pathology Flashcards
(173 cards)
1
Q
Diffuse disease
A
affects hepatocytes and interferes with liver function
2
Q
the hepatocytes is a parenchymal liver cell that
A
Performs all the functions ascribed to the liver
3
Q
how is diffuse disease measured?
A
through a series of liver function tests
4
Q
diffuse diease what are hepatic enzyme level elevated with?
A
with cell necrosis
increased in LFT’s
5
Q
fatty liver
A
is an aquired, reversible disorder of metabolism resulting in an accumulation of triglycerides within the hepatocytes
6
Q
true or false
fatty liver is reversible
A
true
7
Q
what does fatty infiltration imply?
A
implies increased lipid accumlation in the hepatocytes and is the result of major injury to the liver or systemic disorder leading to impaired or excessive metabolism of fat
8
Q
what is attenuation?
A
is the reduction in power and intesity of sound waves as they travel through tissue
9
Q
Mild Fatty Infiltration
A
Minimal diffuse increase in hepatic echogenicity with normal visualization of the diaphragm and intrahepatic vascular borders
10
Q
Moderate Fatty Infiltration
A
Increased echogenicity with slightly impaired visualization of the diaphragm and intrahepatic vascular borders
11
Q
Severe Fatty Infiltration
A
Significant increase in echogenicity of the liver parenchyma, decreased penetration of the posterior segment of the right lobe of the liver, and decreased to poor visualization of the diaphragm and hepatic vessels
12
Q
what are the causes of fatty liver?
A
obesity
excessive alcohol intake
poorly controlled hyperlipidemia
diabetes
excess corticosteriods
pregnancy
total parenteral hyperlimentation
severe hepatitis
glycogen storage disease
cystic fibrosis
pharmaceutical
13
Q
focal fatty sparing is most commonly seen
A
adjacent to the gallbladder and right portal vein
14
Q
What can focal fatty sparing mimic?
A
a mass/tumor
15
Q
what doppler do you use on focal fatty sparing?
A
color doppler
16
Q
Focal fatty sparing scan
A
area of hypoechogencity
17
Q
focal fatty sparing
A
manifestation of fatty liver disease in which an area of the liver is spared from fatty infiltration
18
Q
viral hepatitis
A
inflammation of the liver caused by a virus
19
Q
hepatitis is the general name for
A
inflammatory and infectious disease of the liver
20
Q
Where does viral hepatitis disease result from?
A
From a local infection (viral hepatitis) from an infection elsewhere in the body (infectious mononucleosis, amebiasis) or from chemical or drug toxicity
21
Q
What does the mild inflammation impair
A
Impairs hepatocyte function
22
Q
What does the severe inflammation and necrosis may lead to and impairs
A
may lead to obstruction of blood and bile flow in the liver
impairs liver cell function
23
Q
What are the common hepatitis?
A
Hepatitis A Virus (HAV)
Hepatitis B Virus (HBV)
Hepatitis C Virus (HCV)
24
Q
What is hepatitis considered to result from?
A
an infection by a group of viruses that specifically target the hepatocytes
25
Where is Hepatitis A Virus (HAV) found?
Is found worldwide
26
How is Hepatitis A Virus (HAV) spread?
Primarily by fecal contamination because the virus lives in the alimentary tract
27
Hepatitis A Virus (HAV)
Is an acute infection that leads to either complete recovery or death from acute liver failure
28
how is hepatitis b virus caused?
By the type B virus, which exists in the bloodstream
29
How is hepatitis b spread?
Can be spread by transfusions of infected blood or plasma or using contaminated needles
30
Which virus is the greatest risk to health care workers?
Hepatitis B
31
Where else can the hepatitis b virus be found?
In body fluids, such as saliva and semen and may be spread by sexual contact
32
How is Hepatitis C Virus (HCV) diagnosed?
Is diagnosed by the presence in blood of the antibody to HCV (anti-HCV)
33
Acute hepatitis ultrasound
Liver texture may appear normal, or portal vein borders may be more prominent than usual. -STARRY SKY
Liver parenchyma is slightly more echogenic than normal.
Attenuation may be present.
Hepatosplenomegaly is present.
Gallbladder wall is thickened.
34
Chronic hepatitis
exists when clinical or biochemical evidence of hepatic inflammation extends beyond 6 months
35
What are the causes of chronic hepatitis?
Viral, metabolic, autoimmune, or drug-induced
36
What are patients symptoms of chronic hepatitis?
Nausea, anorexia, weight loss, tremors, jaundice, dark urine, fatigue, and varicosities
37
Chronic persistent hepatitis is a
Benign, self limiting process
38
Chronic hepatitis ultrasound
-Liver parenchyma is coarse with decreased brightness of the portal triads
-Degree of attenuation is not as great as is seen in fatty infiltration
-Liver does not increase in size with chronic hepatitis
-Fibrosis may be evident, which may produce soft shadowing posteriorly
39
Cirrhosis
chronic degenerative disease of the liver
40
What happens to the liver with cirrhosis?
Lobes are covered with fibrous tissue
parenchyma degenerates
lobules are infiltrated with fat
41
What is an essential feature with cirrhosis?
parenchymal necrosis, regeneration, and diffuse fibrosis, resulting in a disorganization of lobular architecture
42
What is the process of cirrhosis of the liver?
is a diffuse process of fibrosis and distortion of normal liver architecture.
initially there is liver enlargement but continued insult results in hepatic atrophy
43
what are the causes of cirrhosis?
hepatitis c and b
alcoholic liver disease
nonalcoholic fatty liver disease
44
what is the most common cause of cirrhosis?
hepatitis c
45
what may chronic cirrhosis progress to?
to liver failure and portal hypertension
46
Sonographic findings of cirrhosis
hepatomegaly (acute)
liver atrophy (chronic)
ascites may be present
surface nodularity
fatty infiltration increased echogenicity
changes related to portal vein
increased incidence of hepatocellular carcinoma
47
portal venous hypertension
increase in portal venous pressure or hepatic venous gradient present
48
When does portal venous hypertension exist?
when the portal venous pressure is above 10 mmHg or the hepatic venous gradient more than 5 mmHg
49
what diameter of the portal vein suggests portal hypertension?
greater than 13 mm
50
True or False
portal hypertension is asymptomatic
true
51
what is a major cause of portal hypertension?
cirrhosis
52
what do patients usually present with?
with upper GI hemorrhage to rupture of the esophageal varices
53
what can acute or chronic hepatocellular disease block?
can block the flow of blood throughout the liver, causing it to back up into the hepatic portal circulation
54
what does hepatocellular disease cause?
caused the blood pressure in the hepatic circulation to increase and leads to the development of portal hypertension
55
what happens to relieve the pressure?
collateral veins are formed that connect to the systemic veins
56
where does varicose veins most occur?
most frequently in the area of the esophagus, stomach and rectum
57
What is the most common cause of intrahepatic portal hypertension?
cirrhosis
58
when may portal hypertesion develop?
when hepatopedal flow (toward the liver) is impeded by thrombosis or tumor invasion
59
what is used to confirm diagnosis of portal hypertension?
color doppler
60
what indicates portal hypertension?
reversal of flow (hepatofugal)
61
portal hypertension=
hepatofugal flow in the main portal vein
62
to blood becomes obstructed as it pass through the liver to the hepatic veins
and is diverted to collateral pathways in the upper abdomen
63
what happens when the blood vessels decrease in diameter?
the pressure increases
64
collateral veins
tiny capillary size veins
65
varices or varicose veins
enlarged, tortuous and dilated veins
66
when do collateral veins exist?
when the functional veins can't do their job properly
67
Intrahepatic portal hypertension
cirrhosis
schistosomiasis
hepatitis
veno-occlusive disease
sclerosing cholangitis
primary biliary cirrhosis
wilson's disease
hemochromatosis
alpha-1 antitrypsin
granulomatous disease
congential fibrosis
68
Recanalized umbilical vein
Re-opening of the umbilical vein (ligamentum teres) to act as a collateral
69
how can recanalized umbilical vein occur?
in patients with long-standing portal hypertension to provide a collateral venous channel
70
what is the most common treatment for portal hypertension?
a transjugular intrahepatic portosystemic shunt or TIPS
71
what does the treatment TIPS do?
helps reduce the pressure that is being caused by the portal hypertension and in turn is causing the recanalized umbilical vein
72
what can portal vein thrombosis lead into?
portal hypertension
73
A recanalized umbilical vein is a sonographic finding that is most common in patiets with?
cirrhosis and portal hypertension
74
What are the characteristics features that are seen using doppler when recanalized umbilical vein is present?
hepatofugal flow and lack of phasicity
75
what is the most common complication of portal venous hypertension?
ascites
76
What is ascites?
accumulation of fluid in the peritoneal cavity
77
What are the symptoms of ascities?
early feeling of fullness
increase in size of abdomen
feeling out of breathe
78
What is paracentesis?
removal of fluid from the abdominal cavity
79
what are the three types of shunts?
portacaval, mesocaval, splenorenal
80
portacaval shunt
Attaches the main portal vein at the superior mesenteric vein-splenic vein confluence to the anterior aspect of the inferior vena cava.
81
mesocaval shunt
Attaches the mid-distal superior mesenteric vein to the inferior vena cava
May be difficult to image if overlying bowel gas is present
82
splenorenal shunt
Attaches the splenic vein to the left renal vein
83
what should shunt and connecting vessels be documented with?
real-time pulsed Doppler and color Doppler to determine flow patterns and patency
84
What is a shunt?
redirect blood flow in cases of long standing portal hypertension
85
in cases there are no good hepatic vein what shunt is used
splenorenal
86
what is the number one complication for TIPS procedure?
stenosis
87
How is portal vein thrombosis defined?
As occlusion of the portal vein
88
cavernous transformation of the portal vein
Numerous wormlike venous collaterals that oarallel the chronically thrombosed PV.
89
cavernous transformation is typically seen
with bengin causes of PV thrombosis.
90
what are the causes of portal vein thrombosis?
hepatocelluar carcinoma
metastatic liver diease
pancreatic carcinoma
cirrhosis
91
Budd-Chiari syndrome
thrombosis of hepatic veins
92
how is budd-chiari syndrome characterized?
by hepatic vein obstruction
93
patients with budd-chiari syndrome presents signs associated with?
portal vein: ascites, hepatomegaly, splenomegaly
94
patients with budd-chiari syndrome shows
enlarged liver, dilated IVC with thrombus
95
what are symptoms of budd-chiari syndrome?
ascites
hepatomegaly
abdominal pain
hepatosplenomegaly
jaundice
vomiting and diarrhea
96
liver cysts
fluid filled spaced lined by biliary epithelium
97
sonographic criteria for liver cyst
anechoic
thin walled
acoustic enhancement
98
liver cysts can be
simple or complex
99
how will a complex hemorrhagic cyst appear?
as assist with internal echoes accompanied by retrograde in pain and a decrease in hemocrit (the ratio of the volume of red blood cells to the total volume of blood)
100
Polycystic liver disease
inherited in an autosomal dominant pattern that affects 1 in 500 individuals.
101
atleast ____ of patients with polycystic renal disease have one to several hepatic cysts
50% to 74% of patients with polycystic liver disease,60% have associated polycystic renal parenchyma
102
what is the size of polycystic liver diease?
small, less then 2 or 3 cm and multiple throughout the hepatic parenchyma
103
polycystic liver diease may
enlarge and cause biliary obstruction in the porta hepatis
104
what is the most common benign tumor of the liver?
Hemangioma
105
hemangimos consists of
multiple cascular chanels that create multiple vascular channels that create multiple sonographic interfaces which give this mass
106
Hemangioma characteristics
hyperechoic apperance
107
sonographic findings of hemangioma
hyperechoic
posterior enhancement
can be single or multiple
108
hemangioma may
enlarge with pregnancy administration of estrogen
109
hemangioma may appear
hypoechoic within the background of fatty infiltrated liver
110
what does not typically demonstrate flow within the hemangioma?
color Doppler
111
Benign hepatic tumors- canvernous hemangiomas are found
in the subcapsular hepatic parenchyma or in posterior right lobe more than the left of the lobe
112
benign hepatic tumors
enlarges slowly and undergoes degeneration, fibrosis, and califaction
113
Focal nodular hyperplasia
A benign solid liver mass that is believed to be a developmental hyperplastic lesion rather than a true neoplasm
114
Focal nodular hyperplasia is found
in women under the age of 40
115
true or false
focal nodular hyperplasia patients are asymtomatic
true
116
sonographic findings of focal nodular hyperplasia
Solid mass with varying echogenicity
Central fibrous scar
Stellate vascularity
117
what is focal nodular hyperplasia mass thought to arise?
from developmental hyperplastic lesions related to an area of congential vascular formation
118
lesions of focal nodular hyperplasia occur
more in the right lobe of the liver
119
what is the second most common benign liver mass?
hepatic adenoma
120
Hepatic adenoma
a benign solid hepatic mass
121
what is hepatic adenoma associated with?
the use of contraceptive agents
122
sonographic finding of hepatic adeoma
solid hepatic mass
nonspecific echogenicity
may have tumor hemorrhage
may have vascularity
123
what is recommended for hepatic adeoma?
surgical resection is recommended due to the risk of malignant transformation
124
Common duct stricture
Clinically, the patient is jaundiced and has had a previous cholecystectomy. Laboratory values show an increase in the direct bilirubin and alkaline phosphatase levels.
125
Hepatic Lipoma
extremely rare fatty tumor
126
Sonographic findings hepatic lipoma
hyperechoic mass
127
what is used to comfirm hepatic lipoma?
ct scan can be useful in confirming the fatty tumors
128
Hepatocellular carcinoma
liver cancer
129
what is the most common primary maglignancy of the liver?
hepatocellular carcinoma
130
Hepatocellular carcinoma occurs
10-25% of patients with cirrhosis
most frequent in men
131
extrahepatic mass
An extrahepatic mass in the area of the porta hepatis causes the same clinical signs as seen in biliary obstruction
132
Clinical Presentation of hepatocellular carcinoma
a previous history of cirrhosis or hepatitis B and C, a palpable mass, hepatomegaly, appetite disorder, and fever
133
Diffuse Abnormalities of the Liver Parenchyma
- Extrahepatic mass
- Common duct stricture
- Passive hepatic congestion
134
hepatoceullar carcinoma has been known to
invade the hepatic veins to produce Budd-Chiari syndrome
135
Hepatocellular carcinoma commonly invades
venous structures (portal vein, hepatic veins, IVC)
136
sonographic findings of hepatocellular carcinoma
multiple hypoechoic solid mass
variable in apperance
137
Biliary Obstruction: Distal clincal findings
Common duct stones cause RUQ pain, jaundice, pruritus.
Elevated bilirubin and alk phos.
Dilated intrahepatic ducts, usually a small gallbladder, gallstones often present.
138
Biliary Obstruction: Distal
Caused by stones in the common duct, an extrahepatic mass in the porta hepatis, or stricture of the common duct.
139
biliary obstruction: proximal clinically the pateint may be
Clinically, the patient may be jaundiced and have pruritus (itching).
140
with hepatocellular carcinoma increase in lab values
Alpha feta protein, AST and ALT
141
metastatic liver cancer
is cancer that started in the liver and spread (or metastasized) to other areas of the body
142
Liver metastases
are cancers that have spread (or metastasized) to the liver from a tumor that started in another par of the body
143
most live metastes are
multiple
144
Liver metastasis found most commonly in
i
the colon or rectum
145
in general, the imagining apperances of liver metastes are
nonspecific and a liver biospy speciments are required for histological diagnosis
146
metastatic spread to the liver occurs
as the tumor erodes the wall and travels through the lymphatic system or through bloodstream to the portal vein or hepatic artery to the liver
147
biliary obstruction: proximal liver function tests
Liver function tests show an elevation in the direct bilirubin and alkaline phosphatase levels.
148
inflammatory disease of the liver
-Hepatic abscesses occur most often as complications of biliary tract disease, surgery, or trauma.
149
the following 3 basic types of abscess formation occur in the liver:
intrahepatic, subhepatic, and subphrenical (under the diaphragm; upper part of the liver
150
clinically patients with inflammatory diease have
fever, elevated white cell count, RUQ pain
151
on sonographic examination of hepatic abscesses
the sonographer searches for solitary or multiple lesions in the liver, abnormal fluid collections in morison's pouch, sub diaphragmatic or subphrenic space
152
pyogenic abscess
pus forming abscess
153
many routes for bacteria to gain access to the liver
the biliary tree, portal vein, or hepatic artery a direct extension from a contiguous infection and rarely
heaptic trauma
154
sources of the infection include
cholangitis; portal pyemia secondary to appendicitis, diverticulitis, inflammatory disease or colitis
direct spread from the another organ
trauma with direct contamination
infarction after embolization or from sickle cell anemia
155
Hepatic candidiasis is caused by:
a species of Candida
156
hepatic candidiasis occurs
in immunocomprised hosts, such as patients undergoing chemotherapy, organ transplant, recipients or individuals with human immunodeficiency infection (HIV)
157
hepatic candidiasis
a hepatic mass that results from the spread of fungus in the blood to the liver
158
the candidal fungus invades
the bloodstream and may affect any organ, with kidney, brain, and heart affected the most
159
Amebic abscess is caused bya parasite called
Entamoeba histolytica
160
How is Entamoeba histolytica transmitted?
contaminated food and water
161
what are the main characterized symptoms of amebic abscess?
diarrhea and abdominal pain
162
what is the treatment of amebic abscess?
includes anti-parasitic via the portal vein
163
how do parasities reach the liver parenchyma?
via the portal vein
164
patients with amebic abscess may
be asymptomatic or may show gastrointestinal symptoms of abdominal pain, diarrhea, leukocytosis, and low fever
165
Hepatic echinococcosis
an infectious cystic disease common in sheep-herding areas of the world
166
the echinococcosis is
a tapeworm that infects humans as the intermediate host
167
Pneumocystic pneumonia
is a common life-threatening infection in patients with HIV
invasion of the porta hepatic
168
Pneumocystic carinii is the most common organism causing
opportunistic infection in patients with acquired immunodificiency syndrome
169
pneumocystis carinii affects
patients undergoing bone marrow and organ transplantation or a patient receiving chemotherapy
170
sonographic findings of pneumocystis cariniipattern
ranges, tiny, non-shadowing echogenic foci to extensive replacement of the liver parenchyma by various echogenic clumps of calcifications
171
biliary obstruction
blockage of bile ducts
172
biliary obstruction sonographically
extrahepatic mass
173
biliary obstruction: proximal
Biliary obstruction proximal to the cystic duct can be caused by:
Gallstones
Carcinoma of the common bile duct
Metastatic tumor
