Ch. 40 Liver & Spleen Flashcards
(97 cards)
1
Q
In cats, a larger portion of the liver is left/right-sided
A
right
2
Q
A
3
Q
The hepatic margin may protrude more caudally in the left/right lateral projection.
A
right
4
Q
In which case would the caudoventral liver appear rounded, but not enlarged?
A
oblique projection
5
Q
A
6
Q
A
7
Q
Which breed of dog typically has a smaller liver length ratio?
a) Poodles
b) Pekingese
c) German Shepherds
d) Labradors
A
b) Pekingese
8
Q
What can cause the liver to extend beyond the costal arch without indicating disease?
A
- thoracic overexpansion e.g. deep inspiration
- age (loose triangular ligament with older dogs, neonatal status)
- obesity
9
Q
What are the 2 most common causes of microhepatia?
A
Congenital portosystemic shunt and hepatic cirrhosis
10
Q
A
11
Q
A
12
Q
Linear trails of mineralized opacities extending peripherally within the hepatic parenchyma are indicative of _____________.
A
choledocholiths
13
Q
Are choledocholiths benign/incidental or clinically significant?
A
They are often incidental findings, but choledocholiths can cause biliary obstruction, especially in the cat.
14
Q
Mineralization of the gallbladder wall has been associated with _________________.
A
gallbladder carcinoma,
as well as:
- cholecystitis
- cystic mucinous hyperplasia
15
Q
_______________infection can result in large hepatic soft tissue masses with mineralization of varying patterns and should be considered in endemic areas.
A
Echinococcosis
16
Q
Gas within portal vessels may occur because of _____________, which is often associated with______________.
A
severe necrotizing gastritis or enteritis
gastric dilation and volvulus complex
16
Q
What infection can result in large hepatic soft tissue masses with mineralization in endemic areas?
a) Echinococcosis
b) Coccidioidomycosis
c) Histoplasmosis
d) Tuberculosis
A
a) Echinococcosis
17
Q
A
Lateral (A) and ventrodorsal (VD; B) radiographs of a cat with a large radiopaque cholelith (arrow) and trails of mineralized choledocholiths and pancreatoliths.
18
Q
A
abdomen of a dog with chronic hepatitis that led to microhepatia. There is marked cranial displacement of the stomach
19
Q
______________may be a common predisposing factor for emphysematous cholecystitis.
A
Obstruction of the cystic duct
20
Q
Obstruction of the cystic duct may be a common predisposing factor for _______________.
A
emphysematous cholecystitis
21
Q
In emphysematous cholecystitis, gas bubbles form within _____ of disease onset.
A) 30-60 min
B) 6-8 hours
C) 1-2 days
D) 5-7 days
E) 2-3 weeks
A
C) 1-2 days
22
Q
T or F: Gas in or around the gallbladder occurs with emphysematous cholecystitis only in diabetic dogs.
A
F; diabetic or non-diabetic
23
Q
When can gas in the bile duct be incidental, in cats?
A
reflux of gas from the duodenum; seen occasionally in cats (incompetent sphincter of Oddi)
24
Which anatomical point is responsible for keeping duodenal contents from travelling into the bile duct
sphincter of Oddi
25
Causes of hepatic abscess (4)
- necrotic tumour
- ascending infection from portal system
- adjacent infection (e.g. pancreas)
- penetrating wound
26
What are the most common EHPSS?
s-PAC
spleno-Phrenic
spleno-Azygous
spleno-Caval
R gastric-caval
R gastric-caval with caudal loop.
27
When is the arterial phase?
early venous / portal?
delayed / equilibrium?
A: 13-20s
early V: 30-40s
delayed: 120s
28
Appearance of hepatocellular carcinomas through multiphase study?
Heterogenous contrast in all phases, hypoattenuating to normal liver in portal and delayed phase (NOT IN ARTERIAL)
29
30
Appearance of hepatic metastases through multiphase study?
Homogeneous, and hypoattenuating to normal liver in ALL phases (arterial, portal, delayed)
30
Appearance of benign hepatic adenomas through multiphase study?
diffuse arterial enhancement which persists in portal phase
30
How do metastases and hepatocellular carcinomas differ through multiphase study (contrast enhancement)?
In early phase, HCC is not hypoattenuating to liver (whereas mets are); HCC is has heterogenous enhancement, mets have homogenous.
31
Appearance of hepatic nodular hyperplasia through multiphase study?
Homogenous marked contrast in arterial and portal which dilutes to isoattenuation in delayed phase
32
Which is true?
A) Hepatocellular carcinomas are hypoattenuating to normal liver in arterial and venous phases.
B) Benign hepatic adenomas have diffuse enhancement in the portal and delayed phase.
C) Benign hepatic hyperplasia is strongly homogenously enhancing in arterial and portal, but isoattenuates in delayed.
D) Hepatic metastases are homogenously hypoattenuating in the arterial phase, but isoattenuating in the venous phases.
B) Benign hepatic adenomas have diffuse enhancement in the portal and delayed phase.
33
Are CT findings differentiate benign from malignant hepatic lesions based on contrast phase enhancement?
No; too much overlap.
34
35
multiple hypoattenuating nodules are noted throughout the hepatic parenchyma. The gallbladder wall is thickened, with a double layered appearance. Hepatic metastasis secondary to a jejunal carcinoma was diagnosed on necropsy. Gallbladder wall edema was of undetermined etiology.
36
a large, hypoattenuating, lobular mass is present in the left lateral liver lobe. Hepatocellular carcinoma was diagnosed on histopathology post liver lobe resection
36
dog with hepatic abscessation secondary to hepatic carcinoma. An irregular, focal radiolucency is in the midportion of the liver, just to the left of midline (black arrows).
37
How to differentiate hepatic from portal veins on US
Portal veins are smoothly tapering vessels characterized by bright, echogenic borders
37
38
Which direction is hepatic venous blood flow?
towards hilus (from periphery)
39
How do you recognise hepatic arteries on US?
Normal hepatic arteries are not visualized easily without color Doppler examination.
39
Which veins course from the hilus to periphery - portal or hepatic v.?
portal
40
What is the normal gallbladder volume in dogs?
up to 1 ml/kg
41
What is the normal gallbladder volume in dogs?
a) 1 mL/kg or less body weight
b) 2 mL/kg or less body weight
c) 2.4 mL regardless of body weight
d) 3 mL/kg or less body weight
a) 1 mL/kg or less body weight
41
What could the presence of gallbladder sludge indicate in dogs?
a) Normal finding with no clinical significance
b) Gallbladder dysmotility
c) Acute biliary obstruction
d) Chronic liver disease
b) Gallbladder dysmotility
(but usually incidental finding)
42
What is the normal feline gallbladder volume?
2.4 ml
43
Normal thickness of gallbladder wall in cats
<1mm
44
caudate liver lobe and right kidney of a dog with hepatic lipidosis. The caudate lobe surrounds the right kidney completely, consistent with hepatomegaly. The liver is markedly hyperechoic to the renal cortex.
45
Normal thickness of gallbladder wall in dogs
1-2mm
46
What is the significance of a septated gallbladder in cats - congenital or acquired?
Incidental, congenital (abnormal embryonic development)
47
Normal CBD diameter in cats
up to 4mm
48
Normal CBD diameter in dogs
up to 3mm
49
Normal US appearance/size of intrahepatic bile ducts
not visible
50
Common causes for diffuse hyperechoic liver? What is most common in cats?
- Vacuolar hepatopathy e.g. lipidosis (most common in cats, cannot be differentiated from non-pathological hyperechoic liver in some obese cats), steroid hepatopathy,
- Chronic hepatitis with fibrosis, cirrhosis (microhepatica and ascites)
- Lymphosarcoma
- Amyloidosis
- Cholangiohepatitis
- MCT (can also be isoechoic or with hypoechoic nodules)
51
Common causes for diffuse hypoechoic liver? What is most common in cats?
Congestion
Leukemia
Lymphosarcoma
Amyloidosis
Cholangiohepatitis
52
Severe hepatic disease can have a normal US appearance - T or F?
True
53
what is US useful for distinguishing in terms of liver lesions?
cysts from solid masses
54
what's the most common primary canine hepatic tumour? 2nd most common? Other common ones?
1. HCC hepatocellular carcinoma
2. Cholangiocarcinoma
3. neuroendocrine, HSA, histiocytic, lymphosarcoma
55
how much more common are hepatic mets compared to primary neoplasia? From where do they originate?
2.5x
Spleen, GI, pancreas
56
Target lesions are associated with..
malignancy, but can be found in benign processes.
57
Most common primary hepatic neoplasia in cats, and how does it look?
biliary cystadenoma; usually has a cystic component
58
most common MALIGNANT neoplasia in cat livers?
cholangiocarcinoma
59
Nodular hyperplasia will result in which biochemical change?
increased serum alkaline phosphate (ALP)
60
Nodular hyperplasia will commonly result in increases in:
A) ALT
B) ALP
C) AST
D) GGT
B) ALP
61
How might contrast in US help differentiate benign from malignant processes?
At peak contrast, benign processes will be ISO to the normal liver (i.e. behave like normal liver tissue), whereas malignancies will be HYPOechoic. However, you cannot differentiate tumour types.
62
Besides nodular hyperplasia, what else can cause a nodular appearance?
Chronic hepatitis, hepatocutaneous syndrome
63
Hematomas initially are Hyper/Iso/Hypoechoic to the normal liver, then ___, then ___.
HYPER sandwich:
hyper - gas/RBC aggregates
hypo/anechoic
hyper - reorganisation, possible mineralisation
64
Which other organ should you check if you find hepatic cysts?
kidneys - associated with PKD
65
Immobile gallbladder sludge has what sens/spec for bactibilia and cholecystitis?
70% sens / 100% spec
66
causes of GB wall edema
Reasons People Have Swollen .. gallbladders after bee stings (Anaphylaxis)
R-CHF
Pulmonary hypertension
Hypoproteinemia
Sepsis
Anaphylaxis
67
GB wall thickening goes back to normal after underlying disease is fixed - T or F
it can persist
68
Choledocholiths and choleliths - do they cause obstruction or are they caused by obstruction? are they significant?
Both - can cause and be caused. Can also be incidental, but with a potential to obstruct.
69
what percentage of asymptomatic dogs have dependent/mobile GB sludge?
up to 53%
70
To assess bile peristalsis/movement, how long should you wait after feeding, and what amount of reduction/volume should you expect in a normal dog?
1-2 hours, GB volume should be 1ml/kg in dogs, or reduced by >25%
71
Which of the following drugs groups has been reported in Thrall as causing splenomegaly with no associated change in echogenicity
Phenothiazine
Iminipem
Ketoconazole
Selegiline
Phenothiazine
72
What phase of imaging would you get if you performed a CT 30 to 40s after injection of contrast?
Hepatic arterial
Early portal venous phase
Late portal venous phase
Delayed phase
Early portal venous phase
73
What is the normal reported length of the liver using T11 in brachycephalic dogs
4.64
4.98
5.16
5.45
5.16
74
Which of the following infectious processes is associated with hepatic mineralisation
Leptospirosis
Echinococcosis
Schistosomiasis
Toxoplasmosis
Echinococcosis
75
Which of the following disease processes is not associated with decreased hepatic echogenicity?
Amyloidosis
Hepatic congestion
Leukaemia
Obesity
Obesity
76
Which of the following is best described by the following description (CT imaging): Diffuse enhancement in the hepatic arterial phase, persistent enhancement in the portal venous phase.
Hepatocellular carcinoma
Metastatic lesions within the liver
Benign hepatic adenoma
Nodular hyperplastic lesions in the liver
Benign hepatic adenoma
77
What is the ellipsoid formula for calculating gallbladder volume?
Length x width x height
Length x width x height x 0.24
Length x width x height x 3.14
Length x width x height x 0.52
Length x width x height x 0.52
78
What is the most common diffuse hyperechoic hepatopathy in cats?
Steroid hepatopathy
Hepatic lipidosis
Hepatic fibrosis
Hepatic cirrhosis
Hepatic lipidosis
79
What is the most common primary hepatic tumour in the cat?
Biliary cystadenoma
Cholangiocarcinoma
Haemangiosarcoma
Neuroendocrine tumour
Biliary cystadenoma
80
What is the most common primary hepatic tumour in a dog?
Cholangiocellular carcinoma
Neuroendocrine tumour
Hepatocellular carcinoma
Haemangiosarcoma
Hepatocellular carcinoma
81
Using CEUS, how do malignant nodules usually appear in the liver?
Isoechoic to surrounding normal liver during peak normal liver perfusion
Hypoechoic to surrounding normal liver during peak normal liver perfusion
Hyperechoic to surrounding normal liver during peak normal liver perfusion
Hypointense to surrounding normal liver during peak normal liver perfusion
Hypoechoic to surrounding normal liver during peak normal liver perfusion
82
The most common causes for generalized splenomegaly in a cat are…
FIP
Toxoplasma
Round cell neoplasia (lymphosarcoma and mast cell infiltration)
Mast cell infiltration
Round cell neoplasia (lymphosarcoma and mast cell infiltration)
83
The most common causes of splenic lesions in dogs are…
Haemangiosarcoma and haematomas
Haematomas and hyperplastic nodules
Hyperplastic nodules
Mast cell infiltration
left lateral, usually most caudal
84
In a VD projection of a cats abdomen the liver is usually…
More left sided
More right sided
Symmetrically distributed
More right sided
85
Which of the following has NOT been associated with the gallbladder changes in the image below?
Cystic mucinous hyperplasia
Gallbladder carcinoma
Cholecystitis
Leptospirosis
mineralisation - not in Lepto
86
Hepatic abscess
Hepatobiliary cyst
Hepatocellular carcinoma
Echinococcosis
Echinococcosis
87
What is your top differential for a 6-year-old Burmese cat with raised liver enzymes, pre regenerative anaimia, hepatomegaly with a heterogenous mottled echotexture and a moderate volume echogenic peritoneal effusion?
Hepatic lipidosis
Amyloidosis
Chronic hepatitis
Mast cell infiltration
Amyloidosis, chronic hepatitis less likely to be mottled/heterogenous and have anemia. Also the breed.
88
Which of the following can be enlarged in acromegalic cats?
Liver and pancreas
Kidneys and spleen
Liver and kidneys
All the above
All the above : Liver, Spleen, Kidneys, Pancreas
89
Reticulonodular pattern of the spleen was most marked in dogs or what age?
0-12 weeks
16-24 weeks
28-36 weeks
36-44 weeks
28-36 weeks
90
6.8%, non- neoplastic causes most likely
23.4% non- neoplastic causes most likely
6.8%, neoplastic causes most likely
23.4% neoplastic causes most likely
6.8%, non- neoplastic causes most likely
