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Green Book GI > Stomach and Bowel > Flashcards

Stomach and Bowel Flashcards

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1
Q

Where do drugs cause gastritis?

A

Distally or near the greater curve.

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2
Q

Name 8 causes of gastritis?

A 
Gut Bacteria
Alcohol, allergy
Stress
Trauma
Radiation
Ischaemia, Infection
Corrosives, Bile
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3
Q

H pylori is a/w what % of gastric and duodenal ulcers?

A

60% of gastric ulcers

80% of duodenal ulcers

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4
Q

T/F H pylori is a/w cancer?

A

True

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5
Q

4 features of gastritis on barium?

A
  1. Thickened folds
  2. Inflammatory nodules
  3. Coarse area gastricae
  4. Erosions
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6
Q

Name 3 other types of gastritis?

A
  1. Phlegmonous (a/w bacteria)
  2. Emphysematous
  3. Corrosive
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7
Q

9 risk factors for gastric cancer?

A 
Gatrojejunostomy and partial gastrectomy
Adenomatous and villous polyps
Smoking
H pylori
Menetriers
Atrophi gastritis
Nitrites, nitrates
Pickled vegetables
Pernicious anemia
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8
Q

T/F 60% of gastric cancer along lesser curve?

A

True

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9
Q

5 year survival gastric cancer?

A

5-18%

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10
Q

T Staging gastric cancer?

A

T1: mucosa/submucosa
T2: muscle or serosa
T3: through serosa
T4a: invasion of adjacent contiguous tissues
T4b: invasion of adjacent organs, diaphragm or abdominal wall.

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11
Q

Blumer’s shelf?

A

Peritoneal seeding to rectal wall

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12
Q

T/F normal stomach does not contain lymphoid follicles?

A

True- they can develop following infection with H pylori. Persistent antigenic stimulation by H pylori is thought to lead to neoplastic transformation.

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13
Q

T/F MALT is usually locally contained at time of dx?

A

True - better prognosis than NHL

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14
Q

Commonest site of MALT?

A

Antrum

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15
Q

T/F Perforation common with MALT?

A

False- rare

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16
Q

MALT on Barium?

A

Can be focal and infiltrative or diffuse

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17
Q

T/F Ulceration common with MALT?

A

False- rare

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18
Q

4 Res for PUD?

A
  1. H Pylori
  2. Analgesia
  3. Smoking
  4. Zollinger Ellison
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19
Q

T/F GIST a/w NF1?

A

True and Carney’s triad

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20
Q

Causes of thickened mucosal folds?

A
  1. Inflammatory causes
    - gastritis
    - ZE syndrome
    - acute pancreatitis
    - Crohn’s
  2. Infiltrative and neoplastic causes
    - lymphoma
    - carcinoma
    - eosinophilic gastroenteritis
  3. Other causes
    - Menetrier’s
    - Varices
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21
Q

Causes of Linitis Plastica?

A
  1. Neopalsia
    - gastric carcinoma
    - lymphoma
    - metastases
    - local invasion from pancreatic cancer
  2. Inflammatory causes
    - corrosives
    - radiotherapy
    - granulomas
    - eosinophilic enteritis
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22
Q

Causes of target lesions in the stomach?

A
  1. Submucosal metastases
    - melanoma
    - lymphoma
    - carcinoma/carcinoid
  2. Leiomyoma
  3. Ectopic pancreatic tissue
  4. Neurofibroma
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23
Q

Commonest site of small bowel injury following blunt trauma?

A

Jejunum- distal to ligament of Trietz

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24
Q

T/F Bowel wall thickening is a sensitive sign of injury?

A

True- Seen in 75% of transmural injuries. Isolated mesenteric lacerations may also give this sign.

Bowel wall enhancement more than the posts with thickening adds specificity.

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25
T/F With bowel injury, mesenteric stranding is seen on the mesenteric side?
True
26
Other signs of bowel injury?
- Free fluid - Interloop fluid - 5% of hepatic and splenic lacerations are a/w bowel injury - intramural haematoma - mesenteric haematoma
27
Cause of malrotation?
- arrest in embryological development of rotation and fixation. - abnormal gut position due to narrow mesenteric attachment.
28
In what % of cases of malrotation is the SMV to the left of the SMA?
80%
29
Name 2 lumbar hernias?
1. Grynfelt | 2. Petit lumbar
30
Where does obturator hernia occur?
Between pectineus and obturator externus.
31
Direct inguinal hernia?
- Defect in Hesselbachs triangle | - medial to inferior epigastric vessels
32
Indirect inguinal hernia?
- passes through the inguinal canal lateral to the inferior epigastric vessels
33
Paraduodenal hernias are due to a defect in what?
Descending mesocolon
34
Where do duodenal hernias usually occur?
1st part of duodenum
35
Complications of duodenal diverticulum?
- perforation - obstruction - biliary obstruction - bleeding - diverticulitis
36
Ddx Duodenal cap BIG cobblestones?
1. Hypertrophy of Brunner's glands 2. Oedema 3. Crohn's 4. Varices 5. Carcinoma 6. Lymphoma
37
Ddx Duodenal cap SMALL cobblestones?
1. Food residue 2. Duodenitis 3. Nodular lymphoid hyperplasia 4. Hypertrophic gastric mucosa
38
5 causes of absent or decreased duodenal folds?
1. Amyloid 2. Crohn's 3. CF 4. Scleroderma 5. Strongyloides
39
Ddx thickened duodenal folds?
1. Inflammatory - Crohns - Duodenitis - Pancreatitis - ZE syndrome 2. Neoplasia - Mets - Lymphoma - Infiltrations - Eosinophilic - Amyloid - Mastocytosis - Whipples 3. Oedema - Hypoproteinemia - Venous obstruction - Lymphatic obstruction - Angioneurotic oedema 4. Infestation - worms - giardiasis
40
Causes of dilated duodenum?
Mechanical Obstruction 1. Bands 2. Atresia/web/stenosis 3. Annular pancreas 4. SMA syndrome Paralytic ileus Scleroderma
41
What is the most common small bowel malignant tumour?
Lymphoma
42
Res for intestinal lymphoma?
1. Coeliac 2. AIDS 3. SLE 4. Crohns 5. Chemotherapy
43
Imaging features of SI lymphoma?
- large, cavitating ulcerative mass | - aneurysmal dilatation
44
Types of SI lymphoma?
Hodgekins or NHL
45
What type of tumours are MALTomas?
Low grade B cell
46
Staging of GI lymphoma?
1. Confined to SI 2. Local LNs 3. Widespread LNs 4. Disseminated to liver, marrow and other sites
47
T/F SI lymphoma is the commonest cause of intussusception?
True- 51% ileum, 47% jejunum, 2% duodenum
48
What does SI lymphoma arise from?
Peyer's patches?
49
Describe the 4 types of SI lymphoma?
1. Single or multiple polypoid masses, cobblestoning. A/w ulceration and intussusception. 2. Infiltrating lymphoma involving <5cm of the bowel wall- a/w desmoplastic response, thickened valvulae and aneurysmal dilatation. 3. Mesenteric or retroperitoneal lymphoma- may be single or multiple extra-luminal masses, in a 'cake' configuration engulfing multiple small bowel loops or a 'sandwich' configuration in which a mass surrounds mesenteric vessels that are separated by perivascular fat. Can also occur as a mesenteric and retroperitoneal mass. 4. Endoexoenteric lymphoma- a large mass with small intramural component which can cause fistulas.
50
Most common site of lymphoma in large bowel?
Caecum (85%)
51
What is the most common primary malignant tumour of small bowel?
Carcinoid- 33% in small bowel (81% ileum), 45% appendix
52
What % of ppl with small bowel carcinoid have another primary malignancy?
33%
53
What % of gastric carcinoid have mets at presentation?
50-70%
54
Hairpin turn?
Seen in small bowel carcinoid if there is fibrosis in the tissues, there may be a kink in the small bowel.
55
T/F 2% of carcinoids < 1cm metastasise, 85% > 2cm metastasise?
True
56
T/F Mets are more common in carcinoid of the ileum than appendix?
True
57
T/F adenocarcinoma more common in distal small bowel?
False- proximal small bowel
58
Imaging features adenocarcinoma of small bowel?
- ulceration - annular constriction with shouldering - desmoplastic reaction - polyps
59
What causes fold reversal in coeliacs?
Jejunal atrophy results in hypertrophy of the ileum
60
Hyposplenism/atrophy in what % of coeliacs?
30-50%
61
T/F coeliac a/w SCC of oesophagus?
True
62
What % of coeliacs have endocrine disease?
10%- autoimmune thyroiditis and Sjogrens
63
Imaging features Coeliac?
- Jejunal atrophy (3 folds or fewer per 2.5cm jejunum) - Fold reversal - Fold thickening - Mosaic pattern of mucosa in jejunum 10% - bowel dilatation - barium flocculation (hyper secretion and malabsorption) - jejunisation of ileum (hypertrophy of ileum with thickening of folds) - gastric metaplasia in the duodenum can give rise to mucosal nodules (bubbly bulb sign)
64
T/F Whipples seen in immunocompromised ppl?
True m:f, 9:1
65
Whipples clinical presentation?
- muscle wasting - arthralgia - fever - diarrhoea - pericarditis
66
Whipples barium?
THIckening of duodenal or jejunal folds
67
Mechanism of injury in radiation enteritis?
- inability to repopulate the surface epithelium - collagen deposition and fibrosis - leads to bowel wall thickening, obliterative endarteritis and neural injury all of which lead to impaired mucosal and motor function
68
8 causes of SBO?
1. Adhesions 2. Hernia 3. Intussusception 4. Crohns 5. Gallstone ileus 6. Ileus 7. Tumour 8. Foreign body
69
4 causes LBO?
1. Faeces 2. Sigmoid/caecal volvulus 3. Tumour 4. Diverticulitis
70
Causes of dilated small bowel with thick folds? CLAIREE
``` Crohns Lymphoma Amyloid Ischaemia Radiation Ellison Zollinger Extensive SB resection ```
71
What is a Meckel's diverticulum?
Persistence of the omphalomesenteric duct on the anti-mesenteric border of the ileum.
72
T/F Meckel's diverticulum is commonest congenital anomaly of GIT?
True
73
Complications of Meckel's?
Bleeding Diverticulitis Bowel obstruction secondary to intussusception Malignancy
74
T/F Meckel's- ectopic mucosa in 50%?
True- gastric, pancreatic and colonic
75
S and S of Tc Pertech for Meckels?
85% sensitive and >95% specific but sensitivity drops after adolescence because less likely to contain gastric mucosa
76
Meckels on angio- what is pathognommic?
Identification of Vitelline artery
77
Cause of primary epiploic appendigitis?
Torsion or venous thrombosis. 50% in RLQ
78
Causes of small bowel strictures? CLAIRE
``` Crohns Lymphoma (and other tumours) Adhesions Ischaemia Radiation Enteric coated potassium tablets ```
79
Causes of small bowel nodules?
Inflammatory - Nodular lymphoid hyperplasia - Crohns Infiltrative - Whipples - Waldenstrom's macroglobulinemia - Mastocytosis Neoplasia - Lymphoma - Polyposis - MEts Infective causes - Typhoid - Yersiinia
80
Lesions in TI?
Inflammatory - Radiation - Crohns - UC Infective causes - TB - Actinomycosis - Yersiinia - Histoplasmosis Neoplasia - Lymphoma - Carcinoid - Mets
81
3 causes of small bowel pathos ulceration?
1. Crohns 2. PAN 3. Yersinia
82
Bowel ischaemia- Griffith's point?
80% of cases- splenic flexure
83
Bowel ischaemia- Sudeck's point?
Rectosigmoid junction
84
Bowel ischaemia- left colon more often than right?
True
85
Complications of diverticulitis?
1. Abscess 2. Intestinal fistula (14%) 3. Perforation 4. Obstruction 5. Peritonitis 6. Sepsis and shock 7. Bleeding
86
2 different types of polyp?
1. Hyperplastic (90%) - most commonly rectosigmoid - some malig potential (hyper plastic polyposis syndrome) 2. Tubular - 10% risk malig >1.5cm
87
What % of large polyps does CT colonoscopy detect?
80%
88
Modified Duke's staging?
A- Limited to mucosa B- Involvement of muscularis propria C- LN mets D- Distant mets
89
Most common sites colon cancer?
Rectum 30% | Sigmoid 30%
90
T/F Sigmoid volvulus twists on mesenteric axis?
True
91
5 causes of secondary pneumatosis intestinalis?
- NEC - Colitis and enteritis - Collagen disorders - Leukaemia - Steroids and other immunosuppressive tx
92
Causes of widened pre sacral space?
Neoplasia - Rectal Ca - Rectal mets - Sacral tumour Inflammatory causes - Crohns/UC - Abscess - Radiotherapy - Diverticulitis Pelvic lipoma Anterior sacral meningocele Enteric duplication cyst
93
3 Res for Crohn's?
- family hx - smoking - OCP
94
4 complications of Crohn's?
1. Sinus tracks 2. Bowel obstruction 3. Fistula (50%) 4. Malignant transformation
95
T/F in UC, risk of malignant transformation increases by 0.5-1% per year after 10 years of the disease?
True, toxic megacolon in 2%
96
UC mucosa?
- Mucosal oedema- fine granular pattern - Collar button ulcers - confluent ulceration as a coarse granular appearance
97
Thumb printing?
Haustral thickening from oedema
98
Pseudopolyps?
Result from normal mucosa adjacent to areas of ulceration
99
T/F submucosal fat deposition seen in UC more than Crohn's?
True

Green Book GI (3 decks)

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