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Thrall (Diagnostic) > Ch. 40 Liver & Spleen > Flashcards

Ch. 40 Liver & Spleen Flashcards

1
Q

In cats, a larger portion of the liver is left/right-sided

A

right

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2
Q
A
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3
Q

The hepatic margin may protrude more caudally in the left/right lateral projection.

A

right

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4
Q

In which case would the caudoventral liver appear rounded, but not enlarged?

A

oblique projection

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5
Q
A
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6
Q
A
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7
Q

Which breed of dog typically has a smaller liver length ratio?

a) Poodles
b) Pekingese
c) German Shepherds
d) Labradors

A

b) Pekingese

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8
Q

What can cause the liver to extend beyond the costal arch without indicating disease?

A
  • thoracic overexpansion e.g. deep inspiration
  • age (loose triangular ligament with older dogs, neonatal status)
  • obesity
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9
Q

What are the 2 most common causes of microhepatia?

A

Congenital portosystemic shunt and hepatic cirrhosis

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10
Q
A
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11
Q
A
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12
Q

Linear trails of mineralized opacities extending peripherally within the hepatic parenchyma are indicative of _____________.

A

choledocholiths

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13
Q

Are choledocholiths benign/incidental or clinically significant?

A

They are often incidental findings, but choledocholiths can cause biliary obstruction, especially in the cat.

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14
Q

Mineralization of the gallbladder wall has been associated with _________________.

A

gallbladder carcinoma,
as well as:
- cholecystitis
- cystic mucinous hyperplasia

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15
Q

_______________infection can result in large hepatic soft tissue masses with mineralization of varying patterns and should be considered in endemic areas.

A

Echinococcosis

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16
Q

Gas within portal vessels may occur because of _____________, which is often associated with______________.

A

severe necrotizing gastritis or enteritis

gastric dilation and volvulus complex

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16
Q

What infection can result in large hepatic soft tissue masses with mineralization in endemic areas?

a) Echinococcosis
b) Coccidioidomycosis
c) Histoplasmosis
d) Tuberculosis

A

a) Echinococcosis

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17
Q
A

Lateral (A) and ventrodorsal (VD; B) radiographs of a cat with a large radiopaque cholelith (arrow) and trails of mineralized choledocholiths and pancreatoliths.

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18
Q
A

abdomen of a dog with chronic hepatitis that led to microhepatia. There is marked cranial displacement of the stomach

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19
Q

______________may be a common predisposing factor for emphysematous cholecystitis.

A

Obstruction of the cystic duct

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20
Q

Obstruction of the cystic duct may be a common predisposing factor for _______________.

A

emphysematous cholecystitis

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21
Q

In emphysematous cholecystitis, gas bubbles form within _____ of disease onset.
A) 30-60 min
B) 6-8 hours
C) 1-2 days
D) 5-7 days
E) 2-3 weeks

A

C) 1-2 days

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22
Q

T or F: Gas in or around the gallbladder occurs with emphysematous cholecystitis only in diabetic dogs.

A

F; diabetic or non-diabetic

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23
Q

When can gas in the bile duct be incidental, in cats?

A

reflux of gas from the duodenum; seen occasionally in cats (incompetent sphincter of Oddi)

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24
Q

Which anatomical point is responsible for keeping duodenal contents from travelling into the bile duct

A

sphincter of Oddi

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25
Q

Causes of hepatic abscess (4)

A
  • necrotic tumour
  • ascending infection from portal system
  • adjacent infection (e.g. pancreas)
  • penetrating wound
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26
Q

What are the most common EHPSS?

A

s-PAC
spleno-Phrenic
spleno-Azygous
spleno-Caval
R gastric-caval
R gastric-caval with caudal loop.

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27
Q

When is the arterial phase?
early venous / portal?
delayed / equilibrium?

A

A: 13-20s
early V: 30-40s
delayed: 120s

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28
Q

Appearance of hepatocellular carcinomas through multiphase study?

A

Heterogenous contrast in all phases, hypoattenuating to normal liver in portal and delayed phase (NOT IN ARTERIAL)

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29
Q
A
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30
Q

Appearance of hepatic metastases through multiphase study?

A

Homogeneous, and hypoattenuating to normal liver in ALL phases (arterial, portal, delayed)

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30
Q

Appearance of benign hepatic adenomas through multiphase study?

A

diffuse arterial enhancement which persists in portal phase

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30
Q

How do metastases and hepatocellular carcinomas differ through multiphase study (contrast enhancement)?

A

In early phase, HCC is not hypoattenuating to liver (whereas mets are); HCC is has heterogenous enhancement, mets have homogenous.

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31
Q

Appearance of hepatic nodular hyperplasia through multiphase study?

A

Homogenous marked contrast in arterial and portal which dilutes to isoattenuation in delayed phase

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32
Q

Which is true?
A) Hepatocellular carcinomas are hypoattenuating to normal liver in arterial and venous phases.
B) Benign hepatic adenomas have diffuse enhancement in the portal and delayed phase.
C) Benign hepatic hyperplasia is strongly homogenously enhancing in arterial and portal, but isoattenuates in delayed.
D) Hepatic metastases are homogenously hypoattenuating in the arterial phase, but isoattenuating in the venous phases.

A

B) Benign hepatic adenomas have diffuse enhancement in the portal and delayed phase.

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33
Q

Are CT findings differentiate benign from malignant hepatic lesions based on contrast phase enhancement?

A

No; too much overlap.

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34
Q
A
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35
Q
A

multiple hypoattenuating nodules are noted throughout the hepatic parenchyma. The gallbladder wall is thickened, with a double layered appearance. Hepatic metastasis secondary to a jejunal carcinoma was diagnosed on necropsy. Gallbladder wall edema was of undetermined etiology.

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36
Q
A

a large, hypoattenuating, lobular mass is present in the left lateral liver lobe. Hepatocellular carcinoma was diagnosed on histopathology post liver lobe resection

36
Q
A

dog with hepatic abscessation secondary to hepatic carcinoma. An irregular, focal radiolucency is in the midportion of the liver, just to the left of midline (black arrows).

37
Q

How to differentiate hepatic from portal veins on US

A

Portal veins are smoothly tapering vessels characterized by bright, echogenic borders

38
Q

Which direction is hepatic venous blood flow?

A

towards hilus (from periphery)

39
Q

How do you recognise hepatic arteries on US?

A

Normal hepatic arteries are not visualized easily without color Doppler examination.

39
Q

Which veins course from the hilus to periphery - portal or hepatic v.?

40
Q

What is the normal gallbladder volume in dogs?

A

up to 1 ml/kg

41
Q

What is the normal gallbladder volume in dogs?

a) 1 mL/kg or less body weight
b) 2 mL/kg or less body weight
c) 2.4 mL regardless of body weight
d) 3 mL/kg or less body weight

A

a) 1 mL/kg or less body weight

41
Q

What could the presence of gallbladder sludge indicate in dogs?

a) Normal finding with no clinical significance
b) Gallbladder dysmotility
c) Acute biliary obstruction
d) Chronic liver disease

A

b) Gallbladder dysmotility
(but usually incidental finding)

42
Q

What is the normal feline gallbladder volume?

43
Q

Normal thickness of gallbladder wall in cats

44
Q
A

caudate liver lobe and right kidney of a dog with hepatic lipidosis. The caudate lobe surrounds the right kidney completely, consistent with hepatomegaly. The liver is markedly hyperechoic to the renal cortex.

45
Q

Normal thickness of gallbladder wall in dogs

46
Q

What is the significance of a septated gallbladder in cats - congenital or acquired?

A

Incidental, congenital (abnormal embryonic development)

47
Q

Normal CBD diameter in cats

48
Q

Normal CBD diameter in dogs

49
Q

Normal US appearance/size of intrahepatic bile ducts

A

not visible

50
Q

Common causes for diffuse hyperechoic liver? What is most common in cats?

A
  • Vacuolar hepatopathy e.g. lipidosis (most common in cats, cannot be differentiated from non-pathological hyperechoic liver in some obese cats), steroid hepatopathy,
  • Chronic hepatitis with fibrosis, cirrhosis (microhepatica and ascites)
  • Lymphosarcoma
  • Amyloidosis
  • Cholangiohepatitis
  • MCT (can also be isoechoic or with hypoechoic nodules)
51
Q

Common causes for diffuse hypoechoic liver? What is most common in cats?

A

Congestion
Leukemia
Lymphosarcoma
Amyloidosis
Cholangiohepatitis

52
Q

Severe hepatic disease can have a normal US appearance - T or F?

53
Q

what is US useful for distinguishing in terms of liver lesions?

A

cysts from solid masses

54
Q

what’s the most common primary canine hepatic tumour? 2nd most common? Other common ones?

A
  1. HCC hepatocellular carcinoma
  2. Cholangiocarcinoma
  3. neuroendocrine, HSA, histiocytic, lymphosarcoma
55
Q

how much more common are hepatic mets compared to primary neoplasia? From where do they originate?

A

2.5x
Spleen, GI, pancreas

56
Q

Target lesions are associated with..

A

malignancy, but can be found in benign processes.

57
Q

Most common primary hepatic neoplasia in cats, and how does it look?

A

biliary cystadenoma; usually has a cystic component

58
Q

most common MALIGNANT neoplasia in cat livers?

A

cholangiocarcinoma

59
Q

Nodular hyperplasia will result in which biochemical change?

A

increased serum alkaline phosphate (ALP)

60
Q

Nodular hyperplasia will commonly result in increases in:
A) ALT
B) ALP
C) AST
D) GGT

61
Q

How might contrast in US help differentiate benign from malignant processes?

A

At peak contrast, benign processes will be ISO to the normal liver (i.e. behave like normal liver tissue), whereas malignancies will be HYPOechoic. However, you cannot differentiate tumour types.

62
Q

Besides nodular hyperplasia, what else can cause a nodular appearance?

A

Chronic hepatitis, hepatocutaneous syndrome

63
Q

Hematomas initially are Hyper/Iso/Hypoechoic to the normal liver, then ___, then ___.

A

HYPER sandwich:

hyper - gas/RBC aggregates
hypo/anechoic
hyper - reorganisation, possible mineralisation

64
Q

Which other organ should you check if you find hepatic cysts?

A

kidneys - associated with PKD

65
Q

Immobile gallbladder sludge has what sens/spec for bactibilia and cholecystitis?

A

70% sens / 100% spec

66
Q

causes of GB wall edema

A

Reasons People Have Swollen .. gallbladders after bee stings (Anaphylaxis)

R-CHF
Pulmonary hypertension
Hypoproteinemia
Sepsis
Anaphylaxis

67
Q

GB wall thickening goes back to normal after underlying disease is fixed - T or F

A

it can persist

68
Q

Choledocholiths and choleliths - do they cause obstruction or are they caused by obstruction? are they significant?

A

Both - can cause and be caused. Can also be incidental, but with a potential to obstruct.

69
Q

what percentage of asymptomatic dogs have dependent/mobile GB sludge?

70
Q

To assess bile peristalsis/movement, how long should you wait after feeding, and what amount of reduction/volume should you expect in a normal dog?

A

1-2 hours, GB volume should be 1ml/kg in dogs, or reduced by >25%

71
Q

Which of the following drugs groups has been reported in Thrall as causing splenomegaly with no associated change in echogenicity

Phenothiazine

Iminipem

Ketoconazole

Selegiline

A

Phenothiazine

72
Q

What phase of imaging would you get if you performed a CT 30 to 40s after injection of contrast?

Hepatic arterial

Early portal venous phase

Late portal venous phase

Delayed phase

A

Early portal venous phase

73
Q

What is the normal reported length of the liver using T11 in brachycephalic dogs

4.64

4.98

5.16

5.45

74
Q

Which of the following infectious processes is associated with hepatic mineralisation

Leptospirosis

Echinococcosis

Schistosomiasis

Toxoplasmosis

A

Echinococcosis

75
Q

Which of the following disease processes is not associated with decreased hepatic echogenicity?

Amyloidosis

Hepatic congestion

Leukaemia

Obesity

76
Q

Which of the following is best described by the following description (CT imaging): Diffuse enhancement in the hepatic arterial phase, persistent enhancement in the portal venous phase.

Hepatocellular carcinoma

Metastatic lesions within the liver

Benign hepatic adenoma

Nodular hyperplastic lesions in the liver

A

Benign hepatic adenoma

77
Q

What is the ellipsoid formula for calculating gallbladder volume?

Length x width x height

Length x width x height x 0.24

Length x width x height x 3.14

Length x width x height x 0.52

A

Length x width x height x 0.52

78
Q

What is the most common diffuse hyperechoic hepatopathy in cats?

Steroid hepatopathy

Hepatic lipidosis

Hepatic fibrosis

Hepatic cirrhosis

A

Hepatic lipidosis

79
Q

What is the most common primary hepatic tumour in the cat?

Biliary cystadenoma

Cholangiocarcinoma

Haemangiosarcoma

Neuroendocrine tumour

A

Biliary cystadenoma

80
Q

What is the most common primary hepatic tumour in a dog?

Cholangiocellular carcinoma

Neuroendocrine tumour

Hepatocellular carcinoma

Haemangiosarcoma

A

Hepatocellular carcinoma

81
Q

Using CEUS, how do malignant nodules usually appear in the liver?

Isoechoic to surrounding normal liver during peak normal liver perfusion

Hypoechoic to surrounding normal liver during peak normal liver perfusion

Hyperechoic to surrounding normal liver during peak normal liver perfusion

Hypointense to surrounding normal liver during peak normal liver perfusion

A

Hypoechoic to surrounding normal liver during peak normal liver perfusion

82
Q

The most common causes for generalized splenomegaly in a cat are…

FIP

Toxoplasma

Round cell neoplasia (lymphosarcoma and mast cell infiltration)

Mast cell infiltration

A

Round cell neoplasia (lymphosarcoma and mast cell infiltration)

83
Q

The most common causes of splenic lesions in dogs are…

Haemangiosarcoma and haematomas

Haematomas and hyperplastic nodules

Hyperplastic nodules

Mast cell infiltration

A

left lateral, usually most caudal

84
Q

In a VD projection of a cats abdomen the liver is usually…

More left sided

More right sided

Symmetrically distributed

A

More right sided

85
Q

Which of the following has NOT been associated with the gallbladder changes in the image below?
Cystic mucinous hyperplasia

Gallbladder carcinoma

Cholecystitis

Leptospirosis

A

mineralisation - not in Lepto

86
Q

Hepatic abscess

Hepatobiliary cyst

Hepatocellular carcinoma

Echinococcosis

A

Echinococcosis

87
Q

What is your top differential for a 6-year-old Burmese cat with raised liver enzymes, pre regenerative anaimia, hepatomegaly with a heterogenous mottled echotexture and a moderate volume echogenic peritoneal effusion?

Hepatic lipidosis

Amyloidosis

Chronic hepatitis

Mast cell infiltration

A

Amyloidosis, chronic hepatitis less likely to be mottled/heterogenous and have anemia. Also the breed.

88
Q

Which of the following can be enlarged in acromegalic cats?

Liver and pancreas

Kidneys and spleen

Liver and kidneys

All the above

A

All the above : Liver, Spleen, Kidneys, Pancreas

89
Q

Reticulonodular pattern of the spleen was most marked in dogs or what age?

0-12 weeks

16-24 weeks

28-36 weeks

36-44 weeks

A

28-36 weeks

90
Q

6.8%, non- neoplastic causes most likely

23.4% non- neoplastic causes most likely

6.8%, neoplastic causes most likely

23.4% neoplastic causes most likely

A

6.8%, non- neoplastic causes most likely

Thrall (Diagnostic) (22 decks)

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