1. 1 Hepatobiliary & Genitourinary Spring 2009 FINAL 3-5-09

2. 2 Hepatobiliary System Comprised of: –Liver –Gallbladder –Biliary tree Pancreas shares a portion of the biliary ductal system

3. 3 Biliary System

4. 4 Biliary Tree

5. 5 Hepatobiliary

6. 6 Inflammatory Diseases

7. 7 Cirrhosis 1.__ is modality of choice 1.Shrunken liver & ascites 2.__________ not useful 3.__________ also used 1.Demonstrates enlargement of spleen and liver 2._______ done under US

8. 8 Cirrhosis 1.Chronic liver condition liver parenchyma is destroyed & fibrous tissue is laid down 1.Regenerative nodules are formed 2.Results from alcoholism, drug abuse, autoimmune disorders, metabolic & genetic disease, hepatitis, heart problems, biliary obstruction

9. 9 Cholelithiasis 1.Most commonly demonstrated with ________________ 2.Most calculi are ________________ 1._______ are calcified enough to see on x- rays

10. 10 Cholelithiasis 1.Greater incidence in people who are: 1. diabetic 2. ________________ 3. elderly 4.have a diet high in fats sugar and salt 5._________________ 2.Symptoms 1.______________ ______________

11. 11 Cholecystitis 1.Acute inflammation of the gallbladder 2.Sudden onset of pain, fever, nausea & vomiting

12. 12 Cholecystitis 1.Stones may be visible on 1._________________ 2. ________________ 3. ________________ 2.X-rays appear as ___________ stones 1.Have thickened walls surrounding gallbladder

13. 13 Pancreatitis 1.Primary Modalities: 1._________________ 2.Secondary: 1.Endoscopy & MRI 3.CT demonstrates an _______________ of the gland 4.Pancreas has a __________ irregular contour

14. 14 Pancreatitis 1.Inflammation of pancreas 2.Causes include: 1. ____________________ 2. obstruction of ampulla of vater by __________ or _____________________ 3.Can be chronic or acute 1.Chronic causes irreversible change to the pancreatic function

15. 15 Neoplastic Diseases

16. 16 Hemangioma 1.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. 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. 18 Metastatic Liver Disease 1.__________ is most commonly used to screen 2.______________ all accurate diagnosis 3.Liver biopsy under US provides ______ diagnosis

19. 19 Metastatic Liver Disease 1.Much more common than primary carcinoma of the liver 2.It is a common site for metastases from primary sites 1.Colon 2.Pancreas 3.Stomach 4.Lung 5.breast

20. 20 Pancreatic Cancer CT is the best method of imaging the pancreas Sonography is used to evaluate the biliary tree

21. 21 Pancreatic Cancer 1.__________ leading cause of cancer death in the U.S. 2.Prognosis is poor 1._____________ survival rate 3.Signs & symptoms are nonspecific 4.Tumor is well advanced when diagnosis is made

22. 22 Carcinoma of Renal Cells 1.US reveals as a ____________________ 2.__________ is the most accurate for diagnosis & regional spread 1._____ have calcifications 3.MRI allows demonstration of renal anatomy & approaches accuracy of CT 1.More _______________ than CT if contrast enhancement cannot be used

23. 23 MISC pathologies of Hepatobiliary System

24. 24 Biliary Stenosis

25. 25 Genitourinary System

26. 26 Urinary System

27. 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. 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.Symptoms 1.Difficulty starting, stopping, & maintaining urine flow 5.Can cause urinary obstruction & UTI’s

29. 29 Congenital Anomaly

30. 30 Renal Agenesis 1.______anomaly 2._____________ of one kidney & opposite kidney is enlarged

31. 31 Hypoplasia 1.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. 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. 33 Horseshoe Kidney

34. 34 Kidney Malrotation 1._________OR ____________ rotation of the kidneys 2.No clinical significance unless it causes an obstruction

35. 35 Kidney Malrotation

36. 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. 37 Pelvic or Ectopic Kidney

38. 38 Double Collecting System

39. 39 Double Collecting System

40. 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. 41 Urteterocele

42. 42 Bladder Diverticula Con occur congenitally or caused by chronic bladder obstruction and infection

43. 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. 44 Polycystic Kidney 1.__________ disease 2.__________ enlarge as pt ages 3.Enlargement destroys normal tissues 4.It is the cause of ______ of end-stage renal disease

45. 45 Inflammatory Diseases

46. 46 Pyelonephritis 1.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. 47 Pyelonephritis 1.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. 48 Cystitis 1.Inflammation and congestion of the bladder mucosa 2.Cystography may demonstrate backflow of bladder into ureters

49. 49 Urinary System Calcifications

50. 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. 51 Staghorn Calculus

52. 52 Ureter Stone

53. 53 Bladder Stones

54. 54 Bladder Calculi

55. 55 Renal Stones

56. 56 Renal Stone

57. 57 Degenerative Diseases

58. 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. 59 Neoplastic Diseases

60. 60 Tumor (Wilm’s) 1.CT is modality of choice to assessing extent & spread of tumor 1.Largely replaced IVU 2.US differentiates between cystic and solid masses

61. 61 Carcinoma of the Bladder 1.IVU or cystogram may demonstrate filling defect of bladder 2.Cystoscopy is method of choice 1.Diagnosis is made via biopsy or resection 3.US, MRI & CT stage the disease once diagnosis is made

62. 62 Carcinoma of the Bladder

63. 63 Ureter Stenosis

64. 64 Ureteral Stent

65. 65 Renal Stent

66. 66 Vesicoureteral Reflux

67. 67 Vesicoureteral Reflux