Flashcards in pathology of the liver test 2 Deck (120):
What is patient prep for liver exam?
NPO for 6-8 hours
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
What is the assessment criteria for the liver?
size of the liver in sag
attenuation of liver parenchyma
presence of hepatic vascular structures ligaments and finish
What are you basically looking for in the liver parenchyma?
What is situs inversus?
the organs are backwards in the body
What is agenesis?
the organ isn't there - incompatible with life
What are the classifications of the liver diseases?
hepatic vascular disorders
What is hepatocellular diffuse disease?
interferes with liver function
What are the diffuse liver diseases?
what is diffuse?
throughout the organ
What needs to be in the pictures of the liver?
What is fatty infiltraton
increased lipid and triglycerides
benign and may be reversible
other symptoms: jaundice, nausea, vomiting, pain
What are the causes of fatty liver?
excessive alcohol intake
poorly controlled hyperlipidemia
total parenteral hyperalimentation (tube feed)
glycogen storage disease
the main cause of fatty liver is?
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
What does fatty liver look like sonographically?
posterior liver diaphragm and vessels - may be hard to see
greater attenuation = decreased visualization
What are the three grades of fatty infiltration?
grade 1 - slight
grade 2 - moderate
grade 3 - marked
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
What is grade 2 fatty infiltration?
moderate - diffuse increase in fine echoes with slightly impaired visualization of the intrahepatic vessels and diaphragm
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
What is steatosis?
synonym for fatty infiltration at the cellular level
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
Where might you find fatty sparing?
anterior to the GB or PV
near Porta hepatis
posterior left lobe
What are granulomas?
small calcifications in the liver and spleen
What are granulomas caused by
What is histoplasmosis?
in an infection caused by breathing in spores of a fungus often found in bird and bat droppings
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
What are the symptoms of granulomas?
how do granulomas appear sonographically?
echogenic pearls with shadowing
Where else beside liver will you see granulomas?
in the spleen
What is hepatitis?
inflammatory and infectious disease
How do you get hepatitis A?
How do you get hepatitis B?
exposure to needles and blood
What are some things that develop from hepatitis?
inflammation can lead to cirrhoisis
What are some symptoms of hepatitis?
Hep B and C also cause
aversion to smoking
What are the lab values for hepatitis?
marked increase in AST and ALT
ALT fall rapidly after several days
What happens with acute hepatitis?
mild to necrosis
kupffer cell enlarging and regeneration
how does acute hepatitis look sonographically?
the portal radicals (branches of portal vein) becoming even more echogenic
thick GB walls
What happens if you have chronic hepatitis?
fibrosis (a course-ness, not smooth)
may progress to liver failure and cirrhosis
will become smaller
What are the sonographic findings for chronic hepatitis?
soft shadow from fibrosis
Symptoms and causes of chronic hepatitis is the same as acute?
What is cirrhosis?
progress to liver failure and portal hypertension
CHRONIC ALCOHOL ABUSE
What is cirrhosis sequela?
varicosities in the abdomen
portal vein thrombosis
What are the symptoms for chirrhosis?
fatigue and weakness
varicose veins on the abd
clubbing of nails and fingers
What are the lab values for cirrhosis?
AST, ALT and Bilirubin are all increased
What does a smaller, coarse, nodular, structure with free fluid and a dilated portal vein indicate?
a liver with cirrhosis
what might also increase with cirrhosis?
the caudate lobe
early stage liver: enlarged
advanced stage: small
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
What does EtOH stand for?
What is glycogen storage disease?
type 1 von Gierke
genetic disorder of carbohydrate metabolism
stores too much glycogen...cant metabolise it
What are the sonographic findings of vonGierke?
What is a glycogen storage disease with adenomas?
von Gierke's disease
What is the definition of glycogen storage disease?
abnormally large amounts of glycogen are deposited in the liver and kidneys
What is Hemochromatosis?
liver cannot metabolize iron
cannot see on ultrasound
Where is the orgin of bile?
in the liver
where is the proximal biliary tree?
within the liver
Where is the distal biliary tree?
closest to the pancreatic head
Where does biliary dilatation usually occur?
proximal to the level of the obstruction
Where are the most common obstructions of the CBD?
Distal CBD with dilatation CBD, GB, intrahepatic ducts
What are the lab values for biliary obstruction?
elevated bilirubin and ALK PHOS
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
What are the symptoms of distal biliary obstruction?
stones in the CBD
What are the sonographic findings of distal biliary obstruction?
GB size may be small
What is the sonographic findings in an extrahepatic mass?
hydropic GB - distended
lesion may be lymph or pancreatic Ca (ca blocks the duct)
What are the symptoms of the common duct stricture?
increase in bilirubin and alk phos
sonographically: dilated ducts
What are the focal diseases of the liver?
What are the sonographic findings of a cyst of the liver?
If its not a random cyst in the liver, what is it?
What is polycystic liver disease?
associated with polycystic kidneys
sonographic: cyst criteria
Are the cysts in polycystic liver disease small or large?
small, less than 2 -3 cm
multiple throughout the hepatic parenchyma
What are liver abscess?
escherichia coli (E. coli) and anaerobes
multiple infection symptoms
How does an abscess appear sonographically?
micro air bubbles cause SHADOWING
looks like cysts webbed together
What is a fungal (candidiasis) abscess?
immunocompromised hosts such as cancer patients and organ transplant patients are most likely to get it
how does candidiasis look sonographically?
multiple hypoechoic masses
target or bull's eye lesions
"wheel within a wheel" early
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
what is fever and travel to foreign country indicate?
What is an echninoccal (parasitic) abscess?
aka: hydatid cysts
sheep and cattle herding
parasite causing hydatid disease
what are the clinical symptoms of echninoccal parasitic hydatid cysts?
What is the sonograhic findings of echninoccal parasitic hydatid cysts?
WATER LILY SIGN
cyst within a cyst
What is a schistosomiasis (parasitic) abscess?
sonographic: thickened portal walls and dilatation (portal hypertension)
collaterals (opens ligamentum teres)
What are benign tumors of the liver?
focal nodular hyperplasia
What are malignant tumors of the liver?
Are tumors focal or diffuse?
What is a cavernous hemangioma?
MOST COMMON benign tumor
echogenic because it is highly vascular
usually looks round
What is an adenoma?
female oral contraceptives increase the occurance
may become malignant
how does and adenoma appear sonographically?
What is focal nodular hyperplasia?
second common benign liver mass
women under 40
Where is focal nodular hyperplasia most often found?
on the anterior portion of the left lobe
What is an infantile hemangioendothelioma?
presents with abd mass
sonographic: multiple lesions with hyperechoic margins
What is a hamartoma?
children under 2
palpable abd mass
sonographic: well defined large complex mass
What is hepatocellular carcinoma (HCC) hepatoma?
most common primary malignant neoplasm
related to cirrhosis
unexplained mild fever
sonographic: halo lesions, hepatomegaly
What is encountered more HCC or Mets?
what are the labs for HCC? (hepatocellular carcinoma)
elevated alpha fetoprotein***
abnormal liver function tests
unexplained weight loss***
How does hepatocellular carcinoma present?
solitary massive tumor
multiple nodules throughout the liver
diffuse infiltrative masses in the liver
how will HCC pathologically present?
invasive lesion with necrosis and hemorrhage
poorly defined lesion
When cancer invades the hepatic veins what do you have?
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
What is the neonate hepatomegaly TORCH?
T - toxoplasmosis
O- other infections
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
What are the signs for trauma with a hepatic hematoma?
What could be a consequence of trauma or surgery in the liver?
What are indications for a liver transplant?
what are complications for a liver transplant?
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
What is the problem with portal hypertension?
it causes the pressure to go up and the vessels start to pop
what is the most common cause of portal hypertension?
what are collaterals?
when portal hypertension forces the body to create new paths for blood flow
coronary and esophageal vein
varices tortuous dilations
What happens with a varicose or collateral vein ruptures?
person bleeds out
what is the limit on the portal vein size?
1.3cm any greater and you suspect portal hypertension
What happens to the umbilical vein when you have portal hypertension?
recanalization of the umbilical vein = Medusa's head
What is the most common connection to release pressure when there is portal hypertension?
transjugular intrahepatic portosystemic shunt
Where is TIPS placed?
between the portal and hepatic veins***
placed to reduce pressure
What are the sonographic findings of portal hypertension?
shrunken right lobe
enlarged caudate and left lobe
What are the doppler findings for portal hypertension?
monophasic flow in the hepatic veins
hepatofugal flow in the portal veins
enlarged portal vein
reversed flow in the splenic vein
what is Budd-Chiari?
thrombosis of the hepatic vein or IVC
what is the songraphic finding of Budd-Chiari?
caudate lobe enlarged
atrophy of rt hepatic lobe thrombosed vein enlarges
What is an angiosarcoma?
malignant from the blood vessels
60-80 years old
sonographic: solid mass
what is metastatic disease?
primary: breast, colon, lung
lab: abnormal LFT
sonographic: multiple nodes, bull's eye lesions, calcifications
What is lymphoma?
hodgkins and non-hodgkins
sonographic: bull's eye, multiple
What are the pediatric malignancies?
neuroblastoma (adrenal gland)