosis
D. Gardner's syndrome
```
Gardner's syndrome
180
Case 122
| What is the MC location of duodenal carcinoma?
Descending duodenum (D2)
181
Case 123
| What is the difference between T4a and T4b in esophageal cancer?
T4a = invades pleura, pericardium or diaphragm. RESECTABLE.
T4b = invades aorta, vertebral body, trachea, or bronchus. UNRESECTABLE.
182
Case 124
| What is the mechanism of Mirizzi's syndrome?
Gallstone impacted in cystic duct resulting in compression of the common hepatic or common bile duct secondary to local inflammatory response
183
Case 123
| What is the definition of T4 disease in esophageal cancer?
T4 = invasion of local structures
| - determines resectability
184
Case 123
| Historically, what is the MC type of esophageal carcinoma?
Squamous Cell Carcinoma
| - AdenoCA increasing and now more equal
185
Case 124
| What is a potential surgical pitfall in Mirizzi's syndrome?
Inadvertent ligation of the common hepatic duct
186
Case 124
| Most common cause of obstructive jaundice?
Choledocolithiasis
187
Case 125
| What is the MC source of hematogenous metastatic disease to the colon?
Breast cancer
188
Case 125
| What is the MC site of GI tract metastasis from breast cancer?
Stomach
189
Case 125
| What is the MC type of breast cancer histology to result in metastatic spread to the GI tract?
Lobular carcinoma
| - vs ductal infiltrative
190
Case 125
| What is the most common morphology of GI mets from primary lobular breast carcinoma?
Linitis plastica
191
Case 126
| What percentage of Meckel's diverticula contain gastric mucosa?
About 50%
192
Case 126
| What is the cause of Meckel's?
Embryologically the incomplete obliteration of the vitelline duct (omphalomesenteric duct)
193
Case 126
What nucs study is used for Meckel's?
How reliable is it?
Tc99 pertechnetate
- to detect gastric mucosa
Not very
194
Case 126
T/F
In scintigraphic evaluation of Meckel's, pentagastrin and glucagon are useful
True
195
Case 126
| What are potential complications of Meckel's diverticulum?
```
Pain
Bleeding
SBO
Intussusception
Volvulus
Littre hernia
```
196
Case 126
| In Meckel's diverticula, what other type of ectopic tissue may be found besides gastric mucosa?
Pancreatic tissue
197
Case 126
| On angiography, what is diagnostic of Meckel's diverticula?
A persistent Vitelline artery
198
Case 126
| What potential appearance does Meckel's have on CT?
Elongated ileal polyp
199
Case 126
| Plain film radiographs visualize about 50% of Meckel's enteroliths
True
200
Case 126
How common is a Meckel's enterolith?
Potential complications?
10 %
Obstruction and bleeding
201
Case 127
| Which side is more common with traumatic diaphragmatic rupture?
Left sided
| - 8 x more likely
202
Case 127
| What is the most common perception error in right sided diaphragmatic rupture?
Mistaken for elevation or eventration of the intact hemidiaphragm
203
Case 127
| What is the most common type of diaphragmatic tear in blunt trauma?
Posterolateral and radial
204
Case 127
| Most common visceral injury associated with left diaphragmatic injury?
Spleen
205
Case 128
| What is the MC technique for esophagectomy?
Ivor-Lewis esophagectomy
206
Case 128
| What is the MC intraoperative complication in esophagectomy?
Recurrent laryngeal nerve injury
207
Case 128
| What is the most common non-malignant reason for performing an esophagectomy in a pediatric patient?
Esophageal Atresia
208
Case 128
| In the setting of esophagectomy with jejunal interposition, what are the major long term complications?
Gastric acid reflux
| TEF
209
Case 129
What type of hepatoma occurs in young adults?
Sex predominance?
Fibrolamellar hepatoma
Males
210
Case 129
| What percentage of fibrolamellar hepatomas calcify?
50%
211
Case 129
| What is the appearance of the central scar of fibrolamellar HCC on MRI?
Typically hypointense on all sequences
212
Case 129
| What is the appearance of fibrolamellar hepatoma on Tc-99m sulfur colloid imaging?
Does not take up sulfur colloid
| - does not contain Kupfer cells
213
Case 129
| In younger patients, what is an unusual variant of hepatocellular carcinoma?
```
Fibrolamellar carcinoma
Not assoc w
- cirrhosis
- chronic hepatitis
Responds well to chemo
```
214
Case 130
| Most common gastric malignancy?
Adenocarcinoma
215
Case 128
| Which is the most common type of esophageal atresia often associated with tracheoesophageal fistula?
EA with distal TEF
216
Case 130
| List two complications of lesions in the pre-pyloric gastric antrum?
Gastric outlet obstruction
| Transpyloric extension
217
Case 130
| What is the MC gross appearance of gastric adenocarcinoma?
Mass lesion
NOT: ulcer, linitis plastica, or thickened folds
218
Case 131
What type of injury is MC associated with traumatic pancreatic injury?
What is the incidence pancreatic injury in the setting of blunt trauma?
Penetrating injury
10%
219
Case 130
| Most likely malignancy to cross the pylorus?
Adenocarcinoma
- Lymphoma has a greater tendency but
- AdenoCA is much more common (90%)
220
Case 131
| What is the most common site of pancreatic injury?
Body of the pancreas
221
Case 131
| What is the most important concern in suspected pancreatic injury?
Injury of the main pancreatic duct
222
Case 132
| What infectious dz of the small bowel typically involves the terminal ileum?
Yersinia enterocoliticus
223
Case 133
| What is the MC site of involvement with acute GVHD?
Skin
224
Case 133
| What are the major organs involved in graft v. host disease (GVHD)?
Skin
GI
Lungs
Liver
225
Case 133
| When does subacute GVHD occur?
Within 1-4 months of BMT
226
Case 133
| What is the MC site of GI tract chronic GVHD?
Oral cavity
227
Case 133
| How does GVHD manifest itself in the GI Tract?
Fold thickening
Effacement of folds
Luminal Narrowing
Separation of bowel loops
228
Case 134
| In mastocytosis, what is the skin condition called?
Urticaria Pigmentosa
229
Case 134
| What are the clinical and imaging manifestations of mastocytosis in the small bowel?
```
Diarrhea
Tachycardia
Flushing
Thickened folds
Bowel wall thickening
PUD
```
230
Case 134
| After the skin, what is the MC site of involvement in mastocytosis?
Small bowel: Thickened folds and bowel wall thickening
231
Case 135
| What part of the GI tract does actinomycosis classically involve?
Ileocecal junction
232
Case 135
| What iatrogenic pelvic procedure has been associated with sigmoid actinomycosis?
IUD placement
233
Case 135
| What is the treatment of choice in Actinomycosis?
Penicillin
234
Case 135
| Characteristics of Actinomyces israelii
Gram-positive bacillus
Normal GI fluora
Can breach normal barriers
- like TB
235
Case 136
| What is the anatomic site of weakness in a Killian-Jameson diverticulum?
- Below the level of the cricopharyngeus muscle
| - Lateral to the longitudinal muscles of the esophagus
236
```
Case 136
Which of the following is a true diverticulum?
A. Traction diverticulum
B. Zenker's diverticulum
C. Killian-Jamieson diverticulum
D. Intramural pseudodiverticulum
```
A. Traction diverticulum
237
Case 136
| What is a potential surgical pitfall in resecting a Killian-Jamieson diverticulum?
Recurrent laryngeal nerve injury
238
Case 136
| Why is it important to distinguish betwen Killian-Jamieson and Zenker's diverticulum?
Surgical management differs
- KJ requires endoscopic management
- Due to potential recurrent laryngeal nerve injury
239
Case 134
| Name two conditions that result in elevation of serum gastrin levels.
1. Zollinger-Ellison syndrome
- gastrin-secreting tumor
- results in highest gastrin levels
2. Mastocytosis
- mast cells release histamine
- increases gastrin levels
239
Case 137
| What is the MC cause of an appendiceal mucocele?
Mucinous cystadenoma
240
Case 138
| Most common cause of asymmetric ovoid intramural mass in the duodenum?
Duodenal hematoma
| - Trauma
241
Case 136
With regards to the cricopharyngeus muscle and position relative to midline, what are the differences between KJ and Zenker's diverticula?
Cricopharyngeus Bar
- Z is above
- KJ is below
Midline
- Z is midline
- KJ is Lateral
A/P
- Z is posterior
- KJ is anterior
241
Case 137
| Most common malignant neoplasm of the appendix?
Mucinous Adenocarcinoma
242
Case 138
T/F
In the setting of MVA and blunt abdominal trauma in children, abdominal wall bruising indicates significant intraabdominal injury in children
True
243
Case 137
| What is the MC neoplasm of the appendix?
Carcinoid
| - Typically benign
245
Case 139
| What is the most consistently recognized CT finding of active Crohn's disease?
Bowel wall thickening
246
Case 139
| What is the most common cause of small bowel obstruction in young adults?
Adhesions
247
Case 140
| What percentage of colonic adenomas at 1 to 2 cm in diameter contain carcinoma?
10%
248
Case 139
T/F
A person with Crohn's disease is more likely to have a relative with IBD
True
249
Case 140
| What is the MC site of colonic villous adenomas?
Rectum
250
Case 141
| Describe Zollinger-Ellison Syndrome
Excessive gastrin secretion
- Secondary to non-islet cell tumors
- > Gastrinomas predominantly pancreatic
- 60 % are malignant
- PUD from elevated gastrin levels
- Associated with MEN I
- -> Parathyroid, pituitary, adrenal
- Hypervascular on CT (arterial phase)
251
Case 140
T/F
Incidence of carcinoma in colonic adenomas increases with increasing size
True
252
Case 140
| Which imaging sign on barium enema is used to describe a pedunculated polyp?
Mexican hat sign
253
Case 141
| What other diseases are gastrinomas associated with?
MEN I
- Parathyroid
- Pituitary
- Adrenal tumors
254
Case 141
What is the typical clinical presentation of Zollinger-Ellison syndrome?
What typical appearance on UGI series?
Diarrhea
Thickened gastric rugal folds
255
Case 141
| What are the MC locations for gastrinoma?
```
Pancreas - 75%
Duodenum - 15%
Para-aortic
Bladder
Ovaries
Liver
```
255
Case 141
| What is the typical appearance of a pancreatic gastrinoma on CT?
Hypervascular tumor
- Enhances brightly on arterial phase
- Typically in the pancreatic head
256
Case 141
| What serum levels of gastrin is indicative or suggestive of ZES?
Anything > 1000 pg/mL
257
Case 142
| What is the most important vascular finding in patients with GI malrotation?
SMA/SMV transposition
258
Case 141
| What is the best diagnostic test to localize a gastrinoma?
In-111 Octreotide scan
| - Somatostatin receptor scintigraphy
259
Case 142
| In malrotation, what is the leading cause of death?
Congenital heart disease
- heterotaxy
- other congenital abnormalities
260
Case 143
| What operation can result in gastric fundal pseudotumor?
Fundoplication
261
Case 143
| What is the most serious complication of partial gastrectomy?
Cancer
262
Case 142
| What is the typical presentation of midgut malrotation?
Newborn
263
Case 143
| What is pseudo-lymphoma of the stomach?
Lymphoid tissue proliferation that simulates lymphoma
264
Case 144
| Most common foreign body seen in the upper esophagus?
Fish or chicken bone
| - typically difficult to see radiographically
265
Case 145
| What is the MC tumor associated with dilation of the pancreatic duct?
Ductal adenocarcinoma of the pancreatic head
266
Case 145
| Dilated pancreatic duct containing signal poor filling defects on MRCP?
Calculi
267
Case 144
| What is the MC site of impaction of an ingested foreign body?
Pharynx
| - Lateral radiograph gives the best chance to detect
268
Case 145
| Even though MRCP is superior to CT in the evaluation of the biliary tract, what advantage does CT have over MR?
CT has better spatial resolution
269
Case 146
| List five causes of fistula
```
Diverticulitis
Crohn's
TB
Neoplasm
Radiation
```
271
Case 146
| What is the MC cause of lower urinary tract fistulas?
Gynecologic surgery
272
Case 146
| What is the most common etiology of colovesical fistula?
Diverticulitis
273
Case 146
| What is the most common type of fistula to the lower urinary tract?
Fistula to vagina
274
Case 147
| Name 4 infections that typically affect the ileocecal region
Tuberculosis
Amebiasis
Yersiniasis
Actinomycosis
275
Case 147
| Most common site of involvement of abdominal tuberculosis?
Lymph nodes
276
Case 148
What is the triad of findings for gallstone ileus?
What is it called?
Ectopic gallstone in bowel
Small Bowel Obstruction
Pneumobilia
Rigler's triad
277
Case 148
| In gallstone ileus, where does the gallstone typically become impacted?
Terminal ileum
278
Case 147
| What is the characteristic appearance of tuberculosis at the terminal ileum
Thickening of the lips of the ileocecal valve with gaping of the valve and narrowing of the terminal ileum
279
Case 148
| How often is Rigler's triad seen on plain film radiography?
10%
280
Case 149
| Most common complication of colon cancer?
Obstruction
281
Case 149
In the setting of colonic perforation, what features can help distinguish between malignancy and other benign causes of perforation?
Irregular thickening of the colonic wall
282
Case 149
| What finding can help distinguish colon carcinoma from diverticulitis?
Presence of pericolic lymph nodes
283
Case 150
| What MRI finding most reflects active pathologic inflammation of the bowel in Crohn's dz?
Contrast enhancement
284
Case 150
| What is the advantage of MRI over CT for the evaluation of Crohn's?
Lack of ionizing radiation
286
Case 100
Most common cause of:
Primary Achalasia
Secondary Achalasia
Primary: Idiopathic
Secondary: Cancer
287
Case 150
| Name five causes of small bowel feces
Anything that delays SB transit time
- Crohn's
- Obstruction
- Ischemia
- Adhesions
- Cystic fibrosis
