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
