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159 Cards in this Set
- Front
- Back
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Unresectable pancreatic cancer factors?
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Vascular encasement (SMA). Direct invasion of adjacent organs. Liver metastasis. Adenopathy. Ascites (peritoneal spread).
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Paraneoplastic condition in pancreatic adenocarcinoma?
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Trousseau's sign (spontaneous venous thrombosis).
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Normal size of duodenal papilla?
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Less than 1.5 cm.
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Perivaterian neoplasms?
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Carcinoma. Polyps. Leiomyoma. (Familial polyposis syndrome and associated Gardner's syndrome)
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Two types of gastric volvulus?
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Organoaxial. Mesenteroaxial.
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Small bowel folds in Celiac disease and Scleroderma?
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Celiac: Jejunum decreased folds, ileum increased folds. Scleroderma: Increased folds throughout. 5 folds per inch is normal.
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Ileocecal valve upper limits of normal size?
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3 cm, certainly abnormal if > 4 cm.
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Most common cause of enlarged ileocecal valve?
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Lipomatous infiltration.
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Diseases that can enlarged the ileocecal valve?
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Lipoma. Crohn's disease. Lymphoma. Prolapsing ileal neoplasms.
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2 conditions that can cause eccentric sacculations of the small bowel?
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Crohn's disease. Scleroderma.
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What vitamin deficiency may occur with small bowel diverticula?
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Vitamin B12 from bacterial overgrowth.
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Causes of toxic megacolon?
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Ulcerative colitis. Crohn disease. Infectious colitis (especially in AIDS). Ischemia. Pseudomembranous colitis.
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Which colon segment is most commonly involved in toxic megacolon?.
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Transverse colon (most non-dependent).
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What causes the colonic dilation in toxic megacolon?
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Transmural inflamation with destruction of ganglion cells (myenteric plexus).
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3 causes of intramural tracking?
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Diverticulitis. Crohn's disease. Malignancy.
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What disorders cause wide-mouth diverticula (pseudosacculations) in the colon?
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Scleroderma. Crohn's disease. Ischemia.
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In what patient population does right-sided diverticulitis occur?
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Young adults. Asians.
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Main differential feature of diffuse esophageal spasms and presbyesophagus?
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Diffuse esophageal spasm presents with chest pain. Presbyesophagus is asymptomatic.
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Does emphysematous cholecystitis result in air in the biliary system outside of the gallbladder?
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No, because the cystic duct is obstructed.
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What tumors of the appendix can product pseudomyxoma peritonei?
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Mucocele. Mucinous cystadenoma. Myoglobulosis.
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What are the two categories of cecal volvulus?
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Axial torsion. Bascule (folding of cecum on right colon without significant twisting).
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What underlying condition do patients with emphysematous cholecystitis most likely have?
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Diabetes.
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What conditions can lead to superior mesenteric artery syndrome?
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Rapid weight loss. Immobilization. Wearing a body cast. Decreased peristalsis. Drugs.
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What's the Bourne test?
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In suspected enterovesical fistula, urine is collected, spun, and radiographed for dectection of barium.
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What's the difference between a fistula and a sinus tract?
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Fistula tract connects two mucosal lined structures. Sinus tract ends blindly or in a cavity without normal mucosa.
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What drug is associated with pneumatosis of the bowel?
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Steroids.
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What pulmonary and collagen vascular diseases can cause pneumatosis of the bowel?
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Scleroderma. SLE. Dermatomyositis. Asthma. COPD. CF.
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Factors that distinguish a pancreatic abscess from pseudocyst?
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Abscess (forms earlier after pancreatitis, days to weeks, high HU 20-50, may contain air).
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Gallstone ileus triad?
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Air in biliary system. Radiopaque stone. Bowel obstruction. All 3 present probably only 30% of the time.
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Causes of nodular filling defects in duodenal bulb and proximal duodenum?
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Heterotopic gastric mucosa. Benign lymphoid hyperplasia. Brunner's gland hyperplasia (large nodules).
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What conditions may result in loss of haustral folds?
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Most types of colitis. Laxative abuse. Scleroderma.
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Most common location in stomach for a malignant ulcer?
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Antrum (most common area for benign ulcers, too). Fundus ulcers, though uncommon, are more likely to be malignant.
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What liver lesion exhibitis cetripetal opacification?
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Hemangioma, peripheral to central enhancement over time.
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Spigelian, Richter's, and Littre's hernias?
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Spigelian: lower quadrant through semilunar line. Richter's: only one wall of bowel involved. Littre's: Meckel's diverticulum hernia.
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Disorder that causes thyroid and breast abnormalities, hyperkeratosis, and harmartomas of the small bowel?
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Cowden disease.
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Features of Cronkhite-Canada syndrome?
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Weight loss. Anorexia. Alopecia. Multiple intestinal hamartomas.
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Cutaneous masses and small bowel tumors?
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Neurofibromatosis.
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What conditions may cause focal strictures of the small bowel?
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Crohn's disease. Certain infections. Radiation therapy. Ischemia.
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What neoplasms of the stomach grow exophytically?
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Spindle cell tumors (GISTs, leiomyoma, leiomyosarcoma, leiomyoblastoma). Neurofibromas. Lymphomas.
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Bony abnormalities in patients with adenomatous polyposis syndrome?
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Osteomas. Cortical hyperostosis.
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Possible extraintestinal neoplasms of FAPS?
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Osteomas. Glioblastomas. Medulloblastomas. Thyroid carcinoma.
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Congenital condition that may cause diffuse bowel edema?
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Lymphangiectasia.
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Complications of Caroli's disease (Type V Choledochal Cyst or communicating cavernous ectasia of the bile ducts)?
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Cholangitis. Fibrosis. Portal hypertension. Cholangiocarcinoma.
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Most common cause of portal hypertension and varices worldwide (parasite)?
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Shistosomiasis.
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Unusual variant of esophageal carcinoma that spreads submucosally producing thickened folds?
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Varicoid carcinoma of the esophagus.
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Most common internal hernia?
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Paraduodenal hernia.
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A left paraduodenal hernia extends through the fossa of?
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Landzert.
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A right paraduodenal hernia etends through the fossa of?
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Waldeyer.
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Paraduodenal hernia is due to a congenital defect in the?
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Transverse mesocolon.
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Causes of rectal varices (not internal hemorrhoids)?
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Portal hypertension. IVC obstruction. Severe abdominal adhesions.
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Amyloidosis most commonly affects what part of the GI tract?
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Small intestine, with valvulae thickening and mucosal granularity.
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Causes of Booerrhaave's syndrome?
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Endoscopy. Seizures. Coughing. Asthma. Childbirth. Severe straining. Blunt trauma.
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Pancreatic phlegmon (massive enlargement of the pancreas by inflammation tissue) complications?
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Necrosis. Hemorrhage. Infection.
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CREST?
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Subcutaneous Calcinosis. Raynaud's phenomenon. Esophageal dysfunction. Sclerodactyly. Telangiectasia.
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Crowding of the valvulae by fibrosis (scleroderma) term?
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Hidebound.
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What age groups are symptomatic in annulary pancreas?
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50% present as children. 50% present as adults.
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Annular pancreas complications?
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Duodenal obstruction. Increased susceptibility to pancreaatitis.
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The substance secreted by this tumor causes an intense desmoplastic response, producing mesentery fibrosis, with tethering and kinging of small bowel?
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Carcinoid tumor secreting serotonin.
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Insulinoma facts?
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90% benign. small less than 2 cm. Most difficult to detect on imaging.
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Gastrinoma facts?
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Major cause of Zollinger-Ellison syndrome. MEN-1 syndrome. 60% Malignant. Ectopic locations outside pancreas.
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Glucagonoma facts?
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Secrete glucagon. Produce Diabetes Mellitus. 80% Malignant.
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VIPoma facts?
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Secrete vasoactive intestinal peptide. WDHA (Watery Diarrhea, Hypokalemia, Achlorhydria). Variable malignancy.
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Somatostatinoma facts?
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Rare. Cause diarrhea.
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Nonfunctioning islet cell tumor facts?
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3rd most common islet cell tumor. Generally malignant. Larger. Necrotic on imaging studies.
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Causes of ischemic bowel?
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Low flow states (shock, major surgery, cardiac abnormality). Atherosclerosis (chronic). Embolism (acute). Venous occlusion (mesenteric venous occlusive disease).
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Major inflammatory processes that affect the terminal ileum?
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Crohn's disease. Tuberculosis. Yersiniosis.
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Distinguishing features between Crohn's disease and Yersiniosis?
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Yersiniosis: lacks lumen narrowing, lacks deep ulceration, short, self-limited course, heals without scarring.
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Benign splenic tumors and CT characteristics?
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Hemangioma and lymphangioma (hypodense to splenic tissue, may calcify). Hamartoma (isodense to splenic tissue).
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Syndrome of generalized angiomatosis?
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Klippel-Trenaunay-Weber syndrome.
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Define pseudopolyp, cobblestoning, and post-inflammatory polyp?
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Pseudopolyp: island of normal or edematous mucosa surrounded by ulcerated or denuded mocusa. Cobblestoning: normal mucosa surrounded by linear ulceration (Crohn's disease). Postinflammatory polyp: regenerating normal mucosa.
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FAPS (Gardner's type) effect on the mesentery?
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Mesenteric fibromatosis.
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When mesenteric fibromatosis occurs in a round shape this is called?
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Desmoid.
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Causes of portal venous gas?
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Infarcted bowel. Ulcers. Acute bowel dilation. Endoscopy. Necrotizing enterocolitis.
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Through what does a Zenker's diverticulum protrude?
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Killian's dehisence.
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What are lateral diverticula of the pharyngoesophageal junction termed?
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Killian-Jamieson diverticula.
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Colon watershed regions?
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Splenic fleXure (SMA, IMA junction). Rectosigmoid.
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Appearance of the liver with enhancing lobules of hepatocytes and areas of edema that do not enhance?
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Nutmeg liver (can be seen in patients with passive venous congestion of liver and early stages of Budd-Chiari syndrome).
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3 types of anal canal malignant neoplasms?
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Adenocarcinoma. Squamous cell carcinoma. Cloacogenic carcinoma (women, worse prognosis).
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Storage disease associated with splenomegaly?
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Gaucher's disease. Amyloidosis. Hemochromatosis. Niemann-Pick disease.
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Pancreatic cystic neoplasm associated with von-Hippel Lindau disease?
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Microcystic adenoma.
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What liver malignancies may calcify?
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Fibrolamellar HCC. Hepatoblastoma. Intrahepatic cholangiocarcinoma. Metastases.
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Nuclear scanning distinction of FNH from fibrolamellar HCC?
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FNH is hot (has Kupffer cells). Fibrolamellar HCC is cold (No Kupffer cells).
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Pathognomonic finding for cavernous hemangiomas of the colon?
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Phleboliths.
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What is the most common location of Burkitt's lymphoma in North America?
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Distal ileum.
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Longitudinal dimension of the spleen should not eceed?
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12 - 14 cm
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Heterogeneous spleen in early arterial phase?
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Moire spleen.
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Congenital splenic cysts which contain an epithelial lining?
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Epidermoid cysts.
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Accessory spleen versus splenosis?
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Accessory (supernumerary) splenic tissue at hilum not post-traumatic (splenosis).
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Granulomatous disease of the spleen, major finding and common causes?
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Multiple punctate calcifications. Histoplasmosis. Tuberculosis. Sarcoidosis.
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Fungal infections of the spleen, most common finding?
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Microabscesses, multiple small low densities.
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Benign splenic neoplasms (2)?
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Lymphangioma. Hemangioma.
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Malignant splenic neoplasms?
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Hemangiosarcoma. Angiosarcoma (thorotrast 1950s). Kaposi sarcoma. Lymphoma (AIDS and non-AIDS). Leukemia.
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Normal splenic finding may mimic a splenic laceration?
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Splenic cleft.
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Splenic artery aneurysm demographics?.
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Women (medial dysplasia) rupture risk at pregnancy. Men (atherosclerosis).
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Sicke cell disease's eventual effect on spleen?
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Autosplenectomy, small, densely calcified splenic remnant.
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Longitudinal dimension of the spleen should not exceed?
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12 - 14 cm.
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Maximal size of pancreatic duct in adults and elderly?
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3 mm and 5 mm.
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Common sites of ectopic pancreatic tissue?
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walls of stomach, duodenum, and Meckel diverticulum.
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Fatty replacement of the pancreas is common in?
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diabetes. obesity. elderly. Cystic fibrosis.
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Pancreatitis complications?
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Necrotizing pancreatitis. Hemorrhagic pancreatitis. Thrombosis (splenic, portal, mesenteric veins). Pseudoaneurysms. Pseudocysts. Ascites. Abscess.
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Pancreatic endocrine neoplasms?
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Insulinomas. Gastrinomas. VIPomas. Somatostatinomas. Glucagonomas.
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Pancreatic exocrine neoplasms?
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Adenocarcinoma. Cystic pancreatic neoplasms (microcystic adenoma, mucinous cystic neoplasms). Cystic teratomas.
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Low attenuation pancreatic mass with dilated loops of bowel?
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VIPoma.
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Interposition of the hepatic fleure between the dome of the liver and the right hemidiaphragm?
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Chilaiditi sign.
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Extracolonic sequelae of ulcerative colitis?
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Hepatitis. Sclerosing cholangitis. Cholangiocarcinoma. Sacroilitis. Ankylosing spondylitis.
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Neutropenic colitis (pericecal)?
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Typhlitis.
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Gardner syndrome?
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Intestinal adenomatous polyps with osteomas of the skull or long bones. Epidermoid cysts. Fibromatosis.
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Turcot syndrome?
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Medulloblastoma. Glioblastoma multiforme. Family polyposis.
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Most common appendiceal tumor?
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Carcinoid tumor.
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Pneumatosis cystoides coli?
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Asymptomatic, large round air collections in colon wall (iatrogenic mucosal injury).
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Pneumatosis intestinalis causes?
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Infectious colitis. Necrotizing colitis. Bowel infarction. Typhlitis. Toxic megacolon.
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Most common site for intussusception in colon?
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Ileocecal.
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Rare condition with mucinous cysts in colon wall?
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Colitis cystica profunda.
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Term for sensation of a lump in the throat?
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Globus.
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Nasopharyngeal reflux is prevented by the soft palate apposing the posterior pharyngeal wall, known as the?
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Passavant cushion or pad.
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Functional abnormalities of the pharynx in barium swallows?
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Nasopharyngeal reflux. Laryngeal penetration. Tracheal aspiration. Cricopharyngeal achalasia. Cricopharyngeal hypertrophy.
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Major structural abnormalities of the pharynx on barium swallow?
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Strictures. Webs. Diverticula (Zenker [pharygoesophageal]). Lateral pharyngeal pouches. Lateral pharyngeal diverticula.
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For an esophagram, if esophageal rupture is suspected what contrast should be used?
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Water-soluble contrast.
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For an esophagram, if aspiration or a tracheo-esophageal fistula is suspected what contrast should be used?
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Barium. water-soluble contrast should be avoided for it can cause pulmonary edema.
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What does the Z-line represent?
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Zigzagging transition zone between squamous epithilium to columnar.
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Describe proximal escape in esophagography?
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Occurs when a primary contraction wave pushes barium caudally but at the mid third of the esophagus it breaks with regression of the bolus proximally
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Tertiary contraction waves?
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Nonpropulsive contractions of muscularis propria seen as indentations at the margins of the esophagus which occur locally or over large segments.
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Feline esophagus differential?
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Normal variant. Scleroderma. GER.
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Incomplete relaxation of the LES because of neuronal degeneration?
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Achalasia.
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Diffuse esophageal spasm characteristics?
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Severe tertiary contractions following 30% of swallows. Corckscrew appearance at -ray.
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Primary versus secondary achalasia?
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Primary, no known source. Secondary, known source (neoplasm, Chagas disease).
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Chagas disease?
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South American Trypanosoma cruzi destroys myenteric plexus of esophagus and colon. Causes myocarditis and cardiac aneurysms.
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Progressive systemic sclerosis' effect on esophagus?
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Muscular atrophy and collagen deposition of distal 2/3 of esophagus resulting in reflux.
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VACTERL congenital anomaly mnemonic?
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Vertebral. Anal atresia. Cardiac. Tracheoesaphageal fistula/esophageal atresia. Renal agenesis/dysplasia. Limb.
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2 most common vascular rings to effect to the esophagus?
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Double aortic arch. Aberrant left subclavian artery.
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Describe course of aberrant left subclavian artery?
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Last branch of right aortic arch that usually passes behind the esophagus to ascend on the left.
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Describe course of aberrant right subclavian artery?
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Last branch of left aortic arch that usually passes behind the esophagus to ascend on the right.
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Describe course of pulmonary sling?
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Left pulmonary artery arises from right pulmonary artery and courses between the trachea and esophagus.
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2 types of hiatal hernias?
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Sliding hiatal hernia (GE j moves). Paraesophageal hernia (GE j stable, cardia moves).
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A-ring?
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Muscular/contractile ring at the tubulovestibular junction.
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B-ring?
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Mucosal ring, ridge of tissue at the squamosal-columnar junction of the distal esophagus.
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Schatzki ring?
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Pathologic B-ring that can result in dysphagia (inflamed B-ring from reflux).
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Barrett esophagus?
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Metaplastic replacement of squamous epithelium with columnar above normal Z-line secondary to longstanding reflux.
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Common esophagitides?
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Esophageal candidiasis (shaggy mucosa). Herpes esophagitis (discrete ulcers). Cytomegalovirus esophagitis (larger ulcers). HIV esophagitis (largest ulcers).
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Benign esophageal neoplasms?
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Leiomyoma. Fibrovascular polyp. Squamous papilloma.
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Malignant esophageal neoplasms?
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SCC. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Spindle-cell carcinoma. Leiomyosarcoma. Metastases.
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Common location for Booerhave esophagus perforation?
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Left posterior lateral wall of distal esophagus just proximal to the gastroesophageal junction.
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Esophageal bypass surgical techniques?
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Gastric pull-through (esophagogastrectomy). Colonic interposition.
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Structural abnormalities of the small intestine?
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Atresia (jejunum, ileum > duodenum). Jejunoileal stenosis. Enteric duplication cyst. Malrotation. Meckel diverticula. Diverticula. Small bowel obstruction. Small bowel hernias. Adhesions. Adynamic ileus.
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Common causes of small bowel obstruction?
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Adhesions. Hernias. Neoplasms. Intussusception. Volvulus. Foreign bodies. Inflammatory process.
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Prestenotic phase of Crohn disease, findings?
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Blunting, flattening, distortion, straightening, and thickening of mucosal folds.
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Other prestenotic changes of Crohn disease?
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Apthous erosions. Cobblestoning. Inflammatory pseudopolyps. Postinflammatory polyps. Skip lesions. Pseudodiverticula.
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Small bowel infection that can mimick appendicitis clinically and Crohn disease radiographically?
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Yersiniosis at terminal ileum.
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Small bowel infection of middle aged men with malabsorption, fever, weight loss, chronic uveitis, endocardiits, arthralgia, lymphadenpathy, and skin pigmentation?
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Whipple disease.
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Diffuse intestinal disease?
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Menetrier disease. Intestinal lymphangiectasia. Mastocytosis. Radiation enteritis. Progressive systemic sclerosis. Celiac disease. Graft-versus-host disease. Ischemic enteritis.
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Benign small bowel neoplasms?
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Adenomas. Leimyomas. Lipoma. Peutz-Jeghers syndrome. Cowden disease. Familial polyposis.
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Malignant small bowel neoplasms?
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Carcinoid tumors. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Leiomyosarcoma. Metastases.
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Sharp angulation in the lesser curvature that demarcates the junction of the body and antrum?
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Angular notch.
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Two common causes of gastroparesis?
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Diabetes. Progressive systemic sclerosis.
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Focal loss of superficial epithelium?
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Erosion.
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Middle-aged men, enlargement of gastric rugal folds?
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Menetrier disease (protein-losing enteropathy).
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Benign gastric neoplasms?
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Hyperplastic polyp (sessile, less than 1cm). Adenomatous polyps (>1cm). Leiomyoma.
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Malignant gastric neoplasms?
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Gastric adenocarcinoma. Gastric lymphoma. Kaposi sarcoma.
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Billroth I versus Billroth II?
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I: partial gastrectomy with gastroduodenoscopy. II: partial gastrectomy with gastrojejunoscopy.
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