1

Hepatobiliary & Genitourinary

Spring 2012

2

Hepatobiliary System

• Comprised of:

– Liver– Gallbladder– Biliary tree

• Pancreas shares a portion of the biliary ductal system

3

Biliary System

4

Biliary Tree

5

Hepatobiliary

6

Inflammatory Diseases

7

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

8

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

9

Cholelithiasis

1. Most commonly demonstrated with ________________

2. Most calculi are ________________1. _______ are calcified

enough to see on x-rays

10

Cholelithiasis1. Greater incidence in people who are:

1. diabetic

2. ________________

3. elderly

4. have a diet high in fats sugar and salt

5. _________________

2. Symptoms1. ______________

______________

11

Cholecystitis1. Acute inflammation of the gallbladder

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

12

Cholecystitis1. Stones may be

visible on 1. _________________

2. ________________

3. ________________

2. X-rays appear as ___________ stones

1. Have thickened walls surrounding gallbladder

13

Pancreatitis1. Primary Modalities:

1. _________________

2. Secondary:1. Endoscopy & MRI

3. CT demonstrates an _______________ of the gland

4. Pancreas has a __________ irregular contour

14

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

15

Neoplastic Diseases

16

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

17

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

18

Metastatic Liver Disease1. __________ is most

commonly used to screen

2. ______________ all accurate diagnosis

3. Liver biopsy under US provides ______ diagnosis

19

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

20

Pancreatic Cancer

CT is the best method of imaging the pancreas

Sonography is used to evaluate the biliary tree

21

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

22

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

23

MISC pathologies ofHepatobiliary System

24

Biliary Stenosis

25

Genitourinary System

26

Urinary System

27

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

28

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

29

Congenital Anomaly

30

Renal Agenesis

1. ______anomaly

2. _____________ of one kidney & opposite kidney is enlarged

31

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 ___________

32

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

33

Horseshoe Kidney

34

Kidney Malrotation1. _________OR____________ rotation of the kidneys

2. No clinical significance unless it causes an obstruction

35

Kidney Malrotation

36

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

37

Pelvic or Ectopic Kidney

38

Double Collecting System

39

Double Collecting System

40

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

41

Urteterocele

42

Bladder Diverticula

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

43

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

44

Polycystic Kidney1. __________ disease

2. __________ enlarge as pt ages

3. Enlargement destroys normal tissues

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

45

Inflammatory Diseases

46

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

47

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

48

Cystitis

1. Inflammation and congestion of the bladder mucosa

2. Cystography may demonstrate backflow of bladder into ureters

49

Urinary System Calcifications

50

Staghorn Calculus

1. 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

51

Staghorn Calculus

52

Ureter Stone

53

Bladder Stones

54

Bladder Calculi

55

Renal Stones

56

Renal Stone

57

Degenerative Diseases

58

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

59

Neoplastic Diseases

60

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

61

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

62

Carcinoma of the Bladder

63

Ureter Stenosis

64

Ureteral Stent

65

Renal Stent

66

Vesicoureteral Reflux

67

Vesicoureteral Reflux