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Hagan Ansert 7th edition Chpt. 10

Fatty Infiltration Lab values

Normal to elevated hepatic enzymes
Elevated Alk Phos
Elevated Direct Bilirubin

Fatty Infiltration Sonographic Findings

Increased Echogenicity
Increased Attenuation
Impaired visualization fo borders of portal/hepatic structions (secondary to increased attenuation)
May be patchy, inhomogeneous
Focal Sparing

Fatty Infiltration differential considerations


Acute Hepatitis Lab Values

Elevated AST, ALT
Elevated Bilirubin

Acute Hepatitis Sonographic Findings

Nonspecific & Variable
Normal to slightly increased Echogenicity
Increased brightness of portal vein borders
Increased thickness of GB Wall

Acute Hepatitis differential considerations

Fatty Liver

Chronic Hepatitis Lab values

Elevated AST, ALT
Elevated Bilirubin

Chronic Hepatitis Sonographic Findings

Coarse hepatic parenchyma
Increased echogenicity
decreased visualization brightness of portal triad
Fibrosis may produce soft shadowing

Chronic Hepatitis differential considerations

Fatty Liver

Cirrhosis Lab values

Elevated Alk Phos
Elevated Direct Bilirubin
Elevated AST, ALT

Cirrhosis Sonographic Findings

Coarse liver parenchyma w/nodularity
Increased Echogenicity
Increase Attenuation
Decreased Vascular markings with acute cirrhosis
Hepatosplenomegaly w/ascites
Shrunken liver w/chronic cirrhosis(aslo increased nodularity)
Regeneration of hepatic nodules
Portal hypertension

Cirrhosis differential considerations

Fatty Liver

Gycogen Storage Disease Lab Values

Disturbance of acid-base balance

Gycogen Storage Disease Sonographic Appearance

Increased Echogenicity
Increased Attenuation
Von Gierke's adenoma(round, homogeneous)

Gycogen Storage Disease differential considerations

Focal Nodular Hyperplasia
Fatty Liver

Hemochromatosis Lab Values

Elevated Iron levels in blood

Hemochromatosis Sonographic appearance

Increased echogenicity throughout liver

Hemochromatosis differential considerations


Causes of Fatty Liver

obesity,excessive alcohol intake,poorly controlled hyperlipidemia,diabetes mellitus, excess corticosteroids, pregnancy, Total Parenteral Hyperalimenation(nutrition),Severe hepatitis, Glycogen storage disease, cystic fibrosis, pharmaceutical, chronic illness

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