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Abdomen > Liver Pathology Online Review > Flashcards

Liver Pathology Online Review Flashcards

1
Q

What is the difference between atrophy, hypertrophy and hyperplasia

A

HT - Enlargement of cells
Atrophy - Decrease in size of cells
Hyperplasia - Increase in number of cells

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1
Q

Transformation of one cell type to a less specialized type

A

Metaplasia

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2
Q

What is fatty infiltration of the liver

A

Non specific reversible metabolic disorder
Abnormal accumulation of fat within hepatocytes

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3
Q

What are the causes of fatty infiltration of the liver

A

Obesity
Excessive alcohol consumption
Hyperlipidemia
Diabetes
Pregnancy
Chronic hepatitis
Cystic fibrosis
Chemotherapy

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4
Q

Describe difference between diffuse fatty infiltration and focal fatty infiltration

A

DFI - Increase echogenicity, attenuation of sound beam, difficult to visualize parenchyma, vessles, and diaphgram
FFI - Focal area increased echogenicity, occurs near porta hepatis

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5
Q

Focal area in the liver that doesn’t demonstrate fatty infiltraion and where does it most commonly occur

A

Focal fatty sparing
Commonly occurs in caudate lobe or near porta hepatis

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6
Q

How can you differentiate a mass vs. focal fatty sparing

A

Look for “mass effect” - Displacement of vessels, and contours
Normal TSC scan
Area of low attenuation in C.T scan

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7
Q

What is glycogen storage disease

A

Congenital enzyme deficiency affecting glycogen metabolism

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8
Q

What is the sonographic appearance of glycogen storage disease

A

Appears similar to diffuse fatty infiltration
Also could present as focal solid masses

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9
Q

What is hemochromatosis
Who is at higher risk
What are these people at risk for

A

Excessive accumulation of iron within the liver
Males higher risk (7:1)
Increased risk of HCC (Hepatocellular carcinoma)

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10
Q

What is the sonographic appearance of hemochromatosis

A

See diffuse increased echogenicity Attenuation with hepatomegaly
Also indistinguishable from fatty infiltration
Cirrhotic changes (parenchyma might change)

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11
Q

Define hepatitis

A

Inflammation of the hepatocytes

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12
Q

Symptoms of hepatitis

A

Asymptomatic
Loss of appetite
Malaise
Jaundice
Abnormal LFT’s

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13
Q

Types of hepatitis
Describe them

A

Drug induced
A - Transmitted via fecal/oral route
B - Transmitted via blood/body fluids
C - Transmitted via blood/body fluids
D - Transmitted via blood/body fluids
E - Similar to Hep A, transmitted via fecal-oral route
Acute - Fully recoverable, result of Hep A
Chronic - Persistence of hepatitis for longer than 6 months

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14
Q

Describe clinical manifestions of hepatitis

A

-Uncomplicated acute hepatitis
-Fulminant
-Increase AST/ALT
-Increase bilirubin & leukopenia

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15
Q

Describe the difference in sonographic appearance between chronic and acute hepatitis.

A

A:
-Decreased echogenicity
-Increased brightness of portal triad walls, “Starry sky” appearance
-Hepatomegaly & Splenomegaly
-GB wall thickening
C:
-Hepatic parenchyma progressively damaged
-Visualized as course echotexture, heterogenous, decreased size

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16
Q

Irreversible liver damage that replaces normal liver architecture with abnormal fibrotic nodules
Describe the classifications.

A

Cirrhosis
Classifications:
Micronodular: 0.1-1 cm
Macronodular: 1-5 cm

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17
Q

What are the causes of cirrhosis? What is the most common cause?

A

-Alcoholic liver (70%) – Most common
-Viral hepatitis (10%)
-Biliary causes (10%)
-Hemochromatosis (5%)
-Other (5%)- Ex. Wilson’s Disease

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18
Q

What are the clinical symptoms of cirrhosis?

A

-Anorexia
-Indigestion
-Nausea/vomiting
-Diarrhea/constipation
-Abdominal pain
-Abnormal bleeding
-Edema/ascites
-Jaundice
-Fatigue
-Hepatic encephalopathy

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19
Q

When liver function tests are ordered, what values are increased in a patient with cirrhosis? What values are decreased?

A

I - PT Time, AST/ALT, Bilirubin
D - Total protein, Albumin

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20
Q

Chronic progressive often fatal form of cirrhosis
Intrahepatic

A

primary biliary cirrhosis

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21
Q

Periportal fibrosis secondary to prolonged obstruction of an extrahepatic biliary tree

A

secondary biliary cirrhosis

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22
Q

What are the sonographic patterns/appearances of cirrhosis

A

Volume redistribution
Course texture

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23
Q

Describe other findings associated with cirrhosis

A

-Ascites
-Pancreatitis
-Narrowed HV’s and/or IVC by nodular regeneration
-Portal hypertension
-Ligamentum teres should not have blood inside of it
-Cirrhosis
-Recanalized umbilical vein

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24
Q

What is proximal biliary obstruction? Where is the obstruction located?

A

Block in the bowel duct, can be caused by stones or tumor invasion of porta hepatis
Obstruction proximal to the cystic duct

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25
Q

Symptoms of proximal biliary obstruction

A

Jaundice
Pruritis (Itching of skin)
Elevated bilirubin and alko phos

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26
Q

What are the sonographic findings of proximal biliary obstruction

A

Normal GB even after food
Dilated ducts in liver periphery

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27
Q

Where is the obstruction located in a patient with distal biliary obstruction

A

Distal cystic duct caused by stone or extrahepatic mass CBD extrahepatic

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28
Q

What are the sonographic findings of distal biliary obstruction

A

Small GB
Stones

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29
Q

An extrahepatic mass that affects the liver is located where? What are the sources of these masses?

A

Mass located in the area of the porta hepatis
Sources:
- Pancreatitis or carcinoma
- Lymph nodes
- Pseudocyst

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30
Q

What are the symptoms of a common hepatic duct stricture? Sonographic findings?

A

Condition with:
- Previous cholecystectomy
- Jaundice
-Increased bilirubin and alk phos
Sonographic findings:
- Intrahepatic biliary dil
- No mass in porta hepatis

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31
Q

What is passive congestion
What are the sonographic findings

A
  • Congestion due to heart failure
    Sonographic findings:
  • Hepatomegaly
  • Enlarged hepatic veins, IVC, PV, and SV
  • Ascites
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32
Q

What is a simple cyst

A

Asymptomatic cyst that is usually found incidental

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33
Q

4 characteristics/criteria of a simple cyst

A
  • Well defined borders
  • Thin walls
  • Anechoic
  • Posterior enhancement
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34
Q

What are the symptoms of a congenital hepatic cyst

A

Asymptomatic
Rare to find a solitary cyst
Incidental findings

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35
Q

Polycystic liver disease is associated with

A
  • Associated with autosomal dominant disease and polycystic kidney disease
  • Less than 500 individuals affected
36
Q

What are the sonographic findings of polycystic liver disease

A
  • Less than 2-3 cm
  • One to multiple cysts
  • Can be small
  • Typically simple
37
Q

What is a hematoma
What locations can they be found in

A

Contained collection of blood
Subcapsular
Intrahepatic

38
Q

T or F:
A hematoma doesn’t increase chance of carcinoma

A

T

39
Q

Describe the difference in sonographic appearance of a hematoma between one that is scanned within the 1st 24 hours and one that is imaged later on

A

1st 24 hours:
- Echogenic
Image later on:
- Hypoechoic with lysis of blood
Strandy
Internal echoes

40
Q

What is a liver abscess

A

Occurs when bacteria destroys hepatic tissue producing cavity which fills with infectious organisms

41
Q

A liver abscess is ____ and happens possible after ___ or _____

A

Necrotic
Possible after surgery or trauma

42
Q

What is a pyogenic abscess

A

Pus-filled abscess in the liver that can be small or large and is an infection in portal cavity

43
Q

What are the symptoms of a pyogenic abscess

A

Elevated WBC
Fever
Anemia
Abnormal LFT

44
Q

What are the sonographic findings of a pyogenic abscess

A

Cystic lesion
Variable apperance
Complex-debris or fluid level
In right lobe

45
Q

Liver affected by hematogenous fungual spread of infection, usually in the lungs

A

Hepatic Candidiasis

46
Q

Who does hepatic candidiasis usually affect

A

Commonly affects immunocomprimised patients such as:
- Chemotherapy
- Surgical treatment
- Patients with HIV

47
Q

What are the symptoms of candidiasis

A

Fever
Localized pain
Elevated WBC

48
Q

What are the sonographic findings of candidiasis

A

Multiple small hypoechoic lesions
Hypoechoic rim with echogenic center
Bull’s eye/Target sign (wheel within wheel)
FNA for diagnosis (Fine needle aspiration)

49
Q

Disease genetically heterogenous immunodeficiency disorder result from inability of phagocytes killing micobes ingested

A

Chronic granulomatous disease

50
Q

What are the sonographic findings of chronic granulomatous disease
What are the symptoms

A

Symptoms:
- Pediatric patients with recurrent URI’s
- Asymptomatic
- FNH
Sonographic findings:
- Ill defined margins
-Hypoechoic
- Posterior enhancement
- FNA necessary for diagnosis

51
Q

What are the symptoms of amebic abscess

A
  • Elevated WBC
52
Q

What are the sonographic findings of ambeic abscess

A
  • Simple round or oval cyst
  • Hypoechoic wit debris
53
Q

In an amebic abscess the parasite reaches the

A

Portal vein via the bloodstream

54
Q

Water/snail born parasite can penetrate skin, mucosa, lungs, and liver

A

schistosomiasis

55
Q

Where does the schistosomiasis go through and what does it do

A

Enters liver and destroys terminal portal veins and branches

56
Q

What is the most common liver parasite

A

Schistosomiasis

57
Q

What are the sonographic findings of Schistosomiasis

A

Widened echogenic portal tract
Initial hepatomegaly, disease progresses liver decreases
Periportal fibrosis
Portal hypertension
Varices
Ascites

58
Q

Most common organism causing opportunistic infections
Who does this most commonly affect

A

Pneumpcystis carinii
Affects HIV patients

59
Q

What are the sonographic findings of pneumpcystis carinii

A
  • Diffuse
  • Tiny
  • Non-shadowing echogenic foci throughout liver
  • Replacement of normal liver tissue with echogenic clumps of calcification
60
Q

What is an echinococcal (hydatid) cyst
What are the symptoms

A

Parasitic disease in sheep/cattle raising countries
Elevated WBC

61
Q

What are the sonographic findings of an echinococcal (hydatid) cyst

A
  • Simple cyst with possible sand
  • Have detached endocyst
  • Densely calcified
  • Cyst within a cyst
62
Q

What is a hemangioma
What are the symptoms
What are the sonographic findings

A

Large blood filled cystic spaces
Symptoms:
- Most common mass
- Asymptomatic
Sonographic findings:
- Hyper-hypoechoic
- Enhancement
- Mixed pattern from necrosis

63
Q

Describe what a lipoma is
What are the symptoms
Sonographic findings

A

Benign tumor primarily composed of fat cells
Symptoms:
- Asymptomatic
Songraphic findings:
- Hyperechoic mass
- Propagation speed artifact

64
Q

Describe the difference in sonographic findings between a hemangioma and a lipoma

A

H:
- Enhancement
- Mixed pattern from necrosis
- Collection of blood vessels
L:
- Hyperechoic mass
- Propagation speed artifact

65
Q

What is an adenoma
What are the symptoms

A

Glandular epithelial mass that is rare and benign
Symptoms:
- Asymptomatic
Possible RUQ pain
Related to OCP’s

66
Q

What are the sonographic findings of an adenoma

A
  • Hyperechoic with central echoes
  • Solitary or multiple
  • Encapsulated, well defined
67
Q

What is focal nodular hyperplasia
Who’s most at risk

A

Rare, benign liver mass
Most risk is women under 40

68
Q

What are the symptoms of focal nodular hyperplasia

A
  • Found in right lobe
  • Multiple
  • Well defined hyper to isoechoic patterns
  • Contour changes or displacement of vessels
69
Q

What are alternative names for hepatocellular carcinoma
Who is most commonly affected

A

Hepatoma, HCC, Primary liver cell cancer
Males more affected (Ratio of 5:1)

70
Q

What are the predisposing factors of HCC

A
  • Chronic Hep B & C
  • Cirrhosis
  • Aflatoxins
71
Q

What are the symptoms of HCC

A

Asymptomatic
RUQ pain
Weight loss
Ascites
Fatigue
Malaise
Elevated AST
High mortality rate

72
Q

What is the sonographic appearance of HCC

A
  • Variable
  • Solitary, multiple, diffuse infiltration
  • Smaller masses hypo echoic –> Isoechoic
  • Larger masses heterogeneous, hyperechoic ducts to area of hemorrhage and necrosis
  • Venous invasion
  • HCC has arterial and venous flow
73
Q

What is the role of the sonographer in imaging a patient with HCC

A
  • Localize, measure, and characterize mass
  • Evaluate abdomen and pelvis for adenopathy for ascites
  • Guidance for biopsy, percutaneous alcohol injection, or cryogenic therapy
74
Q

What are the symptoms and sonographic findings for metastasis

A

Symptoms:
- Elevated LFT’s
- Jaundice
- Weight loss
Sonographic findings:
- Hypoechoic or echogenic
- Bull’s eye
- Solitary or multiple
- Well to ill defined

75
Q

Malignant neoplasms involving lymphocyte proliferation in lymph nodes
What are the 2 types
How can you differentiate

A

Lymphoma
2 Types:
- Hodgkin’s
- Non-Hodgkin’s
Differentiate by:
- Lymph node biopsy

76
Q

What are the symptoms and sonographic findings of lymphoma

A

Symptoms:
- Hepatomegaly
- Elevated LFT’s
- Lymphadenopathy
Sonographic findings:
- Other nodes may be seen
- Multiple small discrete masses
- Hypoechoic, solid, no enhancemnt

77
Q

What is portal hypertension
What is the primary cause

A

Increased pressure in the portal venous system - Build up of portal vein pressure due to progressive hepatic fibrosis
Cause:
- Cirrhosis (90%)

78
Q

What are the sonographic findings of portal hypertension

A
  • Portal vein becomes monophasic
  • Blood flow reverses direction
  • Splenomegaly
  • MPV >13 mm
  • Ascites
  • Porta systemic collaterals
79
Q

Describe difference between hepatofungal and hepatopedal flow

A

HF - Out flow
HP - In flow

80
Q

Ligamentum teres is a remnant of what obliterated vein

A

Umbilical veins

81
Q

Ligamentum venosum is remnant of what obliterated vein
What was its purpose prenatally

A

Ductus venosus
Shunts blood from umbilical vein to IVC

82
Q

Describe what portosystemic collaterals are
Where do they commonly occur

A

Form due to increased venous pressure
Commonly occur in umbilical vein and gastroesophageal junction

83
Q

What is the purpose of portosystemic shunts

A

Relieve portal hypertension and pressure on varices

84
Q

What is a TIPS

A

Trans jugular intrahepatic portosystemic shunt

85
Q

Rare disorder characterized by occasional of hepatic veins, may involve the IVC

A

Budd-Chiari syndrome

86
Q

What are the causes of Budd-Chiari

A

Congenital
Coagulation abnormalities
Pregnancy
Oral contraceptive use
Tumor extension
Trauma

87
Q

What are the sonographic appearrance of Budd-Chiari

A

-Hepatomegaly and ascites
-Partial or complete inability to visualize hepatic veins
-Visible stenosis or thrombus in lumen
-Hemorrhagic infractions will appear hypoechoic intially
-Enlarged caudate lobe
-Abnormal blood flow detected in HV

88
Q

What is Wilson’s Disease
What would you look for sonographically

A

Excessive intake of copper
Look for hematoma on images

Abdomen (10 decks)

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