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Year 1/2 > Elimination & Detox 2: Hepatobiliary Imaging > Flashcards

Elimination & Detox 2: Hepatobiliary Imaging Flashcards

1
Q

what are the 5 things we look at when evaluating the LIVER under RADIOGRAPHS?

which is MOST IMPORTANT? (*)

A
  1. SIZE (*)
  2. SHAPE
  3. MARGINATION
  4. RADIOPACITY
  5. LOCATION
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2
Q

how do we diagnose HEPATOMEGALY on RADIOGRAPHS? (3)

A
  1. the liver SHADOW is EXTENDING CAUDAL TO COSTAL ARCH
  2. GASTRIC AXIS of the stomach is CAUDODORSALLY DISPLACED
  3. MARGINS of the liver are ROUNDED
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3
Q

if there’s GENERALIZED HEPATOMEGALY with SMOOTH MARGINS, what are 6 DDxs?

A
  1. VENOUS CONGESTION
  2. DIFFUSE NEOPLASIA (LSA is very common)
  3. CUSHING’S
  4. DIABETES MELLITUS (fat accumulates in liver)
  5. HEPATIC LIPIDOSIS
  6. HEPATITIS/infection
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4
Q

when determining what KIND of hepatomegaly, how do we DIFFERENTIATE?

A

GENERALIZED = all over change

FOCAL = only ONE PART is ENLARGED

if GENERALIZED…
1. SMOOTH margins = maintains NORMAL LIVER SHAPE

  1. IRREGULAR margins = disease
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5
Q

what is a COMMON MALIGNANT NEOPLASIA that INFILTRATES THE LIVER?

A

LYMPHOSARCOMA

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6
Q

if there’s GENERALIZED HEPATOMEGALY with IRREGULAR MARGINS, what 5 DDxs?

A
  1. NODULAR HYPERPLASIA
  2. MULTIFOCAL/METASTATIC NEOPLASIA
  3. MULTIPLE GRANULOMAS
  4. MULTIPLE ABSCESSES
  5. HEPATITIS
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7
Q

if FOCAL HEPATOMEGALY, what are the 7 DDxs? which one is the PRIMARY Ddx? (*)

A
  1. NEOPLASIA (*)
  2. ABSCESS
  3. CYST
  4. LIVER LOBE TORSION
  5. HEPATOMA
  6. HEMATOMA
  7. BILOMA
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8
Q

HEPATOMA definition?

BILOMA definition?

associated with WHAT radiographic finding?

A

HEPATOMA = BENIGN LIVER TUMOR

BILOMA = focal BILE ACCUMULATION in CAVITATED PORTION OF LIVER

associated with FOCAL HEPATOMEGALY

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9
Q

how do we diagnose MICROHEPATICA on RADIOGRAPHS?

A
  1. via the GASTRIC AXIS being displaced in the CRANIOVENTRAL DIRECTION
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10
Q

MICROHEPATICA can be normal in… & give one specific example

in these animals, the liver is located…

A

DEEP-CHESTED DOGS, such as GREAT DANES

liver is located TUCKED INTO DIAPHRAGM, but NOT REALLY SMALL, JUST CONFORMATION

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11
Q

if we see MICROHEPATICA in a YOUNGER ANIMAL, what disease should we suspect?

A

PSS from liver NOT GETTING TROPHIC FACTORS FROM PORTAL CIRCULATION

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12
Q

if you see MICROHEPATICA in an OLDER ANIMAL, likely should see WHAT diseases? (1 main, 2 specific)

WHAT should we see on bloodwork?

A

CHRONIC PRIMARY LIVER DZ such as CIRRHOSIS or FIBROSIS

look for SIGNS OF LIVER FAILURE ON BLOODWORK

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13
Q

why CAN’T the BILIARY TREE be NORMALLY ASSESSED ON RADIOGRAPHS?

when CAN we use radiographs to look at BILIARY TREE? (3)

A

has SIMILAR OPACITY TO SURROUNDING LIVER PARENCHYMA

when CAN we use radiographs to look at BILIARY TREE?
1. MARKEDLY ENLARGED GALLBLADDER forms OPACITY AROUND LIVER
2. MINERALIZED MATERIAL IN BILIARY TREE
3. GAS in the BILIARY SYSTEM (PNEUMOBILIA)

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14
Q

EMPHYSEMATOUS CHOLECYSTITIS…

= definition?

what do we see on RADIOGRAPHS?

how is this CONFIRMED?

A

= when there’s GAS in the GALLBLADDER associated with GAS-FORMING BACTERIAL INFECTION

see GAS OPACITY in BILIARY TREE

ABDOMINAL US NEEDED TO CONFIRM

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15
Q

ID lesion & DEFINE IT

A

CHOLELITHIASIS = mineralized material in the GALLBLADDER

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16
Q

ID lesion & DEFINE IT

A

EMPHYSEMATOUS CHOLECYSTITIS = BACTERIAL INFECTION in GALLBLADDER that causes GAS FORMATION

17
Q

HEPATOBILIARY ULTRASOUND…

comparison to biliary rads?

what 7 things can we evaluate?

where do we USUALLY place the probe? (direction & position)

A

gives MORE information than BILIARY RADS

what can we evaluate?
1. SIZE
2. SHAPE of liver margin
3. STRUCTURE of PARENCHYMA
4. ECHOGENICITY of liver
5. VASCULATURE of over
6. BILIARY TREE
7. LYMPH NODES

probe usually oriented in CRANIODORSAL DIRECTION at RETROXYPHOID POSITION

18
Q

describe the DIRECTION & POSITION of this probe

what is it LIKELY being used to evaluate?

A

DIRECTION = CRANIODORSAL

POSITION = RETROXYPHOID

likely used for HEPATOBILIARY US

19
Q

NORMALLY, the liver is ____ECHOIC to the SPLEEN

but if liver is ____ECHOIC to the SPLEEN, it can be due to… (5, give one COMMON & one RARE)

A

NORMALLY, liver is HYPOECHOIC to the LIVER

if liver is HYPERECHOIC to the SPLEEN, then due to..
1. STEROID HEPATOPATHY –> COMMON
2. HEPATIC LIPIDOSIS
3. DIABETES MELLITUS
4. CHRONIC HEPATITIS (infectious or toxins)
5. LYMPHOMA –> RARE

20
Q

use 2 terms to describe liver on the RIGHT

give 5 DDxs!

A

DIFFUSELY HYPERECHOIC LIVER

5 DDxs?
1. STEROID HEPATOPATHY
2. HEPATIC LIPIDOSIS
3. DIABETES MELLITUS
4. CHRONIC HEPATITIS (infectious or toxins)
5. LYMPHOMA

21
Q

use 3 words to describe this liver

give 4 DDxs!

A

DIFFUSELY HYPOECHOIC ENLARGED LIVER

4DDxs
1. ACUTE HEPATITIS/TOXIC hepatitis
2. CHOLANGIOHEPATITIS
3. LYMPHOMA
4. CONGESTION due to RIGHT-SIDED CHF

22
Q

what is a COMMON cause of DIFFUSELY HYPOECHOIC, ENLARGED LIVER?

which cause DIFFUSELY HYPOECHOIC, ENLARGED LIVER is MORE COMMON IN CATS?

A

what is a COMMON cause of DIFFUSELY HYPOECHOIC, ENLARGED LIVER? = LYMPHOMA

which cause DIFFUSELY HYPOECHOIC, ENLARGED LIVER is MORE COMMON IN CATS? = CHOLANGIOHEPATITIS

23
Q

describe this liver (3)

what 2 disease processes can be used to describe this?

A

describe liver…
1. SMALL LIVER MARGINS
2. IRREGULAR, NODULAR SURFACE
3. ANECHOIC EFFUSION secondary to PORTAL HYPERTENSION

2 processes?
1. MICROHEPATICA
2. CIRRHOSIS

24
Q

what diagnostic imaging technique is BEST for FOCAL liver lesions?

what is one DRAWBACK? how do we overcome it?

A

ULTRASOUND

lacks SPECIFICITY, so UNSURE IF IT’S BENIGN OR MALIGNANT; need to do FNA or BIOPSY for further diagnosis

25
Q

what is a CONTRAINDICATION for LIVER BIOPSY/FNA?

A

BLEEDING DISORDERS

26
Q

= gallbladder basic definition

how does it eventually connect to the DUODENUM? (3)

A

= STORAGE organ for BILE which is PRODUCED IN THE LIVER

connection?
1. gallbladder connected to CYSTIC DUCT which drains the LIVER LOBES
2. cystic duct merges with the COMMON BILE DUCT
3. enters DUODENUM at MAJOR DUODENAL PAPILLA

27
Q

describe what the PURPLE ARROW is pointing to & RED CIRCLE

everything UPSTREAM from this lesion is…

A

PURPLE ARROW = STONES (CHOLELITHS)

RED CIRCLE = ACOUSTIC SHADOWING from MINERAL PRESENT (artifact)

everything UPSTREAM from the stones are DILATED, including COMMON BILE DUCT

28
Q

what is this OVERALL structure/pathology in the liver?

2 findings that help confirm this?

A

DILATED INTRAHEPATIC BILE DUCT

2 findings?
1. TUBULAR HYPERECHOIC STRUCTURE
2. WAVY APPEARANCE

29
Q

NAME RED & PURPLE (only one is a normal structure)

A

RED = GALLBLADDER

PURPLE = DILATED CYSTIC DUCT

30
Q

name 4 STRUCTURES

two are PATHOLOGY

A

RED = DUODENUM

PURPLE = DILATED COMMON BILE DUCT

BLUE = PANCREATIC MASS

GREEN = PANCREAS & PANCREATIC DUCT

31
Q

describe OVERALL PATHOLOGY & what we see here

A

CHOLEDOCHITIS

see THICKENING OF WALL OF COMMON BILE DUCT from INFLAMMATION

32
Q

in INFLAMMATION of the BILE DUCT, can often see HYPERECHOGENICITY why?

A

because FAT BECOMES HYPERECHOIC when BILE DUCT INFLAMED

33
Q

name OVERALL CONDITION & RED, GREEN & BLUE structures

A

OVERALL = GALLBLADDER MUCOCELE

GREEN = THICKENED GALLBLADDER WALL

RED = STEATITIS & EFFUSION suggestive of RUPTURE

BLUE = STATIC ECHOGENIC CONTENT WITHIN MUCOCELE

34
Q

what pathology commonly looks like a KIWI FRUIT appearance on ULTRASOUND?

A

GALLBLADDER MUCOCELE

35
Q

what 2 FUNCTIONS does CT have for HEPATIC MASSES? & give 1 for HEPATIC PATHOLOGY?

A

HEPATIC MASSES
1. determine if the mass is SURGICALLY RESECTABLE OR NOT by ASSESSING OTHER STRUCTURES IN THE AREA

  1. ANGIOGRAPHIC STUDY for EMBOLIZATION PLANNING to STARVE NEARBY VESSELS to force mass to SHRINK (if we can’t remove it)

HEPATIC PATHOLOGY
1. ANGIOGRAPHIC STUDY for DIAGNOSIS of VASCULAR ANOMALIES like PORTOSYSTEMIC SHUNTS

36
Q

what diagnostic should we use for DIAGNOSIS of PSS? & give 3 reasons as to why?

A

CT > US

why?
1. FASTER/EASER
2. MORE SENSITIVE & PRECISE
3. can also help EMBOLIZATION TREATMENT PLANNING

Year 1/2 (139 decks)

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