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Term 2 > Abd (Intro. & Liver: Benign Tumors) > Flashcards

Abd (Intro. & Liver: Benign Tumors) Flashcards

1
Q

Pathology

A

-precise study and diagnosis of a disease

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2
Q

4 Components of Disease

A

1) cause/etiology
2) pathogenesis
3) morphological changes
4) clinical manifestations

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3
Q

Colour Doppler

A
  • apply on any abnormal mass
  • take an image with colour box over the area of interest
  • adjust parameters accordingly
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4
Q

Power Doppler

A
  • more sensitive
  • try using if colour is not readily apparent
  • very motion sensitive
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5
Q

What should a technical impression reporting a pathology include?

A
  • location
  • how many
  • description of pathology (homogenous, hyperechoic, etc.)
  • measurements
  • vascularity colour
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6
Q

Lesion

A
  • lump/bump on skin or solid organ
  • general term describing an abnormality seen on imaging
  • cystic or solid
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7
Q

Nodule

A
  • small mass or rounded or irregular shape
  • benign or cancerous
  • within parenchyma, tendons, muscles or vocal cords
  • called a solid nodule on a cyst wall or septation
  • used to describe thyroid cystic or solid focal areas
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8
Q

Mass

A
  • abnormal growth or tissue resulting from multiplication of cells
  • synonym for tutor or neoplasia
  • may push or displace surrounding tissue or vessels
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9
Q

Consistency (Tumour Characterization)

A
  • solid: might attenuate or no enhancement
  • liquid: posterior enhancement
  • mixed: solid and fluid
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10
Q

Echogenicity (Tumor Characterization)

A
  • hypoechoic
  • hyperechoic
  • anechoic
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11
Q

Echotexture (Tumor Characterization)

A
  • homogenous

- heterogenous

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12
Q

Contour (Tumor Characterization)

A
  • irregular

- smooth margins or well delineated

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13
Q

Tumor Characterizations

A
  • consistency
  • echotecture
  • echogenicity
  • contour
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14
Q

What is a tumors relation to adjacent organs/structures?

A
  • mass affect (pushing or displacing)

- invading (moving into a vein or another organ)

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15
Q

How does vasculature help with tumor characterization?

A
  • fluid filled will show no vascularity
  • solid may show vascularity
  • doppler characteristics
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16
Q

What imaging modality can be used to confirm fat density?

A

CT

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17
Q

Appearance of a Cystic Lesion

A
  • anechoic
  • thin walled
  • through transmission of posterior enhancement
  • may have thin septations or hemorrhage
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18
Q

Benign Characteristics

A
  • no vascularity or peripheral vascularity
  • smooth contour or margins
  • slow growing
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19
Q

Malignant Characteristics

A
  • highly vascular
  • irregular margins
  • bulls eye or halo
  • rapid growth
  • Hx of cancer
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20
Q

What do multiple solid liver masses suggest?

A
  • metastatic or multifocal disease

- may be benign

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21
Q

What can a hypoechoic halo be?

A

-omnious sign

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22
Q

Acute Symptoms

A
  • sudden
  • high pain
  • ex: RLQ could be appendicitis
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23
Q

Chronic Symptoms

A
  • pain on and off
  • long lasting
  • on treatment for other conditions
  • ex. LLQ could be constipation
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24
Q

Secondary Signs

A
  • may not always see the pathology

- look for signs of inflammation (ex. fluid, inflamed fat, increased lymph nodes)

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25
Q

Couinaud’s

A
  • evaluation of liver in multiple planes
  • precise lesion localization
  • universal
  • based on portal segments
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26
Q

What does each segment of Couinaud’s have?

A

-blood supply (arterial, portal and hepatic venous)

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27
Q

Functions of the Liver

A
  • produces proteins
  • metabolization
  • stores nutrients (vitamins, minerals, sugars)
  • produces bile
  • absorbs vitamins A, D, E and K
  • produces substances that reduce blood clotting
  • immunity (removes bacteria from blood)
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28
Q

Hepatocytes

A

-bile duct, portal vein and hepatic artery

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29
Q

HA (hepatic artery)

A
  • branch of celiac axis

- supplies liver cells with oxygenated blood

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30
Q

PV (portal vein)

A
  • formed by the confluence of the SMV and splenic vein
  • supplies liver with lymphocytes and RBC’s from the spleen and blood from the intestines that needs to be purifies by the liver
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31
Q

HV’s (hepatic veins)

A

-drain blood from the liver into the IVC (returns deoxygenated blood to the cardiopulmonary system for rejuvenation)

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32
Q

Which structure separates the LLL and LML of the liver?

A

-Lt intersegmental fissure

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33
Q

Which structures lie with the Lt intersegmental fissure?

A

Cranially- LHV

Mid- ascending LPV

Caudally- ligamentum teres

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34
Q

The HV’s are visualized when scanning which portion of the liver?

A

-superior

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35
Q

What does the MHV separate?

A

-anterior RL and medial LL

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36
Q

What borders each side of the RHV?

A

-anterior and posterior RL

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37
Q

What is the name of the capsule surrounding the liver?

A

-glisson’s capsule

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38
Q

Why is there a bare area on the liver?

A

-lacks peritoneum

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39
Q

What should the posterior Rt lobe of the liver measure?

A

13-17cm

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40
Q

Contour of Liver

A

-smooth

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41
Q

Echogenicity of Liver

A

-hyperechoic

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42
Q

Echotexture of Liver

A

-homogenous

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43
Q

Portal venous flow is ______ in direction.

A

hepatopedal

44
Q

Normal Doppler Flow of HV’s

A
  • phasic flow
  • pulsatile
  • hepatofugal
  • ‘W’
45
Q

What should be evident in all lobes in the portal and hepatic venous system?

A

-colour flow

46
Q

Normal Doppler Flow in the HA

A
  • low resistance

- hepatopedal flow

47
Q

Diameter of MPV

A

-less than 13mm AP

48
Q

What do hepatocytes contain?

A
  • bile duct
  • HA
  • PV
49
Q

What is produced within a hepatocyte?

A

-bile

50
Q

What type of blood does the HA supply?

A

-oxygenated

51
Q

What does the PV supply to hepatocytes?

A
  • wbc’s

- returns flow to the liver from the intestines for cleansing

52
Q

Which vein drains old blood back to the HV’s?

A

-central vein

53
Q

Diaphramatic Slips

A
  • invagination of dome of diaphragm
  • cause of pseudomass (examine is TRV and SAG)
  • appearance changes with respiration
54
Q

What is associated with diaphragmatic slips?

A

-diaphramatic muscle bundles that attach the central tendon to the thoracic cage

55
Q

What is normal clotting time?

A

10-15 sec

56
Q

Prothrombin Time

A
  • enzyme produced by the liver

- production depends on the amount of vitamin K

57
Q

What does prothrombin time elevate with?

A
  • cirrhosis
  • malignancy
  • malabsorption of vitamin K
  • clotting failure
58
Q

What does prothrombin time decrease with?

A
  • subacute/acute cholecystitis
  • internal biliary fistula
  • carcinoma of the GB
  • biliary duct injury
  • prolonged extra hepatic biliary obstruction
59
Q

Leukocytosis

A
  • high wbc count

- not a disease, but a lab finding

60
Q

What is leukocytosis a sign of?

A
  • inflammation

- infection (includes parasites)

61
Q

Serum Albumin

A

-decrease in protein synthesis

62
Q

Normal Total Bilirubin

A

0.3 to1.1 d/L

63
Q

Normal Direct Bilirubin

A

0.1 to 0.4 d/L

64
Q

What is bilirubin a product of?

A

-the breakdown of hemoglobin in old rbc’s

65
Q

What can a disruption in the bilirubin process cause?

A

-abnormal levels

66
Q

How does bilirubin give skin a yellow appearance?

A

-leakage into tissue

67
Q

What does bilirubin reflect?

A

-balance between production and excretion of bile

68
Q

What is elevation or conjugated bilirubin associated with?

A
  • obstruction
  • hepatitis
  • cirrhosis
  • liver metastases
69
Q

What is elevation of indirect or unconjugated bilirubin associated with?

A

-nonobstructive conditions (ex. steatosis)

70
Q

Partial Liver Agenesis

A
  • one lobe compensatory hypertrophy normally occurs (if Lt lobe is missing, Rt lobe will be bigger)
  • compatible with life
71
Q

Situs Inversus Totalis

A

-liver is found in Lt hypochondrium

72
Q

Congenital Disphramatic Hernia/Omphalocele

A

-liver may herniate into thorax or outside of abd cavity

73
Q

Benign Hepatic Neoplasms

A
  • incidentally detected in asymptomatic patient
  • LFT’s normal
  • granulomas
  • hamartomas
  • cysts
  • cavernous hemangioma
  • FNH (focal nodular hyperplasia)
  • adenomas
  • fatty tumors
74
Q

Liver Granulomas

A
  • asymptomatic
  • appear as calcification within liver parenchyma
  • may be solitary or multiple
  • may be related to scarring or an underlying disorder (ex. hepatitis or sarcoidosis)
75
Q

Hamartomas

A
  • small
  • focal
  • solid
  • hypoechoic
  • benign malformations (cells go haywire and hypertrophy)
  • less than 6% of population on autopsy
  • often confused with metastatic disease (CT is needed to clarify)
  • single or multiple
76
Q

Benign Liver Cysts

A
  • fluid filled space
  • epithelial lining (lining of tissue)
  • congenital

-cyst may hemorrhage or become infected (pain and fever)

77
Q

What is the cause of benign liver cysts?

A

-unclear

78
Q

what population are benign liver cysts common in?

A

-middle aged (2.5% of pop.)

79
Q

What may form in a liver cyst?

A

-abscess

80
Q

How do abscess’ appear?

A
  • internal echoes
  • septations
  • thick walls
  • solid
81
Q

What will happen to a cyst with epithelial lining when drained?

A

-it will recur

82
Q

Is polycystic kidney disease inherited?

A

Yes.

83
Q

What % of patients are liver cysts seen in?

A

57-74%

84
Q

If LFT’s are abnormal in cysts, there may be…

A
  • tumor
  • infection
  • biliary obstruction
85
Q

What is the most common benign tumor?

A

-cavernous hemangioma

86
Q

Is cavernous hemangioma more common in males or females?

A

5x more common in female’s

87
Q

Appearance of Cavernous Hemangioma

A
  • hypoechoic
  • avascular
  • homogenous or heterogenous
  • tangle of tiny blood vessels
  • well circumscribed
88
Q

What may a cavernous hemangioma be followed up by?

A
  • CT

- MRI

89
Q

Blood Flow of a Cavernous Hemangioma

A
  • extremely low

- avascular on US

90
Q

Size of Cavernous Hemangioma

A
  • small
  • often incidentally found
  • asymptomatic
91
Q

What is the 2nd most common tumor?

A

-focal nodular hyperplasia (FNH)

92
Q

Which gender is focal nodular hyperplasia (FNH) more common in?

A

-women

93
Q

What is a factor of FNH and when is it commonly seen in women?

A
  • hormonal influences
  • OC use
  • often seen in childbearing years
94
Q

How is FNH usually found?

A
  • incidentally

- asymptomatic finding

95
Q

Which tumor may exhibit a central scar (vascular formation)?

A

-FNH

96
Q

Appearance of FNH?

A
  • solitary
  • isoechoic
  • well circumscribed
  • hypervascular, stellate pattern
  • spoke wheel pattern
  • contour abnormality of liver surface ay displace vessels
97
Q

Hepatic Adenoma

A
  • seen less commonly than FNH
  • more common in women linked with OC use
  • resection is recommended
98
Q

What does hepatic adenoma have a risk of?

A

-malignant degeneration

99
Q

What symptoms may be present with hepatic adenoma?

A
  • RUQ mass felt (if large)

- bleeding within lesion causes pain

100
Q

Vasularity of Hepatic Adenoma

A

-hypervascular from periphery

101
Q

Why do hepatic adenomas’ appear more heterogenous than other benign liver tumors?

A

-due to fat, glycogen and hemorrhagic products in the lesion

102
Q

What is the difference between hepatic adenomas arteries and arteries with FNH?

A

Hepatic Adenomas- multiple HA’s, supply from periphery

FNH- 1 central HA

103
Q

What else can distinguish a hepatic adenomas from FNH?

A

-hepatic adenomas may have a capsule (in 1/3 of cases)

104
Q

Fatty Tumors

A
  • rare
  • asymptomatic
  • well defined
  • echogenic
105
Q

What are fatty tumors associated with?

A

-renal angiomyolipomas

106
Q

What is a classic sign of a fatty tumor?

A

-broken diaphragm

107
Q

Are we able to distinguish fatty tumors from hemangioma, metastasis or focal fat on US?

A

No, we need CT to confirm.

Term 2 (19 decks)

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