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Flashcards in AB-Liver Deck (43)
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1

Budd Chiari disease

uncommon, often dramatic illness caused by thrombosis of the hepatic veins or inferior vena cava.
20% are reported to be portal vein thrombosis

2

Budd Chiari often occurs in patients with..

Hypercoaguable states
Oral contraceptives
Collagen vascular diseases
Hepatic tumors

3

Clinical findings for Budd Chiari

Ascites
Elevated liver function test
Hepatomegaly
Splenomegaly
Upper abdominal pain

4

Sonographic findings for Budd Chiari

Reduced visualization of the hepatic veins
Thrombus within the hepatic veins
Enlarged caudate lobe
Lack of flow within the hepatic veins with color Doppler
Narrowing of the inferior vena cava

5

Fatty infiltration of the liver

An acquired and reversible disease
Benign
Increased lipid accumulation in the hepatocytes leading to impaired or excessive metabolism of fat

6

Clinical findings for fatty liver

Asymptomatic
Alcohol abuse
Chemotherapy
Diabetes mellitus
Elevated liver function test
Obesity Pregnancy

7

Sonographic findings for fatty liver

Diffusely echogenic liver
Liver may appear patchy, inhomogenous due to focal sparing
Liver is enlarged(hepatomegaly)
Increased attenuation of the sound beam
Walls of the hepatic vasculature and diaphragm will not be easily imaged(secondary to increased attenuation)
Compare the echogenicity of the right kidney to the liver.

8

Glycogen storage disease

Is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissues, especially the liver and kidneys.

9

Type I glycogen storage disease

von Gierke's disease
Most common type
Abnormally large amounts of glycogen are deposited in the liver and kidneys

10

Glycogen storage disease is associated with..

Hepatic adenomas
Focal nodular hyperplasia
Hepatomegaly

11

Sonographic findings for glycogen storage disease

Hepatomegaly
Increased echogenicity
Slightly increased attenuation (similar to diffuse fatty infiltration)

12

Hepatocellular carcinoma (HCC)

Most common primary malignant neoplasm
Related to cirrhosis, hepatocarcinogens in food, and hepatitis B and C
Symtoms-unexplained mild fever and weight loss, hepatomegaly

13

Appearance for hepatocellular carcinoma

Varies from solitary mass to diffuse infiltration or multiple tumors
Invades portal venous system and hepatic vein
Heterogenous masses scatered throughout the liver
Mass with a hypoechoic halo

14

Clinical findings for hepatocellular carcinoma

Elevated alpha-fetoprotein
Abnormal liver function tests
Cirrhosis
Chronic hepatitis
Unexplained weight loss
Hepatomegaly
Fever
Palpable mass
Ascites

15

Ligaments and fissures in the liver

Glisson's capsule-thin connective tissue covering the liver
Main lobar fissure-boundary between right and left lobes of the liver; hyper echoic line extending from the PV to the neck of the GB
Falciform ligament- extends from umbilicus to the diaphragm in a parasagittal plane and contains the ligament teres
Ligament teres-bright echogenic triangle on transverse scan; separates the medial and lateral segments of the left lobe
Ligamentum venosum- separates the left lobe from the caudate lobe

16

Severe hepatocellular disease lab value tests

Elevation of AST and ALT
Levels frequently exceed 1000 units

17

Hemangioma

benign, congenital tumor consisting of large, blood-filled cystic spaces
Most common benign tumor of the liver
More frequent in women
Asymptomatic-may bleed, RUQ pain

18

Sonographic findings for hemangioma

Most are hyper echoic with enhancement
Round or oval, well defined
Larger masses may show necrosis, degeneration, calcification

19

Extrahepatic masses

Internal invagination or discontinuity of the liver capsule
Formation of the triangular fat wedge
Anteromedial shift of the IVC
Anterior displacement of the right kidney

20

Intrahepatic masses

Displacement of the hepatic vascular radicles
External bulging of the liver capsula
Posterior shift of the IVC

21

Focal Nodular Hyperplasia (FNH)

Second most common benign tumor seen in women <40 years old
Asymptomatic
Appears as a subtle liver mass usually <5cm
Has a well developed central and peripheral blood vessels coursing through seen with Color Doppler

22

Hepatoblastoma

Most common malignant tumor of childhood High incidence with children who have Beckwith-Wiedemann syndrome

23

Elevated Alkaline Phosphatase

Associated with biliary obstruction or the presence of mass lesions in the liver
Acute cholecystitis
*Produced by the liver, bone, intestines, and placenta
Good indicator of intrahepatic or extrahepatic obstruction, hepatic carcinoma, abscess, or cirrhosis

24

Liver

Largest organ in the body next to skin
Weighs approx. 1500g in the adult
Intraperitoneal organ

25

Location of the liver

Occupies almost all of the right
hypochondrium, the greater part of the epigastrium, and the left hypochondrium as far as the mammillary line.
Inferior to the diaphragm
The posterior border is in contact with the
right kidney and inferior vena cava
The aorta lies posterior to the left lobe of the
liver

26

Subphrenic Space

Between the liver and the diaphragm; a common site for abscess formation

27

Morison's pouch

In the right sub hepatic space
Common space for peritoneal fluid or blood to collect

28

Lesser sac

Enclosed portion of the peritoneal space posterior to the liver and stomach is another site for abscess formation

29

Bare Area

Area superior to the liver that is not covered by peritoneum so that the IVC may enter the chest

30

Lobes of the liver

Right Lobe-largest lobe. Contains 3 fossae-porta hepatis, gallbladder, IVC
Left Lobe-size varies; found under xiphoid process
Caudate Lobe-small lobe; situated inferior to the ligamentum venous and superior to the IVC