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Hepatobiliary & Genitourinary

Spring 2009 FINAL3-5-09

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Hepatobiliary System

• Comprised of:

– Liver– Gallbladder– Biliary tree

• Pancreas shares a portion of the biliary ductal system

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Biliary System

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Biliary Tree

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Hepatobiliary

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Inflammatory Diseases

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Cirrhosis

1. __ is modality of choice1. Shrunken liver & ascites

2. __________ not useful

3. __________ also used1. Demonstrates

enlargement of spleen and liver

2. _______ done under US

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Cirrhosis1. Chronic liver condition liver parenchyma is destroyed & fibrous tissue is laid down1. Regenerative nodules

are formed

2. Results from alcoholism, drug abuse, autoimmune disorders, metabolic & genetic disease, hepatitis, heart problems, biliary obstruction

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Cholelithiasis

1. Most commonly demonstrated with ________________

2. Most calculi are ________________1. _______ are calcified

enough to see on x-rays

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Cholelithiasis1. Greater incidence in people who are:

1. diabetic2. ________________3. elderly4. have a diet high in

fats sugar and salt5. _________________

2. Symptoms1. ______________

______________

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Cholecystitis1. Acute inflammation of the gallbladder

2. Sudden onset of pain, fever, nausea & vomiting

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Cholecystitis1. Stones may be

visible on 1. _________________2. ________________3. ________________

2. X-rays appear as ___________ stones

1. Have thickened walls surrounding gallbladder

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Pancreatitis1. Primary Modalities:

1. _________________

2. Secondary:1. Endoscopy & MRI

3. CT demonstrates an _______________ of the gland

4. Pancreas has a __________ irregular contour

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Pancreatitis1. Inflammation of

pancreas

2. Causes include:1. ____________________2. obstruction of ampulla of

vater by __________ or _____________________

3. Can be chronic or acute1. Chronic causes

irreversible change to the pancreatic function

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Neoplastic Diseases

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Hemangioma1. Increased echogenicity

may be demonstrated in US

2. US can assess shape and size of tumor

3. NM using labeled blood cells that are attracted to the tumor

4. CT & MRI with contrast demonstrates peripheral enhancement

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Hemangioma

Most common tumor of the liver

Well circumscribed

CAN range from microscopic to 20 cm

More common in women than men

It is a benign neoplasm

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Metastatic Liver Disease1. __________ is most

commonly used to screen

2. ______________ all accurate diagnosis

3. Liver biopsy under US provides ______ diagnosis

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Metastatic Liver Disease

1. Much more common than primary carcinoma of the liver

2. It is a common site for metastases from primary sites1. Colon2. Pancreas3. Stomach4. Lung5. breast

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Pancreatic Cancer

CT is the best method of imaging the pancreas

Sonography is used to evaluate the biliary tree

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Pancreatic Cancer

1. __________ leading cause of cancer death in the U.S.

2. Prognosis is poor1. _____________ survival rate

3. Signs & symptoms are nonspecific

4. Tumor is well advanced when diagnosis is made

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Carcinoma of Renal Cells

1. US reveals as a ____________________

2. __________ is the most accurate for diagnosis & regional spread1. _____ have calcifications

3. MRI allows demonstration of renal anatomy & approaches accuracy of CT1. More _______________

than CT if contrast enhancement cannot be used

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MISC pathologies ofHepatobiliary System

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Biliary Stenosis

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Genitourinary System

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Urinary System

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Benign Prostatic Hyperplasia

1. Enlargement can be demonstrated on an intravenous urographic exam as a __________ at the base of the bladder

2. ________________can also identify pathology

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Benign Prostatic Hyperplasia

1. Most common benign enlargement

2. Can be diagnosed with rectal exam & PSA levels

3. Generally affects men over 50

4. Symptoms1. Difficulty starting, stopping,

& maintaining urine flow

5. Can cause urinary obstruction & UTI’s

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Congenital Anomaly

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Renal Agenesis

1. ______anomaly

2. _____________ of one kidney & opposite kidney is enlarged

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Hypoplasia1. A _____________kidney

that is smaller in size but works normally

2. Often other kidney is _______ to compensate

3. Significance of this anomaly depends on the volume of ___________

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Horseshoe Kidney

Most common fusion anomaly

Lower poles of kidney are joined

Causes a rotation anomaly on one or both sides

Kidney function is generally unimpaired

If obstruction is present surgery may be required

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Horseshoe Kidney

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Kidney Malrotation1. _________OR____________ rotation of the kidneys

2. No clinical significance unless it causes an obstruction

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Kidney Malrotation

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Pelvic or Ectopic Kidney 1. Kidney or kidneys

are _________ than normal, often in pelvic region

2. Most asymptomatic but there is an increased incidence of ______________ junction obstruction

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Pelvic or Ectopic Kidney

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Double Collecting System

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Double Collecting System

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Urteterocele

Cyst like dilatation of a ureter near its opening into the bladder

X-ray demonstrates a filling defect of the bladder

US demonstrates a cyst

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Urteterocele

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Bladder Diverticula

• Con occur congenitally or caused by chronic bladder obstruction and infection

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Polycystic Kidney

1. US demonstrates __________&___________________________

2. IVU show bilateral enlargement of the ___________, calyceal stretching & distortion (poorly visualized outlines)

3. CT demonstrates a _____ eaten appearance

4. CT & US can detect before conventional x-rays

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Polycystic Kidney1. __________ disease

2. __________ enlarge as pt ages

3. Enlargement destroys normal tissues

4. It is the cause of ______ of end-stage renal disease

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Inflammatory Diseases

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Pyelonephritis1. Can be demonstrated on a CT and US

2. IVU will often look normal in a acute attack

3. Interstitial edema causes less visualization of collecting structures

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Pyelonephritis1. Bacterial infection of the calyces and renal pelvis

2. Stagnation or obstruction of urine flow causes an infection

3. People with recurrent UTI’s have more of a chance of getting this

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Cystitis

1. Inflammation and congestion of the bladder mucosa

2. Cystography may demonstrate backflow of bladder into ureters

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Urinary System Calcifications

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Staghorn Calculus1. LG calculus that

assumes shape of pelvicaliceal junction

2. Most visible on x-ray, IVU or retrograde pyelogram

3. CT’s bone study is the modality of choice

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Staghorn Calculus

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Ureter Stone

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Bladder Stones

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Bladder Calculi

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Renal Stones

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Renal Stone

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Degenerative Diseases

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Hydronephrosis

1. IVU is largely replaced by CT

2. CT allows diagnosis 90% of the time

3. US is initial modality of choice because it does not require contrast

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Neoplastic Diseases

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Tumor (Wilm’s)

1. CT is modality of choice to assessing extent & spread of tumor1. Largely replaced IVU

2. US differentiates between cystic and solid masses

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Carcinoma of the Bladder

1. IVU or cystogram may demonstrate filling defect of bladder

2. Cystoscopy is method of choice1. Diagnosis is made via

biopsy or resection

3. US, MRI & CT stage the disease once diagnosis is made

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Carcinoma of the Bladder

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Ureter Stenosis

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Ureteral Stent

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Renal Stent

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Vesicoureteral Reflux

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Vesicoureteral Reflux