Liver Pathology Flashcards
What is the effect of fatty infiltration on LFTs?
Increased alkaline phosphatase, increased bilirubin
What is the effect of acute/chronic hepatitis on LFTs?
Increased alanine transaminase, increased aspartate transaminase, increased bilirubin
What is the effect of cirrhosis on LFTs?
Increased ALT, increased ALP, increased AST, increased bili
What is the effect of glycogen storage disease on LFTs?
Increased lactic acid dehydrogenase
What is fatty infiltration?
- Acquired, reversible condition
- accumulation/deposit of fatty triglycerides within hepatocytes
What are risk factors of fatty infiltration?
- obesity
- hypertension
- diabetes
- high cholesterol
What is the Sonographic appearance of fatty infiltration?
- normal size, hepatomegaly
- diffuse or focal increase in parenchymal echogenicity
- fatty focal sparing
- impaired visualization of hepatic vessels
What is focal sparing?
Small unaffected area in a fatty liver which appears hypoechoic
What are the signs and symptoms of hepatitis?
Chronic: variable due to duration/severity, persisting 3-6 months
Acute:
- elevated LFTs
- jaundice
- hepatomegaly
- RUQ pain
- fever
What is the sono appearance of chronic hepatitis?
- increased echogenicity
- coarse
- hypo PV walls
- portal HTN
- associated with cirrhotic appearance
What is the sono appearance of acute hepatitis?
- may look normal
- decreased echogenicity
- echogenic PV walls “starry sky”
- hepatomegaly
- GB wall thickening
What is the treatment for hepatitis C?
Antivirals
What is cirrhosis?
- irreversible, chronic degenerative disease
- progressive fibrosis
- parenchymal necrosis
- infiltration of fat
What are S&S of cirrhosis?
- abnormal LFTs
- jaundice
- hepatomegaly
- portal HTN
What is the sono app of early cirrhosis?
- hepatomegaly
- fatty infiltration
- surface nodularity
What is the sono app of late cirrhosis?
- small heterogenous liver
- caudate lobe enlargement with IVC compression
- coarse texture with surface nodularity
What is a common side effect of cirrhosis?
Ascites
Cirrhosis is associated with the development of what other liver patho?
Hepatocellular carcinoma
What is portal hypertension?
Increased pressure within portal venous system caused by increased resistance
What are S&S of portal HTN?
- asymptomatic
- can have symptoms due to enlarged & bleeding veins
Ex. Blood in vomit/stool, edema in lower extremities
What is the sono app of portal HTN?
- increased PV diameter
- abnormal Doppler flow
- development of collaterals
- ascites
- splenomegaly
What are some pathologies portal HTN is associated with?
Cirrhosis, schistosomiasis, blood clots
What is hemachromatosis?
Abnormal iron metabolism causing excess iron deposits throughout body
What are S&S of hemachromatosis?
- abdominal pain
- liver failure
- bronze/gray skun
What is the sono app of hemachromatosis?
not distinguishable
Hemachromatosis is highly associated with developing what pathos?
Cirrhosis and portal HTN
What is Budd-Chiari syndrome?
Serious illness caused by thrombus or obstruction within hepatic veins or IVC
What are S&S of BCS?
- abdominal pain
- vomiting
- diarrhea
- severe ascites
- jaundice
- hepato-splenomegaly
What is the sono app of BCS?
- enlarged caudate, atrophic right lobe
- thrombus in hepatic vessels
- initially hypo
- later hyper, hetero, hepatic vessels not seen
How does obstruction of vessels occur in BCS?
When there is a membranous web covering the IVC at the junction of the hepatics
What is glycogen storage disease?
Large amounts of glycogen deposits in the liver, highly sensitive to enzyme defects
What are S&S of glycogen storage disease?
Depends on LFTs
What is the sono app of glycogen storage disease?
- increased echogenicity
- hepatomegaly
- possible adenoma
- possible FNH
What is a Pyogenic abscess?
Bacterial abscess, localized collection of pus
What are S&S of Pyogenic abscess?
- fever
- N/V/D
- pain
- pleuritic pain
- leukocytosis
- elevated LFTs
- anemia
What is the sono app of a Pyogenic abscess?
- usually in R lobe
- solitary
- round or ovoid
- irregular
- poorly defined walls
- variable echogenicity due to pus
- micro bubbles
- calcs during healing
- posterior enhancement
How is a Pyogenic abscess treated?
Aspiration/drainage of fluid and antibiotics
What is an amebic abscess?
Parasitic abscess, localized cavity caused by Entamoeba parasite
What are S&S of amebic abscesses?
- pain
- diarrhea
- leukocytosis
- abnormal LFTs
What is the sono app of an amebic abscess?
- variable echogenicity
- located along liver capsule
- round/ovoid
- possible enhancement
What could differentiate an amebic abscess?
Could possibly see motion from parasite
What is schistosomiasis?
Parasitic worm aka snail fever
What are S&S of schistosomiasis?
- mainly affects liver & urinary system
What is the sono app of schistosomiasis?
- tubular
- echogenic structure
- variable
How does a person become infected with schistosomiasis?
When skin comes into direct contact with contaminated water
What is hepatic candidiasis?
An infectious, fungal disease caused by candida, fungus invades bloodstream and reaches liver
What are S&S of hepatic candidiasis?
Persistent fever, neutropenic patient with increasing WBCs
What is the sono app of hepatic candidiasis?
- multiple small hypo masses with echogenic centers
- bullseye or wheel within wheel appearance
What is an echinococcal cyst?
Infectious, cystic disease in sheep-herding parts of the world
What is the sono app of echinococcal cyst?
- round w possible calcs
- septations with honeycomb appearance
- water lily or cyst within a cyst
What is a parent and daughter cyst?
Parent: new, separate lesion
Daughter: cystic protrusion within parent lesion
What is echinococcal cyst also called?
Hyatid cyst
How does a person get an echinococcal cyst?
Tapeworm lives in small intestine of dogs, eggs in feces are ingested by humans
What is a neoplasm?
any new growth of tissue, either benign or malignant
What is the appearance of a benign neoplasm?
- grows focally, does not spread
- may compress or displace adjacent structures/tissues
What is a cavernous hemangioma?
a large, blood filled cystic space
Who are cavernous hemangiomas more common in?
females
What is the sono app of cavernous hemangioma?
- round, hyper, homogenous
- < 3 cm
- common to have multiple
- posterior enhancement
- possible degeneration, fibrosis, calcs
What is focal nodular hyperplasia?
- comprised of Kupffer cells, hepatocytes, biliary structures
- lacks normal hepatic triads and veins
- hyperplastic lesions arise from an area of congenital vascular malformation
Who is FNH more common in?
women under 40, hormone drive pathology
What is the sono app of FNH?
- 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
What is hepatocellular carcinoma?
- primary cancer
- highly invasive
- can produce BCS
Who is HCC more common in?
- males
- Africa, Japan, SE Asia, Italy, Greece
What are S&S of HCC?
- palp mass
- hepatomegaly
- loss of appetite
- fever
What is sono app of HCC?
- solitary or multiple
- hypo, hyper, iso
- thin peripheral hypo halo
- diffuse parenchymal heterogeneity w/o distinct mass
HCC is strongly associated with what other liver pathos?
Chronic liver disease ex.
- Hep B, C, cirrhosis
Aflatoxin exposure
Hepatocarcinogens in food
What is hepatoblastoma?
Infantile version of HCC
Who does hepatoblastoma affect?
Children under 4, majority under 1
What is sono app of hepatoblastoma?
- 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
What are mets to liver?
spread of primary cancer from another part of body to the liver, travels via invaded lymph channels
What are S&S of mets to liver?
- abnormal LFTs
- jaundice
- weight loss
- loss of appetite
- hepatomegaly
What is the sono app of mets to liver?
variable, “bullseye”
Ex:
- well-defined hypo mass
- well-defined echogenic mass
- diffuse distortion of normal tissue w/o mass
hypovascular
typically multiple lesions
Where do mets to liver most often come from?
Colon, breasts, lungs
Where does HCC often metastasize to?
pancreas, stomach, esophagus
What values are checked on LFT?
- alanine transaminase ALT
- aspartate transaminase AST
- alkaline phosphatase ALP
- bilirubin
- lactic acid dehydrogenase LDH
- prothrombin time
- alpha-feto protein
