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Abd Review > Ch2 Liver > Flashcards

Ch2 Liver Flashcards

1
Q

Amebic hepatic abscess

A

an abscess that develops from a parasite that grows in the colon and invades the liver via the portal vein

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2
Q

anastomosis

A

the surgical connection between two structures

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3
Q

arteriovenous fistula

A

an abnormal passageway between an artery and a vein

following trauma to the liver, an abnormal passageway between an after & vein

may also be discovered following a liver biopsy, cholangiography, or hepatic surgery

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4
Q

autoimmune disorders

A

disorders in which the body’s immune system attacks and destroys health tissues and/or organs

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5
Q

autosomal dominant polycystic kidney disease

AKA?

A

an inherited disease that results in the development of renal, liver, and pancreatic cysts late in life
also referred to as ADULT POLYCYSTIC KIDNEY DISEASE

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6
Q

bare area

A

the region of the liver not covered by peritoneum

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7
Q

Beckwith-Wiedmann syndrome

A

a growth disorder syndrome synonymous with enlargement of several organs, including the skull, tongue, and liver

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8
Q

Budd-Chiari syndrome

A

a syndrome described as the occlusion of the hepatic veins with possible coexisting occlusion of the inferior vena cava

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9
Q

caput medusa

A

recognizable dilation of the superficial veins of the abdomen

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10
Q

cavernous hemangioma

A

the most common benign liver tumor
they can be found in men, but are more common in women
are asymptomatic

is within the rt lobe of the liver
will appear small, hyperechoic mass measuring less than 3cm, although some may be quite large and referred to as “giant hemangiomas”
occasionally, posterior enhancement may be seen

although hemangiomas are comprised of blood vessels, detectable flow may not be seen with color Doppler because the flow within the vessels tend to be exceedingly slow

they may also appear hypoechoic or complex, and therefore can be monographically indistinguishable from metazoic liver disease

there may also be multiple hemangiomas present, further complicating the sonographic diagnosis and consequently leading to other imagining or biopsy

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11
Q

cholangitis

A

inflammation of the bile ducts

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12
Q

cirrhosis

A

condition defined as hepatocyte death, fibrosis and necrosis of the liver, and the subsequent development of regenerating nodules

cirrhosis can also be caused by Wilson disease, primary biliary cirrhosis, hepatitis, cholangitis, and hemochromatosis

lab findings include: elevation of AST, LDH, ALT & Bilirubin

patients may also present with jaundice, fatigue, weight loss, diarrhea, initial hepatomegaly, and ascites

sonographic findings include an echogenic small right lobe, an enlarged caudate and left lobe, nodular surface irregularity, coarse echo texture ascites, and splenomegaly

NORMAL nodules typically measure less than 1 cm (micro nodular) \
Cirrhosis caused nodules measure between 1 - 5 cm (macro nodular)

Doppler findings in patients WITH cirrhosis: monophonic flow within the hepatic veins & hepatofugal flow within the portal veins

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13
Q

cystic fibrosis

A

genetic disorder linked with the development of scar tissue accumulation within the lungs, liver, pancreas, kidneys, and or intestines

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14
Q

diaphragmatic slip

A

a pseudo mass of the liver seen on sonography resulting from hypertrophied diaphragmatic muscle bundles

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15
Q

dystentery

A

infection of the bowel which leads to diarrhea that may contain mucus and/or blood

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16
Q

echinococcal cyst

AKA?

A

aka hydatid liver cyst
which is a liver cyst that develops from a tapeworm that lives in dog feces; also referred to as ECHINOCOCCAL CYST because it originates from the parasite ECHINOCOCCUS GRANULOSUS

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17
Q

Echinococcus granulosus

A

a parasite responsible for the development of hydatid liver cysts

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18
Q

Epstein-Barr virus

A

the virus responsible for the mononucleosis and other potential complications

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19
Q

fatty liver
AKA?
types?

A

a reversible disease characterized by deposits of fat within the hepatocytes
AKA: HEPATIC STEATOSIS
Types:
Nonalcoholic fatty liver disease - has been cited as the MOST common liver disorder in the western world & the MOST common cause of chronic liver disease
Alcoholic fatty liver disease - caused from heavy life long drinking
Causes of NONALCOHOLIC: starvation, obesity, chemotherapy, diabetes mellitus, hyperlipidemia, pregnancy, glycogen storage disease or VON GIERKE DISEASE (glycogen storage disease type 1), total parental hyperalimentation, severe hepatitis, cystic fibrosis, intestinal bypass surgery for obesity, and the use of some drugs such as corticosteroids

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20
Q

fibrosis

A

the formation of excessive fibrous tissue; the development of scar tissue within an organ

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21
Q

focal fatty infiltration

A

manifestation of fatty liver disease in which fat deposits are localized
it will appear as an area of increased echogenicity and can thus appear much like a solid, hyperechoic mass

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22
Q

focal fatty sparing

A

manifestation of fatty liver disease in which an area of the liver is spared from fatty infiltration
it is much more likely that the signs of sparing and infiltration are seen adjacent to the gallbladder, near the portal hepatic , and the left medial segment

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23
Q

focal nodular hyperplasia

A

a benign liver mass composed of combination of hepatocytes and fibrous tissue that typically contains a central scar
are asymptomatic

it is the SECOND most common benign liver tumor and MORE COMMONLY incidentally discovered in women

mass is composed of a combination of hepatocytes and fibrous tissue

most patients are asymptomatic, but if the mass impinges upon surrounding anatomy or hemorrhage occur, pain will most likely ensue

not caused by oral contraceptives, it can enlarge because of them (masses are estrogen dependent)

may appear isoechoic, echogenic, and hypoechoic

the central scar, when seen, will appear as a hypoechoic or hyperechoic, linear structure within the mass

hypervascularity within the scar can be identified by using color doppler

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24
Q

gastroesophageal junction

A

the junction between the stomach and the esophagus

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25
Q

Glisson capsule

A

the thin fibrous casing of the liver

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26
Q

hematemesis

A

vomiting blood

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27
Q

hematoma

A

a localized collection of blood

can appear solid or complex depending on their age

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28
Q

hemochromatosis

A

an inherited disease characterized by disproportionate absorption of dietary iron

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29
Q

hepatic candidiasis

A

a hepatic mass that results from the spread of fungus (primarily Candida albicans) in the blood to the liver

affects those that are immunocompromised

patient may have right RUQ pain, fever & hepatomegaly

findings include multiple hyperechoic (central portion) masses with hypoechoic boarders

these masses may be described as “target,” “halo,” or “bull’s-eye” lesions and are typically 1 cm or smaller

older lessons may calcify

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30
Q

hepatic encephalopathy

A

a condition in which a patient becomes confused or suffers from intermittent loss of consciousness secondary to the overexposure of the brain to toxic chemicals that the liver would normally remove from the body

in a newborn, brain damage can occur with severe jaundice, as a result of bilirubin exposure, a condition referred to as kernicterus

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31
Q

hepatic steatosis

A

aka fatty liver

a reversible disease characterized bad deposits of fat within the hepatocytes

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32
Q

hepatitis

types?

A

inflammation of the liver
Types:
Acute - is said to resolve within 4 months
Chronic - persists beyond 6 months
A, B, C, D, E & G; the 2 MOST common are: hepatitis A & B

Currently, hepatitis C is the leading indication for liver transplantation in the US

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33
Q

hepatocellular adenoma

AKA?

A

a RARE benign liver mass often associated with the use of oral contraceptives

AKA HEPATIC ADENOMA or LIVER CELL ADENOMA

pt is typically asymptomatic, but hemorrhage of the tumor leads to abdominal pain
and because of the hemorrhage and a small propensity to become malignant (termed malignant degeneration), hepatic adenomas are often surgically removed

and although a solid, hypoechoic echogenicity is common, they may be hyperechoic, isoechoic, or have mixed echogenicities
it is mostly hypoechoic

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34
Q

hepatofugal

hepatopetal

A

hepatofugal - blood flow AWAY from the liver

hepatopetal - blood flow TOWARDS the liver

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35
Q

hepatoma

A

the malignant tumor associated with hepatocellular carcinoma

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36
Q

hepatomegaly

A

enlargement of the liver

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37
Q

hepatosplenomegaly

A

enlargement of the spleen and liver

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38
Q

hydatid liver cyst

AKA?

A

a liver cyst that develops from a tapeworm that lives in dog feces

also referred to as an echinococcal cyst because it originates from the parasite Echinococcus granulosus

may appear as an anechoic mass containing some debris (aka hydatid sand)
may have the “water lily” sign, or “mother” cyst containing the “daughter” cysts

the mass may also contain some elements of dense calcification

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39
Q

hyperlipidemia

A

abnormally high levels of fats within the blood (i.e. high cholesterol and high triglycerides)

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40
Q

hypovolemia

A

decreased blood volume

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41
Q

idiopathic

A

no recognizable cause; from an unknown origin

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42
Q

immunocompromised

A

a patient who has a weakened immune system

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43
Q

jaundice

A

the yellowish discoloration of the skin, mucous membranes, and sclerae; found with liver disease and/or biliary obstruction

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44
Q

kernicterus

A

brain damage from bilirubin exposure in a newborn with jaundice

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45
Q

Kupffer cells

A

specialized macrophages within the liver that engulf pathogens and damaged cells

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46
Q

leukocytosis

A

an elevated WBC count

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47
Q

lipoma

A

a benign fatty tumor

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48
Q

liver hilum

A

the area of the liver where the common bile duct exits the liver and portal vein and hepatic artery enter the liver; also referred to as the portal hepatis

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49
Q

low-resistance flow

A

a flow patter that characteristically has integrate flow throughout the cardiac cycle

50
Q

malaise

A

feeling of uneasiness

51
Q

malignant degeneration

A

the deterioration of a benign mass into malignancy

52
Q

mass effect

A

the displacement or alteration of normal anatomy that is located adjacent to a tumor

53
Q

monophasic

A

vascular flow yielding a single phase

54
Q

necrosis

A

death of tissue

55
Q

periportal cuffing

A

an increase in the echogenicity of the portal triads as seen in hepatitis and other conditions
the sonographic manificstation of this phenomenon is referred to as the “starry sky” sign

56
Q

porta hepatis

A

the area of the liver where the portal vein and hepatic artery enter an dot hepatic duct exit; also referred to as the liver hilum

57
Q

portal hypertension

A

the elevation of blood pressure within the portal venous system

with portal hypertension, the coronary vein will demonstrate abnormal flow toward the esophagus and will measure greater than 6mm

58
Q

portal triads

A

an assembly of a small branch of portal vein, bile duct, and hepatic artery that surround each liver lobule

59
Q

portal vein thrombosis

A

the development of clot within the portal vein

is seen in conditions such as HCC, portal hypertension, pancreatitis, cholecystitis, pregnancy, oral contraceptive use, and surgery

the development of collaterals within the portal vein region will occur; these small vessels try to shunt blood around the clot.

60
Q

pseudocirrhosis

A

nodular appearance of the liver caused by multiple metastatic tumors

61
Q

pseudomass

A

false mass

62
Q

pyogenic liver abscess

A

a liver abscess that can result from the spread of infection from inflammatory conditions such as appendicitis, diverticulitis, cholecystitis, cholangitis, and endocarditis

the bacteria enter the liver through the PV, HA, Biliary tree, or from an operative procedure

clinical symptoms: fever, leukocytosis, possible abnormal liver function tests, right upper quadrant pain, and hepatomegaly

it may appear as a complex cyst with thick walls, debris, separation, and/or gas.

the air within the abscess may produce dirty shadowing or ring-down artifacts

63
Q

quadrate lobe

A

the medial segment of the left lobe

64
Q

recanalization

A

the reopening of canals or pathways

65
Q

Riedel lobe

A

a tonguelike extension of the right hepatic lobe

66
Q

sequela

A

an illness resulting from another disease, trauma, or injury

67
Q

serpiginous

A

twisted or snakelike pattern

68
Q

situs inversus

A

condition in which the organs of the abdomen and chest are on the opposite sides of the body (i.e. the liver is within the left upper quadrant instead of the right upper quadrant)

69
Q

splenomegaly

A

enlargement of the spleen

70
Q

starry sky sign

A

the sonographic sign associated with the appearance of perioportal cuffing in which there is an increased echogenicity of the walls of the portal triads

71
Q

steatohepatitis

A

a type of fatty liver disease that causes inflammation of the liver
is a precursor for chronic liver disease, leading to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) in some individuals

72
Q

total parental hyperalimentation

A

procedure in which an individual receives vitamin and nutrients through a vein, often the subclavian vein

73
Q

transjugular intrahepatic portosystemic shunt (TIPS)

A

the therapy for portal hypertension that involves the placement of stent between the portal veins and hepatic veins to reduce portal systemic pressure

74
Q

triphasic

A

vascular flow yielding three phases

75
Q

von Gierke disease

A

condition in which the body does not have the ability to break down glycogen; also referred to as glycogen storage disease type 1

76
Q

von Hippel-Lindau disease

A

a inherited disease that includes the development of cysts within the liver, pancreas, and other organs

77
Q

Wilson disease

A

a congenital disorder that causes the body to accumulate excess copper

78
Q

associated abnormalities if you have a decrease of albumin:

A

chronic liver disease

cirrhosis

79
Q

associated abnormalities if you have an increase of ALP (alkaline phosphatase):

A 
cirrhosis
extra hepatic biliary obstruction
gallstones
hepatitis
metastatic liver disease
pancreatic carcinoma
80
Q

associated abnormalities if you have an increase of ALT (alanine aminotransferase)

A

biliary tract obstruction
hepatitis
hepatocellular disease
obstructive jaundice

81
Q

associated abnormalities if you have increase of AST (aspartate aminotransferase)

A

cirrhosis
fatty liver
hepatitis
metastatic liver disease

82
Q

associated abnormalities if you have increase gamma-Glutamyl transferase

A

diffuse liver disease

post hepatic obstruction

83
Q

associated abnormalities if you have increase LDH (lactate dehydrogenase)

A

cirrhosis
hepatitis
obstructive jaundice

84
Q

associated abnormalities if you have increase of Serum bilirubin

A

unconjugated (direct) bilirubin: acute hepatocellular disease
conjugated (indirect) bilirubin: biliary tract obstruction
total bilirubin: cirrhosis, hepatitis, and other liver cell diseases

85
Q

associated abnormalities if you have PT (prothrombin)

A

prolonged PT: metastasis of the liver and hepatitis

shortened PT: extra hepatic duct obstruction

86
Q

associated abnormalities if you have increase AFP (a-Fetoprotein)

A 
hepatocellular carcinoma (hepatoma)
hepatoblastoma
87
Q

clinical findings of fatty liver disease:

A 
asymptomatic
alcohol abuse
chemotherapy
diabetes mellitus
elevated liver function est (specifically AST & ALT)
hyperlipidemia
obesity
pregnancy
88
Q

sonographic findings of diffuse fatty liver disease:

A

diffusely echogenic liver
increased attenuation of the sound beam
wall of the hepatic vasculature and diaphragm will not be easily imaged

89
Q

sonographic findings of focal fatty infiltration

A

hyperechoic area adjacent to the gallbladder, near the port hepatic, or part of a lobe may appear echogenic

90
Q

sonographic findings of focal fatty sparing

A

hypoechoic area adjacent to the gallbladder, near the portal hepatic, or part of a lobe or an entire lobe may be spared
can appear much like pericholecystic fluid when identified adjacent to the gallbladder.

91
Q

Clinical findings of Hepatitis

A 
chills
dark urine
elevated liver function sets (ALP, ALT, AST, LDH, total bilirubin, prothrombin (PT))
fatigue
fever
hepatosplenomegaly
jaundice
nausea
vomiting
92
Q

sonographic findings of hepatitis

A

normal liver
enlarged hypoechoic liver
periportal cuffing with “starry sky”
gallbladder wall thickening

93
Q

clinical findings of cirrhosis

A 
ascites
diarrhea
abnormal liver function tests (specifically elevated ALP, ALT, AST, bilirubin, PT, partial prothrombin time (PTT), total protein, and decreased albumin)
fatigue
hepatomegaly (initial)
jaundice
splenomegaly
weight loss
94
Q

sonographic findings of cirrhosis

A 
hepatosplenomegaly (initial)
shrunken, echogenic right lobe of th eliver
enlarged caudate and left lobes
nodular surface irregularity
coarse echotexture
splenomegaly
ascites
monophonic flow within the hepatic veins
hepatofugal flow within the portal veins
95
Q

examples of portosystemic collaterals that may result from portal hypertension

A 
coronary vein
short gastric vein
gastrorenal pathway
splenorenal pathway
umbilical vein
anterior abdominal wall vein
superior mesenteric vein
96
Q

clinical findings of portal hypertension

A 
abnormal liver function tests
ascites
diarrhea
fatigue
hepatomegaly (initially)
hepatic encephalopathy
caput medusa
tremors
gastrointestinal bleeding
97
Q

Sonographic findings of portal hypertension

A

hepatomegaly (initially)
shrunken right lobe of the liver
enlarged caudate lobe of the liver
nodular surface irregularity
coarse echotexture
splenomegaly
ascites
monophonic flow within the hepatic veins
hepatofugal flow within the portal veins
enlargement o the portal vein (diameter will exceed 13 mm in the anteroposterior dimension)
enlargement of the superior mesenteric vein
enlargement and reversed flow within the coronary vein
enlarged hepatic arteries
abdominal varicosities at the splenic hilum, renal hilum, and gastroesophageal junction
patent paraumbilical vein (also called a reanalyzed paraumbilical vein)

98
Q

clinical findings of portal vein thrombosis

A 
abdominal pain
elevated liver function tests
hypovolemia
leukocytosis
low-grade fever
nausea
vomiting
99
Q

sonographic findings of portal vein thrombosis

A

echogenic thrombus within the portal vein
cavernous transformation of the portal veins will appear as wormlike or serpiginous vessels within the region of the portal vein

100
Q

clinical findings of portal venous gas

A

recent bout of diverticulitis, appendicitis, inflammatory bowel disease, bowel obstruction, ulcers within the bowel, gastrointestinal cancer, and invasive procedures that involve stent placement (TIPS) or endoscopic analysis of the bowel

101
Q

sonographic findings of portal venous gas

A

small, bright reflectors noted within the circulating blood inside the portal vein
large air collections may produce ring-down artifact

102
Q

clinical finding of budd-chiari syndrome

A 
ascites
elevated liver function test
hepatomegaly
splenomegaly
upper abdominal pain
103
Q

sonographic findings of Budd chiari syndrome

A

nonvisualization or reduced visualization of the hepatic veins
thrombus within the hepatic veins
enlarged caudate lobe
lack of flow within the hepatic veins with color doppler
narrowing of the IVC

104
Q

diffuse infiltration

A

will cause the liver to appear diffusely echogenic, and it will be more difficult to penetrate
the walls of the hepatic vasculature and diaphragm will not be easily imaged, secondary to the attenuation of the sound beam

105
Q

hemopoiesis

A

the formation and development of blood cells

106
Q

Portosystemic collaterals & vericosities

A

can consequently develop within the abdomen as a result of the body’s attempt to repair itself by channeling blood away from the damaged liver

107
Q

clinical findings of hepatic cysts

A

asymptomatic
possible normal liver function tests
ADPKD (autosomal dominant polycystic kidney disease)
Hemorrhagic or large cysts may cause right upper quadrant pain

108
Q

sonographic findings of hepatic cysts

A

anechoic mass or masses with posterior enhancement
may have irregular shapes
clusters of cysts may be noted

109
Q

clinical findings of hydatid liver cyst

A 
leukocytosis
low-grade fever
nausea
obstructive jaundice
RUQ tenderness
possible recent travel abroad
110
Q

sonographic finding of a hydatid liver cyst

A

anechoic mass containing some debris (hydatid sand)
“water lily” sign appears as an endocyst floating within the pericyst
“mother” cyst containing one or more smaller “daughter” cyst
mass may contain some elements of dense calcification

111
Q

clinical findings of an amebic hepatic abscess

A 
hepatomegaly
RUQ or General abdominal pain
general malaise
diarrhea (possibly bloody)
fever
leukocytosis
elevated liver function tests
mild anemia
possible recent travel abroad
112
Q

sonographic findings of amebic hepatic abscess

A

round hypoechoic or anechoic mass or masses
may contain debris (with fluid-debris layering)
acoustic enhancement

113
Q

clinical findings of a pyogenic hepatic abscess

A 
fever
hepatomegaly
leukocytosis
possible abnormal liver function tests
right upper quadrant pain
114
Q

sonographic findings of a pyogenic hepatic abscess

A

complex cyst with thick walls
mass may contain debris, separations, and/or gas
the air within the abscess may produce dirty shadowing or ring-down artifact

115
Q

clinical findings of hepatic candidiasis

A

immunocompromised patients including cancer patients, recent organ transplant patients, and patients w/ human immunodeficiency virus
RUQ pain
fever
hepatomegaly

116
Q

sonographic findings of hepatic candidiasis

A

multiple masses with hyperechoic center portions & hypoechoic boarders (may be described as “target,” “halo,” or “bull’s-eye” lesions)
these masses are typically 1 cm or smaller in size
older lesions may calcify

117
Q

hepatic lipoma

A

is rarely encountered; patients are asymptomatic, and its sonographic appearance is that of hyperechoic mass

118
Q

Hepatic Hematoma

A

can be consequence of trauma or surgery

pts will have pain and a decreased hematocrit

can be located within the liver parenchyma, termed INTRAHEPATIC, or around the liver, which is termed SUBCAPSULAR (under Glisson capsule).

they can appear solid or complex depending on their age

initial hemorrhage appears echogenic with the development of clot, and over time as it resolves, it may appear more cystic or complex

119
Q

Focal Hematoma

A

have been known to calcify

120
Q

hepatocellular carcinoma

A

HCC is the MOST COMMON primary form of liver cancer (although it’s not encountered as often as metastatic liver disease)

Is found most often in men, and accompanied by cirrhosis, or chronic hepatitis

the malignant mass associated w/ HCC is referred to as HEPATOMA

other causes: hemochromatosis, von Gierke disease, and Wilson disease

pts w/ HCC will have possible abnormal liver function tests, signs of cirrhosis, history of chronic hepatitis, unexplained weight loss, hepatomegaly, fever, abdominal swelling with ascites, and perhaps a palpable mass

a tumor marker for HCC is serum alpha-fetoprotein (AFP)
in the fetus, AFP is produced in lg amounts by the liver
in an adult, low levels of AFP exist
MOST patients w/ HCC will have an ELEVATED AFP - this occurs because AFP is produced in excess by the malignant hepatocytes that make up the tumor

there may be an individual mass, or multiple masses, it may appear as a solitary, small, hypoechoic mass, or as heterogeneous masses scattered throughout the liver

a hypoechoic halo MAY BE noted around the hepatoma as well, yielding the “target” or “bull’s-eye” pattern - - the target lesion will yield a hypoechoic rim, with the center of the mass often isoechoic to normal liver tissue

121
Q

Hepatic Metastasis

A

It is the MOST COMMON form of liver cancer; it is much MORE COMMON than primary liver cancer BECAUSE malignant cells from OTHER SITES enter the liver through the PV or Lymphatic channels.

Primary cancers that metastasize to the liver include: gallbladder, colon, stomach, pancreas, breast, & lung (lung being the most common primary source).

Patients w/ hepatic metastasis may present w/ weight loss, jaundice, RUQ pain, hepatomegaly, and ascites; HOWEVER, about half of patients there are no signs/symptoms INCLUDING normal liver function tests.

Mastatic cancer – from the gastrointestinal tract & pancreas tends to be calcified tumors

Hyperechoic Masses – tend to arise from the gastrointestinal tract as well, most commonly the colon, but they may also be from the kidney, pancreas, or biliary tree.

Hypoechoic Masses – may be from the breast, lung, or lymphoma

Cystic Metastatic Masses – within the liver have also been seen with ovarian cancers

Metastatic disease – in the liver can appear as an individual mass, several large masses, or diffuse involvement

Target lesions – are also common w/ metastasis and may be the expression of lung or colon metastasis within the liver, although they may be the manifestation of many forms of cancer

Diffuse metastasis – can produce an appearance of a nodular liver (PSEUDOCIRRHOSIS)

Masses can appear:
hyperechoic, hypoechoic, calcified, cystic, or heterogeneous masses
mass or masses demonstrating a hypoechoic rim & central echogenic region
diffusely heterogeneous liver
possible ascites

122
Q

Normal flow w/in the PV should be?
Normal HV flow?
Normal HA flow?

A

PV: Hepatopetal, continuous, monophonic, & have low velocity (between 20-40 cm/sec).

HV: typically demonstrate a triphasic flow pattern (assessment should be obtained at the END of respiration)

HA: should demonstrate a continuous, low-resistance wave form pattern, with a quick upstroke, and gradual deceleration with diastole (normal resistive index of the HA is between 0.5-0.8)

Abd Review (2 decks)

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