午安

泌尿道系統 (GU tract)

KUB: kidney, ureter, bladder
後腹腔的解剖

腹膜

Renal capsule

Gerota’s fascia
 1
2
3

1. Anterior pararenal space: 內含胰臟、升降結腸、十二指腸第二

至第四部份
2. Perirenal space (Gerota’s fascia 包圍)：腎臟及腎上腺
3. Posterior pararenal space: 不含器官
腎包膜 (Renal
capsule)下積水
Turbo FLASH
5‘, 15’, 45‘
JG cell
Renin-Angiotensin-Aldosterone (RAA) system

aldosterone BP 升高

Angiotensin II
Converting enzyme (lung)

Angiotensin I
血量減
renin 少、血
JG cell 壓低
Angiotensinogen (liver)
Page kidney
Stretching of
intrarenal vessels---
RAA activation
 腎臟常見的腫瘤
惡性：
– RCC (renal cell carcinoma)：腎細胞癌
– TCC (transitional cell carcinoma)：移型細胞癌
良性：
– Angiomyolipoma (hamartoma)
Renal cell carcinoma
Transitional cell carcinoma
(TCC)
老年人，男較女多，與抽煙有關
膀胱癌多半也是TCC
APN
急性腎絲球腎炎
APN
急性腎絲球腎炎
 腎上腺疾病
Hyperplasia
Tumor
– Binign: adenoma (都從皮質來)
Cushing, Conn’s
– Malignant
Adenocarcinoma
pheochromocytoma
 腎上腺肥大
腦下垂體—ACTH
--- 腎上腺皮質
Adrenal adenoma: Cushing or Conn
syndrome

Cushing:
cortitosteroid

Conn’s:
aldosterone
Pheochromocytoma:
Epi/NE
GIT radiology
Radiological anatomy of GIT
Esophagus
Stomach: fundus, body, antrum, LCS,
GCS
Duodenum: 1st to 4th portion
Small intestine: jejunum a LUQ, ileum at
RLQ
Colon: cecum, appendix, AC, TC, DC,
SC, rectum
 Contrast medium

Barium sulfate
Gastrographin
Double contrast: barium and air
 Barium study for the GIT
Esophagogram
UGI series
Hypotonic duodenogram
Small bowel series
Barium enema
defecogram
 解剖上的 UGI and LGI

UGI: esophagus, stomach,

duodenum
LGI: jejunum, ileum, colon
 申請單上的 UGI and LGI
UGI series
Small bowel series
LGI series
Ulceration
1. Ulcer niche
2. Hampton’s line:
1-2 mm translucent line

Hampton
Benign ulcer,
Niche, cratus
Hampton’s line
spasm
 Filling defect

Polyp
Apple-core lesion:
annular filling
defect
Filling defect
Filling defect: polyp
 polyp
1. Sessile vs Pedunculated
2. Size
<1cm - 1% malignant
>2cm - 25% malignant
3. Surface
smooth vs irregular
Filling defects
again
rigidity
Diseases of Gastrointestinal Tract
Achalasia
– Failure in myenteric
plexus
– Beak-like smooth
tapering of EG junction
– Scleroderma
 Carcinoma of esophagus
Irregular narrowing of
lumen
Esophagobronchial
fistula
Advanced Carcinoma of Stomach

Borrmann’s Classification

Type I. – a non-ulcerated polypoid lesion.

Type II. – an ulcerated, circumscribed, disc-like tumor
with clearly defined sharp margins.
Type III. – an ulcerated tumor that is not sharply
circumscribed.
Type IV. – a diffuse, infiltrative type of gastric cancer
that can involve the entire stomach
Advanced Carcinoma of Stomach

Borrmann’s classification
Borrmann Type I Advanced Carcinoma

a non-ulcerated polypoid
tumor.
Borrmann Type II Advanced
Carcinoma
an ulcerated, circumscribed, disc-
like tumor with clearly defined
sharp margins.
Borrmann Type III Advanced Carcinoma

an ulcerated tumor that is

not sharply circumscribed
lesion
Borrmann Type IV Advanced Carcinoma

diffuse, infiltrative type of

gastric cancer
Polyposis Syndrome

1. Familial polyposis coli

2. Peutz - Jeghers syndrome
3. Cronkhite - Canada syndrome
4. Gardner’s syndrome
5. Cowden’s disease ( Multiple hamartoma
syndrome)
 Peutz-Jeghers syndrome

– Mucocutaneous
pigmentation
– Hamartomatous
polyposis
Submucosal (intramural ) Tumor of Stomach:
gastrointestinal stromal tumor (GIST)

GIST
 Intussusception
Barium study : coil spring appearance
Ulcerative Colitis
Crohn’s disease
 D/D of Crohn’s and UC
Crohn’s disease:
– skip lesion
– Any portion of GIT
– Granulomatous lesion, whole layer
– fistula
UC
– Continuous lesion
– From distal GIT
Colonic polyp
 Familial polyposis
malignant
transformation:
30% by
10years; 100%
by 20years
 Carcinoma of colon

Annular type
– apple-core
Polypoid type

Polypoid
Diverticulum,
diverticulitis