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127 Cards in this Set
- Front
- Back
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What is the cause of barretts esophagus
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columnar metaplasia of esophageal epithelium
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What percent of pt with reflux get barretts
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10 %
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Is barretts a major risk factor for adenocarcinoma
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yes
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What are the radiographic findings of barretts esophagus
4 |
nodularity, ulceration, focal strictures, reticular mucosal pattern.
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What location in the esophagus does barretts occur
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proximal or mid
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What population commonly gets candida esophagus
3 |
immunocompromised (AIDS)
achalasia scleroderma |
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What are the early findings of candida esophagus
1 |
mucosal nodules in longitudinal columns
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What are the late findings of candida esophagus
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shaggy esophagus
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What is the ddx of candida esophagus
5 |
herpes esophagus
glycogenic acanthosis reflux esophagitis superfi spreading squamous cancer papillomatosis |
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What are the typical findings in herpes esophagus
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Multiple, small, discrete, punched-out ulcers on background of normal mucosa
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Describe the findings in glycogenic acanthosis compared to candidiasis
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Numerous small nodules or plaques; less well-defined than candidiasis
Localized or diffuse; asymptomatic |
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What is the cause of downhill varies
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SVC obstructions with collaterals through the azygous
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What should be done if there are downhill varices
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order a CT or CXR to look for SVC syndrome.
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How is down hill varicies diffferentiated from up hill
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down hill will occur in the proximal half and uphill occur in the distal 1/2
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What is the DDX of downhill varicies
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varcoid CA and lymphoma
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What is a characteristic of varicies that helps to differentiate from other pathology
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it will change in size and shape.
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What is the DDX of a esophageal stricture
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infection (TB and Candida)
Inflammation (reflux, barrett, caustic, NG, radiation, Crohns,blistering skin) Neoplasm (Mets, Lymphoma, SCC) |
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Where do inflammatory esophagogastric polyps occur
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GE jxn
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What are the best clue of a esophagogastric polyp
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Best clue: Smooth, ovoid protuberance and "sentinel fold" on barium esophagram in patient with history of acid-reflux disease
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Do you need endoscopy if a lesion is classic for a esophagogastric polyp
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no, but if if has lobulation then you need to get biopsy bc you cant tell the difference btwn adenomatous polyp and adenocarcinoma
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What is the ddx of inflammatory esophagogastric polyp
3 |
adenoma, papilloma, varicies
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Do the ulcers of HIV esophagitis cause large or small ulcers
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large
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What is the ddx for a large esophageal ulcer
3 |
cmv, hiv and medication induced
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What happens the distensibility of the gastric antrum in antral gastritis
2 |
non-distensible, thickened folds
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What is the ddx of thickened gastric folds
5 |
LAMAZE:
Lymphoma Adenocarcinoma Menetriers Zollinger Ellison Eosiniophillic gastritis |
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Name 5 causes of gastritis
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hypertrophic, alcoholic, infectious (H.pylori), eosinophilic
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What is the cause of menetriers
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unknown
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What portion of the stomach is predominately involved
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proximal and antral sparring
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What is the pathophysiology of menetriers
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low gastric acid and protein losing enteropathy leading to hypoproteinemia
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What are 3 SS of menetriers
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pain, anorexia and weightloss
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What are the findings in an UGI in a pt with ZES
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markedly thickened folds of the stomach, doudenum and jejunum.
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What is the cause of ZES
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gastrinoma
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What does a gastrinoma look like on CECT
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small hypervascular mass in the pancreatic head
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How does pancreatitis cause gastric varicies
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splenic vein thrombosis leading to portal HTN
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What is the pathway of the blood leading to the gastric varicies
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portal vein htn backs into the coronary (left gastric vein) to short gastrics.
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What are findings of linitus plastica on a double contrast UGI
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narrowing and scalloping of borders
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What is the MCC of linitis plastica
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scirrhous gastric adenoCA
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What is the DDX of linitis plastica
(GRAM) |
GRAM STAIN
Granulomatous infection (TB)/Crohn’s/Lymphoma Radiation Adenocarcinoma Metastasis-breast |
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What should be done if a biopsy of linitis plastica comes back gastritis
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do a transmural bx
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What are the findings of crohns dz on upper GI
3 |
fistula, cobblestone,string sign,
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Do you see psoas abscess in crohns dz
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yes
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What is the ddx of TI dz
4 |
crohn, infection (TB, yersina), neoplasm, abscess, (appendicitis)
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What are the neoplastic causes of TI dz
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lymphoma, mets, carcinoid
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What are some findings of carcinoid in the mesentery on UGI
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SB angulation, kinding, tethering
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What is the ddx of mesenteric tumor 8
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carcinoid, intraperitoneal mets, radiation, retractile mesenteritis, peritonitis, mesenteric desmoid, endometriosis, peritonea mesothelioma
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What may cause tetering on UGI in a young women
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endometriosis
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What is the criteria of measurement of SB fold thickening
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greater than 3mm
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What is the ddx of irregular sb fold thickening
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Irregular Thickening
MALE COW MAI Amyloid Lymphoma Eosinophillic Gastroenteritis Crohn’s Other-Giardiasis Whipple |
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What is the ddx of doudenal fold thickening
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PAD LOCZS
PAncreatitis Duodenitis-ETOH/meds LymphOma Cystic Fibrosis/Crohn’s Zollinger Ellison Sprue/strongyloides |
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What are 6 causes of intramural hemorrhage
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anticoagulation, hemophilia, hsp, itp, trauma, vasculitis
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What is the ddx of TI disease and narrowing of the cecum
4 |
crohn
tb adjacent inflammaton (app, diver) neoplasm (adenoCA, mets, lymphoma) |
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Describe the findings of lymphoid hyperplasia found in a child
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small nodules (3mm) often have a central dimple that fills with barium
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What are the most common locations of lymphoid hyperplasia
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ileocecal region and rectum
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What is the ddx of small nodules in TI region in an adult
3 |
giardiasis, IBD, hypogammaglobunemia
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What is the most common location of a microcystic (serous) csytadenoma
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head
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What is the MC location for a mucinous cystic neoplasm
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tail
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What is potential malignant; microcystic (serous) or mucinous
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mucinous
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What is the ddx of a cystic pancreatic lesion
5 |
pseudocyst
mucinous cystadenoma microcystic (serous) cystadenoma IPMT cystic islet cell tumor |
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What are the characteristics of mucinous cystic neoplasm
4 |
usually greater than 2 cm, 15% have calcification in wall, potentially malignant
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What demographic typicaly gets mucinous cystic neoplasm
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elderly female
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What is the treatment of mucinous cystic neoplasm
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resection
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What are the characteristics of a microcystic (serous) neoplasm
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33% with amorphous central ca, not premalignant, usually in the head
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Do elderly females typicaly get microcrocystic cystadenoma
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yes both mucinous and microcytic get these most commonly
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What is a macrocystic and oligocytic cystadenoma a variant of
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microcystic
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What is macrocystic and oligocystic cystadenoma
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these are variants of microcystic that mimic mucinous but the location is in the head of the pancreas, has a lobulated contour and lacks wall enhancement.
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Does a pseudocyst capsule enhance
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yes
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Should a psuedocyst be considered in the ddx of medistinal cystic lesions
What is the ddx of regular ' picket fence' SB fold thickening |
yes
Regular Thickened “Picket Fence” HEMORRHAGE HSP Anticoagulation EDEMA CHF Hypoproteinemia OTHER Lymphoma Lymphagectasia Radiation |
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Can a psuedocyst fistulize with adjacent organs
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yes, such as the stomach. YOu will see contrast enter the pseudocyst
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Besides the pancreas where do pseudocyst occur
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the spleen (subcapsular), medistinum
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Can a pseudocyst be hemorrhagic
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yes, it will contain higher attenuation fluid
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What is the ddx for a pancreatic cyst
4 |
pseudocyst
abscess aneurysm congenital neoplasm |
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What are some neoplasms that are cystic
4 |
mucinous
serous Intraductal papillary mucinous tumor cystic islet cell |
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What is a ipmt
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cystic dilation of branch of the pancreatic ducts in the head or uncinate
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What is the appearance of the pancreas in CF on ct
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fatty replacement
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What is the ddx of fatty replacement of the pancreas
4 |
shwachman-diamond syndrome
CF Old age chronic pancreatis |
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What is shwachman-diamond syndrome
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Shwachman-Diamond syndrome (SDS) is a rare autosomal recessive disorder characterized by exocrine pancreatic insufficiency, bone marrow dysfunction, leukemia predisposition, and skeletal abnormalities. In 1964, Shwachman, Diamond, Oski, and Knaw first reported the syndrome in a group of 5 children participating in a cystic fibrosis (CF) clinic at Harvard Medical School. Shwachman-Diamond syndrome is the second most common cause of inherited pancreatic insufficiency after cystic fibrosis and the third most common inherited bone marrow failure syndrome after Fanconi anemia and Blackfan-Diamond anemia. In most cases, Shwachman-Diamond syndrome is associated with mutations in the Shwachman-Bodian-Diamond syndrome (SBDS) gene located on chromosome 7.
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What are findings of chronic pancreatitis
3 |
fatty replacement
dilated duct calcs |
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Where do 75% of benign gastric ulcers occur
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the lesser curve
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When to the folds go to the crater edge; benign or malignant gastric ulcers
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benign
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What is the contour of a benign and malignant gastric ulcer
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benign-round or linear
malignant-irregular |
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What does the ulcer collar look like in a benign gastric ulcer
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well defined
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Do benign gastric ulcers alway have a collar
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yes
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Do malignant gastric ulcers have a collar
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not always and if they do it will be shaggy and irregular
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If there are multiple ulcers if it more likely benign or malignant
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benign
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What has a higher association with doudenal disease; benign or malignant doudenal ulcers
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benign
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When is carman sign present
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malignant gastric ulcers
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When is the crescent sign present
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benign
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What is a diagnostic way to determine if an ulcer is benign or malignant
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treatment and if it decreases in size then it is benign.
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When is hamtons line seen
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benign gastric ulcers
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Describe a hamptons line
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thin straight line at the neck of the ulcer in profile (from the side) view which represents the thin rim of undermined gastric mucosa
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Do you expect a benign appearing stomach ulcer to project benign the expected confines of the stomach wall
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yes
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What creates a carman meniscus
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Created by a large, flat ulcer with heaped-up edges
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What are the findings in a carman meniscus
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Edges trap a lenticular (biconvex) barium collection that is convex relative to the lumen when the edges are folded upon themselves during compression
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Name the benign gastric ulcer findings
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Ulcer crater-collection of barium on dependent surface which usually projects beyond anticipated wall of stomach in profile (penetration)
• Hampton’s line-1 mm thin straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa • Ulcer collar-smooth, thick, lucent band at neck of ulcer in profile view representing thicker rim of edematous gastric wall • Ulcer mound-smooth, sharply delineated tissue mass surrounding a benign ulcer • Ring shadow-thin rim of contrast which represents an ulcer on the non-dependent surface of an air-contrast study |
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Describe a carmen meniscus
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carman-Kirkland meniscus complex (lesser curvature antrum or body)
Broad, flat lesion; central ulceration, elevated margins Prone compression view (mass on anterior wall): Radiolucent halo filling defect due to elevated edges; meniscoid ulcer-convex inner border, concave outer border. |
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Can aspirin cause multiple gastric ulcers
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yes
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Describe the findings in erosive gastritis
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shallow defects in the mucosal layer of the stomach that do not penetrate beyond the muscularis mucosa
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What are 3 categories of causes of erosive gastritis
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peptic
crohn infectious |
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What are the peptic causes of erosive gastritis
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nsaids
alcohol burns steroids stress |
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What are the infectious causes of erosive gastritis
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cmv, herpes, candida
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What are the causes of apthous ulcers
6 |
crohn (mc)
viral ishcemia behcet amebiasis salmonellosis |
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What is the cause of gallstone ileus
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GS erodes gb into bowel and becomes impacted at the TI
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What are the findings in GS ileus
3 |
SBO, GS in RLQ, pneumobilia
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What is the ddx of sacculation of the antimesenteric side of the SB
2 |
crohn, scleroderma
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What is the cause gi abnormalities of scleroderma
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abnormal collagen deposition in bowel wall
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What are the findings of scleroderma in the GI
3 |
hidebound bowel (closely packed valvulae connivente)
sacculations in the antimesenteric side dilated, atonic doudenum proximal to the aorticomesenteric angle |
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What is the appearance of hidebound bowl
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dilated bowel, but despite being dilated the folds are close together. (>5/inch)
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What is the appearance of the abnormal doudenum in scleroderma
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Dilated, atonic duodenum proximal to the aorticomesenteric angle
pseudo SMA syndrome |
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What are the findings of SMA syndrome
2 |
dilated bowel proximal to the SMA
active peristalisis |
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What is a major cause of bowel PV gas and gas in the wall of bowel
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bowel infarction
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What are 10 causes of air in bowel wall. (pneumatosis intestinalis)
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NEC,
bowel infarction pseudomembranaous colitis, IBD infection steroid uses scleroderma SLE dermatomyositis obstruction trauma BE |
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Where is the bowel wall does pneumatosis intestinalis occur
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air in the subserosa and submucosa of the bowel
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can air end up in the bowel wall as a normal process
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Can also be primary, which is a benign condition, and usually has rounded (submucosal) rather than linear (subserosal) gas collections
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Where in the liver does PV gas tend to collect
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peripheral
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What is the most common cause of PV gas
adult and kids |
NEC in kids
bowel infarct in adults |
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What is the ddx of PV gas
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penetrating ulcer
acute gastric or intestinal distension IBD iatrogenic (recent BE, endoscopy) umbilical venous catheters |
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What should be suspected in an Older patient with history of cardiac disease who presents with sudden dramatic onset of severe abdominal pain accompanied by diarrhea
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sma embolism
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What is pneumatosis cystoides coli
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intramural air within the colon
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What are the associations of pneumatosis cystoides coli
4 |
collagen vascular disorders, ischemia,
diabetes h/o trauma |
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Describe the findings in pneumatosis cystoides coli
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radiolucent collections of gas within the bowel wall, often rounded and grapelike
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can pneumatosis cystoides coli be discovered incidentaly
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yes, it often is
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Describe two classic findings in celiac disease
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moulage pattern
jejunal/ilial reversal |
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What is the cause of celiac dz
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sensitivity to gluten
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What are 3 clinical presenting SS of celiacs
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Malabsorption, steatorrhea, diarrhea
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What neoplasms occur with increased frequency in celiac pt
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lymphoma and adenocarcinoma
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What are 4 radiographic findings in celiac dz
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-Small bowel dilation
-↑ Secretions w/dilution or flocculation of barium -Decreased folds (< 3/in) in the jejunum and increased folds (> 5/in) in the ileum -Transient small bowel intussusceptions |
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DDX of small bowel dilation WITHOUT fold thickening
4 |
-Mechanical obstruction
-Paralytic ileus -Scleroderma (hidebound appearnce) -Sprue (celiac disease) |
