Diagnostic Sonography Chapter 10: Liver Pathology

Front 1

Incompatible with life

Back 1

Agenesis

Front 2

Anomalies of Position
the organs are reversed with the liver on the left and the spleen on the right

Back 2

Situs Inversus

Front 3

At least 45% of patients may have what variations?

Back 3

Vascular Anomalies

Front 4

What is vascular anomalies?

Back 4

the hepatic artery may have many variations as it arises from the celiac axis.

Front 5

Name the 3 variations?

Back 5

1. replaced left hepatic artery originating form the left gastric artery
2. replaced right hepatic artery originating from the sma
3. replaced common hepatic artery originating from the sma

Front 6

What is the most common variation?

Back 6

the accessory vein drains the superoanterior segment of the right lobe

Front 7

This disease effects the hepatocytes and interferes with liver function.

Back 7

Diffuse hepatocellular disease

Front 8

What is a hepatocyte?

Back 8

parenchymal liver cell that performs all the functions of the liver

Front 9

What are the subcategories of diffuse parenchymal disease?

Back 9

fatty infiltration, acute and chronic hepatitis, early alcoholic liver disease, acute chronic cirrhosis

Front 10

This is an acquired, reversible disorder of metabolism resulting in an accumulation of triglycerides within the hepatocytes

Back 10

Fatty Infiltration

Front 11

How does the patient present with fatty infiltration?

Back 11

asymptomatic however some patients may present with jaundice, nausea, vomiting and abdominal tenderness or pain.

Front 12

Fatty infiltration is not always uniform throughout the liver parenchyma, some regions have increased echogenicity within a normal liver parenchyma.

Back 12

Focal fatty infiltration

Front 13

This condition should be suspected in patients who have masslike hypoechoic areas in typical locations in a liver that is otherwise increased in echogenicity

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Focal Sparing

Front 14

The general name for inflammatory and infectious disease of the liver, of which there are many causes

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Viral Hepatitis

Front 15

An acute infection that leads to either complete recovery or death from acute liver failure

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Hepatitis A

Front 16

How is Hepatitis A spread?

Back 16

spread primarily by fecal contamination because the virus lives in the alimentary canal

Front 17

Caused by the type B virus which exists in the blood stream and can be spread by transfusions of infected blood or plasma or through the use of contaminated needles

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Hepatitis B

Front 18

Which hepatitis has the greatest risk to health care workers?

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Hepatitis B

Front 19

Diagnosed by the presence in blood of the antibody HCV. Major health problem in Italy and other Mediterranean countries

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Hepatitis C

Front 20

This is entirely dependent on hepatitis B virus for its infectivity. Occur primarily in IV drug users

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Hepatitis D

Front 21

How long is recovery for acute hepatitis without complications?

Back 21

4 months

Front 22

What are the pathologic changes seen in acute hepatitis?

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1. liver cell injury, swelling of the hepatocytes and hepatocyte degeneration, which may lead to cell necrosis.
2. reticuloendothelial and lymphocytic resone with kupffer cells enlarging
3. regeneration

Front 23

Exists when there is clinical are biochemical evidence of hepatic inflammation that extends beyond 6 months. Causes include those that are viral, metabolic, autoimmune or drug induced

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Chronic Hepatitis

Front 24

A chronic degenerative disease of the liver in which the lobes are covered with fibrous tissue, the parenchyma degenerates and the lobules are infiltrated with fat

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Cirrhosis

Front 25

How may cirrhosis be classified?

Back 25

1. micronodular (nodules 0.1 cm-1cm in diameter)
2. macronodular (nodules up to 5cm in diameter)

Front 26

What happens at the end stage of cirrhosis?

Back 26

liver cell failure and portal hypertension

Front 27

Micronodular cirrhosis is the most common result of?
Macronodular cirrhosis is the most common result of?

Back 27

alcohol abuse
chronic viral hepatitis

Front 28

How do patients present with acute cirrhosis?

Back 28

some asymptomatic but symptoms include nausea, flatulence, ascites, light colored stools, weakness, abdominal pain, varicosities, and spider angiomas

Front 29

How do patients with chronic cirrhosis present?

Back 29

symptoms include nausea, anorexia, weight loss, jaundice, dark urine, fatigue or varicosities

Front 30

Chronic cirrhosis may progress to what?

Back 30

liver failure and portal hypertension

Front 31

What is the first sonographic finding in the early stages of cirrhosis

Back 31

hepatomegaly

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This is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissues, especially the liver and kidneys

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Glycogen Storage Disease

Front 33

This is a rare disease of iron metabolism characterized by excess iron deposits throughout the body

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Hemochromatosis

Front 34

Defined as an increase in portal venous pressure or hepatic venous gradient

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Portal Venous Hypertension

Front 35

The invasion of the portal system with tumor or thrombosis may cause what

Back 35

portal hypertension

Front 36

May develop secondary to trauma, sepsis, cirrhosis, or hepatocellular carcinoma

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portal vein thrombosis

Front 37

With U/S how does portal vein thrombosis present?

Back 37

shows absence of portal flow with echogenic thrombus within the lumen of the vein

Front 38

If portal hypertension becomes extensive what happens?

Back 38

the portal system can become decompressed by shunting blood to the systemic system

Front 39

What are the three types of shunts?

Back 39

portacaval, mesocaval and splenorenal

Front 40

This shunt attaches the main portal vein at the smv-splenic vein confluence to the anterior aspect of the IVC.

Back 40

portacaval shunt

Front 41

This shunt attaches the middistal superior mesenteric vein to the IVC

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mesocaval shunt

Front 42

This shunt attaches the splenic vein to the left renal vein

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splenorenal shunt

Front 43

This is an uncommon, often dramatic illness caused by thrombosis of the hepatic veins or IVC. Has a poor prognosis and is characterized by abdominal pain, massive ascites and hepatomegaly

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Budd-Chiari Syndrome

Front 44

What is the most characteristic clinical feature of Budd-Chiari Syndrome?

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Ascites

Front 45

This obstruction is proximal to the cystic duct and can be caused by gallstones, carcinoma of the CBD, or metastatic tumor or invasion of the porta hepatis

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Biliary obstruction: Proximal

Front 46

This obstruction is distal to the cystic duct may be caused by stones in the common duct, an extrahepatic mass in the porta hepatis, or stricture of the common duct

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Biliary obstruction: Distal

Front 47

Clinically how may a patient present with proximal biliary obstruction?

Back 47

Jaundice and may experience pruritus

Front 48

What are the sonographic findings for biliary obstruction proximal?

Back 48

carcinoma of the CBD appears as a tubular branching with dilated intrahepatic ducts

Front 49

What does the laboratory tests show with biliary obstruction proximal

Back 49

elevation in bilirubin and alp levels

Front 50

Clinically how may a patient present with distal biliary obstruction?

Back 50

RUQ pain, jaundice, pruritus

Front 51

What laboratory values will be elevated with distal obstruction?

Back 51

ALP, bilirubin

Front 52

What are the sonographic findings for distal biliary obstruction?

Back 52

dilated intrahepatic ducts are seen in the periphery of the liver
*Shotgun sign

Front 53

Usually refers to a solitary nonparasitic cyst of the liver

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hepatic cyst

Front 54

Sonographic finding of a benign cyst show what?

Back 54

the lesion to be well demarcated, thin walled, and anechoic with posterior acoustic enhancement

Front 55

This disease is inherited in an autosomal dominant pattern that affects 1 in 500 individuals.

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Polycystic liver disease

Front 56

At least 50-74% of patients with polycystic disease have what?

Back 56

hepatic cysts

Front 57

Patients with polycystic liver disease 60% have what?

Back 57

associated polycystic renal disease

Front 58

How does the cyst appear in polycystic liver disease?

Back 58

the cysts are small less than 2-3 cm and multiple throughout the hepatic parenchyma

Front 59

How does the cyst appear on U/S?

Back 59

anechoic, well defined borders with acoustic enhancement

Front 60

Hepatic abscesses occur most often when

Back 60

complication of biliary tract disease, surgery or trauma

Front 61

A pus forming abscess

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pyogenic abscess

Front 62

What are some sources of infection

Back 62

cholangitis, diverticulitis, colitis

Front 63

Caused by a species of Candida. Usually occurs in immunocompromised hosts, organ transplant recipients, or HIV individuals.

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hepatic candidiasis

Front 64

How does hepatic Candidiasis spread?

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the candida fungus invades the bloodstream and may affect nay organ, with more perfused kidney, brain and heat

Front 65

A collection of pus formed by disintegrated tissue in a cavity, usually in the liver caused by the protozoan parasite

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Amebic abscess

Front 66

How is an amebic abscess contracted?

Back 66

through contaminated water and food.

Front 67

An infectious cystic disease common in sheep herding areas of the world. A tapeworm that infects humans as the intermediate host. The worm resides in the small intestine of dogs.

Back 67

Echinoccal cyst

Front 68

The most common organism causing opportunistic infection in patients with AIDS. It affects patients undergoing bone marrow and organ transplants or patients receiving chemo.

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Pneumocystis carinii

Front 69

Any new growth of new tissue either benign or malignant

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neoplasm

Front 70

A benign congenital tumor consisting of large blood filled cystic spaces.

Back 70

hemangioma

Front 71

The most common benign tumor of the liver its found more frequently in females

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Cavernous hemangioma

Front 72

A tumor of the glandular epithelium in which the cells of the tumor are arranged in a recognizable glandular structure . More common in women and has been related to oral contraceptives

Back 72

Liver cell adenoma

Front 73

the second most common benign liver mass after hemangioma. It is found in women under 40 yrs. Lesions occur more in the right lobe of the liver

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Focal Nodular Hyperplasia

Front 74

The most common tumor. Prevalence varies depending on predisposing factors such as Hep B and aflatoxin exposure.

Back 74

hepatocellular carcinoma

Front 75

High incidence of Hepatocellular carcinoma is linked to where?

Back 75

Africa, Japan, Greece, Italy and Southeast Asia

Front 76

The pathogenesis of hepatocellular carcinoma is related to

Back 76

cirrhosis

Front 77

Clinically patients with hepatocellular carcinoma present

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with a previous history of cirrhosis, Hep B and C, palpable mass, hepatomegaly, appetite disorder and fever

Front 78

The most common form of neoplastic involvement of the liver is

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metastatic disease

Front 79

The primary sites for metastatic disease are?

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colon, breast, and lung

Front 80

What are the 3 specific patterns that describe a metastatic tumor

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1. well defined hypoechoic mass
2. well defined echogenic mass
3. diffuse distortion of the normal homogeneous parenchymal pattern without focal mass

Front 81

The most common indications for transplantation in adults is

Back 81

hep C followed by alcoholic liver disease