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Abdo review > Liver- focal, inflammatory, parasitic > Flashcards

Liver- focal, inflammatory, parasitic Flashcards

1
Q

hepatic cyst?

A
  • Solitary nonparasitic cyst of the liver
  • May be congenital or acquired
  • May be solitary or multiple
  • Patients are often asymptomatic and require no treatment.
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2
Q

u/s features of benign cyst?

A

show the lesion to be well-demarcated, thin-walled, and anechoic with posterior acoustic enhancement

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3
Q

simple hepatic systs on u/s?

A
  • usually incidental because most patients are asymptomatic.
  • As the cyst grows, it may cause pain or a mass effect to suggest a more serious condition, such as infection, abscess, or necrotic lesion.
  • Occur more often in women than in men
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4
Q
A

simple hepatic cyst

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5
Q

Peribiliary Cysts?

  • size
  • commonly found in
  • located
  • obstruction may occur when
A
  • Range in size from 0.2 to 2.5 cm
  • More commonly found in patients with severe liver disease
  • Located centrally within the porta hepatis at the junction of the right and left hepatic ducts
  • Obstruction may occur if the cyst becomes large enough to cause biliary obstruction
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6
Q
A

peribiliary cysts

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7
Q

polycystic liver disease?

A
  • Inherited in an autosomal dominant pattern that affects 1 in 500 individuals
  • At least 50% to 74% of patients with polycystic renal disease have one to several hepatic cysts.
  • Of patients with polycystic liver disease, 60% have associated polycystic renal disease.
  • Small, less than 2 to 3 cm, and multiple throughout the hepatic parenchyma
  • May enlarge and cause biliary obstruction in the porta hepatis
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8
Q

Pyogenic bacteria? hoe does it reach the liver? (4)

A
  • means pus forming

reaches the liver by several routes:

1-Via the biliary tract in patients with suppurative (pus) cholangitis, cholecystitis
2-Travels through portal venous system- diverticulitis and appendicitis
3-Travels through hepatic artery- Osteomyelitis and bacterial endocarditis
4-Also occurs as a result of blunt or penetrating trauma to liver- Results in hepatic abscess

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9
Q

Hepatic abscesses most often occurs as conplications of? (3)

A
  • biliary tract disease
  • surgery
  • trauma
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10
Q

three basic types of abscess formation occur in the liver?

A
  • intrahepatic
  • subhepatic
  • subphrenic
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11
Q

Inflammatory Disease of the Liver clinically?

A
  • fever
  • elevated wbc’s
  • RUQ pain
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12
Q

Inflammatory Disease of the Liver on u/s?

A
  • solitary or multiple lesions in the liver
  • abnormal fluid collections in Morison’s pouch
  • subdiaphragmatic
  • subphrenic space
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13
Q
A

pyogenic abscess

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14
Q

Varied sonographic signs of liver abscess?

A
  • Frankly purulent-cystic with fluid ranging from echo free to highly echogenic
  • Early supperation-solid with altered echogenicity, usually hypoechoic due to necrotic hepatocytes
  • Gas producing organisms give rise to echogenic foci with posterior reverberation artifacts
  • Fluid/fluid interfaces, internal septations &debris
  • Walls can be thick, irregular or well defined
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15
Q

liver abscess d/d?

A

Amebic or echinococcal infection
Simple cyst with hemorrhage
Necrotic or cystic neoplasm
Hematoma

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16
Q

Hepatic Candidiasis?

A
  • Liver frequently involved secondary to hematogeneous spread of mycotic infections in other organs-esp lungs
  • Patients are generally immunosuppressed
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17
Q

Hepatic Candidiasis occurs when?

A
  • pregnancy

- after hyperalimenation

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18
Q

Hepatic Candidiasis presents as?

A

Persistent fever in a neutropenic patient(low white blood cell count) whose leukocyte count is returning to normal

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19
Q
A

hepatic candidiasis

20
Q

Which patients are immunosuppressed? (7)

A 
Transplant pre and post
Cancer 
Chemotherapy/radiation therapy
AIDS/HIV
Inherited disease-blood disorders
Underlying systemic infection
Poor nutrition
21
Q

Varied Ultrasound features of Candidiasis? (6)

A
  • wheel withnin a wheel
  • central nidus
  • hyperechoic foci
  • bulls eye
  • uniformly hupoechpic
  • echogenic
22
Q

Chronic Granulomatous Disease?

A
  • Congenital defect in immune system cells called phagocytes that renders the cells unable to kill ingested bacteria, resulting in increased susceptibility to severe infections
  • Occurs mostly in children with a more frequent occurrence in girls
23
Q

Chronic Granulomatous Disease on u/s?

A
  • Poorly marginated, hypoechoic mass is seen with posterior enhancement.
  • Calcification may be present with posterior shadowing.
  • Aspiration is necessary to classify the mass specifically as granulomatous disease.
24
Q

Amebic Abscess?

A
  • A collection of pus formed by disintegrated tissue in a cavity, usually in the liver
  • Caused by the protozoan parasite, Entamoeba histolytica
  • Parasites reach the liver parenchyma via the portal vein
25
Q

Amebic Abscess contracted by? affects?

A
  • Amebiasis is contracted by ingesting the cysts in contaminated water and food.
  • Ameba usually affect the colon and cecum, and the organism remains within the gastrointestinal tract.
  • If the organism invades the colonic mucosa, it may travel to the liver via the portal venous system.
26
Q

amebic abscess s/s?

A
  • abdo pain
  • diarrhea
  • leukosytosis
  • low fever
27
Q

amebiasis sono features?

A

round or oval shaped lesion
absence of prominent wall
hypoechogenicity
low level echoes, distal enhancement

28
Q
A

amebic abscess

29
Q

Hydatid disease-echinococcal disease?

A
  • Most common cause is the parasite Echinococcus granulosis-worldwide
  • Prevalent in sheep & cattle raising countries
  • Tape worm 3-6mm long
  • Embryos are freed in duodenum-reach the liver via portal veins
  • Most of the embryos are trapped in the liver
  • May involve lungs, kidneys, spleen and CNS
  • Right lobe most frequently involved
30
Q

Echinococcal Cyst 2 layers?

A
  • Has two layers: (1) the inner layer and (2) the outer, or inflammatory reaction, layer.
  • Smaller, daughter cysts may develop from the inner layer.
  • Cysts may enlarge and rupture.
  • Cysts may also impinge on the blood vessels and lead to vascular thrombosis and infarction.
31
Q
A

echinococcal cyst

32
Q

Sonographic features of Hydatid disease and treatment?

A

Simple cysts
Cysts with detached endocyst secondary to rupture
Cysts with daughter cysts
Densely calcified masses

Surgery is conventional treatment
US used to monitor therapy in patients

33
Q

Pneumocystis Carinii?

A

Most common organism causing opportunistic infection in patients with AIDS
Pneumonia-most common cause of life-threatening infection
Patients undergoing bone marrow and organ transplants-at risk

34
Q

Pneumocystis Carinii sono?

A

Tiny ,diffuse non shadowing echogenic foci

Or extensive replacement of normal hepatic parenchyma by echogenic clumps of dense calcification

35
Q
A

pneumocystis carinii

36
Q

Schistosomiasis?

A

Most common parasitic infection in humans
4 different parasites
Ova reach liver via portal vein
Terminal portal vein branches become occluded

37
Q

Schistosomiasis leads to? (4)

A

portal hypertension
splenomegaly
varices
ascites ensues

38
Q

Schistosomiasis on u/s?

A

Widened echogenic portal tracts- up to 2cm
See dilated bilary ducts
Porta hepatis is region most often affected
Initially-hepatomegaly then periportal fibrosis occurs liver then shrinks
portal hypertension prevails

39
Q
A

schistosomaiasis

40
Q

List 4 complications of viral hepatitis

A

Portal hypertension
Cirrhosis
HCC
Liver failure

41
Q

Starry night sign is associated with?

A

acute viral hepatitis

42
Q

List 2 complications of chronic hepatitis seen on US?

A

cirrhosis

liver failure

43
Q

List 2 most common causes of bacterial disease via the biliary tract?

A
  • cholangitis

- cholecystitis

44
Q

The most common complication of bacterial disease associated with fever and leukocytosis?

A

abscess

45
Q

What sonographic sign could differentiate between a hematoma and an abscess?

A

GAS

Echogenic foci with ring down artifact or posterior reverberation artifact

46
Q

What fungal disease is most commonly associated with patients who are immunosuppressed?

A

Candidiasis

47
Q

parasitic disease prevalent in sheep and cattle raising countries?

A

Hydatid disease

Abdo review (11 decks)

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