sistema digestorio 2
DESCRIPTION
Radiologia do sistema digestivo 2TRANSCRIPT
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SISTEMA DIGESTÓRIO
GLÂNDULAS ANEXAS
DRA PAULA CRISTINA D. DA ROCHA
DRA BRENDA M. RAMOS MARTINES
PROFA. DRA. ILKA REGINA S. OLIVEIRA
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FÍGADO
MÉTODOS :
• ULTRA-SONOGRAFIA
• TOMOGRAFIA COMPUTADORIZADA
• RESSONÂNCIA MAGNÉTICA
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PARÂMETROS AVALIADOS:
Textura do órgão
Dimensões
Contornos
Relação com estruturas vizinhas
Linfonodomegalia
ULTRA-SONOGRAFIA
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INDICAÇÕES:
Doenças difusas / focais
Rastreamento de hepatocarcinoma
Relação com estruturas adjacentes
Fluxo sanguíneo
ULTRA-SONOGRAFIA
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TOMOGRAFIA COMPUTADORIZADA
PARÂMETROS AVALIADOS:
Dimensões do órgão
Atenuação do parênquima
Distúrbios perfusionais
Nódulos
Calcificações
Estadiamento de neoplasias
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RESSONÂNCIA MAGNÉTICA
Melhor sensibilidade para lesões focais
Não utiliza radiação ionizante
Contra-indicação ao uso de meios de
contraste iodados
Estudo vascular e volumétrico
Reconstruções em múltiplos planos
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RESSONÂNCIA MAGNÉTICA
Limitações:
Custo do equipamento
Paciente dependente
Relação custo-benefício deficitária
Tempo longo de exame
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VP-TRONCO
RAMO E
RAMO D
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FÍGADO
LESÕES DIFUSAS
LESÕES FOCAIS
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FÍGADO
LESÕES DIFUSAS
Infiltração gordurosa
Hepatopatia crônica
Doenças de depósito
Infiltração tumoral difusa
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Infiltração gordurosa
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Infiltração gordurosa
Fígado normal
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Hepatopatia crônica - cirrose
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Hepatopatia Crônica
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Hepatopatia crônica - esquistossomose
• Fibrose perivesicular
• Fibrose periportal
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Hepatocarcinoma
Trombose da veia porta
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Hepatocarcinoma
Trombose da veia porta
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Infiltração Metastática
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Infiltração Metastática
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FÍGADO
PATOLOGIAS FOCAIS
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FÍGADO
LESÕES FOCAIS
• Cistos
• Abscesso
• Hemangioma
• Adenoma
• Hiperplasia nodular focal
• Carcinoma hepatocelular
• Carcinoma fibrolamelar
• Metástases
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Cisto Hepático
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Cisto septado - parasitário
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Doença Policística Hepatorrenal
RD
RE
FÍGADO
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Doença Policística Hepatorrenal
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Doença Policística Hepatorrenal
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Cisto complexo - abscesso
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Hemangioma
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Hemangioma
F. PRÉ CONTRASTE
F. PORTAL
F. EQUILÍBRIO
F. ARTERIAL
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Hemangioma
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Adenoma
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Adenoma
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Hiperplasia Nodular Focal
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Hiperplasia Nodular Focal
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Hiperplasia Nodular Focal
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Carcinoma Hepatocelular
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Carcinoma Hepatocelular
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Carcinoma Hepatocelular
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Metástases Focais
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Metástases Focais
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Hemangiomas Atípicos
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Corpo Estranho
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VESÍCULA BILIAR, VIAS
BILIARES E PÂNCREAS
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MÉTODOS
• COLANGIOGRAFIA
• ULTRA-SONOGRAFIA
• TOMOGRAFIA COMPUTADORIZADA
• RESSONÂNCIA MAGNÉTICA
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• Endoscópica retrógrada
• Pelo dreno de Kehr
• Colangio Ressonância
COLANGIOGRAFIA
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INDICAÇÕES - AVALIAÇÃO:
Vias biliares intra e extra hepáticas
Pré, intra e pós-operatória
Posicionamento do dreno
Identificação de cálculos
COLANGIOGRAFIA
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PROCESSOS INFLAMATÓRIOS:
AGUDOS X CRÔNICOS
Colecistopatia aguda
Colecistopatia crônica calculosa
Coledocolitíase
Colangite
Pancreatite aguda
Pancreatite crônica
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COLECISTITE AGUDA CALCULOSA:
• Vesícula hidrópica
• Espessamento parietal
• Bile espessa
• Cálculos
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Colecistite Aguda Calculosa
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COLECISTITE AGUDA:
•Espessamento de parede
•Líquido peri-vesicular
•Distúrbio perfusional
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COLECISTITE AGUDA ENFISEMATOSA
- Espessamento de parede
- Líquido peri-vesicular
- Gás luminal e parietal
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Colecistite Aguda Enfisematosa
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Colecistopatia Crônica Calculosa
USG
TC
RM
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Bile Espessa
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Cálculos
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Coledocolitíase
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Coledocolitíase
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Coledocolitíase
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PANCREATITE AGUDA
CAUSAS
Colelitíase, coledocolitíase ou microlitíase biliar
Abuso da ingestão de álcool
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PANCREATITE AGUDA
PAPEL DOS MÉTODOS DE IMAGEM :
Diagnóstico
Determinar a causa
Estratificação de gravidade
Avaliar complicações
Guiar possíveis punções
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Pancreatite Aguda
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Pseudocisto de Pâncreas
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Pancreatite Complicada
- Necrose cauda pâncreas
- Coleção e gás peri-pancreáticos
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Pancreatite Crônica
- Redução de volume
- Textura heterogênea
- Dilatação do duto pancreático principal
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Pancreatite Crônica
- Calcificações grosseiras
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Duto pancreático principal
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PROCESSOS NEOPLÁSICOS
Vesícula biliar
Pólipos
Adenocarcinoma
Colangiocarcinoma
Neoplasias peri-ampolares
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Pólipo de vesícula biliar
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Adenocarcinoma de vesícula biliar
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Adenocarcinoma de vesícula biliar
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Adenocarcinoma de vesícula biliar
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Colangiocarcinoma
Obstrução biliar proximal (intra-hepática)
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Colangiocarcinoma
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Neoplasia peri-ampolar
- Obstrução biliar distal
- Neoplasia de papila
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Obstrução biliar distal - dilatação das
vias biliares intra e extra-hepáticas
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Neoplasia peri-ampolar
Adenocarcinoma de cabeça de pâncreas
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Neoplasia peri-ampolar
Adenocarcinoma de cabeça
pâncreas
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OUTRAS NEOPLASIAS
PANCREÁTICAS
SÓLIDAS
Linfoma
Insulinoma
CÍSTICAS
Macrocístico
Microcístico
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Insulinoma
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Linfoma Pancreático
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NEOPLASIAS PANCREÁTICAS CÍSTICAS
Benignos
Adenoma microcístico
Adenoma macrocístico mucinoso
Malignos
Cistoadenocarcinoma mucinoso
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Adenoma Microcístico
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Cistoadenocarcinoma Mucinoso
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GIST simulando neoplasia de pâncreas
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Cisto de adrenal simulando pseudocisto pancreático
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Ascaris em vesícula biliar