Test 1-transplants and liver, kidney, and pancreas pathology

Question 1

Fatty infiltration, what type of disease processes will we see it with? When will we observe fatty infiltration?

Answer 1

Acquired, reversible disorder of metabolism resulting in an accumulation of triglycerides within the hepatocytes. Enlargement of lobe affected. more diff to see the outline of the portal vein and hepatic vein borders. Increased attenuation. Hepatomegaly. May be focal sparring(anterior to the gallbladder or portal vein and periportal region of the medial LLL)
Causes: obesity, excessive alcohol, poorly controlled hyperlipidemia, diabetes, excessive corticosteroids, pregnancy, glycogen storage disease, severe hepatitis, cystic fibrosis, chronic illness.
+alk phos + direct bilirubin + echogenicity + attenuation

Question 2

What are the sonographic findings of acute hepatitis?

Answer 2

Sono: normal to slightly increased echogenicity, increased brightness of portal vein borders (starry night) hepatosplenomegaly. Increased thickness of gallbladder wall.

Question 3

3. Budd-chiari, what is it?

Answer 3

Thrombosis of the hepatic veins or IVC. Poor prognosis characterized by abd pain and massive ascites and hepatomegaly.
Sono findings: enlarged caudate lobe, atrophy in the right lobe of the liver

Question 4

Where are the most common location of a echinoccal cyst?

Answer 4

(the liver??
Infectious cystic disease common with sheep herding. Increased WBC. Simple to complex cysts, acoustic enhancement, oval or spherical, calcification, honeycomb appearance/ water lily sign

Question 5

The most common benign tumor of the liver?

Answer 5

Cavernous hemangioma- congenital, large, blood-filled cystic spaces. More frequent in females, asymptomatic. Found in the subcapsular hepatic parenchyma or in the posterior right lobe more than the left lobe.
Sono: most are hyperechoic with enhancement. Round or oval, well defined. Larger masses may show necrosis, degeneration, calcifications.

Question 6

What benign tumor of the liver is found in patients with type 1 glycogen storage disease(von Gierke’s disease-increased amount of glycogen deposited into liver and kidneys)?

Answer 6

Adenoma-presents as well-demarcated, round, homogeneous, echogenic tumors. If large may be slightly inhomogeneous.
Glycogen storage disease also associtated with focal nodular hyperplasia and hepatomegaly

Question 7

Patients who have hepatocellular carcinoma(aka hepatoma) are likely to have had what?

Answer 7

-Cirrhosis
Occurs in 10-25% of patients with cirrhosis, also hep b. more frequent in men.
Is the most common primary malignant neoplasm. Increase AFP.
Invades venous structures (portal veins, hepatic veins, and IVC)
Sonographic findings: variable appearance, most are hypoechoic

Question 8

Most common form of neoplastic involvement of the liver?

Answer 8

-metastaic disease.
Primary sites are from colon, breast and lung.
Sono: Bullseye sign. Sol or multi, heypo or echogenic mass.
Abn LFT’s , jaundice, heptomegaly, weith loss decrease appetite
-Not HCC b/c most common malignant tumor
-Not cav. Hemangioma bc most common benign liver tumor.

Question 9

In severe hepatocellular destruction the AST and ALT levels are going to be what?

Answer 9

Increase. ( levels frequently about 1000 units)

Question 10

Elevation in the serum bilirubin results in?

Answer 10

Jaundice. Which is a yellow coloration of the skin, scerae, and body secretions

Question 11

Typical symptoms a patient may have with abscess formations?

Answer 11

Occur most commonly as complications of biliary tract disease surgery or trama.
Symptoms: fever, elevated white cell count, and RUQ pain

Question 12

What tumor consists of large blood filled spaces?

Answer 12

Cavernous hemangioma

Question 13

Dilated intrahepatic ducts may be seen with all of the following except?

Answer 13

Can be seen in biliary carcinoma of the CBD, biliary obstruction, prox and distal.common duct stricture

Question 14

What benign liver tumor is located near the free edge of the liver?

Answer 14

Focal nodular hyperplasia

Said Beth today

Question 15

Common malignancies that effect the pediatric population?

Answer 15

Most common tumors 1. Neruoblastoma 2. Wilm’s ( aka Nephroblastoma) 3. Hepatoblastoma

HEPATOBLASTOMA- Most common malignant LIVER TUMOR in early childhood (from PowerPoint)
Third most common intra-abdominal child hood malignancy after adrenal NERUOBLASTOMA-MOST COMMON TUMOR of childhood-book) and Wilm’s tumor (nephroblastoma)
Most occurrences are prior to two years of age
Pt. presents with an enlarging asymptomatic abdominal mass

Question 16

Older man, hx of alcoholism, has been dx with acute pancreatitis, his hematocrit and hypertension levels are decreased, what do you think is happening?

Answer 16

Hemorrhage secondary to acute pancreatitis

Question 17

Patient with painless jaundice, weight loss and loss of appetite?

Answer 17

Adenocarcinoma(in pancreas ) could also be metastatic disease to the liver or possible cirrhosis(but doesn’t say loss of apt) but think she is asking for adenocarcinoma

Question 18

A serum _______ level of 2x the normal usually indicates acute pancreatitis?

Answer 18

Amylase

For acute amylase(2x) and lipase elevate but lipase stays elevated longer

Question 19

What are the clinical signs and symptoms of acute pancreatitis?

Answer 19

Acute pancreatitis: clinical- sudden abd pain radiating to back. –nausea and vomit –hx of gallstones –increase Amylase and lipase sono: norm to enlarged – hypoechoic –distinct but irregular borders –enlargement of head causes depression on IVC –pancreatic duct may be enlarged –parapancreatic fluid collection

Question 20

Chronic pancreatitis signs and symptoms

Answer 20

Chronic pancreatitis: clinical- severe abd pain radiating to back –malabsorption –fatty stool –signs of diabetes –weight loss –jandice -increased amylase and lipase but Beth said amylase would not be?
Sono: small fibrotic – irreg borders – mixed echogenicity(heterogeneous) –dilated pan duct (string of pearls) – calculi w/I duct

Question 21

Whats the most common cause of pancreatitis in the US?

Answer 21

Billary tract disease-gallstones are present in 40-60% (alcohol is the 2nd)

Question 22

22. What condition causes increase secretion of abnormal mucous by the exocrine glands?

Answer 22

Fibrocystic disease of the pancreas

endocrine would be:
Cystic fibrosis

Question 23

Orthotopic:

Answer 23

in the same place- a liver transplant is orthotopic bc it is place into the same place the original was.
Kidneys are not-(donors left kid is placed in the right iliac fossa)
Pancreas is not-( Patients diseased pancreas is left in place
The donor’s pancreas is put into the right portion of the pelvis along with a small amount of the donor’s duodenum

Question 24

How many liver transplants are performed each year?

Answer 24

Approx. 5000 liver transplants are performed in the US each year

Question 25

Complication from a liver transplant:

Answer 25

Most common complication is hepatic artery thrombosis.
Anastomotic stenosis-flow pattern is a turbulent, high velocity signal indicative of hepatic -arterial stenosis
-Thrombus in the portal vein or IVC
-Infection
fluid collections-hematomas, abscesses, bilomas, ascites, and seromas
Rejection-occurs in 50-70% of transplants
Biliary leaks-most common site is biliary anastomosis

Question 26

Complication of renal transplants?

Answer 26

Rejection, ATN, cyclosporine toxicity, malignancy extraperitoneal fluid collections :HAUL( hematoma, abscess, urinoma, lymphocele)

Question 27

4 types of renal transplant rejections

Answer 27

1-Hyperacute: w/in hours. Caused by vasculitis leading to thrombosis and usually loss of graft. 2-acute rejection:within days-months. 3- immunologic: causes include pre-formed antibodies, immune complexes, and cell-mediated responses. 4- chronic rejection: can occur months after with gradual onset, secondary to mononuclear infiltration and fibrosis

Question 28

What does ESRD stand for?

Answer 28

end stage renal disese

Question 29

Sonographic appearance of a kidney that is failing?

Answer 29

-Enlargement and decreases echo of the pyramids(not uniform-could be a few)
-hyperecho cortex - localized area of renal parenchyma, including both the cortes and the medulla presenting an anechoic appearance. – distortion of the renal outline, the renal sinus echoes may appear compressed and displaced. – patch sonolucent areas involving both cortex and medulla.
Inlong standing rejection 2 patterns:
-normal-size with little diff b/w parenchymal and renal sinus or –small kidney with irregular margins and irregular parenchymal pattern

Question 30

Know about ATN.

Answer 30

Acute tubular necrosis- common cause of acute posttransplant kidney failure. Some degree of disorder occurs in most patients. As many as 50% of recep of cadaveric kidneys –ATN usually occurs after loss of blood supply.(donor b4 transplant, during harvesting,preserving, transport, as a resulf of poor circulation after transplant, cardiac arrest) Often reversible. Associated with ischemia.
-creatinine elevated –urine volumes may be good initially, then oliguria or anuria.