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THRALL - Thom > 40 - Liver and Spleen > Flashcards

40 - Liver and Spleen Flashcards

1
Q

What objective measure of liver size can be used radiographically? What are reported normal values?

A

Liver length (caudoventral extremity to caudal VC) vs length of T11

Normal; 5.4-5.5 x
Brachy: 5.16x
Pekingese: 4.64x

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2
Q

Name 6 nonpathological causes for caudal extension of the liver (beyond costal arch)

A

Deep inspiration / thoracic overexpansion
Laxity of triangular lig. in older animals
Pendulous abdomen
Obesity (less dorsal extension)
Conformation (brachys / chondrodystrophics)
Young animals - larger liver relative to body size

-> Should see blunting to dx hepatomegaly

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3
Q

Mineralisation of the gallbladder wall has been associated with which three diseases?

A

Gallbladder carcinoma, cholecystitis, cystic mucinous hyperplasia

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4
Q

List 6 causes of focal hepatic mineralisation

A 
Haematoma
Echinococcus
Granuloma
Hepatic necrosis
Neoplasia
Abscess
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5
Q

List 5 causes of portal gas accumulation

A 
Necrotizing gastritis / enteritis
GI Trauma
GI ulceration
GI distension
Interventional procedures

-> Similar to air bronchograms

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6
Q

Describe the progression of gas accumulation in emphysematous cholecystitis

A

In wall -> filling gallbladder lumen (24-28hrs) -> In pericholecystic tissues

-> Obstruction of cystic duct may predispose

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7
Q

List two EXPECTED causes of gas accumulation in biliary system

A

Duodenal / biliary surgery

Incidental reflux in cats (incompetence of sphincter of Oddi)

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8
Q

List 4 causes of hepatic abscesses

A

Necrotic tumours
Adjacent infection (e.g. pancreatic)
Penetration wounds
Ascending portal infection

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9
Q

List 4 most common EHPSS (according to Thrall!)

A

Spleno-phrenic
Spleno-caval
Right gastro-caval
Right gastro-caval with caudal loop

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10
Q

What is the normal gallbladder volume in the dog and cat?

A

1ml/kg or less in dogs

2.4ml in cats

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11
Q

What is the normal thickness of the gallbladder wall in the dog and cat?

A

Cat: <1mm

Dog 1-2mm

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12
Q

What is the normal diameter of the CBD in the dog and cat?

A

Cat: up to and including 4mm
Dog: up to and including 3mm

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13
Q

List 6 causes of hyperechoic liver

A 
Vacuolar hepatopathy (Hepatic lipidosis /steriod hepatopathy)
Chronic hepatitis
Lymphoma
Amyloidosis
Cholangiohepatitis
\+- MCT
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14
Q

List 6 causes of hypoechoic liver

A 
Acute suppurative hepatitis
Lymphoma
Leukaemia
Amyloidosis
Congestion
Cholangiohepatitis
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15
Q

List 4 primary hepatic tumours

A

Hepatocellular carcinoma (1st most common)
Cholangiocarcinoma (2nd)
Haemangiosarcoma
Neuroendocrine tumour

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16
Q

What is the most common hepatic malignancy in the dog?

A

Metastatic neoplasia! 2.5x more likely than 1ry neoplasia

Most commonly: Spleen, GIT and pancreas

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17
Q

What is the most common 1ry hepatic neoplasia in the cat?

And what is the most common hepatic malignancy?

A

Biliary cystadenoma = most common 1ry neoplasia

Cholangiocarcinoma = most common malignancy

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18
Q

What CEUS features of benign vs malignant hepatic nodular disease are describe?

A

Benign - iso to liver at peak normal liver perfusion

Malignant - hypo

19
Q

What US features are described with hepatocutaneous syndrome (superficial necrolytic dermatitis)?

A

Honeycomb appearance (hypo nodules with hyper surrounding parenchyma)

20
Q

Describe approximate US progression of haematomas

A

Hyper -> Hypo/an -> hyper (reorganisation / mineralisation)

21
Q

What feature of the GB has been associated with a 70Sn and 100% sp for bactibilia and bacterial cholecystitis?

A

Immobile gallbladder sludge

22
Q

Cystic mucinous hyperplasia has been linked to which disease?

A

Gallbladder mucocoele

23
Q

List 5 causes of gallbladder wall oedema

A 
R CHF
Anaphylaxis
Hypoproteinaemia
Portal hypertension
Sepsis
24
Q

What percentage of dogs have mobile GB sludge?

A

53% asymptomatic

35-48% of ALL dogs

25
Q

How do you calculate the volume of GB / urinary bladder ?

A

width x height x length X 0.52 (ml?)

26
Q

What two objective measures are used to demonstrate normal GB motility?

A

Reduction in volume 60 / 120mins post feeding:

By 25%

OR

to <1ml/kg

27
Q

What is the incidence of loss of GB wall integrity / rupture in mucocoele?

A

50%

28
Q

List 3 US features associated with GB rupture

A

Discontinuity of wall
Bright pericholecystic fat
Pericholecystic fluid

29
Q

Which endocrinopathy is associated with GB mucocoele?

A

HyperA

30
Q

Define the timeline for the US appearance of progressive biliary obstruction

A

GB and cystic duct dilation - 24 hours
CBD dilation (progressive) - 48hrs
Hepatic duct dilation - 3-4 days
Lobar and interlobar duct dilation - 7 days

31
Q

What % of cats with EH obstruction had gallbladder dilation? What is a more reliable feature (and what % have this)?

A

43% GB dilation

Bile duct dilation more reliable - 97%

32
Q

What is the normal ratio of PV: VC? And what is seen in PSS?

A

0.7-1.25 normal

<0.65 PSS

33
Q

Name 2 sites the acquired EHPSS are commonly located

A

Medial to spleen

Medial to L kidney

34
Q

Which intrahepatic shunt may represent patent ductus venosus?

A

Left divisional

35
Q

In which radiographic projection does the distal splenic extremity tend to be most conspicuous?

A

Right lateral

36
Q

In a study of 100 cats, how frequently was the distal extremity of the spleen visualised in lateral radiographis?

A

1! Very rare!

If seen = splenomegaly

37
Q

What feature of the feline spleen makes it less able to enlarge? What are the two most common causes of feline splenomegaly?

A

Non-sinusoidal. Cannot store large volumes of blood

Lymphoma and MCT

38
Q

What is the most common neoplasia of the canine spleen? And what are the 2 most common lesions of the canine spleen?

A

HSA

Haematoma and hyperplasia

39
Q

What are normal splenic measurements in the cat?

A

Transverse thickness

Different studies:
Height = 7.1mm (5.1-9.1mm)
Height 8.2mm (5.3-11.1mm)

40
Q

Splenomegaly without change in echogenicity has been described with which 2 anaesthetic agents?

A

Phenothiazines

Pentobarbital

41
Q

Name 5 features that have been described in splenic torsion on US

A

Splenomegaly
“Lacy” apperanance - hypo parenchyma with hyperechoic lines
Dilated splenic veins with intravascular thrombi
Lack of flow
Hyperechoic hilar triangle
Gas within parenchyma

42
Q

Name 5 diffuse infiltrative neoplasms of the spleen

A 
Lymphoma
Leukaemia
Malignant histiocytosis
MCT
Multiple myeloma
43
Q

Name a fungal cause of splenitis in the cat!

A

Histoplasmosis

THRALL - Thom (40 decks)

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