Lesson 1B (Part 2) Flashcards
What are the 3 characterizations of steatosis?
- Mild
- Moderate
- Severe
Mild steatosis
Minimal diffuse increase in hepatic echogenicity
Moderate steatosis (2)
- Moderate diffuse increase in hepatic echogenicity
2. Slightly impaired visualization of intrahepatic vessels and diaphragm
Severe steatosis (4)
- Marked increase in echogenicity
- Poor penetration of posterior liver
- Poor or no visualization of hepatic vessels and diaphragm
- Hepatomegaly often present
What are some sonographic appearances of fatty liver? (3)
- Focal Fatty Infilitration
- Fatty Sparing
- Focal Fat
Focal fallt infiltration
Regions of increased echogenicity are present within a background of normal liver
- can mimic a MASS
Fatty sparing
Islands of normal liver parenchyma appear as hypoechoic masses within a dense fatty infiltrated liver “no mass effect”
- most of the liver is fat with little bits of normal liver
What are the sonographic features of steatosis? (4)
- Rapid change in time in both appearance and resolution
- 6 days - NO Mass Effect
- No liver contour abnormality
- Focal fat may appear rounded, nodular, or interspersed with normal tissue
What is the preferred site for focal fat in steatosis?
Anterior to the portal vein at the porta hepatis
Where is the preferred site for focal fatty sparing or infiltration?
Anterior to the portal vein at the porta hepatis, gallbladder fossa, and liver margins
When does glycogen storage disease occur?
During neonatal period
- large amounts of glycogen are deposited in the liver and kidneys
How do glycogen storage diseases appear?
Indistinguishable from diffuse fatty infiltration
- need to remember different age group
Cirrhosis
Diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules
- coarse texture
What are 3 major pathological mechanisms that combine to create cirrhosis?
- Cell death
- Fibrosis
- Regeneration
What is the most common cause of micronodular form?
Alcohol consumption
What is the most frequent cause of macronodular?
Chronic viral hepatitis
Is cirrhosis usually acute or chronic?
Chronic
What is the most common cause of portal hypertension?
Cirrhosis
What are 3 clinical presentations of cirrhosis?
- Hepatomegaly
- Jaundice
- Ascites
What are 4 other causes of cirrhosis?
- Biliary cirrhosis
- Wilsons disease
- Primary sclerosing cholangitis
- Hemochromatosis
What is the sonographic appearance of cirrhosis? (5)
- Volume redistribution
- enlarged/irregular contour (early)
- small (advanced) - Coarse echotexture
- Nodular surface
- ascites - Nodules (colour doppler)
- regenerative and dysplastic - Portal hypertension
- ascites, splenomegaly and varices
NASH
Nonalcoholic steatohepatitis
What is nonalcoholic steatohepatitis commonly known as?
Silent liver disease
- resembles alcoholic liver disease, but occurs in people who drink little or no alcohol
What is the major feature of NASH? (3)
- Fat in the liver
- Inflammation
- Damage
What can NASH lead to?
Cirrhosis
What is NASH related to?
Obesity
- can lead to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH
What are signs and symptoms of NASH? (4)
- Fatigue
- Weight loss
- Weakness
- may begin once the disease is advanced or cirrhosis is present - Increased LFTs
What is the treatment for NASH? (2)
- Reduce weight
- eat a balanced diet
- engage in physical activity
- avoid alcohol and unnecessary medications - Liver transplant may be necessary if cirrhosis ensues
What is the sonographic appearance of NASH? (2)
- Dense fatty infiltration
2. Cirrhosis
