liver pathology power point Flashcards
Diffuse Liver Disease
affects the hepatocytes and interferes with liver function
Diffuse Liver Diseases
Fatty Liver Disease
Hepatitis
Cirrhosis
Portal Hypertension
Portal vein thrombosis
Budd-Chiari Syndrome
Fatty Infiltrate
An acquired and reversible disease
Benign
Increased lipid accumulation in the hepatocytes leading to impaired or excessive metabolism of fat
Clinical findings of Fatty Liver Disease
Asymptomatic
Alcohol abuse
Chemotherapy
Diabetes mellitus
Elevated liver function test
Obesity
Pregnancy
Sonograhic 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.
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.
Acute and Chronic
Results from infection by a group of viruses that specifically target the hepatocytes
Hepatitis types
Hep A(HAV)
Hep B(HBV)
Hep C(HCV)
Hep D (HDV)
Hep E (HEV)
Hep (HGV)
Hep A(HAV)
viral, spread primarily by feces since the virus lives in the alimentary tract. Found worldwide, accounts for 20% of cases. Acute
Hep B(HBV)
viral, spread by transfusions of infected blood or plasma or through contaminated needles. Can also be transmitted from body fluids. Greatest risk for Health Care workers, accounts for 60% of cases
Hep C(HCV)
viral, diagnosed by the presence in blood of the antibody to HCV. Seen mostly in Italy and other Mediterranean countries
Hep D (HDV)
viral, entirely dependent on HBV for its infectivity, rare in North America, seen primarily in IV drug users Must have HBV to aquire
Hep E (HEV)
viral, caused by fecally infected waters May be seen in liver transplantation
Hep (HGV)
viral, newly discovered, first described in 1996, caused by blood transfusion
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
Cirrhosis
Diffuse process characterized by fibrosis and conversion of normal liver parenchyma into structurally abnormal nodules
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
Cirrhosis-Continued
A leading cause of death in the US
Most common causeof micronodular cirrhosis is Alcohol Abuse. (.1-1.0 cm)
Most common cause of macronodular (1.0-5.0 cm) cirrhosis is Viral Hepatitis.
Other causes of cirrhosis include drug abuse,obesity,chronic bile retention, cardiac insuffiency,and some medications
Clinical findings of cirrhosis
Ascites
Diarrhea
Elevated liver function tests
Fatigue
Hepatomegaly(initial)
Jaundice
Splenomegaly
Weight loss
Sonographic findings of Cirrhosis
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
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 Hypertension-Continued
Portal vein may enlarge (>13mm)
Flow becomes less phasic and reverses (hepatofugal) as disease progresses
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. So look for the color bar on the image.
Sonographic findings of Portal Vein Thrombosis
Echogenic thrombus within the portal vein
Cavernous transformation of the portal veins will appear as wormlike or serpiginous vessels within the region of the portal vein
Budd-Chiari Syndrome
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%
Clinical findings of Budd-Chiari Syndrome
Ascites
Elevated liver function test
Hepatomegaly
Splenomegaly
Upper abdominal pain
Sonographic findings of Budd-Chiari Syndrome
Nonvisualization or 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
Focal Abnormalities
Must differentiate between intrahepatic or extrahepatic
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
Focal Liver Disease
Hepatic cysts
Hydatid Liver cyst
Pyogenic Hepatic Abscess
Amebic Hepatic Abscess
Hepatic Candidiasis
Hepatocellular Adenoma
Hepatic Hematoma
Cavernous Hemangioma
Focal Nodular Hyperplasia
Hepatic Lipoma
Hepatic cysts
Congenital,traumatic,parasitic, or inflammatory in origin
Well defined borders,anechoic,good posterior acoustic enhancement
Symptoms-generally asymptomatic, may have epigastric pain
Rt lobe more often affected
Women more effected than men
Clinical findings of Hepatic Cysts
Asymptomatic
Normal liver function tests
Polycystic kidney disease
Sonographic 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
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,and pleuritic pain
100% mortality if left untreated
Appears as round or oval mass,irregular walls,internal echoes
Clinical findings of a pyogenic hepatic abscess
Fever
Hepatomegaly
Leukocytosis
Possible abnormal liver function tests
Right upper quadrant pain
Sonographic findings of a pyogenic 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
Pneumocystis Carinii
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
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
Clinical findings of an Amebic Hepatic Abscess
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
Sonographic findings of amebic hepatic abscess
Round, hypoechoic or anechoic mass or massed
May contain debris
Acoustic enhancement
Clinical findings of Hydatid Liver cyst
Leukocytosis
Low-grade fever
Nausea
Obstructive jaundice
Right upper quadrant tenderness
Sheep herding countries
Sonographic findings of hydatid liver cysts
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
Tumors-Benign- Pediatric
Infantile hemangioendothelioma
Most frequently see symptomatic vascular tumor of the liver in infants
Most common in females <6 months old
Symptoms, abdominal mass and high cardiac output due to av shunting throughout the tumor
Appears as hyperechoic,hypoechoic or complex mass AV shunting may contribute to large draining veins and dialated prox aorta
Tumors-Benign- Adult
Focal nodular hyperplasia (FNH)
Second most common benign tumor seen in women < 40 years old
Asymptomatic
Appears as a subtle liver mass usually <5cm
Has a well developed central and peripheral blood vessels coursing through seen with Color Doppler
Tumors-Benign
Liver cell adenoma
More frequently seen in women taking oral contraceptives
Symptoms are palpable mass, severe RUQ pain due to rupture of the mass
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
Tumors-Benign
Lipomas
Rare,comprised of mesenchymal elements
All fatty liver tumors are not lipomas and differentials include angiomyolipoma and hepatoma. Confirmation is made by CT
Tumors-Malignant-Pediatric
Hepatoblastoma
Most common malignant tumor of childhood
High incidence with children who have Beckwith-Wiedemann syndrome
Tumors-Malignant-Adult
Hepatocellular carcinoma HCC
Related to cirrhosis, hepatocarcinogens in food, and hepatitis B and C
Symtoms – unexplained mild fever and weight loss, hepatomegaly
Appearance varies from solitary mass to diffuse infiltration or multiple tumors
Invades portal venous system and hepatic veins
Clinical findings of Hepatocellular Carcinoma
Elevated alpha-fetoprotein
Abnormal liver function tests
Cirrhosis
Chronic hepatitis
Unexplained weight loss
Hepatomegaly
Fever
Palpable mass
Ascites
Sonographic findings of Hepatocelluar Carcinoma
Solitary, small hypoechoic mass
Heterogenous masses scatered throughout the liver
Mass with a hypoechoic halo
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
Sonographic findings of Hepatic Metastasis
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
Liver Transplants
Ultrasound is used for pre and post-op evaluation
Pre-op, main focus is to evaluate portal vein size and patency. Patency of hepatic veins and hepatic artery
Most common post op complication is hepatic artery thrombosis and infection
