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A ADVANCED ABDOMEN > Pathology Lecture for Quiz 2/3 > Flashcards

Pathology Lecture for Quiz 2/3 Flashcards

1
Q

What is the highest echogenicity of parenchymal organs?

A

Renal sinus

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2
Q

What is the parenchymal organ order for echogenicity?

A

Renal sinus/retro fat, pancreas, spleen, liver, renal cortex, renal medulla

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3
Q

In scanning, what overlaps the spleen?

A

The top of the left lobe of liver

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4
Q

What are three sonographic liver patterns?

A

Normal, centri-lobular, fatty-fibrotic

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5
Q

What is the appearance of a centri-lobular pattern?

A

Decreased echogenicity of the liver parenchyma with bright echogenic dots (starry night)

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6
Q

With centri-lobular pattern, how is the PV wall affected?

A

Increased visualization through brightness and number

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7
Q

What are the causes of centril-lobular pattern?

A

Acute hepatitis, acute RT side HF, leukemia/lymphoma, toxic shock syndrome

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8
Q

What percentage of people develop centri-lobular pattern????? ASK

A

2%

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9
Q

Why does starry night/centri-lobular pattern occur?

A

Edematous swelling (water) of hepatocytes w/resultant decrease in the hepatic echogenicity

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10
Q

With starry night, what do the altered acoustic properties between the portal venous radicals and hepatic lobules cause?

A

Sonographic accentuation of the venule walls

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11
Q

How does fatty fibrotic pattern appear?

A

Increased echogenicity of the liver parenchyma

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12
Q

How do PV walls appear with fatty fibrotic pattern?

A

Decreased definition

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13
Q

What are the two types of echotexture that can occur with fatty liver?

A

Homogenous (fine), heterogenous (coarse)

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14
Q

What happens to sound with fatty liver?

A

Posterior sound attenuation (darker bottom of screen)

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15
Q

What are causes of fatty liver?

A

Fatty infiltration, chronic hepatitis, cirrhosis, acute alcoholic hepatitis

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16
Q

What happens to the size of the liver with fatty liver?

A

It enlarges

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17
Q

What type of echotexture does fatty liver tend to have?

A

Homogenous

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18
Q

What are two types of focal fatty liver changes?

A

Liver penetration and fatty sparing

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19
Q

What type of pattern does cirrhosis show?

A

Fatty fibrotic pattern with heterogenous texture

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20
Q

Is there posterior attenuation with cirrhosis (in relation to fatty liver?)

A

Almost none

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21
Q

What can happen to the liver with cirrhosis?

A

It shrinks

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22
Q

What type of surface occurs with cirrhosis?

A

Nodular surface

23
Q

What is the ratio for elevated caudate to right lobe identifying cirrhosis?

A

Higher than .65

24
Q

What does portal hypertension account for?

A

90% of all cases of cirrhosis

25
Q

With cirrhosis, which liver architecture is distorted?

A

Fibrosis, regenerating nodules, distorted vascular channels

26
Q

What increases with portal hypertension?

A

Hepatic resistance, portal venous pressure

27
Q

What eventually decreases with portal hypertension?

A

Portal flow

28
Q

What is the prognostication for risk of hemorrhage?

A

Reversed portal flow

29
Q

What are symptoms of ascites?

A

Jaundice, sudden weight gain, a distended abdomen,

difficulty breathing when lying down, diminished appetite, abdominal pain, bloating, nausea and vomiting, heartburn

30
Q

What are sonographic signs of portal hypertension?

A

Ascites, dilated MPV, SV, SMV, collaterals, splenomegaly, various doppler findings

31
Q

Where can ascites collect?

A

Morrison’s pouch, below diaphragm and around the liver

32
Q

What does most dependent area mean?

A

Lower support (standing = feet, lying on side = Morrison’s

33
Q

What are the 8 porto-systemic collaterals?

A

Gastroesophageal, coronary, umbilical, gastrosplenic, splenorenal/gastrorenal, perisplenic, instestinal (rectum), retroperitoneal

34
Q

What is the coronary vein?

A

Left gastric vein

35
Q

What is the upper normal limit of the coronary vein?

A

5 - 6 mm

36
Q

Which porto-systemic collateral system is most prevalent?

A

Coronary (80 - 90%)

37
Q

What appearance can coronary vein have?

A

Tortuous (as it extends superiorly toward GE junction

38
Q

When an umbilican vein (UV) is extending from LPV, what is the diameter?

A

1.8 mm

39
Q

What happens to doppler of portal vein with portal hypertension?

A

Loss/respiratory variation, decreased velocity of MPV, reversed flow

40
Q

What happens to doppler of hepatic veins with portal hypertension?

A

Loss of normal pulsatility, non triphasic flow, flattened wave

41
Q

What happens to hepatic arteries during portal hypertension?

A

They enlarge

42
Q

Other than portal hypertension, what else can cause resistance?

A

Scarred liver, shrunken liver

43
Q

Besides MPV, what else may have reversed flow with portal hypertension?

A

SMV and SV

44
Q

What is ultrasound excellent in detecting with liver?

A

Focal liver lesions, liver cysts larger than 1 cm

45
Q

What is ultrasound not good for?

A

Differentiating among pathologic entities / between benign and malignant lesions

46
Q

What is better than ultrasound for triphasic study of lesions?

A

CT / MRI

47
Q

How is ultrasound helpful regarding biopsy?

A

Diagnosis, follow up and guidance

48
Q

What are the 6 benign hypoechoic liver masses?

A

Abscess, adenoma, focal nodular hyperplasis, hemangioma, microabscesses, focal fatty sparing

49
Q

What are the 3 malignant hypoechoic liver masses?

A

Metastases, hepatocellular carcinoma, lymphoma

50
Q

What are the 6 hyperechoic liver masses?

A

Hemangioma, abscess, adenoma, focal nodular hyperplasia, hemorrhagic cyst, focal fat infiltration

51
Q

What are the 3 malignant hyperechoic liver masses?

A

Metastases, hepatocellular carcinoma, lymphoma

52
Q

What’s the similarity between hypoechoic and hyperechoic malignant masses?

A

They are the same diseases (3)

53
Q

What are the benign liver masses common with hypoechoic and hyperechoic masses?

A

Abscess, hemangioma, adenoma, focal nodular dysplasia

54
Q

What is LFT?

A

Liver function test

A ADVANCED ABDOMEN (9 decks)

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