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112 Cards in this Set

  • Front
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normal esophageal contour deformities
cricopharyngeus
postcricoid impression
aortic impression
left mainstem bronchus
left atrium
diaphragm
primary peristaltic contraction
initiated by swallowing
propulsive wave
secondary peristaltic contraction
locally intitiated
propulsive wave
tertiary peristaltic contraction
uncoordinated, nonpropulsive wave
increase with age
only activity seen in achalasia
difference between esophageal web and post-cricoid impression
web - usually anterior
post-cricoid impression - posterior
Plummer - Vinson Syndrome (4 features)
1. Upper esophageal (cervical) web
2. Fe deficiency
3. Cheiliosis (fissured lips)
4. Koilonychia (spoon nails)

Increase risk of hypopharyngeal ca.
Zenker's diverticulum position
Killian's dehiscence (above cricopharyngeus)
mildline
posterior
Killian-Jamieson diverticulum position
below cricopharngeus
off midline
Esophagitis causes
Infectious
Herpes
Candidiasis
CMV
HIV

Chemical
Reflux
Corrosive (lye)

Drugs
Tetracycline
NSAIDS
Potassium
Iron
bisphosphonates

Iatrogenic
RT
extended NG

Other
Scleroderma
Crohn's disease
Derm (pemphigoid, dermatomyositis bullosa)
herpes esophagitis ulcer size
< 5 mm
cmv esophagitis ulcer size
> 2 cm
hiv esophagitis ulcer size
> 2 cm
candida esophagitis ulcer morphology
plaquelike, reticular
achalasia causes
primary (idiopathic)

secondary
adenoca
mets
chagas' disease
achalasia complications
recurrent aspirations
esophageal carcinoma
chagas disease findings
esophagus - achalasia
megacolon, sigmoid volvulus, megastomach, megaduodenum
cardiomyopathy
encephalitis
benign esophageal neoplasms
leimyoma 50%
fibrovascular polyp 25%
cysts 10%
papilloma 3%
fibroma 3%
hemangioma 2%
malignant esophageal neoplasms
SCC 50-70%
adenoca 30-50%
lymphoma
leiomyosarcoma
mets
esophageal SCC associations
head and neck ca
smoking
alcohol
achalasia
lye ingestion
benign gastric ulcers
PUD 90%
NSAIDs
steroids
hormonal (stress, burns, head injury, hyperPT)
gastritis
malignant gastric ulcers
carcinoma 90%
lymphoma 5%
sarcoma, carcinoid, mets
menetrier's disease - clinical features
hypertrophic gastritis with protein losing enteropathy
clinical triad: achlorhydria, hypoproteinemia, edema
middle aged men
menetrier's disease - radiographic features
giant proximal rugal folds
hypersecretion (poor Ba coating)
gastric wall thickening
small bowel thickening (due to hypoproteinemia)
peptic ulcers are uncommon
eosinophilic gastroenteritis - clincial features
inflammatory
suspected allergic
abdo pain, diarrhea, eosinophilia
eosinophilic gastroenteritis - radiographic features
esophageal strictures
antral stenosis
pyloric stenosis
gastric fold thickening
SB fold thickening
SB dilatation
stenosis
zollinger-ellison syndrome - clinical features
excessive gastrin production
diarrhea, PUD, pain
gastrinoma 90%
antral G cell hyperplasia 10%
zollinger-ellison syndrome - radiographic features
ulcers: bulb>stomach>post-bulbar
multiple ulcers 10%
thickened folds (S+D)
increased secretions
reflux
gastric polyps - clinical features
hyperplastic 80%
<1cm, sessile
typically multiple (fundus, body)
5-25% synchronous gastric ca

adenomatous 20%
>2cm, sessile
familial polyposis, Gardner's
35% synchronous gastric ca

hamartomatous rare
peutz-jagher, Gardner's
gastric carcinoma risk factors
pernicious anemia
adenomatous polyps
chronic atrophic gastritis
billroth 2 > billroth 2
gastric carcinoma staging
T1 limited to mucosa,submucosa
T2 muscle,serosa involved
T3 through serosa
T4 adjacent organs
gastric lymphoma - clinical features
NHL >>> hodkins

primary 10% (h. pylori associated maltoma)

secondary 90%
hematogenous mets to stomach
melanoma
breast
lung
carney's triad
gastric leiomyosarcoma
extra-adrenal paraganglioma
pulmonary chondroma
billroth I procedure
gastroduodenostomy
billroth II procedure
gastrojejunostomy (isoperistaltic, antiperistaltic, roux en y)
sprue radiographic features
sb dilatation (most typical feature)
nodular changes in duodenum
jejunal and ileal fold pattern reversal
segmentation, moulage, flocculation
sprue associated disorders
dermatitis herpetiformis
selective IgA deficiency
hyposplenism
adenopathy
cavitary mesenteric lymph node syndrome
mastocytosis - clinical features
mast cell proliferation in RES and skin with histamine release. diarrhea, steatorrhea, hitamine effects
systemic amyloidosis associated diseases
infectious (TB, chronic osteomyelitis, decubitus ulcers, bronchiectasis, chronic pyelo)

inflamm (RA, AS, chrohn's, reiter's, psorias)

neoplasm (hodgkin's, RCC)
whipple's disease - clinical features
rare multisystem disease, likely bacterial. SI joints, valves, CNS, jejunum
whipple's disease - radiographic features
small micronodules in jejunum
no dilatation
low attenuation, hyperechoic nodal masses in mesentery
sacroileitis
distal SB infections
yersinia, campy, salmonella, TB, amebiasis
carcinoid - clinical fetures
80% gi (60% appendix, 20% terminal ileum)

15% bronchial tree (90& central, 10% peripheral)

B - bronchospasm
F - flushing
D - diarrhea
R - R sided heart failure

foregut tumors produce little 5HIAA, mid and hingut produce more

carcinoid syndrome - rare
90% have liver mets
gi carcinoid - radiographic features
very vascular

strong desmoplastic reaction

stippled calcification
colonic polyp types
hyperplastic (40-60%)(old lit 90%)
adenomatous (50%)
hamartomatous
inflammatory
adenomatous polyp types
tubular (75%) - least malignant potential
tubulovillous (15%)
villous (10%) - most malignant potential
Gardner's syndrome - clinical features
FAP + osteomas, soft tissue tumors, and gastric hamartomas
Peutz Jeghers syndrome - clincial features
multiple gi hamartomas (except esophagus)
mucocutaneous pigmentations
Juvenile polyposis - clinical features
usually large solitary rectosigmoid polyp
Cowden disease
multiple gi hamartomas (including esophagus)
mucocutaneous pigmentation
skin lesions
other neoplasms
lhermite-duclos (cerbellar gangliocytoma)
turcot's syndrome
colonic adenomas + cns gliomas and medulloblastomas

autosomal recessive
all the colonic polyposis are autosomal dominant except _____ which is recessive and _______ which is not hereditary
Turcot's

Chronkite-Canada
Lynch syndrome - clinical features
hereditary non-polyposis coli

no polyps
80% lifetime risk colon ca
30-50% lifetime risk endometrial ca
bowel wall layers (inside to outside)
mucosa (epithelium, lamina propria, muscularis mucosa)
sub-mucosa
muscularis propria (T2 dark)
serosa
Colon ca TNM staging T
T1 mucosa/submucosa only
T2 invasion of muscularis propria
T3 invasion into subserosa
T4 invasion into adjacent structures
Colon ca TNM staging N
N1 1-3 pericolic nodes >5mm
N2 >3 pericolic nodes
N3 nodes along named vascular trunk
Appendiceal mucocele causes
mucinous cystadenocarcinoma (most common)
obstruced orifice
sigmoid volvulus - radiographic features
inverted U shape
left flank overlap sign
liver overlap sign
cecal volvulus - radiographic features
rotates toward midabdomen and LUQ
small bowel dilatation
liver segment changes in cirrhosis
shrunken right lobe (5,6,7,8) and medial left (4). lateral left (2,3) and caudate (1) appear larger as a result
fatty liver causes
obesity (most common)
alcohol
TPN
debilitation
chemotherapy
hepatitis
steroids, Cushings
CF
glycogen storage disease
toxins (CCl4, yellow phosphorous)
von Gierke's enzyme deficiency
glucose-6-phosphatase
gaucher's disease enzyme deficiency
glucocerbrosidase --> accumulation of ceramide in cells of RES
gaucher's disease - radiographic features
hepatomegaly
splenomegaly
splenic infarcts
erlenmyer flask deformity of femur
osteopenia
multiple lytic bone lesions
femoral head avn
hemosiderosis vs hemochromatosis
hemochromatosis - Fe accumulation in organs --> damage
hemosiderosis - Fe accumulation in organs - no damage
MR differentiation between hemochromatosis and hemosiderosis
pacnreas signal (dark in hemochromatosis, normal in hemosiderosis)
liver and spleen will be dark in both
echinococcus granulosus hosts
dog, cattle
echinococcus multilocularis
rodents
echinococcus pathogenesis
penetrate intestinal mucosa and disseminate to liver and lungs >> spleen, kidney, bone, CNS
e. granulosus - radiographic features
well-delineated cysts, large
daughter cysts within larger cysts - pathognomonic
cyst calcification
double-rim sign
waterlily sign
enhancement cyst wall
e. multilocularis - radiographic features
poorly marginated
infiltrative
punctate and dystrophic calcification
cystic primary liver tumors by age
infant - mesenchymal hamartoma
young - ebryonal cell sarcoma
adult - biliary cystadenoma/carcinoma
giant hemangioma defn
> 5cm
kasabach-merritt syndrome
sequestration of thrombocytes in hemangioma causing thrombocytopenia
FNH cell composition
hepatocytes
kupffer cells
bile ducts
hepatic adenoma cell composition
hepatocytes
very few kupffer cells (Tc99-SC cold)
no bile ducts (the presence of hepatocytes without bile ducts can make these lesions HIDA hot)
HCC risk factors
cirrhosis
hepatitis B
toxins (aflatoxin, OCP, thorotrast)
metabolic (storage disease, galactosemia)
HCC mets
lung > adrenal, LN > bone
portal hypertension defn
hepatic wedge pressure > 10 mmHg
portal hypertension causes
presinusoidal

PV thrombosis, compression
PVenule obstruction (fibrosis, PVC, myelofibrosis, Wilson's, sarcoid, malaria, schistosomiasis)

sinusoidal

chirrosis (most common)
sclerosing cholangitis

post-sinusoidal

budd-chiari
CHF
budd-chiari - clinical features
thrombosis of main hepatic veins, hepatic vein branches, or IVC
budd-chiari causes
idiopathic 50-75%
coagulation anomalies (clotting disorders, PRV)
tumors (HCC, RCC)
trauma
OCP, chemotherapy
variations of intrahepatic biliary anatomy
normal 60%
right posterior ducts drain directly into LHD 20%
right posterior and right anterior and LHD form CHD 10%
variations of papillary insertion
Y type 75%
V type 25%
U type 5%
location of HA relative to CBD
80%
HA between CBD and PV
HA medial to MPV
CBD lateral to PV

20%
HA anterior to CBD
HA posterior to PV
location of papilla
5% 1st part
35% prox 2nd part
55% dist 2nd part
5% 3rd part
gallstone types
cholersterol (precipitation of supersaturated bile) - western population F>M, old>young

pigment stones (precipitation of calcium bilirubinate) - asian population

mixed stones - most common
cholelithiasis predisposing factors
obesity
hemolytic anemia
abnormal enterohepatic circulation of bile salts (Crohn's, SB resection)
diabetes
cirrhosis
hyperparathyroidism
sludge cuases
fasting (30% at 10d, 100% at 6w)
hyperalimentation
infection, obstruction
mirizzi syndrome
impacted stone in cystic duct causes compression of CHD. can ultimely erode into the CHD or gut
acute cholecystitis causes
95% stones
5% acalculous
acute cholecystititis radiographic (US) features
distention (>4cm)
wall thickening (>5mm) usually worse on hepatic side
gallstones
+ murphy's sign
pericholecystic fluid
acute cholecystitis complications
gangrenous cholecystitis
emphysematous cholecystitis
empyema
chronic cholecystitis US findings
wall thickening
intramural epithelial crypts (R-A sinuses)
gallstones (95%)
failure to contract
acalculous cholecytitis causes
trauma
burn
prolonged fasting, hyperalimentation
diabetes
AIDS
other - colitis, hepatic arterial chemotherapy, postpartum, vascular insufficiency
xanthogranulomatous cholecystitis - clinical features
usually women 60-70y
presents like a cholecystitis
xanthogranulomatous cholecystitis - radiographic (US) features
gallstones
wall thickening
inflammatory changes in contiguous hepati parenchyma
difficult to distinguish from adenocarcinoma
oriental cholangiohepatitis causes
clonorchis sinensis and ascaris infections
oriental cholangiohepatitis - morphologic features
duct dilatation
strictures
intrahepatic calculi (may not be seen on CT)
oriental cholangiohepatitis - complications
abcess
portal vein occlusion --> atrophy
cholangiocarcinoma
pancreatic duct involvement
xanthogranulomatous cholecystitis - clinical features
usually women 60-70y
presents like a cholecystitis
xanthogranulomatous cholecystitis - radiographic (US) features
gallstones
wall thickening
inflammatory changes in contiguous hepati parenchyma
difficult to distinguish from adenocarcinoma
oriental cholangiohepatitis causes
clonorchis sinensis and ascaris infections
oriental cholangiohepatitis - morphologic features
duct dilatation
strictures
intrahepatic calculi (may not be seen on CT)
oriental cholangiohepatitis - complications
abcess
portal vein occlusion --> atrophy
cholangiocarcinoma
pancreatic duct involvement
sclerosing cholangitis - clinical features
inflammatory process
20% intrahepatic bile ducts
80% extrahepatic bile ducts

more common in males
sclerosing cholangitis - types
primary (idiopathic)
secondary (IBD, cirrhosis, RPF, pancreatitis)
sclerosing cholangitis - radiographic features
string of beads appearance
sclerosing cholangitis - complications
cholangiocarcinoma
biliary chirrhosis
portal hypertension
hyperplastic cholecytoses - groups
adenomyomatosis
cholesterolosis
GB adenomyomatosis - radiographic features
large R-A sinuses (diffuse or focal)
hypoechoic if bile filled
hyperechoic if sludge or calculi
comet-tail
wall thickening
hypercontractability
cholesterolosis - radiographic features
punctate hyperechoic lipid deposits in wall
no shadow, occ ring down
can be associated with small polyps