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Abdomen > Liver Pathology Online Review > Flashcards

Liver Pathology Online Review Flashcards

1
Q

What is the difference between atrophy, hypertrophy and hyperplasia

A

HT - Enlargement of cells
Atrophy - Decrease in size of cells
Hyperplasia - Increase in number of cells

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1
Q

Transformation of one cell type to a less specialized type

A

Metaplasia

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2
Q

What is fatty infiltration of the liver

A

Non specific reversible metabolic disorder
Abnormal accumulation of fat within hepatocytes

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3
Q

What are the causes of fatty infiltration of the liver

A

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

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4
Q

Describe difference between diffuse fatty infiltration and focal fatty infiltration

A

DFI - Increase echogenicity, attenuation of sound beam, difficult to visualize parenchyma, vessles, and diaphgram
FFI - Focal area increased echogenicity, occurs near porta hepatis

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5
Q

Focal area in the liver that doesn’t demonstrate fatty infiltraion and where does it most commonly occur

A

Focal fatty sparing
Commonly occurs in caudate lobe or near porta hepatis

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6
Q

How can you differentiate a mass vs. focal fatty sparing

A

Look for “mass effect” - Displacement of vessels, and contours
Normal TSC scan
Area of low attenuation in C.T scan

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7
Q

What is glycogen storage disease

A

Congenital enzyme deficiency affecting glycogen metabolism

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8
Q

What is the sonographic appearance of glycogen storage disease

A

Appears similar to diffuse fatty infiltration
Also could present as focal solid masses

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9
Q

What is hemochromatosis
Who is at higher risk
What are these people at risk for

A

Excessive accumulation of iron within the liver
Males higher risk (7:1)
Increased risk of HCC (Hepatocellular carcinoma)

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10
Q

What is the sonographic appearance of hemochromatosis

A

See diffuse increased echogenicity Attenuation with hepatomegaly
Also indistinguishable from fatty infiltration
Cirrhotic changes (parenchyma might change)

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11
Q

Define hepatitis

A

Inflammation of the hepatocytes

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12
Q

Symptoms of hepatitis

A

Asymptomatic
Loss of appetite
Malaise
Jaundice
Abnormal LFT’s

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13
Q

Types of hepatitis
Describe them

A

Drug induced
A - Transmitted via fecal/oral route
B - Transmitted via blood/body fluids
C - Transmitted via blood/body fluids
D - Transmitted via blood/body fluids
E - Similar to Hep A, transmitted via fecal-oral route
Acute - Fully recoverable, result of Hep A
Chronic - Persistence of hepatitis for longer than 6 months

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14
Q

Describe clinical manifestions of hepatitis

A

-Uncomplicated acute hepatitis
-Fulminant
-Increase AST/ALT
-Increase bilirubin & leukopenia

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15
Q

Describe the difference in sonographic appearance between chronic and acute hepatitis.

A

A:
-Decreased echogenicity
-Increased brightness of portal triad walls, “Starry sky” appearance
-Hepatomegaly & Splenomegaly
-GB wall thickening
C:
-Hepatic parenchyma progressively damaged
-Visualized as course echotexture, heterogenous, decreased size

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16
Q

Irreversible liver damage that replaces normal liver architecture with abnormal fibrotic nodules
Describe the classifications.

A

Cirrhosis
Classifications:
Micronodular: 0.1-1 cm
Macronodular: 1-5 cm

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17
Q

What are the causes of cirrhosis? What is the most common cause?

A

-Alcoholic liver (70%) – Most common
-Viral hepatitis (10%)
-Biliary causes (10%)
-Hemochromatosis (5%)
-Other (5%)- Ex. Wilson’s Disease

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18
Q

What are the clinical symptoms of cirrhosis?

A

-Anorexia
-Indigestion
-Nausea/vomiting
-Diarrhea/constipation
-Abdominal pain
-Abnormal bleeding
-Edema/ascites
-Jaundice
-Fatigue
-Hepatic encephalopathy

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19
Q

When liver function tests are ordered, what values are increased in a patient with cirrhosis? What values are decreased?

A

I - PT Time, AST/ALT, Bilirubin
D - Total protein, Albumin

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20
Q

Chronic progressive often fatal form of cirrhosis
Intrahepatic

A

primary biliary cirrhosis

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21
Q

Periportal fibrosis secondary to prolonged obstruction of an extrahepatic biliary tree

A

secondary biliary cirrhosis

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22
Q

What are the sonographic patterns/appearances of cirrhosis

A

Volume redistribution
Course texture

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23
Q

Describe other findings associated with cirrhosis

A

-Ascites
-Pancreatitis
-Narrowed HV’s and/or IVC by nodular regeneration
-Portal hypertension
-Ligamentum teres should not have blood inside of it
-Cirrhosis
-Recanalized umbilical vein

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24
What is proximal biliary obstruction? Where is the obstruction located?
Block in the bowel duct, can be caused by stones or tumor invasion of porta hepatis Obstruction proximal to the cystic duct
25
Symptoms of proximal biliary obstruction
Jaundice Pruritis (Itching of skin) Elevated bilirubin and alko phos
26
What are the sonographic findings of proximal biliary obstruction
Normal GB even after food Dilated ducts in liver periphery
27
Where is the obstruction located in a patient with distal biliary obstruction
Distal cystic duct caused by stone or extrahepatic mass CBD extrahepatic
28
What are the sonographic findings of distal biliary obstruction
Small GB Stones
29
An extrahepatic mass that affects the liver is located where? What are the sources of these masses?
Mass located in the area of the porta hepatis Sources: - Pancreatitis or carcinoma - Lymph nodes - Pseudocyst
30
What are the symptoms of a common hepatic duct stricture? Sonographic findings?
Condition with: - Previous cholecystectomy - Jaundice -Increased bilirubin and alk phos Sonographic findings: - Intrahepatic biliary dil - No mass in porta hepatis
31
What is passive congestion What are the sonographic findings
- Congestion due to heart failure Sonographic findings: - Hepatomegaly - Enlarged hepatic veins, IVC, PV, and SV - Ascites
32
What is a simple cyst
Asymptomatic cyst that is usually found incidental
33
4 characteristics/criteria of a simple cyst
- Well defined borders - Thin walls - Anechoic - Posterior enhancement
34
What are the symptoms of a congenital hepatic cyst
Asymptomatic Rare to find a solitary cyst Incidental findings
35
Polycystic liver disease is associated with
- Associated with autosomal dominant disease and polycystic kidney disease - Less than 500 individuals affected
36
What are the sonographic findings of polycystic liver disease
- Less than 2-3 cm - One to multiple cysts - Can be small - Typically simple
37
What is a hematoma What locations can they be found in
Contained collection of blood Subcapsular Intrahepatic
38
T or F: A hematoma doesn't increase chance of carcinoma
T
39
Describe the difference in sonographic appearance of a hematoma between one that is scanned within the 1st 24 hours and one that is imaged later on
1st 24 hours: - Echogenic Image later on: - Hypoechoic with lysis of blood Strandy Internal echoes
40
What is a liver abscess
Occurs when bacteria destroys hepatic tissue producing cavity which fills with infectious organisms
41
A liver abscess is ____ and happens possible after ___ or _____
Necrotic Possible after surgery or trauma
42
What is a pyogenic abscess
Pus-filled abscess in the liver that can be small or large and is an infection in portal cavity
43
What are the symptoms of a pyogenic abscess
Elevated WBC Fever Anemia Abnormal LFT
44
What are the sonographic findings of a pyogenic abscess
Cystic lesion Variable apperance Complex-debris or fluid level In right lobe
45
Liver affected by hematogenous fungual spread of infection, usually in the lungs
Hepatic Candidiasis
46
Who does hepatic candidiasis usually affect
Commonly affects immunocomprimised patients such as: - Chemotherapy - Surgical treatment - Patients with HIV
47
What are the symptoms of candidiasis
Fever Localized pain Elevated WBC
48
What are the sonographic findings of candidiasis
Multiple small hypoechoic lesions Hypoechoic rim with echogenic center Bull's eye/Target sign (wheel within wheel) FNA for diagnosis (Fine needle aspiration)
49
Disease genetically heterogenous immunodeficiency disorder result from inability of phagocytes killing micobes ingested
Chronic granulomatous disease
50
What are the sonographic findings of chronic granulomatous disease What are the symptoms
Symptoms: - Pediatric patients with recurrent URI's - Asymptomatic - FNH Sonographic findings: - Ill defined margins -Hypoechoic - Posterior enhancement - FNA necessary for diagnosis
51
What are the symptoms of amebic abscess
- Elevated WBC
52
What are the sonographic findings of ambeic abscess
- Simple round or oval cyst - Hypoechoic wit debris
53
In an amebic abscess the parasite reaches the
Portal vein via the bloodstream
54
Water/snail born parasite can penetrate skin, mucosa, lungs, and liver
schistosomiasis
55
Where does the schistosomiasis go through and what does it do
Enters liver and destroys terminal portal veins and branches
56
What is the most common liver parasite
Schistosomiasis
57
What are the sonographic findings of Schistosomiasis
Widened echogenic portal tract Initial hepatomegaly, disease progresses liver decreases Periportal fibrosis Portal hypertension Varices Ascites
58
Most common organism causing opportunistic infections Who does this most commonly affect
Pneumpcystis carinii Affects HIV patients
59
What are the sonographic findings of pneumpcystis carinii
- Diffuse - Tiny - Non-shadowing echogenic foci throughout liver - Replacement of normal liver tissue with echogenic clumps of calcification
60
What is an echinococcal (hydatid) cyst What are the symptoms
Parasitic disease in sheep/cattle raising countries Elevated WBC
61
What are the sonographic findings of an echinococcal (hydatid) cyst
- Simple cyst with possible sand - Have detached endocyst - Densely calcified - Cyst within a cyst
62
What is a hemangioma What are the symptoms What are the sonographic findings
Large blood filled cystic spaces Symptoms: - Most common mass - Asymptomatic Sonographic findings: - Hyper-hypoechoic - Enhancement - Mixed pattern from necrosis
63
Describe what a lipoma is What are the symptoms Sonographic findings
Benign tumor primarily composed of fat cells Symptoms: - Asymptomatic Songraphic findings: - Hyperechoic mass - Propagation speed artifact
64
Describe the difference in sonographic findings between a hemangioma and a lipoma
H: - Enhancement - Mixed pattern from necrosis - Collection of blood vessels L: - Hyperechoic mass - Propagation speed artifact
65
What is an adenoma What are the symptoms
Glandular epithelial mass that is rare and benign Symptoms: - Asymptomatic Possible RUQ pain Related to OCP's
66
What are the sonographic findings of an adenoma
- Hyperechoic with central echoes - Solitary or multiple - Encapsulated, well defined
67
What is focal nodular hyperplasia Who's most at risk
Rare, benign liver mass Most risk is women under 40
68
What are the symptoms of focal nodular hyperplasia
- Found in right lobe - Multiple - Well defined hyper to isoechoic patterns - Contour changes or displacement of vessels
69
What are alternative names for hepatocellular carcinoma Who is most commonly affected
Hepatoma, HCC, Primary liver cell cancer Males more affected (Ratio of 5:1)
70
What are the predisposing factors of HCC
- Chronic Hep B & C - Cirrhosis - Aflatoxins
71
What are the symptoms of HCC
Asymptomatic RUQ pain Weight loss Ascites Fatigue Malaise Elevated AST High mortality rate
72
What is the sonographic appearance of HCC
- Variable - Solitary, multiple, diffuse infiltration - Smaller masses hypo echoic --> Isoechoic - Larger masses heterogeneous, hyperechoic ducts to area of hemorrhage and necrosis - Venous invasion - HCC has arterial and venous flow
73
What is the role of the sonographer in imaging a patient with HCC
- Localize, measure, and characterize mass - Evaluate abdomen and pelvis for adenopathy for ascites - Guidance for biopsy, percutaneous alcohol injection, or cryogenic therapy
74
What are the symptoms and sonographic findings for metastasis
Symptoms: - Elevated LFT's - Jaundice - Weight loss Sonographic findings: - Hypoechoic or echogenic - Bull's eye - Solitary or multiple - Well to ill defined
75
Malignant neoplasms involving lymphocyte proliferation in lymph nodes What are the 2 types How can you differentiate
Lymphoma 2 Types: - Hodgkin's - Non-Hodgkin's Differentiate by: - Lymph node biopsy
76
What are the symptoms and sonographic findings of lymphoma
Symptoms: - Hepatomegaly - Elevated LFT's - Lymphadenopathy Sonographic findings: - Other nodes may be seen - Multiple small discrete masses - Hypoechoic, solid, no enhancemnt
77
What is portal hypertension What is the primary cause
Increased pressure in the portal venous system - Build up of portal vein pressure due to progressive hepatic fibrosis Cause: - Cirrhosis (90%)
78
What are the sonographic findings of portal hypertension
- Portal vein becomes monophasic - Blood flow reverses direction - Splenomegaly - MPV >13 mm - Ascites - Porta systemic collaterals
79
Describe difference between hepatofungal and hepatopedal flow
HF - Out flow HP - In flow
80
Ligamentum teres is a remnant of what obliterated vein
Umbilical veins
81
Ligamentum venosum is remnant of what obliterated vein What was its purpose prenatally
Ductus venosus Shunts blood from umbilical vein to IVC
82
Describe what portosystemic collaterals are Where do they commonly occur
Form due to increased venous pressure Commonly occur in umbilical vein and gastroesophageal junction
83
What is the purpose of portosystemic shunts
Relieve portal hypertension and pressure on varices
84
What is a TIPS
Trans jugular intrahepatic portosystemic shunt
85
Rare disorder characterized by occasional of hepatic veins, may involve the IVC
Budd-Chiari syndrome
86
What are the causes of Budd-Chiari
Congenital Coagulation abnormalities Pregnancy Oral contraceptive use Tumor extension Trauma
87
What are the sonographic appearrance of Budd-Chiari
-Hepatomegaly and ascites -Partial or complete inability to visualize hepatic veins -Visible stenosis or thrombus in lumen -Hemorrhagic infractions will appear hypoechoic intially -Enlarged caudate lobe -Abnormal blood flow detected in HV
88
What is Wilson's Disease What would you look for sonographically
Excessive intake of copper Look for hematoma on images

Abdomen (10 decks)

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