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ARDMS ABD PATHOLOGY > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

T/F: fatty infiltration affects the entire liver parenchyma

A

TRUE

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2
Q

is fatty infiltration a reversible disease?

A

yes

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3
Q

causes of fatty infiltration (7)

A
  1. obesity
  2. chronic alcohol abuse
  3. pregnancy
  4. medication
  5. severe hepatitis
  6. glycogen storage disease
  7. chemotherapy
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4
Q

fatty infiltration can be divided into ___ categories

A

3
mild, moderate and severe

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5
Q

severe (grade III) fatty infiltration usually cause abnormal LFTs such as ____ and ____ levels

A

AST and ALT

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6
Q

what are the 2 most common causes of severe (grade III) fatty infiltration?

A

obesity and alcohol abuse

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7
Q

patients with fatty infiltration usually are ______

A

asymptomatic

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8
Q

some patients with fatty infiltration present with (4)

A

jaundice
nausea
vomiting
abdominal tenderness

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9
Q

size of a liver with fatty infiltration

A

normal to enlarged

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10
Q

________ is when there are focal areas of fat deposits and the rest of the liver is normal

A

focal fatty infiltration

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11
Q

focal fatty infiltration is most common seen at the (3)

A

porta hepatis
GB area
medial segment of the LLL

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12
Q

focal fatty infiltration may mimic as a _____

A

neoplasm (abnormal tissue growth)

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13
Q

a small area of normal liver parenchyma not affected by fatty infiltration

A

focal fatty sparing

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14
Q

focal fatty sparing is commonly seen ______ to the porta hepatis, GB area, & medial segment of the LLL

A

adjacent

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15
Q

ultrasound appearance of focal fatty sparing

A

hypoechoic masses within a dense fatty infiltrated liver

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16
Q

focal fatty sparing may mimic ____ and _____

A

neoplasm
pericholecystic fluid {abnormal fluid collection around the GB}

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17
Q

what is hepatitis?

A

swelling and inflammation of the liver

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18
Q

hepatitis can be cause by (2)

A

infectious
noninfectious agents

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19
Q

what are some examples of infectious agents? (4)

A

viral
bacterial
fungal
parasitic

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20
Q

what are some examples of noninfectious agents? (3)

A

medications
toxins
autoimmune disorders

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21
Q

what are the 2 most common forms of hepatitis?

A

Hep A and Hep B

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22
Q

how does hepatitis A spread?

A

fecal-oral route in contaminated water or food

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23
Q

how does hepatitis B spread?

A

contact with contaminated bodily fluids

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24
Q

how does hepatitis C spread?

A

most commonly through exposure to infected blood

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25
Q

viral hepatitis may be fatal with ____ or _____

A

secondary acute hepatic necrosis or chronic hepatitis

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26
Q

hepatitis can lead to (3)

A

cirrhosis
PHTN
HCC

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27
Q

Hep ____ has the highest risk for the development of HCC

A

Hep C

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28
Q

acute hepatitis lasts for

A

less than 6 months

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29
Q

8 signs/symptoms of acute hepatitis

A
  1. fever
  2. chills
  3. increase WBC
  4. jaundice
  5. anorexia
  6. nausea
  7. fatigue
  8. hepatomegaly
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30
Q

increased lab values for acute hepatitis (3)

A

AST
ALT
indirect (unconjugated) bilirubin

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31
Q

in severe cases of acute hepatitis, conjugated bilirubin increases ____

A

LDH

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32
Q

ultrasound appearance of acute hepatitis (9)

A
  1. normal to enlarged liver
  2. decreased echogenicity
  3. increased blood vessels visualization
  4. periportal cuffing
  5. “Starry sky” sign
  6. extensive demonstration of PV radicles
  7. GB wall thickening
  8. liver abscess
  9. splenomegaly
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33
Q

T/F: chronic hepatitis is reversible

A

FALSE

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34
Q

chronic hepatitis usually progresses to (3)

A

cirrhosis, liver failure, HCC

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35
Q

chronic liver disease caused by Hep C is the most frequent indication for

A

liver transplant

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36
Q

signs/symptoms of chronic hepatitis (2)

A

fatigue and jaundice

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37
Q

ultrasound appearance of chronic hepatitis (4)

A
  1. decrease liver size
  2. increase echogenicity
  3. decrease visualization of blood vessels
  4. coarse liver texture
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38
Q

what is cirrhosis?

A

liver cell death with subsequent regenerating nodules

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39
Q

T/F: cirrhosis is reversible

A

FALSE

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40
Q

what is the #1 cause of cirrhosis?

A

alcohol abuse

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41
Q

what is the #2 cause of cirrhosis?

A

Hep C

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42
Q

what are other causes of cirrhosis? (5)

A

obstruction
drug abuse
cholangitis
hemochromatosis
Wilson’s disease

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43
Q

what is hemochromatosis?

A

too much iron

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44
Q

what is Wilson’s disease?

A

too much copper

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45
Q

8 signs/symptoms of cirrhosis

A
  1. hepatomegaly (caudate lobe)
  2. ascites (Morison’s pouch)
  3. splenomegaly
  4. hepatic encephalopathy
  5. nausea
  6. anorexia/weight loss
  7. dark urine
  8. fatigue
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46
Q

complications of cirrhosis (7)

A
  1. sequela
  2. PHTN
  3. splenomegaly
  4. ascites
  5. HCC
  6. monophasic flow HV
  7. hepatofugal flow PV
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47
Q

what is the #1 cause of PHTN?

A

cirrhosis

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48
Q

4 signs/symptoms of PHTN

A
  1. hematemesis
  2. hepatic encephalopathy
  3. caput medusa
  4. tremors
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49
Q

most common ultrasound finding in PHTN

A

recanalization of the paraumbilical vein

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50
Q

with PHTN, varicosities are found around (3)

A

splenic hilum, renal hilum, GE junction

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51
Q

PV diameter when there is PHTN

A

greater than 13mm

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52
Q

SMV diameter with PHTN

A

greater than 10mm

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53
Q

Budd Chiari can be secondary to (7)

A
  1. congenital webbing disorder
  2. coagulation abnormalities
  3. tumor invasion from HCC
  4. thrombosis
  5. oral contraceptive use
  6. pregnancy
  7. trauma
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54
Q

ultrasound appearance of Budd Chiari (3)

A

decreased visualization of HV
enlarged caudate lobe
narrowing of IVC

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55
Q

another name for Von Gierke’s Disease

A

glycogen storage disease

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56
Q

what is von gierke’s disease?

A

large amounts of glycogen deposits in the liver and kidneys

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57
Q

von gierke’s disease is associated with ___

A

adenomas

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58
Q

hemochromatosis may lead to ___ and ____

A

cirrhosis and PHTN

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59
Q

another name for Wilson’s disease

A

hepatolenticular degeneration

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60
Q

key sign/symptom of Wilson’s disease

A

brown/rusty colored ring around the eye

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61
Q

hepatic cysts are often associated with ____

A

ADPKD

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62
Q

hepatic cysts are common on the

A

right lobe of the liver

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63
Q

another name for hydatid cysts

A

echinococcal cyst

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64
Q

what is echinococcus granulosus?

A

tapeworm that lives in dog feces
causes hydatid cysts

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65
Q

hydatid cysts have a high prevalence in

A

sheep and cattle raising countries

66
Q

ultrasound appearance of hydatid cysts (4)

A

anechoic with some debris
water lily sign
mother and daughter cysts
some elements of dense calcification

67
Q

5 signs/symptoms of hydatid cysts

A

leukocytosis
low grade fever
nausea
jaundice
RUQ tenderness

68
Q

rupture of a hydatid cyst can lead to

A

anaphylactic shock

69
Q

what is Entamoeba histolytica?

A

parasite that causes amebic hepatic abscesses

70
Q

ultrasound appearance of amebic abscess (3)

A

round, hypoechoic to anechoic mass
may contain debris
acoustic enhancement

71
Q

signs/symptoms of amebic hepatic abscess (6)

A

hepatomegaly
RUQ pain
general malaise
signs of dysentery
bloody diarrhea
fever

72
Q

amebic hepatic abscess most often are seen where?

A

right lobe of the liver

73
Q

amebic hepatic abscess is indistinguishable from _____ and therefore require _______ confirmation

A

indistinguishable from pyogenic hepatic abscess
require serologic confirmation

74
Q

what causes a pyogenic abscess?

A

result from the spread of infection from inflammatory conditions

75
Q

ultrasound appearance of pyogenic hepatic abscess (2)

A

complex cyst with thick walls
air/gas may produce dirty shadowing or ring-down artifact

76
Q

signs/symptoms of a pyogenic hepatic abscess (4)

A

fever
hepatomegaly
leukocytosis
RUQ pain

77
Q

what causes hepatic candidiasis?

A

fungus called Candida albicans

78
Q

hepatic candidiasis occurs mostly in

A

immunocompromised patients

79
Q

ultrasound appearance of hepatic candidiasis

A

target, halo, or bulls eye
older lesions may calcify

80
Q

signs/symptoms of hepatic candidiasis (3)

A

RUQ pain
fever
hepatomegaly

81
Q

polycystic liver is an inherited _______

A

autosomal dominant disease

82
Q

50% of patients with polycystic liver will also have

A

polycystic renal, pancreas, and spleen disease

83
Q

ultrasound appearance of polycystic liver disease (3)

A

anechoic
well-defined borders
acoustic enhancement

84
Q

T/F: a patient with polycystic liver disease usually is asymptomatic

A

true

85
Q

T/F: polycystic liver disease causes abnormal LFTs

A

FALSE - normal LFTs

86
Q

what is the most common benign tumor of the liver?

A

hemangioma

87
Q

hemangiomas are more common in ___ because they are stimulated by ____

A

more common in females
stimulated by estrogen

88
Q

hemangiomas mostly occur where?

A

right lobe of the liver

89
Q

ultrasound appearance of hemangiomas (3)

A

hyperechoic mass less than 3cm
posterior enhancement may be seen (slice thickness artifact = blood vessels are smaller than beam size)
no color flow

90
Q

larger hemangiomas may appear _____ and be indistinguishable from _____

A

heterogenous and hypoechoic
metastatic liver disease

91
Q

how do you distinguish a hemangioma from malignant tumor?

A

core biopsy

92
Q

T/F: hemangiomas usually don’t cause any symptoms

A

true

93
Q

what is a lipoma?

A

benign lesion composed of fat cells

94
Q

lipomas are extremely ____ and are indistinguishable from (3)

A

extremely rare
indistinguishable from hemangiomas, focal fatty infiltration, echogenic mass

95
Q

ultrasound appearance of lipomas (2)

A

well defined echogenic mass
propagation speed artifact

96
Q

what is the most common benign liver tumor in children?

A

infantile hemangioendothelioma

97
Q

85% of infantile hemangioendothelioma occur before ___ months of age

A

6 months

98
Q

children with infantile hemangioendothelioma usually present with _____ early in life due to _____ within the tumor

A

cardiac failure
AVM within the tumor

99
Q

infantile hemangioendothelioma spontaneously regresses in most patients before age ____

A

2 years old

100
Q

what is the second most common benign liver tumor?

A

focal nodular hyperplasia (FNH)

101
Q

FNH is thought to be a hyperplastic response to a ____

A

congenital AVM

102
Q

______ may enlarge FNH

A

oral contraceptives

103
Q

ultrasound appearance of FNH (2)

A

homogenous
hypervascular star-like scar*

104
Q

FNH is referred to as a

A

stealth lesion

105
Q

what is an adenoma?

A

rare benign tumor that grows rapidly

106
Q

hepatocellular adenomas are associated with (3)

A

oral contraceptive use
men using steroids
von gierke’s disease

107
Q

liver cell adenomas have a tendency to

A

rupture and hemorrhage

108
Q

adenomas have a propensity to become _____

A

malignant
called malignant degeneration

109
Q

what is hepatic congestion?

A

diffuse venous congestion within the liver that results from right-sided heart failure

110
Q

ultrasound appearance of hepatic congestion (4)

A

hepatomegaly
splenomegaly
dilated IVC, HV, PV
ascites

111
Q

what are hepatic granulomas?

A

benign liver masses associated with inflammatory liver diseases

112
Q

what are the 2 most common causes of hepatic granulomas?

A

histoplasmosis and tuberculosis

113
Q

what is pneumocystis carini?

A

most common organism causing infection in AIDS patients

114
Q

ultrasound appearance hepatic granulomas?

A

diffuse echogenic foci within the liver

115
Q

another name for HCC

A

hepatoma

116
Q

what is the most common primary form of liver cancer

A

HCC

117
Q

HCC is very common in patients with

A

cirrhosis and Hep C

118
Q

HCC has the tendency to (3)

A

destroy PV walls
invade HV
produce Budd-Chiari syndrome

119
Q

ultrasound appearance of HCC (5)

A

solitary, hypoechoic mass
heterogeneous masses scattered throughout
halo sign
ascites
hypervascular

120
Q

signs/symptoms of HCC (3)

A

unexplained weight loss
hepatomegaly
palpable mass

121
Q

HCC causes elevated

A

AFP

122
Q

80% of patients with ____ develop HCC

A

cirrhosis

123
Q

what is the most common form of liver cancer?

A

hepatic metastasis

124
Q

where are the primary sites of cancer for hepatic metastasis? (5)

A

gallbladder
GI tract (stomach and colon)
pancreas
breast
lung (most common)

125
Q

hepatic metastasis from the GI tract and pancreas tend to appear as

A

calcified tumors

126
Q

hypoechoic masses of hepatic metastasis may be from (3)

A

breast
lung
lymphoma

127
Q

diffuse hepatic metastasis appears as

A

pseudocirrhosis

128
Q

what is schistosomiasis?

A

most common parasitic infection in humans that is a major cause of PHTN worldwide

129
Q

another name for schistosomiasis

A

Bilhatziasis

130
Q

what is the most common primary malignant liver tumor in children?

A

hepatoblastoma

131
Q

hepatoblastoma is common in boys younger than ____

A

5 years old

132
Q

there is an increased risk of hepatoblastoma with (2)

A

Beckwith-Wiedemann syndrome
Wilm’s tumor

133
Q

normal PV velocity

A

20 to 40 cm/s

134
Q

normal RI of hepatic artery

A

0.5 to 0.8

135
Q

TIPS is most often placed between the

A

RPV and RHV

136
Q

normal velocity within a TIPS

A

90 to 190 cm/s

137
Q

what is an anastomosis?

A

surgical connection between two structures

138
Q

what is the most common complication of a liver transplant?

A

HA thrombosis

139
Q

liver trauma is mostly in the ____ side of the liver and is very common in ____

A

right side of the liver
very common in children

140
Q

decrease _____ is associated with liver trauma

A

hematocrit

141
Q

liver trauma is better viewed with

A

CT

142
Q

3 types of liver trauma

A
  1. rupture of liver and capsule (perihepatic, intraperitoneal hematoma)
  2. separation of capsule (subcapsular hematoma)
  3. central rupture (intraparenchymal hematoma)
143
Q

what is caput medusa?

A

cluster of swollen veins in the abdomen

144
Q

the RHA may originate (replaced) from the ____

A

SMA

145
Q

a replaced RHA is seen posterior to the ___ and ____

A

head of pancreas
MPV

146
Q

high resistance HA waveform suggests (2)

A

venous congestion of the liver
organ rejection

147
Q

____ is the most common source of pyogenic liver abscess

A

biliary tract disease

148
Q

____ is needed to confirm pyogenic abscess diagnosis

A

aspiration

149
Q

amebic abscess of the liver occurs almost exclusively in ___ or ___

A

immigrants or travelers

(not that common in the US)

150
Q

fatty liver disease is also known as

A

steatosis

151
Q

normal PV pressure

A

5 to 10 mmHg

152
Q

TIPS are created to avoid the development or rupture of ____ and reducing the accumulation of ____

A

avoid the development or rupture of gastroesophageal varices
reducing the accumulation of ascites

153
Q

with a wide patent TIPS, the RPV and LPV should demonstrate ____ flow

A

hepatofugal

154
Q

criteria for TIPS malfunction (5)

A

low shunt velocity (50 cm/sec)
high shunt velocity (>190 cm/sec)
hepatopetal LPV or RPV
hepatofugal MPV
absent shunt flow

155
Q

with a recanalized umbilical vein,
the flow direction of the ____ may be in either direction

A

LPV

156
Q

____ is an indication for liver transplant in children

A

biliary atresia

157
Q

what is MELD?

A

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

158
Q

what is cavernous transformation?

A

numerous worm-like venous collaterals that parallel the thrombosed PV

usually seen with benign causes of PV thrombosis

159
Q

in infants, intrahepatic PV gas is due to ____

A

necrotizing entercolitis

160
Q

what is METAVIR used for?

A

elastography assessment of liver fibrosis

161
Q

an increase in AST without ALT, is seen with ____

A

myocardial infarction

ARDMS ABD PATHOLOGY (13 decks)

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