1 Hepatobiliary & Genitourinary Spring 2012. 2 Hepatobiliary System Comprised of: –Liver...
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Transcript of 1 Hepatobiliary & Genitourinary Spring 2012. 2 Hepatobiliary System Comprised of: –Liver...
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Hepatobiliary & Genitourinary
Spring 2012
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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. diabetic
2. ________________
3. elderly
4. have a diet high in fats sugar and salt
5. _________________
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 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
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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