Abnormal liver

What is Diffuse Hepatocellular disease?

Affects all liver cells(Mainly hepatocytes)

How does liver echo texture look with Hepatocellular disease?

Does not really change the echotexture or shape

What are the types Hepatocellular Disease?

Fatty Liver Infiltration

Hepaitis

Cirrhosis

What is Fatty liver Infiltration?

liver injury

What is Fatty liver Infiltration also know as?

hepatic steatosis

What can Fatty liver Infiltration lead to?

fibrosis and cirrhosis

What is the fatty liver an accumulation of?

Fats/lipid within the liver cells

Is Fatty liver Infiltration usually aquired and reversable?

yes

reversable when abnormal conditions is corrected

what parts of the body is affected by fatty liver Infiltration?

may affect the whole lover or parts of the liver

Cause of fatty liver Infiltration?

-Can be idiopathic(no known cause)

-Excessive alcohol intake(stimulates lipolysis)

-Non alcohol fatty liver disease(Diabetes,Obesity,Dyslipidemia)

-Chemical made drugs(corticosteroid)

-Chemotherapeutic agents(Methotrexate,chemotherapy,amiodarone

-Cystic Fibrosis

-Ulcerative Celitis

-Hyperlipidemia

-Hyperalimentation

-Sever hepatitis

-protein Malnutrition

-High Cholesterol

-pregancy Fatty liver

-Glucogen storage disese

-jejunoileal bypass for obesity

-Chrones disease

-Melnutrition and starvation

What are the laboratory finding of fatty liver Infiltration?

abnormal elevation of( Liver function tests)(Serum Glutamic exalocetic transaminase)(Serum Glutamic pyruvic transaminase)(Bilirubin)

patients may present with RUQ,abdominal pain,nausea,vomiting,jaundice

What is the sonographic appearance of fatty liver Infiltration?

Can be (mild,moderate,severe)

Can increase the beams attenuation(not able to penetrate)

Can see liver enlargement

IT JUST MEANS THE LIVER IS MORE ECHOGENIC DUE To THE FAT

What are the categories of Steatosis?

Mild- normal visualization of diaphragm and blood vessels

Moderate-decreased visualization of diaphragm and blood vessels

Severe-Poor visualization of the posterior segment of rt lobe and diaphram

What can Focal fatty infiltration be confused as?

with malignancy and mimic Focal mass

What is the fatty liver most common at?

At the Anterior aspect of medical part of LLL and adjacent to falciform liver

What does Fatty Foccal sparing most commonly involves?

the periportal region of quadrate lobe,GB fossa

appears as hypoechoic

Describe this image?

Fatty infiltrations

we see increased echogenicity in the Anterior segement

poor beam penetration

Describe this image

Fatty liver infiltration

what is this image

Fatty liver Infiltration (We see the increased echogenicity)

Describe this image

The is fatty infiltration (we see the hyperechoic region)

The echogenicty is near the hepatic vessels

Describe this image?

There is an increased echogenicity and vasculature

What is this image?

This is fatty focal sparing

Describe this image?

There is an increased hyperechoic mass in the liver at the Anterior aspect and the posterior aspect

It looks completely different than the liver

Describe this image?

it involves the periportal region of the quadrate lobe and the GB fossa

We see a hypoechoic area

What is Glycogen storage disease known as?

Gierke disease

Clycogenosis

what organs does Glycogen storage disease affect?

kidneys

liver

What is Glycogen storage disease?

an excessive accumulation of glycogen in the hepatocytes and proximal kidney

what is Glycogen storage disease due to?

Due to the impairment of glucose 6 phosphatase preventing glycogenolysis and release of glucose

Is Glycogen storage disease (type 1 ) an automal disease?

yes it is a genetic disorder

What is Glycogen storage disease associated with?

adenomas

less commonly with Hepatocellular carcinoma

Sonographically explain Glycogen storage disease?

hepatomegally and renomegally seen

Increased echogenicity

Increased attenuation

adenomas seen

mimic fatty infiltration

Describe this image?

There is increased echogenicity in the liver(image2)

Enlarged liver and posterior attenuation(image 2)

We see increased attenuation(image 1

May mimic fatty infiltration(image 1

What do we see with Hemocharomatosis?

iron deposit in various organs and organ disfunction

Is Hemochromatosis rare and where does it occur?

It is a rare thing

affects the liver

What can Hemochromatosis lead to?

Cirrhosis

Portal Hypertension

What can Hemochromatosis caused by?

-Blood Transfusion

-Hemolytic anemia

-Myelodysplasia

What are the clinical presentation of Hemochromatosis?

Hyperpigment skin

hepatomegaly

Diabetes

Heart failure

Arthralgia

What are the sonographic feature of Hemochromatosis?

liver shows increased echogenicity

What does this image describe?

there is an increased echogenicty with the echotexture

THis is Hemochromatosis

What is Cirrhosis associated with?

End stage chronic liver disease

What is Cirrhosis?

Fibrosis of the normal liver tissue with abnormal liver nodules

How does Cirrhosis present in the liver?

Late stage of scarring and fibrosis of the liver

With Cirrhosis how does the scarring tissue affect the liver?

Scar tissue block blood flow

Slows process of nutrients,hormones,drugs and other toxis

Is Cirrhosis irreversible?

yes it is often irreversible and progressive

What are the causes of Cirrhosis?

Alcoholism

Viral infection(Hepatitis B,C,D)

Nonalcoholic steatohepatitis

Enviromental toxins

Hemochromatosis

Wilsons disease

Glycogen storage disease

Cystic Fibrosis

Alpha 1 deficiency

Primary Sclerosing Cholangitis

Hepatic Veni occlusion/Budd Chiari syndrome

Chronic hepatitis

What are the Types of Cirrhosis?

Micronodular & Macronodular

What is Micronodular Cirrhosis?

Most common in alcohol consumption

What is Macronodular Cirrhosis?

mostly seen with chronic viral hepatitis

What is the classical presentations of Cirrhosis?

Hepatomegaly

Jaundice

Ascites

What are some asymptomatic clinical symptoms of Cirrhosis?

Fatigue

Jaundice

loss of appetite

vomiting

nausea

itching

spider like blood vessles

weight loss

Abnormal(LFTS,AST,SGOT,ALT,SGPT)

Ascites

hepatic encephalopathy

Coagulopathy

Dilated superficial veins of the abdominal walls

What are the sonographic appearance of Cirrosis?

edema swelling

increased caudate lobe size

increased echogenicity

Shrunken liver

ascites

splenomegaly

GI bleeding

Portal Hypertension

Hepatic vein- shrunken

Hepatic artery enlargement

Explain these images

Cirrhosis

(we see enlargement of the liver)

We also see Hepatic artery enlargement

What is this image?

This is Cirrhosis

we see nodular and irregular liver surface capsul

Describe this image?

Cirrhosis

liver more echogenic that Renal capsul

What is this image?

Cirrhosis

recanilization of the umbilical vein

What is A cute Hepatitis referred to as?

inflammation of the liver

What is A cute Hepatitis result in ?

Inflammatory change and swelling of the liver parenchyma

What is acute Hepatitis cause?

Paraascites

Bacteria

Drugs/Toxins

Autoimmune Hepatitis

Steatohepatitis

Matabolic disease

What are Acute Hepatitis presentations?

Fever

Abdominal pain

Jaundice

Dark urine

Pale stool

Loss of appetite

Unexplained weight loss

Elevation of AST & ALT

What is the name of hepatitis if it affected by a virus?

Viral Hepatitis

How is Hepatitis A transmitted?

Mouth to Mouth

How is Hepatitis A commonly transmitted?

By food preparation and unwashed hands

What do patients with hepatitis A present with?

Nausea,Vomiting,Headache

How is Hepatitis B transmitted?

Transmitted through blood (unclean needles and sexual contact)

What hepatitis is the greatest threat to health care workers?

Hepatitis B

What do Hepatitis B presented with?

Malaise

Fatigue

Anorexia

Changes in tase

What is Hepatitis C called ?

non-A/ Non-B Hepatitis

What do most patients with Hepatitis C develop?

chronic liver disease

What do patients with hepatitis C present with?

Vomiting

Headache

Cough and low grade fever

What are the Lab values of Hepatitis?

AST

ALT

Serum Bilirubin

ALP

Leukopenia

What is Hepatitis pathway?(Image)

What is Acute Hepatitis Sonographic appearance?

liver normal

decrease in echogenicity

Increased in brightness at portal triads

thickend gallbladder wall

Liver present with starry sky pattern

Describe this image?

Decreased echogenicity

We see a thinned gallbladder

What is chronic hepatitis?

Continuation of acute hepatitis

What is Chronic Hepatitis usually a a processes to?

Cirrhosis

liver failure

What is Chronic Hepatitis caused by?

Viral hepatitis

Drugs

Alcohol

Hemochromatosis

Alpha 1 antireypsin

Wilsons disease

Autoimmune hepatitis

what can patients with chronic hepatitis?

Fatigue and mild jaundice

What is Chronic Hepatitis sonographically?

Liver is echogenic due to fibroids

Decreased echogenicty of portal triads

What is this image

Chronic Hepatitis

(echogenic due to the spreads of fibroids)

What is Hepatic Infection Diseases usually a complications of?

• Biliary tract disease (cholangitis, cholecystitis)

• Diverticulitis or appendicitis (through the portal

venous system)

• Osteomyelitis or bacterial endocarditis (through

the hepatic artery)

• Crohn’s disease

• Colitis

• Sickle cell disease

• Surgery

• Trauma

• Neoplasm

• Bacteremia/sepsis in compromised patients

• Diabetes mellitus

What is Pyogenic/Bacterial Abscess?

Absus filled with puss

What is Pyogenetic Abscess caused by?

Escherichia coli=Adults

Straphycoccus=in childer

What are the symptoms of the bacterial abscesses?

• Fever,

• Chills

• RUQ pain

• Nausea

• Vomiting

• Diarrhea

• Anemia, malaise, anorexia

• Pleuritis ( Inflammation of the tissues that

line the lungs and chest cavity)

• Sepsis, shock

• Increase in LFT’s

• Leukocytosis

What are the sonographic finding of Pyogenic?

Can have weel defined or irregular defined walls

Can be anechoic to highly echogenic

We see shadowing and reverberations

Describe this image?

We see less echogenic than the liver

What is this image?

Pyogenic absces

Hypoechoic in comparison to the liver

What is the most common type of fungal hepatic infection?

Candidiasis

Who is candidiasis caused by?

caused by candida albicans

Who is Candidiasis most prevalent in?

ones with diabetes and immunosuppression.

Who can Candidiasis most prevalent in?

transplant recipients, cancer patients on chemotherapy , and HIV

infected patients

also pregnant women

What do patients with Candidiasis present with?

ersistent fever -

chills

hypotension

• Positive blood cultures for pseudohyphae

• Normal white blood cell count in an otherwise neutropenic patient

Oral thrushing

What organs does the Candidiasis affects?

Brain

Heart

Kidneys

What is the sonographic appearance of Candidiasis

Hypoechoic rim corresponding to fibroids

hyperechoic rims corresponding to inflammatory disease

What is the Candidiasis describes as having?

Bulls eye apperence that mimics Metastases

Describe this image?

Candidiasis

The heterogenous liver with micro and punctate calcification of liver and kidney

Ended at slide 65

What is Parasitic Absces Amebiasis?

primary infection of colon and cecum

What is the most common non-enteric Absces?

Parasitic Abscess

What is Parasitic Abscess caused by?

Enteameba Histolytica(collection of puss destroying liver parenchyma)

How is Parasitic Abscess transmitted and occur?

Transmitted through-Fecal oral route

Occurs in warm climate with continamated food and water