chapter 10 Flashcards
Affects the hepatocytes and interferes with liver function..
Diffuse hepatocellular disease
Is a parenchymal liver cell that performs all the functions ascribed to the liver.
Hepatocyte
Is an acquired, reversible disorder of metabolism, resulting in an accumulation of triglycerides
Fatty Infiltration
Normal to elevated hepatic enzymes elevated Alk Phos elevated Direct bilirubin
Fatty Infiltration Clinical findings
Echogenicity Attenuation Impaired visualization of borders of portal/hepatic structures (secondary to increased attenuation) Hepatomegaly May be patchy, inhomogeneous Focal sparing
Fatty Infiltration Sonographic findings
Hepatitis
Cirrhosis
Metastases
Fatty Infiltration differential considerations
Elevated AST, ALT
Elevated Bilirubin
Leukopenia
Acute Hepatitis Clinical findings
Nonspecific and variable Normal to slightly elevated Echogenicity Increased brightness of portal vein borders Hepatosplenomegaly Increased thickness of gallbladder wall
Acute hepatitis Sonographic Findings
Fatty liver
Differential considerations Acute hepatitis
Elevated AST, ALT
Elevated bilirubin
Leukopenia
Chronic hepatitis Clinical findings
COarse hepatic parenchyma
Increased echogenicity
Decreased visualization brightness of portal triad
Fibrosis may produce soft shadowing
Chronic Hepatitis Sonographic findings
Cirrhosis
Fatty liver
Chronic Hepatitis Differential considerations
INcreased phos
Increased direct bilirubin
Increased AST, ALT
Leukopenia
Cirrhosis clinical findings
Coarse liver parenchyma with nodularity Increased echogenicity Increased attenuation Decresasd vascular markings with acute cirrhosis Hepatosplenomegaly with ascites Shrunken liver with chronic cirrhosis (also increased nodularity) Regeneration of hepatic nodules Portal hypertension
Sonographic findings Cirrhosis
Fatty liver
Hepatitis
Cirrhosis Differential considerations
Disturbance of acid-base balance
Glycogen Storage Disease Clinical findings
Hepatomegaly
Increased echogenicity
Increased attenuation
Von Gierek’s adenoma (Round, homogeneous)
Glycogen Storage Disease Sonographic findings
Focal nodular hyperplasia
Glycogen Storage Disease differential considerations
Increased Iron levels in blood
Hemochromatosis clinical findings
Increased echogenicity throughout live
Sonographic findings Hemochromatosis
Cirrhosis
Differential considerations hemochromatosis
Obesity Excessive alcohol intake (alcohol stimulates lipolysis Poorly controlled hyperlididemia Diabetes mellitus Excess corticosteriods Pregancy Total parenteral Hyperalimentation (nutrition) Severe hepatitis Glycogen storage disease Cystic fibrosis Pharmaceutical Chronic illness
Causes of fatty liver
Suspected portal hypertension secondary to liver disease
Portal vein compression thrombosis
Acute onset of hepatic vein occlusion (Budd-Chiari syndrome) constrictive pericarditis, or congestive heart failure with tricupsid regurgiatation
Congential, traumatic, or neoplastic arterioportal fistula
Indications for Portal hypertension
Develops when the normal venous channels become obstructed.
Collateral circulation
Ascites, right upper quadrant pain, hepatomegaly
Budd-Chiari syndrome Clinical findings
Increased caudate lobe atrophy in right lobe of the liver
Budd-Chiari syndrome Sonographic findings
Portal hypertension
Budd-Chiari syndrome Differential considerations
N/A
Simple Hepatic cysts Clinical findings
Anechoic Thin Walls Well-defined borders Distal posterior enhancement May have calcification
Simple Hepatic cysts Sonographic findings
Congenital
Hematoma
Necrotic tumor
Simple Hepatic cysts Differential considerations
Autosomal dominant
25%-50% of patients with polycystic kidney disease have hepatic cysts
60%of patients with polycystic liver disease have associated PKD
Polycystic liver disease clinical findings
Anechoic
Well defined borders
Increased acoustic enhancement
Multiple cysts throughout liver parenchyma
Polycystic Liver disease sonographic findings
Necrotic metastasis Echinococcal cyst Hematoma Abscess Hepatic cystadenocarcinoma
Polycystic Liver disease Differential considerations
Increased white cell count
Abnormal LFT
Anemia
Pyogenic Abscess Clinical findings
Variable appearance Right central lobe most common site Hypoechoic to complex to hyperechoic when fluid level present Round to oval irregular Complex
Pyogenic Abscess Sonographic findings
Amebic abscess
Echinococcal cyst
Hepatic candidiasis
Pyogenic Abscess differential considerations
Increased WBC
Fever
Hepatic candidiasis clinical findings
Multiple small hypoechoic masses with echogenic central core
“bulls-eye” lesions “wheel-within-wheel” pattern
Hepatic candidiasis sonographic findings
Abscess
Echinococcal cyst
Metastases
Hepatic candidiasis differential considerations
N/A
Chronic Granulomatous disease Clinical findings
Poorly marginated
Hypoechoic
Posterior enhancement
May have calcification/shadowing
Chronic Granulomatous Disease clinical sonographic findings
Abscess
Chronic Granulomatous Disease Differential Consideratioins
Increased Leukocytes
Low fever
Abdominal pain and diarrhea
Amebic Abscess clinical findings
Mass is variable
Round or oval; lack notable borders
Hypoechoic with debris
Amebic Abscess sonographic findings
Pyogenic abscess
Echinococcal cyst
Hepatic candidiasis
Amebic Abscess differential considerations
Increased WBC
History of sheep-farming exposure
Exhinococcal cyst clinical findings
Simple to complex cysts Acoustic enhancement Oval or spherical Calcification Honeycomb appearance/"water lily" sign
Echinococcal cyst sonographic findings
Polycystic liver disease
Amebic abscess
Pyogenic abscess
Echinococcal cyst differential considerations
Most common benign tumor of the liver
Cavernous Hemangioma
Any new growth of new tissue, either benign or malignant
Neoplasm
Small percentage may bleed; RUQ pain
More frequent in women
Cavernous Hemangioma Clinical findings
Most are hyperechoic with enhancement
Round or Oval, well defined
Larger masses may show necrosis, degeneration, calcification
Cavernous Hemangioma sonographic findings
Metastasis
Hepatoma (HCC)
Adenoma
Focal nodular hyperplasia
Cavernous Hemangioma Differential considerations
RUQ pain when mass bleeds
Liver cell adenoma clinical findings
Hyperechoic with central echogenic area caused by hemorrhage
Solitary or multiple
Fluid may be present
Liver cell adenoma Sonographic findings
Hemangioma
Focal Nodular hyperplasia
Hepatoma (HCC)
Live cell adenoma differential considerations
More frequent in women below 40
Focal nodular hyperplasia clinical findings
Multiple, well defined with hyperechoic to isoechoic patters
Frequently found in right lobe of the liver
Focal nodular hyperplasia sonographic findings
Hemangioma
Hepatoma (HCC)
Metastases
Adenoma
Focal Nodular hyperplasia differential considerations
70% of patients have increased alpha-fetoprotein level
Abnormalities in liver function tests, with the indications of cirrhosis
Hepatocellular carcinoma clinical findings
Solitary, multiple Infiltrative, diffuse HYpoechoic, isoechoic, or hyperechoic May invade hepatic veins Thrombus
Hepatocellular carcinoma sonographic findings
Hemangioma
Metastases
Hepatocellular carcinoma differential considerations
Abnormal LFTs
Jaundice
Hepatomegaly
Weight loss decreased appetite
Metastatic disease Clinical findings
Hypoechoic or echogenic mass
Diffuse distortion of bull’s eye pattern
Solitary or multiple
well to ill defined
Metastatic disease sonographic findings
Abscess
Hemangioma
Hepatoma (HCC)
Adenoma
Metastatic disease differential considerations
Abnormal LFT
Lymphoma clinical findings
Hypoechoic of diffuse patterns
Target or echogenic lesions
Intrahepatic and lucent multiple small, discrete solid lesions without enhancement
Lymphoma sonographic findings
Hemangioma
HCC
metastases
lymphoma differential considerations
