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Small Parts > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

What is the effect of fatty infiltration on LFTs?

A

Increased alkaline phosphatase, increased bilirubin

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2
Q

What is the effect of acute/chronic hepatitis on LFTs?

A

Increased alanine transaminase, increased aspartate transaminase, increased bilirubin

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3
Q

What is the effect of cirrhosis on LFTs?

A

Increased ALT, increased ALP, increased AST, increased bili

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4
Q

What is the effect of glycogen storage disease on LFTs?

A

Increased lactic acid dehydrogenase

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5
Q

What is fatty infiltration?

A
  • Acquired, reversible condition
  • accumulation/deposit of fatty triglycerides within hepatocytes
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6
Q

What are risk factors of fatty infiltration?

A
  • obesity
  • hypertension
  • diabetes
  • high cholesterol
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7
Q

What is the Sonographic appearance of fatty infiltration?

A
  • normal size, hepatomegaly
  • diffuse or focal increase in parenchymal echogenicity
  • fatty focal sparing
  • impaired visualization of hepatic vessels
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8
Q

What is focal sparing?

A

Small unaffected area in a fatty liver which appears hypoechoic

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9
Q

What are the signs and symptoms of hepatitis?

A

Chronic: variable due to duration/severity, persisting 3-6 months
Acute:
- elevated LFTs
- jaundice
- hepatomegaly
- RUQ pain
- fever

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10
Q

What is the sono appearance of chronic hepatitis?

A
  • increased echogenicity
  • coarse
  • hypo PV walls
  • portal HTN
  • associated with cirrhotic appearance
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11
Q

What is the sono appearance of acute hepatitis?

A
  • may look normal
  • decreased echogenicity
  • echogenic PV walls “starry sky”
  • hepatomegaly
  • GB wall thickening
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12
Q

What is the treatment for hepatitis C?

A

Antivirals

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13
Q

What is cirrhosis?

A
  • irreversible, chronic degenerative disease
  • progressive fibrosis
  • parenchymal necrosis
  • infiltration of fat
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14
Q

What are S&S of cirrhosis?

A
  • abnormal LFTs
  • jaundice
  • hepatomegaly
  • portal HTN
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15
Q

What is the sono app of early cirrhosis?

A
  • hepatomegaly
  • fatty infiltration
  • surface nodularity
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16
Q

What is the sono app of late cirrhosis?

A
  • small heterogenous liver
  • caudate lobe enlargement with IVC compression
  • coarse texture with surface nodularity
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17
Q

What is a common side effect of cirrhosis?

A

Ascites

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18
Q

Cirrhosis is associated with the development of what other liver patho?

A

Hepatocellular carcinoma

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19
Q

What is portal hypertension?

A

Increased pressure within portal venous system caused by increased resistance

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20
Q

What are S&S of portal HTN?

A
  • asymptomatic
  • can have symptoms due to enlarged & bleeding veins
    Ex. Blood in vomit/stool, edema in lower extremities
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21
Q

What is the sono app of portal HTN?

A
  • increased PV diameter
  • abnormal Doppler flow
  • development of collaterals
  • ascites
  • splenomegaly
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22
Q

What are some pathologies portal HTN is associated with?

A

Cirrhosis, schistosomiasis, blood clots

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23
Q

What is hemachromatosis?

A

Abnormal iron metabolism causing excess iron deposits throughout body

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24
Q

What are S&S of hemachromatosis?

A
  • abdominal pain
  • liver failure
  • bronze/gray skun
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25
Q

What is the sono app of hemachromatosis?

A

not distinguishable

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26
Q

Hemachromatosis is highly associated with developing what pathos?

A

Cirrhosis and portal HTN

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27
Q

What is Budd-Chiari syndrome?

A

Serious illness caused by thrombus or obstruction within hepatic veins or IVC

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28
Q

What are S&S of BCS?

A
  • abdominal pain
  • vomiting
  • diarrhea
  • severe ascites
  • jaundice
  • hepato-splenomegaly
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29
Q

What is the sono app of BCS?

A
  • enlarged caudate, atrophic right lobe
  • thrombus in hepatic vessels
  • initially hypo
  • later hyper, hetero, hepatic vessels not seen
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30
Q

How does obstruction of vessels occur in BCS?

A

When there is a membranous web covering the IVC at the junction of the hepatics

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31
Q

What is glycogen storage disease?

A

Large amounts of glycogen deposits in the liver, highly sensitive to enzyme defects

32
Q

What are S&S of glycogen storage disease?

A

Depends on LFTs

33
Q

What is the sono app of glycogen storage disease?

A
  • increased echogenicity
  • hepatomegaly
  • possible adenoma
  • possible FNH
34
Q

What is a Pyogenic abscess?

A

Bacterial abscess, localized collection of pus

35
Q

What are S&S of Pyogenic abscess?

A
  • fever
  • N/V/D
  • pain
  • pleuritic pain
  • leukocytosis
  • elevated LFTs
  • anemia
36
Q

What is the sono app of a Pyogenic abscess?

A
  • usually in R lobe
  • solitary
  • round or ovoid
  • irregular
  • poorly defined walls
  • variable echogenicity due to pus
  • micro bubbles
  • calcs during healing
  • posterior enhancement
37
Q

How is a Pyogenic abscess treated?

A

Aspiration/drainage of fluid and antibiotics

38
Q

What is an amebic abscess?

A

Parasitic abscess, localized cavity caused by Entamoeba parasite

39
Q

What are S&S of amebic abscesses?

A
  • pain
  • diarrhea
  • leukocytosis
  • abnormal LFTs
40
Q

What is the sono app of an amebic abscess?

A
  • variable echogenicity
  • located along liver capsule
  • round/ovoid
  • possible enhancement
41
Q

What could differentiate an amebic abscess?

A

Could possibly see motion from parasite

42
Q

What is schistosomiasis?

A

Parasitic worm aka snail fever

43
Q

What are S&S of schistosomiasis?

A
  • mainly affects liver & urinary system
44
Q

What is the sono app of schistosomiasis?

A
  • tubular
  • echogenic structure
  • variable
45
Q

How does a person become infected with schistosomiasis?

A

When skin comes into direct contact with contaminated water

46
Q

What is hepatic candidiasis?

A

An infectious, fungal disease caused by candida, fungus invades bloodstream and reaches liver

47
Q

What are S&S of hepatic candidiasis?

A

Persistent fever, neutropenic patient with increasing WBCs

48
Q

What is the sono app of hepatic candidiasis?

A
  • multiple small hypo masses with echogenic centers
  • bullseye or wheel within wheel appearance
49
Q

What is an echinococcal cyst?

A

Infectious, cystic disease in sheep-herding parts of the world

50
Q

What is the sono app of echinococcal cyst?

A
  • round w possible calcs
  • septations with honeycomb appearance
  • water lily or cyst within a cyst
51
Q

What is a parent and daughter cyst?

A

Parent: new, separate lesion
Daughter: cystic protrusion within parent lesion

52
Q

What is echinococcal cyst also called?

A

Hyatid cyst

53
Q

How does a person get an echinococcal cyst?

A

Tapeworm lives in small intestine of dogs, eggs in feces are ingested by humans

54
Q

What is a neoplasm?

A

any new growth of tissue, either benign or malignant

55
Q

What is the appearance of a benign neoplasm?

A
  • grows focally, does not spread
  • may compress or displace adjacent structures/tissues
56
Q

What is a cavernous hemangioma?

A

a large, blood filled cystic space

57
Q

Who are cavernous hemangiomas more common in?

A

females

58
Q

What is the sono app of cavernous hemangioma?

A
  • round, hyper, homogenous
  • < 3 cm
  • common to have multiple
  • posterior enhancement
  • possible degeneration, fibrosis, calcs
59
Q

What is focal nodular hyperplasia?

A
  • comprised of Kupffer cells, hepatocytes, biliary structures
  • lacks normal hepatic triads and veins
  • hyperplastic lesions arise from an area of congenital vascular malformation
60
Q

Who is FNH more common in?

A

women under 40, hormone drive pathology

61
Q

What is the sono app of FNH?

A
  • solitary or multiple well-defined lesions
  • iso to liver
  • subtle contour abnormalities
  • central hypo area
  • typically along subcapsular area
  • <5 cm, may displace tissue or vessels
  • peripheral or central vessels creating spoke-wheel app
62
Q

What is hepatocellular carcinoma?

A
  • primary cancer
  • highly invasive
  • can produce BCS
63
Q

Who is HCC more common in?

A
  • males
  • Africa, Japan, SE Asia, Italy, Greece
64
Q

What are S&S of HCC?

A
  • palp mass
  • hepatomegaly
  • loss of appetite
  • fever
65
Q

What is sono app of HCC?

A
  • solitary or multiple
  • hypo, hyper, iso
  • thin peripheral hypo halo
  • diffuse parenchymal heterogeneity w/o distinct mass
66
Q

HCC is strongly associated with what other liver pathos?

A

Chronic liver disease ex.
- Hep B, C, cirrhosis
Aflatoxin exposure
Hepatocarcinogens in food

67
Q

What is hepatoblastoma?

A

Infantile version of HCC

68
Q

Who does hepatoblastoma affect?

A

Children under 4, majority under 1

69
Q

What is sono app of hepatoblastoma?

A
  • solitary, solid, large
  • mixed echogenicity due to necrosis or hemorrhage
  • poorly marginated
  • can have small cysts or irregular calcium deposits
  • does not show diffuse infiltration
70
Q

What are mets to liver?

A

spread of primary cancer from another part of body to the liver, travels via invaded lymph channels

71
Q

What are S&S of mets to liver?

A
  • abnormal LFTs
  • jaundice
  • weight loss
  • loss of appetite
  • hepatomegaly
72
Q

What is the sono app of mets to liver?

A

variable, “bullseye”
Ex:
- well-defined hypo mass
- well-defined echogenic mass
- diffuse distortion of normal tissue w/o mass

hypovascular
typically multiple lesions

73
Q

Where do mets to liver most often come from?

A

Colon, breasts, lungs

74
Q

Where does HCC often metastasize to?

A

pancreas, stomach, esophagus

75
Q

What values are checked on LFT?

A
  • alanine transaminase ALT
  • aspartate transaminase AST
  • alkaline phosphatase ALP
  • bilirubin
  • lactic acid dehydrogenase LDH
  • prothrombin time
  • alpha-feto protein

Small Parts (13 decks)

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