What is the most common cause of echogenic liver?
Fatty infiltration is ____ and ____ disorder of fat metabolism.
What is fatty infiltration?
Increased lipid storage in hepatocytes.
What are the common causes of fatty infiltration?
Obesity, diabetes, alcoholic liver
What does diffuse fatty infiltration look like on U/S?
Increases echogenicity of parenchyma, fine texture, decreased visualization of hepatic vessels, beam may not penetrate all the way through, hepatomegaly,
What is focal fatty infiltration?
A dense focal area of fat.
What does focal fatty infiltration look like on U/S?
Increased echogenicity in one spot that does not displace hepatic vessels
Where does focal fatty infiltration often lie?
Near the porta hepatis
What is Focal fatty sparing?
A fatty liver with spots that are unaffected.
Where does focal fatty sparing spots generally appear?
next to the gallbladder
What is another name for glycogen storage disease?
Von Gierk's disease
How does glycogen storage appear on U/S?
Similar to fatty liver, cannot be diagnosed with ultrasound only.
What is hemochromatosis?
Rare disorder that is the excessive accumulation of iron in the liver
How does Hemochromatosis look on U/S?
Similar to fatty infiltration, hepatomegaly, chirrhotic changes
What is hepatitis?
Inflammatory/infectious process of the liver.
What causes hepatitis?
Infections, parasites, toxins, drugs, chemicals, alcohol and auto-immune diseases
Is hepatitis reversible?
YES (usually), but can cause permanent damage that can lead to liver failure and death.
How is hepatitis transferred?
What are the clinical symptoms of hepatitis?
loss of appetite, malaise, jaundice, Abnormals LFTs
How does acute hepatitis appear on ultrasound?
May be normal, but usually will be a "starry night" appearance, hepatomegaly, hepatosplenomegaly, thick GB wall
How does chronic hepatitis appear on ultrasound?
Hyperechoic liver parenchyma, course texture, small liver, decreased echogenicity of portal vein walls
Is cirrhosis reversible?
What is the cirrhotic process?
Parenchyma necrosis, hepatocytes attempt to regenerate, but are fibrotic, leads to scarring and nodules
What causes cirrhosis?
alcoholism, viral hepatitis
How does cirrhosis present clinically?
Hepatomegally, jaundice, ascites, portal hypertension, coagulopathy, hepatic encephalopathy
How does a cirrhotic liver appear on U/S?
small, echogenic, beam does not attenuate, nodularity, dilated umbilical vein, diminished vascular structures, irregular borders
What else may a sonographer see with cirrhosis?
ascites, pancreatitis, narrowed hepatic veins, portal hypertenstion, hepatofugal flow
What does the shot gun sign/ parallel channel refer to?
intrahepatic duct dilation.
How does proximal biliary obstruction present clinically?
itching and jaundice
How does the gallbladder look with a proximal blockage?
What are common reasons for common duct stricture?
prior local surgery (cholesectomy), pancreatitis, trauma, gallstones
What is passive hepatic congestion?
It is a secondary condition to heart failure (usually right) due to a back up in the venous system
What does passive hepatic congestion look like?
dilated hepatic veins, hepatomegaly, pulsatility in veins, ascites
What is Budd-Chiari Syndrome??
A rare disorder characterized by occlusion of the hepatic vein lumen with or without occlusion of the IVC
What causes Budd-C S?
Congenital, thrombosis, Trauma. It is associated with renal cell carcinoma, HCC or oral contraceptives
How does Budd-C S present clinically?
Abdominal Pain, massive ascites, hepatomegaly
What is one thing we need to do with Budd-C-Patientes?
determine presence and direction of hepatic venous flow
What does portal hypertension occur in response to?
to increased pressure in the portal vein due to mass