Abnormal Liver

hepatocellular carcinoma

-90% liver cancer -RUQ pain, abdominal mass, elevation AFP, cirrhosis, weight loss, unexplained fever, hepatomegaly -solitary tumor, multiple nodules, diffuse infiltration -small lesions appear hypoechoic, large lesions appear heterogenous -hypervascular -washout with contrast

polycystic liver disease

-autosomal dominant -25-50% with polycystic renal will have liver cysts, 60% with polycystic liver will have renal cysts -4:1 F:M

liver adenoma

-benign epithelial tumor -contains hepatocytes (no kupffer cells or ducts) -associated with oral contraceptives -marginated and partially/completely encapsulated -areas of necrosis or hemorrhage -6-30 cm -well-defined hyperechoic mass with central hypoechoic areas, variable appearances -peripheral color flow -hypervascular arterial phase, centripetal filling portal venous phase

candidiasis/fungal abscess

-candida albicans -common in hospitalized patients, diabetics and immunocompromised patients -persistent fever, chills, hypotension, low neutrophils -multiple, wheel within a wheel (outer hypoechoic rim [fibrosis], inner hyperechoic ring [inflammation], central hypoechoic focus [necrosis])

acute hepatitis

-decreased echogenicity (water in tissue from inflammation) -increased brightness of portal triads and portal vein borders -thickened GB wall -starry-sky pattern (hypoechoic liver with increased brightness of portal walls) -hepatomegaly

echinococcus/parasitic abscess hydatid disease

-echinococcus granulosus -inner germinal epithelial layer (daughter cyst) and outer inflammatory layer -extrinsic compression: thrombosis, infarction, portal HTN - RUQ pain, fever, jaundice, hepatomegaly -simple cysts, multilocular cystic mass, honeycomb/cartwheel, cyst within complex mass

glycogen storage disease

-excessive accumulation of glycogen in the hepatocytes and PCT of kidneys -hepatomegaly/renomegaly, increased echogenicity, increased attenuation, adenomas

hemochromatosis

-excessive iron deposition -can lead to cirrhosis and portal HTN -primary (autosomal recessive from abnormal HFE gene) or secondary (blood transfusion, hemolytic anemia) -hyperpigmented/bronze skin, hepatomegaly, diabetes, heart failure or arrhythmia, arthralgia, diffuse increased echogenicity

cirrhosis

-fibrosis and conversion of liver tissue into abnormal nodules and scar tissue -caused by alcohol, viral infections, hemochromatosis, Wilson's disease, GSD, CF -hepatomegaly, jaundice, ascites, fatigue, vomiting, spiderlike blood vessels, weight loss, abnormal LFTs, portal HTN -diffuse coarse, heteromogeneous texture, increased echogenicity and attenuation, increased size (early) or shrunken (late)

pyogenic/bacterial abscess

-filled with thick purulent material and lined by fibrous tissue -males>females, high mortality -escherichia coli (adults) or staphylococcus (children) -fever, chills, RUQ pain, nausea, diarrhea, anemia, leukocytosis

fatty infiltration

-increased lipid accumulation in the hepatocytes -results from major injury or a systematic disorder leading to impaired or excessive metabolism of fat

amebiasis/parasitic abscess

-infection of the colon/cecum -enteamoeba histolytica -collection of pus causing destrcution to parenchyma -RUQ pain, diarrhea, melena, leukocytosis, fever -oval/round, hypoechoic with internal echoes

hepatitis

-inflammation of the liver -fever, abd pain, jaundice, loss appetite, dark stool, elevated LFTs -Hep A: oral-fecal, food prep, can be cured -Hep B: blood contact, transfusions, needles, sexual contact -Hep C: blood contact, develop cirrhosis

lipoma

-mesenchymal elements -nonencapsulated -wellcircumscribed echogenic mass with variable posterior shadowing

chronic hepatitis

-more than 3-6 months -fatigue, jaundice, acute hep symptoms -increased echogenicity (spread of fibrosis) -decreased echogenicity of walls of portal vein radicles

cavernous liver hemangioma

-most common benign liver tumor -vascular endothelial lined space filled with blood -most common posterior right lobe, peripheral -hormonal dependent -well-defined oval lesion <3 cm diameter -can be complex with hypoechoic areas of necrosis, hemorrhaging, fibrosis -slow venous flow

pneumocystis carnii/parasitic abscess

-most common in AIDS patients, life-threatening -immunocompromised patients -multiple, tiny, nonshadowing echogenic foci disperesed throughout liver

liver metastases

-most common site metastatic disease -primary sites: GB, GI tract, breasts, lungs, neuroblastoma, Wilm's tumor, leukemia -invasion of liver through portal veins, HA, lymphatics, GB and stomach -hepatomegaly, localized pain/tenderness, abnormal LFTs, ascites, low-grade fever, jaundice, weight loss -most commonly hypoechoic, halo around mass

micronodular cirrhosis

-nodules are within 0.1-1 cm in diameter -most common cause is alcohol

Budd-Chiari syndrome

-partial or complete obtruction of hepatic venous outflow

The most common locations of focal fatty sparing include:

-periportal region of the quadrate lobe -GB fossa -along liver margins -posterior portion of the left lobe -anterior to the GB or portal vein

focal nodular hyperplasia

-rare benign tumor -increased incidence with contraceptives -lateral aspect of liver, right lobe -solitary, nonencapsulated, well-circumscribed mass -contains hepatocytes, kupffer cells, bile ducts, fibrous connective tissue -0.5-20 cm, usually < 8 cm -central stellate scar, fibrous septa radiate laterally -homogenous and isoechoic to liver -high arterial flow, will take Tc99 radionuclide

macronodular cirrhosis

-various nodules, up to 5 cm in diameter -mostly seen with chronic viral hepatitis

liver hematomas

-walled-off blood collections -3rd most injured organ (after spleen and kidney) -echogenic <24 hours -hypoechoic and anechoic, blood clots start to liquefy

schistosomiasis/parasitic abscess

-worm schistosoma -marked increase thickness portal vein walls, portal HTN

Enlargement of the caudate lobe is most commonly associated with which of the following pathologies? a. cirrhosis b. candidiasis c. fatty infiltration d. liver meastasis e. polycystic disease

a. cirrhosis

Severe insult to the liver cells leading to subsequent necrosis describes: a. cirrhosis b. portal hypertension c. fatty infiltration d. Budd-Chiari syndrome e. focal nodular hyperplasia

a. cirrhosis

Clinical findings of fatty infiltration of the liver include: a. elevated liver function tests b. fever c. fatigue d. weight loss

a. elevated liver function tests

Which hepatic mass is closely associated with oral contraceptive use? a. hepatic adenoma b. hepatic hypernephroma c. hepatic hamartoma d. hepatic hemangioma

a. hepatic adenoma

In the fatty infiltrated liver, there is a minimal diffuse increase in echogenicity and the diaphragm and blood vessel walls are visualized normally. What degree of fatty infiltration is present? a. mild b. moderate c. severe

a. mild

All of the following are clinical findings of hepatocellular carcinoma except: a. reduction in a-fetoprotein b. unexplained weight loss c. fever d. cirrhosis

a. reduction in a-fetoprotein

A patient presents with a history of RUQ pain, fever, and leukocytosis. Upon further questioning, the patient admits to recently traveling abroad. A complex mass is identified in the right lobe of the liver. This most likely represents: a. hepatoma b. abscess c. adenoma d. cystadenoma e. echinococcal cyst

b. abscess

Which of the following liver pathologies is associated with immune-suppressed patients? a. adenoma b. candidiasis c. cavernous hemangioma d. polycystic disease e. echinococcal cyst

b. candidiasis

All of the following are sequela of cirrhosis except: a. portal vein thrombosis b. hepatic artery enlargement c. portal hypertension d. splenomegaly

b. hepatic artery enlargement

Prominence of the portal veins is most commonly associated with: a. cirrhosis b. hepatitis c. polycystic disease d. fatty infiltration e. glycogen storage disease

b. hepatitis

The liver appears to have a moderate diffuse increase in echogenicity and the visualization of the diaphragm and blood vessel walls is decreased. What degree of fatty infiltration is present? a. mild b. moderate c. severe

b. moderate

A cavernous hemangioma most commonly appears on ultrasound as a(n): a. irregular complex mass b. smooth hyperechoic mass c. large complex mass d. smooth hypoechoic mass e. irregular hypoechoic mass

b. smooth hyperechoic mass

An abnormally enlarged or dilated vein is most commonly termed a(n): a. shunt b. varix c. stent d. aneurysm e. perforator

b. varix

The adult liver is considered enlarged once the anteroposterior diameter exceeds: a. 10 cm b. 12 cm c. 15 cm d. 20 cm e. 22 cm

c. 15 cm

Glycogen storage disease is also known as: a. Liver disease b. Budd Chiari syndrome c. Von Gierke's disease d. Cavernous hemangioma

c. Von Gierke's disease

Patients with a history of hep B have a predisposing risk factor for developing: a. an adenoma b. an abscess c. a hepatoma d. focal nodular hyperplasia e. a cavernous hemangioma

c. a hepatoma

Hepatomegaly is commonly associated with all of the following except: a. hepatitis b. fatty infiltration c. acute pancreatitis d. congestive heart failure e. polycystic liver disease

c. acute pancreatitis

In the US, a hepatic abscess is most likely to develop in which of the following conditions? a. acute pancreatitis b. biliary obstruction c. ascending cholangitis d. portal vein thrombosis e. Budd-Chiari syndrome

c. ascending cholangitis

Metastatic lesions involving the liver most commonly originate from a primary malignancy of the: a. pancreas b. kidney c. colon d. stomach e. gallbladder

c. colon

Budd-Chiari syndrome leads to a reduction in the size of the: a. hepatic arteries b. portal veins c. hepatic veins d. common bile duct

c. hepatic veins

Which of the following is the most common form of liver cancer? a. hepatoceulluar carcinoma b. adenocarcinoma c. metastatic liver disease d. hepatoblastoma

c. metastatic liver disease

There is a marked increase in the echogenicity of the liver and poor visualization of the posterior segment of the right lobe and diaphragm. What degree of fatty infiltration is present? a. mild b. moderate c. severe

c. severe

A true cyst exhibits all of the following except: a. anechoic b. posterior acoustic enhancement c. well defined walls d. blood flow

d. blood flow

Immunocompromised pateints are more prone to develop what form of hepatic abnormality? a. hepatic adenoma b. amebic abscess c. hydatid liver abscess d. candidiasis

d. candidiasis

Sonographically, when the liver is difficult to penetrate and diffusely echogenic, this is indicative of: a. portal vein thrombosis b. metastatic liver disease c. primary liver carcinoma d. fatty liver disease

d. fatty liver disease

Sonographic findings commonly associated with portal hypertension include all of the following except: a. hepatomegaly b. splenomegaly c. dilated MPV d. hypoechoic liver parenchyma e. formation of venous collaterals

d. hypoechoic liver parenchyma

Clinical findings of hepatitis include all of the following except: a. jaundice b. fever c. chills d. pericholecystic fluid

d. pericholecystic fluid

The most common symptom associated with acute thrombosis of the portal veins is: a. jaundice b. tachycardia c. weight loss d. severe abdominal pain e. lower-extremity edema

d. severe abdominal pain

Organs most commonly associated with the development of polycystic disease include all of the following except: a. liver b. kidney c. spleen d. pancreas e. adrenal gland

e. adrenal gland

Daughter cysts are associated with which of the following pathologies? a. adenoma b. hepatoma c. fungal abscess d. cystadenoma e. echinococcal cyst

e. echinococcal cyst

All of the following symptoms are associated with hepatocellular carcinoma except: a. weight loss b. hepatomegaly c. abdominal pain d. unexplained fever e. elevated serum albumin

e. elevated serum albumin

Von Gierke disease is most commonly associated with: a. cirrhosis b. polycystic disease c. schistosomiasis d. focal nodular hyperplasia e. glycogen storage disease

e. glycogen storage disease