Liver Pathology Flashcards
What pathology is congenital,traumatic,parasitic, or inflammatory in origin. Affecting the Rt lobe most often, and affects women more than men.
Hepatic cysts
Asymptomatic, Normal liver function tests, Polycystic kidney disease
Clinical findings of Hepatic Cysts
Anechoic mass or masses with smooth walls and
posterior acoustic enhancement
May have irregular shapes Clusters of cysts may be noted
Sonographic findings of Hepatic Cysts
Infection
Pyogenic Abscess
Results when bacteria enters the liver from the biliary
tree,portal vein or hepatic artery
Pyo(pus filled) Most common source is E Coli, but often the etiology
is unknown
Symptoms- fever,pain,n/v,diarrhea,andpleuritic pain 100% mortality if left untreated Appears as round or oval mass,irregularwalls,internal
echoes
Fever Hepatomegaly Leukocytosis Possible abnormal liver function tests Right upper quadrant pain
Clinical findings of a pyogenic hepatic abscess
Complex cyst with thick walls Mass may contain debris,septations, and/or gas The air within the abscess may produce dirty
shadowing or ring-down artifact
Results from a spread of infection from an
inflammatory condition such as appendicitis, diverticulitis, endocarditis, .. Bacteria enters the liver through the PV, HA, or from a surgery
Sonographic findings of a pyogenic
abscess
Most often associated with AIDS, but also affects bone
marrow and organ transplant patients
Appears as diffuse micro-echogenic foci without
shadowing to macro-echogenic clusters of dense calcifications
Pneumocystis Carinii
Parasitic Disease
Amebic abscess Parasites reach the liver via the portal vein Amebiasis is contracted by eating contaminated food
or water
The organism often will remain confined to the GI
tract and patient is asymptomatic, those who are symptomatic will present with diarrhea, and abd pain, increased WBC’s
Appears as round or oval mass with internal echoes
Echinococcal cyst
Parasite is found in areas of the world where dogs
assist in cattle and sheep herding
Daughter cysts develop within a parent cyst
Recent travel out of the country
This infection is caused by the protozoa E histolytica,
which ascends the portal venous system
Hepatomegaly Right upper quadrant or general abdominal pain General malaise Diarrhea (possibly bloody) Fever Leukocytosis Elevated liver function tests Mild anemia
Clinical findings of an Amebic
Hepatic Abscess
Round, hypoechoic or anechoic mass or massed May contain debris Acoustic enhancement
Sonographic findings of amebic
hepatic abscess
Leukocytosis Low-grade fever Nausea Obstructive jaundice Right upper quadrant tenderness Sheep herding countries
Clinical findings of Hydatid Liver cyst
Anechoic mass containing some debris(hydatid sand) “Water lily” sign-wall of the endocyst seen floating
within the pericyst
“Mother” cyst containing one or more smaller
“daughter” cyst
Mass may contain some elements of dense
calcification
Sonographic findings of hydatid
liver cysts
Symptoms, abdominal mass and high cardiac output
due to av shunting throughout the tumor
Tumors-Benign- Pediatric
Tumors-Benign- Pediatric
I Most frequently see symptomatic vascular tumor of
the liver in infants
Most common in females
Appears as hyperechoic,hypoechoic or complex mass
AV shunting may contribute to large draining veins and dialated prox aorta
infantile hemangioendothelioma
Focal nodular hyperplasia (FNH)
Tumors-Benign- Adult
Second most common benign tumor seen in women
Focal nodular hyperplasia (FNH)
Appears as a subtle liver mass usually
Focal nodular hyperplasia (FNH)
infantile hemangioendothelioma
Tumors-Benign- Pediatric
Liver cell adenoma
-Benign More frequently seen in women taking oral
contraceptives
Symptoms are palpable mass, severe RUQ pain due to
rupture of the mass
Liver cell adenoma
Appearance is variable ranging from hypoechoic to
hyperechoic. Solitary, well defined margins. Range in size to 15 cm
Surgical resection recommended since these may
become malignant
Liver cell adenoma
Lipomas
Rare,comprised of mesenchymal elements All fatty liver tumors are not lipomas and differentials
include angiomyolipoma and hepatoma. Confirmation is made by CT
Benign
Hepatoblastoma
Tumors-Malignant-Pediatric
Most common malignant tumor of childhood High incidence with children who have Beckwith-
Wiedemann syndrome
Hepatocellularcarcinoma HCC
Malignant-Adult
Related to cirrhosis, hepatocarcinogens in food, and
hepatitis B and C
Symtoms – unexplained mild fever and weight loss,
hepatomegaly
Hepatocellularcarcinoma HCC
Appearance varies from solitary mass to diffuse
infiltration or multiple tumors
Invades portal venous system and hepatic veins
Hepatocellularcarcinoma HCC
Elevated alpha-fetoprotein Abnormal liver function tests Cirrhosis Chronic hepatitis Unexplained weight loss Hepatomegaly Fever Palpable mass Ascites
Clinical findings of Hepatocellular
Carcinoma
Solitary, small hypoechoic mass Heterogenous masses scatered throughout the liver Mass with a hypoechoic halo
Sonographic findings of
Hepatocelluar Carcinoma
Metastasis
Primary source is from colon,lung and breast Spread to the liver via the portal vein,hepatic artery
and lymphatics
Appears as one of four patterns discrete echogenic,
target or bullseye,discrete hypoechoic, cystic or diffusely inhomogenous
GI tract and pancreas tend to be calcified tumors Hypoechoic masses may be from the breast, lung, or
lymphoma
Hyperechoic masses may be from the kidney and
pancreas
“Target” or “bulls-eye” lesion may be from lung or
colon
Sonographic findings of Hepatic
Metastasis
Most common post op complication of Liver transplant
hepatic artery
thrombosis and infection
Ultrasound is used for pre and post-op evaluation for Liver transplant
Pre-op, main focus is to evaluate portal vein size and
patency. Patency of hepatic veins and hepatic artery
affects the hepatocytes and interferes
with liver function
Diffuse disease
An acquired and reversible disease Benign Increased lipid accumulation in the hepatocytes
leading to impaired or excessive metabolism of fat
Fatty Infiltrate
Asymptomatic Alcohol abuse Chemotherapy Diabetes mellitus Elevated liver function test Obesity Pregnancy
Clinical findings of Fatty Liver Disease
Diffusely echogenic liver Liver may appear patchy, inhomogenous due to focal
sparing
Liver is enlarged(hepatomegaly) Increased attenuation of the sound beam Walls of the hepatic vasculature and diaphragm will
not be easily imaged(secondary to increased attenuation)
Compare the echogenicity of the right kidney to the
liver.
Sonograhic findings of Fatty Liver Disease
Locations for Focal Fatty Sparing
Adjacent to the gallbladder Near the porta hepatis Entire medial segment of the left lobe Can appear much like pericholecystic fluid when seen
adjacent to the gallbladder
Hepatitis
Broadly defined as inflammation of the liver
Contracted through contact with fecal
matter,contaminated food, body fluids, and blood.
Hepatitis
Acute and Chronic
Results from infection by a group of viruses that
specifically target the hepatocytes
Hepatitis
spread primarily by feces since the
virus lives in the alimentary tract. Found worldwide, accounts for 20% of cases. Acute
Hep A(HAV) viral
spread by transfusions of infected
blood or plasma or through contaminated needles
Hep B(HBV) viral
Can also be transmitted from body fluids. Greatest risk for Health Care workers, accounts for 60% of cases
Hep B(HBV) viral
diagnosed by the presence in blood
of the antibody to HCV. Seen mostly in Italy and other Mediterranean countries
Hep C(HCV) viral
entirely dependent on HBV for its
infectivity, rare in North America, seen primarily in IV drug users Must have HBV to aquire
Hep D (HDV) viral
caused by fecally infected waters
May be seen in liver transplantation
Hep E (HEV) viral
newly discovered, first described in
1996, caused by blood transfusion
Hep (HGV)viral
Clinical findings of Hepatitis
Chills Dark urine Elevated liver function tests Fatigue Fever Hepatosplenomegaly Jaundice Nausea Vomiting
Sonographic findings of hepatitis
Normal liver Enlarged, hypoechoic liver Periportal cuffing with “starry sky” Gallbladder wall thickening
Diffuse process characterized by fibrosis and
conversion of normal liver parenchyma into structurally abnormal nodules
Cirrhosis
Cirrhosis
Generalized involvement of the liver by parenchymal
necrosis, regeneration, and diffuse fibrosis
Scarring is progressive and irreversible leading to liver
cell failure and portal hypertension
A leading cause of death in the US
Cirrhosis
Most common causeof micronodular cirrhosis
Alcohol Abuse
Most common cause of macronodular (1.0-5.0 cm)
cirrhosis
Viral Hepatitis
drug
abuse,obesity,chronic bile retention, cardiac insuffiency,and some medication
Other causes of cirrhosis
Clinical findings of cirrhosis
Ascites Diarrhea Elevated liver function tests Fatigue Hepatomegaly(initial) Jaundice Splenomegaly Weight loss
Hepatomegaly( initially) Shrunken right lobe of the liver Enlarged caudate and left lobe Nodular surface irregularity Coarse echotexture Splenomegaly Ascites Monophasic flow within the hepatic veins Hepatofugal flow within the portal veins
Sonographic findings of Cirrhosis
Portal Hypertension
> 90% due to cirrhosis
Can also be due to obstruction of the portal,hepatic
veins, and/or IVC, or longstanding CHF
Contributes to the formation of ascites,splenomegaly
and GI bleeding
Varices and collateral venous channels Caput medusal sign- collateral vessels on the
abdominal wall
Portal vein enlarge (>13mm)
Portal Hypertension
If red is the top color on the color scale, this means
blood flow is toward the probe, toward the liver. The normal color than for the PV is
red
Echogenic thrombus within the portal vein
Cavernous transformation of the portal veins will
appear as wormlike or serpiginousvessels within the region of the portal vein
Sonographic findings of Portal Vein
Thrombosis
Obstruction of the hepatic venous outflow
Etiologies include hypercoaguable states,oral
contraceptives,collagen vascular diseases,hepatic tumors
Portal vein thrombosis has been reported in approx
20%
Budd-Chiari Syndrome
Ascites Elevated liver function test Hepatomegaly Splenomegaly Upper abdominal pain
Clinical findings of Budd-Chiari Syndrome
Most common benign mass in liver
Cavernous hemangeoma
Sonographic findings of Budd-
Chiari Syndrome
Nonvisualizationor reduced visualization of the
hepatic veins
Thrombus within the hepatic veins Enlarged caudate lobe Lack of flow within the hepatic veins with color
Doppler
Narrowing of the inferior vena cava
Extrahepatic
anterior displacement of the RK.
Anteromedial shift of the IVC. Discontinuity of the liver capsule,
Intrahepatic
Posterior displacement of the IVC.
Displacement of the hepatic vascular radicles. External bulging of the liver capsule
