Liver Flashcards
What does it mean if the liver disease is hepatocellular
The liver cells are the cause of the problem
What is unconjugated bilirubin? Is it soluble?
RBC breakdown -> heme -> unconjugated, insoluble bilirubin
What is conjugated bilirubin? Is it soluble?
bilirubin after the liver removes albumin. It is soluble.
What is Alpha-Fetoprotein? What does it mean if a non-pregnant patient has high levels?
Alpha Fetoprotein is for fetal development only. If seen in non-pregnant patient it might indicate liver carcinoma
Is Riedel’s Lobe more common in men or women?
Women
Variations of the portal vein are rare. Are variations of the hepatic veins common? What is the most common?
They are common. The most common is when the accessory vein
drains the superoanterior segment.
What is hemochromatosis and what diseases might it lead to?
Rare disease characterized
by excess iron deposits throughout the body that may lead to cirrhosis and portal HTN.
How does hemochromatosis appear sonographically?
Hepatomegaly, increased echogenicity
What is Glycogen Storage Disease? What kind is most common?
Inherited disease characterized by abnormal storage and accumulation of glycogen. Most common is type I or Von Gierke disease.
How does Glycogen Storage Disease appear sonographically?
Hepatosplenomegaly, increased echogenicity, increased attenuation, solid liver masses.
What is Portal Hypertension and what is a cause?
Increased pressure in the portal venous system. Portal vein enlargement
What are the four types of Portal Hypertension?
Extrahepatic presinusoidal (prehepatic), intrahepatic presinusoidal, intrahepatic, Intrahepatic postsinusoidal (posthepatic)
What is the most common cause of Intrahepatic Portal Hypertension?
Cirrhosis
Collateral/varicose veins help relieve pressure. Where are these veins most frequently located? What happens if they rupture?
They most frequently occur in the esophagus, stomach, and rectum. Rupture causes severe bleeding that may result in death
When would collateral circulation occur? What are the most common (80-90%) pathways?
It occurs when the normal
venous channels become obstructed. Most common pathways are through
the coronary and esophageal veins.
What are some physical signs of collateral circulations?
Dilated veins on anterior
abdominal wall, tortuous
collaterals (medusa) around umbilicus, ascites, hemorrhoids
How does Portal Hypertension appear sonographically?
dilation (>13mm) of MPV, splenomegaly, ascites, collaterals, venous thrombosis
How do hepatic waveforms normally appear?
“wavy” or triphasic due to proximity to the heart
What is a Shunt and what is it used for?
A shunt is a new connection between two vessels. They are used to decompress pressure by shunting blood into other vessels.
The three types of shunts are Portacaval, Mesocaval, and Splenorenal. What does each shunt connect?
Portacaval: attaches Splenic/ SMV confluence to the anterior IVC. Mesocaval: attaches distal SMV to IVC Splenorenal: attaches Splenic to L renal vein
A Transjugular Intrahepatic
Portosystemic Shunt (TIPS) is placed between which two structures?
A portal and hepatic vein. Usually the Right PV and Right HV.
What are causes and symptoms of Portal Vein Thrombosis?
Liver metastasis, sepsis, and cirrhosis are some causes. Symptoms include lack of appetite and ab pain
How does portal vein thrombosis appear sonographically?
Hypoechoic echos in the portal lumen, increase in diameter, abnormal or absence of waveforms.
Budd Chiari Syndrome is caused by thrombosis of the hepatic veins or IVC. What are symptoms? What is its prognosis?
abdominal pain, ascites, and hepatosplenomegaly are syptoms. It has a poor prognosis
How might Budd Chiari Syndrome appear sonographically?
enlarged liver, dilated IVC w/ thrombus, hypoechoic echoes in hep veins, wall thickening.
What is the difference between primary and secondary Budd-Chiari Syndrome?
Primary is caused by a congenital obstruction of Hep veins or IVC by membranous webs. The secondary type is characterized as thrombosis in the Hep veins or IVC.
What are some possible causes of a biliary obstruction? What are symptoms?
Gallstones, carcinoma of the bile duct, and metastatic tumor in porta hepatis. The patient might have jaundice, itching, and elevated direct bilirubin
A solitary hepatic cyst is often asymptomatic. In what percent of the population are these most likely to occur?
5% of the population, most commonly after the age of 50. They are more common in women
Peribiliary cysts are located centrally within porta hepatis. Who is more commonly at risk for this pathology?
They are more commonly found in patients with severe liver disease.
Polycystic Liver Disease is a disease that could affect the kidney, pancreas, and spleen in addition to the liver. Who is at risk?
It affects 1/500 people and is more common in women. It is strongly correlated with polycystic renal disease.
Hepatic abscesses occur most often as complications of what? What are symptoms?
biliary tract disease or trauma. The patient likely has fever, increase in WBC, and RUQ pain
When would a fungal abscess of the liver (hepatic candidiasis) occur?
In immunocompromised hosts such as those undergoing chemo, organ transplants, or HIV.
Chronic Granulomatous Disease is a congenital defect in phagocytes that increases susceptibility to severe infections. Who is most commonly affected?
It is most common in children, more frequently in females.
What is an echinococcal cyst?
An infectious cystic disease common in sheep-herding areas of the world. Ova from tapeworms make their way into the human liver.
How does an Echinoccocal Cyst appear sonographically
As a septated cystic mass with a honeycomb appearance. Cysts may contain other cysts or have mobile inner echoes.
What is the enzyme in tissues with high metabolic activity (heart, muscle) that indicates liver disease sometimes.
AST- Aspartate Aminotransferase
The time is takes for blood to clot is called
Prothombin time
What is the enzyme found in high concentrations in the liver and is almost always specific for liver disease
ALT- Alanine Aminotransferase
What is the enzyme produced by the liver, bones, intestines, and placenta that is not specific for liver disease in pregnant women (with placenta) or children (growing bones)
Alkaline Phosphatase
What is the enzyme found in several tissues including kidney, heart, muscle, brain, lungs. It elevates if there is cell death in any of these tissues
LDH- Lactic Acid Dehydrogenase
What is Fatty Liver caused by? How does it appear sonographically?
Casued by obesity and excessive alcohol intake. It has increased echogenicity and decreased attenuation
What does it mean if the liver is focal fatty sparing?
A fatty liver with focal areas of normal liver parenchyma
What does it mean if the liver has focal fatty infiltration?
A normal liver with focal regions of fat infiltration
Hepatitis A B and C cause over 90% of cases of acute hepatitis in the US. What percent of cases are each type?
60% of hepatitis is B, 20% is A, and 20% is another type
What is Hepatitis A
It is found in developing countries and caused by the ingestion of fecal matter.
What is Hepatitis B
Hepatitis B is found in bodily fluids such as saliva and semen and can be spread through transfusions of blood or plasma through needles.
What is Hepatitis C
is diagnosed by the presence in
blood of the antibody to HCV
What are symptoms of acute hepatitis? How does it appear sonographically?
elevation of ALT, AST, total bilirubin, fatigue, anorexia, jaundice.
It appears as the starry night appearance with an enlarged liver
What is the sonographic appearance of a liver with chronic hepatitis?
The liver might become more heterogenous and smaller, fibrosis might be evident, portal veins are less echogenic
Cirrhosis is a degenerative disease of the liver. What are the symptoms?
Patients present with hepatomegaly, jaundice, and ascites. Increase in AST, ALT, LDH, bilirubin.
How does cirrhosis appear sonographically?
Liver will have ascites and a thick GB wall. It will be enlarged with acute and smaller with chronic.
What is the most common organism causing infection in patients with AIDS? How does it appear sonographically?
Pneumocystis Carinii. it appears with tiny echogenic foci (no shadowing) to extensive calcification of the liver.
What is Schistosomiasis? What are the symptoms?
A parasite that travels from the lung to the liver and causes portal hypertension. Symptoms are rash, fever, diarrhea and lymphadenopathy.
What is the most common benign tumor of the liver? Is it more common in men or women?
Cavernous Hemangioma. More common in women
How does cavernous hemangioma appear sonographically? What are the symptoms?
It is asymptomatic. It is homogenous, well-defined and round, hyperechoic, and does not have vascularity.
What are the symptoms of Liver Cell Adenoma? Who does it affect? What other disease is associated?
The symptom is RUQ pain. It is found more commonly in women and is associated with oral birth control and type 1 Von Gierke disease.
What is the second most common benign liver mass? What are the symptoms and who is commonly affected?
Focal Nodular Hyperplasia. It is asymptomatic and most commonly affects women under 40.
How does Focal Nodular Hyperplasia appear sonographically?
isoechoic, might have a central scar, usually in right lobe, has peripheral and central flow.
What is the most common primary malignant neoplasm of the liver? 80% of patients with cirrhosis develop this pathology.
Hepatocellular Carcinoma.
What is hepatoma? Is it more common in men or women?
Hepatoma is hepatocellular carcinoma. It is more common in men.
What are the symptoms of hepatocellular carcinoma? How does it appear sonographically?
Hx of cirrhosis or Hep B/C, increased ALT, AST, AlkPhos, Alpha Fetoprotein. Might be focal or diffuse. Might have halo
What is the most common form of neoplastic involvement of the liver?
Metastatic disease. Primary sites are most commonly the colon, breast, and lung
What is a common appearance of metastatic disease? How might we confirm the diagnosis?
May have a “target” appearance. Multiple appearances would be confirmed with Bx
What are the symptoms of lymphoma?
Hepatomegaly, focal mass
The liver is the third most commonly injured abdominal organ after the spleen and kidney. Which lobe is more commonly affected.
The right lobe is more frequently affected.
What enzyme increases in both hepatocellular and obstructive disease and is more sensitive than ALP in diagnosing obstructive disease.
GGTP- Gamma Glutamyl Transpeptidase
What is indicated when both GGTP and ALK PHOS levels increase
Hepatobiliary disease
What does CEA stand for and what does it indicate?
Carcinoembryonic Antigen. It indicates carcinoma
What is the most common symptomatic vascular tumor in infancy
Hemangioendothelioma
Hodgkin and Non Hodgkin lymphoma are differentiated by lymph node biopsy. What is the difference? Which is more common?
Non Hodgkin is more common. Hodgkin is marked by the presence of Reed Sternberg cells.
