Flashcards Davies Abdomen 2
large (pericyst) cyst, containing one or more smaller daughter cysts (endocysts). Fine, internal echoces (hydatid sand) are also found within these cysts. Undergoes a sequence of changes, ending as a collapsed calcified mass
echinococcal cyst
______ is one of the most common parasitic infections worldwide (Africa and South America).
Schistosomiasis
What is the most significant vascular event associated with schistosomiasis?
portal vein occlusion by the larvae
Portal vein occlusion by the larvae in schistomiasis leads to:
portal hypertension
splenomegaly
varices
ascites
What is the sonographic appearance of schistosomiasis?
distended, echogenic debris-filled intrahepatic portal veins
What is the most common organism causing infections in AIDS and other immunocompromised patients?
Pneumocystis carinii
How does pneumocystis carinii look sonographically?
nonshadowing echogenic foci
Describe the sonographic appearance of focal fatty infiltration
regions of increased echogenicity present within a background of normal liver parenchyma.
Where is fatty infiltration in the liver most commonly seen?
porta hepatis
Describe the sonographic appearance of focal fatty sparing
islands of normal liver parenchyma, which appear as hypoechoic masses within a dense fatty infiltrated liver.
Where is focal fatty sparing most commonly seen?
adjacent to the gallbladder
results in large quantities or glycogen being deposited in the hepatocytes of the liver and convulated tubules of the kidney
glycogen storage disease
Glycogen storage disease results in large quantities of glycogen being deposited in the _____ of the liver and ______
hepatocytes
convulated tubules of the kidney
What liver mass is associated with glycogen storage disease?
Hepatic adenomas
_____ are associated with glycogen storage disease
hepatic adenomas
Hepatic adenomas are associated with
glycogen storage disease
_____ are linked to the usage of oral contraceptive agents.
hepatic adenomas
Hepatic adenomas are linked to the usage of ______
oral contraceptive agents
Due to the increased incidence of tumor hemorrhage and risk of malignant transformation, surgical resection is recommended for:
hepatic adenomas
Due to the increased incidence of _____ and risk of ______, surgical resection is recommended for hepatic adenomas.
tumor hemorrhage
malignant transformation
What is the sonographic appearance of a hepatic adenoma?
nonspecific. Often difficult to distinguish from focal nodular hyperplasia.
Hepatic adenomas are often difficult to distinguish from ______
focal nodular hyperplasia
What are three major pathologic mechanisms of cirrhosis?
Hepatocellular death
fibrosis
regeneration
What is the classic clinical presentation of a patient with cirrhosis?
hepatomegaly
jaundice
ascites
What are the clinical signs of portal hypertension>
ascites
splenomegaly
varices
______ has been associated with hepatocellular carcinoma, metastatic liver disease, pancreatic carcinoma, and pancreatitis to name a few.
Portal vein thrombosis
Portal vein thrombosis has been associated with ____, _____, _____, and _____ to name a few.
hepatocellular carcinoma
metastatic liver disease
pancreatic carcinoma
pancreatitis
What are the sonographic signs of portal vein thrombosis?
intraluminal thrombus
increased vein diameter
cavernous transformations
______ is characterized by occlusion of the hepatic veins.
Budd-Chiari syndrome
characterized by occlusion of the hepatic veins
Budd-Chiari syndrome
Budd-Chiari is characterized by occlusion of the _____
hepatic veins
What are the sonographic findings associated with Budd-Chiari syndrome?
hepatic vein thrombosis
ascites
hepatomegaly- acute phase
caudate lobe enlargement- chronic phase
portal hypertension
most common benign tumors of the liver
cavernouse hemangiomas
_____ may enlarge during pregnancy or with estrogen replacement therapy.
cavernous hemangiomas
Cavernous hemangiomas may enlarge during ____ or with ______
pregnancy
estrogen replacement therapy
What is the typical sonographic appearance of a cavernous hemangioma?
small, well-defined hyperechoic mass with possible posterior acoustic enhancement
What is the sonographic appearance of a focal nodular hyperplasia?
solitary mass, usually less than 5 cm in diameter, that may have a central fibrous scar.
Stealth lesion
focal nodular hyperplasia
solitary mass, usually less than 5 cm in diameter, that may have a central fibrous scar
focal nodular hyperplasia
Name four well-defined hyperechoic liver masses
hemangiomas
hepatic lipomas
echogenic metastasis
focal fatty infiltration
Name the most common primary malignant tumor of the liver
hepatocellular carcinoma
Etiologic factors for hepatocellular carcinoma
alcoholic cirrhosis
chronic hepatitis B and C infections
With hepatocellular carcinoma there is a propensity toward
portal vein invasion
Sonographic appearance of hepatocellular carcinoma
variable; typically seen as a hypoechoic mass
In patients with ____, surgically placed portosystemic shunts decompress the portal system.
portal hypertension
In patients with portal hypertension, surgically placed _______ decompress the portal system.
portosystemic shunts
Name five portosystemic shunts
portocaval shunt
proximal splenorenal shunt
Distal splenorenal (Warren shunt)
mesocaval shunt
transjugular intrahepatic portosystemic shunt
The distal splenorenal shunt is also known as the
Warren Shunt
Shunt patency is confirmed sonographically by:
demonstrating the flow within the shunt itself
the presence of hepatofugal portal vein flow
The ____ shunt and the _____ shunt will have hepatopedal portal vein flow.
Warren or distal splenorenal
transjugular intrahepatic portosystemic shunt
The Warren shunt and transjugular intrahepatic portosystemic shunt will have ______ flow.
hepatopedal
The _____, _____, and ______ shunt will have hepatofugal flow.
portocaval shunt
proximal splenorenal shunt
mesocaval shunt
The portocaval shunt, proximal splenorenal shunt, and the mesocaval shunt will have ____ portal vein flow.
hepatofugal
With a properly functioning transjugular intraphepatic portosystemic shunt, what is the flow direction of the right and left portal branches?
hepatofugal
What are the two types of gallbladder folding?
junctional fold
phrygian cap
folding of the gallbladder neck
junctional fold
What is a junctional fold in the gallbladder?
folding of the gallbladder neck
folding of the gallbladder fundus
phrygian cap
What is a phrygian cap?
folding of the gallbladder fundus
What are the two terms that describe a stone filled contracted gallbladder
wall-echo-shadow (WES sign)
double arc shadow sign
What is the purpose of administering a fatty meal to a patient?
helpful in assessing biliary obstruction.
An obstructed bile duct should ______ in size following administration of a fatty meal
increase
A non obstructed bile duct should _____ in size after administration of a fatty meal.
decrease
What does a significant elevation of conjugated bilirubin levels indicate?
obstructive jaundice
intrahepatic cholestasis
biliary tree obstruction
Gallbladder wall thickening is diagnosed when the wall is greater than ___
3 mm
What are the causes for a gallbladder wall thickening?
cholecystitis (inflammation)
ascites
hypoalbuminemia
hepatitis
congestive heart failure
renal disease
AIDS
sepsis
Name the sonographic criteria for gallstones
mobile, echogenic structure with posterior acoustic shadowing
Describe the composition of gallstones
cholesterol
calcium bilirubinate
calcium carbonate
Gallstones are composed of ______, ______, _______
cholesteral
calcium bilirubinate
calcium carbonate
______ are composed of cholesterol, calcium bilirubinate, calcium carbonate
Gallstones
Describe acute cholecystitis
usually precipitated by a stone obstructing the cystic duct. This situation results in an obstruction of venous drainage, and inflammation of the gallbladder wall with variable degrees of necrosis and infection
Acute cholecystitis is usually precipitated by a stone obstructing the _____
cystic duct
Acute cholecystitis results in an obstruction of ______, and _______ with variable degrees of necrosis and infection
venous drainage
inflammation of the gallbladder wall
What symptoms accompany acute cholecystitis?
right upper quadrant tenderness, guarding, fever, chills, and leukocytosis
Name the five sonographic criteria that define acute cholecystitis
gallstones
sonographic murphys sign
diffuse wall thickening
gallbladder dilatation
sludge
What is emphysematous cholecystitis?
an infection associated with gas-forming bacteria within the wall of the gallbladder
an infection associated with gas-forming bacteria within the wall of the gallbladder
emphysematous cholecystitis
Describe the sonographic appearance of emphysematous cholecystitis
gas shadowing from the wall of the gallbladder
Hydrops of the gallbladder
distended, non inflamed gallbladder due to total obstruction of the cystic duct
distended, non inflamed gallbladder due to total obstruction of the cystic duct
hydrops of the gallbladder
Hydrops of the gallbladder is defined as a distended, non inflamed gallbladder due to total obstruction of the _____
cystic duct
The traped bile is resorbed and the gallbladder is filled with a clear mucinous secretion derived from the mucosa
hydrops of the gallbladder
What are Rokitansky- Aschoff sinuses (RAS)?
diverticula within the wall of the gallbladder
diverticula within the wall of the gallbladder
Rokitansky-Aschoff sinuses (RAS)
What is the pathology associated with Rokitansky- Aschoff sinuses?
adenomyomatosis
Adenomyomatosis is pathology associated with:
Rokitansky- Aschoff sinuses
Sludge and stones accumulate within the sinuses, and present as focal wall thickening. Echogenic foci are visible within the thickened wall. This accumulation causes a characteristic comet tail reverberation artifact
Rokitanksy- Aschoff sinuses
What is the sonographic presentation of gallbladder carcinoma
intraluminal mass, asymmetric wall thickening, or a mass-filled gallbladder
What three other findings should be investigated to confirm the diagnosis of gallbladder carcinoma?
liver metastases
lymphadenopathy
bile duct dilatation
What are the two most common causes of biliary tract obstruction?
gallstones (choledocholithiasis)
carcinoma of the pancreas
What lab values are most likely to be elevated due to biliary tract obstruction?
alkaline phosphatase
conjugated (direct) bilirubin
gamma glutymi transpeptidase
What are the two signs that indicate intrahepatic bile duct dilatation?
shotgun sign
parallel channel sign
What are the shotgun sign and the parallel channel sign associated with?
intrahepatic bile duct dilatation
What is Mirizzi’s syndrome?
extrahepatic bile duct obstruction due to a stone within the cystic duct
Extrahepatic bile duct obstruction due to a stone within the cystic duct
Mirizzi’s syndrome
Mirrizi’s syndrome is an extrahepatic bile duct obstruction due to a stone within the _____
cystic duct
In Mirizzi’s syndrome, the stone causes extrinsic mechanical compression of the ______
common hepatic duct
Describe sonographic findings associated with Mirizzi’s syndrome
intrahepatic bile duct dilatation
normal sized CBD
large stone in the cystic duct of the gallbladder
Name three extrahepatic biliary ducts
common hepatic duct
cystic duct
common bile duct
What pathology causes intrahepatic biliary dilatation without extrahepatic biliary dilatation?
Klatskin tumor
