HEPATOBILARY RADIOLOGY
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By the end of lecture the student should know:
Investigations for hepatobiliary disorders
LIVER
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INVESTIGATION:
Ultrasound
Ct scan
Isotope scan
Mri
Angiography
CIRRHOSIS &PORTAL HYPERTENSION
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Chronic liver disease lead to renal failure
Cirrhosis is one of the condition.
Cause:
Alcohol
Hepatitis complication A B C
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COMPLICATION:
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esophageal varices
Barium swallow shows tortuous vessels
Hepatoma
Ascites
Ultrasound and CT helpful
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ABSCESS
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Causes may be
Parasitic-----Amoebic---Entamoeba Hys.
Pyogenic
Ultrasound investigation of choice
Abscess may be solitary or multiple
Image shows internal echoes
Treatment aspiration
Size variable
LIVER MASSES
Liver Masses may be solid or cystic or complex
Cyst may be acquired or congenital
Liver cyst mostly seen in right lobe
Liver cyst associated with adult poly cystic kidney disease
Hydated cyst common. Cause Echinococcal infection
They may have daughter cyst
UNILOCULAR HYDATED CYST
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Ultrasound and CT investigation of choice
Appearance spoke wheel appearance
Aspiration decision Yes or No
Serum antigen antibodies test for hydrated disease.
NEOPLASM
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Hemengioma
Adenoma
FNH
Heptoma
Metastasis Most common
CT and Ultrasound investigation of choice
HEPATOMA OR HEPATOCELLULAR CARCINOMA
LIVER METASTASIS
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GALL BLADDER
RADIOLOGICAL INVESTIGATION.
Investigation of Choice ---Ultrasonography
Isotope Scan
CT Scan
PTC
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INVESTIGATION OF JAUNDICE:
For the evaluation of obstructive or Non obstructive Jaundice
Few causes of Jaundice:
Hepatitis--------------- US
Biliary obstruction---------------- US
Metabolic disease--------------- Radiography CT, US
Peripheral red cell destruction. Blood examination
Cholilithiasis----------------- US
Chronic Pancreatitis----- US, Plain Abdomen , CT
Metastasis disease or deposit to the porta Hepatis------ CT & US
Cholingio carcinoma ----- CT US
Pancreatic Carcinoma------- CT --- US
ERCP ROLE evaluate the cause of CBD obstruction
MRCP
CHOLECYSTITIS
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Acute or chronic.
Sign and symptom are different in acute and Chronic Cholicystitis
Acute or Chronic CC may be accompanied by the Presence of Gall
Stone
Gall Bladder appear inflamed swollen with edematous mucosa along
with presence of Gall Stone
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Chronic Cholicystitis shows contracted thick wall Gall bladder with
Gall stone
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H/O Chronic Pain off and on
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Cholicystitis may be without Gall Stone , condition known as A-calculus
cholicystitis
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In obstructive Jaundice Ultrasound and CT are the investigation of
choice
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Ultrasound shows Dilated CBD and its intra hepatic Branches
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Extra Hepatic part of CBD can also be traced
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GALL STONE
For Gall stone, Ultrasound is the investigation of choice
For Gall Bladder examination, Preparation of patient is important
Six-8 hour fasting
Gall bladder clearly visualize otherwise it will be contracted
Gall Stone may be single or multiple
Size may be Variable
It may be tiny Sand like
Some time thick Bile appears as stone, known as Sludge
Gall Stone shows bright echogenic shadow within lumen of GB
CA GALL BLADDER WITH METS
PERCUTANEOUS TRANS HEPATIC CHOLINGIOGRAPHY
PTC
GALL STONE IN CBD
SAME PATIENT AFTER REMOVING GALL STONE
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