40 - Liver and Spleen Flashcards
What objective measure of liver size can be used radiographically? What are reported normal values?
Liver length (caudoventral extremity to caudal VC) vs length of T11
Normal; 5.4-5.5 x
Brachy: 5.16x
Pekingese: 4.64x
Name 6 nonpathological causes for caudal extension of the liver (beyond costal arch)
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
Mineralisation of the gallbladder wall has been associated with which three diseases?
Gallbladder carcinoma, cholecystitis, cystic mucinous hyperplasia
List 6 causes of focal hepatic mineralisation
Haematoma Echinococcus Granuloma Hepatic necrosis Neoplasia Abscess
List 5 causes of portal gas accumulation
Necrotizing gastritis / enteritis GI Trauma GI ulceration GI distension Interventional procedures
-> Similar to air bronchograms
Describe the progression of gas accumulation in emphysematous cholecystitis
In wall -> filling gallbladder lumen (24-28hrs) -> In pericholecystic tissues
-> Obstruction of cystic duct may predispose
List two EXPECTED causes of gas accumulation in biliary system
Duodenal / biliary surgery
Incidental reflux in cats (incompetence of sphincter of Oddi)
List 4 causes of hepatic abscesses
Necrotic tumours
Adjacent infection (e.g. pancreatic)
Penetration wounds
Ascending portal infection
List 4 most common EHPSS (according to Thrall!)
Spleno-phrenic
Spleno-caval
Right gastro-caval
Right gastro-caval with caudal loop
What is the normal gallbladder volume in the dog and cat?
1ml/kg or less in dogs
2.4ml in cats
What is the normal thickness of the gallbladder wall in the dog and cat?
Cat: <1mm
Dog 1-2mm
What is the normal diameter of the CBD in the dog and cat?
Cat: up to and including 4mm
Dog: up to and including 3mm
List 6 causes of hyperechoic liver
Vacuolar hepatopathy (Hepatic lipidosis /steriod hepatopathy) Chronic hepatitis Lymphoma Amyloidosis Cholangiohepatitis \+- MCT
List 6 causes of hypoechoic liver
Acute suppurative hepatitis Lymphoma Leukaemia Amyloidosis Congestion Cholangiohepatitis
List 4 primary hepatic tumours
Hepatocellular carcinoma (1st most common)
Cholangiocarcinoma (2nd)
Haemangiosarcoma
Neuroendocrine tumour
What is the most common hepatic malignancy in the dog?
Metastatic neoplasia! 2.5x more likely than 1ry neoplasia
Most commonly: Spleen, GIT and pancreas
What is the most common 1ry hepatic neoplasia in the cat?
And what is the most common hepatic malignancy?
Biliary cystadenoma = most common 1ry neoplasia
Cholangiocarcinoma = most common malignancy
What CEUS features of benign vs malignant hepatic nodular disease are describe?
Benign - iso to liver at peak normal liver perfusion
Malignant - hypo
What US features are described with hepatocutaneous syndrome (superficial necrolytic dermatitis)?
Honeycomb appearance (hypo nodules with hyper surrounding parenchyma)
Describe approximate US progression of haematomas
Hyper -> Hypo/an -> hyper (reorganisation / mineralisation)
What feature of the GB has been associated with a 70Sn and 100% sp for bactibilia and bacterial cholecystitis?
Immobile gallbladder sludge
Cystic mucinous hyperplasia has been linked to which disease?
Gallbladder mucocoele
List 5 causes of gallbladder wall oedema
R CHF Anaphylaxis Hypoproteinaemia Portal hypertension Sepsis
What percentage of dogs have mobile GB sludge?
53% asymptomatic
35-48% of ALL dogs
How do you calculate the volume of GB / urinary bladder ?
width x height x length X 0.52 (ml?)
What two objective measures are used to demonstrate normal GB motility?
Reduction in volume 60 / 120mins post feeding:
By 25%
OR
to <1ml/kg
What is the incidence of loss of GB wall integrity / rupture in mucocoele?
50%
List 3 US features associated with GB rupture
Discontinuity of wall
Bright pericholecystic fat
Pericholecystic fluid
Which endocrinopathy is associated with GB mucocoele?
HyperA
Define the timeline for the US appearance of progressive biliary obstruction
GB and cystic duct dilation - 24 hours
CBD dilation (progressive) - 48hrs
Hepatic duct dilation - 3-4 days
Lobar and interlobar duct dilation - 7 days
What % of cats with EH obstruction had gallbladder dilation? What is a more reliable feature (and what % have this)?
43% GB dilation
Bile duct dilation more reliable - 97%
What is the normal ratio of PV: VC? And what is seen in PSS?
0.7-1.25 normal
<0.65 PSS
Name 2 sites the acquired EHPSS are commonly located
Medial to spleen
Medial to L kidney
Which intrahepatic shunt may represent patent ductus venosus?
Left divisional
In which radiographic projection does the distal splenic extremity tend to be most conspicuous?
Right lateral
In a study of 100 cats, how frequently was the distal extremity of the spleen visualised in lateral radiographis?
1! Very rare!
If seen = splenomegaly
What feature of the feline spleen makes it less able to enlarge? What are the two most common causes of feline splenomegaly?
Non-sinusoidal. Cannot store large volumes of blood
Lymphoma and MCT
What is the most common neoplasia of the canine spleen? And what are the 2 most common lesions of the canine spleen?
HSA
Haematoma and hyperplasia
What are normal splenic measurements in the cat?
Transverse thickness
Different studies:
Height = 7.1mm (5.1-9.1mm)
Height 8.2mm (5.3-11.1mm)
Splenomegaly without change in echogenicity has been described with which 2 anaesthetic agents?
Phenothiazines
Pentobarbital
Name 5 features that have been described in splenic torsion on US
Splenomegaly
“Lacy” apperanance - hypo parenchyma with hyperechoic lines
Dilated splenic veins with intravascular thrombi
Lack of flow
Hyperechoic hilar triangle
Gas within parenchyma
Name 5 diffuse infiltrative neoplasms of the spleen
Lymphoma Leukaemia Malignant histiocytosis MCT Multiple myeloma
Name a fungal cause of splenitis in the cat!
Histoplasmosis
