Liver Pathology Flashcards
T/F: fatty infiltration affects the entire liver parenchyma
TRUE
is fatty infiltration a reversible disease?
yes
causes of fatty infiltration (7)
- obesity
- chronic alcohol abuse
- pregnancy
- medication
- severe hepatitis
- glycogen storage disease
- chemotherapy
fatty infiltration can be divided into ___ categories
3
mild, moderate and severe
severe (grade III) fatty infiltration usually cause abnormal LFTs such as ____ and ____ levels
AST and ALT
what are the 2 most common causes of severe (grade III) fatty infiltration?
obesity and alcohol abuse
patients with fatty infiltration usually are ______
asymptomatic
some patients with fatty infiltration present with (4)
jaundice
nausea
vomiting
abdominal tenderness
size of a liver with fatty infiltration
normal to enlarged
________ is when there are focal areas of fat deposits and the rest of the liver is normal
focal fatty infiltration
focal fatty infiltration is most common seen at the (3)
porta hepatis
GB area
medial segment of the LLL
focal fatty infiltration may mimic as a _____
neoplasm (abnormal tissue growth)
a small area of normal liver parenchyma not affected by fatty infiltration
focal fatty sparing
focal fatty sparing is commonly seen ______ to the porta hepatis, GB area, & medial segment of the LLL
adjacent
ultrasound appearance of focal fatty sparing
hypoechoic masses within a dense fatty infiltrated liver
focal fatty sparing may mimic ____ and _____
neoplasm
pericholecystic fluid {abnormal fluid collection around the GB}
what is hepatitis?
swelling and inflammation of the liver
hepatitis can be cause by (2)
infectious
noninfectious agents
what are some examples of infectious agents? (4)
viral
bacterial
fungal
parasitic
what are some examples of noninfectious agents? (3)
medications
toxins
autoimmune disorders
what are the 2 most common forms of hepatitis?
Hep A and Hep B
how does hepatitis A spread?
fecal-oral route in contaminated water or food
how does hepatitis B spread?
contact with contaminated bodily fluids
how does hepatitis C spread?
most commonly through exposure to infected blood
viral hepatitis may be fatal with ____ or _____
secondary acute hepatic necrosis or chronic hepatitis
hepatitis can lead to (3)
cirrhosis
PHTN
HCC
Hep ____ has the highest risk for the development of HCC
Hep C
acute hepatitis lasts for
less than 6 months
8 signs/symptoms of acute hepatitis
- fever
- chills
- increase WBC
- jaundice
- anorexia
- nausea
- fatigue
- hepatomegaly
increased lab values for acute hepatitis (3)
AST
ALT
indirect (unconjugated) bilirubin
in severe cases of acute hepatitis, conjugated bilirubin increases ____
LDH
ultrasound appearance of acute hepatitis (9)
- normal to enlarged liver
- decreased echogenicity
- increased blood vessels visualization
- periportal cuffing
- “Starry sky” sign
- extensive demonstration of PV radicles
- GB wall thickening
- liver abscess
- splenomegaly
T/F: chronic hepatitis is reversible
FALSE
chronic hepatitis usually progresses to (3)
cirrhosis, liver failure, HCC
chronic liver disease caused by Hep C is the most frequent indication for
liver transplant
signs/symptoms of chronic hepatitis (2)
fatigue and jaundice
ultrasound appearance of chronic hepatitis (4)
- decrease liver size
- increase echogenicity
- decrease visualization of blood vessels
- coarse liver texture
what is cirrhosis?
liver cell death with subsequent regenerating nodules
T/F: cirrhosis is reversible
FALSE
what is the #1 cause of cirrhosis?
alcohol abuse
what is the #2 cause of cirrhosis?
Hep C
what are other causes of cirrhosis? (5)
obstruction
drug abuse
cholangitis
hemochromatosis
Wilson’s disease
what is hemochromatosis?
too much iron
what is Wilson’s disease?
too much copper
8 signs/symptoms of cirrhosis
- hepatomegaly (caudate lobe)
- ascites (Morison’s pouch)
- splenomegaly
- hepatic encephalopathy
- nausea
- anorexia/weight loss
- dark urine
- fatigue
complications of cirrhosis (7)
- sequela
- PHTN
- splenomegaly
- ascites
- HCC
- monophasic flow HV
- hepatofugal flow PV
what is the #1 cause of PHTN?
cirrhosis
4 signs/symptoms of PHTN
- hematemesis
- hepatic encephalopathy
- caput medusa
- tremors
most common ultrasound finding in PHTN
recanalization of the paraumbilical vein
with PHTN, varicosities are found around (3)
splenic hilum, renal hilum, GE junction
PV diameter when there is PHTN
greater than 13mm
SMV diameter with PHTN
greater than 10mm
Budd Chiari can be secondary to (7)
- congenital webbing disorder
- coagulation abnormalities
- tumor invasion from HCC
- thrombosis
- oral contraceptive use
- pregnancy
- trauma
ultrasound appearance of Budd Chiari (3)
decreased visualization of HV
enlarged caudate lobe
narrowing of IVC
another name for Von Gierke’s Disease
glycogen storage disease
what is von gierke’s disease?
large amounts of glycogen deposits in the liver and kidneys
von gierke’s disease is associated with ___
adenomas
hemochromatosis may lead to ___ and ____
cirrhosis and PHTN
another name for Wilson’s disease
hepatolenticular degeneration
key sign/symptom of Wilson’s disease
brown/rusty colored ring around the eye
hepatic cysts are often associated with ____
ADPKD
hepatic cysts are common on the
right lobe of the liver
another name for hydatid cysts
echinococcal cyst
what is echinococcus granulosus?
tapeworm that lives in dog feces
causes hydatid cysts
hydatid cysts have a high prevalence in
sheep and cattle raising countries
ultrasound appearance of hydatid cysts (4)
anechoic with some debris
water lily sign
mother and daughter cysts
some elements of dense calcification
5 signs/symptoms of hydatid cysts
leukocytosis
low grade fever
nausea
jaundice
RUQ tenderness
rupture of a hydatid cyst can lead to
anaphylactic shock
what is Entamoeba histolytica?
parasite that causes amebic hepatic abscesses
ultrasound appearance of amebic abscess (3)
round, hypoechoic to anechoic mass
may contain debris
acoustic enhancement
signs/symptoms of amebic hepatic abscess (6)
hepatomegaly
RUQ pain
general malaise
signs of dysentery
bloody diarrhea
fever
amebic hepatic abscess most often are seen where?
right lobe of the liver
amebic hepatic abscess is indistinguishable from _____ and therefore require _______ confirmation
indistinguishable from pyogenic hepatic abscess
require serologic confirmation
what causes a pyogenic abscess?
result from the spread of infection from inflammatory conditions
ultrasound appearance of pyogenic hepatic abscess (2)
complex cyst with thick walls
air/gas may produce dirty shadowing or ring-down artifact
signs/symptoms of a pyogenic hepatic abscess (4)
fever
hepatomegaly
leukocytosis
RUQ pain
what causes hepatic candidiasis?
fungus called Candida albicans
hepatic candidiasis occurs mostly in
immunocompromised patients
ultrasound appearance of hepatic candidiasis
target, halo, or bulls eye
older lesions may calcify
signs/symptoms of hepatic candidiasis (3)
RUQ pain
fever
hepatomegaly
polycystic liver is an inherited _______
autosomal dominant disease
50% of patients with polycystic liver will also have
polycystic renal, pancreas, and spleen disease
ultrasound appearance of polycystic liver disease (3)
anechoic
well-defined borders
acoustic enhancement
T/F: a patient with polycystic liver disease usually is asymptomatic
true
T/F: polycystic liver disease causes abnormal LFTs
FALSE - normal LFTs
what is the most common benign tumor of the liver?
hemangioma
hemangiomas are more common in ___ because they are stimulated by ____
more common in females
stimulated by estrogen
hemangiomas mostly occur where?
right lobe of the liver
ultrasound appearance of hemangiomas (3)
hyperechoic mass less than 3cm
posterior enhancement may be seen (slice thickness artifact = blood vessels are smaller than beam size)
no color flow
larger hemangiomas may appear _____ and be indistinguishable from _____
heterogenous and hypoechoic
metastatic liver disease
how do you distinguish a hemangioma from malignant tumor?
core biopsy
T/F: hemangiomas usually don’t cause any symptoms
true
what is a lipoma?
benign lesion composed of fat cells
lipomas are extremely ____ and are indistinguishable from (3)
extremely rare
indistinguishable from hemangiomas, focal fatty infiltration, echogenic mass
ultrasound appearance of lipomas (2)
well defined echogenic mass
propagation speed artifact
what is the most common benign liver tumor in children?
infantile hemangioendothelioma
85% of infantile hemangioendothelioma occur before ___ months of age
6 months
children with infantile hemangioendothelioma usually present with _____ early in life due to _____ within the tumor
cardiac failure
AVM within the tumor
infantile hemangioendothelioma spontaneously regresses in most patients before age ____
2 years old
what is the second most common benign liver tumor?
focal nodular hyperplasia (FNH)
FNH is thought to be a hyperplastic response to a ____
congenital AVM
______ may enlarge FNH
oral contraceptives
ultrasound appearance of FNH (2)
homogenous
hypervascular star-like scar*
FNH is referred to as a
stealth lesion
what is an adenoma?
rare benign tumor that grows rapidly
hepatocellular adenomas are associated with (3)
oral contraceptive use
men using steroids
von gierke’s disease
liver cell adenomas have a tendency to
rupture and hemorrhage
adenomas have a propensity to become _____
malignant
called malignant degeneration
what is hepatic congestion?
diffuse venous congestion within the liver that results from right-sided heart failure
ultrasound appearance of hepatic congestion (4)
hepatomegaly
splenomegaly
dilated IVC, HV, PV
ascites
what are hepatic granulomas?
benign liver masses associated with inflammatory liver diseases
what are the 2 most common causes of hepatic granulomas?
histoplasmosis and tuberculosis
what is pneumocystis carini?
most common organism causing infection in AIDS patients
ultrasound appearance hepatic granulomas?
diffuse echogenic foci within the liver
another name for HCC
hepatoma
what is the most common primary form of liver cancer
HCC
HCC is very common in patients with
cirrhosis and Hep C
HCC has the tendency to (3)
destroy PV walls
invade HV
produce Budd-Chiari syndrome
ultrasound appearance of HCC (5)
solitary, hypoechoic mass
heterogeneous masses scattered throughout
halo sign
ascites
hypervascular
signs/symptoms of HCC (3)
unexplained weight loss
hepatomegaly
palpable mass
HCC causes elevated
AFP
80% of patients with ____ develop HCC
cirrhosis
what is the most common form of liver cancer?
hepatic metastasis
where are the primary sites of cancer for hepatic metastasis? (5)
gallbladder
GI tract (stomach and colon)
pancreas
breast
lung (most common)
hepatic metastasis from the GI tract and pancreas tend to appear as
calcified tumors
hypoechoic masses of hepatic metastasis may be from (3)
breast
lung
lymphoma
diffuse hepatic metastasis appears as
pseudocirrhosis
what is schistosomiasis?
most common parasitic infection in humans that is a major cause of PHTN worldwide
another name for schistosomiasis
Bilhatziasis
what is the most common primary malignant liver tumor in children?
hepatoblastoma
hepatoblastoma is common in boys younger than ____
5 years old
there is an increased risk of hepatoblastoma with (2)
Beckwith-Wiedemann syndrome
Wilm’s tumor
normal PV velocity
20 to 40 cm/s
normal RI of hepatic artery
0.5 to 0.8
TIPS is most often placed between the
RPV and RHV
normal velocity within a TIPS
90 to 190 cm/s
what is an anastomosis?
surgical connection between two structures
what is the most common complication of a liver transplant?
HA thrombosis
liver trauma is mostly in the ____ side of the liver and is very common in ____
right side of the liver
very common in children
decrease _____ is associated with liver trauma
hematocrit
liver trauma is better viewed with
CT
3 types of liver trauma
- rupture of liver and capsule (perihepatic, intraperitoneal hematoma)
- separation of capsule (subcapsular hematoma)
- central rupture (intraparenchymal hematoma)
what is caput medusa?
cluster of swollen veins in the abdomen
the RHA may originate (replaced) from the ____
SMA
a replaced RHA is seen posterior to the ___ and ____
head of pancreas
MPV
high resistance HA waveform suggests (2)
venous congestion of the liver
organ rejection
____ is the most common source of pyogenic liver abscess
biliary tract disease
____ is needed to confirm pyogenic abscess diagnosis
aspiration
amebic abscess of the liver occurs almost exclusively in ___ or ___
immigrants or travelers
(not that common in the US)
fatty liver disease is also known as
steatosis
normal PV pressure
5 to 10 mmHg
TIPS are created to avoid the development or rupture of ____ and reducing the accumulation of ____
avoid the development or rupture of gastroesophageal varices
reducing the accumulation of ascites
with a wide patent TIPS, the RPV and LPV should demonstrate ____ flow
hepatofugal
criteria for TIPS malfunction (5)
low shunt velocity (50 cm/sec)
high shunt velocity (>190 cm/sec)
hepatopetal LPV or RPV
hepatofugal MPV
absent shunt flow
with a recanalized umbilical vein,
the flow direction of the ____ may be in either direction
LPV
____ is an indication for liver transplant in children
biliary atresia
what is MELD?
Model for End-Stage Liver Disease
score derived from a formula that uses a patient’s bilirubin, creatine, and INR
high score = closer to needing a transplant
what is cavernous transformation?
numerous worm-like venous collaterals that parallel the thrombosed PV
usually seen with benign causes of PV thrombosis
in infants, intrahepatic PV gas is due to ____
necrotizing entercolitis
what is METAVIR used for?
elastography assessment of liver fibrosis
an increase in AST without ALT, is seen with ____
myocardial infarction
