Stomach (for PBR 2) Flashcards

(87 cards)

1
Q

This is the major cause of chronic gastritis, duodenitis, benign gastric and duodenal ulcers, gastric adenocarcinoma, and MALT lymphoma

A

Helicobacter pylori infection

Infection is chronic and causes a superficial gastritis, which is most commonly asymptomatic

Approximately 70% of peptic gastric ulcers, 95% of duodenal ulcers, and 50% of gastric adenocarcinoma are caused by this infection

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2
Q

Imaging finding of H. pylori infection

A

Double-contrast technique demonstrates enlarged areae gastricae in 50% of patients

Diagnosis of H. pylori infection is made by serology, urease breath tests, and endoscopic biopsy

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3
Q

This is third most common GI malignancy, following colon and pancreatic carcinoma

Most (95%) are adenocarcinomas; the remainder is diffuse anaplastic (signet ring) carcinoma, squamous cell carcinoma, or rare cell types

Predisposing factors include smoking, pernicious anemia, atrophic gastritis, and gastrojejunostomy

A

Gastric carcinoma

H . pylori infection increases the risk of gastric carcinoma sixfold and is the cause of approximately half of gastric adenocarcinoma cases

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4
Q

Gastric carcinoma has four common morphologic growth patterns

What are these patterns?

A
  1. Polypoid masses (1/3)
  2. Ulcerative masses (1/3)

The remaining 1/3
3. Infiltrating tumors
4. Focal plaque-like lesions with central ulcers
5. Diffusely infiltrating
…with poorly differentiated carcinomatous cells producing bizarre thickened folds and thickened rigid stomach wall, so-called scirrhous carcinomas

*Creator’s notes: 4 pattern by 5 were mentioned (?)

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5
Q

This term may be applied to described the resulting stiff narrowed stomach.

A

“Linitis plastica” and “water bottle stomach”

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6
Q

Hematogeous metastases of gastric carcinoma involves what organs?

A

Liver
Adrenal glands
Ovaries
Rarely - Bone and lung

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7
Q

Intrapertineal seeding of gastric carcinoma presentas as what?

A

Carcinomatosis or Krukenberg ovarian tumors

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8
Q

Finding of early gastric cancer on barium study

A
  1. Gastric polyps (with risk of malignancy increased for lesions larger than 1 cm)
  2. Superficial plaque-like lesions or nodular mucosa
  3. Shallow, irregular ulcers with nodular adjacent mucosa

These lesions are most sensitively detected on double-contrast studies

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9
Q

Findings of gastric carcinoma on CT and MR

These modalities are used to determine the extent of tumor to facilitate preoperative planning

A
  1. Focal, often irregular, wall thickening (>1 cm)
  2. Diffuse wall thickening due to tumor infiltration (linitis plastica) (contrast enhancement is common)
  3. Intraluminal soft tissue mass
  4. Bulky mass with ulceration
  5. Rare, large, exophytic tumor resembling leiomyosarcoma
  6. Extension of tumor into perigastric fat
  7. Regional lymphadenopathy
  8. Metastases in the liver, adrenal, and peritoneal cavity
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10
Q

Mucinous adenocarcinomas frequently contain stippled calcifications

True or false

A

True

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11
Q

What gastric tumor has this imaging features:

Focal wall thickening (>1 cm)
Diffuse wall thickening (linitis plastica)
Large mass
Ulcerated mass that is predominantly intraluminal
Soft tissue stranding from mass into perigastric fat
Adenopathy, peritoneal implants, distant metastases

A

Gastric adenocarcinoma

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12
Q

What gastric tumor has this imaging features:

Marked wall thickening (4-5 cm)
Circumferential wall thickening without luminal narrowing
Homogeneous attenuation of tumor
Multiple polyps with ulceration
Extensive adenopathy, especially if below the renal hila
Transpyloric tumor spreads to the duodenum

A

Gastric lymphoma

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13
Q

What gastric tumor has this imaging features:

Large, heterogeneous exophytic mass (>5 cm)
Extensive ulceration of the mass
Prominent necrosis, hemorrhage, liquefaction
Calcification within the tumor

A

Malignant GIST

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14
Q

What gastric tumor has this imaging features:

Wall thickening similar to primary carcinoma
Focal intramural mass
Ulcerated mural nodule
Direct invasion of the stomach from adjacent tumor

A

Metastases to stomach

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15
Q

This findings limit treatment of gastric carcinoma to palliative surgery or chemotherapy

A

Transmural extension, intraperitoneal spread, or distant metastases

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16
Q

The stomach is the most common site of involvement of primary GI lymphoma

True or false

A

True

It accounts approximately 50% of cases

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17
Q

What are risk factors for gastric lymphoma?

A
Chronic infection with H . pylori
Epstein–Barr virus
Hepatitis B virus,
Campylobacter jejuni
Celiac disease
Atrophic gastritis
Inflammatory bowel disease
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18
Q

What is the reason why gastric lymphoma has better prognosis than carcinoma?

A

Because lymphoma remains confined to the bowel wall for prolonged periods of time

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19
Q

What are the four morphologic patterns of gastric lymphoma?

A
  1. Polypoid solitary mass
  2. Ulcerative mass
  3. Multiple submucosal nodules
  4. Diffuse infiltration
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20
Q

UGI findings of gastric lymphoma

A
  1. Polypoid lesions
  2. Irregular ulcers with nodular thickened folds
  3. Bulky tumors with large cavities
  4. Multiple submucosal nodules that commonly ulcerate and create a target or “bull’s- eye” appearance
  5. Diffuse but pliable wall and fold thickening
  6. Rarely, linitis plastica appearance of diffuse, stiff narrowing
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21
Q

CT is the primary imaging modality used to stage lymphoma

What are helpful CT findings in differentiating gastric lymphoma from carcinoma?

A
  1. More marked thickening of the wall (may exceed 3 cm)
  2. Involvement of additional areas of the GI tract (transpyloric spread of lymphoma to the duodenum in 30%)
  3. Absence of invasion of the perigastric fat
  4. Absence of luminal narrowing and obstruction despite extensive involvement
  5. More widespread and bulkier adenopathy
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22
Q

These are most common mesenchymal tumor to arise from the GI tract

A

Gastrointestinal stromal tumors (GISTs)

Most, but not all, tumors previously classified as leiomyomas, leiomyosarcomas, and leiomyoblastomas are now classified as GISTs

Approximately 60% to 70% of GISTs arise in the stomach and 10% to 30% of these are malignant

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23
Q

Characteristics of gastrointestinal stroma tumors

A

Long-term silent growth to a large size

The overlying mucosa is commonly ulcerated

Dystrophic calcification is relatively common in both benign and malignant tumors (helps differentiate these lesions from other gastric tumors)

Predominantly extraluminal

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24
Q

in GIST - difference between benign and malignant

A

Benign tumors;
Smaller (4 to 5 cm, average size)
Homogeneous in density
Uniform diffuse enhancement

Malignant tumors:
Larger (>10 cm) with central zones of low density caused by hemorrhage and necrosis and show irregular patterns of enhancement

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25
Presentation of metastasis in the stomach
May present as submucosal nodules or ulcerated masses Most are hematogenous metastases Rich blood supply results in common involvement of the stomach and small bowel
26
What are common primary tumors that metastasize to the stomach?
Common primary tumors are melanoma and breast and lung carcinoma Breast cancer metastases may cause linitis plastica
27
Kaposi sarcoma involves the GI tract in 50% of patients with what disease?
Patients with disseminated AIDS
28
Imaging finding of GI Kaposi sarcoma
Double-contrast studies: Flat masses with or without ulceration, polypoid masses, irregularly thickened folds, multiple submucosal masses, and linitis plastica CT: Enhancing adenopathy in the porta hepatis, mesentery, and retroperitoneum *Creator's note: Not very specific
29
These are adenomatous polypoid masses that produce multiple frond-like projections
Villous tumors Most are solitary and 3 to 9 cm in size although giant tumors may be as large as 15 cm Malignant potential is high and varies with size of the lesion (50% for 2- to 4-cm lesions, 80% for lesions >4 cm)
30
These are lesions that protrude into the lumen as sessile or pedunculated masses Their appearance on double-contrast UGI series depends on whether they are on the dependent or nondependent surface
Polyps A polyp on the dependent surface appears as a radiolucent filling defect in the barium pool A polyp on the nondependent surface is covered with a thin coat of barium Polyps are commonly multiple
31
In gastric polyps The x-ray beam catches its margin in tangent, resulting in a lesion whose margins are etched in white. What sign is produced by the acute angle of attachment of the polyp to the mucosa
Bowler hat
32
Sign that consist of two concentric rings and is produced by visualizing a pendiculated polyp end on
Mexican hat sign
33
What are the different types of gastric polyps?
Hyperplastic polyps Adenomatous polyps Hamartous polyps
34
These account for 80% of gastric polyps Most are less than 15 mm in diameter They are not neoplasms, but rather hyperplastic responses to mucosal injury, especially gastritis
Hyperplastic polyps They may be located anywhere in the stomach, are frequently multiple, have no malignant potential, but are indicative of chronic gastritis
35
These account for 15% of gastric polyps and are true neoplasms with malignant potential
Adenomatous polyps Most are solitary, located in the antrum, and are larger than 2 cm in diameter
36
Characteristic of a polyp what have risk of malignancy
Larger than 1 cm Lobulated Pedunculated Should be biopsied
37
Polyps that occur in Peutz-Jeghers syndrome
Hamartomatous polyps Have no malignant potential
38
This is a common intramural lesion, usually found in the antrum Lobules of heterotopic pancreatic tissue, up to 5 cm in size, are covered by gastric mucosa Most are nipple- or cone-shaped with small central orifices
Ectopic pancreas
39
This refers to an intraluminal gastric mass consisting of accumulated undigested material
Bezoar Stones may be ingested or form with the bezoar Any ingested foreign body may produce an intraluminal filling defect
40
Bezoars may be composed of a wide variety of substances This bezoar is composed of hair
Trichobezoars
41
Bezoars may be composed of a wide variety of substances This bezoar is composed of fruit or vegetable products
Phytobezoars
42
Bezoars may be composed of a wide variety of substances This bezoar consist of tablets and semi-solid mass of drugs
Pharmacobezoars
43
Causes of multiple gastric filling defects
1. Hyperplastic polyps 2. Adenomatous polyps (especially with polyposis syndromes) 3. Metastases 4. Lymphoma 5. Varices
44
Key points in thickened gastric folds/ thickened wall Irregular, focal (< 5m length), asymmetric bowel wall thickening suggest: a. Benignancy b. Malignancy
b. Malignancy Regular, homogeneous, symmetric bowel wall thickening suggests a benign process
45
Key points in thickened gastric folds/ thickened wall Diffuse bowel wall thickening (>6 cm in length) is usually caused by: a. benign process b. malignant process
A. benign process Caused by benign inflammatory, ischemic, or infectious diseases
46
Key points in thickened gastric folds/ thickened wall Following intravenous contrast administration, bowel wall thickening that shows alternating densities of high and low attenuation (target appearance) is nearly always: a. benign b. malignant
a. benign Nearly always benign and secondary to inflammation or ischemia The low-density layer is indicative of bowel wall edema
47
Key points in thickened gastric folds/ thickened wall Perigastric fat stranding disproportionally more severe than the degree of wall thickening suggests what process?
Inflammatory process *Creator's note: does not specify if benign or malignant process
48
Hallmarks of gastritis
Thickened folds and superficial mucosal ulcerations (erosions) Thethickened folds are usually caused by mucosal edema and superficial inflammatory infiltrate
49
These are defined as defects in the mucosa that do not penetrate beyond the muscularis mucosae
Erosions Erosions heal without scarring
50
These are also called as varioliform erosions These are complete erosions that appear as tiny central flecks of barium surrounded by a radiolucent halo of edema
Aphthous ulcers
51
These may mimic erosions, appearing as distinct punctate barium spots but without the distinctive radiolucent halo of a true erosion
Barium precipitates
52
Gastritis is commonly accompanied by duodenitis True or false
True
53
CT findings of gastritis
1. Wall thickening of the distal stomach and duodenum, often with target appearance indicating wall edema 2. Involved mucosa may enhance avidly 3. Edematous stranding in the perigastric and periduodenal fat
54
Different types of gastritis
``` H. pylori gastritis Erosive gastritis Crohn gastritis Atrophic gastritis Phlegmonous gastritis Emphysematous gastritis Eosinophilic gastroenteritis Menetrier disease ```
55
This is the most common form of gastritis and is the most common cause of thickened gastric folds
Helicobacter pylori gastritis Almost all patients with benign gastric and duodenal ulcers have H. pylori gastritis
56
UGI findings of H. pylori gastritis
1. Thickening (<5 mm) of gastric folds 2. Nodular folds 3. Erosions 4. Antral narrowing 5, Inflammatory polyps 6. Antral narrowing 7. Enlarged areae gastricae
57
This gastritis is most often caused by alcohol, aspirin, and other nonsteroidal anti-inflammatory agents, or steroids
Erosive gastritis
58
UGI findings of erosive gastritis
1. Erosions (aphthous ulcers) 2. Thickened, nodular folds in the antrum 3. Limited distensibility of the antrum 4. Wall stiffness and limited peristalsis
59
This gastritis characteristically involves the gastric antrum and proximal duodenum Early-stage disease manifests as aphthous ulcers identical to those seen with erosive gastritis More advanced disease shows antral narrowing, wall thickening, and fistulas
Crohn gastritis
60
This gastritis is a chronic autoimmune disease that destroys the fundic mucosa but spares the antral mucosa Destruction of parietal cells results in decreased acid and intrinsic factor production that lead to vitamin B12 deficiency and pernicious anemia
Atrophic gastritis
61
UGI findings of atrophic gastritis
1. Decreased or absent folds in the fundus and body (“bald fundus”) 2. Narrowed, tube-shaped stomach (fundal diameter <8 cm) 3. Small (1 to 2 mm) or absent areae gastricae
62
This is an acute, often fatal, bacterial infection of the stomach α-Hemolytic streptococci are the most common cause, but a variety of other bacteria have also been identified It may arise as a complication of septicemia, gastric surgery, or gastric ulcers
Phlegmonous gastritis
63
Findings of phelgmonous gastritis
Multiple abscesses are formed in the gastric wall, which is markedly thickened The rugae are swollen Barium may penetrate into abscess crypts in the gastric wall Peritonitis develops in 70% of cases Healing usually results in a severely contracted stomach
64
This is a form of phlegmonous gastritis caused by gas- producing organisms, usually Escherichia coli, Clostridium welchii, or mixed infections with Staphylococcus aureus Most cases are caused by caustic ingestion, alcohol abuse, surgery, trauma, or ischemia
Emphysematous gastritis Multiple gas bubbles are apparent within the wall of the stomach Gastric folds are thickened and edematous
65
This is a rare disease characterized by diffuse infiltration of the wall of the stomach and small bowel by eosinophils Any or all layers of the wall may be involved
Eosinophilic gastroenteritis The condition is associated with a peripheral eosinophilia as high as 60%
66
Findings of eosinopholic gastroenteritis
Initially, the folds are markedly thickened and nodular, especially in the antrum When chronic, the antrum is narrowed with a nodular “cobblestone” mucosal pattern Ascites and pleural effusions may be present
67
This is also called as giant hypertrophic gastritis Condition characterized by excessive mucus production, giant rugal hypertrophy, hypoproteinemia, and hypochlorhydria
Menetrier disease Pathologically patients have mucosa thickened by hyperplasia of epithelial cells
68
UGI findings of Menetrier disease
1. Markedly enlarged (>10 mm in the fundus) and tortuous but pliable folds in the fundus and body, especially along the greater curvature, with sparing of the antrum 2. Hypersecretion that has diluted the barium and impaired mucosal coating
69
CT finding of Menetrier disease
Demonstrates nodular markedly thickened folds with smooth serosal surface and normal gastric wall thickness between folds
70
Varices are most common in what area?
Fundus and usually accompany esophageal varices Isolated gastric varices occur with splenic vein occlusion
71
MDCT with bolus contrast enhancement is an excellent method for confirming the presence of gastric varices as well as demonstrating their cause CT findings of varices
CT shows well-defined clusters of rounded and tubular enhancing vessels Additional findings of portal hypertension may be evident
72
Most common location for gastric neoplasm
Distal stomach Lymphoma and superficial spreading gastric carcinoma may produce distorted rigid gastric folds that are commonly ulcerated and appear nodular
73
Definition of gastric ulcer
Full-thickness defect in the mucosa About 95% of ulcerating gastric lesions are benign
74
Diagnostic method of choice for gastric ulcer
Gastroduodenal endoscopy
75
Signs of ulcers on UGI
1. Barium-filled crater on the dependent wall 2. A ring shadow caused by barium coating the edge of the crater on the nondependent wall 3. A double ring shadow if the base of the ulcer is broader than the neck 4. A crescentic or semilunar line when the ulcer is seen on tangent oblique view
76
Causes of benign gastric ulcers
H. pylori infection Chronic use of NSAIDs The effects of the two conditions are additive for development of peptic disease Alcohol and smoking are other exacerbating factors
77
Major complications of peptic ulcer disease
Bleeding Perforation Obstruction
78
Most gastric ulcers are: a. benign b. malignant
Benign
79
What is the hallmark of benign ulcers and the basis of radiographic signs of benignancy
Mucosa that is intact to the very edge of an undermining ulcer
80
Sign of benignancy in gastric ulcer
1. Smooth ulcer mound with tapering edges 2. An edematous ulcer collar with overhanging mucosal edge 3. An ulcer projecting beyond the expected lumen 4. Radiating folds extending into the crater 5. Depth of ulcer greater than width 6. Sharply marginated contour 7. Hampton line (a thin, sharp, lucent line that traverses the orifice of the ulcer)
81
This is caused by an overhanging gastric mucosa in an undermined ulcer
Hampton's line Best demonstrated on spot films obtained with compression
82
CT scan finding of benign gastric ulcer
1. Wall thickening usually involving both the antrum and duodenum 2. Edema and edematous stranding extending into periantral and periduodenal fat or involving adjacent organs 3. Deep ulcers that may show focal discontinuity of mucosal enhancement and/or outpouching of the lumen
83
Differential diagnosis for benign ulcers
``` H . pylori peptic disease Gastritis Hyperparathyroidism Radiotherapy Zollinger–Ellison syndrome ```
84
Sign of malignancy in gastric ulcer
1. An ulcer within the lumen of the stomach 2. An ulcer eccentrically located within the tumor mound 3. A shallow ulcer with a width greater than its depth 4. Nodular, rolled, irregular, or shouldered edges 5. Carmen meniscus sign
85
This sign describes a large flat-based ulcer with heaped-up edges that fold inward to trap a lens-shaped barium collection that is convex toward the lumen
Carmen meniscus sign
86
Differential diagnosis of malignant ulcer
1. Gastric adenocarcinoma 2. Lymphoma 3. Leiomyoma 4. Leiomyosarcoma
87
Equivocal ulcers may show the following finding
1. Coarse areae gastricae abutting the ulcer 2. Nodular ulcer collar 3. Mildly irregular folds extending to the ulcer edge