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A ADVANCED ABDOMEN > Pathology Lecture for Quiz 2/3 > Flashcards

Pathology Lecture for Quiz 2/3 Flashcards

1
Q

What is the highest echogenicity of parenchymal organs?

A

Renal sinus

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2
Q

What is the parenchymal organ order for echogenicity?

A

Renal sinus/retro fat, pancreas, spleen, liver, renal cortex, renal medulla

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3
Q

In scanning, what overlaps the spleen?

A

The top of the left lobe of liver

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4
Q

What are three sonographic liver patterns?

A

Normal, centri-lobular, fatty-fibrotic

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5
Q

What is the appearance of a centri-lobular pattern?

A

Decreased echogenicity of the liver parenchyma with bright echogenic dots (starry night)

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6
Q

With centri-lobular pattern, how is the PV wall affected?

A

Increased visualization through brightness and number

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7
Q

What are the causes of centril-lobular pattern?

A

Acute hepatitis, acute RT side HF, leukemia/lymphoma, toxic shock syndrome

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8
Q

What percentage of people develop centri-lobular pattern????? ASK

A

2%

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9
Q

Why does starry night/centri-lobular pattern occur?

A

Edematous swelling (water) of hepatocytes w/resultant decrease in the hepatic echogenicity

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10
Q

With starry night, what do the altered acoustic properties between the portal venous radicals and hepatic lobules cause?

A

Sonographic accentuation of the venule walls

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11
Q

How does fatty fibrotic pattern appear?

A

Increased echogenicity of the liver parenchyma

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12
Q

How do PV walls appear with fatty fibrotic pattern?

A

Decreased definition

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13
Q

What are the two types of echotexture that can occur with fatty liver?

A

Homogenous (fine), heterogenous (coarse)

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14
Q

What happens to sound with fatty liver?

A

Posterior sound attenuation (darker bottom of screen)

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15
Q

What are causes of fatty liver?

A

Fatty infiltration, chronic hepatitis, cirrhosis, acute alcoholic hepatitis

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16
Q

What happens to the size of the liver with fatty liver?

A

It enlarges

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17
Q

What type of echotexture does fatty liver tend to have?

A

Homogenous

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18
Q

What are two types of focal fatty liver changes?

A

Liver penetration and fatty sparing

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19
Q

What type of pattern does cirrhosis show?

A

Fatty fibrotic pattern with heterogenous texture

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20
Q

Is there posterior attenuation with cirrhosis (in relation to fatty liver?)

A

Almost none

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21
Q

What can happen to the liver with cirrhosis?

A

It shrinks

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22
Q

What type of surface occurs with cirrhosis?

A

Nodular surface

23
Q

What is the ratio for elevated caudate to right lobe identifying cirrhosis?

A

Higher than .65

24
Q

What does portal hypertension account for?

A

90% of all cases of cirrhosis

25
With cirrhosis, which liver architecture is distorted?
Fibrosis, regenerating nodules, distorted vascular channels
26
What increases with portal hypertension?
Hepatic resistance, portal venous pressure
27
What eventually decreases with portal hypertension?
Portal flow
28
What is the prognostication for risk of hemorrhage?
Reversed portal flow
29
What are symptoms of ascites?
Jaundice, sudden weight gain, a distended abdomen, | difficulty breathing when lying down, diminished appetite, abdominal pain, bloating, nausea and vomiting, heartburn
30
What are sonographic signs of portal hypertension?
Ascites, dilated MPV, SV, SMV, collaterals, splenomegaly, various doppler findings
31
Where can ascites collect?
Morrison's pouch, below diaphragm and around the liver
32
What does most dependent area mean?
Lower support (standing = feet, lying on side = Morrison's
33
What are the 8 porto-systemic collaterals?
Gastroesophageal, coronary, umbilical, gastrosplenic, splenorenal/gastrorenal, perisplenic, instestinal (rectum), retroperitoneal
34
What is the coronary vein?
Left gastric vein
35
What is the upper normal limit of the coronary vein?
5 - 6 mm
36
Which porto-systemic collateral system is most prevalent?
Coronary (80 - 90%)
37
What appearance can coronary vein have?
Tortuous (as it extends superiorly toward GE junction
38
When an umbilican vein (UV) is extending from LPV, what is the diameter?
1.8 mm
39
What happens to doppler of portal vein with portal hypertension?
Loss/respiratory variation, decreased velocity of MPV, reversed flow
40
What happens to doppler of hepatic veins with portal hypertension?
Loss of normal pulsatility, non triphasic flow, flattened wave
41
What happens to hepatic arteries during portal hypertension?
They enlarge
42
Other than portal hypertension, what else can cause resistance?
Scarred liver, shrunken liver
43
Besides MPV, what else may have reversed flow with portal hypertension?
SMV and SV
44
What is ultrasound excellent in detecting with liver?
Focal liver lesions, liver cysts larger than 1 cm
45
What is ultrasound not good for?
Differentiating among pathologic entities / between benign and malignant lesions
46
What is better than ultrasound for triphasic study of lesions?
CT / MRI
47
How is ultrasound helpful regarding biopsy?
Diagnosis, follow up and guidance
48
What are the 6 benign hypoechoic liver masses?
Abscess, adenoma, focal nodular hyperplasis, hemangioma, microabscesses, focal fatty sparing
49
What are the 3 malignant hypoechoic liver masses?
Metastases, hepatocellular carcinoma, lymphoma
50
What are the 6 hyperechoic liver masses?
Hemangioma, abscess, adenoma, focal nodular hyperplasia, hemorrhagic cyst, focal fat infiltration
51
What are the 3 malignant hyperechoic liver masses?
Metastases, hepatocellular carcinoma, lymphoma
52
What's the similarity between hypoechoic and hyperechoic malignant masses?
They are the same diseases (3)
53
What are the benign liver masses common with hypoechoic and hyperechoic masses?
Abscess, hemangioma, adenoma, focal nodular dysplasia
54
What is LFT?
Liver function test

A ADVANCED ABDOMEN (9 decks)

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