chapter 10 Flashcards by Harley Schemenauer

Affects the hepatocytes and interferes with liver function..

Diffuse hepatocellular disease

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Is a parenchymal liver cell that performs all the functions ascribed to the liver.

Hepatocyte

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Is an acquired, reversible disorder of metabolism, resulting in an accumulation of triglycerides

Fatty Infiltration

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Normal to elevated hepatic enzymes elevated Alk Phos elevated Direct bilirubin

Fatty Infiltration Clinical findings

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Echogenicity
Attenuation 
Impaired visualization of borders of portal/hepatic structures (secondary to increased attenuation) Hepatomegaly 
May be patchy, inhomogeneous 
Focal sparing

Fatty Infiltration Sonographic findings

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Hepatitis
Cirrhosis
Metastases

Fatty Infiltration differential considerations

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Elevated AST, ALT
Elevated Bilirubin
Leukopenia

Acute Hepatitis Clinical findings

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Nonspecific and variable 
Normal to slightly elevated 
Echogenicity
Increased brightness of portal vein borders
Hepatosplenomegaly 
Increased thickness of gallbladder wall

Acute hepatitis Sonographic Findings

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Fatty liver

Differential considerations Acute hepatitis

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Elevated AST, ALT
Elevated bilirubin
Leukopenia

Chronic hepatitis Clinical findings

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COarse hepatic parenchyma
Increased echogenicity
Decreased visualization brightness of portal triad
Fibrosis may produce soft shadowing

Chronic Hepatitis Sonographic findings

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Cirrhosis

Fatty liver

Chronic Hepatitis Differential considerations

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INcreased phos
Increased direct bilirubin
Increased AST, ALT
Leukopenia

Cirrhosis clinical findings

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Coarse liver parenchyma with nodularity 
Increased echogenicity 
Increased attenuation 
Decresasd vascular markings with acute cirrhosis 
Hepatosplenomegaly with ascites
Shrunken liver with chronic cirrhosis (also increased nodularity)
Regeneration of hepatic nodules 
Portal hypertension

Sonographic findings Cirrhosis

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Fatty liver

Hepatitis

Cirrhosis Differential considerations

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Disturbance of acid-base balance

Glycogen Storage Disease Clinical findings

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Hepatomegaly
Increased echogenicity
Increased attenuation
Von Gierek’s adenoma (Round, homogeneous)

Glycogen Storage Disease Sonographic findings

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Focal nodular hyperplasia

Glycogen Storage Disease differential considerations

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Increased Iron levels in blood

Hemochromatosis clinical findings

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Increased echogenicity throughout live

Sonographic findings Hemochromatosis

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Cirrhosis

Differential considerations hemochromatosis

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Obesity 
Excessive alcohol intake (alcohol stimulates lipolysis
Poorly controlled hyperlididemia 
Diabetes mellitus
Excess corticosteriods 
Pregancy 
Total parenteral Hyperalimentation (nutrition) 
Severe hepatitis 
Glycogen storage disease 
Cystic fibrosis 
Pharmaceutical 
Chronic illness

Causes of fatty liver

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Suspected portal hypertension secondary to liver disease
Portal vein compression thrombosis
Acute onset of hepatic vein occlusion (Budd-Chiari syndrome) constrictive pericarditis, or congestive heart failure with tricupsid regurgiatation
Congential, traumatic, or neoplastic arterioportal fistula

Indications for Portal hypertension

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Develops when the normal venous channels become obstructed.

Collateral circulation

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Ascites, right upper quadrant pain, hepatomegaly

Budd-Chiari syndrome Clinical findings

Increased caudate lobe atrophy in right lobe of the liver

Budd-Chiari syndrome Sonographic findings

Portal hypertension

Budd-Chiari syndrome Differential considerations

N/A

Simple Hepatic cysts Clinical findings

``` Anechoic Thin Walls Well-defined borders Distal posterior enhancement May have calcification ```

Simple Hepatic cysts Sonographic findings

Congenital Hematoma Necrotic tumor

Simple Hepatic cysts Differential considerations

Autosomal dominant 25%-50% of patients with polycystic kidney disease have hepatic cysts 60%of patients with polycystic liver disease have associated PKD

Polycystic liver disease clinical findings

Anechoic Well defined borders Increased acoustic enhancement Multiple cysts throughout liver parenchyma

Polycystic Liver disease sonographic findings

``` Necrotic metastasis Echinococcal cyst Hematoma Abscess Hepatic cystadenocarcinoma ```

Polycystic Liver disease Differential considerations

Increased white cell count Abnormal LFT Anemia

Pyogenic Abscess Clinical findings

``` Variable appearance Right central lobe most common site Hypoechoic to complex to hyperechoic when fluid level present Round to oval irregular Complex ```

Pyogenic Abscess Sonographic findings

Amebic abscess Echinococcal cyst Hepatic candidiasis

Pyogenic Abscess differential considerations

Increased WBC | Fever

Hepatic candidiasis clinical findings

Multiple small hypoechoic masses with echogenic central core "bulls-eye" lesions "wheel-within-wheel" pattern

Hepatic candidiasis sonographic findings

Abscess Echinococcal cyst Metastases

Hepatic candidiasis differential considerations

N/A

Chronic Granulomatous disease Clinical findings

Poorly marginated Hypoechoic Posterior enhancement May have calcification/shadowing

Chronic Granulomatous Disease clinical sonographic findings

Abscess

Chronic Granulomatous Disease Differential Consideratioins

Increased Leukocytes Low fever Abdominal pain and diarrhea

Amebic Abscess clinical findings

Mass is variable Round or oval; lack notable borders Hypoechoic with debris

Amebic Abscess sonographic findings

Pyogenic abscess Echinococcal cyst Hepatic candidiasis

Amebic Abscess differential considerations

Increased WBC | History of sheep-farming exposure

Exhinococcal cyst clinical findings

``` Simple to complex cysts Acoustic enhancement Oval or spherical Calcification Honeycomb appearance/"water lily" sign ```

Echinococcal cyst sonographic findings

Polycystic liver disease Amebic abscess Pyogenic abscess

Echinococcal cyst differential considerations

Most common benign tumor of the liver

Cavernous Hemangioma

Any new growth of new tissue, either benign or malignant

Neoplasm

Small percentage may bleed; RUQ pain | More frequent in women

Cavernous Hemangioma Clinical findings

Most are hyperechoic with enhancement Round or Oval, well defined Larger masses may show necrosis, degeneration, calcification

Cavernous Hemangioma sonographic findings

Metastasis Hepatoma (HCC) Adenoma Focal nodular hyperplasia

Cavernous Hemangioma Differential considerations

RUQ pain when mass bleeds

Liver cell adenoma clinical findings

Hyperechoic with central echogenic area caused by hemorrhage Solitary or multiple Fluid may be present

Liver cell adenoma Sonographic findings

Hemangioma Focal Nodular hyperplasia Hepatoma (HCC)

Live cell adenoma differential considerations

More frequent in women below 40

Focal nodular hyperplasia clinical findings

Multiple, well defined with hyperechoic to isoechoic patters Frequently found in right lobe of the liver

Focal nodular hyperplasia sonographic findings

Hemangioma Hepatoma (HCC) Metastases Adenoma

Focal Nodular hyperplasia differential considerations

70% of patients have increased alpha-fetoprotein level | Abnormalities in liver function tests, with the indications of cirrhosis

Hepatocellular carcinoma clinical findings

``` Solitary, multiple Infiltrative, diffuse HYpoechoic, isoechoic, or hyperechoic May invade hepatic veins Thrombus ```

Hepatocellular carcinoma sonographic findings

Hemangioma | Metastases

Hepatocellular carcinoma differential considerations

Abnormal LFTs Jaundice Hepatomegaly Weight loss decreased appetite

Metastatic disease Clinical findings

Hypoechoic or echogenic mass Diffuse distortion of bull's eye pattern Solitary or multiple well to ill defined

Metastatic disease sonographic findings

Abscess Hemangioma Hepatoma (HCC) Adenoma

Metastatic disease differential considerations

Abnormal LFT

Lymphoma clinical findings

Hypoechoic of diffuse patterns Target or echogenic lesions Intrahepatic and lucent multiple small, discrete solid lesions without enhancement

Lymphoma sonographic findings

Hemangioma HCC metastases

lymphoma differential considerations