Quiz 1 Flashcards
1
Q
when stating measurements in your report, what should be stated first?
A
longest measurements first
2
Q
what would you do with colour doppler?
A
-apply on any abnormal mass
-take an image with the colour box over the area of interest
-
3
Q
explain power doppler
A
- more sensitive
- if colour is not readily apparent, try using power doppler
- very motion sensitive
4
Q
lesion
A
-bump or lump on skin or in a solid organ
5
Q
how can a lesion appear?
A
cystic or solid
6
Q
nodule
A
- a small mass of rounded or irregular shape
- benign or cancerous
7
Q
mass
A
abnormal growth of tissue resulting from multiplication of cells
-may push or displace surrounding tissue or vessels
8
Q
what is some tumor consistency?
A
- solid=no enchancment
- liquid=posterior enhancement
- mixed=solid and fluid
9
Q
what is the mass effect?
A
pushing or displacing
10
Q
what is invading?
A
moving into a vein or other organ
11
Q
what would a cystic lesion look like?
A
- anechoic
- thin walled
- posterior enhancement
- may contain thin septations
12
Q
what is a benign tumor?
A
- no vascularity
- peripheral vascularity
- smooth contour
- slow growing
13
Q
what is a malignant tumor
A
- highly vasculature
- irregular margins
- bulls eye or halo
- rapid growth
14
Q
what are examples of acute?
A
- sudden and high pain
- fever
- RLQ
15
Q
what could you have if you have RLQ acute pain?
A
appendicitis
16
Q
what are examples of chronic pain?
A
- pain on and off for longer
- on treatment for other conditions
- LLQ
17
Q
what could you have if you have LLQ and chronic pain?
A
constipation
18
Q
what are some functions of the liver?
A
- produces proteins
- breaks down nutrients
- produces bile
- more on slide 7 lesson 1
19
Q
inside the liver, what produces bile?
A
hepatocytes
20
Q
what does the hepatic artery supply?
A
oxygenated blood
21
Q
what is the function of the portal vein?
A
supplies WBC and returns flow to the liver from the intestines for cleansing
22
Q
which structure separates the medial and lateral left lobe?
A
left intersegmental fissure
left hepatic vein
23
Q
which structures lie within the left intersegmental fissure?
A
cranially-LHV
middle-ascending LPV
caudally-ligamentum teres
24
Q
The hepatic veins are visualized when scanning which portion of the liver?
A
superior
25
What does the MHV separate?
Anterior RL and medial LL
26
What is the name of the capsule surrounding the liver?
Glisson's capsule
27
what is the echogenicity of the liver?
compared to kidney, the liver should be slightly hyperechoic
28
what direction is the portal venous flow?
hepatopedal
29
what kind of flow does hepatic veins have?
phasic flow and hepatofugal
30
what is the flow of the hepatic artery?
low resistant hepatopetal flow
31
Diaphragmatic slip
slip-cause of pseudomass on liver sonography
32
what lab test is a nonspecific marker for malignancy?
Alpha-fetoprotein (AFP)
33
Alpha-fetoprotein (AFP)
a protein normally synthesized by the liver, yolk sac, and GI tract of the fetus
34
what lab test marked elevation is associated with obstructive jaundice?
Alkaline Phosphatase(ALP)
35
Alkaline Phosphatase(ALP)
an enzyme produced primarily by liver,bone and placenta
36
what lab test has an Elevation associated with cirrhosis,hepatitis and biliary obstruction?
Alanine aminotransferase-ALT
37
Alanine aminotransferase-ALT
An enzyme found in high concentration in the liver and lower concentrations in the heart,muscle and kidneys
(used to assess jaundice)
38
what lab test has an elevation that is associated with cirrhosis, hepatitis and mononucleosis?
Aspartate aminotransferase-AST
39
Aspartate aminotransferase-AST
An enzyme present in many kinds of tissue that is released when cells are injured or damaged
40
which lab test has an elevation that is associated with cirrhosis, malignancy, malabsorption of vitamin K and clotting failure
Prothrombin time
41
Prothrombin time
Decreases with subacute or acute cholecystitis,internal biliary fistula,carcinoma of the GB,biliary duct injury and prolonged extrahepatic biliary obstruction
42
Leukocytosis
A sign of inflammatory or infection response when white blood cells are above the normal range
43
serum albumin
Decrease suggests a decrease in protein synthesis
44
Bilirubin
A product from the breakdown of hemoglobin in old red blood cells
-balance between production and excretion of bile
45
Agenesis
Of complete liver is incompatible with life
46
Situs inversus totalis
Liver is found in left hypochondrium
47
Congenital(fetal US) diaphragmatic hernia or omphalocele
Liver may herniate into thorax or outside abdominal cavity
48
Liver granulomas
- Asymptomatic (no symptoms)
- Appear as calcification within the liver parenchyma
- May be solitary or multiple
- may be related to an infection such as hepatitis
49
Hamartomas
- Small, focal ,solid appearing,hypoechoic
- Benign malformations
- Single or multiple
50
what is the most common benign tumor?
cavernoses hemangioma
51
cavernoses hemangioma
- small, asymptomatic
- homogenous and hyperechoic (could be hypoechoic)
- avascular on sonography
- well circumscribed
52
what is the second most common tumor?
Focal Nodular Hyperplasia-FNH
53
Focal Nodular Hyperplasia-FNH
- asymptomatic
- solitary
- isoechoic
- well circumscribed
54
what is more common, FNH or Hepatic Adenoma?
Hepatic Adenoma
55
Hepatic Adenoma
- may be symptomatic (RUQ mass felt if large)
- hypervascular
- risk of malignant degeneration
- resection is recommeded
56
Hepatic Adenoma-sonographic appearance
- Adenomas appear more heterogeneous than other benign liver tumors
- multiple feeding hepatic arteries can be seen
57
what are fatty tumors associated with?
renal angiomyolipomas
58
fatty tumors
- asymptomatic
- well defined echogenic mass
- extremely rare
59
Briefly explain the most common cause of Hydatid disease?
a parasite tapeworm are eaten and enter the duodenum and reaches the liver from the portal system
(mainly in animals)
60
Briefly explain the most common cause of Hydatid disease?
a cystic mass with smaller daughter cysts
61
Briefly describe the classic sonographic appearance of the hemangioma
homogenous and hyperechoic;may be singular or multiple;usually <3cm;may be lobulated
62
What causes the increased echogenicity?
A-numerous interfaces between the walls of the cavernous sinuses and blood within them
63
Is color Doppler helpful in diagnosing Cavernous hemangioma?
no, the flow is too slow
64
What is the differential diagnosis when these lesions are seen?
metastases from colon, HCC (hepatocellular carcinoma)
| -With mets the LFT’s will be increased and with HCC-Hx of cirrhosis or hepatitis
65
Describe the lesions sonographic appearance
highly complex due to hemorrhage;the sonographic appearance will changes with bleeding- duration and amount of hemorrhage
66
What are the patients symptoms when a lesion hemorrhages?
acute abdominal pain due to the hemorrhage or infarction;palpable mass by physician
67
Why is resection of adenomas recommended?
hemorrhage risks and malignant degeneration
68
Briefly describe the sonographic appearance of FNH
isoechoic,hypoechoic,hyperechoic;stellate vascular pattern or vascular stalk;displaces vascular structures;central scar
69
What clinical information may lead you to this diagnosis?
female, OC use
70
what is viral hepatitis?
inflammation of the liver
71
how many distinct virus's are there of hepatitis?
6 distinct viruses (A-E,G)
72
what is serosurvey?
study of blood serum to find antibodies when exposed to hepatitis
73
what may viral hepatitis lead to?
- portal hypertension
- cirrhosis
- hepatocellular carcinoma (HCC)
74
how is hepatitis A spread?
fecal-oral route
75
where is hepatitis A found?
worldwide but usually in developing countries
76
who does hepatitis A mainly affect?
the young
77
what type of infection is type A?
acute infection
78
where is Hepatitis B found?
worldwide but predominate in Asia, Africa, Greenland
79
How is Hepatitis B spread?
parentally (not oral)
- blood transfusions
- needle punctures
- sexual contact
- birth
80
where is Hepatitis C found?
Italy and Mediterranean
81
how is Hepatitis C spread?
spreads through blood (sharing needles)
| presence of antibodies in blood
82
where is the hepatitis D found?
worldwide but predominate in Asia, Africa, Greenland (same as B) uncommon in North america
83
what is hepatitis D dependant on?
hepatitis B for infectivity (must be infected with hep B to be infected with hep D)
84
how is hepatitis D spread?
iv drug users
85
what are some symptoms of viral hepatitis?
-fatigue
-headache
-fever
-nausea
-vomiting
SIGN
-jaundice
86
how long does recovery take for acute hepatitis?
recovery within 4 months
87
what does acute hepatitis look like on ultrasound?
liver parenchyma is more hypoechoic leading to the appearance of bright periportal walls
88
what is acute hepatitis sonographic appearance also known as?
starry night sign
89
how long does chronic hepatitis last?
Biochemical abnormalities persist beyond 6 months
90
how do you test for chronic hepatitis?
antibody and antigen tests can detect different viruses
91
what is the sonographic appearance of chronic hepatitis?
- hepatomegaly and thickening of GB wall
| - liver may appear normal in some cases
92
what chemicals can be harmful to the liver?
- alcohol
- prescription medication
- poor diet
93
what are some disorders of metabolism?
- steatosis (fatty liver)
- glycogen storage disease (neonatal)
- cirrhosis (chronic liver disease)
- NASH (non-alcoholic steatohepatitis)
94
is steatosis reversible?
yes
95
what is the most common cause of steatosis (fatty liver)?
obesity
96
what is steatosis?
Triglycerides(fat) in the hepatocytes
97
what are some causes of steatosis (fatty liver)?
- excessive alcohol (stimulates lipolysis)
- severe hepatitis
- hyperlipidemia (cholesterol)
- diabetes
- pregnancy
- e.t.c
98
steatosis (fatty liver) is a precursor for what?
significant chronic disease and could lead to HCC in some patients
99
what does mild steatosis look like?
minimal diffuse increase in hepatic echogenicity
100
what does moderate steatosis look like?
- moderate diffuse increase in hepatic echogenicity
| - slightly impaired visualization of intrahepatic vessels and diaphragm
101
what does severe steatosis look like?
- marked increase in echogenicity
- poor penetration of posterior liver
- poor or no visualization of hepatic vessels and diaphragm
- Hepatomegaly often present
102
what are other sonographic appearances of fatty liver?
- focal fatty infiltration
- fatty sparing
- focal fat
103
what is focal fatty infiltration?
Regions of increased echogenicity are present within a background of normal liver
-can mimic a mass
104
what is fatty sparing?
Islands of normal liver parenchyma appear as hypoechoic masses within a dense fatty infiltrated liver “no mass effect”
105
does steatosis have a mass effect?
no
106
does steatosis have a liver contour abnormality?
no
107
in steatosis, where will you find focal fat?
anterior to portal vein at porta hepatis
108
in steatosis, where will you find focal fatty sparing or infiltration?
anterior to portal vein at porta hepatis,gallbladder fossa,
| and liver margins
109
what is glycogen storage disease?
large amounts of glycogen are deposited in liver and kidneys
110
when does glycogen storage disease occur?
neonatal-Patients survive to childhood or young adulthood with enzyme therapy
111
what may develop with glycogen storage disease?
benign adenomas or Hepatocellular carcinoma
112
how does glycogen storage disease appear to fatty infiltration?
indistinguishable
113
what 3 major pathological mechanisms combine to create cirrhosis?
- cell death
- fibrosis
- regeneration
114
what is the most common cause of micronodular form?
alcohol consumption
115
what is the most common cause of macronodular form?
chronic viral hepatitis
116
what could be clinical presentation of cirrhosis?
- hepatomegaly
- jaundice
- ascites
117
what is the sonographic appearance of early stages of cirrhosis?
- liver may be enlarged
- may be difficult to distinguish from fatty liver
- look for irregular contour
118
what is the sonographic appearance of advanced stages of cirrhosis?
liver is often small-shrinking, ascites
119
what are the overall sonographic appearances of cirrhosis?
- volume redistribution
- coarse echotexture
- nodular surface
- nodules
- portal hypertension
120
what is NASH?
it resembles alcoholic liver disease but occurs in people who drink little or no alcohol
121
what can NASH lead to?
cirrhosis
122
what are the signs and symptoms of NASH?
- fatigue
- weight loss
- weakness
- increased LFT's
123
what is the treatment of NASH?
- balanced diet
- physical activity
- avoid alcohol
124
what does NASH look like sonographically?
dense fatty infiltration or cirrhosis
125
what are the 2 forms of hepatic failure?
acute and chronic
126
define acute liver failure
the rapid development pf hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease”
127
what can cause liver failure?
- excessive alcohol intake
- hep B or C
- autoimmune, hereditary and metabolic causes
- Steatohepatitis or non-alcoholic fatty liver disease
128
ascites usually occurs secondary to __________
liver cell failure
129
coagulopathy
bloods ability to clot is impaired
130
hepatic encephalopathy
Patient exhibits confusion,altered level of consciousness and coma as a result of liver failure
131
Why is it important to image the right kidney and liver interface?
to compare echogenicity
132
What is the classic clinical presentation of cirrhosis?
- hepatomegaly
- jaundice
- ascites
133
What is the most common malignant tumor of the liver?
HCC
134
What are 2 of the most common predisposing causes of HCC?
alcoholism and hepatitis
135
Hepatocellular carcinoma may invade which other structures? What is useful in the diagnosis?
- portal vein (30-60% of cases)
- hepatic veins
- colour doppler
136
List the most common primary tumors that result in liver meastastases?
- GB
- colon
- stomach
- pancreas
- breast
- lung
137
what structures aid in the spread of primary tumors?
Blood borne route-hepatic artery or portal vein
| Lymphatics route- –stomach,pancreas,ovary or uterus
138
What is the differential diagnosis for hyperechoic lesions in the liver other than mets?
hemangiomas
139
Describe briefly the 3 stages of hematoma sonographic appearance
1-<24 hours-echogenic-fresh hemorrhage
2-within 1st week-becomes more hypoechoic-resorption of tissues and fluid
3-2-3 weeks-increasingly indistinct-fluid resorption and tissue granulation
140
do we see hepatoma's mainly in men or women?
men (5:1)
141
what are the causes of hepatoma?
- alcoholic cirrhosis (west)
- Viral Hep B&C (worldwide)
- fatty liver (western world)
- toxins in food (developing countries)
142
what are symptoms of HCC?
- RUQ pain
- Weight loss
- Abdominal swelling-ascites is present
143
Budd-Chiari Syndrome???
????
144
what is the sonographic appearance of HCC?
- hypoechoic, complex, or echogenic
- may have a thin peripheral hypoechoic halo (fibrous capsule)
- calcification is uncommon
145
where do you find fibrolamellar carcinoma?
adolescents and young adults
146
is calcification present in fibrolamellar carcinoma?
central echogenic scar distinguishes it from hepatomas of HCC
147
Hemangiosarcoma
- extremely rare malignant tumor
| - on US there is a large mass of mixed echogenicity
148
Hepatic epitheliod
-rare malignant tumor of vascular origin
149
what does Hemangiosarcoma look on US?
Large mass of mixed echogenicity on US
150
what does Hepatic epitheliod look like on US?
Multiple hypoechoic nodules-large masses
151
who is seen to have Hemangiosarcoma?
adults 60-70 years of age
152
who is seen to have Hepatic epitheliod?
occurs in adults
153
what is affected in Hepatic epitheliod?
soft tissues, lung, and liver
154
Study sonographic patterns of metastatic disease
Part 3 liver-slide 15/16
155
when do we commonly see the bulls eye or target?
lung cancer
156
shadowing in the liver is most often due to ______________
calcifications, air, stones and fat containing lesions
157
a clean shadow is caused by _____, while a dirty shadow is caused by _____
calcifications, air
158
what is the most common cause of a calcified liver tumor?
metastases
159
does FNH have calcifications?
rarely
160
what is the sonographic appearance of cystic metastases?
- mural nodules
- thick walls
- fluid-filled levels
- internal septations
- extensive necrosis
161
what is the sonographic appearance of Infiltrative metastatic disease?
-hard to distinguish
162
what is contrast enhanced ultrasound?
involves the use of microbubble contrast agents and specialized imaging techniques
163
what is one of the most common causes of hepatomegaly?
alcohol abuse
164
what are symptoms of hepatomegaly?
- abdominal pain
- swelling
- feeling of fullness
- jaundice
165
what is the aurora sign?
ringdown artifact
166
what are the ways that pyogenic bacteria can reach the liver?
1) biliary tract in patients with suppurative (pus)
2) travels through porta venous system
3) travels through hepatic artery
4) result of a blunt or penetrating trauma to liver
167
cholangitis
inflammation of entire biliary system
168
cholecystitis
inflammation of gallbladder
169
diverticulitis
infection of an out pouch of a bowel
170
pyogenic bacteria traveling from biliary tract
cholangitis and cholescystitis
171
pyogenic bacteria travels through portal venous system
diverticulitis and appendicitis
172
pyogenic bacteria travels through hepatic artery
osteomyelitis and bacterial endocarditis
173
what can blunt trauma to the liver result in?
hepatic abscess
174
osteomyelitis
infection of bone
175
bacterial endocarditis
infection of lining of the heart
176
what is hepatic abscess mainly caused by?
anaeurobic (bacterial) infection
177
what are presenting features of pyogenic liver abcess?
- fever, malaise, anorexia, RUQ pain, jaundice
| - leukocytosis
178
is sonography helpful for hepatic abscesses?
yes
179
what are some varied sonographic signs of liver abscess?
- frankly purulent
- early suppuration
- GAS PRODUCING ORGANISMS give rise to echogenic foci
- fluid/fluid interfaces, internal septations and debris
- walls can be thick, irregular, or well defined
180
what are the differential diagnosis for liver abscess?
- amebic or echinococcal infection
- simple cyst with hemorrhage
- necrotic or cystic neoplasm (non identified mass)
- hematoma
181
what confirms diagnosis for liver abscess?
ultrasound guided needle aspiration
182
for fungal disease: candidiasis patients are generally ___________
immunocomprimised
183
when can fungal disease: candidiasis occur?
- pregnancy
| - hyperalimentation (artificial nutrients like getting blood)
184
what does fungal disease: candidiasis present as?
persistent fever in a neutropenic patient (low white blood cell count) whose leukocyte count is returning to normal
185
which patients are immunosuppressed?
weakened immune system
- pre and post transplant
- cancer
- poor nutrition
- pregnant
186
what are some ultrasound features of candidiasis?
- wheel within a wheel
- central nidus (where bacteria form and grow)
- hyperechoic foci
- bulls eye
- uniformly hypoechoic
- echogenic
187
wheel within a wheel
Peripheral hypoechoic zone with inner echogenic wheel & central hypoechoic nidus (where bacteria form and grow)
188
central nidus
Focal necrosis where fungal elements are found
189
hyperechoic foci
multiple small abscesses with air
190
bulls eye
- 1-4 cm lesion with hyperechoic center and hypoechoic rim
| - echogenic center contains inflammatory cells
191
uniformly hypoechoic
-due to progressive fibrosis
192
what is the most common ultrasound feature for candidiasis?
uniformly hypoechoic
193
what is amebiasis?
hepatic infection
194
what is amebiasis caused by?
parasite-entamoeba histolytica
195
how is amebiasis transmitted?
fecal-oral route
| -penetrates through the colon, via mesenteric venules, then to the portal vein, liver
196
what is the most common presenting symptom for amebiasis?
pain
| 15% of patients have diarrhea
197
what is the sonographic features of the amebiasis?
- round or oval shaped lesion
- absence of prominent wall
- hypo echogenicity
- low level echoes, distal enhancement
198
what is another name for hydatid disease?
echinococcal disease
199
what is the most common cause of hydatid disease?
parasite echinococcus granulosis
200
how is hydatid disease transmitted?
embryos are freed in duodenum-reach the liver via portal veins
201
which liver disease involves a tapeworm?
hydatid disease
202
what other organs may hydatid disease involve?
lungs, kidneys, spleen, CNS
203
what are the sonographic features of hydatid disease?
- cysts with daughter cysts
| - simple cysts
204
how is hydatid disease treated?
surgury
205
what disease is referred to the waterlily sign on an ultrasound?
hydatid disease
206
what is the most common parasitic infection in humans?
schistosomiasis
207
how many different parasites are involved in schistosomiasis?
4
208
how does the ova in Schistosomiasis reach the liver?
portal vein
209
what does Schistosomiasis lead to?
- portal hypertension
- splenomegaly
- varices
- ascites ensues
210
what are the sonographic features of Schistosomiasis?
- widened echogenic portal tracts
| - dilated biliary ducts
211
what is the region affected in Schistosomiasis?
porta hepatis
212
what is the process of the infection of Schistosomiasis?
- initially it is hepatomegaly
- then periportal fibrosis occurs
- liver then shrinks
- portal hypertension prevails
213
what is the most common organism causing opportunistic infection in patients with AIDS?
pneumocystis carinii
214
what is the most common cause of life threatening infection?
pneumonia
215
who is at risk for Pneumocystis carinii?
patients undergoing bone marrow and organ transplants
216
what is the sonographic appearance of Pneumocystis carinii?
- tiny, diffuse non shadowing echogenic foci
| - replacement of normal hepatic parenchyma by echogenic clumps of dense calcification
