Elimination & Detox 2: Hepatobiliary Imaging Flashcards
what are the 5 things we look at when evaluating the LIVER under RADIOGRAPHS?
which is MOST IMPORTANT? (*)
- SIZE (*)
- SHAPE
- MARGINATION
- RADIOPACITY
- LOCATION
how do we diagnose HEPATOMEGALY on RADIOGRAPHS? (3)
- the liver SHADOW is EXTENDING CAUDAL TO COSTAL ARCH
- GASTRIC AXIS of the stomach is CAUDODORSALLY DISPLACED
- MARGINS of the liver are ROUNDED
if there’s GENERALIZED HEPATOMEGALY with SMOOTH MARGINS, what are 6 DDxs?
- VENOUS CONGESTION
- DIFFUSE NEOPLASIA (LSA is very common)
- CUSHING’S
- DIABETES MELLITUS (fat accumulates in liver)
- HEPATIC LIPIDOSIS
- HEPATITIS/infection
when determining what KIND of hepatomegaly, how do we DIFFERENTIATE?
GENERALIZED = all over change
FOCAL = only ONE PART is ENLARGED
if GENERALIZED…
1. SMOOTH margins = maintains NORMAL LIVER SHAPE
- IRREGULAR margins = disease
what is a COMMON MALIGNANT NEOPLASIA that INFILTRATES THE LIVER?
LYMPHOSARCOMA
if there’s GENERALIZED HEPATOMEGALY with IRREGULAR MARGINS, what 5 DDxs?
- NODULAR HYPERPLASIA
- MULTIFOCAL/METASTATIC NEOPLASIA
- MULTIPLE GRANULOMAS
- MULTIPLE ABSCESSES
- HEPATITIS
if FOCAL HEPATOMEGALY, what are the 7 DDxs? which one is the PRIMARY Ddx? (*)
- NEOPLASIA (*)
- ABSCESS
- CYST
- LIVER LOBE TORSION
- HEPATOMA
- HEMATOMA
- BILOMA
HEPATOMA definition?
BILOMA definition?
associated with WHAT radiographic finding?
HEPATOMA = BENIGN LIVER TUMOR
BILOMA = focal BILE ACCUMULATION in CAVITATED PORTION OF LIVER
associated with FOCAL HEPATOMEGALY
how do we diagnose MICROHEPATICA on RADIOGRAPHS?
- via the GASTRIC AXIS being displaced in the CRANIOVENTRAL DIRECTION
MICROHEPATICA can be normal in… & give one specific example
in these animals, the liver is located…
DEEP-CHESTED DOGS, such as GREAT DANES
liver is located TUCKED INTO DIAPHRAGM, but NOT REALLY SMALL, JUST CONFORMATION
if we see MICROHEPATICA in a YOUNGER ANIMAL, what disease should we suspect?
PSS from liver NOT GETTING TROPHIC FACTORS FROM PORTAL CIRCULATION
if you see MICROHEPATICA in an OLDER ANIMAL, likely should see WHAT diseases? (1 main, 2 specific)
WHAT should we see on bloodwork?
CHRONIC PRIMARY LIVER DZ such as CIRRHOSIS or FIBROSIS
look for SIGNS OF LIVER FAILURE ON BLOODWORK
why CAN’T the BILIARY TREE be NORMALLY ASSESSED ON RADIOGRAPHS?
when CAN we use radiographs to look at BILIARY TREE? (3)
has SIMILAR OPACITY TO SURROUNDING LIVER PARENCHYMA
when CAN we use radiographs to look at BILIARY TREE?
1. MARKEDLY ENLARGED GALLBLADDER forms OPACITY AROUND LIVER
2. MINERALIZED MATERIAL IN BILIARY TREE
3. GAS in the BILIARY SYSTEM (PNEUMOBILIA)
EMPHYSEMATOUS CHOLECYSTITIS…
= definition?
what do we see on RADIOGRAPHS?
how is this CONFIRMED?
= when there’s GAS in the GALLBLADDER associated with GAS-FORMING BACTERIAL INFECTION
see GAS OPACITY in BILIARY TREE
ABDOMINAL US NEEDED TO CONFIRM
ID lesion & DEFINE IT
CHOLELITHIASIS = mineralized material in the GALLBLADDER
ID lesion & DEFINE IT
EMPHYSEMATOUS CHOLECYSTITIS = BACTERIAL INFECTION in GALLBLADDER that causes GAS FORMATION
HEPATOBILIARY ULTRASOUND…
comparison to biliary rads?
what 7 things can we evaluate?
where do we USUALLY place the probe? (direction & position)
gives MORE information than BILIARY RADS
what can we evaluate?
1. SIZE
2. SHAPE of liver margin
3. STRUCTURE of PARENCHYMA
4. ECHOGENICITY of liver
5. VASCULATURE of over
6. BILIARY TREE
7. LYMPH NODES
probe usually oriented in CRANIODORSAL DIRECTION at RETROXYPHOID POSITION
describe the DIRECTION & POSITION of this probe
what is it LIKELY being used to evaluate?
DIRECTION = CRANIODORSAL
POSITION = RETROXYPHOID
likely used for HEPATOBILIARY US
NORMALLY, the liver is ____ECHOIC to the SPLEEN
but if liver is ____ECHOIC to the SPLEEN, it can be due to… (5, give one COMMON & one RARE)
NORMALLY, liver is HYPOECHOIC to the LIVER
if liver is HYPERECHOIC to the SPLEEN, then due to..
1. STEROID HEPATOPATHY –> COMMON
2. HEPATIC LIPIDOSIS
3. DIABETES MELLITUS
4. CHRONIC HEPATITIS (infectious or toxins)
5. LYMPHOMA –> RARE
use 2 terms to describe liver on the RIGHT
give 5 DDxs!
DIFFUSELY HYPERECHOIC LIVER
5 DDxs?
1. STEROID HEPATOPATHY
2. HEPATIC LIPIDOSIS
3. DIABETES MELLITUS
4. CHRONIC HEPATITIS (infectious or toxins)
5. LYMPHOMA
use 3 words to describe this liver
give 4 DDxs!
DIFFUSELY HYPOECHOIC ENLARGED LIVER
4DDxs
1. ACUTE HEPATITIS/TOXIC hepatitis
2. CHOLANGIOHEPATITIS
3. LYMPHOMA
4. CONGESTION due to RIGHT-SIDED CHF
what is a COMMON cause of DIFFUSELY HYPOECHOIC, ENLARGED LIVER?
which cause DIFFUSELY HYPOECHOIC, ENLARGED LIVER is MORE COMMON IN CATS?
what is a COMMON cause of DIFFUSELY HYPOECHOIC, ENLARGED LIVER? = LYMPHOMA
which cause DIFFUSELY HYPOECHOIC, ENLARGED LIVER is MORE COMMON IN CATS? = CHOLANGIOHEPATITIS
describe this liver (3)
what 2 disease processes can be used to describe this?
describe liver…
1. SMALL LIVER MARGINS
2. IRREGULAR, NODULAR SURFACE
3. ANECHOIC EFFUSION secondary to PORTAL HYPERTENSION
2 processes?
1. MICROHEPATICA
2. CIRRHOSIS
what diagnostic imaging technique is BEST for FOCAL liver lesions?
what is one DRAWBACK? how do we overcome it?
ULTRASOUND
lacks SPECIFICITY, so UNSURE IF IT’S BENIGN OR MALIGNANT; need to do FNA or BIOPSY for further diagnosis
what is a CONTRAINDICATION for LIVER BIOPSY/FNA?
BLEEDING DISORDERS
= gallbladder basic definition
how does it eventually connect to the DUODENUM? (3)
= STORAGE organ for BILE which is PRODUCED IN THE LIVER
connection?
1. gallbladder connected to CYSTIC DUCT which drains the LIVER LOBES
2. cystic duct merges with the COMMON BILE DUCT
3. enters DUODENUM at MAJOR DUODENAL PAPILLA
describe what the PURPLE ARROW is pointing to & RED CIRCLE
everything UPSTREAM from this lesion is…
PURPLE ARROW = STONES (CHOLELITHS)
RED CIRCLE = ACOUSTIC SHADOWING from MINERAL PRESENT (artifact)
everything UPSTREAM from the stones are DILATED, including COMMON BILE DUCT
what is this OVERALL structure/pathology in the liver?
2 findings that help confirm this?
DILATED INTRAHEPATIC BILE DUCT
2 findings?
1. TUBULAR HYPERECHOIC STRUCTURE
2. WAVY APPEARANCE
NAME RED & PURPLE (only one is a normal structure)
RED = GALLBLADDER
PURPLE = DILATED CYSTIC DUCT
name 4 STRUCTURES
two are PATHOLOGY
RED = DUODENUM
PURPLE = DILATED COMMON BILE DUCT
BLUE = PANCREATIC MASS
GREEN = PANCREAS & PANCREATIC DUCT
describe OVERALL PATHOLOGY & what we see here
CHOLEDOCHITIS
see THICKENING OF WALL OF COMMON BILE DUCT from INFLAMMATION
in INFLAMMATION of the BILE DUCT, can often see HYPERECHOGENICITY why?
because FAT BECOMES HYPERECHOIC when BILE DUCT INFLAMED
name OVERALL CONDITION & RED, GREEN & BLUE structures
OVERALL = GALLBLADDER MUCOCELE
GREEN = THICKENED GALLBLADDER WALL
RED = STEATITIS & EFFUSION suggestive of RUPTURE
BLUE = STATIC ECHOGENIC CONTENT WITHIN MUCOCELE
what pathology commonly looks like a KIWI FRUIT appearance on ULTRASOUND?
GALLBLADDER MUCOCELE
what 2 FUNCTIONS does CT have for HEPATIC MASSES? & give 1 for HEPATIC PATHOLOGY?
HEPATIC MASSES
1. determine if the mass is SURGICALLY RESECTABLE OR NOT by ASSESSING OTHER STRUCTURES IN THE AREA
- ANGIOGRAPHIC STUDY for EMBOLIZATION PLANNING to STARVE NEARBY VESSELS to force mass to SHRINK (if we can’t remove it)
HEPATIC PATHOLOGY
1. ANGIOGRAPHIC STUDY for DIAGNOSIS of VASCULAR ANOMALIES like PORTOSYSTEMIC SHUNTS
what diagnostic should we use for DIAGNOSIS of PSS? & give 3 reasons as to why?
CT > US
why?
1. FASTER/EASER
2. MORE SENSITIVE & PRECISE
3. can also help EMBOLIZATION TREATMENT PLANNING
