Metabolic Disease: Liver Flashcards
What kind of process is hepatocellular disease?
Diffuse process
Hepatocellular disease is a dysfunction of what?
Hepatocytes
With hepatocellular disease normal liver is replaced with what?
Fat or fibrosis
With hepatocelluar disease, simple fatty changes into what disease?
Cirrhosis
Hepatocellular disease impacts LFT how? And how does it affect the liver? 2
- Abnormal LFTs
- Often affects liver size
Is fatty infiltration (Steatosis) uniform?
Not always, it can be diffuse or focal
How is fatty infiltration (steatosis) obtained? And is it reversible?
- Acquired
- Reversible
How does someone get fatty infiltration (steatosis)?
Alcohol abuse and obesity
Fatty infiltration (steatosis) is the precursor to what?
Chronic disease
What do we look for when evaluating for fatty infiltration? 4
- Echogenicity changes
- Echo texture changes
- Attenuation characteristics
- Ability to visualize vessels
What is the sonographic appearance of fatty infiltrates? 3
- Liver difficult to penetrate
- Paucity of vessels
- Echogenicity change
What is mild (grade 1) fatty infiltration? 2
- Slight increase in liver echogenicity
- Diaphragm and vessels clearly defined
What is Moderate (grade 2) fatty infiltrates? 2
- Increased in liver echogenicity
- Vessels and diaphragm not sharply defined
What is severe (grade 3) fatty infiltrates? 2
- Liver echogenicity increased markedly
- Extremely difficult to define diaphragm and vessel walls
What are focal fatty changes in the liver in terms of Infiltration?
Focal areas of increased echogenicity (fatty deposits) within mostly normal liver parenchyma
What is focal fatty changes in the liver in terms of sparing?
Focal hypoechoic areas (normal liver tissue) within a mostly fatty liver
Focal fatty changes both commonly involve what areas of the liver?
Periportal areas of medial LL and GB
Does focal fatty changes affect mass?
No mass effect
What is the rate of change for focal fatty changes?
Can rapidly change with time
Focal fatty changes has what type of boundaries?
Map like boundaries
What is cirrhosis?
A diffuse process that destroys the liver cells
What does cirrhosis results in?
Fibrosis with nodular changes
Cirrhosis is commonly secondary to what?
Alcohol abuse
What are some causes of cirrhosis other than alcohol abuse? 2
- Chronic viral hepatitis
- Primary scleroising cholangitis
What is the progressive changes with cirrhosis?
Cell death > Fibrosis > regeneration
Is cirrhosis reversible?
No its irreversible
What are lab values with fatty infiltration? 3
- ALT
- AST
- Possible GGT
Acute cirrhosis appears as what?
Severe fatty infiltration
The lab values of Cirrhosis depend on what?
Stage of disease
What are some lab values that are increased with Cirrhosis? 5
- AST
- ALT
- LDH
- Bilirubin (conjugated)
- Gamma globulin
What lab values are decreased with cirrhosis?
Serum albumin
What are clinical presentations of cirrhosis? 6 (a/s)
- Hepatomegaly
- Jaundice
- Ascites
- Diarrhea
- Feeling of fullness
- Weight loss
Cirrhosis leads to what eventually? (Condition) 2
Portal hypertension and liver failure
What is Glycogen storage disease?
Autosomal recessive disorder which causes excess glycogen deposits in hepatocytes
What is an example of glycogen storage disease?
Von Gierke’s disease
When does Glycogen storage disease begin?
Neonatally
How does benign adenomas and HCC appear in Glycogen storage disease?
Benign adenomas and HCC can be secondary
What is the GSD sonographic appearance? 2
- Diffuse fatty infiltration
- Adenomas - solid masses with variable echogenicity
What is diffuse fatty infiltration look like for GSD?
Indistinguishable from other causes of diffuse focal fatty disease
Von Gierkes disease is a deficiency of what?
G6P enzymes
What are ascites?
Free serous fluid in the abdominal cavity
What does transudate contain?
Little protein/cells
What does transudate suggest? 2
Non inflammatory process in terms of
1. Cirrhosis
2. Congestive heart failure
What does this image demonstrate?
Ascites in the bowel
What does this image represent?
Glucose storage disease
What does this image represent?
Chronic Cirrhosis, you can tell by the
- Small liver
- CL/RL >0.65
- Coarse echo texture
- Nodular surface
- Paucity of vessels
What does this image represent?
Acute cirrhosis, you can tell by the
1. Enlarged liver
2. Textural changes
What does these images represent?
- Fatty infiltration on the left
- Fatty sparing on the right
What does this image represent?
Severe (Grade 3) fatty infiltration
- Liver echogenicity increased
- Extremely difficult to define diaphragm and vessel walls
What does this image represent?
Moderate (grade 2) Fatty infiltrate
- Increase in Liver echogenicity
- Vessels and diaphragm not sharply defined
What does this image represent?
Mild (grade 1) fatty infiltrate
What does transudate look like sonographically?
Anechoic
What does exudate consist of? 2
- High protein content
- Blood, pus, chylous
What does exudate ascites causes?
Inflammation or malignant causes
What does exudate ascites look like sonographically? 3
- Internal echoes
- Echogenic
- Loculations
Free fluid changes with what?
Patient position
Free fluid conforms to what?
Surrounding organs
Free fluid has acute anlges with what?
Organ contact
Does Lobulated fluid change with movement?
No
What are the margins for Loculated fluid?
Rounded margins
Loculated fluid has what kind of effect?
Mass effect
What is the most dependent spaces in the abdomen? 3
- Morison’s pouch (RT lobe and RT kidney)
- Paracolic gutters
- Pouch of Douglas