Liver Pathology Flashcards
1
Q
T/F: fatty infiltration affects the entire liver parenchyma
A
TRUE
2
Q
is fatty infiltration a reversible disease?
A
yes
3
Q
causes of fatty infiltration (7)
A
- obesity
- chronic alcohol abuse
- pregnancy
- medication
- severe hepatitis
- glycogen storage disease
- chemotherapy
4
Q
fatty infiltration can be divided into ___ categories
A
3
mild, moderate and severe
5
Q
severe (grade III) fatty infiltration usually cause abnormal LFTs such as ____ and ____ levels
A
AST and ALT
6
Q
what are the 2 most common causes of severe (grade III) fatty infiltration?
A
obesity and alcohol abuse
7
Q
patients with fatty infiltration usually are ______
A
asymptomatic
8
Q
some patients with fatty infiltration present with (4)
A
jaundice
nausea
vomiting
abdominal tenderness
9
Q
size of a liver with fatty infiltration
A
normal to enlarged
10
Q
________ is when there are focal areas of fat deposits and the rest of the liver is normal
A
focal fatty infiltration
11
Q
focal fatty infiltration is most common seen at the (3)
A
porta hepatis
GB area
medial segment of the LLL
12
Q
focal fatty infiltration may mimic as a _____
A
neoplasm (abnormal tissue growth)
13
Q
a small area of normal liver parenchyma not affected by fatty infiltration
A
focal fatty sparing
14
Q
focal fatty sparing is commonly seen ______ to the porta hepatis, GB area, & medial segment of the LLL
A
adjacent
15
Q
ultrasound appearance of focal fatty sparing
A
hypoechoic masses within a dense fatty infiltrated liver
16
Q
focal fatty sparing may mimic ____ and _____
A
neoplasm
pericholecystic fluid {abnormal fluid collection around the GB}
17
Q
what is hepatitis?
A
swelling and inflammation of the liver
18
Q
hepatitis can be cause by (2)
A
infectious
noninfectious agents
19
Q
what are some examples of infectious agents? (4)
A
viral
bacterial
fungal
parasitic
20
Q
what are some examples of noninfectious agents? (3)
A
medications
toxins
autoimmune disorders
21
Q
what are the 2 most common forms of hepatitis?
A
Hep A and Hep B
22
Q
how does hepatitis A spread?
A
fecal-oral route in contaminated water or food
23
Q
how does hepatitis B spread?
A
contact with contaminated bodily fluids
24
Q
how does hepatitis C spread?
A
most commonly through exposure to infected blood
25
viral hepatitis may be fatal with ____ or _____
secondary acute hepatic necrosis or chronic hepatitis
26
hepatitis can lead to (3)
cirrhosis
PHTN
HCC
27
Hep ____ has the highest risk for the development of HCC
Hep C
28
acute hepatitis lasts for
less than 6 months
29
8 signs/symptoms of acute hepatitis
1. fever
2. chills
3. increase WBC
4. jaundice
5. anorexia
6. nausea
7. fatigue
8. hepatomegaly
30
increased lab values for acute hepatitis (3)
AST
ALT
indirect (unconjugated) bilirubin
31
in severe cases of acute hepatitis, conjugated bilirubin increases ____
LDH
32
ultrasound appearance of acute hepatitis (9)
1. normal to enlarged liver
2. decreased echogenicity
3. increased blood vessels visualization
4. periportal cuffing
5. “Starry sky” sign
6. extensive demonstration of PV radicles
7. GB wall thickening
8. liver abscess
9. splenomegaly
33
T/F: chronic hepatitis is reversible
FALSE
34
chronic hepatitis usually progresses to (3)
cirrhosis, liver failure, HCC
35
chronic liver disease caused by Hep C is the most frequent indication for
liver transplant
36
signs/symptoms of chronic hepatitis (2)
fatigue and jaundice
37
ultrasound appearance of chronic hepatitis (4)
1. decrease liver size
2. increase echogenicity
3. decrease visualization of blood vessels
4. coarse liver texture
38
what is cirrhosis?
liver cell death with subsequent regenerating nodules
39
T/F: cirrhosis is reversible
FALSE
40
what is the #1 cause of cirrhosis?
alcohol abuse
41
what is the #2 cause of cirrhosis?
Hep C
42
what are other causes of cirrhosis? (5)
obstruction
drug abuse
cholangitis
hemochromatosis
Wilson's disease
43
what is hemochromatosis?
too much iron
44
what is Wilson's disease?
too much copper
45
8 signs/symptoms of cirrhosis
1. hepatomegaly (caudate lobe)
2. ascites (Morison's pouch)
3. splenomegaly
4. hepatic encephalopathy
5. nausea
6. anorexia/weight loss
7. dark urine
8. fatigue
46
complications of cirrhosis (7)
1. sequela
2. PHTN
3. splenomegaly
4. ascites
5. HCC
6. monophasic flow HV
7. hepatofugal flow PV
47
what is the #1 cause of PHTN?
cirrhosis
48
4 signs/symptoms of PHTN
1. hematemesis
2. hepatic encephalopathy
3. caput medusa
4. tremors
49
most common ultrasound finding in PHTN
recanalization of the paraumbilical vein
50
with PHTN, varicosities are found around (3)
splenic hilum, renal hilum, GE junction
51
PV diameter when there is PHTN
greater than 13mm
52
SMV diameter with PHTN
greater than 10mm
53
Budd Chiari can be secondary to (7)
1. congenital webbing disorder
2. coagulation abnormalities
3. tumor invasion from HCC
4. thrombosis
5. oral contraceptive use
6. pregnancy
7. trauma
54
ultrasound appearance of Budd Chiari (3)
decreased visualization of HV
enlarged caudate lobe
narrowing of IVC
55
another name for Von Gierke's Disease
glycogen storage disease
56
what is von gierke's disease?
large amounts of glycogen deposits in the liver and kidneys
57
von gierke's disease is associated with ___
adenomas
58
hemochromatosis may lead to ___ and ____
cirrhosis and PHTN
59
another name for Wilson's disease
hepatolenticular degeneration
60
key sign/symptom of Wilson's disease
brown/rusty colored ring around the eye
61
hepatic cysts are often associated with ____
ADPKD
62
hepatic cysts are common on the
right lobe of the liver
63
another name for hydatid cysts
echinococcal cyst
64
what is echinococcus granulosus?
tapeworm that lives in dog feces
causes hydatid cysts
65
hydatid cysts have a high prevalence in
sheep and cattle raising countries
66
ultrasound appearance of hydatid cysts (4)
anechoic with some debris
water lily sign
mother and daughter cysts
some elements of dense calcification
67
5 signs/symptoms of hydatid cysts
leukocytosis
low grade fever
nausea
jaundice
RUQ tenderness
68
rupture of a hydatid cyst can lead to
anaphylactic shock
69
what is Entamoeba histolytica?
parasite that causes amebic hepatic abscesses
70
ultrasound appearance of amebic abscess (3)
round, hypoechoic to anechoic mass
may contain debris
acoustic enhancement
71
signs/symptoms of amebic hepatic abscess (6)
hepatomegaly
RUQ pain
general malaise
signs of dysentery
bloody diarrhea
fever
72
amebic hepatic abscess most often are seen where?
right lobe of the liver
73
amebic hepatic abscess is indistinguishable from _____ and therefore require _______ confirmation
indistinguishable from pyogenic hepatic abscess
require serologic confirmation
74
what causes a pyogenic abscess?
result from the spread of infection from inflammatory conditions
75
ultrasound appearance of pyogenic hepatic abscess (2)
complex cyst with thick walls
air/gas may produce dirty shadowing or ring-down artifact
76
signs/symptoms of a pyogenic hepatic abscess (4)
fever
hepatomegaly
leukocytosis
RUQ pain
77
what causes hepatic candidiasis?
fungus called Candida albicans
78
hepatic candidiasis occurs mostly in
immunocompromised patients
79
ultrasound appearance of hepatic candidiasis
target, halo, or bulls eye
older lesions may calcify
80
signs/symptoms of hepatic candidiasis (3)
RUQ pain
fever
hepatomegaly
81
polycystic liver is an inherited _______
autosomal dominant disease
82
50% of patients with polycystic liver will also have
polycystic renal, pancreas, and spleen disease
83
ultrasound appearance of polycystic liver disease (3)
anechoic
well-defined borders
acoustic enhancement
84
T/F: a patient with polycystic liver disease usually is asymptomatic
true
85
T/F: polycystic liver disease causes abnormal LFTs
FALSE - normal LFTs
86
what is the most common benign tumor of the liver?
hemangioma
87
hemangiomas are more common in ___ because they are stimulated by ____
more common in females
stimulated by estrogen
88
hemangiomas mostly occur where?
right lobe of the liver
89
ultrasound appearance of hemangiomas (3)
hyperechoic mass less than 3cm
posterior enhancement may be seen (slice thickness artifact = blood vessels are smaller than beam size)
no color flow
90
larger hemangiomas may appear _____ and be indistinguishable from _____
heterogenous and hypoechoic
metastatic liver disease
91
how do you distinguish a hemangioma from malignant tumor?
core biopsy
92
T/F: hemangiomas usually don't cause any symptoms
true
93
what is a lipoma?
benign lesion composed of fat cells
94
lipomas are extremely ____ and are indistinguishable from (3)
extremely rare
indistinguishable from hemangiomas, focal fatty infiltration, echogenic mass
95
ultrasound appearance of lipomas (2)
well defined echogenic mass
propagation speed artifact
96
what is the most common benign liver tumor in children?
infantile hemangioendothelioma
97
85% of infantile hemangioendothelioma occur before ___ months of age
6 months
98
children with infantile hemangioendothelioma usually present with _____ early in life due to _____ within the tumor
cardiac failure
AVM within the tumor
99
infantile hemangioendothelioma spontaneously regresses in most patients before age ____
2 years old
100
what is the second most common benign liver tumor?
focal nodular hyperplasia (FNH)
101
FNH is thought to be a hyperplastic response to a ____
congenital AVM
102
______ may enlarge FNH
oral contraceptives
103
ultrasound appearance of FNH (2)
homogenous
hypervascular star-like scar*
104
FNH is referred to as a
stealth lesion
105
what is an adenoma?
rare benign tumor that grows rapidly
106
hepatocellular adenomas are associated with (3)
oral contraceptive use
men using steroids
von gierke's disease
107
liver cell adenomas have a tendency to
rupture and hemorrhage
108
adenomas have a propensity to become _____
malignant
called malignant degeneration
109
what is hepatic congestion?
diffuse venous congestion within the liver that results from right-sided heart failure
110
ultrasound appearance of hepatic congestion (4)
hepatomegaly
splenomegaly
dilated IVC, HV, PV
ascites
111
what are hepatic granulomas?
benign liver masses associated with inflammatory liver diseases
112
what are the 2 most common causes of hepatic granulomas?
histoplasmosis and tuberculosis
113
what is pneumocystis carini?
most common organism causing infection in AIDS patients
114
ultrasound appearance hepatic granulomas?
diffuse echogenic foci within the liver
115
another name for HCC
hepatoma
116
what is the most common primary form of liver cancer
HCC
117
HCC is very common in patients with
cirrhosis and Hep C
118
HCC has the tendency to (3)
destroy PV walls
invade HV
produce Budd-Chiari syndrome
119
ultrasound appearance of HCC (5)
solitary, hypoechoic mass
heterogeneous masses scattered throughout
halo sign
ascites
hypervascular
120
signs/symptoms of HCC (3)
unexplained weight loss
hepatomegaly
palpable mass
121
HCC causes elevated
AFP
122
80% of patients with ____ develop HCC
cirrhosis
123
what is the most common form of liver cancer?
hepatic metastasis
124
where are the primary sites of cancer for hepatic metastasis? (5)
gallbladder
GI tract (stomach and colon)
pancreas
breast
lung (most common)
125
hepatic metastasis from the GI tract and pancreas tend to appear as
calcified tumors
126
hypoechoic masses of hepatic metastasis may be from (3)
breast
lung
lymphoma
127
diffuse hepatic metastasis appears as
pseudocirrhosis
128
what is schistosomiasis?
most common parasitic infection in humans that is a major cause of PHTN worldwide
129
another name for schistosomiasis
Bilhatziasis
130
what is the most common primary malignant liver tumor in children?
hepatoblastoma
131
hepatoblastoma is common in boys younger than ____
5 years old
132
there is an increased risk of hepatoblastoma with (2)
Beckwith-Wiedemann syndrome
Wilm's tumor
133
normal PV velocity
20 to 40 cm/s
134
normal RI of hepatic artery
0.5 to 0.8
135
TIPS is most often placed between the
RPV and RHV
136
normal velocity within a TIPS
90 to 190 cm/s
137
what is an anastomosis?
surgical connection between two structures
138
what is the most common complication of a liver transplant?
HA thrombosis
139
liver trauma is mostly in the ____ side of the liver and is very common in ____
right side of the liver
very common in children
140
decrease _____ is associated with liver trauma
hematocrit
141
liver trauma is better viewed with
CT
142
3 types of liver trauma
1. rupture of liver and capsule (perihepatic, intraperitoneal hematoma)
2. separation of capsule (subcapsular hematoma)
3. central rupture (intraparenchymal hematoma)
143
what is caput medusa?
cluster of swollen veins in the abdomen
144
the RHA may originate (replaced) from the ____
SMA
145
a replaced RHA is seen posterior to the ___ and ____
head of pancreas
MPV
146
high resistance HA waveform suggests (2)
venous congestion of the liver
organ rejection
147
____ is the most common source of pyogenic liver abscess
biliary tract disease
148
____ is needed to confirm pyogenic abscess diagnosis
aspiration
149
amebic abscess of the liver occurs almost exclusively in ___ or ___
immigrants or travelers
(not that common in the US)
150
fatty liver disease is also known as
steatosis
151
normal PV pressure
5 to 10 mmHg
152
TIPS are created to avoid the development or rupture of ____ and reducing the accumulation of ____
avoid the development or rupture of gastroesophageal varices
reducing the accumulation of ascites
153
with a wide patent TIPS, the RPV and LPV should demonstrate ____ flow
hepatofugal
154
criteria for TIPS malfunction (5)
low shunt velocity (50 cm/sec)
high shunt velocity (>190 cm/sec)
hepatopetal LPV or RPV
hepatofugal MPV
absent shunt flow
155
with a recanalized umbilical vein,
the flow direction of the ____ may be in either direction
LPV
156
____ is an indication for liver transplant in children
biliary atresia
157
what is MELD?
Model for End-Stage Liver Disease
score derived from a formula that uses a patient's bilirubin, creatine, and INR
high score = closer to needing a transplant
158
what is cavernous transformation?
numerous worm-like venous collaterals that parallel the thrombosed PV
usually seen with benign causes of PV thrombosis
159
in infants, intrahepatic PV gas is due to ____
necrotizing entercolitis
160
what is METAVIR used for?
elastography assessment of liver fibrosis
161
an increase in AST without ALT, is seen with ____
myocardial infarction
