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1
Q

Small bowel fold reversal with flocculations and sedimentation
Moulage sign
No bowel wall thickening

A

Celiac sprue

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2
Q

Heptomegaly with decreased echogenicity
Periportal edema

A

Viral hepatitis

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3
Q

Tender hepatomegaly
Hepatic veins and IVC enlarged
Congestive heart failure
Nutmeg liver
Increased portal vein pulsatility

A

Passive hepatic congestion

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4
Q

Nuclear medicine uptake for carcinoid

A

111 I-octreotide
If uptake not there- 123 I-MIBG

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5
Q

Ring like indentations of esophagus
With atopy symptoms

A

Idiopathic eosinophilic esophagitis

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6
Q

Ulcer at sites of extrinsic compression in mid esophagus

A

Drug induced esophagitis

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7
Q

Long structure
Reticular mucosal pattern of esophagus
Columnar metaplasia of distal esophagus in response to reflux

A

Barrett esophagitis

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8
Q

Ingestion of corrosive substance
Mid and lower third of esophagus affected
Progression from edema to ulceration to scarring over days

A

Caustic esophagitis

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9
Q

One large longitudinal ulcer in esophagus

A

CMV/HIV

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10
Q

Immunocompromised patients
Flu-like symptoms
Multiple small ulcers , each may have a halo of edema

A

Herpes simplex

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11
Q

Pt with AIDS
Shaggy outline from a pseudomembrane of joined together plaques

A

Fulminant candidiasis

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12
Q

Irregular longitudinal plaques with normal mucosa in between
Upper half of the esophagus
Immunocompromised

A

Candidiasis

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13
Q

Multiple elevated benign nodules in asymptomatic elderly patients -rounded

A

Glycogen acanthosis
D/d - candidiasis : has linear rather than rounded

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14
Q

Nerve innervating esophagus

A

Vagus

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15
Q

Multiple polyps in stomach and colon
Alopecia
Nail atrophy

A

Cronkhite Canada syndrome

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16
Q

Portal venous pulsatality causes

A

Right sided heart failure
Tricuspid regurgitation
Cirrhosis

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17
Q

Location of primary duodenal diverticulum

A

Unilocular lesion adj to medial wall of second part of duodenum with fluid level within it

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18
Q

Peutz Jeghers

A

Carcinomas- upper GI, ovary, thyroid,testis, pancreas, breast least common-lung . RCc not seen
Multiple hamartomatous polyps- present in small bowel -few pedunculated causing intussusception
Mucocutaneous pigmentation

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19
Q

Whipples disease

A

Sand like nodules in the duodenum and prox jejunum
Jejunal mucosal folds thickened
Low near fat density LN
No dilatation unlike scleroderma
Normal transit time unlike scleroderma(delayed due to dilated bowels)

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20
Q

Mastocytosis

A

Nodular fold thickening
Sclerotic bone lesions
Asthma type symptoms( mast cells)
Hepatosplenomegaly
LN enlargement

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21
Q

Carney triad

A

PEG
Pulmonary chondromas
GIST
Extra adrenal paraganglioma

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22
Q

Carney syndrome

A

Atrial myxoma
Facial/buccal pigmentation
Sertoli testis
Pituitary adenoma

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23
Q

Bezoar types

A

Phytobezoar-mottled filling defects
Trichibezoir- linear filling defects

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24
Q

Bouveret syndrome

A

Akin to gallstone ileus where the level of obstruction is the proximal duodenum and there is gastric outlet obstruction

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25
Early opacification of ileocolic vein with cluster of vessels in the antimesenteric border
Angiodysplasia
26
High output CHF Large heart on chest x ray Skin hemangioma Kasabach meritt syndrome -thrombocytopenia What liver mass do u see in infants
Hemangioendothelioma Or infantile hepatic hemangiom
27
Childhood liver mass Elevated AFP Calcification May involve portal vein, hepatic veins and ivc Precocious puberty from making beta HCG Beckwith- weidemann syndrome- so ass with Wilms
Hepatoblastoma
28
Childhood- liver Predominantly cystic mass AFP negative Calcificaitions not present Large portal vein branch feeding the tumor
Mesenchymal Hamartoma
29
Differences between epiploic appendagitis and omental infarction
EA-1. <3 cm,2. Most commonly adj to the sigmoid or cecum, 3. Shorter history OI- 1. >3cm, 2. In right Lower quadrant ,3. Longer history
30
Skeletal osteomas Keloid scarring Soft tissue tumors like desmoid of meant, lipoma, fibroma Supernumerary teeth
Gardner syndrome
31
Rectosigmoid polyp Fibrocystic disease/ fibroadenoma of breast Dysplastic cerebellar gangliocytoma- Lhermitte Duclos disease Skin disease in head and face called trichilemmomas
Cowden syndrome
32
Adenomatous and largely colonic polyps which can lead to cancers Brain tumors- supratentorial glioblastoma or medulloblastoma
Turcot syndrome
33
Innumerable Hamartomatous polyps Pedunculated polyps leading to intussusception Mucocutaneous melanin pigmentation
Peutz jeghers
34
Carpet of colonic polyps Periampullary carcinoma Hepatoblastoma Osteoma Dental anomalies JNA Papillary thyroid carcinoma
FAP
35
CT may demonstrate thickening of the caecum as well as fat stranding, pneumatosis intestinalis, bowel wall thickening and ileus. Features of small bowel obstruction may also be seen. There may be intramural areas of low attenuation which may represent haemorrhage or oedema. In general patients are immunocompromised, usually neutropenic. originates in the caecum and, often extends into the ascending colon, appendix or terminal ileum,
Typhilitis
36
Abscess formation within abdomen With fistula Involvement of psoas Prev history of ruptured appendix Or IUCD usage
Actinomycosis
37
Homogenous hypoechoic lesion with internal echoes and contiguous with the liver capsule
Amoebic abscess- usually single unlike pyogenic abscess, amoebic is found in slightly younger patients-40ys Pyogenic abscess- septicemia , direct spread, trauma, liver procedure Both can have fever
38
Congestive heart failure Constrictive pericarditis Dilated hepatic veins Portal vein- increased pulsatality Nutmeg liver
Passive hepatic congestion
39
Small hepatic venules Normal ivc and hepatic veins Portal vein waveform abnormal - slow, reversed, to and fro
Hepatic veno occlusive disease
40
Causes of increased density of liver in ct
Amiodarone therapy Haemochromatosis Historic thorotrast admission Wilson disease
41
Causes of increased density of liver in ct
Amiodarone therapy Haemochromatosis Historic thorotrast admission Wilson disease
42
Narrow caliber (2-4mm) smooth, symmetrical narrowing at distal GEJ Dysphagia to solids esp steak
Schatzki ring or B ring Notes: a ring is origin of vestibule - 2 cm above hiatus
43
Zenker diverticulum vs Killian Jamieson pulsion diverticulum
Z- above cricopharynx involving hypopharynx(not cervical esophagus), its posterior KJ- below cricopharynx, involved cervical esophagus - its anterior and lateral
44
Retention of barium in vallecula Wide atonic pyriform fossa Regurgitation and nasal reflux Upper 1/3rd of esophagus affected
Polymyositis
45
Mega esophagus Mega duodenum Looks like achalasia Periorbital or palpable edema/conjunctivitis
Chagas disease
46
Hypertrophic pyloric stenosis cut offs
π = 3.1415 pyloric muscle thickness, i.e. diame­ter of a single muscular wall on a transverse image >3 mm (most accurate 1) pyloric transverse diameter ≥14 mm length, i.e. longitudinal measurement >15 mm
47
Hyperechoic area in right lobe of liver in a previously well pt with posterior acoustic enhancement
Capillary hemangioma
48
Contraindications for liver biopsy-
1. Uncooperative patient 2. Extrahepatic biliary duct dilatation (except if benefit outweighs the risk) 3. Bacterial cholangitis (relative contraindication due to risk of septic shock) 4. Abnormal coagulation indices (having a normal INR or PT is not a reassurance that the patient will not bleed; however, there is increased incidence of bleeding with INR above 1.5) 5. Thrombocytopenia (platelet count below 60,000/mm') 6. Prsence of ascites 7. Cystic lesion
49
Tumor markers 1. AFP 2. CEA 3. Beta HCG 4.calcitonin 5. Ca 15-3 6. CA 19-9
Ans 1. AFP- primary hcc 2. CEA- colorectal carcinoma 3. Beta HCG-choriocarcinoma 4.calcitonin- medullary carcinoma 5. Ca 15-3- breast 6. CA 19-9- pancreatic and gastric
50
Infectious colitis organisms which cause on the right and left
Right side- yersinia and salmonella(note- salmonella can cause acute acalculus cholecystitis Left side - schistosomiasis, shigella Diffuse- cmv and E. coli Rectosigmoid- gonorrhae , herpes and chlamydia
51
Rectal carcinoma is it adenocarcinoma or squamous
Almost always adenocarcinoma If squamous- hpv If muscularis mucosa is involved - t3–> neoadjuvent chemo/radio , then resection If low grade cancer but with involvement of spread along the vessels( question will give fusiform dilatation of the sup rectal vein/ micronodularity along the vascular pedicle—> neoadjuvant chemo
52
TIPS contraindications
ABSOLUTE Severe heart failure Mild progressive liver failure: MELD score>18 or child Pugh class C, total bilirubin >3 mL/dl Severe encephalopathy Severe infection (uncontrolled systemic infection) RELATIVE Cavernous transformation of portal vein Severe hepatic encephalopathy
53
Multiracial structures of intra and extra hepatic biliary ducts Ass with inflammatory bowel disease
Primary sclerosing cholangitis Dd : primary biliary cirrhosis - only intrahepatic ducts are dilated , Middle Ages women , ass with RA, scleroderma , hashimotos . It has a ring like right lobe which looks like a pseudo tumor with a shrunken left lobe
54
Post cholecystectomy Persistent bile leak
Duct of lushka/ accessory subvesicular
55
abdominal ultrasound scan on a woman who has been complaining of chronic abdominal pain. There is a large 20 cm multiloculated, ovoid anechoic mass in the right lobe of liver. The internal septations are well visualised and hyperechoic. Further investigation with CT demonstrates enhancement of its thick wall and internal septations.
Biliary cystadenoma
56
Liver mets from colorectal carcinoma Criteria for resectability
A. There is no strict limit on the number of lesions that can be removed, but it is unlikely that more than 6 will be removed B. At least three segments spared from metastatic involvement C. No visible nodal involvement D. At least one main portal vein branch must be spared E. At least one hepatic vein must be spare
57
Normal findings post liver transplant
Both increased periportal attenuation and periportal edema Minimal ascites Right sided pleural effusion Perihepatic hematoma
58
A 66-year-old man is admitted to ITU following complications during his recent coronary artery bypass grafting. He is intubated and ventilated but his doctors notice abdominal distension and elevation of his inflammatory markers and arterial blood sampling shows elevation of his serum lactate. He undergoes a CT scan which shows mucosal hyperenhancement and thumbprinting of the transverse colon and splenic flexure. Which of the following is the most likely explanation for these findings? Coeliac axis stricture Hypotension Inferior mesenteric artery thrombus Internal iliac artery stricture Superior mesenteric artery thrombus
Hypotension / hypoperfusion Watershed areas ( splenic flexure and rectosigmoid junction ) or whole bowel Cecum to splenic flexure- SMA Splenic flexure to rectum - IMA
59
Rectal carcinoma most common type
Adenocarcinoma If squamous cell - HPV
60
A 76-year-old lifelong smoker visits his GP complaining of intermittent crampy abdominal pain. His GP suspects he may have mesenteric angina and arranges for a gastroenterological review as well as a CT mesenteric angiogram. The CT suggests ischaemia affecting the descending colon and splenic flexure. Which of the following findings would be most consistent with a diagnosis of mesenteric angina? Mesenteric vein gas Mural thickening Pneumatosis coli Portal venous gas Smooth stricture
Smooth stricture Mesenteric angina is a clinical syndrome caused by episodic sup-optimal perfusion of the small or large bowel. This typically occurs in the post-prandial setting when the oxygen requirements of the stomach increase and it 'steals' the blood supply from the stenotic, compromised supply to the rest of the bowel. The radiological findings are akin to a chronic type of mesenteric ischaemia or ischaemic colitis. Chronic ischaemia leads to stricturing and, unlike malignant strictures, these will be smooth in nature. By contrast, the other features listed can all be found in an acute setting

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