Abdm Ultra: 100609: Liver Pathology

Front 1

What should the diameter of the MPV be when it enters the portal hepatis?

Back 1

<= 1.3 cm

Front 2

What type of cells make up the wall or lining of all cysts?

Back 2

Epithelial

Front 3

What shape are all cysts?

Back 3

Round or ovid

Front 4

Sonographically, what is the echogenicity of a cyst, and what will we see on its far side?

Back 4

anechoic
posterior enhancement with edge shadowing

Front 5

Liver cysts are usually ____ in origin, but are not connected to them.

Back 5

ductal

Front 6

Liver cysts usually occur in (younger / older) patients

Back 6

Older

Front 7

Liver cysts are usually located near to ______ and the _____, not in the middle of the liver.

Back 7

Glisson's capsule
diaphragm

Front 8

Will liver cysts usually occur singly or in groups?

Back 8

Singly

Front 9

What diameter should a liver cyst be before aspiration and ablation with alcohol (to prevent the cyst from filling back up) is indicated?

Back 9

10 cm

Front 10

Although liver cysts are often asymptomatic, what two symptoms are often consistent with them?

Back 10

Fever
RUQ pain

Front 11

What fluid will a cyst contain?

Back 11

It varies - it may be blood, bile, synovial fluid, or other serous fluids

Front 12

What will be the sonographic appearance of a cyst containing fresh blood?

Back 12

Anechoic

Front 13

What two elements might be present in the sonographic appearance of a cyst containing older blood, or bacteria?

Back 13

1. There may be multiple echoes throughout, and/or layering

2. A "dirty shadow" (a shadow with a blurry, poorly-defined wall, such as the duodenum sheds)

Front 14

What diameter are peribiliary cysts?

Back 14

.2 - 2.5 cm

Front 15

Do peribiliary cysts usually occur singly or in clusters?

Back 15

In clusters, sometimes appearing tubular

Front 16

Where are peribiliary cysts located?

Back 16

Around bile ducts, usually near the porta hepatis

Front 17

What types of diseases are peribiliary cysts associated with?

Back 17

Severe hepatic diseases

Front 18

What are the symptoms associated with peribiliary cysts?

Back 18

They may be asymptomatic, but may also be associated with pain.

Front 19

What are peribiliary cysts?

Back 19

Small obstructed periductal glands

Front 20

What are peribilary cysts always parallel to?

Back 20

The portal vein and the bile duct.

Front 21

Where are the cysts associated with APKD located?

Back 21

They always are in the kidney (which is why they are referenced in the name), but 50-75% of the time, they spread to the liver.

Front 22

Does the appearance of liver cysts imply that the APKD has progressed in the kidneys?

Back 22

No

Front 23

What is the association between APKD and portal hypertension or liver fibrosis?

Back 23

There is none

Front 24

Do the cysts in APKD occur singly?

Back 24

No, there will be multiple cysts.

Front 25

Is APKD rare or common?

Back 25

Common

Front 26

What % of patients with APKD will develop renal failure, requiring dialysis?

Back 26

50-60%

Front 27

What vascular condition often accompanies APKD?

Back 27

Hypertension, because the kidneys help regulate blood pressure

Front 28

How is APKD usually acquired?

Back 28

75% of the cases appear to be hereditary

Front 29

What type of pain often occurs with APKD?

Back 29

Abdominal or lower flank (lower back, on either side of the spine)

Front 30

What 2 symptoms having to do with the urinary system are associated with APKD?

Back 30

1. Microscopic or gross (visible to the eye) hematuria (blood in the urine)
2. A history of urinary tract infections or nephrolithiasis (kidney stones)

Front 31

How is kidney size often associated with APKD?

Back 31

APKD kidneys are often enlarged, sometimes so much so that it is palpable on physical examination

Front 32

What are the criteria for diagnosing APKD?

Back 32

2 or more cysts in patients < age 60;
4 or more cysts in patients >= age 60.

Front 33

What symptom of APKD may be present in the brain?

Back 33

A berry aneurysm

Front 34

What is the most common cause of death for patients with APKD?

Back 34

Renal failure

Front 35

Will the multiple cysts associated with APKD be similar in size and shape?

Back 35

Not necessarily

Front 36

Will cysts associated with APKD connect with one another, be contained within one another, or be separate?

Back 36

They'll be separate

Front 37

What type of cysts typically are connected to each other, or inside one another (aka "daughter cysts")?

Back 37

Parasitic cysts

Front 38

Will APKD cysts appear only in the liver, or in the kidneys as well?

Back 38

They'll appear in the kidneys as well

Front 39

In which part(s) of the liver will APKD cysts be found?

Back 39

Usually they're only in the right lobe, but sometimes they'll also be present in the left lobe

Front 40

What can APKD cysts in the liver result in?

Back 40

Liver failure, meaning a liver transplant is necessary to avoid death

Front 41

What are the most common liver lesions seen at laparotomy?

Back 41

Biliary hamartomas

Front 42

What is another name for the presence of biliary hamartomas?

Back 42

Von Meyenburg complex

Front 43

Are biliary hamartomas located centrally or peripherally?

Back 43

Peripherally

Front 44

Biliary hamartomas are (soft/firm), (smooth/rough), and (black/white).

Back 44

firm
smooth
white to grayish blue

Front 45

Of what are biliary hamartomas composed?

Back 45

They are benign, small, mostly solid nodules orignating in dilated intrahepatic ducts, near the portal vein

Front 46

What is the typical diameter of a biliary hamartoma?

Back 46

They are 1-3 mm in diameter, and less than 1 cm in length

Front 47

How can a biliary hamartoma be distinguished from other types of lesions?

Back 47

By biopsy

Front 48

What other type of disease could a biliary hamartoma be associated with, and, lacking a tissue sample for histology, what diagnostic tool is necessary to make the distinction?

Back 48

Miliary metatstatic lesions
MRI (not CT or ultrasound)

Front 49

Will biliary hamartoma be present as one nodule or several?

Back 49

Several

Front 50

What percentage of biliary hamartomas will be hyperechoic and hypoechoic to the surrounding liver tissue?

Back 50

Hyperechoic: 10%
Hypoechoic: 90%

Front 51

What is a "ringdown artifact"?

Back 51

A series of short lines which appear beneath an echogenic focus

Front 52

What is meant by an "echogenic focus"?

Back 52

A single point that is echogenic

Front 53

What is the most common cause of liver cell necrosis?

Back 53

Viral hepatitis

Front 54

What are 4 ways in which hepatitis may be contracted?

Back 54

1 Virus
2. Drugs
3. Mushroom poisoning
4: Parasites

Front 55

How is hepatitis A usually acquired?

Back 55

HAV is usually acquired through the fecal - oral route, parasites, or poison mushrooms, and is often associated with contaminated food or water, and generally poor socioeconomic conditions.

Front 56

How is hepatitis E usually acquired?

Back 56

HEV is usually acquired parenterally (from an outside source, and then ingested)

Front 57

How is hepatitis C usually acquired?

Back 57

The HCV virus is typically acquired through drug use or sexual contact, and blood transfusions (prior to 1992)

Front 58

How is hepatitis B usually acquired?

Back 58

Through heredity, or by blood, sexual, or needle contact

Front 59

What are the symptoms of hepatitis A?

Back 59

There may be no symptoms, or they may be vague and general - e.g., malaise, fatigue, nausea, low fever, and/or jaundice.

Front 60

What lab test values will raise with any type of hepatitis?

Back 60

ALT and sometimes bilirubin (with an acute condition, they'll be high; with a chronic condition, they'll fluctuate with the other symptoms)

Front 61

What lab test values will usually be normal with hepatitis A?

Back 61

Albumin
Prothrombin time, although this may raise as disease progresses

Front 62

Is hepatitis A easily transmitted?

Back 62

Yes, it is highly infectious

Front 63

How does hepatitis A affect the liver?

Back 63

It impairs the liver's ability to function normally

Front 64

How long can a person have hepatitis A before symptoms start to develop?

Back 64

Up to 6 months

Front 65

Does hepatitis A always require treatment?

Back 65

No, a mild case may work itself out, and there is always eventual resolution, although later reinfection is still possible

Front 66

Is there a vaccine for hepatitis A?

Back 66

Yes

Front 67

What can hepatitis B progress to?

Back 67

Cirrhosis and hepatocellular carcinoma

Front 68

Is there a cure for hepatitis B?

Back 68

No

Front 69

What are typical symptoms of hepatitis A, B, and C?

Back 69

May be asymptomatic, or there could be any of:
Abdominal pain
Lack of appetite
Nausea
Vomiting
Weakness
Fatigue
Muscle pain
Joint pain

Front 70

How many parents must have APKD in order for it to be passed on, and what is the term for this characteristic?

Back 70

One
autosomal dominant

Front 71

Since lab tests results may vary and not point to a specific cause, what is the best way to get specific information about condition of the liver, the nature of a cyst, etc?

Back 71

A biopsy

Front 72

What is the incubation period for hepatitis A?

Back 72

2-6 weeks

Front 73

Which antibodies provide evidence of a prior hepatitis A infection?

Back 73

IgG

Front 74

Which antibodies provide evidence of a recent or current hepatitis A infection?

Back 74

IgM

Front 75

Hepatitis A is rarely _____ and never ____.

Back 75

fulminant (occurs suddenly and quickly)
chronic

Front 76

What causes the most damage from the HBV infection?

Back 76

The host immune response

Front 77

A patient with acute hepatitis B is infective for ____ ____ before clinical presentation.

Back 77

many weeks

Front 78

The incubation period for hepatitis B is ___ ___ to ___ ___.

Back 78

6 weeks
6 months

Front 79

Most patients with chronic hepatitis B infection exhibit __ symptoms and have __ ___ liver histology.

Back 79

no
near normal

Front 80

What is the most common chronic blood-borne infection?

Back 80

Hepatitis C

Front 81

What condition accounts for nearly half of all patients in the US with chronic liver disease?

Back 81

Hepatitis C

Front 82

Health care workers account for less than __ % of hepatitis C cases

Back 82

5

Front 83

Another name for hepatitis D is ___ __.

Back 83

Hepatitis delta

Front 84

Hepatitis D only arises in the presence of ____ __.

Back 84

hepatitis B

Front 85

In the US, hepatitis D infection is (common/uncommon).

Back 85

uncommon

Front 86

With all forms of hepatitis, the liver will be (shrunken/enlarged), exhibit (increased/decreased) vascularity, and show (faint/prominent) portal vein walls.

Back 86

enlarged
increased
prominent

Front 87

With all forms of hepatitis, the gallbladder wall will look (thicker/thinner) due to increased ____ around the gallbladder.

Back 87

thicker
edema

Front 88

Are liver cysts more common in men or women?

Back 88

Women

Front 89

What 4 things can cause liver cysts?

Back 89

1. Inflammatory reactions
2. Trauma
3. Hereditary diseases
4. Parasitic infections

Front 90

At what age do the following types of liver cysts usually occur:
1. Parasitic
2. APKD
3. Congenital

Back 90

1. Parasitic: Any age
2: APKD: > 40
3. Congenital: > 50

Front 91

What are the first and second most common organs to be affected by cysts?

Back 91

1. Kidneys
2. Liver

Front 92

Other than the kidney and liver, what other 2 organs may (less commonly) have cysts?

Back 92

The pancreas and spleen

Front 93

What are the Liver Function Test (LFT) values when APKD is present?

Back 93

They're normal, unless the disease has progressed so far that liver failure is occurring.

Front 94

What type of liver pathology are ringdown artifacts associated with?

Back 94

Biliary hamartomas

Front 95

What is a cyst?

Back 95

A fluid filled mass having an epithelial lining

Front 96

What is the range size for cysts?

Back 96

mm to 20 cm

Front 97

What % of patients with multiple liver cysts will have APKD?

Back 97

25-50%

Front 98

What are the diameter of the cysts typically found with APKD?

Back 98

2-3 cm

Front 99

What is the sonographic appearance of hepatitis A?

Back 99

If fibrosis occurs, the liver will appear coarser, and may be reduced in size

Front 100

How is hepatitis B anc C transmitted?

Back 100

By blood or other body fluids (e.g., transfusions, needle sticks, sexual contact)

Front 101

Which type of hepatitis presents the greatest risk to health care workers?

Back 101

Hepatitis B

Front 102

What 4 liver test values will be elevated with hepatitis B?

Back 102

ALT
AST
bilirubin
globulin

Front 103

What is the sonographic appearance of hepatitis B?

Back 103

Enlarged liver
Hypoechoic liver
Increased vascularity with prominent portal vein walls

Front 104

What is cirrhosis?

Back 104

A disease in which the liver tissue becomes fibrotic, and the texture changes

Front 105

What causes cirrhosis?

Back 105

It is associated with alcoholism, but can also be acquired by viral infections, toxic reactions to drugs, biliary obstructions, or cardiac disease

Front 106

What will cirrhosis lead to?

Back 106

Liver failure, since the normal liver cells are being destroyed

Front 107

What are the symptoms of cirrhosis?

Back 107

Jaundice, fatigue, weight loss, diarrhea, portal hypertension, compromised liver function, and possible abdominal pain

Front 108

What are the 4 forms of cirrhosis?

Back 108

1. Alcoholic
2. Biliary
3. Post-necrotic (from viral hepatitis)
4. Metabolic

Front 109

The sonographic appearance of early cirrhosis includes (shrunken / enlarged) liver, (hyperechoic / hypoechoic) liver, and (minimal / extensive) parenchyma changes.

Back 109

1. enlarged
2. hyperechoic
3. minimal

Front 110

The sonographic appearance of advanced cirrhosis includes
1. (shrunken / enlarged) liver
2. (more / less sound attenuation)
3. (less / more) defined vascular structures
4. (regular / irregular) contour (surface nodularity)

Back 110

1. shrunken liver
2. more attenuation
3. less defined vascular structures
4. irregular contour

Front 111

With cirrhosis, what two sonographically visible symptoms may occur elsewhere than in the liver?

Back 111

1. splenomegaly
2. ascites

Front 112

Cirrhosis often leads to ____ in the portal system, resulting in impeded ____ flow.

Back 112

hypertension
heptopetal

Front 113

With portal hypertension, blood flow in the portal system often becomes ____.

Back 113

hepatofugal

Front 114

When flow through the portal system is impeded, ____ or _____ pathways will sometimes form.

Back 114

varicies
collateral

Front 115

A particular collateral pathway which may develop is the ____ ____ ____.

Back 115

recanalized umbilical vein

Front 116

The umbilical vein develops into the ___ ____.

Back 116

ligamentum teres

Front 117

What symptoms might occur with portal hypertension?

Back 117

Ascites
Hepatosplenomegaly
GI bleeding
Elevated liver enzymes
Jaundice
Hematemesis (vomiting blood)

Front 118

What are the three sonographically visible symptoms of portal hypertension?

Back 118

1. Hepatofugal flow in the portal vein (put Doppler on MPV)
2. Portal vein > 1.6 cm
3. Recanalized umbilical vein (put Doppler on teres)

Front 119

What is used to treat portal hypertension?

Back 119

T.I.P.S (Transjugular Intrahepatic Portosystemic Shunt)

Front 120

Where is a TIPS placed?

Back 120

From the portal vein directly to the hepatic vein

Front 121

How is ultrasound used with a TIPS?

Back 121

Ultrasound is used to check the patency of the TIPS.

Front 122

In a recanalized umbilical vein, where does the blood flow to?

Back 122

The vena cava

Front 123

With all types of hepatitis, the liver will be (enlarged / shrunken), (hyperechoic / hypoechoic), with (decreased / increased vascularity, and with (faint / prominent) portal vein walls. The gallbladder wall will look (thicker / thinner) due to the edema around the gallbladder.

Back 123

1. enlarged
2. hypoechoic
3. increased
4. prominent
5. thicker