Liver Pathology Review

What are the main sonographic characteristics of fatty liver?

Hepatomegaly, increased echogenicity, and attenuation.

What does hepatomegaly mean?

Enlargement of the liver.

Is fatty liver reversible?

Yes, fatty liver is considered reversible.

What structure is liver echogenicity commonly compared to on ultrasound?

The renal cortex.

How should normal liver echogenicity compare with the renal cortex?

The liver should be about the same echogenicity or slightly more echogenic than the renal cortex.

What happens to the ultrasound beam in fatty liver?

It undergoes increased attenuation and loses strength as it travels through the liver.

Why is focal fatty sparing important to recognize?

It can mimic a liver mass.

What is focal fatty sparing?

An area of relatively normal liver tissue surrounded by fatty infiltration.

What are the two main forms of hepatitis?

Acute hepatitis and chronic hepatitis.

What classic sonographic appearance is associated with acute hepatitis?

The starry sky appearance.

What causes the starry sky appearance in acute hepatitis?

Increased echogenicity of the portal vein walls against the liver parenchyma.

Does acute hepatitis cause hepatomegaly?

Yes, acute hepatitis can cause hepatomegaly.

Does chronic hepatitis typically cause hepatomegaly?

No, the liver generally does not increase in size with chronic hepatitis.

When is hepatitis considered chronic?

When it persists for more than 6 months.

What can chronic hepatitis progress to?

Cirrhosis and eventually liver failure.

What changes may occur in the liver with chronic hepatitis?

Coarse echotexture and fibrosis.

What feature helps distinguish chronic hepatitis from acute hepatitis?

Chronic hepatitis generally does not cause liver enlargement, while acute hepatitis can.

What are two major structural changes seen with cirrhosis?

Fibrosis and regenerative nodules.

What lifestyle factor is commonly associated with cirrhosis?

Chronic alcohol use.

What major complications can develop from cirrhosis?

Portal hypertension and liver failure.

What are the three classic clinical findings associated with cirrhosis?

Hepatomegaly, jaundice, and ascites.

What is hepatopetal flow?

Blood flow toward the liver.

What is hepatofugal flow?

Blood flow away from the liver.

What type of portal venous flow may occur with portal hypertension?

Hepatofugal flow.

What liver disease is commonly associated with portal hypertension?

Cirrhosis.

What portal vein measurement may suggest portal hypertension?

A portal vein diameter greater than approximately 13 mm.

What is the typical upper limit for normal portal vein diameter discussed in class?

Less than approximately 13 mm.

What happens to collateral vessels in portal hypertension?

They enlarge and form alternate pathways for blood flow.

What is one important collateral vessel that may become recanalized in portal hypertension?

The umbilical vein.

What are collateral vessels also called?

Varices or varicosities.

Where is a recanalized umbilical vein typically seen in relation to the liver?

Near the left lobe in the region of the falciform ligament.

What two common abdominal findings may occur with portal hypertension?

Ascites and splenomegaly.

Why can portal hypertension cause splenomegaly?

Blood backs up through the portal venous system into the spleen.

What is Budd-Chiari syndrome?

Thrombosis or obstruction of the hepatic veins and/or inferior vena cava.

What vascular structures are affected in Budd-Chiari syndrome?

The hepatic veins and sometimes the inferior vena cava.

What common abdominal finding may occur with Budd-Chiari syndrome?

Ascites.

What type of glycogen storage disease was emphasized in class?

Type I glycogen storage disease.

What is another name for type I glycogen storage disease?

Von Gierke disease.

Why is glycogen storage disease not considered exclusively a hepatocellular disease?

It affects multiple tissues and organs, not only the liver.

What accumulates in the cells in glycogen storage disease?

Glycogen.

What liver condition can glycogen storage disease resemble sonographically?

Fatty liver.

What sonographic findings may occur with glycogen storage disease?

An enlarged echogenic liver with attenuation.

What benign liver tumor is strongly associated with glycogen storage disease?

Hepatic adenoma.

What two benign liver lesions may be associated with glycogen storage disease?

Adenomas and focal nodular hyperplasia.

Which laboratory value is particularly associated with biliary obstruction?

Alkaline phosphatase.

What happens to alkaline phosphatase with biliary obstruction?

It typically becomes elevated.

What clinical sign can occur with biliary obstruction?

Jaundice.

What are common causes of biliary obstruction?

Stones, masses, and strictures.

What occupational or exposure history is classically associated with echinococcal cysts?

Sheep herding.

What characteristic finding is associated with an echinococcal cyst?

Daughter cysts.

What are daughter cysts?

Smaller cysts located inside a larger parent cyst.

How is polycystic liver disease typically inherited?

Autosomal dominant.

What percentage of patients with polycystic liver disease may also have polycystic renal disease according to class notes?

Approximately 60%.

What other organ system is commonly affected in patients with polycystic liver disease?

The kidneys.

How does an amebic abscess typically reach the liver?

Through the portal vein from the gastrointestinal tract.

Why can organisms from the gastrointestinal tract spread to the liver?

Blood from the GI tract drains through the portal vein into the liver.

What is the most common benign liver tumor?

Cavernous hemangioma.

What is a cavernous hemangioma composed of?

Large blood-filled vascular spaces.

How does a cavernous hemangioma typically appear on ultrasound?

Echogenic.

Are cavernous hemangiomas usually symptomatic?

No, they are typically asymptomatic.

In which sex are cavernous hemangiomas more common?

Women.

What is the second most common benign liver tumor?

Focal nodular hyperplasia.

What does FNH stand for?

Focal nodular hyperplasia.

How does focal nodular hyperplasia typically present in terms of number of lesions?

It is typically a solitary lesion.

Which benign liver tumor is associated with oral contraceptive use?

Hepatic adenoma.

In which sex are hepatic adenomas more common?

Women.

What two major associations should you remember for hepatic adenoma?

Oral contraceptive use and glycogen storage disease.

What does HCC stand for?

Hepatocellular carcinoma.

What is the most common primary malignant tumor of the liver?

Hepatocellular carcinoma.

In which sex is hepatocellular carcinoma more common?

Men.

What chronic liver condition is strongly associated with hepatocellular carcinoma?

Cirrhosis.

How does hepatocellular carcinoma behave in relation to nearby structures?

It can be highly invasive and invade blood vessels and surrounding structures.

How can hepatocellular carcinoma lead to Budd-Chiari syndrome?

It may invade or compress the hepatic veins or IVC and cause venous obstruction or thrombosis.

What vascular structures may be invaded by hepatocellular carcinoma?

The hepatic veins and inferior vena cava.

What complications can occur with hepatocellular carcinoma?

Ascites, portal hypertension, vascular invasion, and Budd-Chiari syndrome.

What general symptoms may occur with hepatocellular carcinoma?

Nausea, vomiting, fatigue, weight loss, and sometimes pain.

What is the most common form of malignant neoplasia found in the liver overall?

Metastatic disease.

What is the difference between HCC and metastatic liver disease in terms of frequency?

HCC is the most common primary liver cancer, while metastatic disease is the most common liver malignancy overall.

What primary cancers commonly metastasize to the liver?

Colon, breast, and lung cancers.

How do liver metastases typically present in terms of number of masses?

They usually present as multiple masses.

Which liver lobe is commonly affected by metastases?

The right lobe.

What is the key distinction between hepatocellular carcinoma and metastatic liver disease?

HCC originates in the liver, while metastatic disease spreads to the liver from another primary cancer.

What is the primary function of the gallbladder?

To store bile.

What is the function of the extrahepatic biliary tract?

To transport and regulate the flow of bile from the liver toward the intestines.

What do the right and left hepatic ducts join to form?

The common hepatic duct.

What structure joins the common hepatic duct to form the common bile duct?

The cystic duct.

What is the approximate diameter of the common hepatic duct according to the class notes?

Approximately 4 mm.

What is the approximate upper limit of normal for the common bile duct according to the class notes?

Approximately 6 mm.

What may happen to the common bile duct after the gallbladder is removed?

It may become dilated.

What is the surgical removal of the gallbladder called?

Cholecystectomy.

What combination of findings should make you think of fatty liver?

Hepatomegaly, increased echogenicity, and attenuation.

What finding is especially useful for identifying acute hepatitis?

The starry sky appearance.

What feature helps distinguish chronic hepatitis from acute hepatitis?

Chronic hepatitis typically does not cause liver enlargement.

What Doppler finding strongly suggests portal hypertension?

Hepatofugal portal venous flow.

What definition should immediately make you think of Budd-Chiari syndrome?

Thrombus or obstruction in the hepatic veins or IVC.

What two clues strongly suggest an echinococcal cyst?

Sheep-herding exposure and daughter cysts.

What two associations strongly suggest a hepatic adenoma?

Oral contraceptive use and glycogen storage disease.

What features should make you think of a cavernous hemangioma?

It is the most common benign liver tumor and is typically echogenic and composed of blood-filled spaces.

What features should make you think of metastatic liver disease?

Multiple liver masses with a history of a primary cancer such as colon, breast, or lung cancer.

What features should make you think of hepatocellular carcinoma?

A primary invasive liver tumor associated with cirrhosis that may invade vessels and cause ascites or portal hypertension.