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Flashcards in pathology of the liver test 2 Deck (120):
0

What is patient prep for liver exam?

NPO for 6-8 hours

1

What is the correct transducer for liver evaluation?

Ave adult: 2.5-5 MHz

slender adult and children: 5-7MHz

neonate 7.5-12 MHz

2

What is the assessment criteria for the liver?

size of the liver in sag

attenuation of liver parenchyma

texture

presence of hepatic vascular structures ligaments and finish

3

What are you basically looking for in the liver parenchyma?

size

configuration

homogeneity

contour


8

What is situs inversus?

the organs are backwards in the body

9

What is agenesis?

the organ isn't there - incompatible with life

10

What are the classifications of the liver diseases?

parenchymal

hepatobiliary disorders

hepatic vascular disorders

11

What is hepatocellular diffuse disease?

interferes with liver function

12

What are the diffuse liver diseases?

fatty infiltration

granulomas

hepatitis

cirrhosis

glycogen storage

hemochromatosis

13

what is diffuse?

throughout the organ

14

What needs to be in the pictures of the liver?

the diaphragm

15

What is fatty infiltraton

increased lipid and triglycerides

benign and may be reversible

asymptomatic

other symptoms: jaundice, nausea, vomiting, pain

16

What are the causes of fatty liver?

obesity

excessive alcohol intake

poorly controlled hyperlipidemia

diabetes

excess corticosteroids

pregnancy

total parenteral hyperalimentation (tube feed)

severe hepatitis

glycogen storage disease

cystic fibrosis

pharmaceutical

17

the main cause of fatty liver is?

Increased fats

18

Why does the liver become fatty?

result of major injury to the liver or a systemic disorder

leading to impaired or excessive metabolism of fat

19

What does fatty liver look like sonographically?

increased echogenicity

hepatomegaly

posterior liver diaphragm and vessels - may be hard to see

greater attenuation = decreased visualization

20

What are the three grades of fatty infiltration?

grade 1 - slight

grade 2 - moderate

grade 3 - marked

21

What is grade 1 fatty infiltration?

there is a slight diffuse increase in fine echoes in the hepatic parenchyma, with normal visualization of the diaphragm and intrahepatic vessel borders

22

What is grade 2 fatty infiltration?

moderate - diffuse increase in fine echoes with slightly impaired visualization of the intrahepatic vessels and diaphragm

23

What is grade 3 fatty infiltration?

marked - increase in fine echoes with poor or no visualization of the intrahepatic vessel borders, diaphragm and posterior portion of the right lobe of the liver

24

What is steatosis?

synonym for fatty infiltration at the cellular level

25

What is fatty focal sparing?

where the liver has fatty infiltration diffuse, but somewhere near the porta hepatis...there will be a dark area...this is fatty sparing, not necessarily a tumor

26

Where might you find fatty sparing?

anterior to the GB or PV

near Porta hepatis

posterior left lobe

27

What are granulomas?

small calcifications in the liver and spleen

28

What are granulomas caused by

Histoplasmosis

tuberculosis

29

What is histoplasmosis?

in an infection caused by breathing in spores of a fungus often found in bird and bat droppings

30

what is tuberculosis?

bacterial infection that can spread through the lymph nodes and blood stream to any organ in your body.

most often found in the lungs

31

What are the symptoms of granulomas?

asymptomatic

32

how do granulomas appear sonographically?

echogenic pearls with shadowing

33

Where else beside liver will you see granulomas?

in the spleen

34

What is hepatitis?

inflammatory and infectious disease

35

How do you get hepatitis A?

fecal matter

36

How do you get hepatitis B?

exposure to needles and blood

37

What are some things that develop from hepatitis?

inflammation can lead to cirrhoisis

portal hypertension

hepatocellular carcinoma

38

What are some symptoms of hepatitis?

nausea

vomiting

RUQ pain

fatigue

anorexia

FEVER

headache

jaundice

Hep B and C also cause

skin rash

aversion to smoking

weight loss

arthralgia

39

What are the lab values for hepatitis?

marked increase in AST and ALT

ALT fall rapidly after several days

bilirubin increases

40

What happens with acute hepatitis?

mild to necrosis

hepatocyte injury

kupffer cell enlarging and regeneration

41

how does acute hepatitis look sonographically?

the portal radicals (branches of portal vein) becoming even more echogenic

hepatosplenomegaly

thick GB walls

42

What happens if you have chronic hepatitis?

fibrosis (a course-ness, not smooth)

may progress to liver failure and cirrhosis

will become smaller

43

What are the sonographic findings for chronic hepatitis?

coarse

smaller size

soft shadow from fibrosis

44

Symptoms and causes of chronic hepatitis is the same as acute?

yes

45

What is cirrhosis?

degenerative disease

necrosis

fibrosis

progress to liver failure and portal hypertension

CHRONIC ALCOHOL ABUSE

46

What is cirrhosis sequela?

portal hypertension

varicosities in the abdomen

portal vein thrombosis

splenomegaly

47

What are the symptoms for chirrhosis?

fatigue and weakness

abd bloating

anorexia

jaundice

later symptoms:

GI bleeding

varicose veins on the abd

red palms

clubbing of nails and fingers

ascites

48

What are the lab values for cirrhosis?

AST, ALT and Bilirubin are all increased

49

What does a smaller, coarse, nodular, structure with free fluid and a dilated portal vein indicate?

a liver with cirrhosis

50

what might also increase with cirrhosis?

the caudate lobe

early stage liver: enlarged

advanced stage: small

51

What are doppler characteristics of cirrhosis?

waveform is abnormal

as advances, the hepatic veins develop luminal narrowing

increased velocities and trubulence of the flow patterns

52

What does EtOH stand for?

alcohol abuse

53

What is glycogen storage disease?

type 1 von Gierke

genetic disorder of carbohydrate metabolism

stores too much glycogen...cant metabolise it

54

What are the sonographic findings of vonGierke?

hepatomegaly

increased echogenicity

adenomas**

associated nephromegaly

55

What is a glycogen storage disease with adenomas?

von Gierke's disease

56

What is the definition of glycogen storage disease?

abnormally large amounts of glycogen are deposited in the liver and kidneys

57

What is Hemochromatosis?

rare

liver cannot metabolize iron

hepatomegaly

cirrhotic changes

cannot see on ultrasound

58

Where is the orgin of bile?

in the liver

59

where is the proximal biliary tree?

within the liver

60

Where is the distal biliary tree?

closest to the pancreatic head

61

Where does biliary dilatation usually occur?

proximal to the level of the obstruction

62

Where are the most common obstructions of the CBD?

Distal CBD with dilatation CBD, GB, intrahepatic ducts

63

What are the lab values for biliary obstruction?

elevated bilirubin and ALK PHOS

64

What is a biliary proximal obstruction?

Causes: Gallstones, CA, Mets

Symptoms: Jaundice, pruritus

Labs: elevated bili and alk phos

sonographic: dilated duct, GB normal in size

65

What are the symptoms of distal biliary obstruction?

causes:

stones in the CBD

mass

stricture (narrowing)

symptoms:
RUQ pain

jaundice

pruritis

66

What are the sonographic findings of distal biliary obstruction?

dilated ducts

GB size may be small

Gallstones

67

What is the sonographic findings in an extrahepatic mass?

ductal dilation

hydropic GB - distended

lesion may be lymph or pancreatic Ca (ca blocks the duct)

68

What are the symptoms of the common duct stricture?

jaundice

previous cholecystectomy

increase in bilirubin and alk phos

sonographically: dilated ducts

69

What are the focal diseases of the liver?

cysts

abscess

hematomas

tumors

metastases

70

What are the sonographic findings of a cyst of the liver?

well defined

anechoic

enhancement

71

If its not a random cyst in the liver, what is it?

congenital

72

What is polycystic liver disease?

autosomal dominant

associated with polycystic kidneys

sonographic: cyst criteria

73

Are the cysts in polycystic liver disease small or large?

small, less than 2 -3 cm

multiple throughout the hepatic parenchyma

74

What are liver abscess?

pyogenic (bacterial)

escherichia coli (E. coli) and anaerobes

multiple infection symptoms

75

How does an abscess appear sonographically?

various appearances

usually solitary

debris

complex

micro air bubbles cause SHADOWING

looks like cysts webbed together

76

What is a fungal (candidiasis) abscess?

immunocompromised hosts such as cancer patients and organ transplant patients are most likely to get it

infection

77

how does candidiasis look sonographically?

multiple hypoechoic masses

target or bull's eye lesions

"wheel within a wheel" early

78

What is an amebic (parasitic) abscess?

parasite: entamoeba histolytica

contaminated water and food

enters liver through portal vein

sonographic: variable appearance

air in the mass usually = abscess

79

what is fever and travel to foreign country indicate?

abscess

80

What is an echninoccal (parasitic) abscess?

aka: hydatid cysts

sheep and cattle herding

parasite causing hydatid disease

food contaminated

81

what are the clinical symptoms of echninoccal parasitic hydatid cysts?

fever

RUQ tenderness

82

What is the sonograhic findings of echninoccal parasitic hydatid cysts?

honey comb

WATER LILY SIGN

cyst within a cyst

DAUGHTER CYST

83

What is a schistosomiasis (parasitic) abscess?

contaminated water

sonographic: thickened portal walls and dilatation (portal hypertension)

splenomegaly

collaterals (opens ligamentum teres)

84

What are benign tumors of the liver?

cavernous hemangioma

adenoma

cystadenoma

focal nodular hyperplasia

85

What are malignant tumors of the liver?

carcninoma

metastatic

86

Are tumors focal or diffuse?

focal

87

What is a cavernous hemangioma?

MOST COMMON benign tumor

echogenic because it is highly vascular

usually looks round

typically females

sonographic: hyperechoic

88

What is an adenoma?

glandular

female oral contraceptives increase the occurance

may become malignant

89

how does and adenoma appear sonographically?

hyperechoic

90

What is focal nodular hyperplasia?

second common benign liver mass

women under 40

sonographically:

well defined

multiple nodules

STEALTH LESION

91

Where is focal nodular hyperplasia most often found?

on the anterior portion of the left lobe

92

What is an infantile hemangioendothelioma?

benign overgrowth

females

presents with abd mass

sonographic: multiple lesions with hyperechoic margins

no symptoms

93

What is a hamartoma?

rare

benign

children under 2

palpable abd mass

sonographic: well defined large complex mass

no symptoms

94

What is hepatocellular carcinoma (HCC) hepatoma?

most common primary malignant neoplasm

related to cirrhosis

male

unexplained mild fever

invasive

destroys vessels

sonographic: halo lesions, hepatomegaly

95

What is encountered more HCC or Mets?

Mets

96

what are the labs for HCC? (hepatocellular carcinoma)

elevated alpha fetoprotein***

abnormal liver function tests

cirrhosis

unexplained weight loss***

palpable mass

ascites

97

How does hepatocellular carcinoma present?

solitary massive tumor

multiple nodules throughout the liver

diffuse infiltrative masses in the liver

98

how will HCC pathologically present?

focal lesion

invasive lesion with necrosis and hemorrhage

poorly defined lesion

99

When cancer invades the hepatic veins what do you have?

Budd-Chiari syndrome

100

Hepatoblastoma is what?

associated with becwith-wiedemann

genetic growth disorder - associated with a defect in chromosome number 11

before age 5

labs: elevation in alpha fetoprotein

symptoms: palpable mass, weight loss

101

What is the neonate hepatomegaly TORCH?

T - toxoplasmosis

O- other infections

R- rubella

C - cytomegalovirus

H - herpes

infections in the uterus when the mother catches the infectious disease and carries it through the blood stream to the baby

102

What are the signs for trauma with a hepatic hematoma?

sonographic:

free fliud

hematoma

decreased hematocrit

103

What could be a consequence of trauma or surgery in the liver?

hematoma

hemorrhage

decreased hematocrit

104

What are indications for a liver transplant?

cirrhosis

hepatitis

cholangitis

hepatoma

budd-chiari

105

what are complications for a liver transplant?

rejection

thrombosis

infection

neoplasia

106

What are you assessing in a liver transplant?

vascular structures are assessed for size and patency in the preoperative evaluation

liver parenchyma should be examined to rule out the presence of hepatic architecture disruption

107

What is the problem with portal hypertension?

it causes the pressure to go up and the vessels start to pop

108

what is the most common cause of portal hypertension?

cirrhosis

109

what are collaterals?

when portal hypertension forces the body to create new paths for blood flow

coronary and esophageal vein

varices tortuous dilations

110

What happens with a varicose or collateral vein ruptures?

person bleeds out

111

what is the limit on the portal vein size?

1.3cm any greater and you suspect portal hypertension

112

What happens to the umbilical vein when you have portal hypertension?

recanalization of the umbilical vein = Medusa's head

113

What is the most common connection to release pressure when there is portal hypertension?

TIPS

transjugular intrahepatic portosystemic shunt

114

Where is TIPS placed?

between the portal and hepatic veins***

placed to reduce pressure

temporary treatment

115

What are the sonographic findings of portal hypertension?

initially hepatomegaly

shrunken right lobe

enlarged caudate and left lobe

nodular surface

coarse texture

splenomegaly

ascites

116

What are the doppler findings for portal hypertension?

monophasic flow in the hepatic veins

hepatofugal flow in the portal veins

enlarged portal vein

enlarged SMV

reversed flow in the splenic vein

117

what is Budd-Chiari?

thrombosis of the hepatic vein or IVC

118

what is the songraphic finding of Budd-Chiari?

caudate lobe enlarged

atrophy of rt hepatic lobe thrombosed vein enlarges

splenomegaly

119

What is an angiosarcoma?

malignant from the blood vessels

rare

60-80 years old

sonographic: solid mass

120

what is metastatic disease?

most common

primary: breast, colon, lung

lab: abnormal LFT

sonographic: multiple nodes, bull's eye lesions, calcifications

121

What is lymphoma?

hodgkins and non-hodgkins

hepatomegaly

sonographic: bull's eye, multiple

122

What are the pediatric malignancies?

hepatoblastoma (liver)

neuroblastoma (adrenal gland)

Wilm's (kidney)

leukemia (lymph)

123

What is one tell tale sign of Budd - Chiari syndrome?

edema of the legs