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Liver Pathology Flashcards

1
Q

Abnormal retention of lipids

A

Steatosis

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2
Q

In the general pathological process stress is created whenever there is the change in
If the source of stress is not removed what will happen

A

Environment internally or externally
Cell will go through degenerative changes eventually death

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3
Q

What happens during cellular adaptions

A

Changes the cell makes in order to adjust to stress

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4
Q

Enlargement of cells and increases BP requiring heart to do more work and leads to cardiomegaly

A

Hypertrophy

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5
Q

Increase in amount of cells and will increase demand

A

Hyperplasia

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6
Q

Decrease in cell size

A

Atrophy

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7
Q

Transformation of one cell type to a less specialized type

A

Metaplasia

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8
Q

What are 3 examples of cellular degenerations

A

Swelling
Fatty infiltration
Cell necrosis

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9
Q

Water accumulation within the cells

A

Swelling

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10
Q

Droplets of fat accumulates within cell and liver is often affected due to its role in fat metabolism

A

Fatty infiltration

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11
Q

Death of cells and enzymes are released that digest dead cells

A

Cell necrosis

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12
Q

What are 5 examples of liver pathology

A

Diffuse disease
Parenchyma abnormalities
Focal disease
Masses
Portal hypertension

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13
Q

What are 5 examples of diffuse hepatocellular disease

A

Fatty infiltration
Glycogen storage disease
Hemochromatosis
Hepatitis
Cirrhosis

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14
Q

Fatty infiltration is what type of disorder
Is an abnormal ? And can interfere with ?
Commonly seen on ?

A

Non-specific reversible metabolic disorder
Abnormal accumulation of fat within hepatocytes
Commonly seen in U/S

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15
Q

Fatty infiltration can be corrected by

A

Correction/treatment of primary problem will reverse the process

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16
Q

What are the causes of fatty infiltration

A

Obesity
Excessive alcohol consumption
Hyperlipidemia
Diabetes
Pregnancy
Chronic hepatitis
Cystic fibrosis
Chemotherapy

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17
Q

Diffuse fatty infiltration increases ?
And if difficult to?

A

Echogenicity and attenuation of sound beam
Visualize parenchyma, vessels and diaphragm

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18
Q

What does mild diffuse fatty infiltration look like sonographically

A

Mild increase in echogenicity

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19
Q

What does moderate diffuse fatty infiltration look like sonographically

A

Difficulty visualizing parenchyma and diaphragm

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20
Q

What does severe diffuse fatty infiltration look like sonographically

A

Marked increase in echoes, non-visualization of vessels diaphragm

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21
Q

In focal fatty infiltration there is an increase in
Usually occurs near
Might mimic
Can show rapid

A

Increase in focal area echogenicity
Near porta hepatis
Mimic neoplasm
Rapid change with time

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22
Q

The focal area in focal fatty sparing the liver
How does it appear sonographically
Commonly occurs in ___ near ___

A

Does not demonstrate fatty infiltration
Hypoechoic area within echogenic liver
Occurs in caudate lobe near porta hepatis

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23
Q

How can you differentiate focal fatty sparing and focal fatty infiltration

A

Look for mass effect
Normal TSC scan
Areas of low attenuation on CT scan

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24
Q

What is glycogen storage disease

A

Congenital enzyme deficiency affecting glycogen metabolism

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25
Glycogen storage disease has large amount of ? Has stunted ? ___ may lead to convulsions __% mortality
Large amount of glycogen deposited in hepatocytes and kidneys Stunted growth and platelet dysfunction Hypoglycemia may lead to convulsions 50% mortaility
26
GSD usually appears silimar to ? How does it appear similar
Similar to diffuse fatty infiltration By: - Hepatomegaly - Enalrged kidneys
27
GSD may also present what type of masses How do they appear sonographically
Focal solid masses (Adenomas) Round, echogenic, homogenous
28
Wha is hemochromatosis Who is more at risk What are these patients at higher risk for
Excessive accumulation of iron within the liver Males more at risk (7:1) Increased risk for HCC
29
T or F Hemochromatosis is not a hereditary disease
False Is a hereditary disease
30
How will hemochromatosis be seen on ultrasound
Diffuse increased echogenicity Attenuation with hepatomegaly Indistinguishable from fatty infiltration
31
What is the treatment for hemochromatosis
Weekly removal of the blood
32
For hemochromatosis with screening and early detection patients will
Have a normal life expectancy
33
What is hepatitis What is it caused by What can this lead to
Inflammation of hepatocytes Caused by various viruses, drugs, chemicals, and alcohol Lead to liver failure and death
34
What are the symptoms of hepatitis
Some will not exhibit clinical symptoms Loss of appetite Malaise Jaundice Abnormal LFT's
35
What are the types of hepatits
Drug induced A, B, C, D, E Acute Chronic
36
How is Hep A transmitted What is the recovery rate
Transmitted via fecal-oral route 99% recovery with antibodies
36
You can have hepatitis but still have a normal
Normal liver scan
37
Which types of hepatitis are transmitted via blood/body fluis
Hep B, C, and D
38
For Hep B, C, and D you can be a ? Can progress to ? Patients with these have increases risk of?
Can be a carrier and transmit to others Can progress to chronic liver failure Increased risk of HCC
39
You must have Hep ___ to get Hep B
Must get Hep D to get Hep B
40
Hep E is similar to ? Common in ? Transmitted via
Similar to Hep A Common in India, Asia, and Africa Transmitted via blood/body fluids
41
What is a characteristic of drug induced hepatitis
Clinically and histologically indistigushable from viral hepatitis
42
What are the clinically manifestations of hepatitis
Uncomplicated acute hepatitis Fulminant
43
Uncomplicated acute hepatitis have full ___ and usually result from
Full recovery Result of Hep A
44
What falls under the fulminant clinical manifestation for hepatitis
Hepatic failure (Possible death) Jaundice Coagulopathy Hepatic encephalopathy Chronic hepatitis
45
Most cases of hepatitis
Drug induced toxicity or Hep B
46
What is chronic hepatitis
Persistence of hepatitis for longer than 6 months
47
What is the treatment for hepatitis
Prognosis, treatment of chronic hepatits depends on the etiology
48
What is the sonographic acute hepatitis
Decreased echogenicity Increased brightness of portal triad walls (Starry sky appearance) Hepatomegaly GB wall thickening
49
What is the sonographic appearance of chronic hepatitis
Hepatic parenchyma progressively damaged Visualized as course texture, hetergenous, decreased size
50
Irreversible liver damage that replaces normal liver architecture with abnormal fibrosis nodules
Cirrhosis
51
With cirrhosis as hepatocytes attemot to regenerate ? Leads to ? Replacement of ?
They surround with fibrosis Leads to scarring of liver tissue Replacement with fibrotic nodules
52
What are the classifications of of cirrhosis by size of nodules What are the most common causes of these classifications
Micronodular <3 mm - Alcoholism Marconodular >3 mm - Chronic viral hepatitis
53
What are the causes of cirrhosis What percentage are these causes?
Alcoholic liver disease - 70% Viral hepatitis - 10% Biliary causes - 10% Hemochromatosis - 5% Other - 5%
54
What are the 3 types of alcoholic liver disease
Fatty infiltration Alcoholic hepatits Alcoholic cirrhosis
55
T or F: Fatty lnfiltration is irreversible
False Is reversible
56
Alcoholic hepatits may resolve or progress ? May not have ?
Chronic liver disease May not have any clinical symptoms
57
What is associated with alcoholic cirrhosis
Portal hypertension Ascites Jaundice
58
What are the clinical symptoms of alcoholic liver disease
Anorexia Indigestion Nausea/vomiting Diarrhea/constipation Abdominal pain Abnormal bleeding Edema/ascites Jaundice Fatigue Hepatic encephalopathy
59
When you have abnormal LFT's you could have an increase in? Decrease in?
I - PT time, AST/ALT, Bilirubin D - Total protein, albumin
60
What is primary biliary cirrhosis? Destructs? Causes what to the portal vein? Leads to ?
Chronic, progressive often fatal form of cirrhosis Destructs intrahepatic bile ducts Causes wall inflammation and scarring Leads to liver failure and itchy skin
61
What is secondary biliary cirrhosis
Periportal secondary to prolonged obstruction of an extrahepatic biliary tree
62
What are the sonographic findings of cirrhosis
Volume redistribution - Liver becomes small, shrunken with enlargement of the CL (CL/RL Ratio = 0.65) Course texture - Increased echogenicity, inhomogeneity
63
What are the sonographic patterns of cirrhosis
Nodular surface with easily visible with surrounding ascites Regeneration nodules may mimic neoplasm
64
What are the associated sonographic findings of secondary biliary cirrhosis
Ascites Pancreatitis Narrowed HV's, and/or IVC by nodular regeneration Portal hypertension recanalized in the umbilical vein Cirrhosis
65
T or F Ligamentum teres should not have blood in it
True
66
Bile pigment formed from the hemoglobin portion of destroyed RBC's
Bilirubin
67
Where does bilirubin happen in the body
Liver Spleen Bone marrows
68
Unconjugated/indirect bilirubin
Inital non-water soluble that must be carried through blood by albumin
69
Bilirubin is carried to the ___ and taken up by the ____
Carried by the liver and taken up by hepatocytes
70
Liver converts indirect bilirubin into
Direct/conjugated bilirubin
71
Hepatocytes secrete direct bilirubin into the ?
Secrete direct bilirubin into the bile canaliculi in the lobules
72
Jaundice has elevated levels of
bilirubin in the blood and tissues
73
What are the 2 types of jaundice
Medical/Non-obstructive and surgical/onstructinve jaundice
74
What are the characterisitcs associated with hemolytic jaundice
Abnormally large RBC's being destoryed Elevated indirect bilirubin Hepatocytes can't handle quantity
75
What is hepatocelluar jaundice What is elevated
Due to hepatocyte inflammation or fibrosis bile cannot properly be excreted into bile canaliculi Direct bilirubin is elevated
76
What is surgical jaundice What can cause it What is elevated
Obstruction of bile outflow Causes: - Stone in CBD - Mass in CBD, head of pancreas or duodenum - Inflammatory stricture Direct bilirubin is elevated
77
What are the parenchyma abnormalities
Proximal biliary obstruction Distal biliary obstruction Extrahepatic mass Common duct stricture Passive hepatic congestion
78
In the proximal biliary obstruction where is the obstruction located
Proximal to the cystic duct
79
What are the symptoms of proximal biliary obstruction
Jaundice Pruritis Elevated bilirubin and alk phos
80
What are the sonographic findings of proximal biliary obstruction
Normal GB even after food Dilated ducts in liver periphery
81
Where is the obstruction in a distal biliary obstruction located And what is the most common thing found in the common dust
Distal to the cystic duct Mass or stones
82
What are the symptoms of distal biliary obstruction
RUQ pain Jaundice Pruritis
83
What are the sonographic findings associated with distal biliary obstruction
Small GB Enlarged intrahepatic ducts Stones may be present in GB and/or duct
84
What is an extrahepatic mass
A mass in the area of the porta hepatis
85
What are the possible sources of an extrahepatic mass
Pancreatitis or carcinoma Lymph nodes Pseudocyst
86
What are the sonographic findings of an extrahepatic mass
Irregular, ill defined, hypoechoic mass Intrahepatic bil dil
87
What are the symptoms of a common duct stricture
Previous cholecystectomy Jaundice Increased bilirubin and alk phos
88
What are the sonographic findings of common duct stricture
Intrahepatic bil dil No mass in the porta hepatis
89
What is passive congestion
Congestion due to heart failure
90
What are the symptoms of passive congestion
Possible elevated LFT's Increased hepatic vein pressure
91
What are the sonographic findings of passive congestion
Hepatomegaly Enlarged hepatic veins, IVC, PV, and SV Ascites
92
What are types of focal diseases
Cystic lesions (Simple or congenital) Polycystic disease Hematoma Pyogenic abscess Hepatic candidiasis Chronic granulomatous disease Parasitic infections
93
What are the types of parasitic infections
Amebic abscess Schistosomiasis Pneumocystic carinii Echinococcal cyst (Hydatid disease)
94
What are the symptoms of cystic lesions
Asymptomatic Usually incidental findings
95
What are the sonographic findings of cystic lesions
Thin walls Anechoic Posterior enhancement Well-defined borders Calcifications
96
What is a simple cyst
Asymptomatic and usually incidental finding
97
What are the 4 characteristics of a simple cyst
Well defined borders Thin walls Anechoic Posterior enhancement
98
What are the symptoms of congenital hepatic cyst
Asymptomatic Rare to find a solitary cyst Incidental findings
99
What are the sonographic findings of a congenital hepatic cyst
4 characteristics of a simple cyst Found in right lobe
100
What are the symptoms of polycystic liver disease
Autosomal dominant disease Associated with polycystic kidney disease Can be small Typically simple
101
What is a traumatic cyst
Hematoma
102
What is a hematoma
Contained collection of blood
103
Where can traumatic cysts/hematomas be found
Subcapsular Intrahepatic
104
T or F: Sonographic appearance of hematomas do not vary with age
False Do vary with age
105
What is the sonographic appearance of a hematoma within the 1st 24 hours
Echogenic
106
What is the sonographic appearance of a hematoma after 24 hours
Slowly becomes hypoechoic with lysis of blood Strandy Internal echoes
107
What is a liver abscess Where is the most common place for this
Occurs when bacteria destroy hepatic tissue producing a cavity which fills with infectious organisms Most common in right lobe
108
What is a pyogenic abscess
Pus-filled abscess in the liver
109
What are the symptoms of a pyogenic abscess
Elevated WBC Fever Anemia Abnormal LFT
110
What are the sonographic findings of a pyogenic abscess
Cystic lesion Variable appearance Complex-debris or fluid level Right lobe
111
What is hepatic candidiasis Who is most at risk
Liver affected by hematogenous spread of infection usually from the lungs Immunocompromised patients
112
What are examples of immunocompromised patients
Chemotherapy Transplant patients HIV
113
What are the symptoms of hepatic candidiasis
Fever Localized pain Elevated WBC
114
What are the sonographic findings of hepatic candidiasis
Multiple small hypoechoic lesions Hypoechoic rim with echogenic center Bull's eye/Target sign (Wheel within wheel) FNA of diagnosis
115
What is FNA
Fine needle aspiration
116
What is chronic granulomatous disease
Disease is genetically hetergenous immunodeficiency disorder
117
What does chronic granulomatous disease result in
Inability of phagocytes to kill microbes that they have ingested
118
Who is most at risk for chronic granulomatous disease
Patients with CGD are especially at risk to acquire unusual fungal infections
119
What are the symptoms of chronic granulomatous disease
Pediatric patients with recurrent UTI's Asymptomatic
120
What are the sonographic findings of chronic granulomatous disease
Ill defined margins Hypoechoic Posterior enhancement FNA necessary for diagnosis
121
What are parasitic infections
Various focal disease caused by parasite
122
What are the symptoms of an amebic abscess
Elevated WBC
123
What are the sonographic findings of an amebic abscess
Simple round or ova cyst Hypoechoic with debris
124
What is the most common parasitic infection in humans
Schistosomiasis
125
Water/snail born parasite that can penetrate skin, mucosa, lungs, and liver
Schistosomiasis
126
What happens when the schistosomiasis enters the liver
Destorys the terminal portal veins branches
127
What does schistosomiasis cause What does it do to the portal tract
Causes presinusoidal intrahepatic portal hypertension Wides (2 cm) and makes echogenic
128
What is associated with the initial hepatomegaly for schistosomiasis
Decreased liver size as disease progresses Periportal fibrosis Portal hypertension Varices Ascites
129
What is pneumocystis carinii
Most common organism causing opportunistic infections in HIV patients
130
What is pneumocystis carinii also known as
Pneumocystis jiroveci
131
What is the sonographic appearance of pneumocystis carinii
Diffuse, tiny, non-shadowing echogenic foci throughout liver Replacement of normal liver tissue with echogenic clumps of calcification
132
What is echinococcal (Hydatid) cyst
Parasitic disease in sheep/cattle raising countries
133
What are the symptoms of echinococcal hydatid cyst
Elevated WBC
134
What are the sonographic findings of echinococcal hydatid cyst
Simple cyst with possible sand Have detached endocyst Densely calcified Cysts within cysts (Daughter)
135
What are the types of liver masses
Benign hepatic tumors Malignant tumors
136
What are the benign hepatic tumors
Hemangioma Lipoma Hepatic adenoma Focal nodular hyperplasia
137
What are the malignant tumors
Hepatocellular carcinoma Metastatic disease Lymphoma
138
What is a hemangioma
Large blood filled cystic spaces
139
What are the symptoms of hemangioma
Most common mass Asymptomatic
140
What are the sonographic findings of hemangioma
Hyper to hypoechoic Enhancement Mixed pattern from necrosis
141
What is a lipoma
Benign tumor primarily composed of fat cells
142
What are the symptoms of a lipoma
Asymptomatic
143
What are the sonographic findings of lipomas
Hyperechoic mass Propagation speed artifact
144
What is an adenoma
Glandular epithelial mass
145
What are the symptoms of an adenoma
Asymptomatic Possible RUQ pain Related to OCP's
146
What are the sonographic findings of an adenoma
Hyperechoic with central echoes Solitary or multiple Encapsulated, well defined
147
What is a focal nodular hyperplasia
Rare, benign liver mass composed of normal liver elements
148
Where are focal nodular hyperplasia thought to arise from
Developmental hyperplastic lesions related to congenital vascular formation
149
Who are focal nodular hyperplasia most common in
Women under 40
150
What are the symptoms of focal nodular hyperplasia
Asymptomatic Possible RUQ pain Related to oral contraceptive
151
What are the sonographic findings of focal nodular hyperplasia
Found in the right lobe Multiple Well define hyper to isoechoic patterns Look for contour changes or displacement of vessels
152
What are the Doppler findings of FNH
Show flow radiating from a central vessel Vessels appear larger than normal Arterial signals with high Doppler shifts
153
What is a malignant tumor in the liver
Hepatocellular carcinoma
154
What is hepatocellular carcinoma known as
Hepatoma HCC Primary liver cell cancer
155
What is the most common malignant tumor
Hepatocellular carcinoma
156
Who is more at risk and at what ratio
Males more at risk than females with 5:1 ratio
157
What are the predisposing factors of HCC
Chronic Hep B & C Cirrhosis Aflatoxins
158
What are aflatoxins
Carcinogen produced by fungi that are prevalent in developing countries
159
What are the symptoms of HCC
Asymptomatic until advanced stage RUQ pain Weight loss Ascites Fatigue Malaise Abnormal LFT's Elevated AFP High mortaility rate
160
What is the sonographic apperance of HCC
Variable Solitary, multiple, or diffuse infiltration Venous invasion HCC has arterial and venous flow
161
What is the sonographic apperance of smaller HCC masses to larger HCC masses
S - <5 cm, hypoechoic become isoechoic L - Heterogenous, hyperechoic ducts to areas of hemorrhage and necrosis
162
What are the roles of ultrasound in HCC
Localize, measure, characterize mass Eval abdomen and pelvis for adenopathy or ascites Guidance for biopsy, percutaneous alcohol injection, or cryogenic therapy
163
What is metastasis
Most common neoplasm of the liver
164
What are the primary sites of metastasis
Colon Breast Lung
165
What are the symptoms of metastasis
Elevated LFT's Jaundice Pain Weight loss
166
What are the sonographic findings of metastasis
Hypoechoic or echogenic Bull's eye Solitary or multiple Well to ill defined
167
What is a lymphoma
Malignant neoplasms involving lymphocyte proliferation in lymph nodes
168
What are the types of lymphoma
Hodgkin's or non-Hodgkin's
169
How do you differentiate Hodgkin's and non-Hodgkin's
Lymph node biopsy
170
T or F The cause of a lymphoma is unknown
True
171
What are the symptoms of lymphoma
Hepatomegaly Elevated LFT's Lymphadenopathy
172
What are the sonographic findings of lymphoma
Other nodes may be seen Multiple small discrete masses Hypoechoic, solid, no enhancement
173
What is portal hypertension
Build up of portal vein pressure due to progressive hepatic fibrosis
174
Portal hypertension is increased pressure in the
Portal venous system
175
90% of portal hypertension is caused by
Cirrhosis
176
In portal hypertension as fibrosis increases, hepatic resistance ____ Portal flow must ___ or portal pressure must increase
Increases Decrease
177
The ligamentum teres is a remnant of what obliterated vein
Umbilical vein
178
The ligamentum venosum is a remnant of what obliterated vein
Ductus venosus
179
What is the purpose of the ductus venosus
Until birth it shunts blood from the umbilical vein to IVC
180
Describe the fetal blood flow
Umbilical vein --> Ductus venosus --> IVC
181
What are the sonographic findings in portal hypertension
Splenomegaly Dilated portal veins (MPV > 13mm) Ascites Portosystemic venous collaterals
182
What are the Doppler findings in portal hypertension
Portal vein becomes monophasic As PHTN increases blood flow reverses direction
183
Hepatofungal is the flow ___ the liver
Out of
184
Hepatopedal is the flow __ the liver
In the
185
Portosystemic collaterals form due to Known as the If these form the PV diameter will
Increased venous pressure "Path of least resistance" Decrease
186
This might be placed surgically or percutaneously placed to relieve portal hypertension and pressure on varices
Portosystemic shunt
187
What are the different portosystemic shunts
TIPS Mesocaval Splenorenal
188
What is the splenorenal shunt known as
Warren shunt
189
What is a TIPS
Trans jugular intrahepatic portosystemic shunt
190
TIPS are regularly evaluated with
Ultrasound for patency
191
Where is the TIPS placed
Via jugular vein and IVC between the RHV and MPV
192
What is the normal imaging criteria for TIPS
Baseline velocities should be 125-200 cm/sec Turbulent flow Hepatofungal flow in RPV and LPV
193
What is the abnormal imaging criteria for TIPS
Drop in velocity of 50 cm/sec Overall velocity of 60 cm/sec No flow Hepatopedal flow in RPV/LPV Varices Ascites
194
Where are portosystemic collaterals seen
Gastoesophageal junction Umbilical vein
195
Where is the portosystemic collaterals in the gastroesophageal junction And what will be seen as dilated
Coronary and gastric veins Dilated veins around GE junction
196
The umbilical vein connects to the
LPV to the superficial veins near umbilicus
197
Rare disorder characterized by occlusion of hepatic veins may involve IVC
Budd-Chiari Syndrome
198
What are the causes of Budd-Chiari
Congenital Coagulation abnormalities Pregnancy Oral contraceptive use Tumor extension Trauma
199
What is the sonographic appearance of Budd-Chiari
Hepatomegaly and ascites Partial or complete inability to visualize hepatic veins Visible stenosis or thrombus in lumen Hemorrhagic infractions appear hypoechoic Enlarged caudate lobe Abnormal blood flow detected in HV
200
When the hemorrhagic infractions in BCS ages what happened
Increases echogenicity due to increased pressure on vessel walls
201
What could be associated with abnormal blood flow in HV
No flow Continuous flow Reversed blood flow

Abdomen (10 decks)

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