GIT 3 Flashcards

Question

DDx of this appearance

Answer 1

* Ddx Stomach Linitis Plastica 4 categories 11 ddx AKA - **_Leather bottle stomach_** * Marked thickening and irregularity of the gastric wall (diffuse infiltration) * Rigidity, narrowing and nondistensibility * peristalsis does not pass through linitis * DDx * Tumour * Inflammation * Infiltrative disease * Infection * DDx * Tumour * Scirrhous cancer (most common cause) * Lymphoma * Metastases (most commonly breast cancer) * Pancreatic carcinoma * Inflammation * Erosive gastritis * Radiation therapy * Infiltrative disease * Sarcoid * Amyloid - rare * Intramural gastric hematoma (rare) * Infection * TB * Syphylis https://radiopaedia.org/cases/linitis-plastica-2

Answer 2

* Tumour * Inflammatory * Other * Tumour * Andromcarcinoma * mets * lymphoma * Inflammatory * Crohn's disease * PUD * TB * Sarcoid * Other * Hypertrophic pyloric stenosis * Pulorospasm * Antral web

Answer 3

* Blunting of antral fornices with progressive tapering from antrum to pylorus * DDX * Chronic PUD * Scirrhous carcinoma * Granulomatous Disease * Crohn's disease * TB * Sarcoid * Eosinophilic gastroenteritis * Caustic ingestion

Answer 4

1. Surgery and laparoscopy and other radiologic interventions (most common cause 2. Perforated gastric or duodenal ulcer (second most common cause) 3. Cecal perforation from colonic obstruction 4. pneumatosis coli 5. air through genital trach in females 6. perforated distal bowel (usually a/w abscess and lesser amounts of free air * IBD * Diverticulitis * Tumour

Answer 5

* Neoplastic * benign * Malignant * Other * Bulb * Distal * Neoplastic * benign * often in first portion, asymptomatic * adenoma (usually \<1cm) * Leiomyoma * Carcinoid * Villous Adenoma * Near Papilla, high malignant potential * Malignant * Often distal to first portion, symptomatic * adenocarcinoma at or distal to papilla - 90% of malignant tumors * Metastases * Direct invasion from stomach, pancreas, colon, kidney, or hematogenous such as melanoma * Lymphoma * Other * Bulb * ectopic gastric mucosa * prolapsed antral mucosa * Brunner gland hyperplasia * varices * Distal * Benign lymphoid hyperplasia * ectopic pancreas * Annular pancreas * papilla of vater * tumour * edema with impacted or passed gallstone * choledochocele * duplication cyst * intraluminal diverticulum

Answer 6

* Duodenal Bulb * 90% are benign * 2nd and 3rd portions * 50% are malignant * 4th portion * 90% are malignant

Answer 7

* Ulcer * ulcer with contained perforation * malignant ulcer (rarely primary) * Diverticulum * pseudodiverticulum: ulcer scarring * Choledochoduodenal or cholecytoduodenal fistula * True diverticulum * medial * 2nd part duodenum

Answer 8

* Neoplastic * adenocarcinoma * lymphoma * metastases * direct invasion from colon, kidney, pancreas, GB * GIST * Inflammatory * Intrinsic * post bulbar ulcer * duodenitis * crohn's disease * extrinsic * pancreatitis * annular pancreas * intramural diverticulum * duodenal duplication cyst * duodenal hematoma * aortic aneurysm (3rd portion) * SMA Syndrome * Supine position causes partial obstruction of the 3rd portion of the duodenum by SMA * may be exacerbatedby weight loss

Answer 9

* H. Pylori * Crohn's * Giardiasis * Sprue * Whipple disease * Brunner gland hyperplasia * Lymphoma * Hematoma/trauma * Pancreatitis

Answer 10

* Normal variant * choledochocele * papillary edema * pancreatitis * acute duodenal ulcer * impacted stone * Ampullary tumour * adenomatous polyp * carcinoma

Answer 11

* Disproportionate distribution of gas is the key finding * much more gas and fluid in SB compared with colon * much more gas in proximal; SB compared with distal SB * Fluid retention parallels gas distribution: * no fluid no obstruction * Closed-loop obstruction * lumen occluded at two adjacent sites * obstructed loops distend with fluid * loop may twist * the bowel may or may not be infarcted * Additional examinations in presumed acute SBO include * if very dilated or abundant fluid * CT - the fluid acts as an intrinsic contrast material * if mild dilatation * CT with oral contrast or SBFT * Enteroclysis: * need to decompress bowel before the study, best applied to nonacute situations

Answer 12

* cecal dilation is the key radiographic Finding * cecum is invariably most dilated in colonic obstruction. however it may also be very dilated in paralytic ileus * If the transverse colon is more dilated than the caecum, there is rarely an obstruction * exception: concomitant disease that intrinsically narrows the cecum (IBD) * Fluid retentiaion not necessarily seen in colonic obstruciton * A useful initial screening procedure to rule out distal colonic obstruction is a prone KUB. IF there is no obstruction, gas passes to the rectum. * BE is the definitive study. * Do not perform UGI series in a patient with possible colonic obstruction (contraindicated bc barium impacts in the colon.

Answer 13

* post operative - Most common * Vascular * IBD * Inflammatory * often localised ileus -\> sentinel loop * pancreatitis * appendicitis * cholecystitis * Diverticulitis * peritonitis * Metabolic * hypokalemia * hypocalcemia * Hypomagnesemia * medication * morphine * diphnoxylate (lomotil)

Answer 14

* Adhesions * hernias * tumours * gallstones * inflammation with strictures * Gallstone ileus: * pneumobilia * SBO * Stone within bowel lumen (may obstruct ileocecal valve)

Answer 15

* Signs * dilution of barium (hypersecretion\_ * Flocculation of barium * moulage * segmentation of barium column * delay in transit

Answer 16

* MNEMONIC: WAG CLEM * Whipple disease * Amyloid * Giardiasis (largely affects jejunum) GVH retraction, gammaglobulinopathy * Cryptosporidiosis (largely affects jejunum) * Lymphoma, lymphangiectasis, lactase deficiency * Eosinophilic gastroenteritis * Mycobacterium Avium complex, Mastocytosis

Answer 17

* Ischaemia * Intramural hemorrhage * Radiation * Hypoproteinema * Venous congestion * Cirrhosis Pattern Approach for Diseases of Mesenteric Small Bowel on Barium Studies1 https://geiselmed.dartmouth.edu/radiology/wp-content/uploads/sites/47/2019/04/small\_bowel.pdf

Answer 18

* SOSO * Sprue is the single most important cause of true Malabsorption * Obstruction or ileus * Scleroderma * Other * Medication * Morphine * Lomotil * Atropine * Pro-Banthine * Vagotomy

Answer 19

* Criteria: * Folds \>3mm * By CT, the edema in SB wall may appear as ring or halo sign * Two Types * DIFFUSE: uniformly thickened folds * FOCAL: nodular thickening (pinky printing). * Analogous to thumb printing in ischaemic colitis * stack of coins appearance * picket fence appearance

Answer 20

* Submucosal edema * ischemia * enteritis * infection * radiation * Hypoproteinemia * GVH reaction * Submucosal tumor * lymphoma, leukemia * infiltrating carcinoid causing venous stasis * Submucosal hemorrhage * Henoch-Schonlein disease * Hemolytic uremic syndrome * Coagulopathies (hemophilia, vit K, Anticoagulants) * Thrombocytopenia, disseminated intravascular coagulation

Answer 21

* Mastocytosis * Lymphoid hyperplasia * Lymphoma * Mets * Polyps * Crohns disease

Answer 22

* Anticoagulation * Vasculitis * Trauma * Ischemia * Carcinoid

Answer 23

* Ischemia * Vasculitis * Hemorrhage * Radiation * Collagen vascular disease * inflammatory bowel disease * tumor * adhesions

Answer 24

* TARGET SIGN * Ischaemia * vasculitis * hemorrhage * IBD * Angioedema * ACE inhibitors * Hereditary * Allergic reaction * Portal Hypertension * NSAIDS VERY GOOD ARTICLE: https://radiologyassistant.nl/abdomen/bowel/bowel-wall-thickening-ct-pattern VERY GOOD ARTICLE: https://radiologyassistant.nl/abdomen/bowel/bowel-wall-thickening-ct-pattern

Answer 25

* Tubular, "Toothpaste" appearance on SB Series * GVH disease * Cryptosporidium https://link.springer.com/article/10.1007/s00247-010-1853-x/figures/1 Intestinal graft-versus-host disease Sabah Servaes Pediatric Radiology volume 40, page101 (2010)Cite this article 557 Accesses Metricsdetails A 17-month-old boy with acute lymphoblastic leukemia status 61 days post cord blood transplant presented with vomiting, diarrhea and feeding intolerance. Fluoroscopic examination with barium demonstrates diffuse narrowing of the small bowel lumen referred to as toothpaste- or ribbon-like (Fig. 1) and consistent with graft-versus-host disease (GVHD). Despite improvement of intestinal GVHD with immunosuppressive therapy, the boy developed respiratory failure and infection and died 4 months later.

Answer 26

* Benign * Adenoma (most common) * Leiomyoma (second most common) * Lipoma * Hemangioma * Neurogenic tumours (usually in NF) * Other * brunner gland hyperplasia * Heterotopic pancreatic tissue * Duplication cyst * Inverted Meckel Diverticulum * Malignant Tumours * Mets * Melanoma * kidney * breast * kaposi Sarcoma * Lymphoma * Carcinoid (most common primary - 50% are malignant and have mets at time of diagnosis) * GIST * Sarcoma (Sarcomatous degeneration of benign tumours * eg leiomyosarcoma * lymphosarcoma * usually large ulcerating tumors * adenocarcinoma * Polyposis Syndromes

Answer 27

* Occlusive disease * emboli * (AF, * ventricular aneurysm) * Arterial Thrombosis * (atherosclerosis) * Venous thrombosis * (portal hypertension, * pancreatitis, * tumor) * Nonocclusive disease (ie low flow) * Hypotension * Hypovolemia

Answer 28

* Anxiety * Hyperthyroidism * Medication * Metoclopramide * Neostigmine * Quinidine * Methacholine * Partial SBO * Paradoxical rapid propulsion to point of obstruction

Answer 29

* Non-neoplastic Polypoid Abnormmalities * normal lymphofollicular pattern * Pneumatosis Coli * Colitis Cystitc profunda * Amyloidosis * Endometriosis * Ischaemic Colitis * Polyps * Polyposis syndromes * Benign neoplasms * Lipoma (common) * Leimyoma (rare) * Malignant Neoplasm * Adenocarcinoma * Mets * Lymphoma

Answer 30

* Hyperplastic polyps * 90% of colonic polyps * not true tumors * No malignant potential * Adenomatous polyps * Second Most common Type * 25% are multiple * True tumours * malignant transformation * Types * tubular * villous * tubulovillous * Hamartomatous Polyps * Rare * Peutz-jeghers

Answer 31

* Crohn disease (50% of patients) * amebiasis * Behcet syndrome * CMV * Herpes

Answer 32

* Inflammatory Colitis * UC * Crohn's * Behcet syndrome * infectious Colitis * Amebiasis * TB * Salmonella * Shigella * Histoplasmosis * AIDS * candida * herpes * CMV * Ischemic colitis * Radiation Colitis

Answer 33

* Thumbprinting refers to luminal indentations the size of a thumb, bc of edema, tumor or hemorrhage. * Morphology of accompanying haustral folds may be a clue to underlying diagnosis * preserved haustral folds * infection * ischemia * effaced haustra folds * Tumour * IBD * DDX * Edema * Infectious Colitis * Pseudomembranous colitis (c diff) * CMV colitis * E. coli, shigella, salmonella amebiaisis * Neutropenic Colitis (typhlitis) * IBD * Tumour * Lymphoma * leukemia * Hemorrhage * ischemia * Henoch-schonlein disease, thrombocytopenia, DIC * Coagulopathies * hemophilia * Vit K * Anticoagulants

Answer 34

* Deformities may be symmetric (circumferential, apple core) or asymmetric * Tumor * adenocarcinoma * Saddle shaped if asymmetric * Apple core shaped if circumferential * Mets (common serosal implants: gastric, ovarian) * Inflammation * diverticulitis * Focal inflammation * IBD: Crohn disease UC * Infectious * Ameboma, * TB * Other * endometriosis * Pelvic Abscess * epiploic appendagitis

Answer 35

* Scirrhous adenocarcinoma * lymphoma * UC (with or without carcinoma) * Crohn disease * ischaemic stricture * Radiation

Answer 36

* Cathartic Abuse * often right colon * UC/CD * Amebiasis * Ageing (usually left colon)

Answer 37

* Carcinoma (65%) * diverticulitis (20%) * Volvulus (5%) * Other * impaction * hernia

Answer 38

* Descriptive term for abnormally distended transverse colon \>6cm) most commonly used in conjunction with TMC. * TMC * Haustral deformity, pseudopolps, risk of perforatmion systemic signs * UC, CD * Infectious * amebiasis * shigellosisi * C. Diff * Acute colonic distention * risk of perforation with cecum \>9cm) * Obstructive: cancer * Paralytic ileus * Volvulus * Chronic megacolon (no or small risk of performation) * Cathartic colon (chronic laxtive abuse) * Colonic pseudoobstuctionve (ogilvie syndrome, colonic ileus) * Psuchogenic) * Congenital Hirchsprung disease * chagas disease * Neuromuscular disease * Parkinsonisn * diabetes * scleroderma * Amyloid * Metabolic, drugs * Hypothrouidism * Electrolyte imbalances.

Answer 39

* Ileoileal 40% \> Ileocolic 15% \> other locations * Tumours 35% * Polyps, lipoma 25% * Malignant umours 10% * Mets * lymphoma * Carcinoid * Idiopapthic 20% * Other * meckles * adhesions * Aberrant panceas

Answer 40

* Pneumatosis Cystoides (large, cyst like collection of air, few symptoms), associated with Benign causes * COP * Ventilated patients * Mucosal injury * rectal tube insertion * colonoscopy * surgery * Scleroderma * Chemotherapy * Pneumatosis Intestinalis (symptomatic). Ass/w serious causes. * infarcted bowel (tiny bubbles, lineal gas collections * necrotizing enterocolitis (neonates) * TMC * Typhlitis

Answer 41

* Inflammation (coned cecum) * Typhlitis: Inflammatory changes of cecum and/or ascending colon in neutropenic (immunosuppressed, leukemia, lymohioma) patients. Caued by infection, bleeding, ischaema. * TB: narrow cecum (fleischner sign), narrow crohn may produce same appearance, terminal ileum (stierlin sign) * Amebiasis (predominantly effects the cecum, not terminal ileum) * UC: valve is wide open (gaping), labia are atrophied, terminal ileum is dilated * Crohn's disease (apthous ulcers-\> linear fissues -\> nodules -\> cobblestone -\> stricture, spasm (string sign), fistua). * Tumour * Lymphoma * adenocarcinoma * Carcinoid of the ileum (desmoplastic response) or appendix * Intussusception

Answer 42

* Condulomata acuminata (HPV) * Lymphogranuloma Venereum (chlamydia) * Gonococcal Proctitis * UC, CD * Herpes * CMV

Answer 43

* Solid Liver masses * Neoplasm * Benign: Hemangioma * Malignant: * Primary * Secondary * Focal Fatty liver (pseudotumour) * Regenerating nodules in Cirrhosis

Answer 44

* Cystic Liver masses DDx * Infectious * Benign masses * Malignant * Cystic Liver masses DDx * Infectious * Echinococcosis * Amebiasisi * Other abscesses (often complex and have debris) * Benign masses * Simple liver cysts * Polysystic disease of the liver * Von Meyenburg Complexes * Peribilary cysts * Biliary cystadenoma * Obstructive intrahepatic GB * Biloma * Malignant * Cystadenocarcinoma * Cystic mets (ovarian) * Necrotic Tumours * Cholangiocarcinoma

Answer 45

* Hemochromatosis * Glycogen storage disease * Wilsondisease * Drugs * amiodarone * Cisplatin * Gold * Apparent increased density of liver parenchyma in patients with anemia (relative decreased blood density)

Answer 46

* Fatty liver (common) * CAUSES * Obesity/nutritional * Alcohol * diabetes * steroids * chemotherapy

Answer 47

* Hemangioma * hemangioendothelioma/hemangiopericytoma, angiosarcoma, intrahepatic cholangiocarcinoma * Mets * Islet cell * melanoma * carcinoid * RCC * Thyroid * Breast * Sarcoma

Answer 48

* Hepatic adenoma * HCC * Mets (liposarcoma, teratoma) * Focal fatty infiltration * Lipoma * AML

Answer 49

* mets after rx * cholangiocarcinoma * Focal confluent firbosis * primary sclerosing cholangitis * epithelioid hemangioendothelioma * Hemangioma (rarely)

Answer 50

* **FNH** * **Fibrolamellar HCC** * Large cavernous hemangioma * Cholangiocarcinoma * Adenoma * HCC (with central necrosis mimicking a scar) * Mets (with central necrosis mimicking a scar)

Answer 51

* Regenerative: * benign * proliferation of hepatocytes * Precursor to dysplastic nodule and HCC * Regenerative nodules with hemosiderine are termed **siderotic** **nodules** * They are isointense on CT, Hyperdense on NCT and hypointense on T1 and T2. * Dysplastic nodule * pre-malignant * hyperintense on T1 and hypointense on T2 * When malignancies develop they often appear as a **nodule within a nodule,** where the inner nodule has a characteristic appearance * T1 hypo * T2 hyper * Arterial enhancement * HCC

Answer 52

* Hemangioma * Hyperecehoic mets * Hypervascular mets * sarcoma * Calcificed mets * Primary liver tumours (contain fat) * HCC * Fibrolamellar HCC * Focal Fat/lipoma/angiomyolipoma (TS) * Gaucher disease

Answer 53

* Air in biliary tree * Air in PVs * Biliary Ascariasis

Answer 54

* Tumour * mets * lymphoma * Multifocal HCC * Infection * Multiple pyogenic abscesses * Amebic abscresses * Echinococcus * Candidiasis * Schistosomiasis * Other * Regenerating nodules/cirrhosis * Sarcoid * Extramedullary hematopoiesis * Hematomas * Hemanioma

Answer 55

* biliary gas (ercp, surgery) * PV gas (bowel necrosis, diverticulitis) * May produce short spikes on doppler wave form * Abscess * Emphysematous cholecystitis

Answer 56

* Levels of Obstruction * Intrapancreartic (most common) * Pancreatic cancer * Calculus * Chronic pancreatitis * Suprapancreatic * Primary biliary ductal carcinoma * Metastatic LNs * Portal * invasive GB carcinoma * surgical strictures * hepatoma * choangiocarcinoma

Answer 57

* Tumour * Pancreatitis * Lithiasis Related disease * Cholangitis * Caroli Disease * Intrahepatic biliary neopalsm (rare) * Tumour * Abrupt termination of a duct * mass adjacent to duct * Pancreatitis * smooth, long tapering * Lithiasis Related disease * calculus visible * meniscus sign (ERCP, CT), intrahepatic dilatation * Mirizzi Syndrome * Cholangitis * Sclerosing Cholangitis (50% have UC) * AIDS cholangitis * Intrahepatic biliary calculi (oriental cholangiohepatitis) * Caroli Disease * Congenital disorders comprising of multifocal cystic dilatation of segmental intrahepatic bile ducts. * Intrahepatic biliary neoplasm (rare) * Cystadenoma * Cystadenocarcinoma

Answer 58

* Colour Doppler flow is absent in dilated ducts * acoustic enhancement behind dilated ducts, * blood in contrast attenuates acoustic beam secondary to high protein content * Double duct sign * dilated biliary vessel accompanies PV * Caliber irregularity and tortuosity of dilated bile ducts, * veins are always smooth and taper gradually * Spokewheel appearance at points of conversion of ducts

Answer 59

* Primary sclerosing cholangitis * AIDS cholangiopathy * Mets * Chemotherapy * Post-transplant ischemia

Answer 60

* Calculi * Clot * papillomas * cholangiocarcinoma * Sludge balls

Answer 61

* Thickened portal tracts with enhancement * ascending cholangitis * schistosomiasis, TB, Histoplasmosis * Primary sclerosing cholangitis * Primary biliary cirrhosis * Sarcoidosis * Cholangiocarcinoma

Answer 62

* GB wall thickening \>3mm * Wall thickening typically appears as a hypoechoic region between two echogenic lines. * When measuring walll thickening by US, a 5-MHz transducer should be used. 1. Nonfasting GB (GB is usually \<2mm) 2. Acute cholecystitis (50-75% of patients have thickening) 3. Portal venous Hypertension * Cystic vein dilatation causes edema) 4. Hypoalbuminemia (\<2.5g/dL) 5. Hepatitis 6. AIDS * Cryptosporidiosis * CMV * MAI 7. Vasculitis * Lupus * HSP 8. Ascities * Benign ascites -\> GB wall thickening * Malignant Ascities -\> no GB wall thickening

Answer 63

* GB carcinoma * 40% present with focal thickening, mass typically fills the GB * Mets * Melanoma * Gastric * Pancreas * Benign tumours * polyps (cholesterol, adenomatous) * Adenomyomatosis * Tumefactive sludge adherent to GB wall * AIDS

Answer 64

1. Calculus 2. Polyp 3. Cholesterol 4. Emphysematous Cholecystitis 5. Porcelain GB

Answer 65

* Hepatobiliary excretion of contrast material * Calculi * Milk of calcium bile * Reflux of oral contrast agent after surgery * oral cholecystogram * Hemorrhage (hematocrit effect)

Answer 66

* Ie focal hypoechoic or hypodense pancreatic lesion * Tumour * focal pancreatitis * Adenopathy

Answer 67

* Groove pancreatitis * Cystic dystrophy of the duodenum * Paraductodenal wall cysts

Answer 68

* Unilocular * simple cyst * Pseudocyst post pancreatitis * muliple unilocular * VHL * CF * ADPKD * Microcystic lesions * serous cystadenoma * Macrocystic lesions * mucinous cystadenoma * Mural nodules * pancreatic adenocarcinoma

Answer 69

* Common cystic neoplasms * mucinous cystic neoplasm * Serous cystadenoma * Intraductal papillary mucinous neoplasm (IPMN)

Answer 70

Rare cystic neoplasms * Solid pseudopapillary epithelial neoplasm (SPEN) * Papillary cystic epithelial neoplasm * Acinar cell cystadenocarcinoma * Cystic teratoma * cystic choriocarcinoma * Angiomatous neoplasmas (Lymphangioma, hemangioma) * Paraganglioma

Answer 71

* Solid tumors undergoing cystic change * cystic islet cell tumors * Cystic necrosis pf pancreatic adenocarcinoma * Others * lymphoma * Mets (ovarian clear cell) * Cystic teratoma * Sarcoma

Answer 72

* Chronic pancreatitis * islet cell tumour * serous cystadenoma * mucinous cystic neoplasm * SPEN * Granulomatous disease * sarcoidosis * Histoplasmosis

Answer 73

* CF * Aging * DM * Obesity * Steroids * Shwachman-Diamond Syndrome (picture)

Answer 74

* The normal pancrease appears slightly hyperechoic relative to the liver. Marked hyperechogenicity is seen in: * CF * Pancreatic lipomatosis

Answer 75

* Tumour * Infection * Other * Tumour * mets * Usually in endstage disease * Lymphoma * melanoma * ovary * hemangioma (common benign lesion) * Lymphangioma * Hamartoma * Rare lesions * Myoma * chondroma * osteoma * hemangiosarcoma * fibrosarcoma * Infection * abscess * candidiasis (esp AIDS) * TB MAI * Schistosomiasis * Splenic nodules in 10% * Pneumocystis jiroveci * Other * infarcts * hematoma * cysts: simple, hydatid * Fatty nodules in Gaucher disease