Lesson 1.2 - Infectious Disease & Metabolic Disorders Flashcards
Viral hepatitis may lead to (3)
Portal hypertension
Cirrhosis
HCC
Symptoms (7) and sign (1) of viral hepatitis
Symp: Fatigue Headache Anorexia Fever Abdo pain Nausea Vomiting
Sign:
Jaundice
Recovery time implied for acute hepatitis
4 months
Acute hepatitis sono appearance
Liver parenchyma hypoechoic
Bright periportal walls
Starry night sign is characterized by
acute hepatitis
Chromic hepatitis is characterized by biochemical abnormalities that persist beyond __ months
6 months
Chronic hepatitis sono appearance
Hepatomegaly
Thickening of GB wall
T/F
Liver can appear normal in some cases of chronic hepatitis
true
Disorders of metabolism (4)
- Steatosis “Fatty liver”
- Glycogen storage disease-neonatal
- Cirrhosis
- NASH (non-alcoholic steatohepatitis)
T/F fatty liver is reversible
True
Causes of fatty liver/steatosis
Severe hepatitis* Hyperlipidemia* Excessive alcohol* Hyperalimentation Excess corticosteroids Diabetes Obesity bypass surgery Toxins Pregnancy Cystic fibrosis
T/F steatosis may lead to HCC in some pts
true
Mild steatosis characterized by
minimal diffuse increase in echogenecity
Moderate steatosis characterized by
moderate diffuse increase in echogenecity
slightly impaired visualization of intrahepatic vessels and diaphragm
Severe steatosis characterized by (4)
Marked increase in echogenicity
Poor penetration posterior liver
Poor/no visual hepatic vessels/diaphragm
Hepatomegaly
What is focal infiltration
Appearance of steatosis- regions of increased echogenicity within a background of normal liver - can mimic a mass
What is fatty sparing
Appearance of steatosis- Islands of normal liver parenchyma appear as hypoechoic masses within a dense fatty infiltrated liver - “no mass effect”
Focal fat characterized by
hyperechoic
No mass effect
May appear rounded, nodular or interspersed with normal tissue
Sono features of steatosis
Rapid change in time in both appearance and resolution (6 days)
No Mass Effect
No liver contour abnormality
What is the preferred site for focal fat
anterior to PV at porta hepatis
What is the preferred site for focal fatty sparing or infiltration
anterior to PV at porta hepatis, GB fossa and liver margins
When does glycogen storage disease occur?
In neonatal period where large amts of glycogen are deposited in liver and kidneys
Do patients with glycogen storage disease live?
They survive to childhood or young adulthood with enzyme therapy
What is glycogen storage disease indistinguishable from?
Its indistinguishable from diffuse fatty infiltration
Cirrhosis sono appearance
Fibrosis
Nodular
Coarse hard texture
Increased echogenicity
What three major pathological mechanisms combine to create cirrhosis
cell death
fibrosis
regeneration
What is the most common cause of micronodular form cirrhosis. Whats the measurement?
alcohol consumption
<1 cm
What is the most frequent cause of macronodular form cirrhosis. Whats the measurement?
chronic viral hepatitis
1-5 cm
What is cirrhosis indistinguisable from?
Indistinguishable from end-stage liver disease
Clinical presentation of cirrhosis (3)
Hepatomegaly
Jaundice
Ascites
Causes of cirrhosis (4)
biliary cirrhosis
wilsons disease
primary sclerosing cholangitis
hemochromatosis
What is the most common cause of portal hypertension?
Cirrhosis
Other causes of portal hypertension
Ascites
Splenomegaly
Varices
Early vs advanced stage of cirrhosis and liver size
early - liver may be enlarged
advanced - liver is small-shrinking, ascites
Dysplastic nodule sono pattern
Adenomatous hyperplastic nodules
Larger than 10 mm (premalignant)
What may be indicated if dysplastic nodules found
biopsy to rule out HCC
What is NASH
Nonalcoholic steatohepatitis
What does NASH resemble
alcoholic liver disease but occurs in those who drink little/no alcohol
Major feature in NASH
fat in the liver
inflammation
damage
T/F
NASH can lead to cirrhosis
True
Signs and symptoms of NASH (3)
fatigue
weight loss
weakness
T/F NASH causes decreased LFTs
False. NASH causes increased LFTs
NASH sono appearance
Dense fatty infiltration Cirrhosis
Acute liver failure
Rapid development of hepatocellular dysfunction
Coagulopathy
Encephalopathy
in pt without known prior liver disease
T/F
chronic liver failure usually occurs in the context of cirrhosis
true
Causes of chronic liver failure (4)
Excessive alcohol
Hep B or C
Non-alcoholic fatty liver disease
T/F
Portal hypertension causes ascites
FALSE
Ascites usually occurs secondary to liver cell failure
Death occurs if loss of hepatic parenchyma by necrosis is >___%
> 40%
“Hepatic coma”
hepatic encephalopathy
