Liver Pathology Vocabulary Flashcards

Diffuse Liver Disease

Definition: diffuse disease affects hepatocytes and impairs liver function; measured by elevated hepatic enzyme levels with cell necrosis.
Major diffuse diseases: Fatty infiltration, Hepatitis (acute and chronic), Cirrhosis (acute and chronic).

Reversible accumulation of triglycerides in hepatocytes (steatosis).
Causes: obesity, excessive alcohol, hyperlipidemia, diabetes, corticosteroids, pregnancy, total parenteral nutrition, severe hepatitis, glycogen storage disease, cystic fibrosis, other drugs.
Focal fatty infiltration and focal fatty sparing: sparing often near gallbladder, porta hepatis, caudate lobe, liver margins.

Inflammation/infectious disease of the liver; can be viral, bacterial, fungal, parasitic; toxins/drugs possible.
Acute vs chronic; may elevate ALT, AST, and bilirubin.
Viral types: HAV, HBV, HCV.
HAV: fecal-oral spread; endemic in developing countries; typically acute with recovery or death.
HBV: blood/fluids transmission; risk to healthcare workers; sexual transmission possible.
HCV: anti-HCV marker; blood/body fluids; often from needles or sexual contact.
US distribution: ~60% of acute hepatitis is B, ~20% A, ~20% other.
Acute hepatitis ultrasound: liver may be normal or slightly hyperechoic; Starry Night appearance; hepatosplenomegaly; gallbladder wall thickening; mild attenuation.
Chronic hepatitis ultrasound: coarse parenchyma; decreased brightness of portal triads; fibrosis with piecemeal necrosis; can have non-enlarged liver.

Definition: chronic degenerative liver disease with fibrous tissue covering lobes and parenchymal degeneration; lobules infiltrated with fat; disorganized architecture due to necrosis, regeneration, and diffuse fibrosis.
Causes: Hepatitis C (major), alcohol, NAFLD/NASH, HBV, hemochromatosis, Wilson disease, others.
Nodularity: micronodular (e.g., from alcohol) vs macronodular (viral/infection).
Clinical progression: ascites, varices, portal hypertension; potential progression to liver failure.
Ultrasound progression:
- Early: hepatomegaly, increased echogenicity, coarse texture; vascular changes.
- Mid: nodular borders, lobe atrophy, ascites.
- Late: small shrunken liver, ascites, portal hypertension; risk of hepatocellular carcinoma.
Additional signs: thickened gallbladder wall; altered hepatic vasculature.

Six categories; most common is type I (von Gierke) with excess glycogen deposition in liver and kidneys.
Inheritance: autosomal dominant (as described in the source).
Ultrasound: hepatomegaly, increased echogenicity; round, homogeneous adenomas (seen in caudate/right lobe).

Rare iron metabolism disorder with systemic iron deposition; can lead to cirrhosis and portal hypertension.
Ultrasound: hepatomegaly, cirrhotic changes, uniformly increased echogenicity of the liver parenchyma.

Simple hepatic cysts: well-demarcated, thin-walled, anechoic lesions with posterior acoustic enhancement; usually asymptomatic.
Polycystic liver disease: autosomal dominant; associated with polycystic kidney disease; multiple small cysts throughout liver; may enlarge and cause biliary obstruction at porta hepatis.

Hepatic abscesses common complications of biliary disease, surgery, or trauma.
Types: Pyogenic (80%), Amebic, Echinococcal (hydatid), Fungal (Candida), Pneumocystis, Chronic Granulomatous Disease.
Pyogenic abscess: routes via biliary tract, portal vein, hepatic artery; fever, leukocytosis; biliary infections common.
Amebic abscess: Entamoeba histolytica; via portal system; travel/immigrant exposure; GI symptoms common.
Amebic abscess gross: necrotic material (not pus).
Echinococcal cyst: hydatid disease; water-lily sign; daughter cysts.
Candida (fungal): wheel-within-a-wheel or bull’s-eye appearance; hypoechoic focus.
Pneumocystis: diffuse tiny echogenic foci or extensive calcifications.
Chronic Granulomatous Disease: phagocyte defect; poorly marginated hypoechoic mass; calcifications possible; aspiration needed for diagnosis.

Cavernous Hemangioma: most common benign liver tumor; female predominance; usually asymptomatic; irregular echogenicity due to vascular spaces.
Liver Cell Adenoma: more common in women; linked to oral contraceptives; rupture risk with bleeding; increased in glycogen storage disease; resection advised due to malignant transformation risk.
Lipoma: benign fat-containing lesion; ultrasound artifact possible.

Second most common benign liver mass; occurs in women <40.
Often subcapsular; central fibrous scar; composed of normal hepatocytes, Kupffer cells, bile ducts, and fibrous tissue.
May be multiple nodules separated by fibrous bands; potential bleeding risk.

Most common primary malignant liver tumor; more often a metastasis than primary overall.
Major risk factors: cirrhosis (80%), chronic HBV infection, aflatoxins; more common in men.
Patterns: solitary massive tumor, multiple nodules, or diffuse infiltrative masses.
Invasion: hepatic veins (potential Budd-Chiari), portal venous system; may destroy vessel walls with thrombosis.

Most common form of liver neoplasm overall; primary sites include colon, breast, and lung.
Prognosis varies; ultrasound shows multiple well-defined iso-, hyper-, or hypoechoic nodules; necrosis common in centers.

Hepatoblastoma: most common malignant liver tumor in infants/children <2; enlarged asymptomatic mass; associated with Beckwith-Wiedemann syndrome; increased AFP; may metastasize to lungs; portal vein invasion.
Infantile Hepatic Hemangiomas: benign, rapid neonatal growth; high vascularity; may cause congestive heart failure; often spontaneously regress by 12–18 months.
Lymphoma: hepatomegaly with normal or diffusely altered parenchyma; focal hypoechoic masses possible; systemic symptoms common.

Measures tissue stiffness; malignancies are stiffer than benign tissue.
Useful to assess fibrosis and cirrhosis; helps identify patients with little or no fibrosis who are harder to detect on ultrasound.

Performed with ultrasound guidance to obtain tissue for histology (referenced in the material).

Liver is the third most commonly injured abdominal organ.
Lacerations occur in about 3% of trauma patients and often accompany other injuries.
Management depends on laceration size, amount of hemoperitoneum, and clinical status; right lobe injured more often.