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59 Cards in this Set

  • Front
  • Back
Imaging the billiary system
-oral cholecystography
-operative cholangiography
-Intravenous cholangiography (IVC)
-T-tube cholangiography
-percutaneous transhepatic cholangiography
-endoscopic retrograde cholangiopancreatography (ERCP)
-Computed Tomography
-Radioisotope scans
-Hepatic angiography
Function of the gallbladder
Stores bile so that it is available when a meal is eaten. The ingestion of food causes the release of CCK which relaxes the sphincter of Oddi and releases bile into the duodenum to aid in the breakdown of fat.
Stones or calculi in the gallbladder, these can block the ducts and cause backup of bile in the gallbladder.
Gallstones are made of...
Cholesterol: yellow-green and made of hardened cholesterol (80% of gallstones are this type)
Pigment: small, dark stones made of bilirubin
Mixed: mixture of cholesterol and pigment stones
Gallstones on X-ray
Cholesterol is radiolucent, so most gallstones are only visible on contrast exams or ultrasound. However, some gallstones contain enough calcium to be visible on plain films. The center may be calcified or the periphery of the stone may be visible. On US, gallstones are clearly visible. CT and MRI may also be used to identify gallstones.
Oral cholecystography
OCG: traditional technique for the diagnosis of gallstones in which a patient would take an oral contrast "pill" and imaging would be completed hours later.
Number of gallstones
Patients may have Solitary gallstones, Multiple gallstones or Gravel gallstones. Gravel gallstones describe multiple small stones that look like gravel, may take years to form and can fill the entire gallbladder.
Treatment for cholelithiasis
Asymptomatic--no treatment
Noninvasive--lithotripsy, chemical dissolution
Invasive--ERCP for stone retrieval, laproscopic cholecystectomy
Inflammation of the gallbladder
Acute Cholecystitis
In 95% of cases, this occurs after obstruction of the cystic duct by an impacted gallstone. Gallstones may injure the mucosal wall, allowing bacteria to enter.
Chronic Cholecystitis
Long standing swelling and irritation of the gallbladder, usually caused by repeated attacks of acute cholecystitis. This leads to thickening of the walls which causes the gallbladder to shrink and lose its ability to function properly. Occurs more often in women than in men.
Symptoms of cholecystitis
Upper abdominal pain with nausea and vomitting
Demonstration of cholecystitis
US demonstrates a distended gallbladder containing gallstones and possible edema of the gallbladder wall. NucMed shows a failure to accumulate radioactivity after 4hrs. MR demonstrates the cystic duct and obstructing calculi.
Treatment for cholecystitis
None needed for asymptomatic pts. Antispasmodic and an analgesic help alleviate symptoms. May use lithotripsy, stone removal by ERCP and chemical dissolution. Laproscopic cholecystectomy may also be used to remove the gallbladder entirely.
Function of the liver
Production of bile, amino acids, and urea, converts glucose to glycogen. Filters harmful substances from the blood. Serves as a storage site for vitamins and maintains proper amounts of glucose in the blood. Also responsible for producing cholesterol. Also responsible for the breakdown of RBC's and hormone production.
Cirrhosis of the liver
Diffuse destruction and necrosis of hepatocytes with fibrotic regeneration. This is an end-stage liver disease. Three types: 1) Laennec's, 2) Biliary, and 3) Macronodular
Cause of Cirrhosis of the liver
The major cause is chronic alcoholism, 10-20 years of alcohol abuse. Damage to the liver is related to either the toxic effect of alcohol or to the malnutrition that frequently accompanies chronic alcoholism.
Cirrhosis and CT
Fatty infiltration is demonstrated well on CT. The liver appears much darker than the spleen (should be the opposite) due to the large amount of fat that has accumulated within the liver.
Cirrhosis and Ultrasound
The liver appears with multiple nodules of varying sizes and a nodular liver surface
Cirrhosis and KUB
Accumulation of fluid in the peritoneal cavity (ascites) may be evident on plain radiographs as general abdominal haziness.
Symptoms of liver cirrhosis
Abdominal distention, ascites, esophageal varices, jaundice, breast enlargement in men, poisonous material may accumulate in the circulation, confusion and disorientation, tremors, shaking, sleepiness, hepatic coma.
Treatment for liver cirrhosis
The damage caused by cirrhosis is irreversible and incurable except by liver transplant. Most without one die within 15 years of diagnosis. May control the process by controlling diet, stopping alcoholic consumption, rest and managing the complications of liver failure.
Function of the pancreas
Endocrine gland: produces several important hormones, including insulin and glucagon.
Exocrine gland: secretes pancreatic juices containing digestive enzymes that pass into the small intestine.
Inflammation of the pancreas. Protein and lipid-digesting enzymes begin to digest the pancreas.
Acute pancreatitis
Most common cause of acute pancreatitis is excessive alcohol consumption. May also be related to gallstones where the ampulla of Vater is obstructed.
Symptoms of acute pancreatitis
Sudden onset of severe, steady abdominal pain that radiates to th back. Nausea and vomitting, jaudice, malabsorption syndrome.
Chronic pancreatitis
This results when frequent intermittent injury to the pancreas causes increasing damage that produces scar tissue. May result from chronic alcohol abuse, which may cause the gland to lose its ability to produce digestive enzymes insulin and glucagon. Calcifications may be evident of radiographs.
Symptoms of chronic pancreatitis
Pain, malabsorption causing weight loss and diabetes
Radiographic appearance of pancreatitis
Pancreatic calcifications visible of plain radiographs indicates chronic pancreatitis and an exacerbation of the disease. Ultrasound and CT are used to define the degree of pancreatic inflammation, abscesses, hemorrhage and pseudocyst formation. CT demonstrates an enlarged gland.
Liver Cancer
Hepatocellular carcinoma most commonly occurs in patients with underlying liver cirrhosis (70%), particularly Laennec's and Macronodular Cirrhosis.
Symptoms of liver cancer
Right upper quandrant discomfort, weight loss, hemorrhagic shock from massive intraperitoneal bleeding, which reflects rupture of the tumor into the peritoneal cavity. Invasion of the biliary tree may also produce obstructive jaundice.
Liver Metastasis
The liver is the major recipient of metastasis from many common malignant tumors.
Liver cancer and CT
Modality of choice for diagnosis. The tumor appears as a large mass. Tends to be a solitary mass or a small number of lesions. Invades the hepatic and portal venous systems.
Hepatic Mets on CT and MRI
CT--most metastasis are well marginated and appear less dense than normal liver tissue
MRI--useful for pts who cannot receive IV iodinated contrast agents.
Hepatocellular carcinoma--poor prognosis, surgery and chemo
Hepatic Mets--terminal, palliative treatment only.
Pancreatic Pseudocyst
Loculated fluid collections arising from inflammation, necrosis or hemorrhage associated with acute pancreatitis or trauma. Has a shaggy lining surrounded by dense white scar tissue.
Pancreatic Cancer
Asymptomatic until the disease is well advanced. 60% occur in the head of the pancreas and less commonly hormone-secreting neoplasms of the islet cells of the islets of Langerhans.
Cause of Pancreatic Cancer
"People who smoke have twice as great a chance of contracting cancer of the pancreas as nonsmokers."
Appearance of Pancreatic Cancer
US--tumor 2 cm or greater, irregular contour
CT--most effective, tumor mass, ductal dilitation and invasiveness
Symptoms of Pancreatic Cancer
Abdominal pain, weight loss, jaundice. Usually, this cancer is painless as it grows and goes unnoticed until it is far advanced and has metastisized.
Treatment for pancreatic cancer
Poor prognosis with 2% survival rate. Treat with surgery, radiation therapy, chemo and biologic therapy.
Type I Diabetes Mellitus
Childhood or juvenile-onset diabetes with an insulin deficit. Lack of insulin leads to increase blood and urine glucose. Requires treatment with insulin injections so that cells can absorb and use glucose for energy.
Type II Diabetes Mellitus
Develops later in life, less sever and can often be controlled by diet alone. This is insulin resistant type diabetes.
Symptoms of Diabetes Mellitus
Polyuria (excessive urination), polydipsia (drinking large quantities of liquid), excretion of glucose in the urine (glycosuria). Acidosis and dehydration can lead to diabetic coma. Atherosclerosis and infections, kidney failure and poor circulation are major complications of the disease.
Demonstration of Diabetes Mellitus
Skeletal radiographs--peripheral vessel calcifications, severe osteomyelitis, neuropathic joints, gas gangrene, emphysematous cholecystitis (gas in the lumen and wall of the gallbladder)
Treatment of Diabetes Mellitus
Insulin (type I), proper diet
Metformin, glucophage (type II)
Advanced tx: islet cell transplant, insulin gene insertion
Colon Cancer
Leading cause of death from cancer in the US. About half occur in the rectum and sigmoid. This is primarily a disease of older individuals (50-70 yo).
Diagnosis of colon cancer
Early diagnosis depends on polyp detection. Malignant polyps tend to be lesions without stalks, with irregular, lobulated surfaces. May be greater than 2 cm in diameter.
70% are diagnosed by sigmoidoscopy and 20% by colon examination.
Appearance on x-ray
Puckering of the colon wall seen on profile view at the site of origin of a polyp. Apple core carcinoma appears due to the lumen being squeezed by the tumor pressing on it. "Apple core" is one of the most typical type. May also be found using CT, US, PET.
Causes of Colon Cancer
Heredity, History of ulcerative colitis, environment, diet, and presence of polyps.
Treatment for colon cancer
surgical resection, radiation therapy, chemotherapy.
A loop of bowel twisting on itself that may lead to intestinal obstruction. Most frequently involves the cecum and sigmoid colon. Sigmoid volvulus results from a bulky high-residue diet causing constipation.
Cardinal signs of volvulus
vomitting and marked abdominal distention.
Diagnosis of Volvulus
Obstruction, absence of haustral markings, abnormal air-fluid levels and significant bowel dilatation.
Appearance on x-ray
BE is usually required for diagnosis which demonstrates an obstruction of flow at the site of the volvulus, tapered edge of the column points toward the site of the twist.
Volvulus treatment
Deflation by insertion of sigmoidoscope, therapeutic water soluble enema
Large Bowel Obstruction
Any hinderance to the passage of the intestinal contents. 70% result from colonic carcinoma. Major complication is perforation at the cecum.
Diagnosis of obstruction
An Acute abdominal series shows presence and location of intestinal gas. The colon appears large and dilated and greatly distended with a thin-walled cecum.
Treatment for obstruction
Decompression, surgical detrosion, water soluble enema.