This document summarizes common focal liver lesions that can be seen on multiphasic CT scans. It describes key features of benign lesions such as hemangioma and focal nodular hyperplasia as well as malignant lesions including hepatocellular carcinoma, cholangiocarcinoma, and metastases. Characteristics of each lesion like appearance on different phases of CT and other modalities like MRI are discussed. Differential features between lesions are also provided to aid in diagnosis.
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
Purpose of this presentation is to educate non radiologist about basic CT anatomy of abdominal viscera and basic interpretation of very common diseases
Radiology Spotters collection by Dr Pradeep. Nice collection Radiology spotters mixed collection ppt made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks
Hepatobiliary system radiology revision notesTONY SCARIA
hepatobiliary system
hepatic segments
image based questions
last minute revision
radiology radiodiagnosis
hepatic investigations
based image based questions f
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
Purpose of this presentation is to educate non radiologist about basic CT anatomy of abdominal viscera and basic interpretation of very common diseases
Radiology Spotters collection by Dr Pradeep. Nice collection Radiology spotters mixed collection ppt made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks
Hepatobiliary system radiology revision notesTONY SCARIA
hepatobiliary system
hepatic segments
image based questions
last minute revision
radiology radiodiagnosis
hepatic investigations
based image based questions f
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
SHORT TALK ABOUT DIFFERENTIAL DIAGNOSIS ABOUT SOLID RENAL MASS , COMMON AND LESS COMMON CAUSES WITH CLUES TO DIAGNOSIS AND SOME EXAMPLES
HOPPING YOU LIKE IT
DR HISHAM ALKHATIB
CONSULTANT RADIOLOGIST
Learn Barium Meal & Follow Through for the beginners from a Radiology Resident.For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
Learn Chest X-Ray With Its Normal Positioning & Radio-AnatomyDr.Santosh Atreya
Learn Chest X-Ray With Its Normal Positioning & Radio-Anatomy..For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
This is a powerpoint(case presentation) for radiology and imaging resident.There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
5. Understanding the phases
Liver has dual blood supply.
Normal parenchyma is supplied for 80% by
portal vein & only for 20% by hepatic artery.
All liver tumors get their blood supply from
hepatic artery.
6. Arterial phase
20-40sec
Hypervascular tumors
enhance via the hepatic
artery, when normal liver
parenchyma does not yet
enhance, because contrast
is not yet in the portal
venous system.
Hypervascular tumors
enhance optimally at 35
sec after contrast injection.
Hypervascular lesions
• Benign:
Hemangioma
Adenoma
FNH
• Malignant:
HCC
Metastases(RCC,carcinoi
d,thyroid
ca,NET,sarcoma)
7.
8. Portal venous phase
Normal liver parenchyma enhances in this phase.
To detect hypovascular tumors(more common, majorities are
metastases).
Scanning is done at about 75 seconds.
Delayed/equilibrium/washout phase
Begins at about 3-4minutes after contrast injection &imaging
is best done at 10 minutes.
Valuable for washout of contrast (HCC), retention of contrast
in blood pool (hemangioma) & retention of contrast in fibrous
tissue (capsule of HCC, central scar of FNH).
9.
10. HEMANGIOMA
• Commonest benign hyper vascular liver tumor.
• Is composed of multiple vascular channels
lined by endothelial cells.
• Usually asymptomatic & frequently diagnosed
as an incidental finding on imaging.
• More common In female.
• Size varies from a few mm to more than 10 cm
(giant hemangioma).
• Calcification is rare & seen in <10%, usually in
the central scar of giant hemangioma.
11. USG
• Typically well defined, homogeneous & hyper-
echoic lesions(67%-79%).
• May be hypoechoic, within background of
fatty liver.
• Post acoustic enhancement.
• Large lesion-heterogeneous with central hypo
-echoic foci.
12.
13. CT SCAN
• NECT: Well defined low density mass.
• CECT: Diagnostic triad
Discontinuous, nodular, peripheral enhancement
starting at arterial phase & gradual central filling in.
Retention of contrast in delayed phase.
Enhancement must match blood pool in each
phase(similar to aorta in arterial phase , portal vein
in portal venous phase).
14.
15.
16. MRI
• T1WI: Hypo-intense relative to liver
parenchyma.
• T2WI: Significantly hyperintense –producing
light bulb appearance.
• T1C+(GD): Similar to CECT.
17.
18. FOCAL NODULAR HYPERPLASIA
• 2nd most common benign tumor of liver.
• Characterized by a central fibrous scar
surrounded by nodules of hyperplasic
hepatocytes & small bile ductules.
• More prevalent in women of reproductive age
& associated with OCP use.
• Usually solitary(95%).
• No capsule.
• Asymptomatic.
19. USG
Subtle iso-echoic mass with contour abnormality.
Displacement of vascular structure.
Central scar- hypo-echoic linear or stellate
area, may be hyper-echoic.
Doppler study: well developed peripheral &
central blood vessels are seen.
20.
21. CT SCAN
• NECT: Homogeneous low density mass, often
with a central low density (central scar).
• CECT: lesion enhance markedly & uniformly in
arterial phase with exception of central scar.
• Isodense to normal liver parenchyma in PVP.
• Contrast accumulates within the central scar
in delayed phase.
22.
23.
24. MRI
• T1WI: Iso-intense to normal liver
parenchyma.
• T2WI: Iso to slightly hyper-intense.
• Central scar is hypointense inT1WI &
hyperintense in T2WI.
• T1C+(GD): Similar to CECT.
25.
26. HEPATIC ADENOMA
• Consists of hepatocytes arranged in cords.
• Lacks of portal tracts, hepatic vein, kupffer cell &
biliary canaliculi. Fat & glycogen rich hepatocytes
are often present.
• Most common in women, with H/O OCP or
anabolic steroid.
• Usually solitary.
• Central hemorrhage/necrosis.
• Thin capsule.
• Association: type 1 glycogen storage disease.
• Complication: potential for rupture & may result
hemoperitonium , risk of malignant
transformation.
27. USG
• Nonspecific
• The echogenecity may be iso, hypo , hyperechoic
or mixed.
CT SCAN:
NECT: low attenuation mass (fat, glycogen), high
density if hemorrhage present.
CECT: early peripheral with centripetal
enhancement, no retention of contrast in
later phases because of AV shunting .
28.
29.
30. MRI
• T1WI: mildly increased signal intensity( fat &
hemorrhage).
• T2WI: heterogeneous with iso, hypo &
hyperintense areas.
• Capsule-hypointense rim.
• T1C+(GD) : similar to CECT.
31.
32. HEPATOCELLULAR CARCINOMA(HCC)
Commonest primary malignant neoplasm of liver.
Consists of abnormal hepatocytes arranged in a
typical trabecular pattern.
May be solitary, multiple nodules or diffusely
infiltrating.
Alpha- fetoprotein levels are elevated.
80% of HCC occur in cirrhotic liver.
There is propensity toward venous
invasion(PV>HV).
33.
34. USG
Variable in appearance.
Small <3 cm usually hypoechoic.
A thin ,peripheral hypoechoic halo( fibrous
capsule).
Larger tumors often are heterogeneous
(necrosis,hge & fibrosis).
May invade the portal & hepatic veins.
Most tumor will show central vascularity on
Doppler study.
35.
36. CT SCAN
NECT: large hypodense mass, often with
central area of low attenuation(necrosis).
May be isodense to liver.
CECT: non necrotic area enhances strongly in
arterial phase & early washout in subsequent
phases.
Detection of venous invasion (portal,hepatic
veins,IVC).
37.
38.
39.
40. MRI
• T1WI : variable (fatty
change, internal
fibrosis,hge)
• T2WI : hyperintense
• Capsule : hypo in T1
&T2WI
• CEMR : similar to CECT
41. HCC RNs DPNs
NECT Hypo/ isodense Iso to liver except
siderotic nodule
Hypo to liver but
may be iso or hyper
CECT Early enhancement
in arteial phase &
early washout in
later phases.
Same as liver
parenchyma
Low grade- same as
liver parenchyma
High grade- early
enhancement in
arterial phase but
not early wash out
in delayed phase..
T1WI LOW SI variable High SI
T2WI High(mild to
moderate) SI
Iso/low SI iso/low SI
DWI Restricted diffusion no no
42. • Hepatocellular carcinoma and regenerative nodule.
• T1WI MRI (A) and T2WI MRI (B) demonstrating a
hepatocellular carcinoma (white arrowhead) and an
adjacent atypical regenerativenodule (black
arrowhead).
43.
44. FIBROLAMELLAR CARCINOMA
• Histologic subtype of HCC.
• Found in young adults & adolescents.
• No coexisting liver disease.
• The serum AFP levels are usually normal.
• The prognosis is better compared with HCC.
• Hemorrhage & necrosis –rare.
• A fibrous central scar may present.
• Calcification is common(within the scar in stellate
pattern).
45. USG
• Echogenecity of FLC is variable.
• Puncate calcification & central echogenic scar.
• CT SCAN:
• NECT: well defined ,low density mass with a
more low attenuating central scar.
• CECT: moderate enhancement of the lesion
with delayed enhancement of scar.
46.
47.
48.
49. MRI
• T1WI: Isointense to normal liver.
• T2WI: iso to slightly hyperintense.
• Lac of hemorrhage & necrosis.(HCC-
common).
• Central scar is hypointense in both T1WI &
T2WI due to its fibrous nature.(FNH)
50.
51.
52. HCC FLC
Risk factor Occur in cirrhotic liver Normal liver
Age Old Age Young adult
S.AFP Elevated Normal
Central scar Less common More common
Hemorrhage, necrosis more less
Calcification
Portal vein thrombus
Less common
More common
More common
Less common
53. INTRAHEPATIC
CHOLANGIOCARCINOMA
• An adenocarcinoma, originates in small
intrahepatic ducts.
• 10% of all cholangiocarcinoma.
• Usually large, firm masses with abundant fibrous
tissue. Desmoplastic reaction is prominent.
• Age: 7th decade. M>F.
• Increased incidence- carolis disease, sclerosing
cholangitis, IH calculi & IBD.
• A normal Serum AFP may be helpful in suggesting
ICCA rather than HCC.
55. CT SCAN
• NECT: well defined round to oval hypo dense
mass.
• CECT: typically shows early peripheral
enhancement. Centre of the tumor remains
no enhanced (abundant fibrous stroma).
• In delayed phase centre of the tumor is
enhanced.
• Capsule retraction and biliary dilatation
adjacent to mass is highly suggestive of ICCA.
56.
57.
58. MRI
• The tumour is hypointense on T1WI &
hyperintense on T2WI with an irregular
contour.
• Strongly hypeintense areas on T2WI- necrosis.
• DWI: peripherally hyperintense target
appearance.
• CEMRI is similar to CECT.
59.
60.
61. HCC IHCC
Pathology Soft tumor(lack of stroma) Hard mass(abundant
fibrous tissue)
Risk factor Cirrhosis, alcoholism Sclerosing cholangitis
carolies disease,IBD
Hge & necrosis Common rare
Capsular retraction Less common Common(fibrosis)
Vascular invasion common Less common
NECT Hypodense Homogenous hypodense
CECT Early enhancement(Arterial
phase),
early washout( later
phases).
Heterogeneous minor
peripheral enhancement
with gradual enhancement
centrally.
62. hemangioma ICCA metastasis
age Any age Older age(7th
decade)
Older(but can occur
any age)
sex F M M=F
MRI(T2WI) Iight bulb
appearance
Hyperintense Variable
Cystic—light bulb
Post contrast Nodular peripheral
enhancement
Mild heterogenious
peripheral
enhancement,exce
pt central scar
Peripheral rim like
enhancement
Bile duct invasion no common Less common
Capsular retraction No common No
63. Metastases
• Liver is the most common site of metastasis.
• Usually multiple.
• Majorities are hypovascular (GI tract,lung
breast& head,neck tumour, lymphoma).
• Hypervascular metastasis are less .(NET, RCC,
carcinoid, sarcoma, melanoma).
• Calcified metastases are uncommon( colon,
stomach, breast,melanoma).
• Cystic meatstases occur from mucinous ca of
ovary, colon, sarcoma, melanoma).
66. CT SCAN
• NECT: Typically hypodense, may be iso or
hyperdense, cystic, mixed,calcified.
• CECT: Enhancement is typically peripheral in
arterial phase & washout in delayed phase.
67.
68. MRI
• Variable but usually most metastatic nodules
are hypointense on T1W & hyperintense on
T2WI.
• High signal intensity in T1WI- mets from
melanoma, ca colon.
• Higher signal on T2WI- mets with liquifective
necrosis.
• CEMRI: variable.