Examination Review for Ultrasound : Chapter 2 The Liver

What are the Sonographic findings of a cavernous hemangioma

small, hyperechoic mass

What are the Sonographic findings of hepatocellular carcinoma

solitary small hypoechoic mass heterogeneous masses scattered throughout the liver mass with a hypoechoic halo

What is the "Starry sky sign"

sonographic sign associated with appearance of periportal cuffing in whivh there is increased echogenicity of walls of portal triads

What is Glission capsule

thin fibrous casing of the liver

What is Riedel lobe

tongue like extension of the right hepatic lobe

What is a Lipoma

fatty benign tumor

What are the Clinical findings of a pyogenic hepatic abscess?

fever hepatomegaly leukocytosis possible abn LFT RUQ pain

What is cirrhosis?

hepatocyte death, fibrosis, and necrosis of the liver, and subsequent development of regenerating nodules

What is the Sonographic finding of a hepatic lipoma

hyperechoic mass

What is dysentery?

infection of the bowel which leads to diarrhea that may contain mucus and or blood

What is hepatitis?

inflammation of liver

What is cholangitis?

inflammation of the bile ducts

What is a hematoma?

localized collection of blood

What are the Sonographic findings of hepatic metastasis

1. GI tract and pancreas tend to be calcified tumors 2. hypoechoic masses may be from the breast, lung or lymphoma 3. hyperechoic masses may be from the kidney and pancreas 4. "target" or "bulls-eye" lesion may be from the lung or colon

What are the Sonographic findings of an Amebic hepatic abscess?

1. Round, hypoechoic or anechoic mass or masses 2. May contain debris 3. Acoustic enhancement

What are the Sonographic findings of hydatid liver cyst?

1. anechoic mass containing some debris (hydatid sand) 2. "water lilly" sign - wall of the endocyst seen floating within the pericyst 3. "mother" cyst containing one or more smaller "daughter" cyst 4. mass may comtain some elements of dense calcification

What are the Sonographic findings of hepatic cysts?

1. anechoic mass or masses with smooth wall and posterior enhancement 2. may have irregular shapes 3. clusters of cysts may be noted

What are the Clinical findings of a hepatocellular adenoma

1. asymptomatic 2. oral contraceptive use

What are the Sonographic findings of a hepatic hematoma

1. fresh clot is more echogenic than the surrounding liver 2. may appear cystic or complex

What are the Clinical findings of an amebic hepatic abscess

1. hepatomegaly 2. RUQ or general abdominal pain 3. general malaise 4. diarrhea (possible bloody) 5. fever 6. leukocytosis 7. elevated Liver function tests 8. mild anemia

What are the Clinical findings of hepatic Candidiasis

1. immunocompromised patients including cancer pts, recent organ transplants, patients with HIV 2. RUQ pain 3. Fever 4. Hepatomegaly

What are the Sonographic findings of focal nodular hyperplasia

1. isoechoic, hyperechoic or hypoechoic mass 2. central scar will appear as an hyperechoic or hypoechoic linear structure within the mass and will reveal hypervascularity with color doppler

What are the Clinical findings of a hydatid liver cyst?

1. leukocytosis 2. low-grade fever 3. nausea 4. obstructive jaundice 5. RUQ tenderness

What are the Clinical findings of a hepatic hematoma

1. trauma 2. recent surgery 3. decreased hematocrit

What are the Clinical findings of hepatic metastasis

1. weight loss 2. jaundice 3. RUQ pain 4. hepatomegaly 5. ascites

What are the Clinical findings of portal vein thrombosis

Abdominal pain Elevated liver function tests Hypovolemia Leukocytosis Low-grade fever Nausea Vomiting

What is mass effect?

Ability of a tumor or some foreign entity to disort normal anatomy

What is Amebic (liver) abscess

Abscess that develops from a parasite that grows in the colon and invades the liver via portal vein

What is the Liver hilim

Area of liver where CBD exits the liver and portal vein and hepatic artery enter liver; AKA porta hepatis

What are the clinical findings of portal hypertension?

Ascites Diarrhea Fatigue Hepatomegaly Jaundice Weight loss

What are the Clinical findings of Budd Chiari syndrome?

Ascites Elevated liver function test Hepatomegaly Splenomegaly Upper abdominal pain

What are the clinical findings of cirrhosis?

Ascites Diarrhea Elevated liver function tests Fatigue Hepatomegaly Jaundice Splenomegaly Weight loss

What is the Clinical finding of a hepatic lipoma

Asymptomatic

What are seven clinical findings of fatty liver disease?

Asymptomatic Alcohol abuse Chemotherapy Diabetes mellitus Elevated liver function test Obesity Pregnancy

What are the Clinical findings of hepatic cysts

Asymptomatic Normal liver function tests Polycystic kidney disease

What is nodular hyperplasia?

Benign liver mass composed of a combination of hepatocytes and fibrous tissues that tyically contains central scar

What is Hepatocellular adenoma

Benign liver mass often associated with use of oral contraceptives

What is hepatofugal flow?

Blood flow away from liver

What is Hepatopetal

Blood flow towards liver

What are the 7 vital functions of the liver

Carbohydrate metabolism Lipid metabolism Aminoacid metabolism Removal of waste products Vitamin and mineral storage Drug inactivation Synthesis and secretion of bile

What are the clinical findings of hepatitis?

Chillis Dark urine Elevated liver function tests Fatigue Fever Hepatosplenomegaly Jaundice Nausea Vomiting

What are the Sonographic findings of a pyogenic hepatic abscess?

Complex cyst with thick walls Mass may contain debris, septations, and/or gas Air within the abscess may produce dirty shadowing or ring-down artifact

What is portal vein thrombosis

Development of clot within the portal vein

What are three sonographic findings of defuse fatty liver?

Diffusely echogenic liver Increased attenuation of the sound beam Walls of the hepatic vasculature in diaphragm will not be easily imaged

What is leukocytosis?

Elevated WBC count

What is Portal hypertension

Elevation of blood pressure within the portal venous system

What is hepatomegaly?

Enlargement of liver

What is Ascites

Fluid in the peritoneal cavity

What is Hemopoisis

Formation and development of blood cells

What is recanalization?

Formation of new canals or pathways

The covering of the liver is referred to as:

Glisson capsule

What is Beckwith-Wiedemann syndrome?

Growth disorder syndrome with enlargement of several organ : skull, tongue, liver

What is Hepatic candidiasis

Hepatic mass that results from the spread of fungus in blood to liver

What does the elevation of Lactate dehydrogenase (LDH) In the liver signify?

Hepatitis Cirrhosis Obstructive jaundice

What does the elevation of alanine aminotransferase (ALT) In the liver signify?

Hepatitis Hepatocellular disease Obstructive jaundice

What are the sonographic findings of cirrhosis?

Hepatomegaly Shrunken right lobe of the liver And lodged caudate and left lobe Nodular surface irregularity Coarse echotexture Splenomegaly Ascites Monophasic flow within the hepatic veins Hepatofugal flow Within the portal vein's

What are the sonographic findings of focal fatty infiltration?

Hyperechoic area adjacent to the gallbladder, near the Porta hepatis, or the entire medial segment of the left lobe may appear echogenic

What are the sonographic findings of focal fatty sparing?

Hypoechoic area adjacent to the gallbladder, near the Porta hepatis, or the entire medial segment of the left lobe may be spared Can appear much like pericholecystic fluid when seen adjacent to the gallbladder

What are the Sonographic findings of a hepatocellular adenoma

Hypoechoic, hyperechoic, isoechoic, or mixed echogenicities

What is a Sequela

Ilness resulting from another disease or trauma, injury

What is cavernous hemangioma

most common benign liver tumor

What are the Sonographic findings of hepatic Candidiasis

multiple hyperechoic masses with hypoechoic halos Halo or bull's-eye lesions

What is periportal cuffing?

Increase in echogenicity of portal triads as seen in hepatitis

What is Hemochomatosis

Inherited disease characterized by disproportionate absorption of dietary iron

What is Autosomal dominant polycystic kidney disease

Inherited disease that results in the development of renal, liver, and pan cysts later in life.

The Main portal vein divides into

Left and right branches

What is a Pyogenic hepatic abscess

Liver abscess that can result from spread of infection from inflammatory conditions such as appendicities, diverticulitis, cholecystitis, cholangitis, and endocarditis

What are Hydatid Liver Cysts?

Liver cysts develop as tapeworm that live in dog feces; also known as echinococcal cyst

What is a hepatoma?

Malignant tumor associated with hepatocellular carcinoma

Ligamentum Teres can be used to separate the

Medial and lateral segments of the left lobe

What is the Quadrate lobe

Medial segment of left lobe

The Main lobar fissure contains the

Middle hepatic vein

The left lobe of the liver can be separated from the right lobe by:

Middle hepatic vein

What are the Sonographic findings of budd chiari syndrome?

Non-visualization or reduced visualization of the hepatic veins Thrombus within the hepatic veins Enlarged caudate lobe Lack of flow within the hepatic veins with color Doppler Narrowing of the IVC

What are the sonographic findings of hepatitis?

Normal liver Enlarged, hypoechoic liver Periportal cuffing with "starry sky" Gallbladder wall thickening

What is Budd-Chiari syndrome?

Occlusion of hepatic veins- possible co-existing occlusion of the IVC

What is echinococcus granulosus?

Parasite responsible for the development of hydatid liver cysts

What are the Clinical findings of hepatoblastoma?

Pediatric patient Palpable abdominal mass Hepatomegaly Abdominal pain Weight loss Anorexia Elevated serum a-fetoprotein Jaundice

What is the portal triad?

Portal vein, bile duct, and hepatic artery surround each liver lobule

What is hepatocellular carcinoma

Primary form of liver cancer

How is Prothrombin Time (PT) Interpreted when it comes to liver disease?

Prolonged PT: Metastasis to the liver Shortened PT: Extrahepatic duct obstruction

What is the bare area of the liver?

Region of liver not covered by peritoneum

What is fatty liver?

Reversible disease charachterized by deposits of fat within the hepatocystes

The right intersegmental fissure contains the

Right hepatic vein

What vein separates the anterior segment of the right lobe from the posterior segment of the right lobe?

Right hepatic vein

The right lobe of the liver is divided into segments by the:

Right hepatic veins

What are the sonographic findings of hepatoblastoma?

Solid, hyperechoic, or heterogenous mass Mass may contain some calcifications

What are Kuppfer cells and where are they found?

Specialized macrophages within the liver that engulf pathogens and damaged cells

What are the sonographic findings of portal hypertension?

Splenomegaly, dilated portal veins in which the MPV is greater than 13mm,Ascites, monophasic flow within the hepatic veins, enlargement of the superior mesenteric vein, enlargement and reversal of flow within the coronary vein

What is Gastroesophogeal junction

The junction between the stomach and the esophasgus

What is Transjugular intraheptic portosystemic shunt (TIPS)

Therapy for portal hypertension that involves placement of a stent between the portal veins and hepatic veins to reduce portal systemic pressure

What is Serpiginous

Twisted snakelike pattern

What does the elevation of serum bilirubin in the liver signify?

Unconjugated (indirect ) Bilirubin: acute hepatocellular disease Conjugated (direct ) Bilirubin: biliary tract obstruction Total Bilirubin: cirrhosis other chronic liver cell disease

What are the Clinical findings of a cavernous hemangioma

asymptomatic

What are the Clinical findings of focal nodular hyperplasia

asymptomatic

What does the elevation of Aspartate aminotransferase (AST) In the liver signify?

cirrhosis of the liver Fatty liver Hepatitis Metastatic liver disease

What does the elevation of Alkaline phosphatase(ALP) In the liver signify?

cirrhosis of the liver Hepatitis Extrahepatic biliary obstruction Gallstones Metastatic liver disease Pancreatic Carcinoma

What is hypovolemia?

decreased blood volume

What are the Sonographic findings of portal vein thrombosis?

echogenic thrombus within Portal vein cavernous transformation of the portal vein will appear like wormlike vessels within the region of Portal vein

What are the Clinical findings of hepatocellular carcinoma

elevated alpha-fetoprotein abnormal Liver function tests cirrhosis chronic hepatitis unexplained weight loss hepatomegaly fever palpable mass ascites