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112 Cards in this Set
- Front
- Back
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normal esophageal contour deformities
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cricopharyngeus
postcricoid impression aortic impression left mainstem bronchus left atrium diaphragm |
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primary peristaltic contraction
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initiated by swallowing
propulsive wave |
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secondary peristaltic contraction
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locally intitiated
propulsive wave |
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tertiary peristaltic contraction
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uncoordinated, nonpropulsive wave
increase with age only activity seen in achalasia |
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difference between esophageal web and post-cricoid impression
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web - usually anterior
post-cricoid impression - posterior |
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Plummer - Vinson Syndrome (4 features)
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1. Upper esophageal (cervical) web
2. Fe deficiency 3. Cheiliosis (fissured lips) 4. Koilonychia (spoon nails) Increase risk of hypopharyngeal ca. |
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Zenker's diverticulum position
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Killian's dehiscence (above cricopharyngeus)
mildline posterior |
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Killian-Jamieson diverticulum position
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below cricopharngeus
off midline |
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Esophagitis causes
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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) |
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herpes esophagitis ulcer size
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< 5 mm
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cmv esophagitis ulcer size
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> 2 cm
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hiv esophagitis ulcer size
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> 2 cm
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candida esophagitis ulcer morphology
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plaquelike, reticular
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achalasia causes
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primary (idiopathic)
secondary adenoca mets chagas' disease |
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achalasia complications
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recurrent aspirations
esophageal carcinoma |
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chagas disease findings
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esophagus - achalasia
megacolon, sigmoid volvulus, megastomach, megaduodenum cardiomyopathy encephalitis |
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benign esophageal neoplasms
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leimyoma 50%
fibrovascular polyp 25% cysts 10% papilloma 3% fibroma 3% hemangioma 2% |
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malignant esophageal neoplasms
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SCC 50-70%
adenoca 30-50% lymphoma leiomyosarcoma mets |
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esophageal SCC associations
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head and neck ca
smoking alcohol achalasia lye ingestion |
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benign gastric ulcers
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PUD 90%
NSAIDs steroids hormonal (stress, burns, head injury, hyperPT) gastritis |
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malignant gastric ulcers
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carcinoma 90%
lymphoma 5% sarcoma, carcinoid, mets |
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menetrier's disease - clinical features
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hypertrophic gastritis with protein losing enteropathy
clinical triad: achlorhydria, hypoproteinemia, edema middle aged men |
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menetrier's disease - radiographic features
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giant proximal rugal folds
hypersecretion (poor Ba coating) gastric wall thickening small bowel thickening (due to hypoproteinemia) peptic ulcers are uncommon |
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eosinophilic gastroenteritis - clincial features
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inflammatory
suspected allergic abdo pain, diarrhea, eosinophilia |
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eosinophilic gastroenteritis - radiographic features
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esophageal strictures
antral stenosis pyloric stenosis gastric fold thickening SB fold thickening SB dilatation stenosis |
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zollinger-ellison syndrome - clinical features
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excessive gastrin production
diarrhea, PUD, pain gastrinoma 90% antral G cell hyperplasia 10% |
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zollinger-ellison syndrome - radiographic features
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ulcers: bulb>stomach>post-bulbar
multiple ulcers 10% thickened folds (S+D) increased secretions reflux |
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gastric polyps - clinical features
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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 |
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gastric carcinoma risk factors
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pernicious anemia
adenomatous polyps chronic atrophic gastritis billroth 2 > billroth 2 |
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gastric carcinoma staging
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T1 limited to mucosa,submucosa
T2 muscle,serosa involved T3 through serosa T4 adjacent organs |
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gastric lymphoma - clinical features
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NHL >>> hodkins
primary 10% (h. pylori associated maltoma) secondary 90% |
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hematogenous mets to stomach
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melanoma
breast lung |
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carney's triad
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gastric leiomyosarcoma
extra-adrenal paraganglioma pulmonary chondroma |
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billroth I procedure
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gastroduodenostomy
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billroth II procedure
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gastrojejunostomy (isoperistaltic, antiperistaltic, roux en y)
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sprue radiographic features
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sb dilatation (most typical feature)
nodular changes in duodenum jejunal and ileal fold pattern reversal segmentation, moulage, flocculation |
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sprue associated disorders
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dermatitis herpetiformis
selective IgA deficiency hyposplenism adenopathy cavitary mesenteric lymph node syndrome |
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mastocytosis - clinical features
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mast cell proliferation in RES and skin with histamine release. diarrhea, steatorrhea, hitamine effects
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systemic amyloidosis associated diseases
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infectious (TB, chronic osteomyelitis, decubitus ulcers, bronchiectasis, chronic pyelo)
inflamm (RA, AS, chrohn's, reiter's, psorias) neoplasm (hodgkin's, RCC) |
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whipple's disease - clinical features
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rare multisystem disease, likely bacterial. SI joints, valves, CNS, jejunum
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whipple's disease - radiographic features
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small micronodules in jejunum
no dilatation low attenuation, hyperechoic nodal masses in mesentery sacroileitis |
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distal SB infections
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yersinia, campy, salmonella, TB, amebiasis
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carcinoid - clinical fetures
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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 |
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gi carcinoid - radiographic features
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very vascular
strong desmoplastic reaction stippled calcification |
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colonic polyp types
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hyperplastic (40-60%)(old lit 90%)
adenomatous (50%) hamartomatous inflammatory |
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adenomatous polyp types
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tubular (75%) - least malignant potential
tubulovillous (15%) villous (10%) - most malignant potential |
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Gardner's syndrome - clinical features
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FAP + osteomas, soft tissue tumors, and gastric hamartomas
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Peutz Jeghers syndrome - clincial features
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multiple gi hamartomas (except esophagus)
mucocutaneous pigmentations |
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Juvenile polyposis - clinical features
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usually large solitary rectosigmoid polyp
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Cowden disease
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multiple gi hamartomas (including esophagus)
mucocutaneous pigmentation skin lesions other neoplasms lhermite-duclos (cerbellar gangliocytoma) |
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turcot's syndrome
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colonic adenomas + cns gliomas and medulloblastomas
autosomal recessive |
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all the colonic polyposis are autosomal dominant except _____ which is recessive and _______ which is not hereditary
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Turcot's
Chronkite-Canada |
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Lynch syndrome - clinical features
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hereditary non-polyposis coli
no polyps 80% lifetime risk colon ca 30-50% lifetime risk endometrial ca |
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bowel wall layers (inside to outside)
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mucosa (epithelium, lamina propria, muscularis mucosa)
sub-mucosa muscularis propria (T2 dark) serosa |
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Colon ca TNM staging T
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T1 mucosa/submucosa only
T2 invasion of muscularis propria T3 invasion into subserosa T4 invasion into adjacent structures |
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Colon ca TNM staging N
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N1 1-3 pericolic nodes >5mm
N2 >3 pericolic nodes N3 nodes along named vascular trunk |
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Appendiceal mucocele causes
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mucinous cystadenocarcinoma (most common)
obstruced orifice |
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sigmoid volvulus - radiographic features
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inverted U shape
left flank overlap sign liver overlap sign |
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cecal volvulus - radiographic features
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rotates toward midabdomen and LUQ
small bowel dilatation |
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liver segment changes in cirrhosis
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shrunken right lobe (5,6,7,8) and medial left (4). lateral left (2,3) and caudate (1) appear larger as a result
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fatty liver causes
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obesity (most common)
alcohol TPN debilitation chemotherapy hepatitis steroids, Cushings CF glycogen storage disease toxins (CCl4, yellow phosphorous) |
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von Gierke's enzyme deficiency
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glucose-6-phosphatase
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gaucher's disease enzyme deficiency
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glucocerbrosidase --> accumulation of ceramide in cells of RES
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gaucher's disease - radiographic features
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hepatomegaly
splenomegaly splenic infarcts erlenmyer flask deformity of femur osteopenia multiple lytic bone lesions femoral head avn |
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hemosiderosis vs hemochromatosis
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hemochromatosis - Fe accumulation in organs --> damage
hemosiderosis - Fe accumulation in organs - no damage |
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MR differentiation between hemochromatosis and hemosiderosis
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pacnreas signal (dark in hemochromatosis, normal in hemosiderosis)
liver and spleen will be dark in both |
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echinococcus granulosus hosts
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dog, cattle
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echinococcus multilocularis
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rodents
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echinococcus pathogenesis
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penetrate intestinal mucosa and disseminate to liver and lungs >> spleen, kidney, bone, CNS
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e. granulosus - radiographic features
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well-delineated cysts, large
daughter cysts within larger cysts - pathognomonic cyst calcification double-rim sign waterlily sign enhancement cyst wall |
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e. multilocularis - radiographic features
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poorly marginated
infiltrative punctate and dystrophic calcification |
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cystic primary liver tumors by age
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infant - mesenchymal hamartoma
young - ebryonal cell sarcoma adult - biliary cystadenoma/carcinoma |
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giant hemangioma defn
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> 5cm
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kasabach-merritt syndrome
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sequestration of thrombocytes in hemangioma causing thrombocytopenia
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FNH cell composition
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hepatocytes
kupffer cells bile ducts |
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hepatic adenoma cell composition
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hepatocytes
very few kupffer cells (Tc99-SC cold) no bile ducts (the presence of hepatocytes without bile ducts can make these lesions HIDA hot) |
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HCC risk factors
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cirrhosis
hepatitis B toxins (aflatoxin, OCP, thorotrast) metabolic (storage disease, galactosemia) |
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HCC mets
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lung > adrenal, LN > bone
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portal hypertension defn
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hepatic wedge pressure > 10 mmHg
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portal hypertension causes
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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 |
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budd-chiari - clinical features
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thrombosis of main hepatic veins, hepatic vein branches, or IVC
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budd-chiari causes
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idiopathic 50-75%
coagulation anomalies (clotting disorders, PRV) tumors (HCC, RCC) trauma OCP, chemotherapy |
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variations of intrahepatic biliary anatomy
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normal 60%
right posterior ducts drain directly into LHD 20% right posterior and right anterior and LHD form CHD 10% |
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variations of papillary insertion
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Y type 75%
V type 25% U type 5% |
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location of HA relative to CBD
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80%
HA between CBD and PV HA medial to MPV CBD lateral to PV 20% HA anterior to CBD HA posterior to PV |
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location of papilla
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5% 1st part
35% prox 2nd part 55% dist 2nd part 5% 3rd part |
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gallstone types
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cholersterol (precipitation of supersaturated bile) - western population F>M, old>young
pigment stones (precipitation of calcium bilirubinate) - asian population mixed stones - most common |
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cholelithiasis predisposing factors
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obesity
hemolytic anemia abnormal enterohepatic circulation of bile salts (Crohn's, SB resection) diabetes cirrhosis hyperparathyroidism |
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sludge cuases
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fasting (30% at 10d, 100% at 6w)
hyperalimentation infection, obstruction |
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mirizzi syndrome
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impacted stone in cystic duct causes compression of CHD. can ultimely erode into the CHD or gut
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acute cholecystitis causes
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95% stones
5% acalculous |
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acute cholecystititis radiographic (US) features
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distention (>4cm)
wall thickening (>5mm) usually worse on hepatic side gallstones + murphy's sign pericholecystic fluid |
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acute cholecystitis complications
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gangrenous cholecystitis
emphysematous cholecystitis empyema |
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chronic cholecystitis US findings
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wall thickening
intramural epithelial crypts (R-A sinuses) gallstones (95%) failure to contract |
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acalculous cholecytitis causes
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trauma
burn prolonged fasting, hyperalimentation diabetes AIDS other - colitis, hepatic arterial chemotherapy, postpartum, vascular insufficiency |
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xanthogranulomatous cholecystitis - clinical features
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usually women 60-70y
presents like a cholecystitis |
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xanthogranulomatous cholecystitis - radiographic (US) features
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gallstones
wall thickening inflammatory changes in contiguous hepati parenchyma difficult to distinguish from adenocarcinoma |
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oriental cholangiohepatitis causes
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clonorchis sinensis and ascaris infections
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oriental cholangiohepatitis - morphologic features
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duct dilatation
strictures intrahepatic calculi (may not be seen on CT) |
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oriental cholangiohepatitis - complications
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abcess
portal vein occlusion --> atrophy cholangiocarcinoma pancreatic duct involvement |
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xanthogranulomatous cholecystitis - clinical features
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usually women 60-70y
presents like a cholecystitis |
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xanthogranulomatous cholecystitis - radiographic (US) features
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gallstones
wall thickening inflammatory changes in contiguous hepati parenchyma difficult to distinguish from adenocarcinoma |
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oriental cholangiohepatitis causes
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clonorchis sinensis and ascaris infections
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oriental cholangiohepatitis - morphologic features
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duct dilatation
strictures intrahepatic calculi (may not be seen on CT) |
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oriental cholangiohepatitis - complications
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abcess
portal vein occlusion --> atrophy cholangiocarcinoma pancreatic duct involvement |
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sclerosing cholangitis - clinical features
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inflammatory process
20% intrahepatic bile ducts 80% extrahepatic bile ducts more common in males |
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sclerosing cholangitis - types
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primary (idiopathic)
secondary (IBD, cirrhosis, RPF, pancreatitis) |
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sclerosing cholangitis - radiographic features
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string of beads appearance
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sclerosing cholangitis - complications
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cholangiocarcinoma
biliary chirrhosis portal hypertension |
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hyperplastic cholecytoses - groups
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adenomyomatosis
cholesterolosis |
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GB adenomyomatosis - radiographic features
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large R-A sinuses (diffuse or focal)
hypoechoic if bile filled hyperechoic if sludge or calculi comet-tail wall thickening hypercontractability |
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cholesterolosis - radiographic features
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punctate hyperechoic lipid deposits in wall
no shadow, occ ring down can be associated with small polyps |
