1
Q
most common primary for oesophageal mets
A
breast primary
2
Q
Plummer-Vinson syndrome
A
dysphagia, iron deficiency anaemia, oesophageal webs
stomatitis
glossitis
thyroid disorders
spoon-shaped nails.
An oesophageal web is usually seen near the cricopharyngeus and arises from the anterior oesophageal wall
3
Q
schatzki ring
A
distal structure/lower oesophagus
aka b ring
associated with hiatus hernia or reflux
fluoro is more sensitive than endoscopy as you can see the whole narrowing from outside
4
Q
absolute contraindication to cholecystogram
A
liver disease
liver cannot process the bile
5
Q
multiple small (<1 cm) punctate or linear ulcers with surrounding radiolucent halo of odema
Mid-3rd oesophagus
A
herpes oesophagitis
herpes halos!
6
Q
longitudinally orientated linear or irregular plaque-like lesions separated by normal mucosa and small (<1 cm) punctuate, round, or oval ulcers.
or shaggy plaques
A
candida oesophagitis
7
Q
giant ulcers
2cm
mid
A
CMV/HIV
8
Q
upper/mid
multiple small nodules 2-10mm
A
Glycogenic acanthosis
9
Q
megaoesophagus
absent primary peristalsis
nonperistaltic contractions
A
primary achalasia
10
Q
causes of oesophageal intramural pseudodiverticulosis
A
diabetes
alcohol
reflux
11
Q
causes of secondary achalasia
A
stroke
malignancy
submucosal gastric cancer/lymphoma
12
Q
narrow tubular stomach and a reduction in the normal
gastric folds.
A
atrophic gastritis
13
Q
densities of blood
A
Serum: 0-20 HU
Fresh unclotted blood: 30-45 HU
Clotted blood: 60-100 HU
Active arterial extravasation >180HU (on enhanced scan).
14
Q
features of crohns
A
aphthoid ulcers
erosions
cobblestone mucosa
thickened duodenal folds
15
Q
mural thickening, irregularity, reduced distensibility and absent peristalsis are features of?
A
linitis plastica
most common cause is Scirrhous cancer
16
Q
whipples bowel
A
diffuse 1-2 mm micronodules (“sand-like nodules”) in the jejunum
thickened mucosal folds: especially the jejunum
small bowel calibre: normal or slightly dilated
Low density LNs
17
Q
small bowel lymphoma
A
wall thickened to 1-7cm
18
Q
characteristic feature of TB small bowel
A
Ulcers with elevated margins following orientation of lymphoid follicles
19
Q
SMA supplies
A
up to the splenic flexure
20
Q
ampullary tumours associated with
A
Familial adenomatous polyposis
100’s of polyps
all get ca by age 40 - needs colectomy
21
Q
autosomal dominant
broad based GI polyps
intususseption
cancer of
breast cervix ovaries
pancreas lungs testes
mucocutaneous melanin pigmentation involving the mouth, fingers and toes
A
Peutz Jeghers
22
Q
colonic polyp/cancer
brain tumours (GBM, medulloblastoma)
A
Turcot syndrome
23
Q
FAP
small bowel adenomas
osteomas
epidermal cysts
mesenteric desmoid
soft tissue tumours
periampullary carcinomas
A
Gardner
24
Q
Lhermitte-Duclos disease
thyroid goitres
intellectual disability
fibroadenoma breast
uterine fibroid
skin lesions - palmoplantar keratoses
rectosigmoid polyps - none in the SB
A
Cowden disease
25
pseudomembranous colitis
is c diff colitis
mucosal disease
minimal fat stranding
bowel wall thickening with ascites
involves the whole colon
26
Haemochromatosis on MRI
T2 dark
27
hepatobiliary contrast taken up by
FNH
28
causes of dense liver on CT
haemochromatosis,
haemosiderosis,
iron overload,
glycogen storage disease,
amiodarone treatment (contains iron)
Wilsons (contains copper)
29
Schistosomiasis
blood flukeworm
africa
eggs into portal veins = fibrosis
thick calcified septa
30
mets to spleen
malignant melanoma
31
brightness on MRI of liver spleen
T1 liver > spleen > muscle
T2 spleen > liver
32
HIV with splenic abscess
Fungal
candida, aspergillus, cryptococcus
spreads haematogeneously
33
bile leak after cholecystectomy
injury to duct of luschka
34
biliary enteric fistula
shrunken gallbladder mimicking
a diverticulum of the duodenal bulb
35
dilated intrahepatic ducts
caudate hypertrophy
sjogrens
RA
primary biliary cirrhosis
36
most accurate for staging an ampullary tumour
EUS
37
VHL
Serous cystadenoma of the pancreas
38
post pancreas transplant
difficult to delineate the margins of the gland
acoustic inhomogeneity
dilated pancreatic duct
acute rejection
39
reflux
pancreatic tumour
gastronome cousin Zollinger Ellison
40
CI to glucagon
phaeochromocytoma
insulinoma
glucagonoma
anything which already makes glucose high or low
41
CI to buscopan
Myasthenia gravis - worsens weakness
prostatic enlargement - urinary retention
pyloric stenosis - worsens emptying
42
scarring from reflux oesophagitis
Fixed transverse folds with stepladder appearance of distal oesophagus
43
anterior indentation at C5
cricoid impression
44
octreotide scan
carcinoid
45
small bowel leiomyoma
hypo echoic mass
most common cause of SI bleeding
ulcerated surface bleeds
carcinoids only 1.5% of GI ca and mostly in appendix
46
Linear ulcers on mesenteric border
crohns disease
47
double tracking bowel ulcers
UC
48
hydrostatic reduction
3 attempts
3 mins
3 mins apart
49
carcinoid location
jejunoileal
50
rectal involvement?
UC 95%
crohns 50%
51
reasons for false +ve pertechnetate scan for meckels
ectopic gastric
mucosa
enteric duplication
Barrett's oesophagus
arteriovenous malformations
haemangiomata
hypervascular tumour, aneurysm, duodenal ulcer, ulcerative colitis, Crohn's disease, appendicitis,
intussusception, bowel obstruction and urinary tract obstruction.
all affects blood flow, inflammation or transit
52
false negative for meckels scan
Ileal rotation
haemorrhage
rapid bowel transit
tc99m can't get there or gets out too quick
53
low grade GI bleed
aortic stenosis
caecum/ascending colon
angiodysplasia
54
Lynch
hereditary nonpolyposis colorectal cancer syndrome
Lynch 1 - no extra colonic malignancies
Lynch 2 - TCC
55
most common site of enterocolic fistula
ileocaecal
56
Amoebic abscess
right lobe liver
chocolate sauce
Entamoeba histolytica
57
Thalassaemia
autosomal recessive haemoglobinopathy
Mediterranean region
HS megaly
microcytic anaemia
gallstones
58
splenic angiosarcoma
low t1 and low t2 due to bleeding
59
risk factors for gallbladder cancer
increased body mass
female gender
post-menopausal status
cigarette smoking
60
causes of sludge
chronic fasting, total parental nutrition, critical illness, ceftriaxone therapy and pregnancy.
61
choledochocele
Dilatation of the distal intramural portion of the common bile duct that protrudes in the
duodenum
62
ascending cholangitis
e.coli
63
anastamoses in a whipples CGP
choledochojejunostomy
gastrojejunostomy
pancreaticojejunostomy.
64
serous pancreas
grandmother
>6 cysts
hypervascular
glycogen
amorphous calc
central scar
serous smaller brighter
65
mucinous pancreatic
larger
rim calc
mucin content
66
Deep fissures and large shallow
linear/stellate ulcers with elevated margins are characteristic.
intestinal TB
67
most common appearance of an inflammatory polyp at GOJ
Polypoid protuberance arising near cardia
68
chagas
South America
Chagas disease characteristically involves diffuse oesophageal dilatation, megacolon and
cardiomegaly.
69
Zenker
Zenker is above but behind
above cricopharynxgeus
posterior midline of oesophagus
C5 C6
at Killian's dehiscence
pulsion diverticulum, pseudo diverticulum
70
epiphrenic diverticulum
below LES, above diaphragm
pulsion diverticulum from pressure
associated with hiatus hernia
usually right lateral wall of oesophagus
71
R
72
Killian Jamieson
Killian ahead down
anterolateral cervical oesophagus
below cricopharyngeus
73
bulls eye lesions in the stomach
submucosal mets
74
gastric pancreatic rests
Submucosal umbilicated mass
75
internal hernia that displaces the IMV
Right paraduodenal hernia
76
liver haemangioma rad
low t1
high t2
77
fungal infections enter the liver via the
hepatic artery
78
most common cause of splenic calcification
granulomatous disease
TB histoplasmosis brucellosis
79
Arc-like hyperechogenic areas outlining the gallbladder wall
emphysematous cholecystitis
80
sludge on US
mobile
no shadows
81
emphysematous cholecytitis cause
Clostridium welchii/perfringens
82
mirizzi syndrome causes
Fistulation between the gallbladder and common hepatic duct
83
cause of cholangitis in HIV
CMV
84
UC/PSC increases risk of
intra hepatic cholangiocarcinoma
85
pancreatic islet cell tumour
large gastrinoma 4cm
small insulinoma (symptomatic from a smaller size - 2cm)
86
chronic pancreatitis
focal atrophy OR enlargement
calc fat and fibrosis
autoimmune pancreatitis
AW sjogrens, PSC, PBC, UC SLE
enlarged gland but no fat stranding
featureless, no clefts
thick and irregular main ducts
87
causes of dense ascites
tuberculosis
ovarian tumour
appendiceal
tumour
which produce particularly proteinaceous fluid.
88
malignant ulcer GI
ulcer crater confined within the gastric contour as they are mucosal and don't extend into muscle
width greater than depth
rolled/irregular/shouldered edges
carman meniscus - a flat lens of barium trapped by heaped up edges
89
benign GI ulcer
smooth ulcer
oedematous collar with overhanging edges
ulcer projecting outside beyond the lumen as they are deep lesions (malignant ones are shallow)
mucosal lines extend all the way up to the edge of the ulcer
90
flocculation and segmentation of the barium column. Fold thickness is normal
dilated proximal SB
coeliac
91
fatty liver
<40 HU on contrast CT
10 HU less than liver non con
92
Whipple infection
sand like micro nodules
low density LN's
thickened mucosal folds - jejunum
migratory arthritis
93
hernia inferolateral to the pubic tubercle
femoral hernia
94
hernia superomedial to the pubic tubercle
inguinal
95
obturator hernia
between pectineus and external obturator
96
mutinous ascites
scallops the liver contour
97
pyogenic abscess
developed countries
haematogeneous dissemination (PV/HA) or
due to ascending cholangitis
multiple small, rim enhx, oedema, ill or well defined,
98
amoebic abscess
younger
recent travel
medical treatment
99
fungal abscess
history of immunosuppression
100
erythematous maculopapular lesions on her legs, buttocks and face, and is diagnosed with necrolytic migratory erythema
due to glucagonoma
CT abdomen
weight loss, diarrhoea, diabetes
high rate of malignant transformation and 50% have liver mets at presentation
101
glucagonoma
4D syndrome
diabetes
dermatitis
DVT
depression
102
bleeding rates
radionuclide imaging 0.1-0.5ml/min
CT 0.3ml/min
103
peutz jehgers syndrome increased risk of
GI adenocarcinoma
colorectal stomach SI
extraintestinal malignancies
breast cervix testes pancreas ovary uterus lung
104
melanoma mets in the stomach
submucosal nodule
central ulceration
105
causes of linitis plastica
gastric adenocarcinoma (scirrhous)
metastases breast lung
lymphoma
radiotherapy
eosinophilic enteritis
Crohn disease
tuberculosis
sarcoidosis
scarring (e.g. ingestion of corrosives)
gastric amyloidosis
Ménétrier disease
106
buscopan
unstable cardiac disease - since it causes tachycardia and raises BP - recent MI, chest pain or arrythmia
risk of acute angle closure glaucoma, but not chronic which is a distinct entity
CI in acute angle closure glaucoma
others
myasthenia gravis
paralytic ileus
prostatism - acute YOUR
107
pneumoperitoneum position
left lateral
108
SPIO contrast
makes all liver dark so lesion appears brighter relatively
109
liver enhancement in budd chiari
early central enhancement, poor peripheral
delayed is central washout and peripheral enhancement
caudate enhances normally
110
upper oesophageal varices
SVC obstruction
111
gastric volvulus types
remember mesenteric folds
the mesenteric type folds the stomach in half
organo tilts on it's axis
112
improve detection of meckels
cimetidine
H2RA (decrease secretions)
113
caveatting lymph nodes with fat fluid levels
coeliac
coeliac can get transformation into lymphoma
114
low density LN's
TB
lymphoma
whipple
necrotic mets
coeliac
115
high dose lipase supplements
fibrosing colonopathy
affects right sided colon
116
pancreatic ducts on MRCP
secretin
117
haemachromatosis
liver pancreas heart pituitary
Low T1 and low T2
118
IPMN
bulging papilla at ERCP
119
calcified liver mets
mucinous adenocarcinoma of the gastrointestinal tract
120
angiodysplasia
submucosal
normal barium scan
cluster of vessels on anti-mesenteric border
121
Eosinophilic gastroenteritis
involves gastric antrum thickening
122
rectal cancer
t2
intermediate
t1 post contrast also enhances normal bowel wall so misleading
123
villous adenomas
broad based
excretion of large amounts of thick mucus, which may result in diarrhoea and electrolyte depletion, as well as poor mucosal coating at barium enema.
124
Kaposi’s sarcoma is a low-grade tumour of the blood and lymphatic
vessels
enhancing lymph nodes in abdomen
125
WBC scan
bowel and GU activity always abnormal
spleen liver and bone marrow uptake is normal
126
superparamagnetic iron oxide particles as a contrast agent during
MRI?
back pain
127
smooth posterior bulge at C5 C6
impaired cricopharyngeus relaxation
128
submucosal gastric mass on barium meal, forming an obtuse angle with the gastric wall in profile
GIST
gastric cancer and lymphoma don't have extra gastric growth
129
Insulinoma localisation
small lesion
need high res
EUS
otherwise arterial calcium test
130
NET tumours
dotatate PET
131
amoebic liver abscess
metronidazole - anti parasitic
132
hydatid liver cyst
distinct wall with wall calc and daughter cysts
sheep farming areas
treat with albendazole and surgical removal if large
133
tracheo oesophageal fistula
A atresia
B proximal
C distal
D both
E stenosis
AB gases
134
caecal volvulus
has haustral markings
135
MEN 3
medullary thyroid carcinoma
phaeochromocytomas
mucosal and cutaneous neuromas
prognathism
marfanoid appearance
136
hyper vascular liver mets
carcinoid
islet cell tumours
phaeochromocytoma
RCC
137
pseudomyxoma peritonei
cystadenocarcinoma of appendix (men) and ovary (women)
138
low grade bowel obstruction
small bowel eneteroclysis
139
FNH vs fibrolamellar carcinoma
FNH T2 bright scar
FLC T2 dark scar (cancer is dark on MR)
140
Peutz jehgers
hamartomatous polyps - no malignant transformation but cancers elsewhere
141
small bowel polyps and osteomas
gardner
142
photopenic area in liver and no bowel uptake on HIDA
choledochal cyst
143
barrets on fluoro
this could appear as a reticular mucosal pattern
on a dual contrast esophagram
144
wind instrument performer or a glass blower
lateral pharyngeal pouch
145
features of crohns
apthoid ulcers, deep ulcers, discontinuous ulceration, rectal sparing, pseudodiverticulae, fistulae and
abscess formation.
146
angiodysplasia
mucosal and submucosal vessel dilatation
most commonly on the antimesenteric border of the caecum and right colon
early filling of the ileocolic vein in the arterial phase and delayed emptying of the same vein
needs intervention via endoscope, not IR
147
presacral, multilocular, mucous-secreting cysts
tailgut cyts
rectal pain and bleeding
malignant trasnofmration to adenocarcinoma
dd
duplication cyst - unilocular
meningocele - from the neural foramina
148
bowel infections
jejunal dilatation - coeliac
amyloid - thickened valvulae conniventes
thickening of mucosa - Whipple and eosinophilic gastroenteritis
thickening of mucosa in duodenum and jejunum - giardiasis
149
features of whipples
thickening of mucosal folds - jejunum
sand like nodules - jejunum
low density LNs
150
liver and spleen densities
spleen 10 HU more on non con
spleen 25 HU more on PV
151
pancreatic ductal adenocarcinoma
on MRI -
hypointense on arterial, venous and delayed
T1 iso/hypo
T2 iso/hyper
hypodense on CT
152
mirizzi
compressed hepatic duct by cystic duct/GB neck stone
153
echogenic liver mets
1) colon
2) treated breast cancer
154
causes of oesophageal pseudodiverticulosis
diabetes, candida infection, oesophagitis, stricture and alcohol abuse.
155
post delivery
liver infarcts
bg pre eclampsia
right lobe hepatomegaly
haemorrhage
HELLP
156
most concerning feature of liver lesion on MRI
Peripheral washout: a sign of malignancy on dynamic gadolinium-enhanced MR images of focal liver lesions
rim enhx on arterial
rim washout on PV
157
unresectable tumours
if widespread and not focal
non-treatable primary tumour;
widespread pulmonary disease;
locoregional recurrence;
peritoneal disease;
extensive nodal disease, such as retroperitoneal,
mediastinal or portal nodes;
and bone or CNS metastases.
158
signs of appendix perf
fluid collection adjacent to the appendix,
gas bubbles near the appendix
loss of visualisation of the submucosal layer
159
causes of massive splenomegaly
CML
Gaucher’s disease
malaria
myelofibrosis
schistosomiasis
Leishmaniasis
Lymphoma
160
1 vs 2 haemachromatosis
1 - increased uptake
liver heart pancreas pituitary synovium thyroid
2 - increased deposition (TPN/blood transfusions)
Spleen and RES
161
most common site of oesophageal rupture
left lower 3rd
162
adenomatous GI polyp with a broad base and frond like surface
villous - greatest risk of malignancy
tubular are the most common and sessile
163
SBO of left sided small bowel loops
after a roux en y surgery
Petersons hernia
defect in the mesocolon
when the roux limb is bought up
164
MALT lymphoma
lymphoma of gastric mucosa
most common finding is ulceration
caused by H Pylori
165
most sensitive sign for mesenteric injury
extravasation 100% specific for severe injury
166
echogenic reflectors with posterior shadowing in GB
emphysematous cholecystitis
167
pancreatic cystic lesions
EUS
can image and biopsy
168
TB lymph nodes
mesenteric
portal
peripancreatic
concentric ileocaecal thickening with incompetent IC valve = TB
advanced - mesenteric fibrosis and retraction
omental and mesenteric thickening
high density ascites
169
Lymphoma LNs
para-aortic
170
Hernia types
spigelian - linea semilunaris, lateral edge of rectus
Richter - only one wall of the bowel is trapped - no obstruction but ischaemia
littre - meckels
superior lumbar triangle - grynfelt
inferior lumbar triangle - petit
171
features of carcinoid syndrome
Diarrhoea
flushing
bronchospasm - wheezing
right heart failure
due to serotonin secretion
need octreotide + CT
172
risk factors for cholangiocarcinoma
Caroli disease
choledochal cysts
biliary stones
PSC - inflammation of ducts
recurrent pyogenic cholangitis
Liver cirrhosis
thorotrast digoxin toxicity
viral infections: e.g. HIV, hepatitis B, hepatitis C, EBV
Inflammatory bowel disease - 10x the risk
polycystic liver disease
liver fluke infestation: Opisthorchis spp. and Clonorchis spp
hepatolithiasis
Not - primary biliary cirrhosis is not a RF
173
imaging features of cholangiocarcinoma
ultrasound - hypo vascular (HCC hyper vascular)
non con CT - low density (HCC high density)
enhancing in the delayed phase (HCC arterial phase)
Low T1 high T2 delayed enhx on MRI
174
TIPS
variceal bleeding / refractory ascites
can also do it for hepatorenal and Budd chiari syndrome
must confirm PV patency beforehand
access: RIJV or middle hepatic vein
increases the risk of encephalopathy by 30% because you bypass liver detoxification
175
hepatorenal syndrome
liver disease causing renal hypoperfusion and AKI
176
oesophagus in CREST syndrome
dilated lower oesophagus
patulous LES
reduced peristalsis
ANA +ve
177
causes of double bubble sign
duodenal atresia
mid gut volvulus
annular pancreas
lads bands
duodenal web
duodenal duplication cysts (in the WALL) and obstruct the lumen
178
meckels
incomplete involution of the omphalomesenteric duct
residual vitello-intestinal artery
179
liver adenomas
adenoma cells contain fat - so there is drop out of signal
arterial enhx
T1 bright
homogeneous
low density on CT
180
oesophageal cancer
EUS and FDG PET in all
no IV contrast is given
6 hours. fasting prior
181
Alveolar echinococcosis
more aggressive and invasive form of hepatic hydatid disease caused by Echinococcus multilocularis.
multiple echogenic nodules
irregular margins on US
little or no enhx
multiple clustered hyperechoic nodules (hailstorm pattern
The normal hydatid disease is by Echinococcus granular (well defined lesions)
hydatid disease - mediterranean region and any sheep raising areas
182
features of pneumoperitoneum
riglers
medial umbilical/falciform/lateral ligament
ligamentum teres
peri hepatic gas
sub hepatic gas
scrotal air in kids
183
features of achalasia
can develop SCC
relief with hot drinks
184
bouvret syndrome
gastric outlet obstruction
gallstone impacted in distal stomach or duodenum
stomach dilated
pneumobilia from the perforation
mirizzi causes narrowing of the common hepatic duct and IHBD
185
calcified LNS
chemo
radiotherapy
mucin producing tumours
186
polycystic liver disease
AW PCKD
AD
worsens with age and renal cyst severity
asymptomatic and don't get complications or liver failure
occasional cysts bleed, infected or cause cholestasis
187
normal waveform of hepatic artery doppler
systolic upstroke
continuous diastolic flow
clot - loss of diastolic flow
acceleration time increased
RI reduced
188
cat scratch disease
bartonellosis
painful LNs
granulomas in liver and spleen
189
choledochal cyst
increased risk of cholangiocarcinoma
occurs in 70's
cyst of the CBD
causes
stones
cancer
pancreatitis
cholangitis
cyst may rupture, leading to bile peritonitis
pain jaundice abdominal mass - sc's only in 40%
190
whipples
t whippelli
joint pain
diarrhoea
weight loss
pale shaggy yellow plaques in the duodenum
low density LNs
mucosal thickening in the duodenum and jejunum
splenomegaly
ascites
Umair's 2A
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Decks in class (9)
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