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Hepatobiliary & Genitourinary. Spring 2009 FINAL 3-5-09. Hepatobiliary System. Comprised of: Liver Gallbladder Biliary tree Pancreas shares a portion of the biliary ductal system. Biliary System. Biliary Tree. Hepatobiliary. Inflammatory Diseases. Cirrhosis. - PowerPoint PPT Presentation

Text of Hepatobiliary & Genitourinary

  • *Hepatobiliary & GenitourinarySpring 2009 FINAL3-5-09

  • *Hepatobiliary SystemComprised of:

    LiverGallbladderBiliary treePancreas shares a portion of the biliary ductal system

  • *Biliary System

  • *Biliary Tree

  • *Hepatobiliary

  • *Inflammatory Diseases

  • *Cirrhosis__ is modality of choiceShrunken liver & ascites

    __________ not useful

    __________ also usedDemonstrates enlargement of spleen and liver_______ done under US

  • *CirrhosisChronic liver condition liver parenchyma is destroyed & fibrous tissue is laid downRegenerative nodules are formed

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

  • *CholelithiasisMost commonly demonstrated with ________________

    Most calculi are _______________________ are calcified enough to see on x-rays

  • *Cholelithiasis

    Greater incidence in people who are: diabetic ________________ elderlyhave a diet high in fats sugar and salt_________________Symptoms____________________________

  • *CholecystitisAcute inflammation of the gallbladder

    Sudden onset of pain, fever, nausea & vomiting

  • *CholecystitisStones may be visible on _________________ ________________ ________________

    X-rays appear as ___________ stonesHave thickened walls surrounding gallbladder

  • *PancreatitisPrimary Modalities:_________________Secondary:Endoscopy & MRI

    CT demonstrates an _______________ of the gland

    Pancreas has a __________ irregular contour

  • *PancreatitisInflammation of pancreas

    Causes include: ____________________ obstruction of ampulla of vater by __________ or _____________________

    Can be chronic or acuteChronic causes irreversible change to the pancreatic function

  • *Neoplastic Diseases

  • *HemangiomaIncreased echogenicity may be demonstrated in US

    US can assess shape and size of tumor

    NM using labeled blood cells that are attracted to the tumor

    CT & MRI with contrast demonstrates peripheral enhancement

  • *HemangiomaMost 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

  • *Metastatic Liver Disease__________ is most commonly used to screen

    ______________ all accurate diagnosis

    Liver biopsy under US provides ______ diagnosis

  • *Metastatic Liver DiseaseMuch more common than primary carcinoma of the liver

    It is a common site for metastases from primary sitesColonPancreasStomachLungbreast

  • *Pancreatic CancerCT is the best method of imaging the pancreas

    Sonography is used to evaluate the biliary tree

  • *Pancreatic Cancer__________ leading cause of cancer death in the U.S.

    Prognosis is poor_____________ survival rate

    Signs & symptoms are nonspecific

    Tumor is well advanced when diagnosis is made

  • *Carcinoma of Renal CellsUS reveals as a ____________________

    __________ is the most accurate for diagnosis & regional spread_____ have calcifications

    MRI allows demonstration of renal anatomy & approaches accuracy of CTMore _______________ than CT if contrast enhancement cannot be used

  • *MISC pathologies ofHepatobiliary System

  • *Biliary Stenosis

  • *Genitourinary System

  • *Urinary System

  • *Benign Prostatic HyperplasiaEnlargement can be demonstrated on an intravenous urographic exam as a __________ at the base of the bladder

    ________________can also identify pathology

  • *Benign Prostatic HyperplasiaMost common benign enlargement

    Can be diagnosed with rectal exam & PSA levels

    Generally affects men over 50

    SymptomsDifficulty starting, stopping, & maintaining urine flow

    Can cause urinary obstruction & UTIs

  • *Congenital Anomaly

  • *Renal Agenesis______anomaly

    _____________ of one kidney & opposite kidney is enlarged

  • *HypoplasiaA _____________kidney that is smaller in size but works normally

    Often other kidney is _______ to compensate

    Significance of this anomaly depends on the volume of ___________

  • *Horseshoe KidneyMost 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

  • *Horseshoe Kidney

  • *Kidney Malrotation_________OR____________ rotation of the kidneys

    No clinical significance unless it causes an obstruction

  • *Kidney Malrotation

  • *Pelvic or Ectopic KidneyKidney or kidneys are _________ than normal, often in pelvic region

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

  • *Pelvic or Ectopic Kidney

  • *Double Collecting System

  • *Double Collecting System

  • *UrteteroceleCyst like dilatation of a ureter near its opening into the bladder

    X-ray demonstrates a filling defect of the bladder

    US demonstrates a cyst

  • *Urteterocele

  • *Bladder DiverticulaCon occur congenitally or caused by chronic bladder obstruction and infection

  • *Polycystic KidneyUS demonstrates __________&___________________________

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

    CT demonstrates a _____ eaten appearance

    CT & US can detect before conventional x-rays

  • *Polycystic Kidney__________ disease

    __________ enlarge as pt ages

    Enlargement destroys normal tissues

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

  • *Inflammatory Diseases

  • *PyelonephritisCan be demonstrated on a CT and US

    IVU will often look normal in a acute attack

    Interstitial edema causes less visualization of collecting structures

  • *PyelonephritisBacterial infection of the calyces and renal pelvis

    Stagnation or obstruction of urine flow causes an infection

    People with recurrent UTIs have more of a chance of getting this

  • *CystitisInflammation and congestion of the bladder mucosa

    Cystography may demonstrate backflow of bladder into ureters

  • *Urinary System Calcifications

  • *Staghorn CalculusLG calculus that assumes shape of pelvicaliceal junction

    Most visible on x-ray, IVU or retrograde pyelogram

    CTs bone study is the modality of choice

  • *Staghorn Calculus

  • *Ureter Stone

  • *Bladder Stones

  • *Bladder Calculi

  • *Renal Stones

  • *Renal Stone

  • *Degenerative Diseases

  • *Hydronephrosis IVU is largely replaced by CT

    CT allows diagnosis 90% of the time

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

  • *Neoplastic Diseases

  • *Tumor (Wilms)CT is modality of choice to assessing extent & spread of tumorLargely replaced IVU

    US differentiates between cystic and solid masses

  • *Carcinoma of the BladderIVU or cystogram may demonstrate filling defect of bladder

    Cystoscopy is method of choiceDiagnosis is made via biopsy or resection

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

  • *Carcinoma of the Bladder

  • *Ureter Stenosis

  • *Ureteral Stent

  • *Renal Stent

  • *Vesicoureteral Reflux

  • *Vesicoureteral Reflux

    Women more likely than men to get it*