Ch. 40- Liver and Spleen

Question 1

Ddx for gallbladder edema:

Answer 1

right sided congestive heart failure

portal hypertension

hypoproteinemia

sepsis

anaphylaxis

Question 2

What’s your ultrasonographic description and most likely dx?

Answer 2

Multiple well defined hyperechoic nodules in the spleen. Myelolipomas

Question 3

What is your most likely diagnosis

Answer 3

Acute splenic infarction

Question 4

What’s your dx?

Answer 4

gallbladder edema

Question 5

What are some ddx in a dog with these findings in US?

Answer 5

Lymphoma, MCT, Histiocytic sarcoma

*** disclaimer- there are more ddx… can you nae more ddx? *****

nodular hyperplasia, hematoma, focal extramedullary hematopoiesis, abscess, and infarction

Question 6

Causes of hypoechoic liver:

Answer 6

lymphoma, hepatic congestion, leukemia, amyloidosis, cholangiohepatitis, acute hepatitis

Question 7

Causes of hyperechoic liver:

Answer 7

hepatic lipidosis

vacoular hepatopathies

chronic hepatitis

hepatic cirrhosis

Question 8

What’s your dx?

Answer 8

Emphysematous splenic torsion

Question 9

Causes of generalized hepatomegaly:

Answer 9

Hepatic congestions, steroid hepatopathy, hepatic lipidosis,inflammatory and infiltrative disease, primary neoplasia

Question 10

what part of the spleen is fixed in the left craniodorsal aspect of the stomach?

Answer 10

proximal extremity of the spleen

Question 11

What is your dx?

Answer 11

Dilation of caudal vena cava and hepatic veins

Question 12

Radiographic signs of generalized hepatomegaly:

Answer 12

rounding or blunting of the caudoventral liver margins

extension beyond the costal arch

caudal displacement of the gastric axis

Question 13

Causes for focal hypoechogenicity in the liver:

Answer 13

Cysts, abscesses, primary or metastatic neoplasia, hematomas, granulomas, nodular hyperplasia, and focal extramedullary hematopoiesis

Question 14

In cats, gallbladder wall thickness should be:

In dogs, gallbladder wall thickness should be:

Answer 14

<1mm or not visualized at all

1-2mm

Question 15

What’s your dx?

Answer 15

Cystic mucinous hyperplasia

Question 16

What is your most likely dx?

Answer 16

Metastaic neoplasia due to the target lesion in the spleen

Question 17

Mineral opacities can occur in the hepatic parenchyma or biliary system. Give possible causes for mineralization of bith liver and biliary system.

Answer 17

liver- dystrophic calcification of hepatic granulomas, abscesses, hematomas, neoplastic masses or areas of necrosis

biliary tree- choleliths, gall bladder carcinoma, cholecystitis or cystic mucinous hyperplasia

Question 18

What is your dx?

Answer 18

GB mucocele w/ GB wall rupture

(Gallbladder mucocele is an accumulation of nondependent sludge, semisolid mucus, and inspissated bile, creating an intraluminal centralized echogenicity with peripheral striations, creating a stellate appearance)

Question 19

Most common cause of extrahepatic biliary obstruction in the dog:

Answer 19

Pancreatitis is one of the most common causes of extrahepatic biliary obstruction in the dog, with neoplasia of the liver, bile duct, pancreas, or duodenum also capable of causing obstruction

Question 20

Thickening of the gallblader wall indicate:

Answer 20

Thickening of the gallbladder wall is a nonspecic sign found with primary gallbladder inflammation or neoplasia, or secondary to systemic diseases that have a secondary effect on the gallblad- der wall.

Question 21

What’s your dx?

Answer 21

There is an irregular focal radiolucency in the midportion of the liver due to hepatic abscessation secondary to hepatic carcinoma (other ddx include necrosis of the liver, gas producing bacteria)

Question 22

What is the structure that the white arrow is pointing at? What could this structure represent?

Answer 22

Target lesions. They represent metastatic disease.

Question 23

What is your dx?

Answer 23

Cholangitis

Question 24

What’s your dx?

Answer 24

Gallbaldder wall thickening secondary to potential cholycystitis

Question 25

What's your dx?

Answer 25

dilation of CBD

Question 26

What's your dx?

Answer 26

Cholelith

Question 27

Causes of diffuse splenomegaly:

Answer 27

Considerations for diffuse splenomegaly are numerous and include inflammation caused by infection with toxoplasmosis, fungal organisms, Mycoplasma haemofelis, ehrlichiosis, hyperplasia (e.g., hemolytic disorders), systemic lupus erythematosus, chronic bacteremic disorders, congestion (e.g., from impaired venous drainage), portal hypertension, splenic torsion/ infarction, anesthetic drugs, and infiltrative disease (e.g., primary (Lymphosarcoma, leukemia, systemic mastocytosis, multiple myeloma, and malignant histiocytosis) and metastatic neoplasia, and extramedullary hematopoi- esis), splenic torsion

Question 28

True or False. Portal veins are smoothly tapering vessels characterized by bright, echogenic borders.

Answer 28

True

Question 29

Normal CBD diameter in cats is: Normal CBD diameter in dogs is:

Answer 29

\<4mm 3mm or less

Question 30

What is the most common primary hepatic tumor in dogs? what could be other examples of primary tumors?

Answer 30

hepatocellular carcinoma other examples include: cholangiocarcinoma, neuro endocrine tumor, and histiocytic sarcoma

Question 31

Treu or False. In US the liver is usually hyperechoic to the spleen. Why?

Answer 31

False. Liver is usually hypoechoic to the spleen

Question 32

Is the liver enlarged? why or why not?

Answer 32

The liver is not enlarged. This is a cat w/ pleural effusion and the thorax is overexpanded which results in caudal displacement of the diaphragm and liver

Question 33

Is this a normal or abnormal finding?

Answer 33

Normal liver. Normal finding in young dogs and cats

Question 34

Causes of diffuse splenomegaly:

Answer 34

Extramedullary hematopoiesis, splenic congestion, phenothiazines (phenobarb), diffuse neoplastic infilatration (lymphoma, MCT, histiocytic sarcoma), splenitis ( due to fungal- histoplasmosis in cats)

Question 35

When is splenomegaly considered in the cat in rads?

Answer 35

Splenomegaly in the cat is considered if the distal extremity is visible on the lateral projection of the abdomen.

Question 36

What are target lesions?

Answer 36

Focal masses with a hyperechoic center and hypoechoic periphery \*\*\*but they have been reported with benign disease processes\*\*\*

Question 37

Ddx splenic mass:

Answer 37

Include benign and neoplastic conditions. Primary and metastatic neoplasia, hematoma, nodular hyperplasia, extramedullary hematopoiesis, and abscess are all considerations.

Question 38

The spleen has no absolute size limits in the dog. The normal feline spleen is less variable in size than the dog, and objective measurements have been determined what?

Answer 38

to measure no more than 0.1 cm in the transverse plane

Question 39

What's your dx?

Answer 39

A. hypoattenuating mass in the liver located in the left lateral lobe (most likely primary neoplasia-hepatocellular carcinoma) B. multi focal hypoattenuating nodules in the liver and gall bladder edema (most likely metastatic dz)

Question 40

What's your dx and main ddx? This is an image of the liver.

Answer 40

ehogenic shadows and reverberation artifacts in the liver. The cause of these reverberation artifacts is due to gas. Possible ddx: abscessation or necrosis

Question 41

What's your dx?

Answer 41

Splenic torsion \*\* gas can be also noted in splenic torions\*\*

Question 42

What are some nonpathologic conditions that can result in extension of hepatic margins beyond the costal arch

Answer 42

overexpansion of the thorax or deep inspiration older dogs and cats can have stretching or elongation obese patients some brachycephalic and chondrodystrophic breeds neonatal patients

Question 43

What modalities you can use to detect PSS?

Answer 43

US CT MRI Nuc Med

Question 44

What's your dx?

Answer 44

Multiple hypoechoic nodules in the liver giving a honeycomb appeatance (hepatocutaneous syndrome)

Question 45

How to calculate GB volume in cats and dogs:

Answer 45

Height x width x length x 0.52= \_\_\_mL Dogs 1mL/kg Cats 2.4mL regardless of the weight

Question 46

How to calculate the proper contraction and function of GB in dogs:

Answer 46

1) 12 hr fast 2) calculate GB volume 3) feed that dig 4) wait 2 hrs 5) calculate GB volume 6) find the difference between the 2 values. This should be ~25% or greater.