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abdomen > pathology of the liver test 2 > Flashcards

pathology of the liver test 2 Flashcards

0
Q

What is the correct transducer for liver evaluation?

A

Ave adult: 2.5-5 MHz

slender adult and children: 5-7MHz

neonate 7.5-12 MHz

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1
Q

What is patient prep for liver exam?

A

NPO for 6-8 hours

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2
Q

What is the assessment criteria for the liver?

A

size of the liver in sag

attenuation of liver parenchyma

texture

presence of hepatic vascular structures ligaments and finish

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3
Q

What are you basically looking for in the liver parenchyma?

A

size

configuration

homogeneity

contour

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8
Q

What is situs inversus?

A

the organs are backwards in the body

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9
Q

What is agenesis?

A

the organ isn’t there - incompatible with life

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10
Q

What are the classifications of the liver diseases?

A

parenchymal

hepatobiliary disorders

hepatic vascular disorders

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11
Q

What is hepatocellular diffuse disease?

A

interferes with liver function

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12
Q

What are the diffuse liver diseases?

A

fatty infiltration

granulomas

hepatitis

cirrhosis

glycogen storage

hemochromatosis

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13
Q

what is diffuse?

A

throughout the organ

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14
Q

What needs to be in the pictures of the liver?

A

the diaphragm

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15
Q

What is fatty infiltraton

A

increased lipid and triglycerides

benign and may be reversible

asymptomatic

other symptoms: jaundice, nausea, vomiting, pain

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16
Q

What are the causes of fatty liver?

A

obesity

excessive alcohol intake

poorly controlled hyperlipidemia

diabetes

excess corticosteroids

pregnancy

total parenteral hyperalimentation (tube feed)

severe hepatitis

glycogen storage disease

cystic fibrosis

pharmaceutical

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17
Q

the main cause of fatty liver is?

A

Increased fats

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18
Q

Why does the liver become fatty?

A

result of major injury to the liver or a systemic disorder

leading to impaired or excessive metabolism of fat

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19
Q

What does fatty liver look like sonographically?

A

increased echogenicity

hepatomegaly

posterior liver diaphragm and vessels - may be hard to see

greater attenuation = decreased visualization

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20
Q

What are the three grades of fatty infiltration?

A

grade 1 - slight

grade 2 - moderate

grade 3 - marked

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21
Q

What is grade 1 fatty infiltration?

A

there is a slight diffuse increase in fine echoes in the hepatic parenchyma, with normal visualization of the diaphragm and intrahepatic vessel borders

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22
Q

What is grade 2 fatty infiltration?

A

moderate - diffuse increase in fine echoes with slightly impaired visualization of the intrahepatic vessels and diaphragm

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23
Q

What is grade 3 fatty infiltration?

A

marked - increase in fine echoes with poor or no visualization of the intrahepatic vessel borders, diaphragm and posterior portion of the right lobe of the liver

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24
Q

What is steatosis?

A

synonym for fatty infiltration at the cellular level

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25
Q

What is fatty focal sparing?

A

where the liver has fatty infiltration diffuse, but somewhere near the porta hepatis…there will be a dark area…this is fatty sparing, not necessarily a tumor

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26
Q

Where might you find fatty sparing?

A

anterior to the GB or PV

near Porta hepatis

posterior left lobe

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27
Q

What are granulomas?

A

small calcifications in the liver and spleen

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28
Q

What are granulomas caused by

A

Histoplasmosis

tuberculosis

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29
Q

What is histoplasmosis?

A

in an infection caused by breathing in spores of a fungus often found in bird and bat droppings

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30
Q

what is tuberculosis?

A

bacterial infection that can spread through the lymph nodes and blood stream to any organ in your body.

most often found in the lungs

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31
Q

What are the symptoms of granulomas?

A

asymptomatic

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32
Q

how do granulomas appear sonographically?

A

echogenic pearls with shadowing

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33
Q

Where else beside liver will you see granulomas?

A

in the spleen

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34
Q

What is hepatitis?

A

inflammatory and infectious disease

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35
Q

How do you get hepatitis A?

A

fecal matter

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36
Q

How do you get hepatitis B?

A

exposure to needles and blood

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37
Q

What are some things that develop from hepatitis?

A

inflammation can lead to cirrhoisis

portal hypertension

hepatocellular carcinoma

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38
Q

What are some symptoms of hepatitis?

A

nausea

vomiting

RUQ pain

fatigue

anorexia

FEVER

headache

jaundice

Hep B and C also cause

skin rash

aversion to smoking

weight loss

arthralgia

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39
Q

What are the lab values for hepatitis?

A

marked increase in AST and ALT

ALT fall rapidly after several days

bilirubin increases

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40
Q

What happens with acute hepatitis?

A

mild to necrosis

hepatocyte injury

kupffer cell enlarging and regeneration

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41
Q

how does acute hepatitis look sonographically?

A

the portal radicals (branches of portal vein) becoming even more echogenic

hepatosplenomegaly

thick GB walls

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42
Q

What happens if you have chronic hepatitis?

A

fibrosis (a course-ness, not smooth)

may progress to liver failure and cirrhosis

will become smaller

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43
Q

What are the sonographic findings for chronic hepatitis?

A

coarse

smaller size

soft shadow from fibrosis

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44
Q

Symptoms and causes of chronic hepatitis is the same as acute?

A

yes

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45
Q

What is cirrhosis?

A

degenerative disease

necrosis

fibrosis

progress to liver failure and portal hypertension

CHRONIC ALCOHOL ABUSE

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46
Q

What is cirrhosis sequela?

A

portal hypertension

varicosities in the abdomen

portal vein thrombosis

splenomegaly

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47
Q

What are the symptoms for chirrhosis?

A

fatigue and weakness

abd bloating

anorexia

jaundice

later symptoms:

GI bleeding

varicose veins on the abd

red palms

clubbing of nails and fingers

ascites

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48
Q

What are the lab values for cirrhosis?

A

AST, ALT and Bilirubin are all increased

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49
Q

What does a smaller, coarse, nodular, structure with free fluid and a dilated portal vein indicate?

A

a liver with cirrhosis

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50
Q

what might also increase with cirrhosis?

A

the caudate lobe

early stage liver: enlarged

advanced stage: small

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51
Q

What are doppler characteristics of cirrhosis?

A

waveform is abnormal

as advances, the hepatic veins develop luminal narrowing

increased velocities and trubulence of the flow patterns

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52
Q

What does EtOH stand for?

A

alcohol abuse

53
Q

What is glycogen storage disease?

A

type 1 von Gierke

genetic disorder of carbohydrate metabolism

stores too much glycogen…cant metabolise it

54
Q

What are the sonographic findings of vonGierke?

A

hepatomegaly

increased echogenicity

adenomas**

associated nephromegaly

55
Q

What is a glycogen storage disease with adenomas?

A

von Gierke’s disease

56
Q

What is the definition of glycogen storage disease?

A

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

57
Q

What is Hemochromatosis?

A

rare

liver cannot metabolize iron

hepatomegaly

cirrhotic changes

cannot see on ultrasound

58
Q

Where is the orgin of bile?

A

in the liver

59
Q

where is the proximal biliary tree?

A

within the liver

60
Q

Where is the distal biliary tree?

A

closest to the pancreatic head

61
Q

Where does biliary dilatation usually occur?

A

proximal to the level of the obstruction

62
Q

Where are the most common obstructions of the CBD?

A

Distal CBD with dilatation CBD, GB, intrahepatic ducts

63
Q

What are the lab values for biliary obstruction?

A

elevated bilirubin and ALK PHOS

64
Q

What is a biliary proximal obstruction?

A

Causes: Gallstones, CA, Mets

Symptoms: Jaundice, pruritus

Labs: elevated bili and alk phos

sonographic: dilated duct, GB normal in size

65
Q

What are the symptoms of distal biliary obstruction?

A

causes:

stones in the CBD

mass

stricture (narrowing)

symptoms:
RUQ pain

jaundice

pruritis

66
Q

What are the sonographic findings of distal biliary obstruction?

A

dilated ducts

GB size may be small

Gallstones

67
Q

What is the sonographic findings in an extrahepatic mass?

A

ductal dilation

hydropic GB - distended

lesion may be lymph or pancreatic Ca (ca blocks the duct)

68
Q

What are the symptoms of the common duct stricture?

A

jaundice

previous cholecystectomy

increase in bilirubin and alk phos

sonographically: dilated ducts

69
Q

What are the focal diseases of the liver?

A

cysts

abscess

hematomas

tumors

metastases

70
Q

What are the sonographic findings of a cyst of the liver?

A

well defined

anechoic

enhancement

71
Q

If its not a random cyst in the liver, what is it?

A

congenital

72
Q

What is polycystic liver disease?

A

autosomal dominant

associated with polycystic kidneys

sonographic: cyst criteria

73
Q

Are the cysts in polycystic liver disease small or large?

A

small, less than 2 -3 cm

multiple throughout the hepatic parenchyma

74
Q

What are liver abscess?

A

pyogenic (bacterial)

escherichia coli (E. coli) and anaerobes

multiple infection symptoms

75
Q

How does an abscess appear sonographically?

A

various appearances

usually solitary

debris

complex

micro air bubbles cause SHADOWING

looks like cysts webbed together

76
Q

What is a fungal (candidiasis) abscess?

A

immunocompromised hosts such as cancer patients and organ transplant patients are most likely to get it

infection

77
Q

how does candidiasis look sonographically?

A

multiple hypoechoic masses

target or bull’s eye lesions

“wheel within a wheel” early

78
Q

What is an amebic (parasitic) abscess?

A

parasite: entamoeba histolytica

contaminated water and food

enters liver through portal vein

sonographic: variable appearance

air in the mass usually = abscess

79
Q

what is fever and travel to foreign country indicate?

A

abscess

80
Q

What is an echninoccal (parasitic) abscess?

A

aka: hydatid cysts

sheep and cattle herding

parasite causing hydatid disease

food contaminated

81
Q

what are the clinical symptoms of echninoccal parasitic hydatid cysts?

A

fever

RUQ tenderness

82
Q

What is the sonograhic findings of echninoccal parasitic hydatid cysts?

A

honey comb

WATER LILY SIGN

cyst within a cyst

DAUGHTER CYST

83
Q

What is a schistosomiasis (parasitic) abscess?

A

contaminated water

sonographic: thickened portal walls and dilatation (portal hypertension)

splenomegaly

collaterals (opens ligamentum teres)

84
Q

What are benign tumors of the liver?

A

cavernous hemangioma

adenoma

cystadenoma

focal nodular hyperplasia

85
Q

What are malignant tumors of the liver?

A

carcninoma

metastatic

86
Q

Are tumors focal or diffuse?

A

focal

87
Q

What is a cavernous hemangioma?

A

MOST COMMON benign tumor

echogenic because it is highly vascular

usually looks round

typically females

sonographic: hyperechoic

88
Q

What is an adenoma?

A

glandular

female oral contraceptives increase the occurance

may become malignant

89
Q

how does and adenoma appear sonographically?

A

hyperechoic

90
Q

What is focal nodular hyperplasia?

A

second common benign liver mass

women under 40

sonographically:

well defined

multiple nodules

STEALTH LESION

91
Q

Where is focal nodular hyperplasia most often found?

A

on the anterior portion of the left lobe

92
Q

What is an infantile hemangioendothelioma?

A

benign overgrowth

females

presents with abd mass

sonographic: multiple lesions with hyperechoic margins

no symptoms

93
Q

What is a hamartoma?

A

rare

benign

children under 2

palpable abd mass

sonographic: well defined large complex mass

no symptoms

94
Q

What is hepatocellular carcinoma (HCC) hepatoma?

A

most common primary malignant neoplasm

related to cirrhosis

male

unexplained mild fever

invasive

destroys vessels

sonographic: halo lesions, hepatomegaly

95
Q

What is encountered more HCC or Mets?

A

Mets

96
Q

what are the labs for HCC? (hepatocellular carcinoma)

A

elevated alpha fetoprotein***

abnormal liver function tests

cirrhosis

unexplained weight loss***

palpable mass

ascites

97
Q

How does hepatocellular carcinoma present?

A

solitary massive tumor

multiple nodules throughout the liver

diffuse infiltrative masses in the liver

98
Q

how will HCC pathologically present?

A

focal lesion

invasive lesion with necrosis and hemorrhage

poorly defined lesion

99
Q

When cancer invades the hepatic veins what do you have?

A

Budd-Chiari syndrome

100
Q

Hepatoblastoma is what?

A

associated with becwith-wiedemann

genetic growth disorder - associated with a defect in chromosome number 11

before age 5

labs: elevation in alpha fetoprotein
symptoms: palpable mass, weight loss

101
Q

What is the neonate hepatomegaly TORCH?

A

T - toxoplasmosis

O- other infections

R- rubella

C - cytomegalovirus

H - herpes

infections in the uterus when the mother catches the infectious disease and carries it through the blood stream to the baby

102
Q

What are the signs for trauma with a hepatic hematoma?

A

sonographic:

free fliud

hematoma

decreased hematocrit

103
Q

What could be a consequence of trauma or surgery in the liver?

A

hematoma

hemorrhage

decreased hematocrit

104
Q

What are indications for a liver transplant?

A

cirrhosis

hepatitis

cholangitis

hepatoma

budd-chiari

105
Q

what are complications for a liver transplant?

A

rejection

thrombosis

infection

neoplasia

106
Q

What are you assessing in a liver transplant?

A

vascular structures are assessed for size and patency in the preoperative evaluation

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

107
Q

What is the problem with portal hypertension?

A

it causes the pressure to go up and the vessels start to pop

108
Q

what is the most common cause of portal hypertension?

A

cirrhosis

109
Q

what are collaterals?

A

when portal hypertension forces the body to create new paths for blood flow

coronary and esophageal vein

varices tortuous dilations

110
Q

What happens with a varicose or collateral vein ruptures?

A

person bleeds out

111
Q

what is the limit on the portal vein size?

A

1.3cm any greater and you suspect portal hypertension

112
Q

What happens to the umbilical vein when you have portal hypertension?

A

recanalization of the umbilical vein = Medusa’s head

113
Q

What is the most common connection to release pressure when there is portal hypertension?

A

TIPS

transjugular intrahepatic portosystemic shunt

114
Q

Where is TIPS placed?

A

between the portal and hepatic veins***

placed to reduce pressure

temporary treatment

115
Q

What are the sonographic findings of portal hypertension?

A

initially hepatomegaly

shrunken right lobe

enlarged caudate and left lobe

nodular surface

coarse texture

splenomegaly

ascites

116
Q

What are the doppler findings for portal hypertension?

A

monophasic flow in the hepatic veins

hepatofugal flow in the portal veins

enlarged portal vein

enlarged SMV

reversed flow in the splenic vein

117
Q

what is Budd-Chiari?

A

thrombosis of the hepatic vein or IVC

118
Q

what is the songraphic finding of Budd-Chiari?

A

caudate lobe enlarged

atrophy of rt hepatic lobe thrombosed vein enlarges

splenomegaly

119
Q

What is an angiosarcoma?

A

malignant from the blood vessels

rare

60-80 years old

sonographic: solid mass

120
Q

what is metastatic disease?

A

most common

primary: breast, colon, lung
lab: abnormal LFT
sonographic: multiple nodes, bull’s eye lesions, calcifications

121
Q

What is lymphoma?

A

hodgkins and non-hodgkins

hepatomegaly

sonographic: bull’s eye, multiple

122
Q

What are the pediatric malignancies?

A

hepatoblastoma (liver)

neuroblastoma (adrenal gland)

Wilm’s (kidney)

leukemia (lymph)

123
Q

What is one tell tale sign of Budd - Chiari syndrome?

A

edema of the legs

abdomen (11 decks)

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