Pathology

• gallstones (cholelithiasis)


  cholesterol stones (75%) and pigment stones; higher incidence with family hx, over 40 yrs, excess weight, and female gender, caused by insufficient bile salts in proportion to cholesterol
• acute cholecystitis


  inflammation of the gallbladder, 95% of cases are due to obstruction of the cystic duct by a gallstone, US or Nuc Med scanning are used- shows a distended gallbladder containing stones
• emphysematous cholecystitis

  rare, gas-forming organisms in the gallbladder caused by cystic duct obstruction, can cause is ischemia of the gallbladder, most common in elderly males with uncontrolled diabetes mellitus, radiographic appearance- gas bubbles or streaks in the gallbladder
• treatment of cholecystitis

  no treatment if patient is asymptomatic; lithotripsy, ERCP, and chemical dissolution; most common is laparoscopic cholecystectomy
• porcelain gallbladder

  extensive calcification in the gallbladder wall; chronic cholecystitis causes loss of wall function, results in fibrotic and calcified gallbladder
• liver


  largest gland in the body and responsible for several vital functions; detoxification of the blood,secretes about 1 pint of bile a day, metabolizes proteins, fats and carbohydrates, site of synthesis of the enzymes necessary for various cellular activities, synthesis of clotting factors = fibrinogen and prothrombin, aids in maintaining adequate blood glucose levels, storage for glycogen, iron, and vitamin A, B12 and D
• hepatitis


  most prevalent inflammatory disease of the liver, caused by viral infections or reaction to drugs and toxins, treatment: prevention including using standard precautions
• hepatitis A


  from oral or fecal contant
• hepatitis B


  exposure to contaminated blood, blood products, sexual contact
• hepatitis C

  contracted by blood transfusion or sexual contact
• hepatitis E


  by ingestion of food or water that is contaminated with fecal material
• cirrhosis of the liver


  chronic destruction of liver cells and structure; end stage liver disease; major cause is chronic alcoholism
• radiographic appearance of cirrhosis of the liver

  fatty liver shown on CT or US as well as multiple micronodules or micronodules; splenomegaly and esophageal varices as a result of increased pressure in the portal vein; characteristic symptom is ascites
• hepatocellular carcinoma


  primary liver cell carcinoma most commonly occurs in patients with an underlying hepatocellular disease; symptoms range from RUQ discomfort, weight loss and obstructive jaundice to hemorrhagic shock from intraperitoneal bleeding
• radiographic appearance of hepatocellular carcinoma

  CT is the modality of choice for diagnosis; tumor appears as a large mass with attenuation value similar to normal liver tissue
• hepatic metastases


  the most common malignant tumors involving the liver
• radiographic appearance of hepatic metastases

  CT and MRI demonstrate the best; US and nuc med can be used also, but are less sensitive
• pancreas


  controls the blood glucose levels by secretion of insulin and glucagon; secretes pancreatic enzymes into the duodenum for the digestion of proteins, carbohydrates and fats
• acute pancreatitis


  inflammatory and necrotic process where the organ attacks itself; most common cause is alcohol consumption; symptoms are severe, steady abdominal pain, and sometimes jaundice
• radiographic appearance of acute pancreatitis

  KUB normal appearance, unless an ileus is present; CT shows enlargement of the pancreas and peripancreatic fat
• chronic pancreatitis


  occurs when injury to the pancreas causes increasing damage that produces scar tissue; may result in inability to produce digestive enzymes, insulin, and glucagon; 3 classic symptoms are pain, malabsorption causing weight loss, and diabetes
• radiographic appearance of chronic pancreatitis

  pancreatic calcifications develop in 1/3 of these patients; ductal dilation and atrophy can also be seen on CT and US
• pancreatic pseudocyst


  loculated fluid collections as a result from inflammation, necrosis, or hemorrhage
• radiographic appearance of pancreatic pseudocyst

  has a shaggy lining surrounded by dense white scar tissue. Large cysts can be seen on radiographs when they displace bowel; US echo free structures with a sharp posterior wall; CT sharply defined fluid collection, best seen after injection of contrast
• cancer of the pancreas


  most common malignancy of the pancreas is adenocarcinoma; 60% occur in the head of the pancreas
• radiographic appearance of cancer of the pancreas

  US is often the screening tool used, but small lesions or lesions in the tail are difficult to detect; US is the most affective modality for detection
• pneumoperitoneum


  free air in the abdominal cavity; abdominal pain and tenderness; usually a result of perforation of a gas containing structure
• radiographic appearance of pneumoperitoneum

  as little as 1 cc of free peritoneal gas can be seen on images; patient is in upright position, gas will collect under the diaphragm
• spleen


  largest lymphatic organ in the body; functions to filter blood the same way that lymph nodes filter lymph; remove old and damages RBCs from the blood; reservoir for blood
• enlargement of the spleen

  splenomegaly is associated with many conditions including infections, hemolytic anemia, hemoglobinopathies, and portal hypertension
• radiographic appearance of enlargement of the spleen

  KUB- shows the inferior border well below the costal margin; CT can differentiate between a mass that is palpated vs and enlarges spleen. Can show associated lymph node enlargement
• rupture


  usually caused by trauma; large loss of blood in the peritoneum requires surgery immediately; CT is the best imaging modality to demonstrate