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

Cirrhosis1. CT is modality of choice

1. Shrunken liver & ascites

2. X-ray not useful

3. US also used1. Demonstrates

enlargement of spleen and liver

2. Biopsies done under US

7

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 8

Cholelithiasis1. Most commonly

demonstrated with US

2. Most calculi are radiolucent1. 20% are calcified

enough to see on x-rays

9

Cholelithiasis1. Greater incidence in people who are:

1. diabetic

2. obese

3. elderly

4. have a diet high in fats sugar and salt

5. low in fiber

2. Symptoms1. Bloating, nausea,

RUQ pain

10

Cholecystitis1. Acute inflammation of the gallbladder

2. Sudden onset of pain, fever, nausea & vomiting

11

Cholecystitis1. Stones may be

visible on 1. CT

2. plain films

3. US

2. X-rays appear as radiopaque stones

1. Have thickened walls surrounding gallbladder

12

Pancreatitis1. Primary Modalities:

1. CT and US

2. Secondary:1. Endoscopy & MRI

3. CT demonstrates an enlargement of the gland

4. Pancreas has a shaggy irregular contour

13

Pancreatitis1. Inflammation of

pancreas

2. Causes include:1. alcoholism

2. obstruction of ampulla of vater by gallstone or tumor

3. Can be chronic or acute1. Chronic causes

irreversible change to the pancreatic function

14

Neoplastic Diseases

15

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

16

Hemangioma

17

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 Disease1. 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 sites1. Colon2. Pancreas3. Stomach4. Lung5. breast

19

Pancreatic Cancer

20

CT is the best method of imaging the pancreas

Sonography is used to evaluate the biliary tree

Pancreatic Cancer

1. 5th leading cause of cancer death in the U.S.

2. Prognosis is poor1. 2% survival rate

3. Signs & symptoms are nonspecific

4. Tumor is well advanced when diagnosis is made

21

Carcinoma of Renal Cells

1. US reveals as a solid mass

2. CT is the most accurate for diagnosis & regional spread1. 10% have calcifications

3. MRI allows demonstration of renal anatomy & approaches accuracy of CT1. More definitive than CT if

contrast enhancement cannot be used

22

MISC pathologies ofHepatobiliary 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

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

28

Congenital Anomaly

29

Renal Agenesis

1. Congenital anomaly

2. Absence of one kidney & opposite kidney is enlarged

30

Hypoplasia1. A underdeveloped

kidney that is smaller in size but works normally

2. Often other kidney is larger to compensate

3. Significance of this anomaly depends on the volume of functioning

31

Horseshoe Kidney

32

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

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

40

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

41

Bladder Diverticula

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

42

Polycystic Kidney

1. US demonstrates renal & hepatic cysts

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

3. CT demonstrates a moth eaten appearance

4. CT & US can detect before conventional x-rays

43

Polycystic Kidney1. Congenital disease2. Cysts enlarge as pt

ages

3. Enlargement destroys normal tissues

4. It is the cause of 10% of end-stage renal disease

44

Inflammatory Diseases

45

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

46

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

47

Cystitis

1. Inflammation and congestion of the bladder mucosa

2. Cystography may demonstrate backflow of bladder into ureters

48

Urinary System Calcifications

49

Staghorn Calculus1. 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

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 tumor1. Largely replaced IVU

2. US differentiates between cystic and solid masses

61

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

62

Carcinoma of the Bladder

63

Ureter Stenosis

64

Ureteral Stent

65

Renal Stent

66

Vesicoureteral Reflux

67

Vesicoureteral Reflux

68