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
1
Q
What is patient prep for liver exam?
A
NPO for 6-8 hours
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
3
Q
What are you basically looking for in the liver parenchyma?
A
size
configuration
homogeneity
contour
8
Q
What is situs inversus?
A
the organs are backwards in the body
9
Q
What is agenesis?
A
the organ isn’t there - incompatible with life
10
Q
What are the classifications of the liver diseases?
A
parenchymal
hepatobiliary disorders
hepatic vascular disorders
11
Q
What is hepatocellular diffuse disease?
A
interferes with liver function
12
Q
What are the diffuse liver diseases?
A
fatty infiltration
granulomas
hepatitis
cirrhosis
glycogen storage
hemochromatosis
13
Q
what is diffuse?
A
throughout the organ
14
Q
What needs to be in the pictures of the liver?
A
the diaphragm
15
Q
What is fatty infiltraton
A
increased lipid and triglycerides
benign and may be reversible
asymptomatic
other symptoms: jaundice, nausea, vomiting, pain
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
17
Q
the main cause of fatty liver is?
A
Increased fats
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
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
20
Q
What are the three grades of fatty infiltration?
A
grade 1 - slight
grade 2 - moderate
grade 3 - marked
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
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
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
24
Q
What is steatosis?
A
synonym for fatty infiltration at the cellular level
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
26
Q
Where might you find fatty sparing?
A
anterior to the GB or PV
near Porta hepatis
posterior left lobe
27
Q
What are granulomas?
A
small calcifications in the liver and spleen
28
What are granulomas caused by
Histoplasmosis
tuberculosis
29
What is histoplasmosis?
in an infection caused by breathing in spores of a fungus often found in bird and bat droppings
30
what is tuberculosis?
bacterial infection that can spread through the lymph nodes and blood stream to any organ in your body.
most often found in the lungs
31
What are the symptoms of granulomas?
asymptomatic
32
how do granulomas appear sonographically?
echogenic pearls with shadowing
33
Where else beside liver will you see granulomas?
in the spleen
34
What is hepatitis?
inflammatory and infectious disease
35
How do you get hepatitis A?
fecal matter
36
How do you get hepatitis B?
exposure to needles and blood
37
What are some things that develop from hepatitis?
inflammation can lead to cirrhoisis
portal hypertension
hepatocellular carcinoma
38
What are some symptoms of hepatitis?
nausea
vomiting
RUQ pain
fatigue
anorexia
FEVER
headache
jaundice
Hep B and C also cause
skin rash
aversion to smoking
weight loss
arthralgia
39
What are the lab values for hepatitis?
marked increase in AST and ALT
ALT fall rapidly after several days
bilirubin increases
40
What happens with acute hepatitis?
mild to necrosis
hepatocyte injury
kupffer cell enlarging and regeneration
41
how does acute hepatitis look sonographically?
the portal radicals (branches of portal vein) becoming even more echogenic
hepatosplenomegaly
thick GB walls
42
What happens if you have chronic hepatitis?
fibrosis (a course-ness, not smooth)
may progress to liver failure and cirrhosis
will become smaller
43
What are the sonographic findings for chronic hepatitis?
coarse
smaller size
soft shadow from fibrosis
44
Symptoms and causes of chronic hepatitis is the same as acute?
yes
45
What is cirrhosis?
degenerative disease
necrosis
fibrosis
progress to liver failure and portal hypertension
CHRONIC ALCOHOL ABUSE
46
What is cirrhosis sequela?
portal hypertension
varicosities in the abdomen
portal vein thrombosis
splenomegaly
47
What are the symptoms for chirrhosis?
fatigue and weakness
abd bloating
anorexia
jaundice
later symptoms:
GI bleeding
varicose veins on the abd
red palms
clubbing of nails and fingers
ascites
48
What are the lab values for cirrhosis?
AST, ALT and Bilirubin are all increased
49
What does a smaller, coarse, nodular, structure with free fluid and a dilated portal vein indicate?
a liver with cirrhosis
50
what might also increase with cirrhosis?
the caudate lobe
early stage liver: enlarged
advanced stage: small
51
What are doppler characteristics of cirrhosis?
waveform is abnormal
as advances, the hepatic veins develop luminal narrowing
increased velocities and trubulence of the flow patterns
52
What does EtOH stand for?
alcohol abuse
53
What is glycogen storage disease?
type 1 von Gierke
genetic disorder of carbohydrate metabolism
stores too much glycogen...cant metabolise it
54
What are the sonographic findings of vonGierke?
hepatomegaly
increased echogenicity
adenomas**
associated nephromegaly
55
What is a glycogen storage disease with adenomas?
von Gierke's disease
56
What is the definition of glycogen storage disease?
abnormally large amounts of glycogen are deposited in the liver and kidneys
57
What is Hemochromatosis?
rare
liver cannot metabolize iron
hepatomegaly
cirrhotic changes
cannot see on ultrasound
58
Where is the orgin of bile?
in the liver
59
where is the proximal biliary tree?
within the liver
60
Where is the distal biliary tree?
closest to the pancreatic head
61
Where does biliary dilatation usually occur?
proximal to the level of the obstruction
62
Where are the most common obstructions of the CBD?
Distal CBD with dilatation CBD, GB, intrahepatic ducts
63
What are the lab values for biliary obstruction?
elevated bilirubin and ALK PHOS
64
What is a biliary proximal obstruction?
Causes: Gallstones, CA, Mets
Symptoms: Jaundice, pruritus
Labs: elevated bili and alk phos
sonographic: dilated duct, GB normal in size
65
What are the symptoms of distal biliary obstruction?
causes:
stones in the CBD
mass
stricture (narrowing)
symptoms:
RUQ pain
jaundice
pruritis
66
What are the sonographic findings of distal biliary obstruction?
dilated ducts
GB size may be small
Gallstones
67
What is the sonographic findings in an extrahepatic mass?
ductal dilation
hydropic GB - distended
lesion may be lymph or pancreatic Ca (ca blocks the duct)
68
What are the symptoms of the common duct stricture?
jaundice
previous cholecystectomy
increase in bilirubin and alk phos
sonographically: dilated ducts
69
What are the focal diseases of the liver?
cysts
abscess
hematomas
tumors
metastases
70
What are the sonographic findings of a cyst of the liver?
well defined
anechoic
enhancement
71
If its not a random cyst in the liver, what is it?
congenital
72
What is polycystic liver disease?
autosomal dominant
associated with polycystic kidneys
sonographic: cyst criteria
73
Are the cysts in polycystic liver disease small or large?
small, less than 2 -3 cm
multiple throughout the hepatic parenchyma
74
What are liver abscess?
pyogenic (bacterial)
escherichia coli (E. coli) and anaerobes
multiple infection symptoms
75
How does an abscess appear sonographically?
various appearances
usually solitary
debris
complex
micro air bubbles cause SHADOWING
looks like cysts webbed together
76
What is a fungal (candidiasis) abscess?
immunocompromised hosts such as cancer patients and organ transplant patients are most likely to get it
infection
77
how does candidiasis look sonographically?
multiple hypoechoic masses
target or bull's eye lesions
"wheel within a wheel" early
78
What is an amebic (parasitic) abscess?
parasite: entamoeba histolytica
contaminated water and food
enters liver through portal vein
sonographic: variable appearance
air in the mass usually = abscess
79
what is fever and travel to foreign country indicate?
abscess
80
What is an echninoccal (parasitic) abscess?
aka: hydatid cysts
sheep and cattle herding
parasite causing hydatid disease
food contaminated
81
what are the clinical symptoms of echninoccal parasitic hydatid cysts?
fever
RUQ tenderness
82
What is the sonograhic findings of echninoccal parasitic hydatid cysts?
honey comb
WATER LILY SIGN
cyst within a cyst
DAUGHTER CYST
83
What is a schistosomiasis (parasitic) abscess?
contaminated water
sonographic: thickened portal walls and dilatation (portal hypertension)
splenomegaly
collaterals (opens ligamentum teres)
84
What are benign tumors of the liver?
cavernous hemangioma
adenoma
cystadenoma
focal nodular hyperplasia
85
What are malignant tumors of the liver?
carcninoma
metastatic
86
Are tumors focal or diffuse?
focal
87
What is a cavernous hemangioma?
MOST COMMON benign tumor
echogenic because it is highly vascular
usually looks round
typically females
sonographic: hyperechoic
88
What is an adenoma?
glandular
female oral contraceptives increase the occurance
may become malignant
89
how does and adenoma appear sonographically?
hyperechoic
90
What is focal nodular hyperplasia?
second common benign liver mass
women under 40
sonographically:
well defined
multiple nodules
STEALTH LESION
91
Where is focal nodular hyperplasia most often found?
on the anterior portion of the left lobe
92
What is an infantile hemangioendothelioma?
benign overgrowth
females
presents with abd mass
sonographic: multiple lesions with hyperechoic margins
no symptoms
93
What is a hamartoma?
rare
benign
children under 2
palpable abd mass
sonographic: well defined large complex mass
no symptoms
94
What is hepatocellular carcinoma (HCC) hepatoma?
most common primary malignant neoplasm
related to cirrhosis
male
unexplained mild fever
invasive
destroys vessels
sonographic: halo lesions, hepatomegaly
95
What is encountered more HCC or Mets?
Mets
96
what are the labs for HCC? (hepatocellular carcinoma)
elevated alpha fetoprotein***
abnormal liver function tests
cirrhosis
unexplained weight loss***
palpable mass
ascites
97
How does hepatocellular carcinoma present?
solitary massive tumor
multiple nodules throughout the liver
diffuse infiltrative masses in the liver
98
how will HCC pathologically present?
focal lesion
invasive lesion with necrosis and hemorrhage
poorly defined lesion
99
When cancer invades the hepatic veins what do you have?
Budd-Chiari syndrome
100
Hepatoblastoma is what?
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
What is the neonate hepatomegaly TORCH?
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
What are the signs for trauma with a hepatic hematoma?
sonographic:
free fliud
hematoma
decreased hematocrit
103
What could be a consequence of trauma or surgery in the liver?
hematoma
hemorrhage
decreased hematocrit
104
What are indications for a liver transplant?
cirrhosis
hepatitis
cholangitis
hepatoma
budd-chiari
105
what are complications for a liver transplant?
rejection
thrombosis
infection
neoplasia
106
What are you assessing in a liver transplant?
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
What is the problem with portal hypertension?
it causes the pressure to go up and the vessels start to pop
108
what is the most common cause of portal hypertension?
cirrhosis
109
what are collaterals?
when portal hypertension forces the body to create new paths for blood flow
coronary and esophageal vein
varices tortuous dilations
110
What happens with a varicose or collateral vein ruptures?
person bleeds out
111
what is the limit on the portal vein size?
1.3cm any greater and you suspect portal hypertension
112
What happens to the umbilical vein when you have portal hypertension?
recanalization of the umbilical vein = Medusa's head
113
What is the most common connection to release pressure when there is portal hypertension?
TIPS
transjugular intrahepatic portosystemic shunt
114
Where is TIPS placed?
between the portal and hepatic veins***
placed to reduce pressure
temporary treatment
115
What are the sonographic findings of portal hypertension?
initially hepatomegaly
shrunken right lobe
enlarged caudate and left lobe
nodular surface
coarse texture
splenomegaly
ascites
116
What are the doppler findings for portal hypertension?
monophasic flow in the hepatic veins
hepatofugal flow in the portal veins
enlarged portal vein
enlarged SMV
reversed flow in the splenic vein
117
what is Budd-Chiari?
thrombosis of the hepatic vein or IVC
118
what is the songraphic finding of Budd-Chiari?
caudate lobe enlarged
atrophy of rt hepatic lobe thrombosed vein enlarges
splenomegaly
119
What is an angiosarcoma?
malignant from the blood vessels
rare
60-80 years old
sonographic: solid mass
120
what is metastatic disease?
most common
primary: breast, colon, lung
lab: abnormal LFT
sonographic: multiple nodes, bull's eye lesions, calcifications
121
What is lymphoma?
hodgkins and non-hodgkins
hepatomegaly
sonographic: bull's eye, multiple
122
What are the pediatric malignancies?
hepatoblastoma (liver)
neuroblastoma (adrenal gland)
Wilm's (kidney)
leukemia (lymph)
123
What is one tell tale sign of Budd - Chiari syndrome?
edema of the legs
