Liver pathology study guide

Cirrhosis

a diffuse process destroys the normal architecture of the liver lobules following inflammation

most common causes are hepatitis and other viruses, and alcohol abuse

Increased risk for HCC – Hepatocellular carcinoma

Symptoms fatigue, weakness, weight loss, nausea, and itchy skin

presents with jaundice (yellow skin/eyes), severe abdominal swelling

Fatty Infiltration

Steatosis; also known as fatty liver

Alcohol and obesity are the leading cause

Primary Malignant Tumors

Hepatocellular carcinomas (HCC) AKA Hepatoma

80% to 90% of the primary malignant liver tumors

Cholangiocarcinoma

Second most common primary malignant tumor

Hepatic Cysts

Congenital cysts: True hepatic cysts

Isolated polycystic liver disease (PLD)

cysts are only in liver, Caused by inherited developmental defect in formation of bile ducts

Acquired Cysts - hematoma

Bleeding within simple cyst, hematocrit levels drop, Repeated episodes of bleeding may result in calcification within the cyst

Acquired Cysts Echinococcal Cyst - Hydatid Diseases

Most common caused by Taenia echinococcus or Echinococcus granulosus—parasitic tapeworm

Elevated LFT’s

demonstrate increased levels of ALP, AST, ALT

Glycogen storage disease

Liver Cell Adenoma: Benign

Hepatomegaly

More often solid liver masses (adenomas)

Type 2 and 3 are associated with cirrhosis and HCC

Adenomas. Can occur in up to 40% of patients with type 1 von Gierke disease.

Liver cell adenoma

❖ Association with long-term oral contraceptive use in

women is well documented.

❖ Liver cell adenomas are significantly more common in

women, with a reported female-to-male ratio of 4:1

Elevated AFP

in your blood—greater than 400 ng/mL—could be a sign of liver tumors.

HEPATOMEGALY

Most ultrasound references state that a liver greater than 15.5 to 16 cm in size is considered enlarged

Metastatic masses

liver tumors incidence: 8 to 20 times more common than HCC, liver disease are: Gallbladder, colon, stomach, pancreas, kidney, ovaries, breast, and lung.

Increased vascularity

Lung metastases

Hyperechoic lesion (white bold arrow) with peripheral halo-target sign-highly specific for metastases-lung cancer

TIPS (Transjugular Intrahepatic Portosystemic Shunt)

performed to treat severe complications of portal hypertension, typically caused by cirrhosis or liver scarring. It creates a shunt to lower high blood pressure in the liver's veins, managing refractory ascites, bleeding esophageal varices, and hepato-renal issues

normal velocity: 90-190 cm/s

Common collaterals or varices of cirrhosis include

• Recanalization of the paraumbilical vein

(ligamentum teres)

• Esophageal varices

• Splenic varices

• Splenorenal shunt

Secondary findings of cirrhosis should be documented and can include:

• Portal hypertension

• Splenomegaly

• Varices

• Collaterals

• Ascites

Cavernous Hemangioma

The most common benign solid lesions of the liver

Most measure <3 cm but larger lesions are possible

Autosomal dominant polycystic kidney disease

represents 80% to 90% of all PLD and cysts are present in both the liver and the kidney

Schistosomiasis

Caused by a parasitic tapeworm, sometimes described as a turtle shell appearance

Splenomegaly with portal vein and splenic vein dilatation

Focal fatty sparing

Porta hepatis classic location

Diffuse fatty infiltration

Focal fatty infiltration

Coronary vein

the most commonly involved portal systemic collateral pathway in liver cirrhosis, seen in roughly 80% of cases.

Cirrhosis PW

the hepatic vein waveform commonly becomes monophasic (flat or blunted) in patients with cirrhosis, departing from the normal triphasic pattern

Hepatic Kaposi sarcoma

the most common hepatic neoplasm in patients with AIDS, reported in 34% of cases in an autopsy series. Hepatic KS is typically asymptomatic and rarely diagnosed in life

“starry sky” pattern

Budd chiari

Clinical: pain, jaundice, ascites, hepato/splenomegaly

Hepatic Artery Evaluation:

The primary goal is to exclude hepatic artery thrombosis (HAT) or stenosis, often evaluating the resistive index (RI). An RI less than 0.5–0.6, or a slow systolic upstroke (tardus-parvus), suggests possible complications.

Portal Vein (PV) & Hepatic Vein (HV) Monitoring:

Sonographers check for portal vein thrombosis (PVT) or stenosis, ensuring normal hepatopetal flow. They also verify HV patency to rule out outflow obstruction.

Bull’s eye target lesion