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Liver > pathology > Flashcards

pathology Flashcards

1
Q

Diffuse disease

A

affects hepatocytes and interferes with liver function

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2
Q

the hepatocytes is a parenchymal liver cell that

A

Performs all the functions ascribed to the liver

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3
Q

how is diffuse disease measured?

A

through a series of liver function tests

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4
Q

diffuse diease what are hepatic enzyme level elevated with?

A

with cell necrosis
increased in LFT’s

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5
Q

fatty liver

A

is an aquired, reversible disorder of metabolism resulting in an accumulation of triglycerides within the hepatocytes

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6
Q

true or false
fatty liver is reversible

A

true

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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

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8
Q

what is attenuation?

A

is the reduction in power and intesity of sound waves as they travel through tissue

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9
Q

Mild Fatty Infiltration

A

Minimal diffuse increase in hepatic echogenicity with normal visualization of the diaphragm and intrahepatic vascular borders

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10
Q

Moderate Fatty Infiltration

A

Increased echogenicity with slightly impaired visualization of the diaphragm and intrahepatic vascular borders

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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

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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

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13
Q

focal fatty sparing is most commonly seen

A

adjacent to the gallbladder and right portal vein

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14
Q

What can focal fatty sparing mimic?

A

a mass/tumor

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15
Q

what doppler do you use on focal fatty sparing?

A

color doppler

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16
Q

Focal fatty sparing scan

A

area of hypoechogencity

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17
Q

focal fatty sparing

A

manifestation of fatty liver disease in which an area of the liver is spared from fatty infiltration

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18
Q

viral hepatitis

A

inflammation of the liver caused by a virus

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19
Q

hepatitis is the general name for

A

inflammatory and infectious disease of the liver

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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

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21
Q

What does the mild inflammation impair

A

Impairs hepatocyte function

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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

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23
Q

What are the common hepatitis?

A

Hepatitis A Virus (HAV)
Hepatitis B Virus (HBV)
Hepatitis C Virus (HCV)

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24
Q

What is hepatitis considered to result from?

A

an infection by a group of viruses that specifically target the hepatocytes

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25
Q

Where is Hepatitis A Virus (HAV) found?

A

Is found worldwide

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26
Q

How is Hepatitis A Virus (HAV) spread?

A

Primarily by fecal contamination because the virus lives in the alimentary tract

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27
Q

Hepatitis A Virus (HAV)

A

Is an acute infection that leads to either complete recovery or death from acute liver failure

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28
Q

how is hepatitis b virus caused?

A

By the type B virus, which exists in the bloodstream

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29
Q

How is hepatitis b spread?

A

Can be spread by transfusions of infected blood or plasma or using contaminated needles

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30
Q

Which virus is the greatest risk to health care workers?

A

Hepatitis B

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31
Q

Where else can the hepatitis b virus be found?

A

In body fluids, such as saliva and semen and may be spread by sexual contact

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32
Q

How is Hepatitis C Virus (HCV) diagnosed?

A

Is diagnosed by the presence in blood of the antibody to HCV (anti-HCV)

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33
Q

Acute hepatitis ultrasound

A

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.

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34
Q

Chronic hepatitis

A

exists when clinical or biochemical evidence of hepatic inflammation extends beyond 6 months

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35
Q

What are the causes of chronic hepatitis?

A

Viral, metabolic, autoimmune, or drug-induced

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36
Q

What are patients symptoms of chronic hepatitis?

A

Nausea, anorexia, weight loss, tremors, jaundice, dark urine, fatigue, and varicosities

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37
Q

Chronic persistent hepatitis is a

A

Benign, self limiting process

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38
Q

Chronic hepatitis ultrasound

A

-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

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39
Q

Cirrhosis

A

chronic degenerative disease of the liver

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40
Q

What happens to the liver with cirrhosis?

A

Lobes are covered with fibrous tissue
parenchyma degenerates
lobules are infiltrated with fat

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41
Q

What is an essential feature with cirrhosis?

A

parenchymal necrosis, regeneration, and diffuse fibrosis, resulting in a disorganization of lobular architecture

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42
Q

What is the process of cirrhosis of the liver?

A

is a diffuse process of fibrosis and distortion of normal liver architecture.
initially there is liver enlargement but continued insult results in hepatic atrophy

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43
Q

what are the causes of cirrhosis?

A

hepatitis c and b
alcoholic liver disease
nonalcoholic fatty liver disease

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44
Q

what is the most common cause of cirrhosis?

A

hepatitis c

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45
Q

what may chronic cirrhosis progress to?

A

to liver failure and portal hypertension

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46
Q

Sonographic findings of cirrhosis

A

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

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47
Q

portal venous hypertension

A

increase in portal venous pressure or hepatic venous gradient present

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48
Q

When does portal venous hypertension exist?

A

when the portal venous pressure is above 10 mmHg or the hepatic venous gradient more than 5 mmHg

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49
Q

what diameter of the portal vein suggests portal hypertension?

A

greater than 13 mm

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50
Q

True or False
portal hypertension is asymptomatic

A

true

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51
Q

what is a major cause of portal hypertension?

A

cirrhosis

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52
Q

what do patients usually present with?

A

with upper GI hemorrhage to rupture of the esophageal varices

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53
Q

what can acute or chronic hepatocellular disease block?

A

can block the flow of blood throughout the liver, causing it to back up into the hepatic portal circulation

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54
Q

what does hepatocellular disease cause?

A

caused the blood pressure in the hepatic circulation to increase and leads to the development of portal hypertension

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55
Q

what happens to relieve the pressure?

A

collateral veins are formed that connect to the systemic veins

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56
Q

where does varicose veins most occur?

A

most frequently in the area of the esophagus, stomach and rectum

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57
Q

What is the most common cause of intrahepatic portal hypertension?

A

cirrhosis

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58
Q

when may portal hypertesion develop?

A

when hepatopedal flow (toward the liver) is impeded by thrombosis or tumor invasion

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59
Q

what is used to confirm diagnosis of portal hypertension?

A

color doppler

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60
Q

what indicates portal hypertension?

A

reversal of flow (hepatofugal)

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61
Q

portal hypertension=

A

hepatofugal flow in the main portal vein

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62
Q

to blood becomes obstructed as it pass through the liver to the hepatic veins

A

and is diverted to collateral pathways in the upper abdomen

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63
Q

what happens when the blood vessels decrease in diameter?

A

the pressure increases

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64
Q

collateral veins

A

tiny capillary size veins

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65
Q

varices or varicose veins

A

enlarged, tortuous and dilated veins

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66
Q

when do collateral veins exist?

A

when the functional veins can’t do their job properly

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67
Q

Intrahepatic portal hypertension

A

cirrhosis
schistosomiasis
hepatitis
veno-occlusive disease
sclerosing cholangitis
primary biliary cirrhosis
wilson’s disease
hemochromatosis
alpha-1 antitrypsin
granulomatous disease
congential fibrosis

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68
Q

Recanalized umbilical vein

A

Re-opening of the umbilical vein (ligamentum teres) to act as a collateral

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69
Q

how can recanalized umbilical vein occur?

A

in patients with long-standing portal hypertension to provide a collateral venous channel

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70
Q

what is the most common treatment for portal hypertension?

A

a transjugular intrahepatic portosystemic shunt or TIPS

71
Q

what does the treatment TIPS do?

A

helps reduce the pressure that is being caused by the portal hypertension and in turn is causing the recanalized umbilical vein

72
Q

what can portal vein thrombosis lead into?

A

portal hypertension

73
Q

A recanalized umbilical vein is a sonographic finding that is most common in patiets with?

A

cirrhosis and portal hypertension

74
Q

What are the characteristics features that are seen using doppler when recanalized umbilical vein is present?

A

hepatofugal flow and lack of phasicity

75
Q

what is the most common complication of portal venous hypertension?

A

ascites

76
Q

What is ascites?

A

accumulation of fluid in the peritoneal cavity

77
Q

What are the symptoms of ascities?

A

early feeling of fullness
increase in size of abdomen
feeling out of breathe

78
Q

What is paracentesis?

A

removal of fluid from the abdominal cavity

79
Q

what are the three types of shunts?

A

portacaval, mesocaval, splenorenal

80
Q

portacaval shunt

A

Attaches the main portal vein at the superior mesenteric vein-splenic vein confluence to the anterior aspect of the inferior vena cava.

81
Q

mesocaval shunt

A

Attaches the mid-distal superior mesenteric vein to the inferior vena cava
May be difficult to image if overlying bowel gas is present

82
Q

splenorenal shunt

A

Attaches the splenic vein to the left renal vein

83
Q

what should shunt and connecting vessels be documented with?

A

real-time pulsed Doppler and color Doppler to determine flow patterns and patency

84
Q

What is a shunt?

A

redirect blood flow in cases of long standing portal hypertension

85
Q

in cases there are no good hepatic vein what shunt is used

A

splenorenal

86
Q

what is the number one complication for TIPS procedure?

A

stenosis

87
Q

How is portal vein thrombosis defined?

A

As occlusion of the portal vein

88
Q

cavernous transformation of the portal vein

A

Numerous wormlike venous collaterals that oarallel the chronically thrombosed PV.

89
Q

cavernous transformation is typically seen

A

with bengin causes of PV thrombosis.

90
Q

what are the causes of portal vein thrombosis?

A

hepatocelluar carcinoma
metastatic liver diease
pancreatic carcinoma
cirrhosis

91
Q

Budd-Chiari syndrome

A

thrombosis of hepatic veins

92
Q

how is budd-chiari syndrome characterized?

A

by hepatic vein obstruction

93
Q

patients with budd-chiari syndrome presents signs associated with?

A

portal vein: ascites, hepatomegaly, splenomegaly

94
Q

patients with budd-chiari syndrome shows

A

enlarged liver, dilated IVC with thrombus

95
Q

what are symptoms of budd-chiari syndrome?

A

ascites
hepatomegaly
abdominal pain
hepatosplenomegaly
jaundice
vomiting and diarrhea

96
Q

liver cysts

A

fluid filled spaced lined by biliary epithelium

97
Q

sonographic criteria for liver cyst

A

anechoic
thin walled
acoustic enhancement

98
Q

liver cysts can be

A

simple or complex

99
Q

how will a complex hemorrhagic cyst appear?

A

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
Q

Polycystic liver disease

A

inherited in an autosomal dominant pattern that affects 1 in 500 individuals.

101
Q

atleast ____ of patients with polycystic renal disease have one to several hepatic cysts

A

50% to 74% of patients with polycystic liver disease,60% have associated polycystic renal parenchyma

102
Q

what is the size of polycystic liver diease?

A

small, less then 2 or 3 cm and multiple throughout the hepatic parenchyma

103
Q

polycystic liver diease may

A

enlarge and cause biliary obstruction in the porta hepatis

104
Q

what is the most common benign tumor of the liver?

A

Hemangioma

105
Q

hemangimos consists of

A

multiple cascular chanels that create multiple vascular channels that create multiple sonographic interfaces which give this mass

106
Q

Hemangioma characteristics

A

hyperechoic apperance

107
Q

sonographic findings of hemangioma

A

hyperechoic
posterior enhancement
can be single or multiple

108
Q

hemangioma may

A

enlarge with pregnancy administration of estrogen

109
Q

hemangioma may appear

A

hypoechoic within the background of fatty infiltrated liver

110
Q

what does not typically demonstrate flow within the hemangioma?

A

color Doppler

111
Q

Benign hepatic tumors- canvernous hemangiomas are found

A

in the subcapsular hepatic parenchyma or in posterior right lobe more than the left of the lobe

112
Q

benign hepatic tumors

A

enlarges slowly and undergoes degeneration, fibrosis, and califaction

113
Q

Focal nodular hyperplasia

A

A benign solid liver mass that is believed to be a developmental hyperplastic lesion rather than a true neoplasm

114
Q

Focal nodular hyperplasia is found

A

in women under the age of 40

115
Q

true or false
focal nodular hyperplasia patients are asymtomatic

A

true

116
Q

sonographic findings of focal nodular hyperplasia

A

Solid mass with varying echogenicity
Central fibrous scar
Stellate vascularity

117
Q

what is focal nodular hyperplasia mass thought to arise?

A

from developmental hyperplastic lesions related to an area of congential vascular formation

118
Q

lesions of focal nodular hyperplasia occur

A

more in the right lobe of the liver

119
Q

what is the second most common benign liver mass?

A

hepatic adenoma

120
Q

Hepatic adenoma

A

a benign solid hepatic mass

121
Q

what is hepatic adenoma associated with?

A

the use of contraceptive agents

122
Q

sonographic finding of hepatic adeoma

A

solid hepatic mass
nonspecific echogenicity
may have tumor hemorrhage
may have vascularity

123
Q

what is recommended for hepatic adeoma?

A

surgical resection is recommended due to the risk of malignant transformation

124
Q

Common duct stricture

A

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
Q

Hepatic Lipoma

A

extremely rare fatty tumor

126
Q

Sonographic findings hepatic lipoma

A

hyperechoic mass

127
Q

what is used to comfirm hepatic lipoma?

A

ct scan can be useful in confirming the fatty tumors

128
Q

Hepatocellular carcinoma

A

liver cancer

129
Q

what is the most common primary maglignancy of the liver?

A

hepatocellular carcinoma

130
Q

Hepatocellular carcinoma occurs

A

10-25% of patients with cirrhosis
most frequent in men

131
Q

extrahepatic mass

A

An extrahepatic mass in the area of the porta hepatis causes the same clinical signs as seen in biliary obstruction

132
Q

Clinical Presentation of hepatocellular carcinoma

A

a previous history of cirrhosis or hepatitis B and C, a palpable mass, hepatomegaly, appetite disorder, and fever

133
Q

Diffuse Abnormalities of the Liver Parenchyma

A
  • Extrahepatic mass
  • Common duct stricture
  • Passive hepatic congestion
134
Q

hepatoceullar carcinoma has been known to

A

invade the hepatic veins to produce Budd-Chiari syndrome

135
Q

Hepatocellular carcinoma commonly invades

A

venous structures (portal vein, hepatic veins, IVC)

136
Q

sonographic findings of hepatocellular carcinoma

A

multiple hypoechoic solid mass
variable in apperance

137
Q

Biliary Obstruction: Distal clincal findings

A

Common duct stones cause RUQ pain, jaundice, pruritus.

Elevated bilirubin and alk phos.

Dilated intrahepatic ducts, usually a small gallbladder, gallstones often present.

138
Q

Biliary Obstruction: Distal

A

Caused by stones in the common duct, an extrahepatic mass in the porta hepatis, or stricture of the common duct.

139
Q

biliary obstruction: proximal clinically the pateint may be

A

Clinically, the patient may be jaundiced and have pruritus (itching).

140
Q

with hepatocellular carcinoma increase in lab values

A

Alpha feta protein, AST and ALT

141
Q

metastatic liver cancer

A

is cancer that started in the liver and spread (or metastasized) to other areas of the body

142
Q

Liver metastases

A

are cancers that have spread (or metastasized) to the liver from a tumor that started in another par of the body

143
Q

most live metastes are

A

multiple

144
Q

Liver metastasis found most commonly in
i

A

the colon or rectum

145
Q

in general, the imagining apperances of liver metastes are

A

nonspecific and a liver biospy speciments are required for histological diagnosis

146
Q

metastatic spread to the liver occurs

A

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
Q

biliary obstruction: proximal liver function tests

A

Liver function tests show an elevation in the direct bilirubin and alkaline phosphatase levels.

148
Q

inflammatory disease of the liver

A

-Hepatic abscesses occur most often as complications of biliary tract disease, surgery, or trauma.

149
Q

the following 3 basic types of abscess formation occur in the liver:

A

intrahepatic, subhepatic, and subphrenical (under the diaphragm; upper part of the liver

150
Q

clinically patients with inflammatory diease have

A

fever, elevated white cell count, RUQ pain

151
Q

on sonographic examination of hepatic abscesses

A

the sonographer searches for solitary or multiple lesions in the liver, abnormal fluid collections in morison’s pouch, sub diaphragmatic or subphrenic space

152
Q

pyogenic abscess

A

pus forming abscess

153
Q

many routes for bacteria to gain access to the liver

A

the biliary tree, portal vein, or hepatic artery a direct extension from a contiguous infection and rarely
heaptic trauma

154
Q

sources of the infection include

A

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
Q

Hepatic candidiasis is caused by:

A

a species of Candida

156
Q

hepatic candidiasis occurs

A

in immunocomprised hosts, such as patients undergoing chemotherapy, organ transplant, recipients or individuals with human immunodeficiency infection (HIV)

157
Q

hepatic candidiasis

A

a hepatic mass that results from the spread of fungus in the blood to the liver

158
Q

the candidal fungus invades

A

the bloodstream and may affect any organ, with kidney, brain, and heart affected the most

159
Q

Amebic abscess is caused bya parasite called

A

Entamoeba histolytica

160
Q

How is Entamoeba histolytica transmitted?

A

contaminated food and water

161
Q

what are the main characterized symptoms of amebic abscess?

A

diarrhea and abdominal pain

162
Q

what is the treatment of amebic abscess?

A

includes anti-parasitic via the portal vein

163
Q

how do parasities reach the liver parenchyma?

A

via the portal vein

164
Q

patients with amebic abscess may

A

be asymptomatic or may show gastrointestinal symptoms of abdominal pain, diarrhea, leukocytosis, and low fever

165
Q

Hepatic echinococcosis

A

an infectious cystic disease common in sheep-herding areas of the world

166
Q

the echinococcosis is

A

a tapeworm that infects humans as the intermediate host

167
Q

Pneumocystic pneumonia

A

is a common life-threatening infection in patients with HIV
invasion of the porta hepatic

168
Q

Pneumocystic carinii is the most common organism causing

A

opportunistic infection in patients with acquired immunodificiency syndrome

169
Q

pneumocystis carinii affects

A

patients undergoing bone marrow and organ transplantation or a patient receiving chemotherapy

170
Q

sonographic findings of pneumocystis cariniipattern

A

ranges, tiny, non-shadowing echogenic foci to extensive replacement of the liver parenchyma by various echogenic clumps of calcifications

171
Q

biliary obstruction

A

blockage of bile ducts

172
Q

biliary obstruction sonographically

A

extrahepatic mass

173
Q

biliary obstruction: proximal

A

Biliary obstruction proximal to the cystic duct can be caused by:
Gallstones
Carcinoma of the common bile duct
Metastatic tumor

Liver (3 decks)

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