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115 Cards in this Set

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DDx – Gastric Fold Thickening
* Inflammation (eosinophilic, post RTx, corrosive, Crohn's)
* Infiltration (including CA)
* Ménétrier’s disease
* Varices (fundus)

Zollinger-Ellison syndrome
Amyloidosis
Lymphoid hyperplasia
DDx - Small bowel filling defect
* INFLAMMATION: - Nodular lymphoid hyperplas - Crohn's
* INFILTRATION: - Whipple's - Mastocytosis - Waldenstrom's
* NEOPLASM: - Lymphoma - Polyposis syndromes
DDx - Gastric filling defect (s)
* Mets (lung, breast, melanoma, renal)
* Polyps (syndromes)
* Gastroesoph varices
* Pancreatic rest (single, inf antrum)
DDx - Duodenal Filling Defects
*Benign mass (usu prox)- Adenoma, leiomyoma
*Malignancy (usu distal)- AdenoCA, mets
*Ectopic gastric mucosa, Prolapsed antral mucosa
*Brunner gland hyperplasia, lymphoid hyperplasia
*Varices
*Ectopic pancreas (usu distal)
*Other: Choledococele, annular panc [distal]
DDx – Coned Cecum
*Crohn’s (TI always involved)
*TB (TI usu involved)
*Amebiasis (TI not involved)
*UC (w/ backwash Ileitis)
*Appx, R-sided ticitis
*CA of cecum (and mets)
DDx – Dilated SB with Normal Folds
*Sprue
*Scleroderma
*Lactase Deficiency
*Obstruction / Ileus
*Vagotomy
*Meds: MSO4, Atropine, etc.
*Chaga’s disease
DDx – Regular Thickening of SB Folds
*Hemorrage (anticoag, hemophilia)
*Edema (low protein, angioneurotic)
*Lymphangiectasia
*Radiation
*Early Crohn's
DDx – Irregular SB Fold Thickening
WAG CLEM
*Whipple’s Dz
*Amyloid
*Giardiasis, Graft vs. Host
*Cryptosporidiosis
*Lymphoma
*Eosinophilic gastroenteritis
*MAI
DDx - Mesenteric mass
CRADLE
* Carcinoid -“spoke wheel” (DDx: desmoid)
* Retractile Mesenteritis
* Adenocarcinoma
* Desmoid
* LAD (Lymphoma, TB, Yers, Whipple’s, MAI)
* Everyone forgets metastases
DDx – Liver Lesion with Central Scar
*FNH - brief enh, scar hiT2, hot SC scan
*Fibrolamellar HCC - scar loT2, calcs
*Adenoma - heterogeneous enh
*Hemangioma - centripetal enh
Causes of HCC
WHAT causes HCC?
Wilson’s dz
Hemochromatosis
Alpha-1-antitrypsin
Tyrosinosis
Hepatitis
Cirrhosis
Carcinogens (aflatoxin, sex hormones, thorotrast)
DDx – Multiple Intestinal Polyps
*Adenomatous polyps
--FP (MC, screening)
--Gardner's (osteomas)
--Turcot (a/w CNS glioma)
*Hamartomatous Polyps
--Peutz-Jegher’s(usually SB)
--Cowden’s dz
--Juvenile polyposis
--Cronkhite-Canada syndrome
--Bannayan-Riley-Ruvalcaba
*Post-Inflammatory (filiform)
*Pseudopolyps
Staging – Colorectal CA
A: Limited to mucosa
B: Muscularis propria
-B1 into muscularis propria
-B2 thru muscularis propria
C: Lymph node mets
-C1 limited to bowel wall
-C2 into adipose tissue
D: Distant Metastases
DDx – Cholangitis
* Sclerosing (1° and 2° forms)
- Irreg bile ducts, "tics"
- 1°-idiopath. 10% get CA
- 2°-65% a/w IBD (usu UC)
* Oriental Cholangitis
- Postinf (clonorchis/ascaris)
- Extra & Intra dilat, calculi
* Ascending Cholangitis
- infection of obstructed ducts (E. coli > Klebs > Pseudom)
DDx – Hypervascular Liver Masses (seen in arterial phase)
Primary
- HCC (esp. Fibrolamellar)
- Hemangioma
- FNH
- Hepatic adenoma
- Hemangioendothelioma, hemangiopericyt

Metastases
- Neuroendocr: islet, carcinoid
- RCC
- Breast CA
- Thyroid
- Sarcoma
- Melanoma
DDx – Cystic Pancreatic Lesions:
Microcystic adenoma (Lil old ladies...)
VHL (renal & liver cysts)
Mucinous Cystadenoma /CA
Epithelial
Simple cyst
Pseudocyst
Duct Ectasia
DDx – Hypervascular Pancreatic Mass
Primary
- Islet cell
- SPEN
- Microcystic adenoma
METS
Adrenal, Thyroid, RCC, melanoma
Crohn's mimics
TCbY
Tuberculosis
Campylobacter
Yersinia enterocolitica
UC mimics
Amebiasis
Salmonella / Shigella
Ischemia
Pseudomembranous Colitis
Behcet’s
Esophagus
Diverticular disease:
pharyngocele
Zenker
Killian Jamieson
pseudodiverticula
epiphrenic
Esophagus shows
Luminal narrowing

DDx?
Webs
Plummer-Vinson
Vascular ring - Pulm sling anterior, aberrant R subclav posterior
Schatzki ring
Strictures (long list)
Cancer
Extrinsic compr (Ao, L bronch, L atrium, mediast mass)
Causes of esophageal strictures
*Reflux
*Tumor, Mets, Barrett's
*Meds, RTX, NGT, Lye
*Crohn's, Eosinophilic GEitis
*Scleroderma, Achalasia, Chagas
Esophagus shows
high stricture

DDx?
Barrett’s
RTX, meds
caustic ingestion
CA, mets
skin dz
Crohn’s
Esophagus shows
Low stricture

DDx?
Peptic stricture
Lower esophageal ring
Barrett’s
Esophagus shows
Nodules/plaques

DDx?
DIFFUSE - reflux, Candida, glycogenic acanthosis

LOCALIZED – Candida, superficial spreading CA, Barrett’s
Esophagus shows ulcers

DDx?
*DISTAL – reflux, Crohn’s
*SMALL, MID – Crohn’s, HSV, meds (tetra/doxycycline, KCl, Fe, quinidine, NSAIDs, vit C, Fosamax)
*GIANT – CMV, HIV
Esophagus shows megaesophagus

DDx?
Achalasia
Scleroderma
Chagas
Distal tumor or stricture
Esophagus shows contrast extravasation

DDx?
Esophagitis
Tumor
Vomiting (MW tear, Boerhaave)
TE fistula
Foregut dupl cyst w/comm to esophagus
Iatrogenic
Trauma
Esophagus shows
corkscrew esophagus

DDx
Diffuse esophageal spasm
Presbyesophagus
Esophagus shows
Air-fluid level

DDx
Hiatal hernia
Esophageal diverticulum
CA
Achalasia
Scleroderma
Esophagus shows
Thickened folds

DDx
Esophagitis
Lymphoma
Varicoid carcinoma
Varices
Esophagus shows
Solitary filling defect
INTRALUMINAL – food, foreign body, fibrovasc polyp, spindle cell tumor, leiomyosarc, adenoCA
TUMOR – leiomyoma, fibrovasc polyp, duplication cyst, papilloma, fibroma, hemangioma, SCC, adenoCA, spindle cell tumor, lymphoma, mets (breast, lung, KS, melanoma, RCC)
VARICES – uphill (portal HTN), downhill (SVC obstruction)
EXTRINSIC – lymph nodes, vessels, aneurysms, cysts
Gastritis
seen in the stomach.

DDx
H pylori
Erosive (lye, EtOH, stress, NSAIDS)
Granulomatous (Crohn’s, sarcoid, TB, histo, syphilis)
Eosinophilic
Hypertrophic (Menetrier’s, ZE syndrome)
Gastric ulcer (ZE syndrome, PUD, drugs)
RTX
Emphysematous
Target lesions
seen in the stomach.

DDx
Gastritis (aphthoid) – erosive (NSAID, EtOH), Crohn’s, infection (Candida, HSV, CMV)
Submucosal mets (large ulcer) – melanoma, KS > breast, lung, lymphoma
Solitary giant bullseye (very large ulcer) – leiomyoma, sarcoma, CA, solitary met, ectopic pancr, benign ulcer
UGI surgery
seen in the stomach.

DDx
*plication defect, afferent loop syndrome
*marginal ulcer, leak
*bezoar
*chronic gastritis, *malabsorption
*obstruction, intussusception (jejunogastric)
*gastric CA
Filling defect
seen in the stomach.

DDx
*bezoar, adenoCA
*lymphoma, leiomyoma/sarc, mets, KS
*endometriosis, carcinoid, lipoma
*polyps (hyperplastic #1), *varices
*ectopic pancreas, extrinsic compr from spleen/panc/liver
Free air seen adj to the stomach.

DDx
* Surgery & laparoscopy
* Perforated ulcer
* Perf distal bowel (IBD, diverticulitis, CA)
Antral lesions seen in the stomach.

DDx
AdenoCA, lymphoma, mets
Crohn’s, PUD
TB, sarcoid
HPS, pylorospasm
Antral web
Ectopic pancreas
Erosive gastritis, caustics
Gastroenteric fistula

DDx
PUD
Crohn’s
CA
Iatrogenic
Surgery
Double pylorus seen

DDx
Lesser curve antral ulcer
Crohn’s
Lymphoma
Linitis plastica

DDx
Scirrhous CA (#1)
Lymphoma, mets (esp breast), Pancreatic CA (direct invasion)
RTX, corrosive ingestion
Crohn’s, eosinophilic GEitis
TB, sarcoid
Syphilis
Giant rugal folds in the stomach.

DDx
* Lymphoma, mets
* Menetrier’s
* ZE syndrome
* Gastritis, eosinophilic GEitis, Crohn’s
* RTX
* infection
* varices (mimic)
Filling defect in distal duodenum

DDx
*benign lymphoid hyperplasia
*ectopic / annular pancreas
*ampulla of Vater
*malignancy
*edema w/impacted or passed gallstone
*choledochocele
Filling defect in the duodenum which is soft and changing

DDx
*choledochocele
*lipoma
*duplication cyst
Duodenal benign tumors
(often 1st portion, asx)
* Adenoma
* Leiomyoma
* Lipoma
* Villous adenoma
* Ectopic pancreas
Malignant tumors of duodenum
(distal to 1st portion, sx)
* AdenoCA at or distal to papilla
* Leiomyosarcoma
* Lymphoma
* Mets (melanoma, breast, KS, carcinoid)
Target lesion in duodenum

DDx
* Leiomyoma
* Leiomyosarcoma
* Met (melanoma, KS, breast, lung, lymphoma)
* Ulcer, ZE syndrome
Luminal outpouchings in the duodenum

DDx
* Ulcer
* Diverticulum
* Fistula (with GB or bile duct)
Reverse figure 3 sign of the duodenum

DDx
pancreatitis
pancreatic CA
Notched duodenum

DDx
Annular pancreas
Post-bulbar ulcer
Crohn’s
Post-op
Pancreatitis
Pancreatic CA
Postbulbar narrowing of the duodenum

DDx
*AdenoCA, lymphoma, mets
*Ulcer, duodenitis, Crohn’s
*Pancreatitis, pancr CA, annular panc
*Intramural tic, duplication cyst
*Hematoma, aortic aneurysm, SMA syndr
Enlargement of Ampulla of Vater
(>15mm)

DDx
Papillary edema (pancreatitis, ulcer, stone)
Ampullary CA
Choledochocele
Normal variant
Adynamic ileus

DDx
* Postoperative (#1)
* Inflammatory (often sentinel loop) – pancr, appy, GB, tics, peritonitis
* Metabolic – low K+, Ca++, Mg++
* Medication – morphine
Mechanical SBO causes
Adhesions
Hernia
Tumor
Gallstone
Inflammation w/stricture
SB shows malabsorption with mainly thickened irregular folds

DDx
* Whipple’s
* MAI, Strongyloides (prox), Giardia (jej), Cryptosp (jej)
* Amyloid
* GVH, lymphoma, mastocytosis
eosinophilic GEitis
SB shows malabsorption with mainly dilated loops and normal folds

DDx
* Sprue (#1)
* Obstruction / Ileus
* Scleroderma
* Medication
SB shows thickened folds without malabsorption pattern

DDx
Submucosal...
* Edema – ischemia, infection, RTx, hypoproteinemia, GVH
* Tumor – lymphoma, leukemia
* Hemorrhage – HSP, hemophilia, anticoag
"Tubular" appearance of small bowel

DDx
Cryptosporidium
Sprue (proximal)
Lymphoma
GVH
RTx
Ischemia
Strongyloides (proximal)
Nodules of small bowel (multiple, but not "tiny" in size)

DDx
*Mastocytosis, lymphoid hyperplasia
*Lymphoma, mets
*Polyps
*Crohn’s, eosinophilic GEitis
*TB or other infection
*Amyloid, lymphangiectasia
*Whipple’s, Waldenstrom’s
Diffuse tiny nodules of small bowel

DDx
Lymphoid hyperplasia (#1)
Hypogammaglobulinemia
Giardia
Whipple’s
Waldenstrom’s
Shortened transit time seen in small bowel

DDx
anxiety
hyperthyroid
medication (reglan)
partial SBO
Small bowel tumors

Benign and maligant types
BENIGN – adenoma (#1), leiomyoma (#2), lipoma, hemangioma, neurogenic, Brunner glands, heterotopic pancr tissue

MALIGNANT – mets (melanoma, RCC, breast, KS), carcinoid (#1 1ary tumor), lymphoma, leiomyosarc (large ulcerating), adenoCA
Small bowel stricture:

DDx overall, and for focal stricture with "shouldering"
* Crohn’s
* Lymphoma, mets, adenoCA
* Infection, RTX
* Ischemia
* Extrinsic compression
* NSAIDs

*** Focal w/shouldering – adenoCA (#1), breast mets, TB
Coiled spring appearance of small bowel

DDx
Intussusception
Intramural hematoma
Large ulcerated mass (endoexoenteric)

DDx
* Lymphoma
* Leiomyosarcoma
* Mets (melanoma)
* Interloop abscess
Intraluminal filling defects of small bowel
* Parasites (Ascaris, tapeworm)
* Bezoar
* Foreign body
* Gallstone
* Lipoma
Causes of enteric fistulas
Crohn’s
diverticulitis
CA
TB
radiation
surgery
Serosal lesions of small bowel
Carcinoid
Serosal mets
Diverticulitis
Appendicitis
Endometriosis
Causes of mesenteric ischemia
*occlusive – emboli (Afib, LV aneur), art thrombosis (athero), venous thrombosis (portal HTN, pancreatitis, tumor, hypercoag state, drugs)
*nonocclusive – low flow state
Features of Crohn's dz in the colon
Fold and wall thickening
Nodular pattern (cobblestone)
Aphthoid ulcers
Filiform polyps
Fistulas, strictures, pseudosacc
Mesenteric fat stranding, LAD
String sign, separated loop (omega sign)
Asymmetric, skip lesions
Polypoid filling defects of the colon

DDx
*Polyps - hyperplastic (#1), adenomatous (#2), hamartomatous, post-inflamm
*Polyposis – FAP, Peutz-Jeghers, juv polyposis, Turcot, Cronkhite-Canada, Cowden
*lymphoma
*pneumatosis
Colonic wall thickening (thumbprinting)

DDx
HEMORRHAGE – ischemia, HSP, hemophilia, anticoag
TUMOR– lymphoma, leukemia
EDEMA– IBD, infection (pseudomembr colitis, CMV, E Coli, Salm/Shigella, amebiasis, typhlitis)
Long segment narrowing of colon

DDx
scirrhous adenoCA
lymphoma
IBD
ischemic stricture
radiation
Pseudosacculations of colon
Crohn's
scleroderma
ischemia
Pneumatosis coli

DDx
Pneumatosis cystoides
- COPD
- asthma
- CF
- CVD
- steroids

Pneumatosis intestinalis
- infarct
- NEC
- toxic megacolon
- typhlitis
Deep ulcers of colon
*UC, Crohn’s
*Behcet’s
*infectious (amebiasis, TB, Salm/Shigella, histo, Candida, herpes, CMV)
*Ischemic colitis
*RTx
Circumferential (apple core) or asymmetric narrowing of colon

DDx for single and multiple
Tumor – adenoCA, serosal mets (stom, ova, colon, panc)
Inflamm – diverticulitis, IBD, TB, amebiasis
Other – endometriosis, pelvic abscess, epiploic appendagitis

Multifocal – lymphoma, serosal mets, TB, amebiasis, Crohn’s, endometriosis
Ahaustral colon

DDx
Cathartic abuse (usu R colon)
UC, Crohn’s
Amebiasis
Scleroderma
RTx
Prior ischemia
Aphthoid ulcers of colon

DDx
Crohn’s
amebiasis
Behcet’s
CMV
herpes
TB
Yersinia (TI)
Characteristics of ulcerative colitis
*ahaustral, granular mucosa
*filiform polyps, crypt abscesses
*starts in rectum, continuous spread, backwash ileitis
*strictures (worrisome)
Presacral space widening:
( >2cm )

DDx
*rectal inflammation (colitis, RTX)
*infection
*tumor
*pelvic lipomatosis
*edema or hemorrhage
Megacolon DDx
*toxic – pseudomemb colitis, IBD, amebiasis
*acute distension – obstructive CA, ileus, volvulus
*chronic – laxative abuse, Ogilvie syn, congenital Hirschsprung’s, Chagas, neuromuscular dz (Parkinson, DM, scleroderma, amyloid), hypothyroid
Cecal filling defect and nonfilling appendix

DDx
carcinoid
appendicitis
appendix stump
mucocele
Coned cecum DDx
Crohn’s
lymphoma / mets
TB
amebiasis
typhlitis
Ileocecal deformities

DDx
IBD
amebiasis (spares TI), TB
typhlitis
lymphoma, adenoCA
carcinoid
intussusception
Solid mass in liver

DDx
* Hemangioma, FNH, adenoma
* HCC, mets, lymphoma
* Regenerating nodules
* Focal fat
Cystic mass in liver

DDx
* Infectious – pyogenic abscess, amebiasis, Echinococcus
*Benign – simple cysts, ADPKD, biliary cystadenoma, biloma, intrahepatic GB
*Malignant – necrotic tumors, cystic mets, cholangioCA
Increased density of liver
*Hemochromatosis, Wilson’s
*Glycogen storage dz
*amiodarone, chemo, thorotrast
*anemia
*regenerative nodules - cirrhosis (low T2)
Enlarged ileocecal valve
( >3cm )

DDx
Lipomatous infiltration (#1)
lipoma
Crohn’s
lymphoma
prolapsing ileal neoplasms
Gas in liver:
*pneumobilia – ERCP, surgery, penetrating ulcer, gallstone ileus, CA, bowel obstr
*PV GAS– necrosis > IBD, abscess, obstruction, ulcer, iatrogenic, liver transplant
*abscess
*emphysematous cholecystitis
Decreased density of liver
fatty liver – obesity, alcohol, DM, steroids, chemotherapy

radiation-induced
Liver shows mottled density without a focal mass

DDx
*passive congestion
*Budd-Chiari
*geographic fatty infiltration
*hepatoma
*lymphoma
Hypervascular liver mass

DDx
Hemangioma, hemangioendothelioma
CholangioCA
HCC
Mets (melanoma, RCC, sarcoma, islet cell, thyroid, carcinoid, breast, pheo)
Hyperechoic liver lesion

DDx
ROUND
-- hemangioma
-- mets (hypervasc & Ca++)
-- HCC, fibrolamellar HCC
-- focal fat, lipoma, AML

LINEAR – pneumobilia, PV gas, biliary ascariasis

MULT PUNCTATE FOCI – hepatitis, granulomatous inf, PCP, biliary hamartomas, pneumobilia, PV gas, vascular calcs
Multiple hypoechoic foci in the liver

DDx
TUMOR– mets, lymphoma, HCC
INFECTION– pyogenic, amebic, Echinococcus, Candida, Schistosomiasis
OTHER– regenerative nodules in cirrhosis, sarcoid, extramedullary hematopoiesis, hematomas, hemangiomas
Delayed retention of contrast in a liver lesion
CholangioCA
Hemangioma
Fibrous tumor
Scar (FNH, adenoma, fibrolam HCC, hemangioma)
Hepatic hemorrhage

DDx
iatrogenic
trauma
adenoma
HCC
pregnancy
Extrahepatic biliary dilatation

DDx
*Intrapancreatic (#1) – pancr CA, calculus, chronic p-itis
*Suprapancreatic – cholangioCA, metastatic LNs
*Portal – cholangioCA, GB CA, surgical strictures, hepatoma
*Choledochal cyst
Types of biliary obstruction
*Tumor – abrupt duct termination, mass adj to duct. Bil dil in one lobe of liver - Klatzkin tumor!
*Pancreatitis - smooth, long tapering
*Stone – calculus seen, meniscus, intrahepatic dil
*Cholangitis
*Caroli’s
*Biliary cystadenoma
Double duct sign
(dilated BD and PD)
pancreatitis
pancreatic CA
stone @ ampulla
cholangioCA
duodenal or ampullary CA
Filling defects in bile duct

Possible causes
stone
blood clot
parasite
sludge
tumor
(on ERCP - air bubble)
Hemobilia DDx
iatrogenic
tumor
trauma
infection
Strictures on ERCP
DDx for stricture
- at hilum
- 1cm from ampulla
- long segment
- CHD in area of cystic duct
- multiple intrahepatic
- mult intra & extrahepatic
* Hilum – cholangioCA, porta hepatis nodes, GB CA
* 1cm from ampulla – pancr CA, cholangioCA, mets
* long segment – chronic pancreatitis, lymphoma
* CHD @ cystic duct region – Mirizzi’s, GB CA, cholangioCA
* Multiple intrahepatic – sclerosing cholangitis, HIV, ischemic, primary biliary cirrhosis, liver mets (rare)
* Mult intra & extrahepatic - sclerosing cholangitis, HIV, ischemia
Biliary system shows irregular wall and filling defects
Cholangitis
- HIV
- oriental
- ascending
Pancreatic duct disease
-Stricture
-Cystic dil & side branches
-Variants
* Stricture – pancreatic CA, chronic pancreatitis
* Cystic dil & side branches – chronic pancreatitis, IPMT
* Variants - annular pancr, pancr divisum
Post-cholecystectomy bile leaks are caused by...
cystic duct remnant
duct of Luschka
GB wall thickening
( >3mm)

DDx
* Diffuse – nonfasting, acute or chronic GBitis, portal HTN, low albumin, hepatitis, AIDS (cryptosp, CMV, MAI), ascites
* Focal – GB CA, mets (melanoma), cholesterol polyp, adenomyomatosis, tumefactive sludge, AIDS
Hyperechoic foci in GB wall
Calculus
Polyp
Cholesterol
Emphysematous cholecystitis
Porcelain GB
Dense GB on CT
Vicarious excr of contrast
calculi
milk of calcium
oral cholecystogram
hemorrhage
Biliary enteric fistula is seen.

What are possible causes?
* Cholecystitis (g-stone ileus)
* PUD
* Tumor
* Trauma / surgery
* Crohn’s
Cystic lesions of the pancreas
**Tumor **
microcystic adenoma, mucinous cystadenoma, IPMT, SPEN, islet cell tumor
** Cyst **
simple, pseudocyst, ADPKD, VHL, duct ectasia
** Abscess **
Obstruction of the colon
CA
diverticulitis
volvulus
impaction
hernia
Splenic cyst ddx
*primary (congenital, true cyst)
*secondary (Ca++, false)
prior infarct, trauma, infection, echinococcus, pancreatic pseudocyst
Low density lymph nodes in abdomen
TB / MAI
lymphoma
testicular tumor
mucinous adenoCA
Whipple’s dz
Multiple liver lesions
* abscess
* cystic metastases
* intrahepatic biloma
* Caroli disease
* hepatic cysts
* bile duct hamartoma
* undifferentiated sarcoma
* biliary cystadenoma or cystadenocarcinoma
* cavernous hemangioma
* hydatid cyst
* intrahepatic hematoma