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Diffuse Hepatocellular Disease

Terms in this set (15)

Fatty Liver
Accumulation of fat within the hepatocytes
Causes:
ETOH abuse, steroids, malignancy, diabetes mellitus, protein malnutrition, hepatitis
LAB
Increased LFTS
Acute Viral Hepatitis
Diffuse, inflammatory process of the liver, most common types, HAV, HBV, and HCV.
Clinical Findings: Malaise, nausea, fever, pain, may be jaundiced, enlarged tender liver
LAB:
Increased bilirubin, ALT higher levels than AST, alkaline phosphatase
Hepatosplenomegaly, hypoechoic liver parenchyma, renal cortex more echogenic than the liver, increased echogenicity of portal vein walls, thickening gallbladder wall
Chronic Viral Hepatitis
Most common types HBV and HCV
Findings: Malaise, nausea, ever, pain, may be jaundiced, enlarged tender liver in the early stages
LAB
Increased - Bilirubin, ALT, AST, alkaline phosphatase
Liver paranchyma is coarse and echogenic, the walls of the portal system blend with the liver echogenicity
Cirrhosis
Diffuse fibrotic process that involves the entire liver, most commonly caused by ETOH abuse, HBV or HBC
Fatigue, weight loss, diarrhea, dull ruq pain, ascites
LAB LFTS depend upon the stage and function of the liver, the following values are increased, ALT, AST, Alkaline phosphatase, serum and urine conjugated bilirubin values,

Late Features: small nodular, echogenic liver with decreased through transmission, ascites, portal hypertension, collateral vessels, patent umbilical vein
Chronic hepatic congestion
Hx of heart failure, acute phase causes of RUQ pain
LAB: Normal or slightly abnormal LFTs,
Acute disorder, hepatomegaly, dilation of IVC, hepatic veins, reverse flow during systole, slightly pulsatile portal vein
Glycogen Storage Disease
Autosomal recessive disorder of carbohydrate metabolism, von gierke's disease is the most common type
Clinical Findings: Usually occurs in infancy or young childhood, hypoglycemia
LAB: decreased glucose 6 phosphatase
Hepatomegaly, fatty liver infiltration with diffuse increased liver echogenicity
Fatty liver
Sonographic appearance
Progressive disease, enlarged lt and caudate lobe, increase liver echogenicity, decrease in through transmission, decreased visualization of vessel walls
Acute viral hepatitis
Sonographic appearance
Hepatosplenomegaly, hypoechoic liver parenchyma, renal cortex more echogenic than liver, increased echogenicity of portal vein walls (starry sky), thickening GB wall
Chronic viral hepatitis
Sonographic appearance
Liver parenchyma is coarse and echogenic, the walls of the portal system blend with the liver echogenicity
Cirrhosis
Sonographic appearance
Late features - small nodular, echogenic liver with decrease through transmission,
In SEVERE CASES ascites, portal hypertension, collateral vessels, patent umbilical vein
Chronic (passive) hepatic congestion
acute disorder - Hepatomegaly, dilation of IVC, hepatic veins, slightly pulsatile portal vein
Portal vein hypertension
clinical findings:
Collateral venous channels
Splenomegaly
GI tract bleeding
ascites
Portal vein hypertension
Sonographic findings:
Dilation of the portal vein (>13mm)
Dilation of the SMV and splenic vein (>10mm)
Varices
Portafugal (reversal) blood flow
Splenomegaly
recanalization of the umbilical vein >3mm
Portal vein obstruction
Clinical findings: Hepatocellular carcinoma, pancreatic or GI cancer or lymphoma

Sonographic Findings:
Nonvisualization of the portal vein
echoes within the portal vein
dilation of the splenic and SMV
budd chiari syndrome
obstruction of the hepatic veins caused by thrombosis or compression from a liver mass

Clinical findings:
Abdominal pain
Jaundice
Abnormal LFTs
Hepatomegaly
Ascites

Sonographic findings:
Reduced or nonvisualization of the hepatic veins
Hepatic veins proximal to the obstruction may be dilated
Large and hypoechoic caudate lobe
Abnormal doppler blood flow
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