Gi -- Duodenum

Front 1

What are the benign causes of fold thickening in the duodenum?

Back 1

1. Peptic disease, Zollinger-Ellison syndrome, pancreatitis, Crohn disease, Celiac disease.

Front 2

1. What is the most common cause of duodenitis (fold thickening and/or ulcer formation)?
2. What are some other causes of duodenal ulcers?
3. Which is more common: Gastric ulcers or Duodenal ulcers? Which ulcers are more likely to perforate?
4. Are most duodenal ulcers located in the anterior or posterior duodenum? How do you find anterior located duodenal ulcers?
5. What should you consider if you see multiple duodenal ulcers?
6. Are duodenal ulcers likely to be benign or malignant?
7. If an ulcer is located distal to the ampulla of Vater, what should you consider?

Back 2

1. Peptic ulcer disease 2/2 H. Pylori infection.
2. Acid (peptic ulcer and ZE), Ingestion (meds, alcohol, caffeine, steroids), Infxn/Inflammation (Crohn disease, HSV/CMV infection)
3. Duodenal ulcers are 2-3x more common than gastric ulcers. Duodenal ulcers are more likely to perforate.
4. Most duodenal ulcers are located along the anterior surface of the duodenum and thus are harder to detect. On double contrast UGI, they appear as rings. Compression is important on single contrast images.
5. Zollinger Ellison syndrome
6. Duodenal ulcers are RARELY malignant.
7. Ulcers occuring distal to the ampulla are usually malignant, except in pts with ZE syndrome. Look for other supporting evidence of ZE (Brunner gland hyperplasia, ulcers and fold thickening of the stomach)

Front 3

1. What is pyloric torus defect?
2. What can a pyoric torus defect be confused with? How can you tell them apart?

Back 3

1. Pyloric torus defect is mid pyloric channel widening that has a diamond or triangle shape 2/2 prolapse of mucosa through the muscle bundles of the duodenal wall.
2. Pyloric ulcers. Ulcers do not change in shape whereas pyloric torus defect changes shape with peristalsis.

Front 4

1. What is the clover-leaf deformity of the duodenal bulb?
2. How can you differentiate active ulcers from scarred duodenal bulbs?

Back 4

1. Cloverleaf deformity of the duodenal bulb is seen with scarring from previous peptic ulcer disease.
2. Active ulcers are fixed abnormalities that do not change shape with peristalsis. Scarred duodenal bulbs change shape as the duodenum fills and empties.

Front 5

What is the differential diagnosis of double pylorus?

Back 5

1. Fistulous channel from peptic ulcer disease.
2. Crohn Disease
3. Congenital double pylorus

Front 6

1. What is the sequelae of pancreatitis upon the duodenum?
2. What is the reverse 3 configuration of the duodenum?
3. What can the imaging findings mimic?

Back 6

1. Pancreatitis leads to narrowing of the duodenum from pancreatitis induced edema and spasm. A persistent stricture may develop.
2. Reverese 3 refers to fixed narrowing of the medial wall of the 2nd duodenum from pancreatic adenoCA.
3. Focal narrowing, fold thickening, stricture formation with abrupt edges can mimic adenoCA.

Front 7

1. What is the significance of tethered folds?
2. What is the imaging appearance of tethered folds?

Back 7

1. Tethered folds usually develop from either an extraluminal inflammatory or neoplastic process.
2. Tethered folds usually appears to be pulled from the normal bowel wall toward a central area extrinsic to the bowel. Tethered folds are usually pointed and elongated.

Front 8

What are the malignant causes of filling defect in the duodenum?

Back 8

1. AdenoCA
2. Ampullary CA
3. Lymphoma
4. Malignant GIST
5. Mets

Front 9

What are the benign neoplastic causes of filling defect in the duodenum?

Back 9

1. Villous adenoma
2. Polyps
3. GIST
4. Lipoma

Front 10

What are the non-neoplastic causes of filling defect in the duodenum?

Back 10

1. Heterotopic gastric mucosa
2. Brunner gland hyperplasia
3. Enteric duplication cyst
4. Flexural pseudopolyp
5. Annular pancreas

Front 11

1. What are the imaging appearance of duodenal adeno CA?
2. Are duodenal adenoCA more commonly pre- or post-ampullary?

Back 11

1. Short segment eccentric wall thickening of the duodenum with assoicated luminal narrowing.
2. Post-ampullary

Front 12

1. What are the imaging features of ampullary carcinoma?
2. Ampullary carcinomas are associated with what syndrome?
3. If the patient had recent ERCP or stone passage, what would be another consideration?

Back 12

1. Ampullary carcinomas present as filling defect in the medial wall of the 2nd portion of the duodenum. Look for associated obstruction of the CBD and pancreatic duct.
2. FAP syndromes
3. Edematous papilla (recent stone passage or impacted stone).

Front 13

What are the imaging features of duodenal lymphoma?

Back 13

1. Lymphomatous involvement may lead to overlying mucosal ulceration which is larger than the lumen of the normal, unaffected portion of the duodenum. This gives the appearance of aneurysmal dilatation.
2. Long segment involvement is common.
3. Regional or diffuse adenopathy may be present.

Front 14

1. Are duodenal polyps assocaited with FAP hyperplastic or adenomatous?
2. Patients with FAP are at increased risk of developing what duodenal tumor?
3. What is the nature of the duodenal polyps associated with Peutz-Jegher syndrome?

Back 14

1. Duodenal polyps associated with FAP are more likely to be adenomatous. Whereas gastric polyps associated with FAP are more commonly hyperplastic.
2. Ampullary carcinoma
3. Hamartomatous

Front 15

1. What are the imaging features of heterotopic gastric mucosa in the duodenum?
2. What are the imaging features of Brunner gland hyperplasia?

Back 15

1. Raised nodules measuring a few mm seen about the pylorus.
2. Brunner glands secrete bicarbonate to neutralize stomach acid. Hyperplasia of these glands occur in response to PUD. Look for nodular filling defects in the duodenum bulb and 2nd portion of duodenum. Larger hypertrophic Brunner glands are referred to as Brunner gland hamartomas.

Front 16

1. What are the most common locations of enteric duplication cysts?
2. What are the imaging findings?

Back 16

1. Enteric duplication cysts can occur anywhere but are most common in the esophagus or ileum.
2. Extrinsic mass causing narrowing and obstruction of the affected bowel loop. It, rarely, communicates with the adjacnet bowel.

Front 17

1. What is the most common location for a duodenal diverticulum?
2. How can you differentiate a duodenal diverticulum for an ulcer crater?
3. What can a duodenal diverticulum simulate?

Back 17

1. Duodenal diverticula most commonly arise from the medial wall of the 2nd portion of the duodenum.
2. Duodenal folds enter the diverticulum and the diverticula change shape and size with peristalsis. Whereas, ulcers are static.
3. Duodenal diverticulum can be confused for a cystic pancreatic lesion.

Front 18

1. What is SMA syndrome?
2. What are the imaging findings?
3. What patient population is affected by this condition?

Back 18

1. Compression of the 3rd portion of the duodenum as it courses between the SMA and aorta.
2. Dilatation of the first and second portion of the duodenum to the level of the extramucosal linear obstruction. Vigorous peristalsis of the proximal duodenum is seen as segments attempt to propel duodenal contents beyond the obstruction.
3. Thin patients with recent weight loss

Front 19

1. In traumatic perforation of the duodenum due to blunt abdominal trauma, which is more common, intraperitoneal or retroperitoneal free air?
2. Why is the duodenum the most frequent small bowel site of intramural hemorrhage in blunt abdominal trauma?
3. What associated findings can suggest the diagnosis of small bowel injury?

Back 19

1. Retroperitoneal air. Free intraperitoneal air is unusual in traumatic duodenal perforations. However, it is more common in pts with a perforated duodenal ulcer.
2. Duodenum is most common site of injury due to its lack of mobility and retroperitoneal fixation.
3. "Seatbelt hematoma" in the anterior subcutaneous tissue; Chance fx of the spine.

Front 20

Duodenal carcinoid

Back 20

duodenum is the 2nd most common site for a carcinoid tumor after the distal ileum. However, carcinoid tumors are usually hypervascular, smaller, and are often seen with nodal and liver metastases.