Lesson 1.2 - Infectious Disease & Metabolic Disorders

Question 1

Viral hepatitis may lead to (3)

Answer 1

Portal hypertension
Cirrhosis
HCC

Question 2

Symptoms (7) and sign (1) of viral hepatitis

Answer 2

Symp:
Fatigue
Headache
Anorexia
Fever 
Abdo pain
Nausea
Vomiting

Sign:
Jaundice

Question 3

Recovery time implied for acute hepatitis

Answer 3

4 months

Question 4

Acute hepatitis sono appearance

Answer 4

Liver parenchyma hypoechoic

Bright periportal walls

Question 5

Starry night sign is characterized by

Answer 5

acute hepatitis

Question 6

Chromic hepatitis is characterized by biochemical abnormalities that persist beyond __ months

Answer 6

6 months

Question 7

Chronic hepatitis sono appearance

Answer 7

Hepatomegaly

Thickening of GB wall

Question 8

T/F

Liver can appear normal in some cases of chronic hepatitis

Answer 8

true

Question 9

Disorders of metabolism (4)

Answer 9

1. Steatosis “Fatty liver”
2. Glycogen storage disease-neonatal
3. Cirrhosis
4. NASH (non-alcoholic steatohepatitis)

Question 10

T/F fatty liver is reversible

Answer 10

True

Question 11

Causes of fatty liver/steatosis

Answer 11

Severe hepatitis*
Hyperlipidemia*
Excessive alcohol*
Hyperalimentation
Excess corticosteroids
Diabetes
Obesity bypass surgery
Toxins
Pregnancy
Cystic fibrosis

Question 12

T/F steatosis may lead to HCC in some pts

Answer 12

true

Question 13

Mild steatosis characterized by

Answer 13

minimal diffuse increase in echogenecity

Question 14

Moderate steatosis characterized by

Answer 14

moderate diffuse increase in echogenecity

slightly impaired visualization of intrahepatic vessels and diaphragm

Question 15

Severe steatosis characterized by (4)

Answer 15

Marked increase in echogenicity
Poor penetration posterior liver
Poor/no visual hepatic vessels/diaphragm
Hepatomegaly

Question 16

What is focal infiltration

Answer 16

Appearance of steatosis- regions of increased echogenicity within a background of normal liver - can mimic a mass

Question 17

What is fatty sparing

Answer 17

Appearance of steatosis- Islands of normal liver parenchyma appear as hypoechoic masses within a dense fatty infiltrated liver - “no mass effect”

Question 18

Focal fat characterized by

Answer 18

hyperechoic
No mass effect
May appear rounded, nodular or interspersed with normal tissue

Question 19

Sono features of steatosis

Answer 19

Rapid change in time in both appearance and resolution (6 days)
No Mass Effect
No liver contour abnormality

Question 20

What is the preferred site for focal fat

Answer 20

anterior to PV at porta hepatis

Question 21

What is the preferred site for focal fatty sparing or infiltration

Answer 21

anterior to PV at porta hepatis, GB fossa and liver margins

Question 22

When does glycogen storage disease occur?

Answer 22

In neonatal period where large amts of glycogen are deposited in liver and kidneys

Question 23

Do patients with glycogen storage disease live?

Answer 23

They survive to childhood or young adulthood with enzyme therapy

Question 24

What is glycogen storage disease indistinguishable from?

Answer 24

Its indistinguishable from diffuse fatty infiltration

Question 25

Cirrhosis sono appearance

Answer 25

Fibrosis Nodular Coarse hard texture Increased echogenicity

Question 26

What three major pathological mechanisms combine to create cirrhosis

Answer 26

cell death fibrosis regeneration

Question 27

What is the most common cause of micronodular form cirrhosis. Whats the measurement?

Answer 27

alcohol consumption | <1 cm

Question 28

What is the most frequent cause of macronodular form cirrhosis. Whats the measurement?

Answer 28

chronic viral hepatitis | 1-5 cm

Question 29

What is cirrhosis indistinguisable from?

Answer 29

Indistinguishable from end-stage liver disease

Question 30

Clinical presentation of cirrhosis (3)

Answer 30

Hepatomegaly Jaundice Ascites

Question 31

Causes of cirrhosis (4)

Answer 31

biliary cirrhosis wilsons disease primary sclerosing cholangitis hemochromatosis

Question 32

What is the most common cause of portal hypertension?

Answer 32

Cirrhosis

Question 33

Other causes of portal hypertension

Answer 33

Ascites Splenomegaly Varices

Question 34

Early vs advanced stage of cirrhosis and liver size

Answer 34

early - liver may be enlarged | advanced - liver is small-shrinking, ascites

Question 35

Dysplastic nodule sono pattern

Answer 35

Adenomatous hyperplastic nodules | Larger than 10 mm (premalignant)

Question 36

What may be indicated if dysplastic nodules found

Answer 36

biopsy to rule out HCC

Question 37

What is NASH

Answer 37

Nonalcoholic steatohepatitis

Question 38

What does NASH resemble

Answer 38

alcoholic liver disease but occurs in those who drink little/no alcohol

Question 39

Major feature in NASH

Answer 39

fat in the liver inflammation damage

Question 40

T/F | NASH can lead to cirrhosis

Answer 40

True

Question 41

Signs and symptoms of NASH (3)

Answer 41

fatigue weight loss weakness

Question 42

T/F NASH causes decreased LFTs

Answer 42

False. NASH causes increased LFTs

Question 43

NASH sono appearance

Answer 43

Dense fatty infiltration Cirrhosis

Question 44

Acute liver failure

Answer 44

Rapid development of hepatocellular dysfunction Coagulopathy Encephalopathy in pt without known prior liver disease

Question 45

T/F | chronic liver failure usually occurs in the context of cirrhosis

Answer 45

true

Question 46

Causes of chronic liver failure (4)

Answer 46

Excessive alcohol Hep B or C Non-alcoholic fatty liver disease

Question 47

T/F | Portal hypertension causes ascites

Answer 47

FALSE Ascites usually occurs secondary to liver cell failure

Question 48

Death occurs if loss of hepatic parenchyma by necrosis is >___%

Answer 48

>40%

Question 49

"Hepatic coma"

Answer 49

hepatic encephalopathy