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Term 2 > Abd (Intro. & Liver: Benign Tumors) > Flashcards

Abd (Intro. & Liver: Benign Tumors) Flashcards

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1
Q

Pathology

A

-precise study and diagnosis of a disease

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2
Q

4 Components of Disease

A

1) cause/etiology
2) pathogenesis
3) morphological changes
4) clinical manifestations

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3
Q

Colour Doppler

A
  • apply on any abnormal mass
  • take an image with colour box over the area of interest
  • adjust parameters accordingly
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4
Q

Power Doppler

A
  • more sensitive
  • try using if colour is not readily apparent
  • very motion sensitive
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5
Q

What should a technical impression reporting a pathology include?

A
  • location
  • how many
  • description of pathology (homogenous, hyperechoic, etc.)
  • measurements
  • vascularity colour
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6
Q

Lesion

A
  • lump/bump on skin or solid organ
  • general term describing an abnormality seen on imaging
  • cystic or solid
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7
Q

Nodule

A
  • small mass or rounded or irregular shape
  • benign or cancerous
  • within parenchyma, tendons, muscles or vocal cords
  • called a solid nodule on a cyst wall or septation
  • used to describe thyroid cystic or solid focal areas
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8
Q

Mass

A
  • abnormal growth or tissue resulting from multiplication of cells
  • synonym for tutor or neoplasia
  • may push or displace surrounding tissue or vessels
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9
Q

Consistency (Tumour Characterization)

A
  • solid: might attenuate or no enhancement
  • liquid: posterior enhancement
  • mixed: solid and fluid
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10
Q

Echogenicity (Tumor Characterization)

A
  • hypoechoic
  • hyperechoic
  • anechoic
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11
Q

Echotexture (Tumor Characterization)

A
  • homogenous

- heterogenous

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12
Q

Contour (Tumor Characterization)

A
  • irregular

- smooth margins or well delineated

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13
Q

Tumor Characterizations

A
  • consistency
  • echotecture
  • echogenicity
  • contour
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14
Q

What is a tumors relation to adjacent organs/structures?

A
  • mass affect (pushing or displacing)

- invading (moving into a vein or another organ)

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15
Q

How does vasculature help with tumor characterization?

A
  • fluid filled will show no vascularity
  • solid may show vascularity
  • doppler characteristics
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16
Q

What imaging modality can be used to confirm fat density?

A

CT

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17
Q

Appearance of a Cystic Lesion

A
  • anechoic
  • thin walled
  • through transmission of posterior enhancement
  • may have thin septations or hemorrhage
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18
Q

Benign Characteristics

A
  • no vascularity or peripheral vascularity
  • smooth contour or margins
  • slow growing
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19
Q

Malignant Characteristics

A
  • highly vascular
  • irregular margins
  • bulls eye or halo
  • rapid growth
  • Hx of cancer
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20
Q

What do multiple solid liver masses suggest?

A
  • metastatic or multifocal disease

- may be benign

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21
Q

What can a hypoechoic halo be?

A

-omnious sign

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22
Q

Acute Symptoms

A
  • sudden
  • high pain
  • ex: RLQ could be appendicitis
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23
Q

Chronic Symptoms

A
  • pain on and off
  • long lasting
  • on treatment for other conditions
  • ex. LLQ could be constipation
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24
Q

Secondary Signs

A
  • may not always see the pathology

- look for signs of inflammation (ex. fluid, inflamed fat, increased lymph nodes)

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25
Couinaud's
- evaluation of liver in multiple planes - precise lesion localization - universal - based on portal segments
26
What does each segment of Couinaud's have?
-blood supply (arterial, portal and hepatic venous)
27
Functions of the Liver
- produces proteins - metabolization - stores nutrients (vitamins, minerals, sugars) - produces bile - absorbs vitamins A, D, E and K - produces substances that reduce blood clotting - immunity (removes bacteria from blood)
28
Hepatocytes
-bile duct, portal vein and hepatic artery
29
HA (hepatic artery)
- branch of celiac axis | - supplies liver cells with oxygenated blood
30
PV (portal vein)
- formed by the confluence of the SMV and splenic vein - supplies liver with lymphocytes and RBC's from the spleen and blood from the intestines that needs to be purifies by the liver
31
HV's (hepatic veins)
-drain blood from the liver into the IVC (returns deoxygenated blood to the cardiopulmonary system for rejuvenation)
32
Which structure separates the LLL and LML of the liver?
-Lt intersegmental fissure
33
Which structures lie with the Lt intersegmental fissure?
Cranially- LHV Mid- ascending LPV Caudally- ligamentum teres
34
The HV's are visualized when scanning which portion of the liver?
-superior
35
What does the MHV separate?
-anterior RL and medial LL
36
What borders each side of the RHV?
-anterior and posterior RL
37
What is the name of the capsule surrounding the liver?
-glisson's capsule
38
Why is there a bare area on the liver?
-lacks peritoneum
39
What should the posterior Rt lobe of the liver measure?
13-17cm
40
Contour of Liver
-smooth
41
Echogenicity of Liver
-hyperechoic
42
Echotexture of Liver
-homogenous
43
Portal venous flow is ______ in direction.
hepatopedal
44
Normal Doppler Flow of HV's
- phasic flow - pulsatile - hepatofugal - 'W'
45
What should be evident in all lobes in the portal and hepatic venous system?
-colour flow
46
Normal Doppler Flow in the HA
- low resistance | - hepatopedal flow
47
Diameter of MPV
-less than 13mm AP
48
What do hepatocytes contain?
- bile duct - HA - PV
49
What is produced within a hepatocyte?
-bile
50
What type of blood does the HA supply?
-oxygenated
51
What does the PV supply to hepatocytes?
- wbc's | - returns flow to the liver from the intestines for cleansing
52
Which vein drains old blood back to the HV's?
-central vein
53
Diaphramatic Slips
- invagination of dome of diaphragm - cause of pseudomass (examine is TRV and SAG) - appearance changes with respiration
54
What is associated with diaphragmatic slips?
-diaphramatic muscle bundles that attach the central tendon to the thoracic cage
55
What is normal clotting time?
10-15 sec
56
Prothrombin Time
- enzyme produced by the liver | - production depends on the amount of vitamin K
57
What does prothrombin time elevate with?
- cirrhosis - malignancy - malabsorption of vitamin K - clotting failure
58
What does prothrombin time decrease with?
- subacute/acute cholecystitis - internal biliary fistula - carcinoma of the GB - biliary duct injury - prolonged extra hepatic biliary obstruction
59
Leukocytosis
- high wbc count | - not a disease, but a lab finding
60
What is leukocytosis a sign of?
- inflammation | - infection (includes parasites)
61
Serum Albumin
-decrease in protein synthesis
62
Normal Total Bilirubin
0.3 to1.1 d/L
63
Normal Direct Bilirubin
0.1 to 0.4 d/L
64
What is bilirubin a product of?
-the breakdown of hemoglobin in old rbc's
65
What can a disruption in the bilirubin process cause?
-abnormal levels
66
How does bilirubin give skin a yellow appearance?
-leakage into tissue
67
What does bilirubin reflect?
-balance between production and excretion of bile
68
What is elevation or conjugated bilirubin associated with?
- obstruction - hepatitis - cirrhosis - liver metastases
69
What is elevation of indirect or unconjugated bilirubin associated with?
-nonobstructive conditions (ex. steatosis)
70
Partial Liver Agenesis
- one lobe compensatory hypertrophy normally occurs (if Lt lobe is missing, Rt lobe will be bigger) - compatible with life
71
Situs Inversus Totalis
-liver is found in Lt hypochondrium
72
Congenital Disphramatic Hernia/Omphalocele
-liver may herniate into thorax or outside of abd cavity
73
Benign Hepatic Neoplasms
- incidentally detected in asymptomatic patient - LFT's normal - granulomas - hamartomas - cysts - cavernous hemangioma - FNH (focal nodular hyperplasia) - adenomas - fatty tumors
74
Liver Granulomas
- asymptomatic - appear as calcification within liver parenchyma - may be solitary or multiple - may be related to scarring or an underlying disorder (ex. hepatitis or sarcoidosis)
75
Hamartomas
- small - focal - solid - hypoechoic - benign malformations (cells go haywire and hypertrophy) - less than 6% of population on autopsy - often confused with metastatic disease (CT is needed to clarify) - single or multiple
76
Benign Liver Cysts
- fluid filled space - epithelial lining (lining of tissue) - congenital -cyst may hemorrhage or become infected (pain and fever)
77
What is the cause of benign liver cysts?
-unclear
78
what population are benign liver cysts common in?
-middle aged (2.5% of pop.)
79
What may form in a liver cyst?
-abscess
80
How do abscess' appear?
- internal echoes - septations - thick walls - solid
81
What will happen to a cyst with epithelial lining when drained?
-it will recur
82
Is polycystic kidney disease inherited?
Yes.
83
What % of patients are liver cysts seen in?
57-74%
84
If LFT's are abnormal in cysts, there may be...
- tumor - infection - biliary obstruction
85
What is the most common benign tumor?
-cavernous hemangioma
86
Is cavernous hemangioma more common in males or females?
5x more common in female's
87
Appearance of Cavernous Hemangioma
- hypoechoic - avascular - homogenous or heterogenous - tangle of tiny blood vessels - well circumscribed
88
What may a cavernous hemangioma be followed up by?
- CT | - MRI
89
Blood Flow of a Cavernous Hemangioma
- extremely low | - avascular on US
90
Size of Cavernous Hemangioma
- small - often incidentally found - asymptomatic
91
What is the 2nd most common tumor?
-focal nodular hyperplasia (FNH)
92
Which gender is focal nodular hyperplasia (FNH) more common in?
-women
93
What is a factor of FNH and when is it commonly seen in women?
- hormonal influences - OC use - often seen in childbearing years
94
How is FNH usually found?
- incidentally | - asymptomatic finding
95
Which tumor may exhibit a central scar (vascular formation)?
-FNH
96
Appearance of FNH?
- solitary - isoechoic - well circumscribed - hypervascular, stellate pattern - spoke wheel pattern - contour abnormality of liver surface ay displace vessels
97
Hepatic Adenoma
- seen less commonly than FNH - more common in women linked with OC use - resection is recommended
98
What does hepatic adenoma have a risk of?
-malignant degeneration
99
What symptoms may be present with hepatic adenoma?
- RUQ mass felt (if large) | - bleeding within lesion causes pain
100
Vasularity of Hepatic Adenoma
-hypervascular from periphery
101
Why do hepatic adenomas' appear more heterogenous than other benign liver tumors?
-due to fat, glycogen and hemorrhagic products in the lesion
102
What is the difference between hepatic adenomas arteries and arteries with FNH?
Hepatic Adenomas- multiple HA's, supply from periphery FNH- 1 central HA
103
What else can distinguish a hepatic adenomas from FNH?
-hepatic adenomas may have a capsule (in 1/3 of cases)
104
Fatty Tumors
- rare - asymptomatic - well defined - echogenic
105
What are fatty tumors associated with?
-renal angiomyolipomas
106
What is a classic sign of a fatty tumor?
-broken diaphragm
107
Are we able to distinguish fatty tumors from hemangioma, metastasis or focal fat on US?
No, we need CT to confirm.

Term 2 (19 decks)

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