Hepatobiliary & Genitourinary Spring 2013 RT 91 PATHOLOGY

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 CT is modality of choice X-ray not useful US also used Shrunken liver & ascites X-ray not useful US also used Demonstrates enlargement of spleen and liver Biopsies done under US Cirrhosis

Cirrhosis Chronic liver condition liver parenchyma is destroyed & fibrous tissue is laid down Regenerative nodules are formed Results from alcoholism, drug abuse, autoimmune disorders, metabolic & genetic disease, hepatitis, heart problems, biliary obstruction

Cholelithiasis Most commonly demonstrated with US Most calculi are radiolucent 20% are calcified enough to see on x-rays Cholelithiasis

Cholelithiasis Symptoms Greater incidence in people who are: diabetic obese elderly have a diet high in fats sugar and salt low in fiber Symptoms Bloating, nausea, RUQ pain Cholelithiasis Women more likely than men to get it

Cholecystitis Acute inflammation of the gallbladder Sudden onset of pain, fever, nausea & vomiting

Cholecystitis Stones may be visible on CT plain films US X-rays appear as radiopaque stones Have thickened walls surrounding gallbladder Cholecystitis

Pancreatitis Secondary: Primary Modalities: Endoscopy & MRI CT and US Secondary: Endoscopy & MRI CT demonstrates an enlargement of the gland Pancreas has a shaggy irregular contour Pancreatitis

Pancreatitis Inflammation of pancreas Causes include: alcoholism obstruction of ampulla of vater by gallstone or tumor Can be chronic or acute Chronic causes irreversible change to the pancreatic function Pancreatitis

Neoplastic Diseases

Hemangioma Increased 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 Hemangioma

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

Metastatic Liver Disease US is most commonly used to screen CT & MRI all accurate diagnosis Liver biopsy under US provides definitive diagnosis

Metastatic Liver Disease Much more common than primary carcinoma of the liver It is a common site for metastases from primary sites Colon Pancreas Stomach Lung breast

Pancreatic Cancer CT is the best method of imaging the pancreas Sonography is used to evaluate the biliary tree

Pancreatic Cancer 5th leading cause of cancer death in the U.S. Prognosis is poor 2% survival rate Signs & symptoms are nonspecific Tumor is well advanced when diagnosis is made Pancreatic Cancer

Carcinoma of Renal Cells US reveals as a solid mass CT is the most accurate for diagnosis & regional spread 10% have calcifications MRI allows demonstration of renal anatomy & approaches accuracy of CT More definitive than CT if contrast enhancement cannot be used Carcinoma of Renal Cells

MISC pathologies of Hepatobiliary System

Biliary Stenosis

Genitourinary System

Urinary System

Benign Prostatic Hyperplasia Enlargement can be demonstrated on an intravenous urographic exam as a filling defect at the base of the bladder CT and MRI can also identify pathology Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia Most common benign enlargement Can be diagnosed with rectal exam & PSA levels Generally affects men over 50 Symptoms Difficulty starting, stopping, & maintaining urine flow Can cause urinary obstruction & UTI’s

Congenital Anomaly

Renal Agenesis Congenital anomaly Absence of one kidney & opposite kidney is enlarged

A underdeveloped kidney that is smaller in size but works normally Often other kidney is larger to compensate Significance of this anomaly depends on the volume of functioning Hypoplasia

Horseshoe Kidney Kidney function is generally unimpaired If obstruction is present surgery may be required Most common fusion anomaly Lower poles of kidney are joined Causes a rotation anomaly on one or both sides

Horseshoe Kidney

Kidney Malrotation Incomplete or excessive rotation of the kidneys No clinical significance unless it causes an obstruction

Kidney Malrotation

Pelvic or Ectopic Kidney Kidney or kidneys are lower than normal, often in pelvic region Most asymptomatic but there is an increased incidence of ureteropelvic junction obstruction

Pelvic or Ectopic Kidney

Double Collecting System

Double Collecting System

Ureterocele 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

Urteterocele

Bladder Diverticula Con occur congenitally or caused by chronic bladder obstruction and infection

Polycystic Kidney US demonstrates renal & hepatic cysts IVU show bilateral enlargement of the kidneys, calyceal stretching & distortion (poorly visualized outlines) CT demonstrates a moth eaten appearance CT & US can detect before conventional x-rays Polycystic Kidney

Polycystic Kidney Congenital disease Cysts enlarge as pt ages Enlargement destroys normal tissues It is the cause of 10% of end-stage renal disease Polycystic Kidney

Inflammatory Diseases

Pyelonephritis Can be demonstrated on a CT and US IVU will often look normal in a acute attack Interstitial edema causes less visualization of collecting structures Pyelonephritis

Pyelonephritis Bacterial infection of the calyces and renal pelvis Stagnation or obstruction of urine flow causes an infection People with recurrent UTI’s have more of a chance of getting this

Cystitis Inflammation and congestion of the bladder mucosa Cystography may demonstrate backflow of bladder into ureters

Urinary System Calcifications

LG calculus that assumes shape of pelvicaliceal junction Most visible on x-ray, IVU or retrograde pyelogram CT’s bone study is the modality of choice Staghorn Calculus

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 Obstructive disorder that causes dilitation of the pelvix and calyces with urine. Most common cause is a stone, but it can be congenital, from a tumor, stricture blood clot or inflammation.

Neoplastic Diseases

Malignant renal tumor 1 in every 13,500 births Wilms Tumor Malignant renal tumor 1 in every 13,500 births

Tumor (Wilm’s) CT is modality of choice to assessing extent & spread of tumor Largely replaced IVU US differentiates between cystic and solid masses

Carcinoma of the Bladder IVU or cystogram may demonstrate filling defect of bladder Cystoscopy is method of choice Diagnosis 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