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GI > Liver > Flashcards

Liver Flashcards

1
Q

what is portal venous timing for the liver?

A

70 sec

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2
Q

How does in an out of phase imaging work?

A

The water and fat are summed in the in phase images and subtracted in the out of phase images.

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3
Q

Why does iron load cause loss of signal on the in phase images?

A

Because iron causes longer TE which allows a longer dephasing time, exaggerated T2* effect and loss of signal

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4
Q

Where does focal fat occur? Three places…

A

Gallbladder fossa Subcapsular (along falciform) Periportal (bonus throughout the liver)

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5
Q

What does amyloid look like in the liver?

A

Can cause abnormal extracellular deposition causing focal or diffuse areas of decreased attenuation.

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6
Q

What does Wilsons disease do to the liver? What are three other common features?

A

Wilson disease causes high level of Copper to accumulate in the liver which can be hyperattenuating on Ct with multiple nodules, leading to hepatomegaly and cirrhosis. Also accumulates in the basal ganglia and cornea. AR gene defect.

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7
Q

Diagnosis?

A

Echinoccal disease

Hepatic echinococcosis is caused by ingestion of the eggs of echinoccus granulosus (edemic in Mediteranean basin) with sheep herding

Echinoccal eggs develop into hydatid cysts which on CT loo like a well-defined hypoattenuating mass with a floating membrane or daughter cyst. Peripheral calcifications are possible

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8
Q

Iorn overloaded liver has what signal on all MRI signals? What is the internal control?

A

Hypointense on all signals. Paraspinal muscles are the control.

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9
Q

DDx of hypoattenuating liver lesion?

A

Hepatic steatosis (Most common)

Hepatic amyloid (less likely and can be focal or diffuse)

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10
Q

Definition and DDx of hyperattenuating liver lesions?

A

Definition: HU >75

DDX: Iorn overload (most common)

Medications (amoidarone, gold, methotrexate)

Copper overload (Wilson disease)

Gylcogen excess

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11
Q

Dx?

A

Candidasis

Systemic fungal infection that may seed the liver and the spleen

CT shows multiple tiny hypoattenuating microabscesses in the liver and the spleen which can be rim-enhancing

DDX for hypoattenuating liver lesions: metastatic disease, lymphoma, biliary hamartomas or Caroli disease

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12
Q

Early signs of cirrhosis (3)

A

Expansion of perportal space

Atrophy of the medial segment of the left hepatic lobe causes increaed fat anterior to the right main portal vien

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13
Q

Features of HCC on T2?

A

Classically T2 hyperintense to surrounding liver

Renerative nodules are usually T2 dark

“Nodule within a nodule” is concerning and describes a central bright T2 nodule with a T2 dark border

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14
Q

Hypervascular hepatic mets? (name 5)

A
  1. Neuroendocrine (including pancreatic neuroendocrine and carcinoid)
  2. RCC
  3. Thyroid carcinoma
  4. Melanoma
  5. Sarcoma
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15
Q

Hypovascular hepatic mets?

A

Colorectal cancer and pancreatic adenocarcinoma

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16
Q

Calcified hepatic mets?

A

Colorectal tumors

Ovarian serous tumors

(usually means a better prognosis)

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17
Q

Dx?

A

Pseudocirrhosis

Macronodular liver contour from multiple scirrhous hepatic metastases (mimic cirrhosis)

MCC is treated breast cancer

Capsular retraction is charactersitic when present

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18
Q

Metastatic hepatic lesion appearance on MRI?

A

Hypointense on T1 and hyperintense on T2

(except blood products or melanin (melanoma) are T1 hyperintense)

19
Q

Dx?

A

FNH

Arterial enhancement with quick wasout

Scar is T2 hyperintense. Delayed enhancement of the scar is not shown here

20
Q

Dx?

A

Hemangioma

Note the two areas of nonehnacement on the delayed images consistent with cystic degeneration

21
Q

Causes of Budd Chiari?

A

Caused by venous outflow obstruction which can be thrombotic or non-thrombotic (often a hypercoagulable state such as OCPs, pregnancy, hematologic disorder, malignancy, infection or trauma)

22
Q

Dx?

A

Budd-Chiari

Massive enlargement of the caudate lobe with atrophy of the left lobe and right anterior segments of the liver

Collateral venous drainage is visualized within the periphery

23
Q

Acute Budd Chiari presentation Triad:

A

Hepatomegaly

Ascites

Abdominal Pain

24
Q

What is the MDCT hepatic trauma staging by AAST?

A
25
Q

What portal vein has a longer intra-hepatic course and why does this matter?

A
  • •The right portal vein is longer than the left and is more susceptible to fibrosis.
  • •This is why the right liver shrinks and the left liver grows in cirrhosis.
  • This is also why hepatic abscesses which ascend from hematogenous spread nearly always involve the right hepatic lobe
26
Q

What is the most common vascular variant for the liver?

A

Replaced right hepatic (from the SMA)

27
Q

Most common biliary variant?

A

Right posterior segmental into the left hepatic duct.

28
Q

What is the brightest T1 structure in the abdomen?

Brightest T2 structure?

A

T1 bright- pancreas

T2 bright- spleen

29
Q

What is the definition of portal venous hypertension?

A
  1. Portal venous pressure exceedes hepatic venous pressure by 6-8 mmHg.
  2. Varices are usually >12
30
Q

What are causes of THAD?

A
  1. Cirrhosis
  2. Clot
  3. Mass
  4. Ascess/Infection
31
Q

What side is worse with protal hypertensive colopthy?

A
  • Right colon secondary to lack of collaterals
  • Note this process resolves after transplant
  • Also note the same process can affect the stomach “portal hypertensive gastropathy” causing a thickened gastric wall on CT, as well as upper GI bleeding in the absence of varices.
32
Q

What are common calcified hepatic metastases (3)?

A

Commonly from a mucinous neoplasm

  1. Colon
  2. Ovary
  3. Pancreas
33
Q

What is the diagnosis of portal hypertension?

When does variceal bleeding occur?

A

When the portal venous pressure exceeds the hepatic venous pressure by 6-8 mmHg

Variceal bleeding at >12

34
Q

What percentage of blood supply to the liver is portal and arterial?

A

70% portal and 30% hepatic artery

35
Q

What are common hyperechoic metastases to the liver on ultrasound (6)?

A

Often hypervascular

  1. Renal
  2. Melanoma
  3. Carcinoid
  4. Choriocarcinoma
  5. Thyroid
  6. Islet Cell
36
Q

What are common hypoechoic metastases to the liver on ultrasound (3)?

A

Often hypovascular

  1. Colon
  2. Lung
  3. Pancreas
37
Q

Who gets a Nutmeg Liver? (4)

A
  1. Budd Chiari
  2. Hepatic Veno-occlusive disease
  3. Right heart failure (hepatic congestion)
  4. Constrictive Pericarditis
38
Q

Who gets massive caudate lobe hypertrophy? (3)

A
  1. Budd Chiari
  2. Primary Sclerosing Cholangitis
  3. Primary Biliary Cirrhosis
39
Q

What is Cryptogenic Cirrhosis and what is the most common cause?

A

Cryptogenic cirrhosis: Cirrhosis of unknown cause

MCC: probably nonalcoholic fatty liver disease

40
Q

What is the most common lobe for adult transplants? Pediatric transplants?

What are the four connections?

A

Adult: Right lobe (Segments 5-8)

Peds: Left lobe (segments 2-3)

Connections

  1. IVC
  2. artery
  3. portal vein
  4. CBD
41
Q

Most common cause of jaundice?

A

MC: A benign stricture (from surgery or biliary intervention)

Most people think about a common duct stone

42
Q

What percentage of gallstones are cholesterol stones? pigmented stones?

A

Cholesterol 75%

Pigmented 25%

43
Q

What is associated with polysplenia syndrome?

A

Form of heterotaxia in addition to multiple descrete foci of splenic tissue- always on the same side as the stomach

  1. Severe cardiac anomalies (most die in childhood but if mild cardiac defects will make it to adulthood)
  2. Venous anomalies (interruption of the IVC or hemiaxygous continuation)
  3. Preduodenal portal vein

GI (2 decks)

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