Hepatobiliary Genitourinary Spring 2013 RT 91 PATHOLOGY 1

Hepatobiliary & Genitourinary Spring 2013 RT 91 PATHOLOGY 1

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

Biliary System 3

Biliary Tree 4

Hepatobiliary 5

Inflammatory Diseases 6

1. CT is modality of choice 1. Shrunken liver & ascites Cirrhosis 2. X-ray not useful 3. US also used 1. Demonstrates enlargement of spleen and liver 2. Biopsies done under US 7

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

1. Most commonly demonstrated with US Cholelithiasis 2. Most calculi are radiolucent 1. 20% are calcified enough to see on xrays 9

1. Greater incidence in people who are: Cholelithiasis 1. diabetic 2. obese 3. elderly 4. have a diet high in fats sugar and salt 5. low in fiber 2. Symptoms 1. Bloating, nausea, RUQ pain 10

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

1. Stones may be visible on 1. CT 2. plain films 3. US Cholecystitis 2. X-rays appear as radiopaque stones 1. Have thickened walls surrounding gallbladder 12

1. Primary Modalities: 1. CT and US 2. Secondary: Pancreatitis 1. Endoscopy & MRI 3. CT demonstrates an enlargement of the gland 4. Pancreas has a shaggy irregular contour 13

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

Neoplastic Diseases 15

1. Increased echogenicity may be demonstrated in US Hemangioma 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 16

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 17

Metastatic Liver Disease 1. US is most commonly used to screen 2. CT & MRI all accurate diagnosis 3. Liver biopsy under US provides definitive diagnosis 18

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. 2. 3. 4. 5. Colon Pancreas Stomach Lung breast 19

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

1. 5 th leading cause of cancer death in the U. S. Pancreatic Cancer 2. Prognosis is poor 1. 2% survival rate 3. Signs & symptoms are nonspecific 4. Tumor is well advanced when diagnosis is made 21

1. US reveals as a solid mass 2. CT is the most accurate for diagnosis & regional spread Carcinoma of Renal Cells 1. 10% have calcifications 3. MRI allows demonstration of renal anatomy & approaches accuracy of CT 1. More definitive than CT if contrast enhancement cannot be used 22

MISC pathologies of Hepatobiliary System 23

Biliary Stenosis 24

Genitourinary System 25

Urinary System 26

Benign Prostatic Hyperplasia 1. Enlargement can be demonstrated on an intravenous urographic exam as a filling defect at the base of the bladder 2. CT and MRI can also identify pathology 27

1. Most common benign enlargement Benign Prostatic Hyperplasia 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 28

Congenital Anomaly 29

Renal Agenesis 1. Congenital anomaly 2. Absence of one kidney & opposite kidney is enlarged 30

1. A underdeveloped kidney that is smaller in size but works normally Hypoplasia 2. Often other kidney is larger to compensate 3. Significance of this anomaly depends on the volume of functioning 31

Horseshoe 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 32

Horseshoe Kidney 33

Kidney Malrotation 1. Incomplete or excessive rotation of the kidneys 2. No clinical significance unless it causes an obstruction 34

Kidney Malrotation 35

Pelvic or Ectopic Kidney 1. Kidney or kidneys are lower than normal, often in pelvic region 2. Most asymptomatic but there is an increased incidence of ureteropelvic junction obstruction 36

Pelvic or Ectopic Kidney 37

Double Collecting System 38

Double Collecting System 39

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 40

Urteterocele 41

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

1. US demonstrates renal & hepatic cysts 2. IVU show bilateral enlargement of the kidneys, calyceal stretching & distortion (poorly visualized outlines) Polycystic Kidney 3. CT demonstrates a moth eaten appearance 4. CT & US can detect before conventional xrays 43

1. Congenital disease 2. Cysts enlarge as pt ages Polycystic Kidney 3. Enlargement destroys normal tissues 4. It is the cause of 10% of end-stage renal disease 44

Inflammatory Diseases 45

1. Can be demonstrated on a CT and US Pyelonephritis 2. IVU will often look normal in a acute attack 3. Interstitial edema causes less visualization of collecting structures 46

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 Pyelonephritis 47

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

Urinary System Calcifications 49

1. LG calculus that assumes shape of Staghorn pelvicaliceal junction Calculus 2. Most visible on x-ray, IVU or retrograde pyelogram 3. CT’s bone study is the modality of choice 50

Staghorn Calculus 51

Ureter Stone 52

Bladder Stones 53

Bladder Calculi 54

Renal Stones 55

Renal Stone 56

Degenerative Diseases 57

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 58

Neoplastic Diseases 59

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

1. IVU or cystogram may demonstrate filling defect of bladder Carcinoma of the 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

Carcinoma of the Bladder 63

Ureter Stenosis 64

Ureteral Stent 65

Renal Stent 66

Vesicoureteral Reflux 67

Vesicoureteral Reflux 68