Abdomen Chapter 9 Part 2

it result from infection by a group of viruses that target hepatocytes....may be fatal, patients may initially have flulike and gastrointestinal symptoms

viral hepatitis

a benign reversible disorder that occurs when fat is deposited on liver......implies increased lipid accumulation in the hepatocytes......result in impaired or excessive metabolism of fat.

fatty infiltration

focal regions of increased echogenicity within the normal liver parenchyma.....occurs at porta hepatic

focal fatty infiltration

focal regions of normal liver parenchyma within a fatty infiltrated liver....commonly occurs at anterior to porta hepatis, near GB, adjacent to left PV, adjacent to fissures, and subcapsular

focal fatty sparing

complications of biliary tract disease, surgery or trauma....solitary or multiple lesions.....look for fluid collection in morisons pouch subhepatic or sudiaphragmatic spaces

hepatic abscesses

it is the tumor of glandular epithelium in which the cells of the tumor are arranged in a recognizable glandular structure. associated with the use contraceptive agents, glycogen storage disease, may develop in men being treated for prostate cancer by estrogen hormones.

hepatic adenoma

caused by candida albicans. occurs in pateints with low immune systems. non specific symptoms like fever and pain. need to do a FNA to confirm diagnosis.

hepatic candidiasis

liver inflammation resulting from infectious agants like viral, bacterial, fungal, and non infectious agents like, medication, toxins, and auto immune disorders. it is spread by contact with fecal matter blood body fluids or ingestion of contaminated foods

hepatitis

sonographic appearance of fatty infiltration are?

increased echogenicity and attenuation, hepatomegaly, may be patchy, inhomogeneous focal sparing,

three basic types of abscess formation occur in the liver

intrahepatic, subhepatic, subphrenic

fluid may be present, metastases, hemangioma, 8-15 cm in size by the time they are detected, solitary or multiple, hyperechoic with central echogenic area caused by hemorrhage

liver adenoma

may be single or multiple.....may be congenital or acquired...... their walls are usually smooth and the fluid they contain is typically clear....generally asymptomatic..

liver cyst

minimal diffuse increase in hepatic echogenicity with normal visualization of the diaphragm and intrahepatic vascular borders

mild fatty infiltration

found in feces of farm animals caused by echinococcus granulosus. may be single, multiple, or complex. some exhibit calcifies walls. mother daughter cyst possible. found in the liver and throughout the body

Echinococcal cyst

simple cyst with parallel line inside the wall. cyst with multiple daughter cysts include honey comb appearance the water lily sign. calcifications within the parent cyst

Echinococcal cyst

well circumscribed, less than 5 cm in size, central fibrous scar, non encapsulated

FNH- focal nodular hyperplasia

second most common benign liver mass after hemangioma. the lesions occurs more in the right lobe of the liver. more common in women than man. FNH is typically an incidentally detected liver mass in an asymptomatic patient

Focal Nodular Hyperplasia

Echinococcal Cyst is also known as

Hydatid cysts

increased echogenicity with slightly impaired visualization of the diaphragm and intrahepatic vascular borders

moderate fatty infiltration

range in size from 0.2 to 2.5 cm..... more commonly found in patients with severe liver disease..... located centrally within the porta hepatis at the junction of the right and left hepatic ducts

peribiliary cysts

pattern ranges from diffuse tiny nonshadowing echogenic foci to extensive replacement or the liver parenchyma by various echogenic clumps of calcification

pneumocystic carinii

is a common life threatening infection in patients with human immunodeficiency virus

pneumocystis carinii

is the most common organism causing opportunistic infection in parents with acquired immunodeficiency syndrome. affects patients with human immunodeficiency virus.

pneumocystis carinii

it is autosomal dominant.... congenital... probably see multiple cysts..... the cyst are small, less than 2 to 3 cm, and multiple throughout the liver parenchyma, cysts within the porta hepatis may enlarge and cause biliary obstruction

polycystic disease of the liver

most commonly occurs in the right lobe of the liver. clinical features ruq pain, leukocytosis, fever, chills, labe values increased wbc count, abnormal lft, anemia, increased alp

pyogenic abscess

significant increase in echogenicity of the liver parenchyma, decreased penetration of the posterior segment of the right lobe of the liver, and decreased to poor visualization of the diaphragm and hepatic vessels

severe fatty infiltration

most common type of glycogen storage disease.... usually occurs in infancy or childhood....

VonGierke disease

diffuse inflammatory process of the liver. most common type HAV,HBV,HCV.......clinical features: malaise, nausea, fever, RUQ pain......the liver texture appears normal or there may be echogenic borders in portal veins known as the starry sky sign

acute hepatitis

what are the causes of fatty liver?

alcohol abuse, obesity, pregnancy, severe hepatitis, starvation, glycogen storage disease, corticosteroid therapy, diabetes mellitus, massive tetracycline therapy, and total parenteral hyper alimentation.

occurs when a parasite from the intestine reaches the liver via postal veins. spreads from colon to lungs liver and brain. it reaches the liver parenchyma via the portal vein. patients may be asymptomatic or may present with abdominal pain, diarrhea, leukocytosis and low fever. it is contracted by ingestion of food or water contaminated by the cyst stage of the parasite.

amebic abscess

the abscess is round or oval and lack notable wall echoes. hypoechoic as compared with normal liver parenchyma. some internal echoes on posterior margin. distal enhancement may be seen beyond the mass lesion.

amebic abscess

growth occurs locally but does not spread or invade surrounding structures. it may push surrounding structures aside or adhere to them.

benign tumors

hyperechoic with posterior enhancement... may enlarge with pregnancy...becomes heterogeneous as they undergo degeneration

cavernous hemangioma

most common tumor of the liver...found more in females... most common location right posterior lobe.. single or multiple...majority stable lesions...enlarges slowly and undergo degeneration, fibrosis and calcification

cavernous hemangioma

benign solid lesions include

cavernous hemangioma, adenoma, focal nodular hyperplasia

what are the two types of chronic hepatitis

chronic active and persistent hepatitis

this type there are more extensive changes. may lead to fibrosis

chronic active hepatitis

clinical features nausea, vomiting, anorexia, weight loss jaundice, enlarged liver, increased ast, alt, bilirubin, and alp, sonographic appearance hyperechoic liver parenchyma, small liver, fibrosis may be evident

chronic hepatitis

there is evidence of hepatic inflammation for at least 3 to 6 months.....causes viral metabolic autoimmune or drug induced

chronic hepatitis

is a benign self limiting process

chronic persistent hepatitis

a diffuse process of fibrosis and distortion of the normal liver architecture......it is a chronic degenerative disease, causes include alcohol or drug abuse, chronic bile retention, metabolic disorders, cardiac insufficiency,

cirrhosis

solitary and rare..... usually arises from development defects in the formation of the bile ducts...... may vary in size from tiny to as large as 20 cm..... more often found in right lobe liver than in the left lobe

congenital hepatic cyst