Lesson 1B (Part 2)

Question 1

What are the 3 characterizations of steatosis?

Answer 1

1. Mild
2. Moderate
3. Severe

Question 2

Mild steatosis

Answer 2

Minimal diffuse increase in hepatic echogenicity

Question 3

Moderate steatosis (2)

Answer 3

1. Moderate diffuse increase in hepatic echogenicity

2. Slightly impaired visualization of intrahepatic vessels and diaphragm

Question 4

Severe steatosis (4)

Answer 4

1. Marked increase in echogenicity
2. Poor penetration of posterior liver
3. Poor or no visualization of hepatic vessels and diaphragm
4. Hepatomegaly often present

Question 5

What are some sonographic appearances of fatty liver? (3)

Answer 5

1. Focal Fatty Infilitration
2. Fatty Sparing
3. Focal Fat

Question 6

Focal fallt infiltration

Answer 6

Regions of increased echogenicity are present within a background of normal liver
- can mimic a MASS

Question 7

Fatty sparing

Answer 7

Islands of normal liver parenchyma appear as hypoechoic masses within a dense fatty infiltrated liver “no mass effect”
- most of the liver is fat with little bits of normal liver

Question 8

What are the sonographic features of steatosis? (4)

Answer 8

1. Rapid change in time in both appearance and resolution
   - 6 days
2. NO Mass Effect
3. No liver contour abnormality
4. Focal fat may appear rounded, nodular, or interspersed with normal tissue

Question 9

What is the preferred site for focal fat in steatosis?

Answer 9

Anterior to the portal vein at the porta hepatis

Question 10

Where is the preferred site for focal fatty sparing or infiltration?

Answer 10

Anterior to the portal vein at the porta hepatis, gallbladder fossa, and liver margins

Question 11

When does glycogen storage disease occur?

Answer 11

During neonatal period

- large amounts of glycogen are deposited in the liver and kidneys

Question 12

How do glycogen storage diseases appear?

Answer 12

Indistinguishable from diffuse fatty infiltration

- need to remember different age group

Question 13

Cirrhosis

Answer 13

Diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules
- coarse texture

Question 14

What are 3 major pathological mechanisms that combine to create cirrhosis?

Answer 14

1. Cell death
2. Fibrosis
3. Regeneration

Question 15

What is the most common cause of micronodular form?

Answer 15

Alcohol consumption

Question 16

What is the most frequent cause of macronodular?

Answer 16

Chronic viral hepatitis

Question 17

Is cirrhosis usually acute or chronic?

Answer 17

Chronic

Question 18

What is the most common cause of portal hypertension?

Answer 18

Cirrhosis

Question 19

What are 3 clinical presentations of cirrhosis?

Answer 19

1. Hepatomegaly
2. Jaundice
3. Ascites

Question 20

What are 4 other causes of cirrhosis?

Answer 20

1. Biliary cirrhosis
2. Wilsons disease
3. Primary sclerosing cholangitis
4. Hemochromatosis

Question 21

What is the sonographic appearance of cirrhosis? (5)

Answer 21

1. Volume redistribution
   - enlarged/irregular contour (early)
   - small (advanced)
2. Coarse echotexture
3. Nodular surface
   - ascites
4. Nodules (colour doppler)
   - regenerative and dysplastic
5. Portal hypertension
   - ascites, splenomegaly and varices

Question 22

NASH

Answer 22

Nonalcoholic steatohepatitis

Question 23

What is nonalcoholic steatohepatitis commonly known as?

Answer 23

Silent liver disease

- resembles alcoholic liver disease, but occurs in people who drink little or no alcohol

Question 24

What is the major feature of NASH? (3)

Answer 24

1. Fat in the liver
2. Inflammation
3. Damage

Question 25

What can NASH lead to?

Answer 25

Cirrhosis

Question 26

What is NASH related to?

Answer 26

Obesity | - can lead to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH

Question 27

What are signs and symptoms of NASH? (4)

Answer 27

1. Fatigue 2. Weight loss 3. Weakness - may begin once the disease is advanced or cirrhosis is present 4. Increased LFTs

Question 28

What is the treatment for NASH? (2)

Answer 28

1. Reduce weight - eat a balanced diet - engage in physical activity - avoid alcohol and unnecessary medications 2. Liver transplant may be necessary if cirrhosis ensues

Question 29

What is the sonographic appearance of NASH? (2)

Answer 29

1. Dense fatty infiltration | 2. Cirrhosis