GI - G.K.
Terms
undefined, object
copy deck
- 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 - 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