Liver Powerpoints Flashcards
What is the most common reason for malignant neoplasms in the liver?
Metastatic Disease
Where is the primary areas that mets of the liver originates from and how does it get there?
colon, GB, stomach, pancreas, lung and breast
travels through lymph or portal system
What is the most common primary malignant mass in liver, and who is it more common in? men or women?
HCC
Hepatocellular Carcinoma
Men
What common disease predisposes someone for hepatic CA?
cirrhosis
What are S/S of HCC?
n/v fatigue weight loss appetite disorder fever hepatomegaly
What does HCC looks like on ultrasound?
- solitary
- multiple nodules
- diffuse infiltration
- can invade vascular structures
Name a few malignant liver diseases.
- hepatocellular carcinoma
- mets
- lymphoma
What is 2nd most common benign liver tumor?
Focal Nodular Hyperplasia
Is FNH more common in the right lobe or left?
right
What age range and gender is FNH more common in?
females under 40 ( hormone related)
Focal Nodular Hyperplasia has a central scar on ultrasound.
t/f
true
rare cystic structure within a large lesion
hepatic cyst adenoma
tumor of glandular epithelium that is more common in females.
liver cell adenoma
What is the sonographic appearance of a hemangioma?
hyperechoic, enhancement, well defined borders, over time calcifications, complexity and anechoic, vascular
What does a hemangioma consist of?
blood-filled cystic spaces that is more common in females
Hemangioma’s can sometimes change echotexture due to degeneration, fibrosis, and calcification.
t/f
true
tumor of glandular epithelium
is usually hyperchoic with central hypoechoic structure.
Liver Cell Adenoma
What are the symptoms of a liver cell adenoma?
RUQ pain with rupture
What are patients at risk for with liver cell adenomas?
hemorrhage and can turn into malignancy
a cystic structure within a larger lesion.
is palpable
hepatic cyst adenoma
damage to liver cells that causes decreased liver function?
Hepatocellular disease
What will be elevated with Hepatocellular disease?
increased bilirubin, AST ALT and decreased albumin
Explain the process of how hepatocellular disease happens.
As damage to the hepatocytes increases, the liver function decreases. this affects the livers ability to conjugate bilirubin or reeive blood from PV. The hepatocytes become unable to perform their functions because of the fatty liver. Ascites can accumulate in the abdominal cavity as well.
What are some causes of fatty infiltration?
fat accumulated in liver cells, diabetes, alcoholism, obesity, hepatitis.
What are the clinical findings of fatty livers?
asymptomatic or general RUQ pain
Is a fatty liver reversible?
YES
Explain the different gradings of fatty livers?
grade 1-slight echogenic echotexture vessels and diaphragm still seen
2-moderate echogenicity, slightly difficult to see vessels
3-severe echogenicity and cannot see vessles.
Where is the most common area for focal sparing to be found in the liver?
around the GB
Describe the sonographic findings of fatty infiltration.
Ducts not visualized well, hyperechoic, decreased penetration
What is hepatitis?
inflammatory disease of the liver
Type of hepatitis
fecal contamination 3-6 months
Hep A
type of hepatitis
virus blood and body fluids acute and chronic
Hep B
type of hepatitis
virus, bloods, and body fluids, mostly chronic
Hep C
What is the difference between acute and chronic hepatitis?”
Acute is 3-6 months with mild dysfunction of liver and chronic is longer than 6 months.
What is the sonographic findings of a Hep patient?
it depends on extent of disease
if acute- there will be a larger, more echogenic liver with portal borders more prominent, splenomegaly and thickened GB wall
Chronic-echogenic and coarse liver, smaller, and vessels harder to see
Hepatitis may show up on US as a _______ mass like areas.
hypoechoic
What type of pathology has a “starry sky appearance” that has to do with the echogenic portal walls?
hepatitis
What is the dengenerative disease of the liver called?
cirrhosis
What are some causes of cirrhosis?
alcoholism, hepatitis, drug induced, poor nutritioni and infectious disease
What are the symptoms for acute cirrhosis?
- N/V
- flatulence
- ascites
- light colored stool
- fatigue/weak
- abdominal pain
- Varicosities
What are the symptoms for chronic cirrhosis?
- anorexia
- n/v
- weight loss
- jaundice
- dark urine
- fatigue
- varicosities
What will the liver look like in the early to middle stages of cirrhosis?
- coarsened
- nodularity
- hepatosplenomegaly
- decreased visualization of vessels
- caudate and lt lobe enlarged.
What is the sonographic findings of chronic cirrhosis?
- shrunken
- coarsened
- isoechoic nodules
- portal hypertension
- risk of hepatoma
What pathology is portal hypertension often associated with?
long standing liver diseases such as cirrhosis
What causes the portal hypertension?
fibrosis from cirrhosis causes thrombosis
What pathology is a recanalized umbilical vein often associated with?
cirrhosis
When there is too much glycogen storage and lack of enzymes it is called ______?
glycogen storage disease
What is the most common form of glycogen storage disease?
Von Gierke’s disease
What will glycogen storage disease look like on ultrasound?
echogenic enlarged liver with increased attenuation and focal adenomas and hyperplasia
What is an metabolic disorder that includes having excess iron?
Hemochromatosis
What can cause biliary obstruction?
gallstones, CBD carcinoma, or a tumor invasion.
What are the symptoms of biliary obstruction>?
jaundice, itching, dilated intrahepatic ducts, elevated ALK and direct bilirubin.
There could be a mass at the head of the pancreas that could cause ductal dilation
T/F
True
When is a CBD stricture often seen?
after a cholecystectomy
What are some differentials for focal hepatic disease?
primary carcinoma, mets, cysts, abscesses, or hematoma.
What will Intrahepatic Focal Hepatic Disease look like on Ultrasound
vessel displacement, bulging of liver capsule, and shifting of IVC
What will Extrahepatic Focal Hepatic Disease look like on Ultrasound
invagination of the liver capsule, displacement of IVC anteriormedial
and displacement of right kidney anteriorly.
a genetic disorder often associated with PKD
Polycystic Liver Disease
Polycystic liver disease will appear as multiple small cysts that will looks like an abscess when clumped together
T/F
True
What type of cyst is from tapeworm from dogs and not common in the US?
echinococcal cysts
Sonographically, what will an echinococcal cyst look like on US?
simple to complex cyst with calcifications having a
“honeycomb” appearance
Where is an echinococcal cyst usually found in?
the lungs
a collection of pus and necrosis of tissue
on US, it will look hypoechoic but variable-complex, lack of walls, and posterior enhancement.
amebic abscess
what is a congenital pathology in which white blood cells ingest bacteria but does not kill it?
Chronic Granulomatous
What is chronic granulomatous caused by and when is it usually found?
it is caused by repeated infections and is commonly found in pediatric patients.
What is hepatic candidiasis caused by
caused by candida (fungal infection)
what type of patients are at risk for hepatic candidiasis? And what will the patient present with?
immunocompromised patients
fever and localized pain
What will hepatic candidiasis look like on ultrasound?
multiple, small, hypoechoic lesions with a bulls-eye appearance.
bacteria from an infection somewhere else in the body that travels to the liver and forms an abscess
pyogenic abscess
What will pyogenic abscesses look like on ultrasound?
small-large, mostly on the right lobe, cystic or complex
