Small & Large Bowel Flashcards
(228 cards)
1
Q
What is the M/C/C of s. bowel obstruction?
A
Fibrous adhesions 75% (eg. previous surgery or peritonitis)
2
Q
What is the 2nd M/C/C of s. bowel obstruction?
A
external hernias
3
Q
What is the “triple bubble sign” in infants and children?
A
gas in the stomach, duodenum and proximal jejunum caused by jejunal atresia
4
Q
Gas in the biliary duct and a s. bowel obstruction is indicative of?
A
gallstone obstruction (perforation of gallstone through wall into s. bowel)
5
Q
Which part of the colon is likely to distend the greatest in a bowel obstruction?
A
cecum – thinner walls and thus inc. risk for perforation too
6
Q
In a cecal volvulus, where is the final position of the cecum?
A
left upper quadrant ??
7
Q
What is the M/C/C of l. bowel obstruction?
A
cancer
8
Q
What is the 2nd M/C/C of l. bowel obstruction?
A
diverticulitis
9
Q
What is the M/C location of a colonic obstruction due to a colonic carcinoma?
A
sigmoid colon
10
Q
What is the 3rd M/C/C of l. bowel obstruction?
A
volvulus
11
Q
What is Hirschsprung’s disease and where does it M/C like to affect?
A
Aganglionosis or congenital megacolon = diminution or complete absence of ganglion cells in the myenteric plexus causing massive dilatation of the remaining colon
M/C affects the rectosigmoid region.
12
Q
What is the main differentiating radiographic feature between adynamic ileus and bowel obstruction?
A
adynamic ileus gas pattern does NOT change remarkable over a period of hours/days (unlike bowel obstruction)
13
Q
What is the M/C type of volvulus?
A
sigmoid
14
Q
True or False: You can get volvulus of the s. bowel.
A
False
15
Q
Intussusception is more common in children or adults?
A
children
16
Q
Where is the M/C location of an intussusception in a child?
A
ileocecal valve or ileoileal region
17
Q
What is the M/C/C of intussusception in an adult?
A
intestinal tumor 50-70% (mostly malignant)
18
Q
What % of adult intussusception is due to an underlying cause?
A
90%
19
Q
What is the radiographic sign affiliated with intussception?
A
coiled spring appearance
20
Q
What is the term for idiopathic collection of gas in the bowel wall?
A
benign pneumatosis intestinalis
21
Q
What is the most likely etiology of intestinal wall gas?
A
necrosis of segment of intestine –> gas breaks through or enters through breaks in the mucosa of the involved segment
22
Q
What is the name of the syndrome that babies fed on powdered milk can get?
A
Inspissated milk syndrome
23
Q
What’s the M/C/C of obstruction in the duodenum?
A
duodenal atresia
24
Q
Duodenal atresia presents with what radiographic sign?
A
double bubble sign
25
Single bubble sign is associated with what condition?
Pyloric atresia
26
The wind sock appearance is associated with which condition?
duodenal web -- ballooning of the distal duodenum
| intraluminal diverticulum
27
Which is the rarest duplication involving the GI tract?
duplication of the stomach
28
Most duplications of the stomach are which of the following: Open or closed?
Closed
29
A duplication of the duodenum is most commonly located where?
in the concavity of the 1st and 2nd portions of the duodenum
30
What is the M/C radiographic finding associated with diverticula of the duodenum?
retroperitoneal gas localized to area surrounding duodenum & upper pole of right kidney
31
Pancreatic tissue found in the duodenum (and sometimes stomach) is called what?
Heterotopic or aberrant pancreas
32
What is microgastria and what is its prognosis?
very small, vertically orientated, midline stomach
usually associated with other congenital anomalies --> incompatible with life
33
The double track sign is associated with which condition?
hypertrophic pyloric stenosis -- a central mucosal fold in the pylorus causes barium to move along either side of it
34
Umbrella/mushroom or shouldering is associated with which condition?
hypertrophic pyloric stenosis -- the thickened pyloric muscle bulges into the duodenum giving those appearances
35
How do you differentiate between duodenal constriction from annular pancreas vs. primary malignant tumor?
Annular pancreas -- constriction is smooth
| Primary malignant tumor -- constriction is irregular and involves longer portion of duodenum
36
What's another name for congenital peritoneal bands?
Ladd's bands
37
Ladd's bands are usually asymptomatic until what happens?
volvulus
38
What is the earliest change seen in peptic disease?
rugal enlargement
39
Large gastric folds (with or without) ulceration, erosions, and antral nodularity are good predictors of what?
H. pylori infection (eg. gastritis)
40
Very large benign ulcers found on the greater curvature are often caused by what?
Ingestion of drugs (NSAIDs)
41
Differentiate between benign and malignant stomach ulcers based on the following characteristics:
a. Location
b. Border
c. Projection of ulcer
d. Gastric folds
e. Depth
BENIGN
a. Location = lesser curvature or posterior wall of stomach
b. Border = smooth, round or oval
c. Projection = projects beyond normal margin of gastric lumen
d. Gastric folds = smooth gastric folds that reach the margin of the ulcer
e. Depth = deep
MALIGNANT
a. Location = 90% within fundus
b. Border = irregular and mound-like
c. Projection = does not project beyond the normal expected stomach margin
d. Gastric folds = mucosal folds do not radiate to the ulcer margin
e. Depth = shallow
42
What is Hampton's line?
What is ulcer collar?
What is ulcer mound?
All 3 represent findings in benign ulcers.
Hampton's line = luceny through neck of a benign ulcer
Ulcer collar = lucency surrounding the ulcer from edema build up
Ulcer mound = even larger lucency representing even more edematous changes
43
What is the carmen meniscus sign?
Sign of a malignant ulcer.
Convexity of the crater towards the gastric lumen --> convexity towards the lumen
44
What is more common? Gastric or duodenal ulcers?
Duodenal 4-5x
45
What is the M/C/C of pyloric obstruction?
duodenal ulcers
46
What is the M/C/C of a spontaneous pneumoperitoneum?
Rupture of an ulcer
47
What is the M/C/C of pneumoperitoneum in general?
surgery
48
What is a cloverleaf or butterfly deformity?
A healed duodenal ulcer in the mid-bulb
49
What is a cause of acute hemorrhagic gastritis?
Use of irritants to the stomach lining (eg. alcohol, aspirin or other medication)
50
What is phlegmonous gastritis and what is the M/C/C?
Gastritis caused by bacteria. The M/C organism is alpha-hemolytic streptococcus.
51
Chronic gastritis is associated with which organism?
H. pylori
52
How do you distinguish neoplasm from bezoar?
Bezoars are freely movable with the patient's position.
53
What type of ulcers are associated with Crohn's disease?
Apthous ulcers
54
What is the classic appearance of Crohn's disease?
cobblestone
55
What is the anatomical distribution of Crohn's?
- small bowel (75-80%)
- mostly confined to terminal ileum
- skip lesions
56
What is the target sign or halo sign in Crohn's disease?
3 concentric rings representing hyperemia (hyperdensity) of the outer muscularis and inner mucosal bowel wall with edema (hypodensity) in between the two layers => seen on CT.
57
What is the recurrence rate of Crohn's in patients who have surgery?
almost 100%
58
What is ram's horn?
Gastroduodenal involvement in Crohn's disease (particularly the antrum) causes narrowing of the antrum and then flares out into the normal gastric body and fundus.
59
The diagnosis of celiac disease can be suggested 75% of the time with which procedure?
small bowel enema
60
What complications are associated with celiac disease?
- splenic atrophy (30-50%)
- malignancy (M/C T-cell lymphoma; others: pharyngeal & esophageal squamous cell carcinoma, and small bowel adenocarcinoma)
61
What is Menetrier's disease characterized by:
massive enlargement of rugal folds
62
What is Menetrier's disease?
- hyposecretion of acid
- excessive secretion of gastric mucus
- massive gastric folds
- protein loss d/t altered mucosal permeability --> leads to hypoproteinemia
- most prominent along greater curvature (fundus & cardia)
- its a diagnosis of exclusion!
63
There is an increased incidence of what with Menetrier's?
adenocarcinoma
64
Gastric varices are usually an extension of ______?
esophageal varices
65
Gastric varices isolated to the stomach is caused by:
splenic vein thrombosis/obstruction (splenic drainage is shunted through the short gastric veins to the portal veins)
66
What is the most common cause of splenic vein thrombosis?
- pancreatitis
- pancreatic pseudocyst
- pancreatic carcinoma
67
What is the only location for gastric varices?
fundus
68
What % of gastric tumors are benign?
85-90%
69
Which of the following describes a typical gastric polyp?
a. single, pedunculated, 2.6cm, in body & antrum
b. multiple, sessile,
b. multiple, sessile,
70
a. What is the M/C benign intramural primary tumoral mass of the stomach?
b. What is the M/C primary malignancy tumor of the stomach?
c. What is the M/C primary benign tumor of the duodenum?
d. What is the M/C sarcoma of the duodenum?
a. Leiomyoma (or GIST now)
b. Adenocarinoma
c. Polyps
d. Leiomyosarcoma
71
The Mexican hat is associated with which condition?
polyps
72
Polyps are more common in: stomach or duodenum?
stomach (opposite of diverticulums)
73
What is the "target sign" most commonly associated with?
Crohn's disease
but can be seen with anything that gives ulcers (eg. tumors)
74
What appearance is "linitis plastica" is associated with which conditions?
A stiff, non-distensible wall.
Scirrhous carcinoma
Crohn's disease
Sarcoidosis
Syphilis
75
Which tumor is considered the "slut of the gut"?
Lymphoma
76
Carcinoids are radiographically characterized by what?
calcification in small ring-like configurations
77
What makes up the carcinoid syndrome?
| Remember, this means that the tumor must have metastasized for it to be a syndrome.
- Chronic diarrhea
- Flushing and cyanosis of the skin
- Respiratory distress (asthmatic attacks)
- Right-sided heart disease
78
Target or bulls-eye metastasis to the stomach/duodenum is seen from which primary?
melanoma
79
What is Carmen-Kirklin complex?
It is the lucency around a malignant ulcer representing the tumor and Carmen's sign.
80
What is the rule of 90s when talking about hiatal hernias?
90% missed
90% asymptomatic
90% left
81
What feature denotes the existence of a sliding hernia?
The esophagogastric junction is above the diaphragm.
82
The angle formed by the esophagus (vestibule) leading into the cardia of the stomach is called?
The angle of His
83
Describe paraesophageal hernias and how its different from a sliding hernia.
Aka. Rolling hernia
- Herniation of stomach ANTERIOR to the esophagus (either through an enlarged esophageal hiatus or another diaphragmatic opening).
- Terminal esophagus in the normal position
- Usually on fundus of stomach herniates
- Does NOT cause reflux esophagitis (unlike sliding)
84
Describe Morgagni hernias.
- Congenital hernia
- Occurs most commonly on the right side. It typically contains just omentum.
- Occur in adults with obesity, trauma or increased intra-abdominal pressure
- DDx: pericardial fat, pericardial cyst, pulmonary hamartoma
85
Describe Bochdalek hernias.
- Congenital hernia
- Occurs in the back and to the left
- Due to a defect in the posterior attachment of the diaphram
- 75% are symptomatic
- Unlike Morgagni, contain bowel content
86
What causes traumatic hernias and what side are they typically on?
```
Most commonly caused by laceration by a bullet, knife or other penetrating object.
Left side (90-95%)
```
87
Describe intrapericardial hernias.
- Congenital or traumatic
| - Maintains its conformity to the heart in all views
88
What is the M/C location for a benign hyperplastic polyp in the stomach? And how large does it measure?
fundus & <1cm
Btw, hyperplastic polyps are not true neoplasms (just excessive regeneration of the epithelium).
89
Determine true or false for adenoma polyps in the stomach.
a. Like hyperplastic polyps, are not considered as true neoplasms.
b. M/C like to occur in the fundus.
c. Have a higher tendency for malignancy.
d. Are usually smaller than 1 cm.
a. False -- these are considered as true neoplasms
b. False -- like to occur in the antrum
c. True -- the larger they are the higher the tendency
d. False -- are usually bigger than 1 cm
90
Polyps greater than how many cm will demonstrate a 50% risk for malignancy?
2 cm
91
List 3 adenomatous polyposis syndromes.
1. Familial adenomatous polyposis syndrome (FAPS)
2. Gardner's syndrome
3. Turcot syndrome
92
List 4 hamartomatous polyposis syndromes.
1. Peutz-Jeghers syndrome
2. Cronkhite-Canada syndrome
3. Cowden's disease
4. Juvenile polyposis
93
The polyps in FAPS typically present as:
sessile with diameters less than 5 cm M/C IN THE COLON
94
What are the complications of FAPS?
Development of adenocarcinomas (typically on the left side of the colon)
95
Extraintestinal manifestations of FAPS include?
- epidermoid cysts (common!)
- lipomas & fibromas
- hyperpigmented hamartomatous lesions of the retina
- supernumerary teeth
- desmoid tumors
- bone islands in the mandible
96
What is the triad of Gardner's syndrome?
1. Colonic polyposis
2. Osteomas
3. Soft tissue hamartomas
97
Individuals with Gardner's syndrome risk developing which malignant tumor?
colorectal cancer
98
Other than adenomatosis polyposis, what is the other key component to Turcot's syndrome?
CNS tumors (esp. medulloblastomas & glial tumors)
99
True or false: Hamartomatous polyposis have a higher risk for malignancy than Adenomatous polyposis.
False. Hamartomas are non-neoplastic lesions that are normally found in that tissue but which are arranged in an abnormal fashion.
100
Which hamartomatous syndrome is the M/C?
Peutz-Jeghers syndrome
101
Where is the M/C location in the GI for Peutz-Jeghers syndrome?
SMALL BOWEL (stomach and colon common too)
102
What clinical finding is seen in Peutz-Jeghers?
mucocutaneous pigmentation similar to freckles (most commonly on the face, lips and buccal muccosa)
103
a. What complications can occur with Peutz-Jeghers?
| b. What complications can occur specifically with women?
a. Intussusception of the small bowel (self-reducing).
| b. Ovarian tumors -- gonadal stromal tumor with annular tubules
104
What characterizes Cronkhite Canada?
dilatation of underlying glands and cysts
105
What are the clinically features of Cronkhite Canada?
- diarrhea, malabsorption, GI bleeding, weight loss, hypoproteinemia
- skin hyperpigmentation
- discoloration/thickening of nails, atrophy of nails
- alopecia
106
Where does Cronkhite Canada most commonly affect?
small bowel (colon and stomach possible too)
107
What do Cronkhite Canada, Menetrier's disease and lymphangiectasia have in common?
Hypoproteinemia
108
Which condition does Juvenile polyposis histologically most resemble?
Cronkhite Canada
109
What characterizes Cowden's disease (multiple hamartoma syndrome)?
nodular gingival hyperplasia
110
What is the clinical feature of Cowden's disease and who does it M/C affect?
Dermatological conditions of benign hamartomatous tumors in skin and oral mucosa.
Most commonly affects women.
111
What is the most significant finding associated with Cowden's disease?
Increased risk of bilateral breast carcinoma, thyroid disease and/or follicular carcinoma
112
Which polyposis is associated with macrocepaly and pigmented lesion of the genitalia?
Ruvalcaba-Myhre Smith syndrome
113
Which one polyposis (adanomatous or hamartomatous) can affect the esophagus?
Cowden's syndrome
114
A partial gastric resection (m/c performed for peptic ulcer disease) will present with what sign on a contrast study?
Dumping syndrome = barium empties through the stomach into the jejunum very rapidly
115
What are the two types of volvulus of the stomach and which one is more serious?
1. Mesentero-axial = rotation around the short axis (left and right flip)
= more serious b/c increased incidence of vascular compression (likely risk with a torsion >180 degrees)
2. Organo-axial = rotation around the long axis, from cardia to pylorus (antrum lies below the hemidiaphragm)
= more common!
116
What is a common finding with volvulus of the stomach?
hiatal hernia
117
What is Frostberg's inverted 3 sign?
Pressure defects to the descending duodenum d/t pancreatic head enlargement.
(The central limb of the "3" represents the point fixation of the pancreatic duct and common bile duct as they insert into the papilla of Vater --> they produces a smooth filing defect above and below the papilla that resembles a reverse figure 3.)
118
What is the cut-off limit of a dilated small bowel loop?
>3cm
119
Gas in the s. bowel is distinguished from gas in the colon by these two features:
1. s. bowel gas is seen in the central part of the abdomen (unlike peripheral for colon)
2. The mucosal folds are finer and closer together = STACK OF COINS appearance
120
What does the term coffee bean represent in association with the s. bowel?
It is more commonly used in reference to what other condition?
Closed loop small bowel obstruction.
Typically used for large bowel sigmoid volvulus.
121
Where are fibrous adhesions most likely to occur in the s. bowel and why?
Most likely to occur in the ileum b/c this is where most operative procedures (and inflammatory porcesses) occur.
122
What % of s. bowel obstructions are caused by fibrous adhesions?
75%
123
Gas in the biliary duct system plus signs of a simple obstruction is good evidence of what?
Gallstone ileus (a fistulous connection btwn gallbladder & duodenum)
124
Meconium Ileus is associated with which congenital condition?
Cystic fibrosis (absence of pancreatic & intestinal gland secretions form a thick, sticky meconium that may cause bowel obstruction).
125
How much in total does the midgut (duodenojejunal to mid-transverse colon) rotate during development?
270 degrees (1st stage = 90 degrees counterclockwise; 2nd stage = 180 degrees counterclockwise)
126
How many stages of midgut rotation occur?
3
127
Failure of complete descent of the cecum is an arrest in which stage of midgut rotation?
3rd
128
What is an omphalocele? And what stage is arrested to get this anomaly?
Persistent herniation of the midgut into the umbilical cord.
| Seen with 1st stage arrest.
129
What stage has been arrested when the cecum is found midline and most of the s. bowel is on the right side?
2nd stage
130
Meckel's diverticulum is formed as an arrest of which stage?
1st stage
131
What is the rule of 2s in regards to a Meckel's diverticulum?
a. occurs within 2 ft of the ileocecal valve
b. occurs in 2% of the pop'n
c. less than 2 yrs of age = symptomatic
d. 2 inches in length
132
What is unique about Meckel's diverticulum compares to other diverticulums?
It opens into the anti-mesenteric side of the ileum & it is best diagnosed by nuclear medicine.
133
What is the M/C anomaly of the GI tract?
Meckel's diverticulum
134
S. bowel duplications M/C occur where? And what are commonly associated findings?
They occur in the ileum.
Associated findings:
- spina bifida occulta
- hemivertebra
- meningocele
135
Where does TB M/C affect in the GI?
distal ileum, cecum and proximal ascending colon
136
Barium filling the distal ileum and transverse colon but sparing (or more like rapid emptying) of the cecum and ascending colon as seen in TB is called what sign?
Stierlin's sign
137
What is the M/C parasite of the s. bowel?
Ascaris Lumbricoides
138
How do you differentiate a tapeworm from a roundworm radiographically?
Tapeworms are longer and you will not see the string of barium like you do with a roundworm b/c tapeworms do not have an alimentary canal.
139
What sign is seen in the s. bowel with scleroderma and what causes this sign?
Hidebound -- caused by a dilatated small bowel with normal mucosal fold thickness but closely spaced.
140
What is the moulage sign and flocculations are seen in which condition and what causes these appearances?
Seen in Non-Tropical sprue (Celiac sprue).
The moulage sign is caused by a smooth, tubular appearnce to the small bowel from complete loss of the folds.
The flocculations refer to scattered barium flecks and blotches due to increased fluid content.
141
What is the triad associated with Behcet's syndrome?
1. aphthous stomatitis
2. genital ulcers
3. ocular inflammation
142
What is the clinical features of Celiac sprue?
Malabsorption problem --> osteomalacia, rickets with weight loss and anemia
143
What are the 2 histological findings of Whipple's disease?
1. Sudan-negative macrophages
| 2. Periodic acid-schiff (PAS) positive
144
True or False: mucosal thickening is seen in...
a. lymphangectasia
b. Whipple's disease
c. Amyloidosis
d. Celiac sprue
e. Scleroderma
a. True
b. True
c. True
d. True but not that thick
e. False - normal thickness
145
What's the M/C benign s. bowel tumor?
2nd M/C?
3rd M/C?
```
1st = Leiomyoma (now GIST) HOWEVER, Eisenberg has that M/C primary neoplasm is carcinoid tumors
2nd = adenomas (ileum)
3rd = lipomas (distal ileum/ileocecal valve)
```
146
Where do neurofibromas in the s. bowel arise?
Auerbach's plexus
147
What is the rule of 1/3rds regarding carcinoid tumors?
a. 1/3rd of GI carcinoid tumors
b. 1/3rd show metastasis
c. 1/3rd present with a second malignancy
d. 1/3rd are multiple
148
Carcinoid syndrome is associated with which hormone?
Serotonin
| Carcinoid tumors are seen exclusively in patient with liver metastasis.
149
What is the M/C malignant tumor of the s. bowel?
Adenocarcinoma
150
Where are lymphoma and lymphosarcoma most likely to occur?
Ileum -- d/t the amount of lymph nodes there (Peyer's patches)
151
Which hernia is between the lateral abdominal wall muscles and through the linea semilunaris?
Spigelian
152
Which hernia occurs due to iatrogenic causes? And where and when do they occur?
Incisional hernias -- usually occur ventral & within 1st year postoperative
153
Triangle of Grynfeltt and Lessshaft and triangle of Petit are which kind of hernias?
Lumbar hernias
154
What is the M/C abdominal hernia?
Inguinal hernia (indirect hernia 5x M/C)
155
What is the relationship of a direct and indirect hernia in reference to the epigastic vessels?
```
Direct = inferior and medial to the epigastric vessels
Indirect = inferior and lateral to the epigastric vessels
```
156
What triangle does a direct inguinal hernia go through?
Hasselbach's triangle
157
What's the M/C concerning complication of an indirect hernia?
Stragulation of bowel
158
How do you differentiate between a direct inguinal and femoral hernia?
The femoral hernia goes inferior to the inguinal ligament and lateral to the pubic tubercle.
159
What clinical sign do patients with an obturator hernia demonstrate?
Howship-Romberg sign (pain along the inner aspect of the thigh to the knee or below)
160
Primary pneumatosis intestinalis M/C occurs where and on what side?
colon on the left
161
List some possible causes for gas in the intestinal wall.
1. Intestinal emphysema in lungs -- extends into mediastinum -- travels to retroperitoneal spance -- to subserosa of bowel
2. tumor causes ulceration which causes intramural gas above this obstruction
3. May be seen with: chronic enteritis, intestinal parasites, scleroderma, peptic ulcer, pyloric stenosis, Whipple's disease
162
What is another name for PICA (eating dirt)?
Geophagia
163
Where is the M/C location of colonic atresia?
hepatic flexure
164
What diagnostic procedure is done if imperforate anus is suspected?
Invertograms (upside-down films) or lateral prone films
165
Imperforate anus is part of what complex and what does that complex consist of?
```
V vertebral anomalies
A anal atresia
C cardiovascular anomalies
TE tracheoesophageal fistula
R renal anomalies/radial ray anomalies
L limb anomalies
```
166
What are some particular renal anomalies associated with imperforate anus?
- crossed ectopia
- crossed fused ectopia
- renal agenesis
- hydronephrosis
- vesicoureteral reflux
167
Which pop'n is most likely to have aganglionosis?
Aganglionosis = Hirschsprung's disease
Males
168
What are the basic clinical findings of ulcerative colitis as per the features below.
a. Location
b. Risk factor
c. Gender
d. Age
e. Incidence of arthritis
f. Incidence compared to Crohn's
a. rectum (30%), rectum + colon (40%), pancolitis (30%)
b. 1st degree relative 30-100x > general pop'n
c. F > M
d. 15-25yrs (55-65yrs)
e. 25% will have some form of arthritis
f. higher incidence than Crohn's
169
What are the radiographic features of ulcerative colitis?
- continuous segments
- mucosa and submucosa only (acute)
- thickened folds (acute)
- ulcers
- toxic megacolon
- "backwash ileitis" = distal ileum inflamed
- uniform narrow lumen (chronic)
- pseduopolyps (chronic)
- "lead pipe" = rigidity + loss of normal folds (chronic)
170
What is toxic megacolon?
A complication of inflammatory bowel disease or infectious colitis.
- Systemic toxicity (abdominal pain & tenderness, tachycardia, fever and leukocytosis)
- Dilation of the colon (mostly transverse colon) to >6cm
- Loss of haustral patterns
- Multiple air-fluid levels
- Mucosal ulceration/edema
171
In the colon, Crohn's disease typically likes to affect which location?
Right side (ascending and transverse colon)
172
What are the differences between Crohn's disease & ulcerative colitis?
Crohn's Disease
- transmural
- affects terminal ileum mostly (& proximal colon)
- ulcers random & asymmetric
- skip lesions
- anal lesions
- no gender predilection
Ulcerative Colitis
- mostly just mucosa and submucosa
- affects cecum, sigmoid + rectum
- ulcers monotonous & uniform
- continuous lesions
- male predilection
173
What is blind loop syndrome?
duodenal diverticulum that causes bacterial buildup and a B-12 vitamin deficiency & anemia
174
Which condition looks like a "burned out" ulcerative colitis?
cathartic colon (b/c of its lack of haustral sacculations and smooth appearance)
175
Pseudomembranous colitis is caused by what?
Technically unknown.
Thought to be caused by use of antibiotics (esp. clindamycin).
clostridium difficile is found in the stools
176
What is the main radiographic feature of pseudomembranous colitis?
Thumbprinting -- multiple can give the "accordian sign"
177
"Thumbprinting" can be seen in which conditions?
- Ischemic colitis
- Pseudomembranous colitis
- Crohn's disease
- Ulcerative colitis
178
What is the M/C malignancy associated with Crohn's disease?
adenocarcinoma (although, incidence of malignancy with Crohn's is less than with ulcerative colitis)
179
What are the two types of megacolon and give examples of each.
1. Organic - obstruction of colon leading to gradual enlargement of bowel above level of obstruction
eg. adhesive bands, chronic volvulus, congenital and acquired strictures
2. Functional
eg. faulty bowel habits in children and psychotic adults, impaction of fecal material
180
What is the M/C colitis in the elderly?
Ischemic colitis
181
What are the clinical features of ischemic colitis?
>50 yrs
HX OF PRIOR CVD
self limiting
abrupt onset abdominal pain & rectal bleeding
182
Ischemic colitis is which kind of vascular disease? Occlusive or nonocclusive?
Non-occlusive
183
What locations does ischemic colitis M/C affect?
Watershed areas = Griffth point (splenic flexure SMA & IMA junction); & Sudeck point (rectosigmoid IMA & hypogastric artery junction)
Left side colon --> elderly
Right side colon --> young
184
What are the radiographic features of ischemic colitis?
- pneumatosis, bowel wall thickening & thumbprinting
- ulceration
- "double halo" or "target" sign
185
Necrotizing enterocolitis is seen in which demographics?
Low birth infants within first 5 days of life. They usually undergo hypoxic stress.
Rarely seen in adults
186
Where does necrotizing enterocolitis M/C happen?
ascending colon and ileum
187
What are the radiographic findings of necrotizing enterocolitis?
- intestinal distention
- gas in bowel wall
- free air in peritoneum
- gas in portal venous system
- ascites (may be)
188
What is the one key radiographic finding with segmental ischemia and what causes that appearance?
Thumbprinting -- caused by edema & submucosal hemorrhage causing narrowing of the lumen and scalloped indentations
189
Where does diverticular disease most commonly affect in the colon?
Sigmoid colon
190
Diverticuli in this area herniate at which points in the wall?
Points of anatomical weakness where blood vessels (vasa recta) perforate the muscular coat of the bowel wall.
191
Diverticuli on which side cause significant bleeding?
right colon
192
Where is the most common location for colonic polyps?
Rectum (60-75%) or lower sigmoid
193
What is most common type of colonic polyp?
Adenoma
194
What is the minimum size of an x-ray detectable polyp?
0.7 to 1cm
195
What features of polyp should concern you for malignancy?
- over 1 to 1.5cm in diameter
- irregular surface
- short, thick pedicle more risk for malignancy compared to pedicle greater than 2cm
- grows at a quick rate
196
Colonic polyps associated with FAPS is most commonly seen in which location?
left colon & rectum
197
Which polyposis syndrome is associated with Lhermitte-Duclose syndrome?
Cowden
198
What is Turcot's Syndrome?
Colonic polyps and central nervous system glioblastomas (supratentorial)
199
What % of patients with FAPS will develop colorectal cancer?
67% by age 50
200
What's the M/C polyposis syndrome overall?
FAPS
201
What is the clinical triad of Menetrier's disease?
Achlorohydria (low grastric production), hypoproteinuria, edema
202
A 30 year female experiences menstrual irregularities, chronic bowel obstruction that are further exacerbated during times of menstration. What doe she most likely have?
Endometriosis
203
Villious adenoma M/C occurs where in the colon and what is its diagnostic appearance?
rectum & rectosigmoid colon"
Appears as "cauliflower-like" or "carpet".
204
Which is the least common neoplastic adenomatous polyps?
Villious adenomas
205
Lipomas are ___________ (common, rare) in the colon.
Rare (found on the right side)
206
Carcinoid tumors are M/C found where in the colon?
Rectum
207
What cells do carcinoid in the colon arise from?
Kultschitzkys cells found in the crypts of Lieberkuhn.
208
What's another name for colonic carcinoids?
Argentaffin tumor or argentaffinoma
209
Colonic carcinoids measuring _____ large, metastasize in ____% of cases.
>2cm, 80%
210
Where is the M/C location for a colonic malignant tumor?
rectum & rectosigmoid region
211
Colorectal cancer is M/C in which gender?
M>F (3:2)
212
What's the term to describe EARLY colonic carcinoma?
Polyoid or fungating carcinoma
213
What's the term to describe ADVANCED colonic carcinoma?
Infiltrating or Annular carcinoma
214
What's the route for gastric carcinomas to spread to the transverse colon?
Direct via the gastrocolic ligament
215
Primary tumors that metastasize to the colon are:
- Melanoma
- Stomach
- Lung
- Breast
216
Which primary tumors are M/C to metastasize to the liver?
- GI (mostly)
- Lung
- Breast
- Renal cell carcinoma
- Melanoma
217
What is McBurney's point?
Point to identify the appendix
218
What does the appendix contain?
masses of lymphoid tissue
219
What is the normal position of the appendix?
retrocecal
220
What is the M/C inflammatory disease of the RLQ and list at least 3 causes for this condition?
Acute appendicitis
Obstruction caused by:
1. fecalith/appendicolith
2. post-inflammatory scarring/adhesions
3. hypertrophied Peyer patches
4. foreign body
5. volvulus
6. tumor
221
In what % of normal patients does the appendix not fill with barium?
20%
222
What CT sign is seen with acute appendicitis?
arrowhead
223
What finding virtually excludes the diagnosis of acute appendicitis?
a patent lumen
224
Which benign tumor of the appendix forms b/c of luminal stenosis due to dilatation of the actual appendix?
mucocele
225
Adenocarcinomas M/C occur in what part of the appendix?
distal 1/3rd
226
What's the M/C tumor of the appendix and what cells do they arise from?
Carcinoid
Arise from Kultschitzkys cells - found in crypts of Lieberkuhn. Also known as argentaffin tumors or argentaffinomas.
227
What % of appendiceal tumors are carcinoids and what % of carcinoids arise in the distal ileum and appendix?
90% for both
228
Sx of acute appendicitis?
fever, leukocytosis, right lower abdominal pain
