Liver Pathology Flashcards
The liver stores?
Glycogen
Which lobe of the liver is donated with a transplant?
right
Which lobe of the liver generates faster?
left
Functions of the liver
immunity, factory for proteins and cholesterol, excretes waste via bile, produces bile for fat digestion, regulates blood clotting, detoxification, stores glycogen
2 blood supplies of liver
hepatic artery and portal vein
Fatty Infilatration of the liver is also called?
Fatty liver, steatosis
Fatty Liver
accumulation of fat within hepatocytes
Causes of fatty liver
alcohol abuse, obesity, diabetes, severe hepatitis, pregnancy, glycogen storage disease
Sonographic appearance of fatty infiltration
increased echogenicity, decreased penetration, increased attenuation
With fatty infiltration, vessels and diaphragm are ______ visible
less
With fatty liver, the kidney cortex will appear more _______
hypoechoic
Focal fatty sparing
normal liver tissue appears hypoechoic surrounded by hyperehoic fatty tissue
Where is focal fatty sparing usually found?
medial segment of left lobe near porta hepatis, anterior to the gallbladder, or anterior to the portal vein
What is the most common type of glycogen storage disease?
von Gierke disease type I
Glycogen storage disease
excess deposits of glycogen stored in liver, interstitial tract, and kidneys
Glycogen storage disease can cause severe _____
hypoglycemia
What type of solid liver mass is common with glycogen storage disease?
adenomas
Hepatitis
Inflammation of the liver
How is hepatitis A aquired?
fecal-oral route
True or false: Hepatitis A is acute only
True
Hepatitis A will resolve in how long?
6 weeks
How is hepatitis B transmitted?
drug abuse and unprotected sex
True or False: Hepatitis C is acute only
False; 1/2 cases develop into chronic hepatitis
How is hepatitis C transmitted?
blood to blood contact, transfusion of blood, drug use
How does vasculature appear with hepatitis C? Why?
Hyperechoic because parenchyma is hypoechoic
Cirrhosis
Diffuse process that destroys normal liver lobules
What is the leading cause of cirrhosis?
alcohol abuse
With cirrhosis the liver will initially appear ______, but with continued damage it will _____
enlarged; atrophy
Which lobe of the liver can hypertrophy with cirrhosis?
caudate
Sclerosis cholangitis
progressive inflammation and scarring of bile ducts
How can sclerosis cholangitis cause cirrhosis?
impedes flow of bile which causes backup of bile in liver
What are the 4 categories of cirrhosis?
alcoholic, biliary, postnecrotic, metabolic
1/2 of hepatitis C develop into?
chronic hepatitis
What sonographic finding is consistent with hepatitis?
starry night sign (hyperechoic vessels compared to hypoechoic parenchyma)
True or False: Many patients with cirrhosis are asymptomatic
True
Signs and symptoms of cirrhosis
anorexia, coagulation defects, spider angiomas, cholelithiasis, pruritis
How does early cirrhosis appear?
hepatomegaly, increased echogenicity of liver parenchyma
How does late cirrhosis appear?
shrunken liver with caudate lobe hypertrophy, nodular surface, portal hypertension, ascites
What is the C/RL ratio that 100% indicates cirrhosis?
0.65
What is the C/RL ration that 99% indicated cirrhosis?
0.73
Secondary findings of cirrhosis
portal hypertension, ascites, splenomegaly, splenic and esophageal varices, recanalization of the lig. teres, varices, cholelithiasis
Budd-Chiari syndrome
hepatic vein outflow obstruction; can also include IVC
Budd-Chiari syndrome is also called?
Rokitansky’s disease
Triad of Budd-Chiari syndrome
ascites, hepatomegaly, splenomegaly
Congestive Heart Failure (CHF)
IVC and hepatic veins dilate
Portal vein thrombosis
clotting in portal veins
How are echinoccocal cysts contracted?
dog eats tapeworm and passes it in feces which is ingested by host
Which liver cyst would be common in patient who recently traveled out of the country?
Echinococcal
Pyogenic abscesses are caused by?
bacteria
Which bacteria most commonly caused pyogenic abscesses?
E. coli
Amebic abscesses are caused by?
parasite
True or False: Parasites that cause amebic abscesses invade the hepatic veins
False; do not invade
How is schistosomiasis contracted?
contaminated water
How does schistosomiasis invade the body?
lymphatic or venous system
What sign is consistent with schistosomiasis?
turtleback sign
Which organism associated with HIV causes pneumitis in the liver?
pneumocystic carinii
What is the most common infection in people with HIV?
pneumocystic carinii
Which sign is associated with pneumocystic carinii?
starry sky; punctate calcifications with no shadow
What is the most common benign liver tumor?
hemangioma
Focal nodular hyperplasia tumors contain?
hepatocytes, Kupffer cells, bile ducts, fibrous connective tissue
What is the 2nd most common benign liver mass?
FNH
Sonographic appearance of FNH
isoechoic, well defined borders, centralized flow
FNH is linked to?
oral contraceptives
True or false: Hepatic adenomas to not have Kuppfer cell involvement
True
Hepatic adenomas are associated with?
oral conctraceptives
Angiomyolipomas are often seen in patients with?
tuberous sclerosis
Angiomyolipomas are often located near the?
diaphragm
Sonographic appearance of an angiomyolipoma
echogenic lesion near diaphragm
Angiomyolipomas are commonly also found on the?
kidneys
What is the most common primary malignant liver neoplasm?
HCC
How often does HCC develop from a hepatoma?
80-90%
Tumor of the bile ducts
cholangiocarcinoma
Liver is the ___ most common site for mets
2nd
