Liver - Part 3 Flashcards
What are clinical indications for mets in the liver? (2)
- RUQ pain
2. Loss of appetite
What is discovered on a physical exam for mets in the liver? (3)
- Hepatomegaly
- Weight loss
- Jaundice
What is shown in the blood work of someone who has mets in the liver? (4)
- Increased AST
- Increased ALT
- Increased bilirubin
- Mild increase in alkaline phosphatase
What is the modality of choice for liver metastases?
CT
What is the sonographic appearance for liver metastases? (7)
- Hepatomegaly
- Irregular control
- Multiple hypo echoic lesions
- avascular
- Lesions vary in size
- Ascites around the liver, RLQ and LLQ
- Enlarged hyper vascular paracaval lymph nodes around the IVC
- compressing the IVC
What is the most common neoplasm in an adult liver?
Metastasis
What is the liver a principle target for?
GI malignancies
What is the most common primary sites for metazoic lesions to the liver in adults? (6)
- Colon
- Stomach
- Pancreas
- Breast
- Lung
- Eye
What are 6 patterns of metastases?
- Bulls’eye or target lesion
- Hypoechoic masses
- Hyperechoic masses
- Cystic masses
- Complex masses
- Diffuse pattern
What is the differential diagnosis of mets? (4)
- Multiple abscesses
- Nodular cirrhosis
- not normally associated with hepatomegaly - Fatty infiltration
- Multiple cavernous hemangiomas
What is the most common benign hepatic lesion?
Hemangioma
What is the sonographic appearance of a hemangioma? (3)
- Defined borders
- No colour flow on doppler
- Hyperehcoic
What do hemangiomas typically arise from?
AV malformations
What are the 2 types of hemangiomas?
- Hemangioendotelioma
2. Cavernous hemangioma
Hemangioendotelioma
Blood filled spaces with multilayer endothelium
Cavernous hemangioma
Single layers endothelium
What is the differential diagnosis of hemangioma? (5)
- Mets
- FNH
- Adenoma
- Hematoma
- Abscess
What gender is cavernous hemangioma more common in?
Females
How is cavernous hemangioma typcially discovered?
Incidentally
What is the clinical presentation of cavernous hemangioma? (4)
- Hepatomegaly
- Obstructed jaundice
- Bowel obstruction
- vomiting - Respiratory insufficiency
What is the sonographic features of cavernous hemangioma? (5)
- Well defined
- Hyper echoic
- but can by hypo echoic - Enhancement
- Vascular
- May calcify with PAS
What does mesenchymal hamartoma arise from?
Connective tissue of the portal tracts
- congenital
What is the clinical presentation of mesenchymal hamartoma?
Painless abdominal swelling
What does mesenchymal hamartoma resemble?
Hemangioma
