5c. Abdominal Pathologies Flashcards
what do renal cysts look like in US
look like round collections of fluid in US
are renal cysts malignant
most are harmless
however, can lead to renal failure as the renal tissues get replaced with cystic material
what is the renal tumor look like when enhanced with CM
heterogenously enhancing
what is a shattered kidney
still blood supply going to kidney but doesnt mean that it is salvageable
what is a renal trauma avulsion in terms of what the image looks like
kidney has blood supply cut off and there will be no contrast in it at all
bleed into retroperitoneal space
what are the 2 types of renal masses
cysts and tumors
what are the 2 types of renal trauma injuries
shattered and avulsion kidney
what are the 2 types of congenital renal conditions
horseshoe kidney and renal agenesis
what is a duplex system in the renal system
double ureter
what does a horseshoe kidney look like
2 kidneys attached at the inferior pole
what does a renal agenesis look like
missing a kidney
what are the 3 most common primaries for liver metastases
breast
colon
rectum
how many liver metastases can there be
single or multiple
what determines the resectability of liver metastases
site and size
what is hepatocellular carcinoma associated with
liver inflammation
what are 4 common causes of Primary tumor HCC
liver alcoholic cirrhosis
hep B and C
diabetes
obesity
what are the 3 kinds of malignant liver tumors
hepatocellular carcinoma and metastases
what are 3 types of benign liver tumors
hemangiomas
focal nodular hyperplasia
hepatocellular adenomas
what are hemangiomas
benign liver tumor
masses of abnormal blood vessels
what do hemangiomas look like on US
bright
what is alcoholic liver disease cirrhosis
nodular replacement of tissues and liver becomes stiff
what is MR elastography used for
to see how stiff the liver is in cases such as alcoholic liver fibrosis/cirrhosis
what are the 2 types of liver lesions
abscesses and hydatid cysts
what are hydatid cysts
parasitic tapeworms that grow in the liver and the cyst is filled with cystic form of the parasite
are hydatid cysts harmful
its not harmful unless it ruptures and then the parasite can spread everywhere
mostly space occupying and can push structures
what are the 4 most common primaries for adrenal metastases
lung
colorectal
breast
pancreatic
how does US detect gall stones
Probe sends ultrasounds to tissue in skin and when waves hit surface, it gets refracted back into probe, some hit probe and make image, others hit other structures and then get reflected back into the probe
US wave hits gall stones and gets hit back to probe stones very white as all the signal is getting reflected back, no signal beyond stones as the stones takes up all the signal - acoustic shadowing
what is cholecystitis
increased gall bladder wall thickness from edema and inflammatory change
what is associated with cholecystitis that you can see on a image
mucky fat around the gall bladder as the fat itself is edematous with water due to inflammation
what can happen if cholecystitis gall bladder bursts
bile can get into peritoneal cavity and can lead to huge inflammatory reaction and potential obstruction in small bowel
what is a MRI cholangiogram used for
to detect cause of bile duct obstruction such as stones or tumors
and also look for filling defects and dilated ducts
what is the presentation stage and prognosis of pancreatic tumors
poor prognosis and late presentation
what does the patient present with symptomatically when they have pancreatic tumor
pain or obstruction of bile ducts
for a pancreatic tumor when what area does the tumor have to be in for it to affect its function
why
in the head as it will obstruct bile ducts and pancreatic duct
if in tail or body its not affecting its function that much
why does pancreatic tumors in the head of pancreas cause jaundice
as gall bladder cant drain and obstructs flow of bile out of patient that gets backed up in skin
how do you know if the structure is a renal vein or artery
Renal vein as its straight and not tortuous like artery, loops over the aorta to join the IVC on the side
what is acute pancreatitis
sudden inflammation of the pancreas
what are the 4 causes of acute pancreatitis
gall stone impacted in common bile duct beyod point where pancreatic duct joints CBD
heavy alcohol use
trauma
mumps
what is seen on a CT image for acute pancreatitis
enlarged pancreas and mucky fat in subcutaneous tissues
what is seen in CT of chronic pancreatitis
extensive calcification in pancreas
what is splenomegaly
enlargement of spleen
what is the largest dimension that the spleen should be
less than 11cm
what is the cause of splenomegaly
response to hyperfunction such as raised red cell turnover
Spleen gets big if overworked if increased red cell turnover like sickle cell and haematosis
why does splenomegaly lead to portal hypertension
when high pressure in liver so blood cant flow through liver and finds alternate route back to heart eg via oesophageal varices and pressure in blood vessels can expand the spleen
what does it mean when splenomegaly is caused by infiltration by leukemia/lymphomas
common cause as massive production of white cells abnormal so fills spleen
what is lymphadenopathy
enlarged lymph nodes
why does lymphadenopathy occur
lymph nodes drain lymph from gut and genitalia
what does lymphadenopathy look like on a CT
Should be nothing else in area of IVC and aorta like the 4 lumps around in the image is not normal
what are aortic aneurysms
focal dilation of aorta and enlargement
what is the max diameter of aortas and what happens if its beyond this number
4cm max otherwise it is at risk of rupturing and if ruptured can bleed into body cavities and bleed out
what can you see on a CT image for aortic aneurysms
enlargement and thickening of some aspects of the aortic wall
what is an aortic dissection
false and true lumens in the aorta
for peptic ulcer what is seen around the pit where stomach acid is eating away the wall in a image
oedema around pit
what happens if there is a perforation of the stomach due to peptic ulcer
Small perforation could lead to liquids spreading to surface of peritoneum and set up inflammatory reaction could lead to peritonitis and infection
Perforation of bowels is that the contents have lots of bacteria so if it spreads, can spread peritonitis and infection
If you survive acute event, reaction of peritoneum makes it very sticky and sticks together and at risk of obstruction
what is gastric cancer associated with - 6 things
smoked and salted foods heliobacteria pylori pernicious anemia smoking family hx of gastric cancer stomach polyps
what can be seen in the image when there is gastric cancer
focal thickening of the gastric wall
what is chrons disease and where does it normally occur
small intestine more than large intestine
inflammatory bowel disease
what can be seen in the image for chrons disease
thickening of bowel wall and fat around bowel loops not dark due to oedema
what is ulcerative colitis and what does it affect
large intestine more than small intestine
inflammatory bowel disease
what can be seen in the image for ulcerative colitis
thickening of bowel wall and can result in toxic megacolon and rupture
why does ulcerative colitis cause dilated loops of bowel
bacteria in faeces generates faeces and muscles are flaccid so gas doesn’t go anywhere and can perforate
Faeces in colon can spread in peritoneal cavity -> septic shock
what can you see in appendicitis image
enlarged and filling defect
stranding in fat suggests inflammation
what are colonic polyps and what do they look like on an image
growths on the surface of colon and are usually asymptomatic
filling defect
what can be the symptoms of colonic polyps
blood in stool or rectal bleeding
what can happen to colonic polyps
can progress to cancer
what is colonic tumor associated with and what does it present with
associated with poor diet
presents with bleeding or obstruction
what does colonic tumor look like in an image
apple core channel in middle of tumor which gets narrower and blocks off passage of faecal material from colon to most distal part
what are 3 things to look for as causes of bowel obstruction
hernias
tumours
intussusception
what should be the normal bowel diameter
less than or equal to 4cm
what does inflammation do to the small bowel that causes obstruction
inflammation causes small bowel to get stuck together and the kink formed in the bowel causes obstruction
what is the distribution of bowel loops in small bowel obstruction
central
what is the distribution of bowel loops in large bowel obstruction
peripheral
what happens in sigmoid volvulus
As you get older the sigmoid colon gets longer and if it twist on pedicle, obstruct blood supply to loop of bowel so bacteria causes gas to build up and increase risk of perforation = coffee bean sign
what are the 4 causes of bowel perforation
trauma
tumor
inflammation
ischaemia
what are the 3 signs of free gas in bowel perforation
outside bowel wall
around falciform ligament
in retroperitoneum
what is a sign on the image that there is a bowel perforation
both sides of bowel wall seen as there is air on both sides of the bowel wall
