Practise viva Flashcards by Nick Begg

Budd-Chairi

Nodular liver contour
Idiopathic, congenital (venous web), thrombosis (pregnant, OC, polycythaemia, antiphospholipid, sickle cell disease, other)
Phlebitis - BMT, chemo
Autoimmune
Tumour invasion - RCC, HCC, adrenal Ca
Leiomyosarc of IVC

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Calcific mets

BOTOM
Breast
Osteosarc
Papillary thyroid
Ovary
Mucinous adenocarcinoma (esp colorectal)

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Random points

Second unrelated sign
Common condition on uncommon exam
Talk about findings being persistent or not with fluoroscopy

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Random cases

Aspiration on barium swallow

Double cystic duct and other anatomical variants

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Renal scarring

Reflux nephropathy
Infarct
Chronic infection

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Sigmoid volvulus

Large bowel obstruction
Ahaustral wall, lower end points to pelvis
More common in elderly - associated with chronic neuro conditions, meds for psych conditions, Chagas, chronic laxatives or constipation, fibre rich diet
Rectal tube insertion succesful in treating 90%

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Caecal volvulus

Younger patients than sigmoid

Laparotomy for reduction, may need caecoplexy, or hemicolectomy if ischaemic

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Emphysematous pyelonephritis

Diabetes
E coli, klebsiella, proteus.
Retroperitoneal air or air over renal shadow
High mortality
Drain collections and IV antibiotics

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Emphysematous cholecystitis

Diabetes
More common in men
50% acalculous
High rate of perforation

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Biliary gas v portal venous gas

Biliary central, portal venous peripheral

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Small bowel obstruction radiograph

Herniae
Appendicoliths
Gallstones

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Staghorn calculi

Struvite stone
Setting of recurrent infection with urease producing organisms
Proteus, klebsiella, pseudomonas, enterobacter
More common in women, cord injury, renal tract anamoly, reflux
May progress to xanthogranulomatous pyelonephritis

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Xanthogranulomatous pyelonephritis

Associated with staghorn calculi
Chronic granulomatous pyelonephritis
E coli, proteus
Surgical nephrectomy

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Sclerosing encapsulating peritonitis

Rare benign cause of acute or subacute bowel obstruction
Total or partial encasement of small bowel by thick fibrocollagenous membrane
Idiopathic or secondary to peritoneal dialysis, shunts e.g. VP
And rarely other causes e.g. TB, sarcoid
Wall may calcify

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Relative washout

PV - delayed / PV

>40% suggests adenoma

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Absolute washout

PV - delayed / PV - unenhanced

>60% suggests adenoma

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Abdominal calcification

Don’t forger aneurysm as possible cause

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Hypervascular liver mets

Renal, thyroid, breast, lung, melanoma, carcinoid, chodiocarcinoma, other

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Central scar

FNH, large haemangioma, fibrolamellar HCC

May also be seen in normal HCC, some mets, cholangiocarc

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Hypervascular liver lesion

HCC, haemangioma, FNH, adenoma, mets

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FNH

T2 hyperintense scar
Delayed enhancement of central scar
Takes up hepatobiliary contrast agent - iso cf adenoma hypo
Spoke wheel on doppler, DSA
Usually soitary, subcapsular mass

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Fibrolamellar HCC

May resemble FNH
Will not take up sulphur colloid (Kuppfer cells)
Young adults without cirrhosis
FNH has T2 scar and has less calcs and is less heterogeneous
Better prognosis - 60% 5yr

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Washout of hypervascular liver lesion

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Malignancy until proven otherwise

Pancreatic trauma

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Treat duct injuries with stenting
Complications of pseudocyst, pancreatitis
Duct injury makes grade 3 AAST or above
MRCP can image the duct

Horseshoe kidney associations

Turners, and trisomies (esp 18) VACTERL ``` PUJ obstruction Susceptibility to trauma Calculi Wilms, TCC, renal carcinoid Infection Renovascular hypertension ```

Bilateral renal fossa clips and calcification in pelvis

Bilateral ureteronephrectomy and failed trasplant kidney

Small bowel ischaemia

With embolus in SMA ileocolic

Retroperitoneal tumour

Outside major organs 90% sarcomas 40-50 Extragonadal GCT, and primary retroperitoneal adeno much rarer Liposarc, PUS, leiomyosarc, rhabdoymyosarc Radiotherapy increases risk (e.g. to neuroblastoma as a child)

AMLs and TS

Previous plain film with nephrectomy one side, embolisation coils the other Multiple commonly with TS TS get RCC at same rate as general population but at a younger age. Also associated with renal cysts Can have retroperitoneal LAM

Testicular epidermoid

``` Also known as keratocyst Benign, germ cell origin Most common benign testicular neoplasm Painless Keratinous debris lined by squamous epithelium, layers Non-vascular, onion skin appearance Treatment controversial ```

Bile duct injury in hepatic trauma

May lead to bile peritonitis or biloma

Retroperitoneal colletion, large bowel obstruction, bone and lung mets

Colon ca

Colon ca location

Recotsigmoid - 55% Caecum and ascendeing - 20% Transverse - 10% Descending - 5%

Small bowel dilatations and strictures with intervening normal bowel

Crohns

Haemoperitoneum

Layering dense fluid | Cause may be hepatic mass e.g. adenoma (usually surgically removed to take away risk and confirm diagnsis)

FMD

Renal arteries most common, then carotids Can affect mesenterics and coeliacs Saw viva case with occluded SMA with supply by marginal artery of Drummond or arc of Riolan

SMA IMA anastomoses

Marginal artery of Drummond, arc or Riolan

Retrocaval ureter

On right May have obstruction or infection secondary to stasis Saw viva case with stone posterior to IVC

Spina bifida

May lead to neurogenic bladder | Therefor increased risk of stones (may see both on same plain radiograph)

Malignant v benign gastric ulcer - barium

Benign: exoluminal, smooth folds to edge, Hamptons line (radiolucent normal mucosa at neck) Malignant: endoluminal, nodular folds don't reach edge,, Carman meniscus sign - inner margin convex towards gastric lumen, "Heaped edged"

Herniae causing small bowel obstruction

CT and x-ray appearance

Splenic cysts

``` Epidermoid cyst (most common) Haemangioma (second most common) Lymphangioma Cystic mets Hydatic cyst Bacterial abscess Pancreatic pseudocyst ```

Fat containing liver lesion

``` If Cirrhosis, most likely HCC Other differentials: Focal fat Adenoma Lipoma Hepatic AML and other rarer causes ```

Liver trauma grading

Renal trauma grading

Splenic trauma grading

Pancreatic trauma grading

Hyperechoic liver met

CRC RCC Neuroendocrine (pancreatic or carcinoid) Choriocarcinoma

Hypoechoic liver met

``` Most common (65%) Lung Breast Pancreatic Lymphoma ```

ADPKD

``` Associated with: Berry anuerysms HTN Liver cysts Multiple biliary hamartomas Bicuspid aortic valve Aortic dissection Intracranial dolichoectasia Cr 16 or 4 ```

Striated nephrogram

Ureteric obstruction Pyelonephritis Renal vein thrombosis ATN (bilateral)

Renal vein thrombosis

Cortical nephrocalcinosis

Medullary nephrocalcinosis

Renal papillary necrosis

Polycystic kidneys

On plain film, may see fairly diffuse abdominal calcs (in calcified cysts), and masses displacing bowel

Linitis plastica

Distorted folds or thickened or nodular, and indistensible stomach Most commonly scirrhous adeno Also mets (breast, lung), or lymphoma Infiltrative diseases (/ granulomatous e.g. Crohn's, TB, sarcoid) or scarring (e.g. caustic) also in diffential

Practise viva Flashcards

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