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Abdomen > Liver Disease > Flashcards

Liver Disease Flashcards

0
Q

What is fatty infiltration?

A

Acquired, reversible disorder of metabolism. An accumulation of triglycerides within hepatocytes. No harmful effect on liver function.

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1
Q

What is hepatocellular disease?

A

Defined as a disease process that affects the hepatocytes and interferes with liver function

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2
Q

Causes of fatty liver

A
  1. Obesity
  2. Alcoholism
  3. Diabetes mellitus- hyperglycemia
  4. Pregnancy- rapid weight gain
  5. Severe hepatitis
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3
Q

Diffuse fatty infiltration

A

Will cause increased liver echogenicity and increased attenuation of the ultrasound beam.

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4
Q

Focal fatty infiltration

A

May mimic neoplastic involvement. Regions of increased echogenicity are present within background of normal liver parenchyma. Will have a lack of mass effect. Fatty infiltration may resolve as early as within 6 days. The extent of fatty infiltration is variable but commonly seen at the ports hepatis.

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5
Q

Focal fatty sparing

A

Entire liver is fatty except one spot of normal tissue. Small focal areas of normal liver surrounded by fatty tissue. Appear as hypoechoic masses within a dense fatty infiltrated liver. Commonly seen adjacent to gb fossa.

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6
Q

Cavernous malformation

A

Multiple serpinginous channels at the porta hepatis as a result of recanalization of the thrombosed vein. Usually happens with portal vein thrombosis. Hepatic artery tries to work harder.

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7
Q

Clinical presentation of cavernous malformation

A

Abdominal pain, hematemesis (blood in stomach acids), encephalopathy

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8
Q

What is the sonographic appearance of cavernous malformation?

A

Non visualization of portal vein.

Multiple serpinginous channels within a distorted porta hepatis

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9
Q

What is Budd Chiari Syndrome?

A

It is an obstruction of the hepatic venous outflow tract

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10
Q

What is Budd Chiari Syndrome etiology?

A

Intrinsic thrombus of hepatic vein
Rumors, Extrinsic compression by HCC or RCC
IVC thrombus
Membrane or Webb is present in the IVC or atrium
Hematologist disorders such as polycythemia rubes Vera, and coagulopathies

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11
Q

Signs and symptoms of Budd Chiari Syndrome

A 
Abdominal pain
Jaundice associated with hepatocellular disease
Ascites 
Hepatomegaly 
Splenomegaly
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12
Q

What are the sonographic features of Budd Chiari?

A

Depending on degree from of obstruction
Enlarged hepatic veins (prox to obstruction)
Non visualization of hepatic veins dist to obstruction
Abnormal flow pattern

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13
Q

What may cause a cyst?

A

They may be congenital, traumatic, parasitic or inflammatory in origin.

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14
Q

Single or Policystic disease of the liver

A

A gradual dilation of interlobar bile duct

Commonly associated with polycystic disease of the kidneys, spleen, ovaries and lungs

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15
Q

Characteristics of simple cysts

A 
Anechoic 
Thin walled 
Round well-defined borders
Posterior acoustic enhancement 
Smooth margin
No internal echoes
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16
Q

If only one organ is affected with multiple cysts what is it called?

A

Multicystic

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17
Q

If multiple organs are involved with multiple cysts what is it called?

A

Polycystic

*1:1000 incidence. Affects females more than males 4:1 ratio. Usually through 5th and 6th decade of life.

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18
Q

What is a hematoma

A

Localized collection of blood caused by trauma to the liver

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19
Q

Ultrasound appearance of hematoma

A

Day 1-2: blood is an school or hypoechoic
Day 3-5: more echoes due to clotting
Day 6: hypoechoic to anechoic due to resolving clot

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20
Q

What are the names of cystic structures found in or around liver?

A

Perivascular: near or around vessels
Subcapsular: between glissons capsule and liver
Perihepatic : outside or surrounding the liver

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21
Q

Clinical manifestation of hematoma

A 
RUQ pain
Hepatomegaly 
And distention
Decreased hematocrit
Increased leukocytes 
Hypotension
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22
Q

What is another name for Hydatid Cyst?

A

Echinococcal Cyst

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23
Q

Etiology of Echinococcus

A

Tapeworm larvae ingestion from contaminated vegetables.
Human becomes intermediate host
The eggs invade the intestinal wall and travel through the portal system where they develop into cystic mass

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24
Q

What are the clinical signs of Hydatid cyst?

A

RUQ pain
Nausea
Vomiting
Positive serological testing

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25
Q

Sonographic appearance of Hydatid cyst?

A

1 stage: simple cyst
Later stages:
May develop a daughter cyst (cyst within a cyst)
Cysts with thick septa between the fluid collections
Has a “honeycomb” appearance

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26
Q

Calcified cysts

A

When Hydatid cyst is healing. Surgery removal may be necessary

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27
Q

What is the water lily sign?

A

When echinococcal cyst germinal layer has either collapsed or become detached

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28
Q

What is an amoebic cyst caused by?

A

The amoeba named entamoeba hystolytica

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29
Q

What is the route of transmission of entamoeba hystolytica?

A

Fecal/oral route
Contaminated water
Lives in GI tract
Travels through portal system

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30
Q

Clinical signs and symptoms of amoebic cyst

A 
Abdominal pain
Dysentery (blood and mucus in diarrhea) 
Vomiting 
Fever/chills
Black stools
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31
Q

Lab values of amoebic cyst?

A

Increased wbc and lft

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32
Q

What is the ultrasound appearance of an amoebic cyst?

A

Variable appearance
Largest cyst of liver
Internal echoes
May look like abscess- complex cyst (amoebic abcess)

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33
Q

What is schistosomiasis?

A

Parasitic infection acquired from contaminated water where worms can penetrate the skin or enter GI tract and travel through portal system into liver and causing periportal fibrosis

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34
Q

Clinical signs and symptoms of schistosomiasis

A

Portal hypertension

Cirrhosis is possible

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35
Q

What is the ultrasound appearance of schistosomiasis?

A

Increased echogenicity of periportal region

PV dilation and thickened portal walls

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36
Q

What causes an abscess in the liver?

A

Bacterial infection,

Commonly from biliary infection

37
Q

What is the ultrasound appearance of an abscess?

A 
Thick walls
Round or oval shaped
Irregular, poorly defined borders
Multiple septations
Internal echoes 
Size is variable
80% located in Rt lobe 
Comet tail artifact from micro bubbles
38
Q

What is cavernous hemangioma?

A

Most common benign tumor of the liver
Not a true neoplasm but more of a vascular abnormality
Arterio-venous malformation
Lined with endothelial tissue filled with wbc
More common in women
Typically < 5cm

39
Q

What are the complications of cavernous hemangioma?

A

Enlargement can occur during pregnancy and hormone therapy

40
Q

Clinical signs and symptoms of cavernous hemangioma

A

Usually asymptomatic

Large hemangioma can cause abdominal distention and pain

41
Q

What are the lab values of cavernous hemangioma?

A

Normal

42
Q

What is the ultrasound appearance of cavernous hemangioma?

A 
Hyperechoic
Round
Homogenous
Well circumscribed mass
Usually in art lobe 
May be multiple
As the mass degenerates the center will become anechoic
Post enhancement seen within >2.5 cm
Extremely low flow, may or may not be visualized w Doppler
43
Q

What is focal modular hyperplasia (FNH)?

A

Second most common benign tumor
Excess growth and accumulation of liver lobule components
Occurring most commonly in women of reproductive age
Linked to birth control
Usually <8cm

44
Q

What is the ultrasound appearance of FNH?

A 
Variable
Typically <5 cm
Hypo-hyperechoic
Even isle choice to the liver 
Frequently identified by mass effect
Non capsulated
45
Q

What is liver cell adenoma (LCA)?

A

A true encapsulated neoplasm consisting of atypical cells
Less common than FNH
more common in women and associated with birth control
Women/men ratio incidence 4:1
Variable sonographic appearance

46
Q

What are the clinical signs and symptoms of LCA?

A

Palpable abdominal mass
RUQ pain
Abdominal pressure
Normal labs

47
Q

What is the most common primary liver malignancy?

A

Hepatocellular carcinoma HCC - adult

Hepatoblastoma, germ cell tumor - pediatric under 3 yrs of age

48
Q

Etiology of HCC

A 
Alcohol abuse
Hep B & C
Toxins - hepatocarcinoges in food
Metabolic disorders
More common in men
49
Q

Clinical signs and symptoms of HCC

A

RUQ pain
Palpable mass, rapid liver enlargement
Fever of unknown origin
Rapid weight loss

50
Q

Sonographic appearance of HCC

A

Single or multiple tumor
Variable in echogenicity, usually hypoechoic w irregular borders
Hyper vascular
A distinct tendency to destroy the portal venous wall with invasion into the vessel lumen
Hepatoma gay if mass is large

51
Q

Related findings of HCC

A

Ascites in advanced stages
Portal HTN
jaundice
Splenomegaly

52
Q

What are the lab values of HCC?

A

Increased AFP

Most accurate 70%

53
Q

Complications of HCC

A

Hepatomegaly
Invasion of hepatic vein producing Budd Chiari syndrome
Thrombosis or tumor invasion of portal system occurs in 68% of HCC

54
Q

What is Metastatic disease in liver?

A

Cancer that spreads to liver causing ,ultisols tumor invasion
Can be from lungs, breast, colon, panc

55
Q

Ultrasound appearance of METS

A

Non specific. Depends on primary target lesions
Mets from lung or breast cancer- echogenic w hyperechoic rim
Mets from lymphoma- multiple hypoechoic lesions
Mets from GI tract- echogenic lesions
Mets from mucinous or serous cyst or adenocarcinoma of the ovary- cystic

56
Q

What is Bouveret’s syndrome?

A

Gastric outlet obstruction caused duodenal impaction of large gallstone that has migrated

57
Q

What is double barrel shot gut sign?

A

Dilated bile ducts are caused by obstructed gall stones.

It can also result from neoplasm

58
Q

What is another name for double barrel shot gun sign?

A

Parallel channel sign

59
Q

Sizes do dilated ducts

A

Extrahepatic >5 mm

Intrahepatic >2 mm

60
Q

Complications of gall stones

A 
Cholecystitis 
Cholangitis 
Jaundice
Gangrene 
Ulcer
Perforation
Fistula
Pancreatitis 
Peritonitis 
Paralytic ileus (obstruction of small intestine)
Sepsis
61
Q

Bouveret’s Syndrome

A

Gastric outlet obstruction caused by duodenal impaction of a large gallstone that has migrated through a cholecystoduodenal fistula

62
Q

What kind of treatments for gall stones are there?

A

ESWL
Laproscopic cholecystectomy
Sphincterotomy and extraction of stones
Oral dilution therapy

63
Q

What is ESWL?

A

Stands for extracorporal shock-wave lithotripsy

The shock wave shatters the small stones into smaller pieces. Limited success

64
Q

What is porcelain GB?

A

Porcelain GB is complete or patchy calcification of the GB wall.
Rare. More common in female 5:1

65
Q

What is the sonographic appearance of porcelain GB?

A

Biconvex, curvilinear, hyperechoic structure with variable acoustic shadowing
May simulate stone-filled GB devoid of bile, but lacks WES sign
Low level echoes with the GB wall are not identifiable due to calcification infiltration

66
Q

What is courvoisier gallbladder?

A 
An enlarged, hydropic gallbladder 
Painless distention of the GB
Patients may have palpable mass in RUQ
Usually due to obstruction of cbd 
Pancreatic head mass may obstruct cbd
Clinical 
Obstructive jaundice, increased DB, increased ALP
67
Q

GB polyp?

A 
Benign growth within GB 
Projects into GB lumen on a stalk which is rarely visible
Soft tissue mass
Non-mobile, non-shadowing
Less echogenic compared to stone
68
Q

What is cholesterolosis?

A

Cholesterol deposit in the GB wall.

69
Q

Another name for cholesterolosis

A

Strawberry GB

70
Q

What is adenomyomatosis?

A

Hyperplastic cholecystosis or diverticulosis of GB
Diffuse type involves all mucosal walls of the GB
It is characterized by epithelial proliferation, muscle hypertrophy, intramural diverticula (rokitansky aschoff sinuses) which may be segmental or diffuse
Benign condition that requires no specific treatment, found as an accidental finding in up to 9% of cholecystectomy specimen

71
Q

Other names for adenomyomatosis

A

Hyperplastic cholecystosis

Diverticulosis of GB

72
Q

Sonographic appearance of adenomyomatosis?

A

Mural thickening with calcification and comet tail reverberation artifact due to small cholesterol crystals within rokitansky aschoff sinuses

73
Q

What is Rokitansky Aschoff Sinuses?

A

Diverticula within the wall of GB
The pathology associated with them is adenomyomatosis
Sludge and stones accumulate within the sinuses and present as focal wall thickening. Echogenic foci are visible within the thickened wall.
The accumulation causes a characteristic V-shaped or comet tail reverberation artifact

74
Q

What imaging modality can differentiate adenomyomatosis from GB carcinoma?

A

MRI, by depicting Rokitansky aschoff sinuses.

MRI is the modality of choice.

75
Q

What is Adenoma?

A

Rare, bening epithelial tumor, representing as an overgrowth of the epithelial lining of GB. Protrudes into the GB lumen. Non mobile, adhere to GB wall.

76
Q

What is the sonographic appearance of adenoma?

A 
Solitary, homogenously hyperechoic mass which becomes heterogenous with increasing size. 
Single or multiple
Usually larger than polyps
No shadow, no movement to dependent part
Usually less than 1 cm
77
Q

What is emphysematous GB?

A

An infection associated with gas-forming bacteria within the wall of the GB. Differs from the usual type of acute cholecystitis as cholelithiasis is absent

Incidence: male>female
Men >60 yo

78
Q

What is the predisposing factor of emphysematous GB?

A

Diabetes mellitus
Vascular compromise of cystic area may play role in etiology
Gas may occur in the wall and/or lumen of GB
Gas may spread to peri-cholecystitis tissue
Gas rarely escapes into bile ducts because usually occluded by cholelithiasis

79
Q

Sonographic features of emphysematous GB

A

Indistinct shadowing emanating from the wall or lumen of GB

Ring Down artifact or comet tail artifact from shadowing from air in GB lumen

80
Q

What is pneumobilia?

A

Air in biliary tract
Most commonly seen after ERCP
And can also occur due to surgically created biliary-enteric anastomosis, incompetence of the sphincter of oddi, wall erosion by the gallstone or ulcer into cbd.

81
Q

Where is pneumobilia most commonly seen?

A

In the hilum of liver.

82
Q

What is Mirizzi’s Syndrome?

A

Extrinsic biliary obstruction caused by compression of the stone within the cystic duct. The stone causes extrinsic mechanical compression of the cbd

83
Q

Sonographic features of Mirizzi’s Syndrome

A

Intrinsic hepatic bile dilation, a normal size cbd.

A large stone in the cystic duct of GB

84
Q

What is Caroli’s Desease?

A

Congenital communicating cavernous ectasis of the intrahepatic bile ducts.
It is a segmental, non-obstructive, saccular dilation of intrahepatic bile ducts

85
Q

What is choledochal cyst

A

Congenital cyst in the bile duct

86
Q

Sonographic appearance of choledochal cyst

A

A presence of cyst-like mass in the porta hepatis area

Dilated intrahepatic biliary tree

87
Q

Biliary carcinoma clinical and lab

A 
More common in women 60-70% white women
Stones will be present in almost 95% of cases
May be asymptomatic 
Increased direct bilirubin, WBC and ALP
CEA- carceno embrionic antigen
88
Q

Etiology of biliary carcinoma

A

70-80% of cases the neoplasm is adenocarcinoma

15% is papillary carcinoma

89
Q

What 3 other areas should be investigated to confirm the diagnosis of GB carcinoma?

A

Liver METS
Periaortic lymphadenopathy
Bile duct dilation

90
Q

What is Klatskin Tumor?

A

Is a specific type of cholangiocarcinoma
Causes intrahepatic biliary dilation without extrahepatic dilation.
Located at the hepatic hilum, at the junction of the right and left hepatic ducts.
Signs and symptoms are weight loss, jaundice, RUQ pain, digestive disturbances

Abdomen (10 decks)

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