Liver - Part 7 Flashcards
What is another term for hepatocellular carcinoma?
Hepatoma
What is the cause of a hepatoma? (3)
- Cirrhosis
- Chronic hepatitis B
- Exposure to carcinogens in food or environment
What are the clinical findings for a hepatocellular carcinoma? (7)
- Palpable mass
- Abdominal pain
- Weight loss
- Unexplained fever
- Elevated ALT, AST, and alkaline phosphatase
- Positive AFP
- Jaundice
What is the US appearance for a hepatoma? (5)
- Solid mass with variable echogenicity
- May demonstrate a hypo echoic halo
- Multiple nodules or diffuse infiltrative masses may also be demonstrated
- Hepatomegaly
- Ascites
What are 5 differential diagnosis for hepatocellular carcinoma?
- Metastases
- Abscess
- Cavernous
hemangioma - Adenoma
- Cirrhosis
Where does the majority of metastases occur?
Colon
- then pancreas, breast and lung
What are the clinical findings for metastases? (7)
- Hepatomegaly
- RUQ pain
- Weight loss
- Loss of appetite
- Jaundice
- Increase in AST, ALT, and bilirubin
- Mild increase in alkaline phosphatase
What is the US appearance for metastases? (5)
- Bull’s-eye or target lesion
- Hyper echoic masses
- Cystic masses
- Complex masses
- Diffuse pattern
What are 4 differential diagnosis for metastases?
- Multiple abscesses
- Nodular cirrhosis
- Fatty infiltration
- Multiple cavernous
hemangiomas
What are causes of Budd-Chiari syndrome? (3)
- Hepatoma
- Tumor extension (renal or liver)
- Hematologic disorder
What are the clinical findings for Budd-Chiari syndrome? (4)
- Abdominal pain
- Hepatomegaly
- Lower-extremity edema
- Mild increase in alkaline phosphatase
What is the US appearance of Budd-Chiari syndrome? (9)
- Hypo echoic intraluminal echoes in the hepatic veins (thrombus)
- Dilated hepatic veins
- Vein wall thickening
- Absence of or altered hepatic venous flow
- Hepatomegaly
- Enlarged caudate lobe
- Ascites
- Hyper echoic liver parenchyma
- Thrombosis in the portal veins
What are 3 differential diagnosis for Budd-Chiari syndrome?
- Cirrhosis
- Portal vein
thrombosis - Technical error
What are the causes of portal hypertension? (5)
- Cirrhosis
- Hepatitis
- Fatty infiltration
- Portal vein obstruction
- Budd-Chiari syndrome
What are the clinical findings of portal hypertension? (6)
- Splenomegaly
- Hepatomegaly
- Increase in LFTs
- Hematemesis
- Jaundice
- Abdominal distention
What is the US appearance of portal hypertension? (7)
- Main portal vein diameter exceeding 13mm
- Splenomegaly
- Ascites
- Splenic and superior mesenteric vein exceeding 10mm
- Changes in portal venous flow
- eg) hepatofugal, pulsatile or a decrease in velocity - Portosystemic collaterals
- Resistive index exceeding 0.8 in
the hepatic artery implies portal hypertension
What are 3 differential diagnosis for portal hypertension?
- Cirrhosis
- Budd-Chiari
syndrome - Portal vein thrombosis
What are causes for portal vein thrombosis? (5)
- Hepatoma or liver metastasis
- Sepsis
- Blood coagulation disorders
- Cirrhosis
- Idiopathic
What are the clinical findings for portal vein thrombosis? (2)
- Severe abdominal pain
2. Loss of appetite
What is the US appearance for portal vein thrombosis? (4)
- Hypo echoic intraluminal echoes in the portal vein(s)
- Increase in portal vein diameter
- Prominence of the intrahepatic arteries
- Absence or altered portal venous blood flow
What are 3 differential diagnosis for portal vein thrombosis?
- Budd-Chiari syndrome
- Cirrhosis
- Technical error
TIPS
Transjugular intrahepatic protosystemic shunt
Transjugular intrahepatic protosystemic shunt
A shunt is placed between a portal vein and a hepatic vein
Where is TIPS commonly placed?
Between the right portal vein and the right hepatic vein
What are complications of TIPS? (3)
- Hepatic vein stenosis
- Stent occlusion
- Stent stenosis
What are the clinical findings for TIPS? (2)
- Asymptomatic
2. Symptoms may vary with underlying liver disease
What is the US appearance for TIPS? (2D) (3)
- Brightly echogenic, nonshadowing tubular structure
- Connects a portal vein to the right hepatic vein
- Stent should measure 8-12mm in diameter
What is the US appearance for TIPS? (doppler) (3)
- Hepatopetal flow in main portal vein at 20-60 cm/s
- elevated is abnormal - Hepatofugal flow in right and left portal veins
- Peak flow velocity within stent ranges from 65-225 cm/s
- less than 60 is abnormal
What supplies the only blood supply to the biliary tree?
Hepatic artery
What are best indicators for liver rejection?
LFTs
What is the most common complication for hepatic transplants postoperative?
Hepatic artery thrombosis
- first 6 weeks
- indicates an increase in resistive index (RI)
What are 5 hepatic transplant complications?
- Hepatic artery thrombosis
- Hepatic artery stenosis
- Infection or fluid collections
- Portal vein stenosis
- Portal vein thrombosis
What is the most common cause of cirrhosis in the United States?
Alcohol abuse
What is an hepatic abscess is most likely to develop?
Ascending cholangitis
A patient presents with a history of RUQ pain, fever, and leukocytosis. On further questioning, the patient discloses recent travel abroad. A complex mass is identified in the right lobe of the liver. This mass most likely
Hepatic abscess
Patients with a history of hepatitis B have a predisposing risk factor for developing what?
A hepatoma
What are daughter cysts associated with?
Echinococcal cyst
What is a decrease in prothrombin time associated with?
Acute cholecystitis
The diameter of a TIPS should measure a minimum of…
8mm
