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Spring 2014 - ABD TEST 2 - LIVER ✔️ > Pathology > Flashcards

Pathology Flashcards

0
Q

Name 3 liver developmental anomalies…

A

Agenesis - incompatible with life
Position - situs inversus
Vascular anomalies

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1
Q

Name 4 things about liver parenchyma…

A

Size
Configuration
Homogeneity
Contour

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2
Q

What are the 3 classifications of liver disease?

A

Parenchymal disease
Hepatobiliary disorders
Hepatic vascular disorders

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3
Q

Name the 6 diffuse disease…

A 
Fatty infiltration
Granulomas
Hepatitis
Cirrhosis
Glycogen storage
Hemochromatosis
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4
Q

What does hepatocellular-diffuse diseases do?

A

Interferes with liver function

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5
Q

Describe fatty infiltration…

A

Increased lipid and triglycerides
Benign and may be reversible
Asymptomatic
Symptoms - jaundice, nausea, vomiting, pain

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6
Q

Causes of fatty liver…

A

Obesity, excessive alcohol intake, poorly controlled hyperlipidemia, diabetes, excess corticosteroids, pregnancy, feeding through a tube, severe hepatitis, glycogen storage disease, cystic fibrosis, drug use

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7
Q

Fatty infiltration is a result of what?

A

Major injury to the liver or a systemic disorder leading to impaired or excessive metabolism of fat

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8
Q

Describe fatty infiltration sonographically…

A

Increased echogenicity

Hepatomegaly

Posterior liver diaphragm and vessels may be difficult to see due to the attenuation of the sound

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9
Q

What are the types of fatty infiltration?

A

Grade 1 - slight
Grade 2 - moderate
Grade 3 - marked

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10
Q

What is steatosis?

A

Cellular pathology of fatty infiltration

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11
Q

What is fatty sparing?

A

Anterior to GB or PV
Near porta hepatis
Posterior left lobe

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12
Q

What is granulomas?

A

Small calcifications in liver and spleen

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13
Q

What are granulomas caused by?

A

Histoplasmosis - breathing in fungus from bat or bird droppings
Tuberculosis - bacteria found in lymph nodes and bloodstream

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14
Q

What do granulomas look like sonographically?

A

“Pearls” image

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15
Q

What is hepatitis?

A

Inflammatory and infectious disease

Hep A - from fecal - oral route
Hep B - from needles/blood - body fluid contact

Also there is Hep C, D, E, G, etc

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16
Q

What can hepatitis lead to?

A

Inflammation can lead to cirrhosis, portal hypertension, and hepatocellular carcinoma

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17
Q

What are 8 symptoms of hepatitis?

A

Nausea, vomiting, RUQ pain, fatigue, anorexia, fever, headache, jaundice

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18
Q

What is the lab report for hepatitis?

A

Marked increase in AST
ALT falls rapidly after several days
Bilirubin increases

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19
Q

Describe acute hepatitis…

A

Mild to necrosis
Hepatocyte injury
Kupffer cell enlarging and regeneration

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20
Q

What does hepatitis look like sonographically?

A

Non shadowing foci - portal radicals (branches)
Hepatosplenomegaly
GB wall thick
“Starry night” picture

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21
Q

Describe chronic hepatitis…

A

Fibrosis

May progress to liver failure and cirrhosis

Sonographically - coarse, smaller in size, soft shadow from fibrosis

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22
Q

Describe cirrhosis…

A 
Degenerative disease
Necrosis
Fibrosis
Progress to liver failure and portal hypertension
Chronic alcohol abuse
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23
Q

Cirrhosis sequela…

A

Portal hypertension
Varicosities in the ABD
Portal vein thrombosis
Spenomegaly

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24
Q

Symptoms of cirrhosis…

A 
Fatigue and weakness
Abdominal bloating
Anorexia
Jaundice
Later symptoms - GI bleeding, varicose veins on the ABD, red palms, clubbing of nails and fingers
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25
Q

Cirrhosis lab values…

A

AST, ALT, and bilirubin increased

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26
Q

Cirrhosis sonographically…

A 
Coarse
Decreased vascular
As cites
Hepatosplenomegaly progresses to smaller size
Nodularity
Dilated portal vein
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27
Q

Describe size of liver depending on stage…

A

Early stage - liver enlarged
Advanced stage - liver small
** caudate lobe increases in size

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28
Q

Doppler characteristics of cirrhosis…

A

Waveform is abnormal

Hepatic veins develop luminal narrowing with increased velocities and turbulence of the flow patterns

Doppler gets pointier

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29
Q

Describe glycogen storage disease…

A

Type 1 - VON GIERKE

genetic disorder of carbohydrate metabolism

Abnormally large amounts of glycogen are deposited in the liver and kidneys

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30
Q

Von Gierke sonographically…

A

Hepatomegaly
Increased echogenicity
Adenomas
Associated nephromegaly

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31
Q

Describe hemochromatosis…

A

Rare
Iron metabolism
Sonographically - hepatomegaly, cirrhostic changes

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32
Q

Describe biliary obstruction…

A

Origin of bile in the liver
Prox biliary tree is within the liver
Distal biliary tree in closest to pancreatic head
Biliary dilatation usually occurs prox to level of obstruction
MOST COMMON obstruction is distal CBD with dilatation CBD, BG, intrahepatic ducts

33
Q

Described PROXIMAL biliary obstruction…

A 
Gallstones, CA, mets
Jaundice pruritus (itchy)
Elevated bilirubin and Alk Phos
Sonographic - dilated duct, GB normal in size
"Railroad sign"
34
Q

Described DISTAL biliary obstruction…

A 
Stones in CBD
Mass
Stricture
RUQ pain, jaundice, pruritus
Increased bilirubin and Alk Phos 
Sonographic - dilated ducts, GB size may be small, gallstone
35
Q

Describe extrahepatic mass obstruction…

A

In porta hepatis

Sonographic - ductal dilation, hydropic GB (distended), lesions may be lymph or pancreatic CA

36
Q

Describe common duct stricture obstruction…

A

Jaundice, previous cholecystectomy, increased bilirubin and Alk Phos

Sonographic - dilated ducts

37
Q

Describe passive hepatic congestion obstruction…

A

Secondary to CHF
Hepatomegaly
Sonographic - dilation of IVC, SMV, HV, PV, SV

38
Q

What are the 5 focal diseases?

A 
Cysts
Abscess
Hematoma
Tumors
Metastases
39
Q

Characteristics of a simple cyst..

A 
Well defined
Anechoic
Enhancement
Thin smooth walls
Round or oval
40
Q

Describe a cyst…

A

Congenital
Developmental defects in bile duct formation
Cystic masses that result from trauma are not true cysts
Sonographic - solitary, varied in size

41
Q

Describe polycystic disorder…

A

Autosomal dominant
Associated with polycystic kidneys
Sonographic - cyst criteria
Small, less than 2-3 cm, & multiple throughout the hepatic parenchyma

42
Q

Describe pyogenic abscess…

A

Bacterial - ecoli and anaerobes
Multiple infection symptoms
Sonographic - various appearances, usually solitary, debris, complex, micro air bubbles or pus cause shadowing

43
Q

Describe candidiasis abscess…

A

Fungal

Immunocompromised hosts such as cancer patients and organ transplant patients

Sonographic - multiple hypoechoic masses, target or bulls eye lesions

“Wheel within a wheel” sign - early

44
Q

Describe chronic granulomatous abscess…

A

Congenital defect in the leukocytes
Pediatric
Sonographic - hypoechoic mass, calcification with shadowing

45
Q

Describe amebic abscess…

A 
Parasitic - entamoeba histolytica
Contaminated water and food
Enters liver through portal vein
RUQ pain and fever, traveling outside the us
Sonographic - variable appearance
46
Q

Describe echninoccal abscess…

A

Parasitic

Hydatid cysts - sheep and cattle herding, parasite causing hydatid disease, tapeworm lives in feces, food contaminated

Clinically - fever, RUQ tenderness

Sonographic - honeycomb, cyst within a cyst, daughter cyst, “water lily” sign

47
Q

Describe schistosomiasis abscess…

A

Parasitic - contaminated water

Sonographic - thickened portal walls and dilation (portal hypertension), splenomegaly, collaterals

48
Q

Name the 4 benign and 2 malignant tumors…

A

Benign - cavernous hemangioma, adenoma, cystadenoma, focal nodular hyperplasia

Malignant - carcinoma, metastatic

49
Q

Describe cavernous hemangiomas tumors…

A 
MOST COMMON benign tumor of the liver
Large network of vascular endothelium
Females
Sonographic - hyperechoic 
CT and MRI helpful; biopsy may be indicated
50
Q

Describe adenoma tumors…

A

Glandular
Female - oral contraceptive
May be malignant
Sonographic - hyperechoic with central hypoechoic

51
Q

Describe focal nodular hyperplasia tumors…

A

SECOND MOST COMMON benign liver mass
Women under 40
Sonographic - well defined, multiple nodules, STEALTH LESION

52
Q

Describe hemangioendothelioma tumors…

A 
Infantile
Benign overgrowth
Females
Presents with ABD mass
Sonographic - multiple lesions with hyperechoic margins
53
Q

Describe hamartoma tumors…

A 
Rare
Benign
Children under 2
Palpable ABD mass
Sonographic - well defined large complex mass
54
Q

Describe hepatocellular carcinoma - HEPATOMA…

A 
MOST COMMON primary malignant neoplasm
Related to cirrhosis
Male
Unexplained mild fever
Invasive
Destroy vessels
Sonographic - halo lesions, hepatomegaly
55
Q

Symptoms of HCC - hepatoma…

A 
Elevated alpha fetoprotein 
Abnormal liver function tests
Unexplained weight loss
Palpable mass
Ascites
56
Q

HCC presents in one of what three patterns…

A

Solitary massive tumor
Multiple nodules throughout the liver
Diffuse infiltrative masses in the liver

57
Q

HCC pathologically presents how…

A

Focal lesion
Invasive lesion with necrosis and hemorrhage
Poorly defined lesion

58
Q

What has HCC been known to do…

A

Invade the be

ASIC veins to produce Budd-Chiari syndrome

59
Q

Describe angiosarcoma tumors…

A

Malignant from the blood vessels
Rare
60-80 year olds
Sonographic - solid mass

60
Q

Describe metastatic disease tumors…

A

MOST COMMON form of neoplastic involvement of the liver
Primary: breast, colon, lung
Abnormal LFT
Sonographic - multiple nodes, bulls eye lesions, calcifications

61
Q

Metastatic disease patients with SHORT SURVIVAL RATE…

A

HCC and carcinoma of the pancreas, stomach, and esophagus

62
Q

Metastatic disease patients with LONGER SURVIVAL RATE…

A

Head and neck carcinoma and carcinoma of the colon

63
Q

Describe lymphoma tumors…

A

Hodgin’s and non-Hodgin’s
Hepatomegaly
Sonographic - bull’s eye, multiple

64
Q

Name the 3 PEDIATRIC malignant tumors…

A

Hepatoblastoma - liver
Neuroblastoma - adrenal gland
Wilm’s - kidney
Leukemia

65
Q

Describe hepatoblastoma tumors…

A 
Associated with beckwith-wiedemann
Genetic growth disorder - defect in chromosome 11
Before age 5
Elevation in alpha fetoprotein 
Palpable mass
Weight loss
66
Q

Describe TORCH…

A

Infections - neonate - hepatomegaly

Baby contracts TORCH in the uterus

Toxoplasmosis, other infections, rubella, cytomegalovirus, herpes

67
Q

Describe trauma…

A

Sonographic but CT more specific
Free fluid
Hematoma
Decrease in hematocrit and hemorrhage

68
Q

Name 2 hyperechoic surgical structures seen in the liver…

A

Post operative air

Surgical clips

69
Q

Indications, complications, and sonographic appearance of liver transplants…

A

Indications - cirrhosis, hepatitis, cholangitis, hepatoma, Budd-Chiari

Complications - rejection, thrombosis, infection, neoplasia, biliary stricture

Sonographic - evaluate the portal system and hepatic artery, ascites may be present

70
Q

What is done before a liver transplant…

A

Vascular structures are assessed for size and patency

Liver parenchyma should be examined to rule out the presence of hepatic architecture disruption

71
Q

What is portal venous hypertension…

A

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

72
Q

Describe portal venous hypertension…

A

Increase in portal venous pressure or hepatic venous gradient present

Cirrhosis (most common), thrombus, tumor

Collateral damage - coronary and esophageal vein - varices tortuous dilations

73
Q

Abnormalities of portal venous hypertension…

A

In an effort to relieve pressure, collateral veins are formed that connect to the varicose veins

Varicose veins occur most frequently in the area of the esophagus, stomach, rectum

Rupture of these veins can cause massive bleeding that may result in death

74
Q

Clinically seen in portal venous hypertension…

A

Portal vein greater than 1.3 cm

Splenic vein greater than 1.0 cm

No change in respiration

Recanalization of the umbilical vein (ligamentum teres) - medusa’s head

Color Doppler - flow should be hepatopetal - towards

75
Q

Indications for portal venous hypertension…

A

Suspected secondary to liver disease

Portal vein compression or thrombosis

Acute onset of hepatic vein occlusion (Budd-Chiari), constrictive pericarditis, or congestive heart failure with tricuspid regurgitation

Congenital, traumatic, or neoplastic arterioportal fistula

76
Q

Describe portal vein thrombosis…

A

Collaterals develop - wormlike at the porta hepatis

77
Q

Describe portal venous hypertension shunts…

A

Portacaval - PV confluence - IVC - wall stent

Mesocaval - SMV - IVC

Splenorenal - SV - LRV

TIPS - transjugular intrahepatic portosystemic shunt

78
Q

Describe TIPS…

A

Placement of a stent between the portal and hepatic veins to shunt blood and reduce the pressure

Temporary treatment

79
Q

Portal hypertension sonographic findings…

A 
Initially hepatomegaly
Shrunken right lobe
Enlarged caudate and left lobe
Nodular surface
Coarse texture
Splenomegaly
Ascites
Mono phasic flow in hepatics
Hepatofugal flow in portals
Enlarged PV, SMV
Reversed flow in splenic vein
80
Q

Describe Budd-Chiari Syndrome…

A

Thrombosis of hepatic vein or IVC

Ascites, jaundice, ABD pain, hepatomegaly, edema of legs, vomiting, diarrhea

Poor prognosis - 2 types: primary (congenital) and secondary (thrombosis)

Sonographic - caudate lobe enlarged, atrophy of rt hepatic lobe thrombosis vein enlarges, splenomegaly

Spring 2014 - ABD TEST 2 - LIVER ✔️ (3 decks)

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