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abdomen 2 (Gastrointestinal Tract (Colorectal carcinoma (CT morphology…
abdomen 2
Gastrointestinal Tract
Colorectal carcinoma
- The commonest malignant tumor of the gastrointestinal tract and the second commonest malignant tumor in men and women
- The peak incidence is between 50 and 70 years of age
- The predominant histological type is adenocarcinoma (70%), followed by mucinous carcinoma (20%) and anaplastic carcinoma
- Approximately 90% of all colorectal carcinomas arise from polyps
CT
- show an exophytic, polypous type of growth with frequent central degeneration, and they tend to infiltrate the bowel wall
- More than 50% of colorectal carcinomas occur the rectum and sigmoid colon
- Regional lymph node metastases involve the pericolic and perirectal nodes
- Potential complications of colorectal carcinoma includes: bowel obstruction, perforation, hemorrhage, fistula formation
CT morphology
- Focal or circular wall thickening
- or intramural masses that show enhancement with intravenous contrast
- CT colonography is indicated to detect additional lesions proximal to a stenotic primary that cannot be passed by the endoscope
Bowel perforation
- CT is more sensitive than plain film radiography for the detection of a small pneumoperitoneum and unsuspected gastroduodenal perforation
- Perforation can be result of an injury (seat belt, steering wheel or iatrogenic) or an intrinsic lesion (Crohn’s disease, diverticulitis)
- Perforation of the jejunum, ileum or colon may cause substantial amounts of intra-abdominal free air
Bowel obstruction
- In mechanical bowel obstruction, dilated bowel loops with gas-fluid levels are seen proximal to the obstruction
- CT usually provides more detailed information of the cause (e.g. adhesions, tumor) and location of the obstruction
Gastric ulcer
- The peptic ulcer disease is encountered more frequently in males (M:F 3:1)
- Usually in the older population
- Risk factors include: Helicobacter pylori infection, NSAIDs, corticosteroid
Ulcerative Colitis
- An inflammatory bowel disease which predominantly affects the colon
- Typically ulcerative colitis manifests in young adults (15-40 years of age) and is more prevalent in males
- X-Ray: a mural thickening with thumbprinting
Colonic diverticulosis
- Is very common in westernised countries
- Typically found in older individuals
- At 40 years of age, approximately 5% of the population have diverticula
- At 60 approximately 30%, increasing to 50-80% by the age of 80
KIDNEY
Cyst
- frequency increases with age detected with CT or US exam
- well-marginated anechoic lesion with thin walls
- a few thin septa may be present (5% of cysts)
- a small amount of intracystic hemorrhage/debris may be present, and may require further evaluation (5% of cysts)
Stone
- Most patients tend to present between 30-60 years of age
- incidence is high, seen in as many as 5% of women and 12% of males
- The most common stone is calcium oxalate (75%)
Angiomiolipoma (AML)
- A type of benign renal neoplasm and are composed of vascular, smooth muscle and fat elements.
- They can spontaneously haemorrhage, which can be fatal
- Age of presentation: 43 years
- A strong female predilection
Cancer
- Renal cell carcinomas (RCC)
Usually occur in 50-70 year-old patients
Macroscopic haematuria occurs in 60% of the cases
A moderate male predilection of 2:1
Hydronephrosis
- Dilatation of the urinary collecting system of the kidney
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