Liver/Biliary Flashcards
What would differences between hypervascular and hypovascular lesions of the liver appear on CTA?
Associations between dual-phase CT features and histopathologic diagnoses in 52 dogs with hepatic or splenic masses VRU pre-published 2016
Hypervascular: derive blodo supply from ehaptic artery - early contrast enhancement
Hypovascular lesions - reduced enhancement to surrounding liver in postcontrast iamges
Previous triple phased study showed differences between hepatocellular carcinoma, adenomas and hyperplastic nodules. What were these differences?
Associations between dual-phase CT features and histopathologic diagnoses in 52 dogs with hepatic or splenic masses VRU pre-published 2016
HCC: heterogeneous arterial enhancement, hypoattenuating to normal liver on later phases
Adenomas: diffuse arterial enhancement. Retained contrast in later phases
Hyperplastic nodules: marked arterial enhancement and portal phases. Hypoattenuating to normal liver in delayed phases.
In this dual phased study - what were differences between HCC, nodular hyperplasia, and adenoma within the liver?
Associations between dual-phase CT features and histopathologic diagnoses in 52 dogs with hepatic or splenic masses VRU pre-published 2016
Pre-contrast: heterogeneous, lower attenuation to surrounding parenchyma
Early phase: generalized enhancement
Late phase: persistent enhancement
In this dual phased study - what were differences between HSA, nodular hyperplastic and hematomas lesions within the spleeN?
Associations between dual-phase CT features and histopathologic diagnoses in 52 dogs with hepatic or splenic masses VRU pre-published 2016
Marked diffuse enhancement and early phases that persistented in delayed phases.
Hematomas - mild early phase enhancement, due to contrast accumulation - marked enhancement in delayed phases - could be difficult to differentiat ebetween HSA and hematoma if active bleeding is occurring
What did this article:
Associations between dual-phase CT features and histopathologic diagnoses in 52 dogs with hepatic or splenic masses VRU pre-published 2016
Conclude about CTA and defining between differentials?
Not really possible - too much overlap.
What is recommended procedure for contrast enhanced US cholecystography?
Feasibility of percutaneous contrast US cholecystography in dogs VRU 56.3
10mL of bile removed
10mL of NaCl introduced, and repeated to flush out gallbladder
Then 0.5mL of contrast agent mixed with 10mL of NaCl solution was injected
How long did it take for initial detection, time to peak intensity, and duration of intensity for CE-US cholecystography in dogs?
Feasibility of percutaneous contrast US cholecystography in dogs VRU 56.3
Time to detection - 8.6s
Time to peak intensity - 26s
duration of contrast - 50-53s
What was pattern of time intensity curve for CE-US cholecystography?
Why did it appear this way?
Feasibility of percutaneous contrast US cholecystography in dogs VRU 56.3
Inconsistent, irregular increases and decreases with variable, irregular patterns of intensity
Appeared this way due to contraction and relaxation of the sphincter of Oddi in the gallbladder to control excessive pressure induced by contrast agent
What is prevalence of accessory pancreatic duct opening into the minor papilla in cats?
Imaging diagnosis - EHBO secondary to duodenal foreign body in a cat VRU 48.5
20%
Abnormal GB wall thickness in a cat? CBD?
What about dogs?
Imaging diagnosis - EHBO secondary to duodenal foreign body in a cat VRU 48.5
Cat - GB: >1mm. CBD>5mm
Dog - GB: 1-3mm, CBD >4mm
DDx for EHBO in a cat?
Imaging diagnosis - EHBO secondary to duodenal foreign body in a cat VRU 48.5
cholangiohepatitis, pancreatitis, extra/intraluminal masses, cholelithiasis, diaphragmatic hernia, liver flukes, congenital abnormalities, inflammation of surrounding structures (CBD, pancreas, liver, duodenum/papilla)
What are the most common causes of EHBO in cats?
US features of EHBO in 30 cats VRU 48.5
tumor, inflammation of CBD/pancreas/duodenum, and choledocholithiasis
What clinical signs helped differentiate between cause of EHBO in cats?
US features of EHBO in 30 cats VRU 48.5
Choleliths had an acute onset - the others were more insiduous (1-10d vs 3-180d for other groups)
What is the calculation for gallbladder volume?
US features of EHBO in 30 cats VRU 48.5
Ellipsoid formula
Volume = 0.52 x (height x length x width)
What calculated gallbladder volume was seen with a subjectively dilated gallbladder?
subjectively normal gallbladder?
US features of EHBO in 30 cats VRU 48.5
Dilated - 10mL
Normal -
What was prevalence of subjective gallbladder dilations in the population of cats with EHBO?
US features of EHBO in 30 cats VRU 48.5
43% - 13/30
What was median gallbladder wall thickness in the cat population with EHBO? Did this differ between groups(tumor, choleliths, inflammation?)
US features of EHBO in 30 cats VRU 48.5
Median wall thickness was > 1.7 for all groups
No difference between groups
What was the median cystic duct diameter for the population of cats with EHBO? Did this differ between groups (tumor, choleliths, inflammation?)
US features of EHBO in 30 cats VRU 48.5
Median common bile duct diameter - 8.9mm
Did not differ between groups
What is usually path of dilation in animals with EHBO?
Was this rule followed in the cats in this population?
US features of EHBO in 30 cats VRU 48.5
1) 1st sign – marked gallbladder distension and dilation of the common duct
2) 48 hours – dilation of the common bile duct and extrahepatic ducts
3) 72 hours – dilation of the extrahepatic ducts – too many tubes
4) 5-7d – Dilated intrahepatic ducts
This rule was not followed - 30% of the cats had dilation of the intrahepatic ducts without dilation of the extrahepatic ducts
Why is it believed that cholestasis contributes to biliary tract disease (cholcystitis/cholelithiasis)
Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele VRU 53.1
Prolonged exposure of the gallbladder epithelium to concentrated bile acids
What is criteria for calling gallbladder emptying normal (volume of gallbladder and ejection fraction)?
Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele VRU 53.1
Volume - 1ml/kg
Ejection fraction - >25% ejected after 2h after feeding
How is gallbladder volume calculated?
Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele VRU 53.1
volume = 0.52 x l x w x d
How is ejection fraction of the gallbladder calculated?
Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele VRU 53.1
EF = [(Vo-V) / Vo] X 100%
What were findings between the groups (normal, mobile sludge, immobile sludge, and mucoceles), when evaluating ejection fraction at 60 and 120 minutes?
Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele VRU 53.1
When compared to control group - all other groups had significant decrease in EF60. At EF120, mobile sludge and mucocele had significant decrease
When compared to the abnormal groups - mucocele had lowest EF120 and highest gallbladder volume
What were findings between the groups (normal, mobile sludge, immobile sludge, and mucoceles), when evaluating ejection fraction at 60 and 120 minutes?
Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele VRU 53.1
Mucocele had highest gallbladder volume at all timepoints (including time 0)
3.8 - 4.3 ml/kg vs 0.3-1.6ml/kg
Significant increase in fasting and post prandial gallbladder volume when compared to normal group (mobile and mucocele)
What were approximate ejection fractions for each group (normal, mobile sludge, immobile sludge and mucoceles) at EF 120?
What were findings between the groups (normal, mobile sludge, immobile sludge, and mucoceles), when evaluating ejection fraction at 60 and 120 minutes?
Control: 65%
Mobile: 33%
Immobile: 27%
Mucocele: 8.3%
