Liver Pathology Flashcards by Cara Elmore

What pathology is congenital,traumatic,parasitic, or inflammatory in origin. Affecting the Rt lobe most often, and affects women more than men.

Hepatic cysts

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Asymptomatic, Normal liver function tests, Polycystic kidney disease

Clinical findings of Hepatic Cysts

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Anechoic mass or masses with smooth walls and
posterior acoustic enhancement
May have irregular shapes Clusters of cysts may be noted

Sonographic findings of Hepatic Cysts

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Infection

Pyogenic Abscess

Results when bacteria enters the liver from the biliary
tree,portal vein or hepatic artery
Pyo(pus filled) Most common source is E Coli, but often the etiology
is unknown
Symptoms- fever,pain,n/v,diarrhea,andpleuritic pain 100% mortality if left untreated Appears as round or oval mass,irregularwalls,internal
echoes

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Fever Hepatomegaly Leukocytosis Possible abnormal liver function tests Right upper quadrant pain

Clinical findings of a pyogenic hepatic abscess

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Complex cyst with thick walls Mass may contain debris,septations, and/or gas The air within the abscess may produce dirty
shadowing or ring-down artifact
Results from a spread of infection from an
inflammatory condition such as appendicitis, diverticulitis, endocarditis, .. Bacteria enters the liver through the PV, HA, or from a surgery

Sonographic findings of a pyogenic

abscess

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Most often associated with AIDS, but also affects bone
marrow and organ transplant patients
Appears as diffuse micro-echogenic foci without
shadowing to macro-echogenic clusters of dense calcifications

Pneumocystis Carinii

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Parasitic Disease

Amebic abscess Parasites reach the liver via the portal vein Amebiasis is contracted by eating contaminated food
or water
The organism often will remain confined to the GI
tract and patient is asymptomatic, those who are symptomatic will present with diarrhea, and abd pain, increased WBC’s
Appears as round or oval mass with internal echoes

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Echinococcal cyst

Parasite is found in areas of the world where dogs
assist in cattle and sheep herding
Daughter cysts develop within a parent cyst

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Recent travel out of the country
This infection is caused by the protozoa E histolytica,
which ascends the portal venous system
Hepatomegaly Right upper quadrant or general abdominal pain General malaise Diarrhea (possibly bloody) Fever Leukocytosis Elevated liver function tests Mild anemia

Clinical findings of an Amebic

Hepatic Abscess

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Round, hypoechoic or anechoic mass or massed May contain debris Acoustic enhancement

Sonographic findings of amebic

hepatic abscess

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Leukocytosis Low-grade fever Nausea Obstructive jaundice Right upper quadrant tenderness Sheep herding countries

Clinical findings of Hydatid Liver cyst

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Anechoic mass containing some debris(hydatid sand) “Water lily” sign-wall of the endocyst seen floating
within the pericyst
“Mother” cyst containing one or more smaller
“daughter” cyst
Mass may contain some elements of dense
calcification

Sonographic findings of hydatid

liver cysts

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Symptoms, abdominal mass and high cardiac output

due to av shunting throughout the tumor

Tumors-Benign- Pediatric

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Tumors-Benign- Pediatric

I Most frequently see symptomatic vascular tumor of
the liver in infants
Most common in females

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Appears as hyperechoic,hypoechoic or complex mass

AV shunting may contribute to large draining veins and dialated prox aorta

infantile hemangioendothelioma

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Focal nodular hyperplasia (FNH)

Tumors-Benign- Adult

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Second most common benign tumor seen in women

Focal nodular hyperplasia (FNH)

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Appears as a subtle liver mass usually

Focal nodular hyperplasia (FNH)

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infantile hemangioendothelioma

Tumors-Benign- Pediatric

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Liver cell adenoma

-Benign More frequently seen in women taking oral

contraceptives

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Symptoms are palpable mass, severe RUQ pain due to

rupture of the mass

Liver cell adenoma

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Appearance is variable ranging from hypoechoic to
hyperechoic. Solitary, well defined margins. Range in size to 15 cm
Surgical resection recommended since these may
become malignant

Liver cell adenoma

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Lipomas

Rare,comprised of mesenchymal elements All fatty liver tumors are not lipomas and differentials
include angiomyolipoma and hepatoma. Confirmation is made by CT
Benign

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Hepatoblastoma

Tumors-Malignant-Pediatric Most common malignant tumor of childhood High incidence with children who have Beckwith- Wiedemann syndrome

Hepatocellularcarcinoma HCC

Malignant-Adult Related to cirrhosis, hepatocarcinogens in food, and hepatitis B and C

Symtoms – unexplained mild fever and weight loss, | hepatomegaly

Hepatocellularcarcinoma HCC

Appearance varies from solitary mass to diffuse infiltration or multiple tumors Invades portal venous system and hepatic veins

Hepatocellularcarcinoma HCC

Elevated alpha-fetoprotein Abnormal liver function tests Cirrhosis Chronic hepatitis Unexplained weight loss Hepatomegaly Fever Palpable mass Ascites

Clinical findings of Hepatocellular | Carcinoma

Solitary, small hypoechoic mass Heterogenous masses scatered throughout the liver Mass with a hypoechoic halo

Sonographic findings of | Hepatocelluar Carcinoma

Metastasis

Primary source is from colon,lung and breast Spread to the liver via the portal vein,hepatic artery and lymphatics Appears as one of four patterns discrete echogenic, target or bullseye,discrete hypoechoic, cystic or diffusely inhomogenous

GI tract and pancreas tend to be calcified tumors Hypoechoic masses may be from the breast, lung, or lymphoma Hyperechoic masses may be from the kidney and pancreas “Target” or “bulls-eye” lesion may be from lung or colon

Sonographic findings of Hepatic | Metastasis

Most common post op complication of Liver transplant

hepatic artery | thrombosis and infection

Ultrasound is used for pre and post-op evaluation for Liver transplant

Pre-op, main focus is to evaluate portal vein size and | patency. Patency of hepatic veins and hepatic artery

affects the hepatocytes and interferes | with liver function

Diffuse disease

An acquired and reversible disease Benign Increased lipid accumulation in the hepatocytes leading to impaired or excessive metabolism of fat

Fatty Infiltrate

Asymptomatic Alcohol abuse Chemotherapy Diabetes mellitus Elevated liver function test Obesity Pregnancy

Clinical findings of Fatty Liver Disease

Diffusely echogenic liver Liver may appear patchy, inhomogenous due to focal sparing Liver is enlarged(hepatomegaly) Increased attenuation of the sound beam Walls of the hepatic vasculature and diaphragm will not be easily imaged(secondary to increased attenuation) Compare the echogenicity of the right kidney to the liver.

Sonograhic findings of Fatty Liver Disease

Locations for Focal Fatty Sparing

Adjacent to the gallbladder Near the porta hepatis Entire medial segment of the left lobe Can appear much like pericholecystic fluid when seen adjacent to the gallbladder

Hepatitis

Broadly defined as inflammation of the liver

Contracted through contact with fecal | matter,contaminated food, body fluids, and blood.

Hepatitis

Acute and Chronic Results from infection by a group of viruses that specifically target the hepatocytes

Hepatitis

spread primarily by feces since the | virus lives in the alimentary tract. Found worldwide, accounts for 20% of cases. Acute

Hep A(HAV) viral

spread by transfusions of infected | blood or plasma or through contaminated needles

Hep B(HBV) viral

Can also be transmitted from body fluids. Greatest risk for Health Care workers, accounts for 60% of cases

Hep B(HBV) viral

diagnosed by the presence in blood | of the antibody to HCV. Seen mostly in Italy and other Mediterranean countries

Hep C(HCV) viral

entirely dependent on HBV for its | infectivity, rare in North America, seen primarily in IV drug users Must have HBV to aquire

Hep D (HDV) viral

caused by fecally infected waters | May be seen in liver transplantation

Hep E (HEV) viral

newly discovered, first described in | 1996, caused by blood transfusion

Hep (HGV)viral

Clinical findings of Hepatitis

Chills Dark urine Elevated liver function tests Fatigue Fever Hepatosplenomegaly Jaundice Nausea Vomiting

Sonographic findings of hepatitis

Normal liver Enlarged, hypoechoic liver Periportal cuffing with “starry sky” Gallbladder wall thickening

Diffuse process characterized by fibrosis and | conversion of normal liver parenchyma into structurally abnormal nodules

Cirrhosis

Generalized involvement of the liver by parenchymal necrosis, regeneration, and diffuse fibrosis Scarring is progressive and irreversible leading to liver cell failure and portal hypertension

A leading cause of death in the US

Cirrhosis

Most common causeof micronodular cirrhosis

Alcohol Abuse

Most common cause of macronodular (1.0-5.0 cm) | cirrhosis

Viral Hepatitis

drug | abuse,obesity,chronic bile retention, cardiac insuffiency,and some medication

Other causes of cirrhosis

Clinical findings of cirrhosis

Ascites Diarrhea Elevated liver function tests Fatigue Hepatomegaly(initial) Jaundice Splenomegaly Weight loss

Hepatomegaly( initially) Shrunken right lobe of the liver Enlarged caudate and left lobe Nodular surface irregularity Coarse echotexture Splenomegaly Ascites Monophasic flow within the hepatic veins Hepatofugal flow within the portal veins

Sonographic findings of Cirrhosis

Portal Hypertension

> 90% due to cirrhosis Can also be due to obstruction of the portal,hepatic veins, and/or IVC, or longstanding CHF Contributes to the formation of ascites,splenomegaly and GI bleeding Varices and collateral venous channels Caput medusal sign- collateral vessels on the abdominal wall

Portal vein enlarge (>13mm)

Portal Hypertension

If red is the top color on the color scale, this means | blood flow is toward the probe, toward the liver. The normal color than for the PV is

red

Echogenic thrombus within the portal vein Cavernous transformation of the portal veins will appear as wormlike or serpiginousvessels within the region of the portal vein

Sonographic findings of Portal Vein | Thrombosis

Obstruction of the hepatic venous outflow Etiologies include hypercoaguable states,oral contraceptives,collagen vascular diseases,hepatic tumors Portal vein thrombosis has been reported in approx 20%

Budd-Chiari Syndrome

Ascites Elevated liver function test Hepatomegaly Splenomegaly Upper abdominal pain

Clinical findings of Budd-Chiari Syndrome

Most common benign mass in liver

Cavernous hemangeoma

Sonographic findings of Budd- | Chiari Syndrome

Nonvisualizationor reduced visualization of the hepatic veins Thrombus within the hepatic veins Enlarged caudate lobe Lack of flow within the hepatic veins with color Doppler Narrowing of the inferior vena cava

Extrahepatic

anterior displacement of the RK. | Anteromedial shift of the IVC. Discontinuity of the liver capsule,

Intrahepatic

Posterior displacement of the IVC. | Displacement of the hepatic vascular radicles. External bulging of the liver capsule

Liver Pathology Flashcards

(69 cards)