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Peds > Peds- Liver > Flashcards

Peds- Liver Flashcards

1
Q

When imaging perdiatric liver all adult landmarks must be acquired including?

A
  • PV
  • PV bifurcation
  • CHA
  • CBD
  • HV’s
  • biliary tract
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2
Q

Liver on U/S?

A
  • homogenous
  • more echogenic than kidneys
  • doppler to see bile ducts
  • functional vs. segmental division
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3
Q

4 benign liver tumors?

A
  1. hemangioma
  2. mesenchymal hamartoma
  3. adenoma
  4. focal nodular hyperplasia
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4
Q

3 types of hemangioma?

A
  1. infantile
  2. hemangioendothelioma
  3. cavernous hemangioma
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5
Q

5 malignant liver tumors?

A
  1. hepatoblastoma
  2. HCC
  3. fibrolamellar HCC
  4. mesechymal (embryonal) sarcoma
  5. metastases
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6
Q

what is hemangioma?

  • common or uncommon?
  • arise from?
  • most common?
A
  • rare
  • arise from AV malformations
  • most common heptatic mass in neonate
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7
Q

what is the most common hepatic mass in neonate?

A

hemangioma

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8
Q

what is hemangioendothelioma?

A
  • blood filled spaces with multilayered endothelium
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9
Q

what is cavernous hemangioma?

A
  • single layered endothelium
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10
Q

who does hemangioendothelioma mainly affect? what is it associated with?

A
  • affects infants less than 6 months of age

- associated with skin hemangiomas

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11
Q

clinical presentations of hemangioendothelioma?

  • symptomatic
  • asymptomatic
A

symptomatic:

  • hepatomegly
  • congestice heart failure
  • hemoperitoneum from rupture

asymptomatic
- causes may undergo complete involution

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12
Q

Hemangioendothelioma sono features?

A
  • single or mulltiple
  • varying echo and size
  • contains fine linear foci of calcium
  • may have enhancement
  • vascular
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13
Q

Cavernous Hemangioma?

  • mainly found in?
  • age?
  • usually found how?
A
  • 3x more likely in girls
  • evident by 2 months of age
  • usually found incidentlly
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14
Q

Cavernous Hemangioma clinical presentation?

A
  • large hemangiomas may cause:
  • hepatomegly (palpable)
  • obstructive jaundice
  • bowel obstruction (vomiting)
  • respriratory insufficiency
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15
Q

cavernous hemangioma treatment?

A
  • varies with size of mass
  • usually regresses
  • lobectomy or resection if needed
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16
Q

sono features Cavernous Hemangioma?

A
  • well defined
  • hyperechoic (multiple interfaces between walls of blood-filled vessels)
  • can be hypoechoic (atypical)
  • enhancement
  • vascular
  • may calcify with PAS
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17
Q

what is mesenchymal hamargtoma?

A
  • rare
  • congenital
  • arises from connective tissue of the portal tracts
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18
Q

Mesenchymal Hamartoma clinical presentation?

A
  • painless abdominal swelling
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19
Q

Mesenchymal Hamartoma sono features?

A
  • resembles hemangioma but avascular
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20
Q

Mesenchymal Hamartoma treatment?

A
  • resection

- excellent prognosis

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21
Q

adenoma is highly associated with?

A
  • glycogen storage disease
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22
Q

adenoma sono apperance?

A
  • hyper or hyopechoic
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23
Q

FNH?

A

rare in children

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24
Q

FNH sono features?

A
  • isoechoic

- doppler- blood in centre of lesion

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25
Q

what fraction of solid pediatric liver tumors are malignant?

A

2/3

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26
Q

Most common pediatric liver mass?

A

heptaoblastoma

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27
Q

Hepatoblastoma is most common in?

A

boys younger than 5

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28
Q

Hepatoblastoma clinical presentation?

A
  • hepatomegaly
  • painless, palpable abdominal mass

Advanced cases:

  • fever
  • weight loss
  • pain
  • nausea and vommiting
  • jaundice
  • anemia
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29
Q

Hepatoblastoma lab values?

A
  • increased AFP

- increased LFT

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30
Q

Hepatoblastoma treatment?

A
  • resection if it occupies one lobe and didn’t invade portal vein
  • chemotherapy improved operability
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31
Q

Hepatoblastoma sono features?

A
  • Solitary multinodular mass
  • Heterogeneous
  • Hyperechoic
  • ill-defined borders
  • Areas of necrosis and hemorrhage
  • Calcifications
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32
Q

HCC (hepatoma) affects? associated with (3)?

A
  • affects children older than 3 years of age

associated with:

  • glycogen storage disease
  • wilson’s disease
  • hepatitis
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33
Q

HCC (Hepatoma) clinical presentation?

A
  • sudden liver failure due to thrombosis of portals or HVs
  • hepatomegaly
  • pain
  • GI bleeding, anemia
  • ascites
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34
Q

HCC (hepatoma) lab values?

A
  • increased AFP

- Hypoglycemia

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35
Q

HCC (hepatoma) sono features?

A
  • similar to Hepatoblastoma
  • solid hyperechoic mass involving the entire liver
  • well-defined or ill-defined borders
  • anechoic areas within mass from necrosis
  • hypo-anechoic halo around mass
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36
Q

What is Fibrolamellar HCC? who does it mainly affect?

A
  • Histologic subtype of HCC

- affects teenagers ad young adults

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37
Q

Fibrolamellar HCC clinical presentation?

A
  • abdominal pain
  • mass, fever, weight loss
  • diarrhea
  • vomiting
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38
Q

Fibrolamellar HCC lab values?

A

AFP normal or mildly elevated

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39
Q

Fibrolamellar HCC sono features?

A
  • solitary well0 marginated
  • variable echogenicity
  • focal calcifications
40
Q

What is Mesenchymal Sarcoma? how does it mainly affect?

A
  • rare
  • 5-10 year old
  • fast growing tumor
41
Q

Mesenchymal Sarcoma clinical presentations?

A
  • abdominal pain
  • swelling
  • palpable mass
  • AFP normal
42
Q

Mesenchymal Sarcoma sono features?

A
  • single
  • round, well-defined
  • variable echogenicity with anachoic/ cystic spaces creating enhancement
43
Q

Metastases is usually associated with? (4)

A
  1. neuroblastoma
  2. wilm’s tumor
  3. leukemia
  4. lymphoma
44
Q

most common cause of metastases in children?

A

neuroblastoma

45
Q

Metastases non features?

A
  • variable apperance

- multiiple masses

46
Q

infectious and inflammatory diseased of the liver? (2)

A
  1. hepatitis

2. abscess

47
Q

3 kinds of abcesses?

A
  1. amebic abscess
  2. pyogenic abscess
  3. fungal abscess
48
Q

what is hepatitis?

  • viral?
  • non viral?
A
  • diffuse infaction of the liver
  • inflammation and necrosis of hepatic cells

almost all cases are viral:
- A, B, C, D, E, CMV, herpes

non-viral causes:

  • toxins
  • drugs
49
Q

hepatitis symptoms?

A
  • hepatomegly with pain
  • jaundice
  • nausea
  • fever
  • loss of appetite
50
Q

chronic hepatitis symptoms?

A
  • cirrhosis
  • liver damage
  • cancer
51
Q

hepatitis sono apperance?

A
  • hyper or hypoechoic
  • hepatomegly
  • prominent portal vein
52
Q

liver abscess results from?

A
  • neonatal infection from the umbilicus or surgery
  • seeded into liver through the portal or umbilical vein
  • high mortality rate
53
Q

liver abscess treatment?

A
  • antibiotic therapy
  • drainage
  • surgery
54
Q

who does amebic abscesses affect?

A
  • children in areas where drinking water is contaminated and sanitation is poor
55
Q

amebic abscess enters body? forms?

A
  • enters the liver from colon through portal system

- forms a cavity in liver and becomes abscess

56
Q

Amebic Abscess lab values?

A
  • mildly elavated LFT’s
  • anemia
  • leukocytosis
57
Q

Amebic Abscess clinical presentation?

A
  • abdo distention
  • fever
  • RUQ pain
58
Q

Amebic Abscess cono features?

A
  • hypoechoic spherical lesion

- right lobe

59
Q

What is Pyogenic Abscess?

A
  • rare
  • can be fatal in children
  • E.coli / Klebsiella pneumoniae
  • Immunocompromised children
60
Q

Pyogenic Abscess sono features?

A
  • discretely marginated hypoechoic structures with enhancement
  • complex hyperechoic with poorly defined walls
  • if contains gas – shadowing and reverberation artifacts
  • bull’s eye appearance
61
Q

What is Fungal Abscess?

A
  • immunocompromised children

- cansisa albicans

62
Q

Fungal Abscess sono features?

A
  • multiple small lesions
  • irregular walls
  • round and hypoechoic
  • target or wheel within a wheel appearance
63
Q

Diffuse Liver Disease examples (3)?

A
  • fatty liver
  • cirrhosis
  • hepatic fibrosis
64
Q

fatty infiltration is caused by?

A
  • chronic hepatic injury and results from an accumilation of abnormal triglycerides and lipids
  • can be diffese or focal
65
Q

fatty infiltration associates with?

A
  • many pathological conditions
  • child obesity
  • can be reversable
66
Q

Diffuse Fatty Infiltration sono features?

  • mild
  • moderate
  • severe
A
  • large and echogenic liver with decreased visualization of hepatic veins

Mild - increased echo

Moderate - increased echo, decreased penetration, faint visualization of vasculature

Severe - unable to penetrate liver, no visualization of vasculature

67
Q

focal fatty infiltration sono features?

A
  • distinct areas of increased echogenicity
  • mimics mass without mass effect
  • does not change the contour of the liver
68
Q

What is cirrhosis?

A
  • parenchymal destruction, scarring, fibrosis, and nodular regeneration
69
Q

cirrhosis is due to?

A 
Biliary atresia
Cystic fibrosis
Chronic hepatitis
Metabolic dx
Budd-Chiari syndrome
Medications
70
Q

cirrhosis clinical presentation?

A
  • hepatomegaly (early stages)
  • jaundice
  • ascites
71
Q

cirrhosis lab tests?

A

mildly increased:

  • AST
  • ALT
  • LDH
  • direct and indirect bilirubin
72
Q

Cirrhosis u/s features?

A 
Small liver (late stage)
Surface nodularity
Coarse/heterogenous echo
Increased echo
Signs of ascites, splenomegaly, portal hypertension
73
Q

Hepatic fibrosis?

A
  • rare
  • associated with ARPKD
  • excessive connective tissue build-up due to chronic injury
74
Q

Hepatic Fibrosis clinical presentations?

A
  • hepatomegaly

- portal hypertension

75
Q

Hepatic Fibrosis sono features?

A
  • increased echogenicity of liver

- biliary dilatation

76
Q

Hepatic Vascular Disorders (4)?

A

Portal Hypertension
Portal Vein Thrombosis
Budd-Chiari*
Hepatic Infarction

77
Q

Portal Hypertention?

A
  • increased resistance to normal portal flow
78
Q

Portal Hypertention clinical presentation?

A
  • splenomegly
  • ascites
  • caput medusa

severe cases:

  • hematemesis
  • hepatic encephalopathy
79
Q

Portal Hypertension types of obstruction?

A
  • prehepatic
  • PV or SV thrombosis
  • intrahepatic (cirrhosis)
  • posthepatic (heart conditions)
80
Q

Portal Hypertension sono features?

A
  • Hepatofugal portal flow
  • Varices
  • Splenomegaly
  • Ascities
  • Cirrhosis
81
Q

Portal Vein Thrombosis caused by?

A
  • thrombosis due to dehydration, catheterization, shock, portal hypertension

OR

  • tumor invasion from HCC or hepatoblastoma
82
Q

Portal Vein Thrombosis clinical presentation?

A
  • acute abdo. pain

- splenomegaly

83
Q

Portal Vein Thrombosis sono features?

A
  • Enlarged, echogenic portal veins
  • Absent doppler
  • Visualization of tumor invasion
  • Cavernous transformation (in chronic PVT)
  • Acute PVT can mimic normal portal vein on grey scale
  • Collaterals
84
Q

What is Budd-Chiari syndrome?

A

Clinical features of hepatic venous outflow obstruction

85
Q

Budd-Chiari syndrome causes? (3)

A
  1. idiopathic occlusion
  2. neoplastic invasion
  3. thrombosis
86
Q

Budd-Chiari syndrome sono?

  • primary findings?
  • secondary findings?
A

Primary findings:

  • Hepatomegaly
  • Echogenic clot in HVs
  • Absence of flow in HVs

Secondary findings:

  • Ascites
  • Pleural effusion
  • GB wall edema
87
Q

Hepatic Infarction?

A

Rare due to liver’s dual blood supply

Can occur with hepatic artery occlusion

88
Q

Hepatic Infarction sono?

A
  • Wedge-shaped, round or oval area of decreased echogenicity
  • Good margins
  • Changes from hypo to hyper to calcification over time
89
Q

Hepatic Trauma?

A
  • Liver is the most commonly injured abdominal organ in blunt abdominal trauma in children
  • Hemoperitoneum
  • Hematomas in liver change with time and vary in echogenicity
  • Anechoic to complex with possible calcifications
90
Q

4 types of hepatic trauma?

A
  1. subcapsular
  2. parenchymal
  3. lacerations
  4. fractures
91
Q

Hepatic Cysts?

A
  • Congenital cysts are rare
  • Associated with multicystic kidney disease and Von Hippel Lindau disease
  • Can be acquired via trauma
92
Q

Hepatic Cysts clinical presentations?

A
  • asymptomatic

- unless cyst is large- than palpable

93
Q

Hepatic Cysts sono?

A
  • smooth-walled
  • anechoic
  • enhancement
  • attaches by stalk
94
Q

Hydatid echinococcal cysts?

A

Parasitic (tapeworm)

Echinococcus

95
Q

Hydatid echinococcal cysts causes?

A
  • Exposure to livestock, farming, dogs

- Parasite reaches liver from intestines through PV

96
Q

Hydatid echinococcal cysts sono?

A
  • Simple cyst

- Complex cyst (daughter cysts, septa, debris, floating membranes)

97
Q

Hydatid echinococcal cysts Clinical signs?

A
  • Urticaria
  • RUQ pain
  • Hepatomegaly
  • Lungs, brain, kidneys can be affected
  • Rupture of cyst to peritoneum – anaphylactic shock

Peds (18 decks)

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