Liver Pathology

Front 1

What is the normal craniocaudal length of the right lobe

Back 1

13-15.5 cm

Front 2

in 75 % of cases if the liver is enlarged it is _______

Back 2

hepatomegaly

Front 3

Because the caudate lobe has vessels independent of the rest of the liver it may appear ____ in size compared to the rest of the liver during liver disease

Back 3

enlarged (it is in fact noraml sized and only appears enlarged next to the rest of the shrunken liver)

Front 4

_____ affects the hepatocytes and interferes with liver function

Back 4

diffuse hepatocellular disease

Front 5

______ is a parenchymal liver cell that performs all the functions of the liver

Back 5

hepatocyte

Front 6

_______ is increased lipid accumulation in the hepatocytes that results from injury or systemic disorder leading to impaired or excessive metabolism or fat. It is a benign process that may be reversible.

Back 6

Fatty Infiltration

Front 7

What are some common causes of Fatty Infiltration?

Back 7

Alcoholic liver disease, diabetes mellitus, obesity, severe hepatitis, chronic illness and steroids

Front 8

Fatty infiltraton is characterized by _______ and _______.

Back 8

increased echogenicity, and enlargement of the affected lobe

Front 9

What are some clinical features of fatty infiltration?

Back 9

may include hepatomegaly, and right upper quadrant discomfort, sometimes asympromatic

Front 10

______ is a hypoechoic appearing area in a echogenic, fatty liver. MC seen anterior to gallbladder or portl vein, and posterior portion of the left lobe.

Back 10

Focal Sparing

Front 11

______ is when much of the liver has increased echogenicity along with areas of normal liver tisue that are relatively echogenic and may be mistaking for localized masses. Near porta hepatis is the most common site.

Back 11

focal fatty infiltration

Front 12

_____ can occur anywhere in the liver. They may be acquired or congenital single or multiple. Most common in incresing age and women.

Back 12

Cysts

Front 13

_______ cannont be distinguised from other simple cysts. the primary differences are the increased incidence with age and the presense of a greater number of cysts

Back 13

Congenital Polycystic Disease
(assoc with polycystic kidney disease)

Front 14

If parents have polycystic disease there is a _______ % chance kids will have

Back 14

50

Front 15

Liver cysts rarely cause _______

Back 15

symptoms or problems with liver function

Front 16

______ is a collection of blood in or around the liver most commonly caused by trauma. Occurs when the livre is lacerated cut punctured or bruised. Symptom is pain

Back 16

hematoma

Front 17

______ level may fall producing shock when massive hemorrhage occurs. It can occur as a result of high blood pressure associated with preclampsia and eclampsia of pregnancy.

Back 17

hematocrit

Front 18

new hematomas appear ______

Back 18

clear as the texture of blood

Front 19

As blood begins to coagulate in older hematomas, fibrin stands develop, giving it what apperence?

Back 19

varrying degress of clot

Front 20

Older hematomas take on a _______ appearence

Back 20

complex or solid

Front 21

_______ is an infectious collection in the liver. It does not have smoothe walls. It contains serous fluid, pus, debris, blood, and blood clots. The contents have varying echogenicities. Gas forming organisms may develop in an abcess producing a dirty shadow.

Back 21

Abscesses

Front 22

Patients with abscesses have what symptoms?

Back 22

very ill, RUQ pain, tender hepatomegaly, fever, nausea, vomiting, increased WBC, and weight loss

Front 23

What are the treatments for abscess?

Back 23

Antibiotic and or drainage

Front 24

What are the types of abcess

Back 24

parasitic abscess, and amebic abcess, pyogenic abscess

Front 25

_______ are usually solitary and occur in the right lobe of the liver. They are caused by anaerobic organisms from the gastointestinal system, which reach the liver via the bile ducts, portal veins, hepatic arteries, or lymphatic channels

Back 25

pyogenic abscesses

Front 26

Echogenic foci may be seen as a result of _______

Back 26

gas producing organisms

Front 27

_______ is a parasitic abscess caused by echinococcus parasite which is found in feses. The eggs hatch in the intestines and the embryos travel throughout the body.

Back 27

Echinococcal cyst aka hydatid cyst (may have daughter cysts)

Front 28

_______ is caused by a species of candida (fungal infection) which occurs in immunocompromised hosts such as a pts undergoing chemo, organ transplant, or HIV

Back 28

Hepatic Candidiasis

Front 29

_________ invades the bloodstream and affects any organ most commonly the kidneys brain and heart

Back 29

Candidal fungus

Front 30

Hepatic Candidiasis is characterized by multiple small hyperechoic masses with echogenic central cores and is known as the ________ pattern

Back 30

wheel within wheel pattern

Front 31

_______ is the most common parasitic infection in humans. It is caused by worms found in fresh water. Infection results when the worms puncture the skin and migrate to the portal vein or lymphatic system. It is prominent in South America, Africa, and Eygpt.

Back 31

Schistosomaiasis

Front 32

Schistosomaiasis may be assosciated with what

Back 32

portal hypertension, spleenomegaly, and varices, and acites, initially the liver size is enlarged

Front 33

________ is a recessive trait related to a congenital defect in the leukocyte. It has poorly marginated borders, is a hypoechoic mass with posterior, calcificatons may be present with posterior shadowing

Back 33

chronic granulomatous disease

Front 34

________ are small calcifications seen in the liver or spleen caused by histoplasmosis or tuberculosis infections

Back 34

Granulomas

Front 35

________ is the most common benign tumor of the liver. It is made up of blood vessels and therefore hemorrhage as it enlarges. They are mostly asymptomatic, and most common in women. It is brightly echogenic spheres 1 to 2 cm.

Back 35

hemangiomas

Front 36

________ is a benign mass of epithelial cells that line and cover the organs. It is difficult to differentiate from hemangioma or mestatic mass with ultrasound. They are oftem very large by the time they are detected. Up to 8-15cm. May become maliganant.

Back 36

Adenomas

Front 37

______ is a well circuscribed nonencapsulated solitary mass less than 5cm. May be isoechoic therefore somewhat difficult to recognize. 2nd mc liver mass. Most Common in females under 40.

Back 37

Focal Nodular Hyperplasia

Front 38

Focal nodular Hyperplasia is sonographically characterized by what?

Back 38

hypoechoic ring with hyperechoic center - a targeted appearence

Front 39

________ is a benign neoplasm of fatty (adipos) tissue made up of mature fat cells. It is nonencapsulated and is in continuity with normal liver

Back 39

Lipoma

Front 40

________ is inflammation of the liver.

Back 40

hepatits

Front 41

______ is sudden onset damage ranges from mild to massive necrosis and failure, and hepatomegaly. It is sonographically associated with a starry sky

Back 41

Acute hepatitis

Front 42

________ is inflammation for 3-6 months. It will progress to cirrhosis and is associated with fibrosis.

Back 42

Chronic hepatitis

Front 43

What are some causes of hepatitis?

Back 43

IV drug use, alchol, and viruses

Front 44

What are the clinical features of hepatitis?

Back 44

fatigue, light colored stool, N/V, fever, skin rashes, jaundice, and hepatospleenomegaly

Front 45

What are the lab values for hepatitis?

Back 45

Inc ALT
Inc AST
Inc conjugated and unconjated bilirubin
Inc ptp

Front 46

________ is chronic degenerative disease of the liver that results from alcohol or drug abuse, chronic bile retention, obesity, metabolic disorders, cardiac insufficienc, some meds and hepatitis

Back 46

cirrhosi

Front 47

Cirrhosis is a fibrotic and atrophied liver. What are the symptoms?

Back 47

nausea, weight loss, ascites, light colored shells, hypertension, and liver failure

Front 48

What is the sonographic appearence of a cirrhotic liverq

Back 48

small bright with lumpy borders, and may have regenerating nodules throughout the liver.

Front 49

What are the labs associated with Cirrhosis?

Back 49

Inc hepatic labs
Alk Phos
direct bilirubin
ast
alt

Front 50

________ is a disease of iron metabolism when excess iron deposits are throughout the body. THis leads to cirrhosis.

Back 50

Hemochromatosis

Front 51

________ is deposition of copper in the liver and kidnes that can lead to cirrhosis

Back 51

Wilsons disease

Front 52

________ is the MC form of glycogen storage disease where there are abnormally large amounts of glycogen deposited in the liver and kidneys

Back 52

Von Gierkes disease (assoc with hepatomegaly, FNH, and adenmomas)

Front 53

________ is backed up pressure in the portal system caused by a dense liver, thrombus, or tumor invasion the blood is impeded in entering the liver

Back 53

portal hypertension

Front 54

________ happens post portal hypertension so that portal blood can bypass a congested liver by recanalizatoin of the ligamentum teres and back towards the umbilicus. The teres recanalizes from its connection with the left portal vein

Back 54

Umbilical vein recanalization

Front 55

Portal vein thrombosis is associated with

Back 55

hepatitis, malignancy, trauma, spleenomegaly, chronic pancreatitis, portalcaval shunts, septicemia, pregnancy, primary leiomyosarcoma

Front 56

_______ happens as a result of portal vein thrombosis. Numerous collateral veins develop in the porta heatis.

Back 56

Cavernous transformation of the portal vein

Front 57

_______ is thrombosis of the hepatic veins. It has a poor prognosis, can last a few weeks to several years, and is characterized by abdominal pain, massive ascites, and hepatomegaly, massive swelling of the legs

Back 57

Budd chiari syndrome

Front 58

Primary budd Chiari is caused by ______

Back 58

congenital obstruction of the hepatic veins of IVC by membranous webs. Most common in Asia.

Front 59

Secondary Budd Chiari syndrome is caused by

Back 59

thrombosis in hepatic veins or IVC

Front 60

What is the HELP syndrome

Back 60

Haemolytic anaemia
Elevated liver enzymes
Low platelet count

Front 61

What are the symptoms of HELP syndrome?

Back 61

Severe abdominal pain, NV, areas of hemorrhage, subcapsular hematoma, infarction

Front 62

_______ is the 4rth most common site for an intra abdominal aneurysm. 80% of pateints experience catastrphic rupture into the peritoneum.

Back 62

Hepatic Artery Aneurysm

Front 63

What are some reasons to doppler the portal system?

Back 63

Cirrhosis, primary biliary cirrhosis, primary sclerosing cholangitis, hemochromatosis, wilsons disease, portal hypertension

Front 64

What is the noraml portal vein diameter?

Back 64

13mm or less

Front 65

What should portal vein velocity be?

Back 65

10-20cm/s

Front 66

_______ is related to cirrhosis, and is a primary liver malignancy. Is more frequent in men. It is a solitary massive tumore with multiple nodules throughout the liver. Hepatomegaly and increased AFP are seen. Very invasive to vessels.

Back 66

Hepatocellular Carcinoma

Front 67

What is the ultrasond appearence of hepatocellular carcinoma?

Back 67

Can be solitary or multiple with isoechoic with halo, hypoechoic, or hyperechoic. Liver may simply appear inhomogenic with no distinct maasses.

Front 68

AFP is present in the following diseases?

Back 68

Hepatocellular carcinoma, metastic liver disease, and fetal neural tube defect

Front 69

______ is an extreamly rare malignant tumor that is exclusively in adults with its peak incidence in sixth and seventh decades of life.

Back 69

Hepatic Hemangiosarcoma
(large mass with mixed echogenicities)

Front 70

What is the aka for Hepatic Hemangiosarcoma?

Back 70

Angiosarcoma

Front 71

______ is a rare malignant tumor of vascular origin that occurs in adults. the soft tissues are affected like lung and liver. Many patients survive 5 years with or without treatment.

Back 71

Hepatic Epithelioid Hemangioendothelioma

Front 72

______ is the most common form of malignancies seen in the liver.

Back 72

Metastatic disease (primary sites are: colon, breast, and lung)

Front 73

What is the sonographic appearence of METZ?

Back 73

Bulls eye, target or halo lesion.
can be solid, complex, hyper, hypo, or iso echoic.

Front 74

______ is a rare benign tumor that occurs in infants and children under 2. It is a well cicumscribed anechoic mass with a lacelike configuration.

Back 74

Mesenchymal Hamartoma

Front 75

______ is benign but may become malignant in the elderly. Made up of masses of vessels and similar appearance to hepatoblastoma, but dont produce elevated AFP. Risk of hemorrhage.

Back 75

Hemangioendothelioma

Front 76

Name 3 facts about:
Hemangioendothelioma

Back 76

MC in females, grows rapidly, 85% occur before 6 months of age

Front 77

_________ in the fetus and neonate occurs with certain infections like those associated with torchs and starch.

Back 77

Hepatomegaly

Front 78

______ is a malignant liver tumor that can be found in children and infants. Characterized by hepatomegaly, abdomen distention, elevated AFP, solid and echogenic, mixed and septated cysts.

Back 78

Hepatoblastoma
(most common in boys)