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341 Cards in this Set
- Front
- Back
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The disease process that affects the hepatocytes and interferes w/ liver function is called: |
hepatocellular disease
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Hepatocellular disease ranges from simple ____ changes to ____ depending on severity.
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fatty, hepatitis/cirrhosis
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An acquired, benign and reversible disorder of metabolism is called ____ ____.
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fatty infiltration
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What does fatty infiltration result in?
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accumulation of fatty triglycerides w/in the liver cells secondary to cell injury or impaired fat metabolism
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Fatty infiltration is AKA ____.
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steatosis
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Fatty infiltration typically affects the ____ lobe & may be ____ or ____.
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right, focal or patchy
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What is probably the most common cause of fatty infiltration?
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obesity
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Severe child malnutrition is known as ____.
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kwashiorkor
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A genetic disease in which an enzyme involved in building up glucose into glycogen is absent or defective is:
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glycogen storage disease
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What is the clinical presentation of fatty infiltration?
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asymptomatic, minimal hepatomegaly and elevated LFT's
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What is the sonographic appearance of fatty infiltration?
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normal size or hepatomegaly, diffuse or focal increase in echogenicity, increased attenuation (posterior hard to see)
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Focal fatty infiltration results in non-uniform areas of increased ____ & ____.
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echogenicity & attenuation
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Focal fatty sparing most commonly appears as an area of ____ liver texture.
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hypoechoic
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Where is focal sparing usually seen?
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in the medial segment of the left lobe anterior to the porta hepatis
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Fatty infiltration is a ____ disorder.
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reversible
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What 2 things could possibly reverse fatty infiltration?
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weight loss, and stopping alcohol abuse
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T or F. Fatty infiltration is now thought to be a precursor for significant chronic disease.
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TRUE
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With fatty infiltration lab values may be normal or ____.
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increased
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What lab values are associated with fatty infiltration?
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AST, ALT, and bilirubin
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Hepatitis is defined as ____ of the liver.
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inflammation
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What types of hepatitis can lead to cirrhosis and death?
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B,C, and D
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In cases of viral hepatitis, the offending organism is generally hepatitis ___, ___, or ___.
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A, B, or C
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What types of hepatitis are rare?
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D, E, and F
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Some patients with Hep ___ or ___ will be positive without any symptoms.
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B or C
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What is the type of hepatitis NOT associated w/ liver damage?
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Hepatitis A
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How is hepatitis A contracted?
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through fecal and oral contamination
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How is hepatitis B contracted?
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by blood, sex, feces, IVDA, and mother to infant
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Hepatitis C is contracted through ____ ____ or ____.
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blood transfusions or IVDA
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Hepatitis D is progression from hepatitis ____ and is found in foreign countries.
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B
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What is hepatitis E caused by?
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contamination of water from feces, more prevalent in asia & africa
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Hepatitis F is the ____ form of hepatitis ____.
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japanese, B
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What are some acute symptoms of hepatitis?
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fatigue, jaundice, fever, elevated LFT's
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What lab values are associated with and increased with hepatitis?
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AST, ALT (falls after several days), direct & indirect bilirubin
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Acute hepatitis may have a ____ sonographic appearance.
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normal
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With acute hepatitis there is an overall ____ in liver echogenicity.
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decrease
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With acute hepatitis the portal vein walls may appear more ____.
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echogenic
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What is acute hepatitis associated with?
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GB wall thickening may be present as well as hepatomegaly
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Chronic hepatitis may show ____ echogenicity secondary to ____ & ____.
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increased, fatty change & fibrosis
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bilious vomitting, inability to pass meconium, complication of cystic fibrosis
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meconium ileus
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Decreased echogenicity of the ____ ____ may be seen w/ chronic hepatitis.
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portal vein
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Chronic hepatitis may be a cause for ____ ____.
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non-obstructive jaundice
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What may be present with chronic hepatitis?
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splenomegaly, portal hypertension & sequelae
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The irreversible & progressive chronic diffuse process disease is known as ____.
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cirrhosis
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What is cirrhosis characterized by?
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scarring, parenchymal necrosis, regeneration and diffuse fibrosis
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Cirrhosis is a significant predisposing factor of ____ ____.
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liver carcinoma (cancer)
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What is the 6th leading cause of death in the US?
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cirrhosis
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In the western hemisphere ____% of cirrhosis is secondary to alcohol abuse.
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60-70%
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With cirrhosis there is a loss of normal ____ ____ & it leads to death of ____.
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liver function, hepatocytes
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What replaces the normal liver parenchyma in someone w/ cirrhosis?
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fibrosis of the liver cells
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What lab values are associated with cirrhosis?
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abnormal LFT's, increased bilirubin, AST & ALT.
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What is the sonographic appearance in the early stage of cirrhosis?
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hepatomegaly, fatty infiltration, increased echogenicity & sound attenuation
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What is the sonographic appearance of the later stage of cirrhosis?
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Smaller heterogeneous echogenic coarse liver w/ caudate lobe enlargement, and surface nodularity
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What are associated findings w/ cirrhosis?
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dilated portal vein w/ possible blood flow away from the liver, splenomegaly, ascites, & portosystemic varices
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What technique is used to evaluate cirrhosis?
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caudate to right lobe ratio technique (C/RL)
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If C/RL ratio is less than ____ than cirrhosis is unlikely.
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.60
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What is glycogen storage disease?
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autosomal recessive genetic disorder of carb metabolism
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Glycogen storage disease is characterized by a derangement of either ____ or ____ of glycogen
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synthesis or degradation
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The most common type of glycogen storage disease is ____ ____ disease.
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Von Gieke's (Type 1)
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What is Von Geike's Type 1 disease?
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when excessive gycogen accumulates in the hepatocytes, kidneys & intestines
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When does glycogen storage disease usually occur?
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b/t infancy & young adulthood
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What is the sonographic appearance of type 1 glycogen storage disease?
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hepatomegaly, fatty infiltration, increased echogenicity, liver cell adenomas, focal nodular hyperplasia, nephromegaly
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What are the features most often observed in extrahepatic masses?
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internal invagination & discontinuity of capsule, triangular fat wegde, anteromedial IVC shift, anterior displacement of R kidney
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What are the 3 features most often seen in intrahepatic masses?
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displacement of the hepatic vascular radicles, external bulging of capsule, posterior displacement of IVC
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A fluid-filled liver mass w/ an epithelial lining is a ____.
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cyst
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True liver cysts are ____.
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congenital
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What can liver cysts be a result of?
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may result from developmental defects in bile duct formation
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Liver cysts are usually ____ and multiple or large cysts can cause liver ____.
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benign, enlargement
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Large cysts are more likely to be ____.
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problematic
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What are considered to NOT be true cysts?
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masses from trauma & parasitic or inflammatory changes
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The ____ lobe is affected twice as much as the other lobe.
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right
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Adult polycystic disease affects ____ more and it's incidence is ____.
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females, 1 in 1,000
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Polycystic disease usually affects patients in the ____ decade of life
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5th-7th
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What is the sonographic appearance of a liver cyst?
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anechoic, well defined w/ posterior acoustic enhancement
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If polycystic disease is suspected, what other structures should be checked?
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kidneys, spleen, and pancreas
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What is a type of polycystic disease seen in association w/ adult polycystic kidney disease?
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autosomal dominant polycystic disease
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What are some differential diagnoses of cysts?
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metastatic tumor, cystadenocarcinoma, abscess, hematoma, echinococcal cyst
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What are 5 types of infection seen in the liver?
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echinococcal cyst, pyogenic (bacterial) abscess, amebic (parasitic) absecess, fungal infection and schistosomiasis
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An echinococcal cyst is a ____ infection the most often causes ____ disease.
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parasitic, hydatid
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About ____% of echinococcal cysts are found in the liver.
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50%
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What are the clinical symptoms of an echinococcal cyst?
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pain, fever, leukocytosis, abnormal LFT's & possible jaundice
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The sonographic appearance of echinococcal cysts is ____ and are usually ____ cysts w/ ____ ____.
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variable, simple w/ internal echoes
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Echinococcal cysts may have ____ or ____ walls.
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thick or calcified
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What occurs early in the disease process of an echinococcal cyst?
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a mother/daughter cyst (large cyst w/ a smaller cyst within it)
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Echinococcal cysts may have a ____ appearance and may appear as a ____ ____ liver mass.
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honeycomb, densely calcified
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A "____ ____" sign occurs when the ____ layer has either collapsed or detached.
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water lily, germinal
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What does a complete cyst wall calcification of echinococcal cysts usually indicate?
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an inactive lesion
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Echinococcal cysts cause a postivie ____ test.
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serologic
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A localized collection of pus is known as a ____ ____.
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pyogenic abscess
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Bacteria most commonly enters the liver thru the ____ ____.
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biliary tree
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What are 4 predisposing factors of pyogenic abscess?
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biliary tract obstruction, infection, tumor, and hepatic cysts
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What is the most common bacterial agent?
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E.Coli
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What are the clinical signs/symptoms of a pyogenic abscess?
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fever, pain, pleuritic pain, nausea, vomiting, and diarrhea
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What lab values are usually associated w/ pyogenic abscesses?
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leukocytosis, elevated LFT's, and anemia
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Pyogenic abscesses are most commonly located in the ____ lobe & are usually ____.
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right (80%), solitary (multiple in 10%)
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What is the sonographic appearance of a pyogenic abscess?
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round/oval, 1 cm or >, irregular walls w/ variable echogenicity
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The majority of pyogenic abcesses are ____ echogenic than the liver.
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less
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About ____% of pyogenic abscesses have acoustic enhancement.
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50%
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Sometimes ____ ____ from air in the abscess will cause acoustic shadowing.
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micro bubbles
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A localized cavity (liver infection) that results from ingestion of parasites in contaminated food/water is an ____ ____.
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amebic (parasitic) abscess
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Amebic abscesses are caused most often from the parasite ____ ____.
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Entamoeba histolytica
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The primary infection of amebic abscesses is the ____.
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intestines
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In amebic abscesses, parasites reach the liver thru the ____ ____.
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portal vein
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The parasites w/ amebic abscess cause ____ ____ of the ____.
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liquefaction necrosis, hepatocytes
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Amebic abscess formation is usually ____ in the liver.
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peripheral
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What are the symptoms of an amebic abscess?
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pain, diarrhea, and melena
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What is melena?
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condition characterized by the production of black stools caused by bleeding into the bowel
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What are the 2 main complications w/ amebic abscess?
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rupture into the pleuropulmonary structures & into the peritoneal cavity
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There is an increased ____ and abnormal ____ w/ an amebic abscess.
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WBC, LFT's
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What is the sonographic appearance of an amebic abscess?
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variable echogenicity (< liver), lack of wall echoes, round/oval, distal acoustic enhancement
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Amebic abscesses have a typical ____ location contiguous w/ the ____ ____.
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peripheral, liver capsule
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The fungal infection _____ affects the liver most often in patients who are immunocompromised.
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candidiasis (c.albicans)
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What is the sonographic appearance of a fungal infection?
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hepatomegaly, bulls-eye, uniform & hypoechoic
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What is seen in the early & late stages of a fungal infection?
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early stage- a wheel w/in a wheel,
later stage- echogenic foci w/ variable posterior acoustic enhancement |
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A granulomatous portal vein reaction to parasitic invasion is called _____.
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schistosomiasis
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T or F. Schistosomiasis is a common parasitic infection found where water is contaminated.
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TRUE
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With schistosomiasis, immature worms puncture the skin & migrate via ____ & ____ system.
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lymphatics & venous
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What are 5 clinical signs of schistosomiasis?
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pain, increased LFT's & WBC, fever, and presinusoidal portal hypertension
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What is the sonographic appearance of schistosomiasis?
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normal size liver w/ hepatomegaly in acute phase, thickening & increased echogenicity of the intrahepatic portal vein
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Schistosomiasis causes dilation of the ____ ____ and ____.
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portal vein (hypertension) & splenomegaly
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Usually there are ____ ____ ____ w/ schistosomiasis.
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portosystemic venous collaterals
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T or F. Benign liver tumors are rare.
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TRUE
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Primary liver tumors are ____ common than metastatic tumors.
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less
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What do primary liver tumors originate from?
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hepatic parenchymal cells, bile duct epithelium, or mixture of both
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A cluster of blood vessels is a ____.
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hemangioma
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A tumor of the cells that line internal body surfaces is called ____.
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endothelioma
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What are the different types of benign liver neoplasms?
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cavernous hemangioma, focal nodular hypoplasia, adenoma, cystadenoma, mesenchyma hamartoma
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What is the most common benign liver tumor?
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cavernous hemangioma
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Cavernous hemangioma's are a ____ ____ malformation.
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congenital vascular
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Cavernous hemangioma's are usually ____ & generally ____ slowly.
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asymptomatic, enlarge
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What are cavernous hemangioma's composed of?
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a large network of vascular endothelieum-lined spaces filled w/ RBC's
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Cavernous hemangioma's may undergo ____, ____, & ____.
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degeneration, fibrosis, and calcification
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Where are cavernous hemangioma's more common?
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in the RT lobe & more common in women
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Cavernous hemangioma's are usually ____ or ____ in location.
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subscapular or peripheral
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Cavernous hemangioma's can grow during ____ or w/ ____ therapy.
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pregnancy, hormonal
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What is the sonographic appearance of a cavernous hemangioma?
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typically round, echogenic, homogeneous & well-defined w/ occasional thru transmission (<2.5 cm), usually < 3 cm
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Larger cavernous hemangioma lesions may appear ____ due to degeneration & fibrosis.
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heterogeneous
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What is the 2nd most common benign neoplasm of the liver?
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focal nodular hyperplasia (FNH)
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FNH is considered to be ____ & is usually ____.
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rare, asymptomatic
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What is focal nodular hyperplasia composed of?
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abnormally arranged hepatocytes, bile duct elements, fibrous conn tissue, and kupffer cells
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Phagocytes that partially line the liver lobules & remove foreign matter are ____ ____.
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kupffer's cells
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FNH is most common in ____ under the age of ____.
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women, 40
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There is an increased incidence of FNH with the use of ____ ____.
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oral contraceptives
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FNH is usually found in the ____ lobe.
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right
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What is the common size for FNH?
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.5 - 20 cm
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FNH may be ____ & has variable ____.
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multiple, echogenicity
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Focal nodular hyperplasia is most commonly ____ & is similar to the appearance of an ____.
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isoechoic, adenoma
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A dense non-shadowing linear or stellate group of echoes in a solitary hepatic mass is called an _____.
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FNH
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There is an increased risk of ____ w/in the liver with FNH.
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bleeding
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FNH are ____ w/ a ____ ____ pattern.
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hypervascular, stellar arterial
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With FNH there is a well-defined ____ ____.
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central scar
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A thickening and scarring of connective tissue is called ____.
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fibrosis
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Having a central part w/ smaller parts radiating out from it is called ____.
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stellate
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A uncommon benign epithelial neoplasm of the liver is called ____ ____.
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liver (cell) adenoma
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What are liver cell adenoma's composed of?
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normal or atypical hepatocytes containing areas of bile stasis & focal hemorrhage
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What is the difference b/t liver cell adenoma and FNH?
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the absence of bile ducts or kupffer cells
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Liver cell adenomas are usually ____ and can present as a ____ ____.
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asymptomatic, palpable mass
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Patients w/ liver cell adenoma may present w/ severe ____ ____ secondary to ____.
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RUQ pain, rupture/bleeding
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People w/ liver cell adenomas may go into shock due to ____ of the lesion & ____.
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rupture, hemoperitoneum
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Liver cell adenoma is most common in ____ who take ____.
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women, BCP
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Liver cell adenoma's can occur in ____ who take ____ ____.
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men, anabolic steroids
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Liver cell adenoma's can occur in males from ____ ____ treatment w/ ____ hormone.
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prostate cancer, estrogen
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What do liver cell adenoma's have an increased association with?
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Type 1 glycogen storage disease (von gierke's)
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A mass w/ variable echogenicity, usually seen in the RT lobe w/ well defined encapsulated borders & possible hypoechoic halos is:
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liver cell adenoma
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Liver cell adenoma's may be ____ or ____ & has a similar appearance to ____.
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solitary or multiple, FNH
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On doppler, liver cell adenoma's demonstrate ____ & ____ flow.
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peritumoral & intratumoral
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A rare benign neoplasm occurring in middle-aged women is a ____ ____.
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hepatic cystadenoma
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Hepatic cystadenoma's usually present w/ a ____ ____ and contain ____ structures.
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palpable mass, cystic
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What is the sonographic appearance of a hepatic cystadenoma?
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multilocular w/ mucinous fluid
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What is the most common benign vascular liver neoplasm in infants?
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infantile hemangioendothelioma
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What is infantile hemangioendothelioma?
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overgrowth of the endothelium of minute capillary vessels
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Infantile hemangioendothelioma's are most common in ____ and ____% occur before 6 months.
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females, 85%
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A normal AFP excludes the diagnosis of a _____.
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hepatoblastoma
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T or F. IH's usually grow rapidly and then regress slowly.
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TRUE
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What are 3 clinical symptoms of infantile hemangioendothelioma?
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hepatomegaly, CHF, cutaneous hemangioma
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What are 4 complications w/ infantile hemangioendothelioma?
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thrombocytopenia, angiopathic anemia, GI bleeding, and intra-abdominal rupture
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The state of having fewer than normal # of blood platelets per unit volume of blood is _____.
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thrombocytopenia
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What is the sonographic appearance of infantile hemangioendothelioma?
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varied echogenicity, multiple hypoechoic lesions (1-3cm), w/ large draining veins, and possible dilated prox aorta
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With IH, the distal aorta is either ____ or ____ in size.
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normal, decreased
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There is ____ doppler flow w/in a IH.
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increased
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The cells w/in the embryo that develop into conn tissue, bone, cartilage, blood & lymphatic system are:
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mesenchyme
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A tumor resulting from new growth of normal tissues is a ____.
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hamartoma
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Mesenchyma hamartoma's are ____ & occur in children less than ____ yrs of age.
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rare, 2
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What is a mesenchyma hamartoma?
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A developmental, non-encapsulated, cystic liver tumor
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Mesenchyma hamartoma's cause ____ ____ or a ____ mass.
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diffuse enlargement, palpable
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Histologically, mesenchyma hamartoma tumors have a disordered arrangement of what 3 structures?
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bile ducts, primitive mesenchyme, and hepatic parenchyma (w/ stromal elements)
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What is the sonographic appearance of a mesenchyma hamartoma?
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well-defined, large, complex mass (5-30 cm)
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Mesenchyma hamartoma's are more common in the ____ lobe of the liver.
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right
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Mesenchyma hamartoma's may be predominantly ____ w/ some ____.
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anechoic, trabeculation (or lace-like configuration)
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If mesenchyma hamartoma cysts are tiny, the mass may have a more ____ ____ pattern.
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solid-hyperechoic
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What are the 4 types of malignant tumors?
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hepatoblastoma. hepatocellular carcinoma, hemaniosarcoma. and liver metastasis
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A malignant tumor that begins growing in conn tissue is called a ____.
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sarcoma
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A _____ is a malignant germ cell tumor.
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hepatoblastoma
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What is the most common malignant liver tumor that occurs in infancy & childhood?
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hepatoblastoma
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Histologically, a hepatoblastoma can be classified as either an ____ mass or mixed mass of what 2 cells?
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epithelial, epithelial & mesenchymal
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What are the 3 risk factors associated w/ a hepatoblastoma?
|
beckwith-wiedeman syndrome, hemihypertrophy, sporadic aniridia
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What is beckwith-wiedeman syndrome?
|
a rare inherited disorder which causes enlargement of the tounge & umbilical hernia
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An unequal growth of the cranium, face, and limbs is called _____.
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hemihypertrophy
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A congenital, hereditary, bilateral form of iris hypoplasia is ____ ____.
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sporadic aniridia
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What are the symptoms of a hepatoblastoma?
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weight loss, nausea, vomitting, enlargement, hepatomegaly, & precocious puberty
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Lab values show markedly elevated serum _____ w/ hepatoblastoma's.
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AFP
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What is the sonographic appearance of a hepatoblastoma?
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hyperechoic or cystic mass, heterogeneous, poorly marginated, w/ possible calcifications
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With hepatoblastoma's there is an evaluation of ____ ____.
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neovascular flow
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Hepatocellular carcinoma is also known as a ____.
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hepatoma
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What is the most common primary malignancy/ liver cancer?
|
hepatocellular carcinoma
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What does hepatocellular carcinoma tend to destroy?
|
portal venous radicle walls
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The most common predisposing factor of hepatocellular carcinoma is ____.
|
cirrhosis (80% of cases)
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What is HCC related to?
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hep b, hep c, metabolic disorders, and hepatocarcinogens in food
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What are the symptoms of HCC?
|
mild fever, rapid liver enlargement/palpable mass, signs associated w/ cirrhosis
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HCC often have normal ____ and increased ____.
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LFT's, AFP (70% of pts)
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HCC may also have elevated ____ & ____ levels.
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AST & ALT
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Hepatocellular carcinoma is commonly associated w/ _____.
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hepatomegaly
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Usually _____ or _____ _____ of the portal system occurs w/ HCC.
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thrombosis or tumor invasion (30-70%)
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Invasions of the ____ ____ producing ____ ____ syndrome occur w/ HCC.
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hepatic veins, budd-chiari
|
|
|
Hepatic vein & biliary tree invasion occurs in ____% of pts w/ HCC.
|
13%
|
|
|
HCC is highly ____ in appearance.
|
variable
|
|
|
HCC can appear as ____, ____, or ____ invasion.
|
solitary, multiple, diffuse
|
|
|
Sometimes HCC is associated w/ ____.
|
ascites
|
|
|
An extremely rare malignant neoplasm is known as _____.
|
hemangiosarcoma
|
|
|
What is another term for hemangiosarcoma?
|
hepatic angiosarcoma
|
|
|
Hemangiosarcoma is comprised of ____ & ____ tissue.
|
endothelial & fibroblastic
|
|
|
Usually hemangiosarcoma is seen in pts w/ ____ ____ and surrounds ____.
|
advanced age, vessels
|
|
|
Hermangiosarcoma is related to prior exposure to ____.
|
carcinogens
|
|
|
T or F.When someone has hemangiosarcoma, the tumor progresses rapidly.
|
TRUE
|
|
|
What structures does metastasis occur w/ hemangiosarcoma?
|
PV, speen, lung, lymph node's, thyroid & peritoneal cavity
|
|
|
Hemangiosarcoma appears as a large mass of mixed _____.
|
echogenicity
|
|
|
Usually hemangiosarcoma appears as a ____ mass w/ areas of ____ echogenicity due to hemorrhage/necrosis.
|
solid, decreased
|
|
|
What is liver metastasis?
|
spread of tumor cells to liver from a primary malignant neoplasm
|
|
|
The ____ is the most common site for metastatic change?.
|
liver
|
|
|
How does cancer spread in the liver?
|
via the portal vein, hepatic artery, and lymphatics
|
|
|
Liver metastasis is more common than ____ ____.
|
hepatocellular cancer (which is most common liver malignancy)
|
|
|
What are the 3 primary sites for liver metastasis?
|
GI, breast & lungs
|
|
|
What are the pediatric primary metastasis sites?
|
kidney & adrenal glands (nephroblastoma and neuroblastoma & wilm's tumor)
|
|
|
What are the 4 main symptoms of liver metastasis?
|
hepatomegaly, jaundice, pain & weight loss ( in 50% of pts)
|
|
|
With liver metastasis the ____ are abnormal. What 2 lab values are increased?
|
LFT's, increased alkaline phosphatase & direct bilirubin
|
|
|
Liver metastasis has a varied appearance, typically w/ ____ nodules.
|
multiple
|
|
|
Liver metastasis is diffusely ____.
|
heterogeneous
|
|
|
Some ____ & ____ may be visualized w/ liver metastasis.
|
calcification & degeneration
|
|
|
What are hematoma's caused by?
|
trauma, post biopsy, blood thinners, rupture of neoplasm
|
|
|
What are the 3 categories of a hematoma?
|
central rupture of liver, separation of capsule & subscapular hematoma, rupture of liver & capsule
|
|
|
In children, blunt abdominal trauma accounts for over ____% of all abdominal injuries.
|
90%
|
|
|
The ____ is the 3rd most common organ injured in the abdomen.
|
liver (after spleen & kidney)
|
|
|
Liver laceration occurs in ____% of trauma patients.
|
3%
|
|
|
What is used most often to look at laceration to organs?
|
CT scans
|
|
|
Hematoma's are ____ & cause ____.
|
painful, hypotension
|
|
|
A large hematoma may result in ____ ____.
|
decreased hematocrit
|
|
|
Hematoma's generally appear ____ w/ ____ ____ margins.
|
hypoechoic, poorly defined
|
|
|
Where are hematoma's most often seen?
|
in the posterior segment of the right lobe
|
|
|
Usually hematoma's are ____ & may mimic a ____.
|
round/oval, tumor
|
|
|
Hematoma's appearance varies depending on how ____ it is.
|
old
|
|
|
An acute bleed pattern tends to be ____ due to ____ & ____.
|
echogenic, fibrin & erthyrocytes
|
|
|
A protein that helps blood clot is called ____.
|
fibrin
|
|
|
Coagulation leads to a ____, ____ appearance.
|
complex, solid
|
|
|
As a hematoma reabsorbs it becomes ____ & ____.
|
dense & calcified
|
|
|
A subscapular hematoma has potential ____ bordering the liver.
|
fluid
|
|
|
If there is a capsular rupture it is difficult to ____, and there may be ____ ____ in the peritoneal cavity.
|
identify, free fluid
|
|
|
With a capsular rupture, ____ leaks out & accumulates a ____.
|
blood, mass
|
|
|
Liver hemorrhage can occur during pregnancy due to increased ____ ____ from ____.
|
blood pressure, preeclampsia
|
|
|
A potentially dangerous condition late in pregnancy w/ high blood pressure is _____.
|
preeclampsia
|
|
|
A lipoma is a ____, ____, ____ mass in the liver.
|
rare, benign, echogenic
|
|
|
Lipoma's are ____ ____ & composed of ____ tissue.
|
well circumscribed, adipose
|
|
|
What can lipoma's be confused with?
|
hemangioma, hemorrhage, or angiomyolipoma
|
|
|
Rare congenital disorders of the intrahepatic bile ducts is called ____ ____.
|
caroli disease/syndrome
|
|
|
What are both caroli disease & syndrome characterized by?
|
dilatation of intrahepatic biliary tree
|
|
|
The term caroli disease is applied if the disease is limited to ____ or ____ ____ of the large intrahepatic ducts.
|
ectasia, segmental dilatation
|
|
|
T or F. Caroli disease is less common than caroli syndrome.
|
TRUE
|
|
|
What malformations are associated w/ caroli syndrome?
|
small bile ducts & congenital hepatic fibrosis
|
|
|
Caroli disease is ____, whereas caroli syndrome is generally ____.
|
sporadic, inherited
|
|
|
What is Caroli syndrome often associated with?
|
autosomal recessive polycystic kidney disease
|
|
|
What are 3 causes of hyperechoic foci in the liver region?
|
air in bile ducts, foreign objects, and calcifications
|
|
|
What is ERCP?
|
endoscopic retrograde cholangiopancreatography
|
|
|
Air in the bild duct causes a "____ ____".
|
comet tail
|
|
|
Calcifications can be caused by ____ ____ or a healed ____.
|
granulamatous change, abscess/hematoma
|
|
|
What do calcifications cause?
|
posterior acoustic shadowing
|
|
|
The most appropriate & reliable method of evaluating vascular abnormalities in the liver is ____ ____ & ____ ____.
|
color doppler & spectral waveform
|
|
|
What are 5 factors that influence liver vascularity measurements?
|
fasting state, patient position, respiration, venous collaterals, & disease severity
|
|
|
The hepatic ____ system is usually only evaluated in patients w/ a ____ ____.
|
arterial, liver transplant
|
|
|
With PV evaluation, color is used to identify the ____ vein as well as the left & right ____.
|
splenic, MPV
|
|
|
Blood flow in the portal system is ____.
|
hepatopetal
|
|
|
What is a normal signal w/in the RT & LT portal veins?
|
a continuous monophasic pattern
|
|
|
Abnormal doppler of the portal vein includes ____ or ____ flow.
|
hepatofugal or biphasic
|
|
|
Biphasic flow in the RT & LT branches of the portal vein signifies ____.
|
pathology
|
|
|
What is TIPS?
|
transjugular intrahepatic portosystemic shunts
|
|
|
Velocity has merit in patients w/ ____.
|
TIPS
|
|
|
Presinusoidal portal hypertension is ____ vs. ____.
|
extrahepatic vs intrahepatic
|
|
|
What are 3 causes of extrahepatic PH?
|
thrombosis, occulsion & compression of the MPV or SV
|
|
|
Extrahepatic PH in adults can be caused by what 5 things?
|
sepsis, tumor, shunts, BCP & pancreatitis
|
|
|
What is intrahepatic PH associated with?
|
hepatocellular or metastatic disease, hemorrhage, liver failure
|
|
|
What is the most common causes of intrahepatic PH?
|
cirrhosis (90%)
|
|
|
With PH, blood backs up into the ____ vein & causes ____.
|
splenic, splenomegaly
|
|
|
Portal hypertension is usually ____.
|
asymptomatic
|
|
|
PH causes an ____ in portal vein diameter, ____ flow & a dilated ____ vein.
|
increase (>13mm), hepatofugal, splenic/smv (>10mm)
|
|
|
There is a presence of ____ & ____ w/ PH.
|
varices & ascites
|
|
|
The umbilical vein is ____ w/ PH.
|
recancalized
|
|
|
The liver has a ____ appearance w/ PH.
|
variable
|
|
|
With PH, the portal vein tries to force ____% of the blood flow but cant.
|
70%
|
|
|
What provides relief for increased flow in the PV?
|
collaterals
|
|
|
The most common collateral is the ____ ____ & progresses to ____ ____.
|
left gastric, esophageal varices
|
|
|
What are the 2 sources for collaterals?
|
para-umbilical or recanalized umbilical veins
|
|
|
Presence of thrombus in the portal vein is called ____.
|
PVT
|
|
|
What are the 2 major causes of PVT?
|
reduced portal flow from hepatic parenchymal disease & abdominal sepsis
|
|
|
PVT is commonly ____ unless associated w/ another event.
|
asymptomatic
|
|
|
Hypercoagulable syndromes can lead to ____ & ____ ____ thrombosis.
|
portamesenteric & splenic vein
|
|
|
In the late stages of a PVT, patients may have ____ ____.
|
variceal bleeding
|
|
|
What are the sonographic findings of a PVT?
|
intraluminal echogenic mass, w/ the presence of collaterals
|
|
|
With a PVT, doppler shows a lack of flow in the ____ vein and an enlarged ____ artery.
|
portal, hepatic
|
|
|
What is another name for cavernous transformation of the portal vein?
|
portal cavernoma
|
|
|
What is portal cavernoma?
|
formation of venous channels w/in or around a previously thrombosed portal vein
|
|
|
Portal cavernoma can appear as ____ ____ mass.
|
subhepatic spongelike
|
|
|
Multiple anechoic areas in the porta hepatis w/ the presence of collaterals is the appearance of:
|
cavernous transformation of the portal vein
|
|
|
With portal cavernoma, there are multiple ____ ____ w/in the porta hepatis.
|
small vessels
|
|
|
What is TIPS used for?
|
to relieve portal hypertension symptoms & ascites
|
|
|
How is TIPS inserted?
|
thru the jugular into the hepatic vein & connected to the PV
|
|
|
What does the TIPS stent look like on US?
|
2 echogenic lines in the liver
|
|
|
What type of transducer is generally best for TIPS?
|
low freq transducer (2 MHZ)
|
|
|
What can influence stent velocities?
|
respiration
|
|
|
What is the normal velocity in the mid & distal stents?
|
0.9 - 2.0 m/sec
|
|
|
Radiography of the veins is known as ____.
|
venography
|
|
|
The lowest permissible value for velocity in the PV should not be less than _____.
|
30 cm/second
|
|
|
Blood flow in the native PV is almost always towards the ____.
|
stent
|
|
|
With TIPS, the blood flow in the LT & RT portals is ____.
|
hepatofugal
|
|
|
A specific parameter for stent dysfunction is finding flow away from the ____ in the native ____ veins.
|
stent, portal
|
|
|
Following TIPS, blood flow w/in the hepatic arteries shows evidence of ____ velocities.
|
increased
|
|
|
A scanning pitfall w/ TIPS is that enlarged hepatic arteries can mimic ____ ____ ____ in the liver.
|
portal vein radicles
|
|
|
What 3 things can lead to NO flow seen, even when the shunt is patent?
|
poor acoustic access, poor doppler angle, & other tech problems
|
|
|
Many believe that a positive (abnormal) TIPS doppler must be complemented w/ ____.
|
venography
|
|
|
The hepatic veins drain blood from the ____ to the ____ & than to the ____ atrium of the heart.
|
liver, IVC, right
|
|
|
What is the normal waveform for the hepatic veins?
|
multiphasic
|
|
|
Abnormal flow of the hepatic veins may be related to ____ or ____.
|
obstruction or congestion
|
|
|
Hepatic vein compression by fibrosis in pts w/ cirrhosis is an example of ____.
|
obstruction
|
|
|
Disease processes that affect the RT side of the heart will result in congestion & dilatation of the ____ ____ & ____.
|
hepatic veins & IVC
|
|
|
With abnormal flow in the hepatic veins the waveform is ____ or ____.
|
biphasic or flat
|
|
|
Thrombosis of the main hepatic veins is known as ____ ____ syndrome.
|
budd-chiari
|
|
|
What is budd-chiari syndrome associated with?
|
tumor invasion, ascites, hepatomegaly, splenomegaly, and dilatation of the hepatic vein prox to stenosis
|
|
|
What are some causes of budd-chiari syndrome?
|
chronic leukemia, polycthemia, renal carcinoma, pregnancy
|
|
|
What is necessary to see hepatic vein occlusions & collaterals?
|
doppler
|
|
|
Budd-chiari in america is usually seen in ____ on ____.
|
women, BCP
|
|
|
The ____ lobe is usually spared w/ budd-chiari syndrome.
|
caudate
|
|
|
What is the PSS?
|
portosystemic shunt
|
|
|
The PSS is also known as the ____ shunt and is a bypass of the liver by the body's ____ system.
|
liver, circulatory
|
|
|
An opening b/t two organs or b/t an organ & the skin is called a ____.
|
fistula
|
|
|
Normal hepatic artery flow is ____ & the peak systolic velocity should be < ____.
|
hepatopetal, 60 cm/sec
|
