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81 Cards in this Set

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  • Back
Incompatible with life
Agenesis
Anomalies of Position
the organs are reversed with the liver on the left and the spleen on the right
Situs Inversus
At least 45% of patients may have what variations?
Vascular Anomalies
What is vascular anomalies?
the hepatic artery may have many variations as it arises from the celiac axis.
Name the 3 variations?
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
What is the most common variation?
the accessory vein drains the superoanterior segment of the right lobe
This disease effects the hepatocytes and interferes with liver function.
Diffuse hepatocellular disease
What is a hepatocyte?
parenchymal liver cell that performs all the functions of the liver
What are the subcategories of diffuse parenchymal disease?
fatty infiltration, acute and chronic hepatitis, early alcoholic liver disease, acute chronic cirrhosis
This is an acquired, reversible disorder of metabolism resulting in an accumulation of triglycerides within the hepatocytes
Fatty Infiltration
How does the patient present with fatty infiltration?
asymptomatic however some patients may present with jaundice, nausea, vomiting and abdominal tenderness or pain.
Fatty infiltration is not always uniform throughout the liver parenchyma, some regions have increased echogenicity within a normal liver parenchyma.
Focal fatty infiltration
This condition should be suspected in patients who have masslike hypoechoic areas in typical locations in a liver that is otherwise increased in echogenicity
Focal Sparing
The general name for inflammatory and infectious disease of the liver, of which there are many causes
Viral Hepatitis
An acute infection that leads to either complete recovery or death from acute liver failure
Hepatitis A
How is Hepatitis A spread?
spread primarily by fecal contamination because the virus lives in the alimentary canal
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
Hepatitis B
Which hepatitis has the greatest risk to health care workers?
Hepatitis B
Diagnosed by the presence in blood of the antibody HCV. Major health problem in Italy and other Mediterranean countries
Hepatitis C
This is entirely dependent on hepatitis B virus for its infectivity. Occur primarily in IV drug users
Hepatitis D
How long is recovery for acute hepatitis without complications?
4 months
What are the pathologic changes seen in acute hepatitis?
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
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
Chronic Hepatitis
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
Cirrhosis
How may cirrhosis be classified?
1. micronodular (nodules 0.1 cm-1cm in diameter)
2. macronodular (nodules up to 5cm in diameter)
What happens at the end stage of cirrhosis?
liver cell failure and portal hypertension
Micronodular cirrhosis is the most common result of?
Macronodular cirrhosis is the most common result of?
alcohol abuse
chronic viral hepatitis
How do patients present with acute cirrhosis?
some asymptomatic but symptoms include nausea, flatulence, ascites, light colored stools, weakness, abdominal pain, varicosities, and spider angiomas
How do patients with chronic cirrhosis present?
symptoms include nausea, anorexia, weight loss, jaundice, dark urine, fatigue or varicosities
Chronic cirrhosis may progress to what?
liver failure and portal hypertension
What is the first sonographic finding in the early stages of cirrhosis
hepatomegaly
This is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissues, especially the liver and kidneys
Glycogen Storage Disease
This is a rare disease of iron metabolism characterized by excess iron deposits throughout the body
Hemochromatosis
Defined as an increase in portal venous pressure or hepatic venous gradient
Portal Venous Hypertension
The invasion of the portal system with tumor or thrombosis may cause what
portal hypertension
May develop secondary to trauma, sepsis, cirrhosis, or hepatocellular carcinoma
portal vein thrombosis
With U/S how does portal vein thrombosis present?
shows absence of portal flow with echogenic thrombus within the lumen of the vein
If portal hypertension becomes extensive what happens?
the portal system can become decompressed by shunting blood to the systemic system
What are the three types of shunts?
portacaval, mesocaval and splenorenal
This shunt attaches the main portal vein at the smv-splenic vein confluence to the anterior aspect of the IVC.
portacaval shunt
This shunt attaches the middistal superior mesenteric vein to the IVC
mesocaval shunt
This shunt attaches the splenic vein to the left renal vein
splenorenal shunt
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
Budd-Chiari Syndrome
What is the most characteristic clinical feature of Budd-Chiari Syndrome?
Ascites
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
Biliary obstruction: Proximal
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
Biliary obstruction: Distal
Clinically how may a patient present with proximal biliary obstruction?
Jaundice and may experience pruritus
What are the sonographic findings for biliary obstruction proximal?
carcinoma of the CBD appears as a tubular branching with dilated intrahepatic ducts
What does the laboratory tests show with biliary obstruction proximal
elevation in bilirubin and alp levels
Clinically how may a patient present with distal biliary obstruction?
RUQ pain, jaundice, pruritus
What laboratory values will be elevated with distal obstruction?
ALP, bilirubin
What are the sonographic findings for distal biliary obstruction?
dilated intrahepatic ducts are seen in the periphery of the liver
*Shotgun sign
Usually refers to a solitary nonparasitic cyst of the liver
hepatic cyst
Sonographic finding of a benign cyst show what?
the lesion to be well demarcated, thin walled, and anechoic with posterior acoustic enhancement
This disease is inherited in an autosomal dominant pattern that affects 1 in 500 individuals.
Polycystic liver disease
At least 50-74% of patients with polycystic disease have what?
hepatic cysts
Patients with polycystic liver disease 60% have what?
associated polycystic renal disease
How does the cyst appear in polycystic liver disease?
the cysts are small less than 2-3 cm and multiple throughout the hepatic parenchyma
How does the cyst appear on U/S?
anechoic, well defined borders with acoustic enhancement
Hepatic abscesses occur most often when
complication of biliary tract disease, surgery or trauma
A pus forming abscess
pyogenic abscess
What are some sources of infection
cholangitis, diverticulitis, colitis
Caused by a species of Candida. Usually occurs in immunocompromised hosts, organ transplant recipients, or HIV individuals.
hepatic candidiasis
How does hepatic Candidiasis spread?
the candida fungus invades the bloodstream and may affect nay organ, with more perfused kidney, brain and heat
A collection of pus formed by disintegrated tissue in a cavity, usually in the liver caused by the protozoan parasite
Amebic abscess
How is an amebic abscess contracted?
through contaminated water and food.
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.
Echinoccal cyst
The most common organism causing opportunistic infection in patients with AIDS. It affects patients undergoing bone marrow and organ transplants or patients receiving chemo.
Pneumocystis carinii
Any new growth of new tissue either benign or malignant
neoplasm
A benign congenital tumor consisting of large blood filled cystic spaces.
hemangioma
The most common benign tumor of the liver its found more frequently in females
Cavernous hemangioma
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
Liver cell adenoma
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
Focal Nodular Hyperplasia
The most common tumor. Prevalence varies depending on predisposing factors such as Hep B and aflatoxin exposure.
hepatocellular carcinoma
High incidence of Hepatocellular carcinoma is linked to where?
Africa, Japan, Greece, Italy and Southeast Asia
The pathogenesis of hepatocellular carcinoma is related to
cirrhosis
Clinically patients with hepatocellular carcinoma present
with a previous history of cirrhosis, Hep B and C, palpable mass, hepatomegaly, appetite disorder and fever
The most common form of neoplastic involvement of the liver is
metastatic disease
The primary sites for metastatic disease are?
colon, breast, and lung
What are the 3 specific patterns that describe a metastatic tumor
1. well defined hypoechoic mass
2. well defined echogenic mass
3. diffuse distortion of the normal homogeneous parenchymal pattern without focal mass
The most common indications for transplantation in adults is
hep C followed by alcoholic liver disease