Liver Flashcards
What is the liver’s position in relation to the diaphragm?
Inferior to diaphragm
What is the largest and one of the most complex organs in the body?
Liver
What is the main functional unit of the liver?
Microscopic lobules
What are the two main blood supplies to the liver?
- Hepatic artery (oxygenated blood)
- Portal vein (nutrients from intestine)
What cells in the liver remove bacteria and foreign matter?
Kupffer cells
What are hepatocytes?
Majority of liver cells and functions
What is the ratio of the right lobe to the left lobe of the liver?
6:1
Where is the caudate lobe located?
Posterosuperior surface of left lobe
What does the main lobar fissure divide?
Divides liver into right and left
What is the falciform ligament?
Extends between LPV and anterior abdominal wall and umbilicus to diaphragm
What does the ligamentum teres represent?
Intraabdominal part of umbilical vein
What is hepatopetal flow?
Flow toward liver
What is the indicator of the location of the liver hilum?
Contact with IVC
What happens to blood flow in patients with portal vein hypertension?
Reversal of flow - hepatofugal
What do hepatic veins do?
Drain liver toward heart
What is the liver’s role in carbohydrate metabolism?
Converts dietary sugars into glucose and stores it as glycogen
What are the major sites for metabolizing fats in the liver?
Hepatocytes
What is the liver’s detoxification function?
Detoxifies drugs, poisons, and waste products
What is the condition known as hepatocellular disease?
Diffuse disease process affecting liver cells
What does AFP stand for in the context of liver conditions?
Alpha-fetoprotein
What does an elevated AST indicate?
Acute hepatitis, cirrhosis, hepatic necrosis
What is the best method for evaluating liver disease?
Biopsy
What is a normal texture of the liver on ultrasound?
Homogeneous with fine low-level echoes
What is fatty liver also known as?
Steatosis
What are common causes of fatty liver?
- Obesity
- Excessive alcohol intake
- Poorly controlled hyperlipidemia
- Diabetes
What are the three grades of fatty liver?
- Grade 1: Slight diffuse increase of fine echoes
- Grade 2: More echoes & slightly impaired visualization of vessels
- Grade 3: Increased echoes, poor visualization of vessels
What is hepatitis?
Inflammatory and infectious disease of the liver
What viruses are known to cause hepatitis?
- Hepatitis A virus (HAV)
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Hepatitis D virus (HDV)
- Hepatitis E virus (HEV)
What is the most common type of hepatitis in the United States?
Type C
What is the most common type of hepatitis worldwide?
Type B
What are some initial symptoms of acute and chronic hepatitis?
- Flulike symptoms
- Gastrointestinal symptoms
- Loss of appetite
- Nausea
- Vomiting
- Fatigue
What severe complications can arise from viral hepatitis?
- Acute hepatic necrosis
- Chronic hepatitis
- Portal hypertension
- Cirrhosis
- Hepatocellular carcinoma (HCC)
How long does clinical recovery from acute hepatitis typically take without complications?
4 months
What are the pathologic changes seen in acute hepatitis?
- Liver cell injury
- Swelling of hepatocytes
- Hepatocyte degeneration
- Cell necrosis
- Reticuloendothelial and lymphocytic response
- Kupffer cells enlargement
- Regeneration leading to nodularity
What defines chronic hepatitis?
Clinical or biochemical evidence of hepatic inflammation extending beyond 6 months
What are the causes of chronic hepatitis?
- Viral
- Metabolic
- Autoimmune
- Drug-induced
What distinguishes chronic active hepatitis from chronic persistent hepatitis?
Chronic active hepatitis has more extensive changes with inflammation extending across the limiting plate and causing piecemeal necrosis and fibrosis.
What symptoms may patients with chronic hepatitis experience?
- Nausea
- Anorexia
- Weight loss
- Tremors
- Jaundice
- Dark urine
- Fatigue
- Varicosities
What are the sonographic findings associated with chronic hepatitis?
- Coarse liver parenchyma
- Decreased brightness of portal triads
- Decreased liver size
- Fibrosis
- Poor visualization of vessels
- Hyperechoic liver
- Thickened GB wall
- Splenomegaly
What is cirrhosis?
A chronic degenerative disease of the liver characterized by fibrous tissue covering lobes, parenchymal degeneration, and lobular architecture disorganization.
What are the essential features of cirrhosis?
- Parenchymal necrosis
- Regeneration
- Diffuse fibrosis
What are the sonographic appearances of cirrhosis?
- Small, nodular borders
- Increased attenuation
What is micronodular cirrhosis commonly caused by?
Chronic alcohol abuse
What causes macro-nodular cirrhosis?
Chronic viral hepatitis or other infections
What are some other causes of cirrhosis?
- Biliary cirrhosis
- Cholangitis
- Wilson disease
- Primary sclerosing cholangitis
- Hemochromatosis
What is Budd-Chiari syndrome?
A condition caused by thrombosis of the hepatic veins or inferior vena cava, characterized by abdominal pain, massive ascites, and hepatomegaly.
What are the two types of Budd-Chiari syndrome?
- Primary: congenital obstruction
- Secondary: thrombosis in hepatic veins or inferior vena cava
What are the symptoms of Budd-Chiari syndrome?
- Ascites
- Abdominal pain
- Hepatosplenomegaly
- Jaundice
- Vomiting
- Diarrhea
What is glycogen storage disease?
An inherited disease characterized by abnormal storage and accumulation of glycogen in tissues, especially the liver and kidneys.
What is the most common type of glycogen storage disease?
Type I or von Gierke disease
What symptoms are associated with von Gierke disease?
- Hypoglycemia
- Abdominal distension
- Fatigue
- Hepatomegaly
- Increased echogenicity
- Possible liver adenomas
What are the symptoms of biliary obstruction proximal to the cystic duct?
- Jaundice
- Elevated bilirubin and alkaline phosphatase
What causes biliary obstruction distal to the cystic duct?
- Stones
- Extrahepatic mass
- Stricture
What is hemochromatosis?
An abnormal iron storage condition
What is Wilson’s disease?
An abnormal copper storage condition
What are common findings in focal hepatic disease?
- Cysts
- Abscesses
- Hematomas
- Primary tumors
- Metastases
What is polycystic liver disease?
An inherited condition affecting 1 in 500 individuals, often associated with polycystic renal disease.
What is a pyogenic abscess?
An abscess formed by pus, often due to bacterial infection.
What is the most frequent bacteria causing pyogenic abscess?
E. coli
What is hepatic candidiasis?
A fungal infection in immunocompromised patients characterized by multiple small hypoechoic masses.
What are the symptoms of amoebic abscess?
- Abdominal pain
- Diarrhea
- Leukocytosis
- Low fever
What is the treatment for amoebic abscess?
Medication and aspiration of liver cysts
What is the most widespread infectious disease in the world?
Malaria
What are the cyclical clinical symptoms of malaria?
- Fever
- Chills
What is hepatic echinococcosis?
An infectious cystic disease common in sheep-herding and cattle areas of the world.
What is the echinococcus?
A tapeworm that infects humans as the intermediate host.
Where does the echinococcus reside?
In the small intestine of dogs.
How are echinococcus ova spread into the environment?
They are shed through canine feces.
How do intermediate hosts become infected with echinococcus?
They ingest the eggs from the environment.
What happens after echinococcus larvae enter the human body?
They burrow through the mucosa, enter the portal circulation, and travel to the liver.
How is the severity of hepatic echinococcosis classified?
According to the complexity of cysts found at ultrasound.
What is the treatment for Echinococcal Cyst?
Aspiration and injection of sclerosing agent. If lungs involved, resection of the involved areas followed by medical therapy.
If cysts rupture and hydatid fluid enters circulatory system, patient can go into anaphylactic shock.
What is the Water-Lily Sign?
It refers to a larger cyst (pericyst) containing one or more daughter cysts (endocysts) and internal echoes (hydatid sand) in Echinococcal disease.
How does Schistosomiasis enter the body?
Parasitic worm enters bloodstream, then GI tract, leading to the liver through the portal vein.
Caused by wading or bathing in contaminated water; spread by snails; enters through skin cuts and nicks.
Where is Schistosomiasis endemic?
Asia, Africa, South America, and the Caribbean; it is the second most prevalent disease after malaria.
What are the sonographic findings of Schistosomiasis?
Progressive periportal fibrosis due to granulomatous reaction, distended echogenic debris-filled intrahepatic portal veins, splenomegaly, ascites, and portal hypertension.
What is the most significant vascular event in Schistosomiasis?
Intrahepatic portal vein occlusion by larvae, leading to portal hypertension, splenomegaly, varices, and ascites.
What are the treatment options for Schistosomiasis?
Medical treatment and follow-up for portal hypertension and fibrosis.
What are some complications of Schistosomiasis?
Urinary tract issues and potential effects on testes, including enlargement, hypervascularity, hydroceles, and scrotal edema.
What is endomyocardial fibrosis?
A condition that occurs where Schistosomiasis is endemic, resulting in restrictive cardiomyopathy and can cause death.
What is the most common parasitic infection in humans?
Schistosomiasis.
What is the most common organism causing infection in AIDS patients?
Pneumocystis carinii.
What are other AIDS-related disorders?
Fatty liver infiltration, hepatomegaly, hepatitis, non-Hodgkin’s lymphoma, candidiasis, cholangitis, cholecystitis, and Kaposi’s sarcoma.
What is Pneumocystis pneumonia?
A common life-threatening infection in patients with human immunodeficiency virus, affecting those undergoing bone marrow and organ transplantation or receiving chemotherapy.
What are the sonographic findings of Pneumocystis carinii in the liver?
The pattern ranges from diffuse, tiny, nonshadowing echogenic foci to extensive replacement of the liver parenchyma by various echogenic clumps of calcification.
What is the ‘Starry Sky’ sign?
It is due to microabscesses associated with Pneumocystis carinii in the liver.
What is the most common benign tumor of the liver?
Cavernous hemangioma.
What are the characteristics of cavernous hemangioma?
More often found in women, echogenic with enhancement, can have a non-specific appearance, and is usually an incidentaloma/asymptomatic.
What is liver cell adenoma?
A benign liver tumor more common in women on birth control pills, usually solitary, marginated, and encapsulated but variable in appearance.
What is hepatic cystadenoma?
A rare benign tumor found in middle-aged women that is palpable.
What is focal nodular hyperplasia?
The second most common benign liver mass, typically asymptomatic, well-defined, and usually < 5 cm.
What are the five hyperechoic well-defined liver masses?
- Hemangioma 2. Focal nodular hyperplasia 3. Focal fatty infiltration 4. Echogenic metastatic lesions 5. Lipoma (prop speed artifact)
What are primary tumors of the liver?
Primary tumors of the liver are rare.
What is the most common primary malignancy of the liver?
The most common primary malignancy is hepatocellular carcinoma (HCC) in cirrhotic livers.
What factors can contribute to the development of HCC?
Carcinogenic chemicals, chronic liver disease, and some autoimmune diseases.
What are common symptoms of liver malignancies?
Nausea and vomiting, fatigue, weight loss, and enlarged liver.
In which gender does liver malignancy occur more frequently?
Liver malignancy occurs more frequently in men.
What are the causes of hepatocellular carcinoma?
Cirrhosis and chronic hepatitis B/C (transmitted via needles or sexual contact).
What percentage of HCC patients have preexisting cirrhosis?
80% of HCC patients have preexisting cirrhosis.
What are the presentation patterns of HCC?
- Solitary massive tumor 2. Multiple nodules throughout the liver 3. Diffuse infiltrative masses in the liver.
What is the significance of AFP in HCC?
70% of HCC patients have increased AFP levels.
What is the most common form of neoplastic involvement of the liver?
Metastatic disease is the most common form.
What are the primary sources of metastatic liver disease?
Colon (54%), breast, and lung cancers.
What are common symptoms of metastatic liver disease?
Abnormal LFTs, weight loss, decreased appetite, jaundice, and hepatomegaly.
What is the correlation between echogenic mets and colon cancer?
There is a high correlation of echogenic metastases and colon cancer.
What are common causes of liver metastases in children?
Neuroblastoma, Wilm’s tumor (nephroblastoma), and leukemia.
What is hepatoblastoma?
A rare primary liver cancer in children associated with increased AFP.
What is the most common indication for liver transplantation in adults?
Hepatitis C, followed by alcoholic liver disease and cryptogenic cirrhosis.
What is the most serious complication of liver transplantation?
Hepatic artery thrombosis.
What is portal hypertension?
An increase in pressure in the porta-splenic venous system.
What are common causes of portal hypertension?
- Prehepatic: Portal vein thrombosis 2. Intrahepatic: Cirrhosis, schistosomiasis 3. Posthepatic: Budd-Chiari syndrome, congestive heart failure.
What are the sonographic findings in portal hypertension?
Hepatofugal flow, enlarged hepatic artery, collaterals, dilated coronary vein, varices, ascites, and splenomegaly.
What is a portacaval shunt?
The most common native shunt that connects the main portal vein to the inferior vena cava.
What is TIPS?
Transjugular intrahepatic portosystemic shunt, created to reduce portal hypertension.
What does portal venous gas indicate?
It indicates bowel infarction, as seen in ulcerative colitis or necrotizing enterocolitis.
