Flashcards in Liver Deck (72):
AFP is a tumor marker for what?
hepatocellular carcinoma, germ cell tumors, and testicular cancer
CA 19-9 is a marker for what?
pancreatic cancer, cholangiocarcinoma, GI cancer, lung cancer, colorectal cancer
beta HCG is a marker for what tumor?
germ cell tumor, or testicular tumor
CEA- carcinoembryonic antigen is a marker for what tumor?
colorectal, bile duct, breast, GI, esophageal, lung, thyroid, bladder, uterine
PSA is what?
prostate specific antigen which is a marker for prostate cancer
what is monitored prior to an invasive procedure to insure proper clotting?
PT (INR), PTT and platelets
what is AFP?
alpha fetoprotein. this is a marker for liver and gonadal tumors. it is a protein synthesized by the fetal liver and levels decrease during the first year of life.
elevated AFP is what?
HCC ( hepatoma), germ cell tumors, METS to liver, hepatoblastoma
high levels of hCG over 500 is an indicator for what?
what is low platelet concentration?
thrombocytopenia. this is due to decreased production or increased destruction.
what is elevated platelet concentration?
thrombocytosis- either congenital, reactive, or due to unregulated production.
what is the INR in absence of anticoagulation therapy?
what is the target range for INR in anticoagulant use?
what monitors for heparin?
PTT- partial thromboplastin time
what characterizes blood coagulation?
what helps to diagnose the cause of unexplained bleeding or inappropriate blood clots?
what enzymes does the liver use to metabolize amino acids and make proteins?
aminotransferase. aka transaminases.
when the liver cells are damage what do they spill into the blood stream?
enzymes AST and ALT
what could cause elevation in liver enzymes?
fatty liver, medication and herbs, alcohol, heart failure, hep ABC, autoimmune hepatitis, or inherited disorder like Wilsons.
what is also known as SGOT?
AST- aspartate aminotransferase.
what lab value is specific to myocardial infarction?
increase in AST without ALT.
elevated AST is _______ for liver disease.
what is elevated in almost all hepatocellular diseases?
what causes the highest elevations of AST?
what is also known as SGPT
ALT alanine aminotransferase
ALT is more _______ than AST.
specific for liver disease. this is because of the high concentration in liver tissue.
what is present in hepatocytes and bile duct epithelium?
GGT- gamma glutamyl transpeptidase
an elevation in GGT can indicate?
hepatocellular disease and biliary obstruction.
increased GGT and ALP =
increased GGT with ALT=
what is LDH?
lactic dehydrogenase. this is a tumor marker for testicular cancer. it is widely distributed throughout the body. individual isoenzyme evaluation can indicate specific organ or tissue damage.
what is an uncommon malignant liver neoplasm occurring in infants and children?
hepatoblastoma- this typically happens prior to two years of age.
hepatoblastoma is associated with?
beckwith Wiedmann, lung mets, portal vein invasion, and elevated AFP
what are the common sonographic patterns of METS?
hyperechoic= GI, hypoechoic = lymphoma, bulls eye= lung, calcified= mucinous adenocarcinoma of colon, cystic= leiomyosarcoma
what causes hypoxia and necrosis at the center of METS lesion?
large METS outgrowing their own blood supply
what allows malignant cells to be trapped in the space of Disse?
the fenestrations in the sinusoidal epithelium
what is the most common primary malignant tumor of the liver?
HCC- aka hepatoma. this occurs predominantly in patients with underlying chronic liver disease and cirrhosis( occurring in 10-25% of patients)
HCC is associated with....
elevated AFP, AST, and ALT
what is associated with hepatic lipomas and angiomiolipomas?
describe a hepatic lipoma sonographically.
hyperechoic, with propagation speed artifact. this is due to slower speed in fat.
what is the propagation speed artifact?
decreased speed of sound in fat- 1450 m/s- results in a prolonged return time making objects posterior to a fatty mass further away. it will look misplaced.
what is the most common hyperechoic hepatic mass? what are other hyperechoic hepatic masses?
most common= hemangioma, also lipoma, echogenic METS, and focal fatty infiltration
what is known as a miss arrangement of tissue?
FNH- developmental hyperplastic lesion rather than a true neoplasm
describe FNH sonographically
solid, typically solitary mass, typically with a central fibrous scar and stellate vascularity.
what is the stealth lesion?
FNH with echogenicity equal to surrounding liver parenchyma.
what is specific in diagnosing FNH?
MRI and contrast enhanced ultrasound
what hepatic mass is associated with the use of oral contraceptives?
hepatic adenoma- they have the potential to be malignant
hepatic adenomas are associated with what?
glycogen storage disease and pain due to tumor hemorrhage
what is the most common benign tumor of the liver?
why would a CAV. hemangioma enlarge?
pregnancy or estrogen use
cavernous hemangiomas appear?
hyperechoic with posterior enhancement. this can cause slice thickness artifact
what will appear as a cyst with internal echoes accompanied by RUQ pain and decreasing hematocrit?
liver cysts happen at what age
5th decade, if seen earlier is associated with ADPKD
what happens to the caudate lobe in the event of Budd chiari?
it enlarges while the right and left lobes atrophy. the enlarged caudate can compress the IVC. the caudate love in unaffected because the emissary veins drain directly into the IVC
what causes budd chiari?
it is frequently idiopathic. it can also be congenital, caused by hypercoagulable states, infections, pregnancy, or tumors.
a patient comes in with ascites, hepatomegaly, and splenomegaly. what are the possible diagnosis?
Portal HTN, and Budd chiari
what is associated with air being noted in the intrahepatic portal veins and a high mortality rate?
portal vein gas. aka pneumatosis intestinalis
what is a cause of intrahepatic PV gas in infants?
what is the major cause of portal HTN?
PV diameter exceeding 13 mm indicates what?
increased pressure in the portal venous system in known as what?
what are the four types of portal HTN?
extraheptaic peresinusoidal- PV thrombosis, intrahepatic presinusoidal- schistomiasis, intrahepatic- cirrhosis, and intrahepatic postsinusoidal- HV thrombosis.
what is the most common type of portal HTN?
what can be done to lower portal pressure?
Portacaval shunt, splenorenal/ linton shunt, distal splenorenal/ warren shunt, and TIPS.
what are the portal systemic collaterals?
gastroesophogeal varices, recanalized umbilical vein, splenorenal varices, intestinal varices, and rectal varices
what is the term used to describe tortuous collaterals around umbilicus?
what is the function of portal systemic collaterals?
to connect the portal system to the IVC, bypassing the liver.
the left gastric vein drains into what?
what is the re opening of the umbilical vein aka ligumentum teres?
recanalized umbilical vein. this is a collateral from the left PV to epigastric veins to IVC
the left gastric vein is also known as what?
the coronary vein
how does the left gastric vein communicate with the lower esophageal veins?
several anastomotic channels.