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liver pathology review questions

Terms in this set (86)

What are some of the functions of the liver?
Detoxification, production of bile & proteins, phagocytosis, storage of glycogen, hematopoiesis in fetus
Elevated alpha-fetoprotein in blood suggests
Liver malignancy
What does elevated alkaline phosphatase and direct bilirubin in blood suggest?
Biliary obstruction
What is prothrombin? What is prothrombin time?
Protein/clotting factor. Time blood takes to clot
BUN and albumin _____ in the case of diffuse hepatocellular disease
Decrease
What is an acquired and reversible disease resulting in increased lipid accumulation in the hepatocytes?
Diffuse fatty infiltration/hepatic steatosis
Most common causes of fatty infiltration?
Obesity and alcohol abuse
Sonographic features of fatty infiltration are:
Increase in liver echogenicity, hepatomegaly, increased attenuation, impaired visualization of intrahepatic vessels, and impaired visualization of diaphragm
If you are unable to show the posterior surface of the liver because of attenuation then what should you do?
Use a low frequency transducer for penetration
The signs and symptoms for fatty infiltration are:
Depends on which type or level of severity: Usually asymptomatic (mild cases), some patients present with jaundice, nausea, & vomiting, abdominal tenderness (in severe cases), elevated LFTs (AST, ALT)
Fatty infiltration is irreversible disease. T/F?
False, it is a reversible disease
Hyperechoic focal area of fat present within a background of normal echo texture is a case of:
Focal fatty infiltration
Focal fatty infiltration & focal fatty sparing are commonly seen at:
Commonly seen at the porta hepatis, GB area, medial segment of the left lobe
A hypoechoic area in the area of the porta hepatis, GB, or medial segment of the left lobe within a dense, fatty liver is called:
Focal fatty sparing
Focal fatty sparing is commonly seen at:
Porta hepatis, GB area, medial segment of the left lobe
Inflammation of the liver is called:
Hepatitis
Lab values that indicate acute hepatitis are:
Increased AST (SGOT), ALT (SGPT), indirect bilirubin (unconjugated bilirubin), in severe cases conjugated); decreased albumin, BUN, amylase
Patients signs and symptoms for acute hepatitis are:
Fever, chills, increased WBCC, Anorexia, Nausea, Fatigue, Hepatomegaly, jaundice, dark urine
Hepatitis can be caused by:
1. Infectious agents and 2. Noninfectious agents
Some of the infectious agents that cause hepatitis are:
Viral, bacterial, fungal, and parasitic organisms
_____ infection is responsible for most cases of hepatitis.
Viral
Give some examples of viral hepatitis:
A, B, C, D, E or G
Some of the noninfectious agents that cause hepatitis are:
Medications, toxins, autoimmune disorders
_____ is a disease that is typically spread through fecal-oral route.
Hepatitis A
Hepatitis B or C is spread by contact with contaminated body fluids/blood. T/F?
True
Healthcare workers need to be especially aware of their risk for contracting hepatitis _____ and _____.
B and C
Acute hepatitis is inflammation of the liver lasting:
Less than six months
Sonographic findings associated with acute hepatitis include:
Enlarged liver, decreased echogenicity, increased blood vessels visualization--prominent portal veins (periportal cuffing) and starry sky sign, gallbladder wall thickening, splenomegaly
Sonographic findings associated with chronic hepatitis are:
Decreased size of the liver, increased echo texture, decreased visualization blood vessels, coarse liver texture
Sonographic findings associated with chronic hepatitis include irregular contour and ascites. T/F?
False
_____ is a general term used for chronic and severe attack to the liver cells leading to fibrosis, scarring and formation of regenerating nodules and scarring leading to liver failure and PHTN.
Cirrhosis
Cirrhosis is a progressive hepatocellular disease that could be caused:
Alcoholism (most common, predominates in western & industrialized countries), hepatitis, obstruction, drug abuse, cholangitis, hemochromatosis (too much iron), Wilson's disease (too much copper)
Lab values that indicates cirrhosis:
Elevated AST, ALT, Jaundice, increased conjugated and unconjugated bilirubin
Cirrhosis is a reversible disease. T/F?
False
The 2 benign pathologies (hepatocellular diseases) from which the patients might develop regenerating nodules (HCC/Hepatoma) are:
Cirrhosis and chronic hepatitis
Hepatic encephalopathy is:
Brain toxicity -causing confusion, altered level of consciousness, and coma as a result of liver failure (no blood filtration)
Hepatic encephalopathy is seen in what kind of patients:
Cirrhosis
Untreated hepatitis eventually leads to:
Cirrhosis
Sonographic findings associated with chronic cirrhosis are:
A small liver with increased echogenicity, diminished vascular structures within the liver parenchyma, a nodular outline to the liver (irregularity/nodularity of the surface), course liver texture, nodules (increased risk of HCC in alcoholic cirrhosis)
What are some of the complications of cirrhosis?
Portal hypertension (PV>13mm)-cirrhosis is most common cause of intrahepatic portal hypertension, recanalization of the ligamentum teres, reversal flow in PV, Collaterals develop in portal system (serpiginous, varices, twisted or snakelike pattern), splenomegaly, ascites, hepatoma (HCC)/regenerating nodules, PV thrombosis
Collaterals are also called:
Varices
A nodular liver surface is associated with which abnormality?
Cirrhosis
In patients with cirrhosis and suspected portal hypertension, which other organ should be imaged?
Spleen for size
The worry about collaterals is:
Rupture of these veins can cause massive bleeding that may result in death
Patient is referred to rule out the presence of portal hypertension. You must evaluate the portal vein and other pertinent veins. What vessels form the portal vein?
Superior mesenteric vein, inferior mesenteric vein and splenic vein
Another name for glycogen storage disease is:
Von Gierke's disease
Define glycogen storage disease.
Excess glycogen (glucose) deposits in the liver & kidneys
Hypoglycemia is an indication for which pathology?
Glycogen storage disease
Sonographic finding associated with Von Gierke's disease is:
An echogenic enlarged liver
Glycogen storage disease is associated with what liver tumor?
Adenomas (LCA)
Hemochromatosis is:
Disease of iron metabolism characterized by excess iron deposits
Sonographic finding of acute hemochromatosis of the liver is:
Hepatomegaly
Chronic hemochromatosis may lead to:
Cirrhosis and portal hypertension
____ an autosomal recessive inherited disorder that causes too much copper to accumulate in the liver, brain and other vital organs.
Wilson's disease
U/S appearance of early stage Wilson's disease is:
Small hypoechoic nodules less than 20 mm and hepatomegaly
In end-stage hemochromatosis and Wilson's disease resembles liver _____.
Cirrhosis
The symptoms for simple liver cyst is:
None/Asymptomatic
U/S appearance of liver cyst is:
Well defined, smooth-walled, anechoic, w/posterior enhancement (no attenuation)
____ and _____ (liver abnormalities) are associated with long-term use of oral contraceptives.
FNH, adenoma
Polycystic liver is in an autosomal dominant disease. T/F?
True
Patients with polycystic liver disease may also have:
Polycystic renal, pancreas & spleen disease
Polycystic liver disease is common in older males. T/F?
False
Hemangioma is also called
Cavernous hemangioma
The most common benign liver tumor in adults is:
Hemangioma
Cavernous hemangiomas demonstrate high-velocity color Doppler signals. T/F?
False
The vascular tumor composed of blood vessel cells with hyperechoic and avascular sonographic findings is:
Hemangioma
____ is a benign lesion of the liver composed of fat cells.
Lipoma
Ultrasound appearance of a lipoma is:
Well defined echogenic mass
What are 4 types of hyperechoic hepatic masses?
Hemangioma, focal fatty infiltration, Hepatic Lipoma, echogenic metastasis tumors (from GI, kid, panc)
The most common vascular tumor in infancy is:
Infantile hemangioendothelioma
Infantile hemangioendothelioma is common in females less than 6 months of age. T/F?
True
Ultrasound appearance of infantile hemangioendothelioma is:
Nonspecific
The second most common benign tumor after hemangioma is:
Focal nodular hyperplasia (FNH)
____ is often termed the "stealth" lesion of the liver.
Focal nodular hyperplasia
FNH is a diffuse liver disease. T/F?
False, it is discrete nodular lesion in one portion of the liver
Focal nodular hyperplasia can be differentiated from LCA by demonstrating:
Fibrous septations or central scar (echogenic linear structure)
Ultrasound appearance of FNH is:
Isoechoic or hypoechoic to the liver
Other names for Liver adenoma is:
Liver cell adenoma, hepatocellular adenoma
Liver adenoma commonly seen in what patients
Females taking oral contraceptive 2. Men using steroids 3. Type I glycogen storage disease (Von Gierke's disease)
Sign and symptom for liver cyst, Hemangioma, lipoma, FNH and LCA usually are:
Asymptomatic
_____ is a rapidly growing tumor (tendency to rupture and hemorrhage).
Liver adenoma
_____ has a potential to become malignant, so they are often removed surgically for that reason.
Liver adenoma
U/S appearance of liver cell adenoma is:
Isoechoic or hypoechoic to the liver
Differentials for LCA could be:
FNH, focal fatty sparing, metastatic disease, hepatoma
_____ and _____ are associated with the use of oral contraceptives.
Focal nodular hyperplasia and liver cell adenoma (LCA)
For hepatic adenoma, why is surgical resection recommended?
Due to risk of malignant transformation
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