LIVER

school slides

Fatty liver can lead to

steatohepatitis

what can steatohepatitis lead to

cirrhosis

viral hepatitiis signs

jaundice, dark urine, clay-coloured stool

viral hepatitis labs

increased AFT, ALT, bilirubin

acute hepatitis sono

“starry sky” , hepatomegaly, splenomegaly, thick gb walls

chronic hepatitis may lead to

cirrhosis, HCC, liver failure

what are the causes of cirrhosis

alcoholism, viral hepatitis (B+C), biliary obstruction, wilson disease, budd-chiari, hemochromatosis

what are the s/s of cirrhosis

jaundice, weight loss/fatigue, hepatomegaly, ascites

cirrhosis can lead to

portal hypertension, varicosities, PV thrombosis, splenomegaly, HCC

what are the sono of cirrhosis

• lobe volume redistribution

• coarse echotexture, nodular surface, hepatomegaly, splenomegaly, ascites

• corkscrew appearance of hepatic artery

• monophasic HV flow, heptofugal PV flow

  • collaterals

    • recanalization of umbilical vein off of LPV

    • esophageal varices

what is glycogen storage disease

lack of enzyme that breaks down glycogen into glucose (hypoglycemia- chronic hunger) therefore abnormal accumulation of glycogen in the tissues

• von Gierke is the m/c

• can be caused by oral contraceptives

what is the sono of glycogen storage disease

• increase echogenicity and attenuation

• hepatomegaly

• solid liver masses (adenomas)

what is hemochromatosis

excess iron deposits in tissue

what is wilson disease

excess copper accumulation in tissues

hemochromatosis and wilson disease can lead to

• chronic hepatitis, cirrhosis, HCC

what is the most common cause of portal hypertension

cirrhosis

what is the sono of portal hypertension

• dilated PV veins ( > 13mm) , splenic veins, mesenteric vv

• heptofugal PV flow

• hepatosplenomegaly

Portal hypertension can be relieved by

TIPS

• commonly between right PV and right HV

what can portal vein thrombosis lead to

cavernous transformation of portal vein (worm-like vessels)

what is budd-chiari syndrome

hepatic veins are occluded

• possibly IVC too

what are the s/s of budd-chiari

ascites, RUQ pai, hepatosplenomegaly, increased LFT, leg edema with IVC occlusion

what is the sono of budd chiari

• enlarged caudate

• rt lobe atrophy

• low vis of HVs

• clot in HV or IVC

  • no flow in HVs

• ascites

what is the most common source of infection for pyogenic abscess

cholangitis

what are the s/s of pyogenic abscess

• fever and chills

• increased WBC

• RUQ pain

• N&V

• increased LFT

• hepatomegaly

what is the sono of pyogenic abscess

• variable appearance, usually singular lesion

• hypoechoic with TT

• complex with debris and irregular walls

• fluid level

• dirty shadow (with gas forming bacteria)

• hypervascularity around the lesion

what is candidiasis (fungal abscess) caused by

a species of candida

• occurs in immunocompromised hosts

  • chemo, organ transplant, HIV

what is the sono of candidiasis (fungal abscess)

multiple small hypo lesions with echogenic center

• bulls eye, target lesions, wheel within wheel

what is amebic abscess caused by

protozoan parasite (entamoeba histolytica)

• from contaminated water

primary site is colon

what are s/s of amebic abscess

can be asymptomatic

• abdo pain, diarrhea, leukocytosis, low fever

what is the sono of amebic abscess

• round or oval

• hypoechoic

• debris

• TT

what is hydatid echinococcal cyst caused by

parasitic tapeworm (echinococcus granulosum)

• exposure to livestock, dog feces

what is the s/s of hydatid echinococcal cyst

• urticaria (rash/itchy skin)

• ruq pain, hepatomegaly

• leukocytosis

• obstructuve jaundice (increased ALP and direct bilirubin)

• cysts can get large and rupture

what is the sono of hydatid echinococcal cyst

simple cyst

complex cyst

• daughter cysts

• honeycomb sign (septa)

• mobile debris

• water lilly sign

what is schistosomiasis caused by

common parasitic infection in africa, asia, south america

• worms in contaminated water penetrate skin and travel

  • causes itchy skin/rash

schistosomiasis clinic

• portal hypertension

• splenomegaly

• ascites

• gastroesophageal varices

what is the sono for schistosomiasis

• irregular hepatic surface

• hyperechoic thick PV walls

  • “clay-pipe stem” patterm

• portal hypertension signs

what is the m/c benign liver mass

cavernous hemangioma

what is the second m/c benign liver mass

FNH

• influenced by hormones (OC may cause increase in size)

• F > 40 yrs

what is the sono of FNH

• isoechoic / hyper

• central scar

• well defined

• peripheral and central colour (spoke-wheel pattern)

what is liver adenoma associated with

• long hx of oral contraceptive use

• GSD type 1 (von Gierke)

• F > M

what is the sono for adenoma

• m/c hypoechoic (can be hyper/iso)

  • hypo with hypo ring

• complex - hemorrhage/necrosis

what is the m/c primary liver cancer

HCC (hepatoma)

• male prevalence

HCC can….

invade PV and HV

• can lead to budd-chiari

what can cause HCC

• cirrhosis

• chronic hep B, C

• exposure to carcinogens

• hemochromatosis

• von gierke

• wilson disease

what is the s/s for HCC

• increase AFP

• increase LFT

• signs of cirrrhosis

• weight loss

• fever/night sweats

• palpable mass

what is the sono of HCC

• variable

• solitary hypo mass

• multiple heterogeneous masses

• hypo halo around mass (bulls eye or target sign)

• signs of cirrhosis or chr hepatitis

what is the most common cancer of liver

liver metastatic disease

what are the s/s of liver mets

• hepatomegaly

• weight loss

• RUQ pain

• jaundice

• ascites

what is the sono of liver mets

• well defined hypo

• well defined hyper

• diffuse inhomogeneous exchotexture with no focal mass

• bulls eye/target sing

• hypo halo, hypo center

what is liver lymphoma

• malignant (hodgkin/non-hodgkin)

• lymphocyte proliferation in LNs

• usually liver is metastatic site for lymphoma (non-hodgkin)

what are s/s for liver lymphoma

• increase LNs

• fever, fatigue, weight loss, night sweats, bone pain, splenomegaly

what is sono for liver lymphoma

diffuse or parenchymal change

hypo masses with target sign

what is passive hepatic congestion

develops secondary to congestive heart failure

• dilated IVC, HV, SMV, PV, splenic V

what is pneumocystis carinii

m/c oportunistic infection in pt with AIDS

• also affects organ transplantation, chemo pt

what is the sono of pneumocystis carinii

• diffuse tiny non-shadowing echogenic foci

• replacement of liver parenchyma by echogenic clumps of Ca +2