Where is the bare area of the liver?

The bare area comes in direct contact with the diaphragm

What is riedel's lobe?

congenital variant extension of the right lobe of the liver beyond the lower pole of the right kidney.

What is the major problem with riedel's lobe?

It can be mistaken for hepatomegaly

What are the measurements of the right lobe of the liver?

20 cm / 15 cm

What are the hepatic veins key to?

division of the liver longitudinally

What are the portal veins key to?

transverse division of the liver

What is section 1?

Left Medial superior

What is section 2?

Left lateral superior

What is section 3?

Left lateral inferior

What is section 4?

Left medial inferior

What is section 5?

Right anterior inferior

What is section 6?

Right posterior inferior

What is section 7?

Right posterior superior

What is section 8?

Right anterior superior

Explain where the liver lies in the abdomen

right hypochondriac

epigastrium

Left hypochondriac to the left mammary line

What covers the liver?

Glisson's capsule

Fibrous peritoneum - covers all but bare area

How is the left lobe divided?

medial / lateral

How is the right lobe divided?

posterior / anterior

How is the liver oxygenated?

portal veins - 80%

Hepatic arteries - 20%

Explain the inferior liver.

sits on the mesentery

medial left lobe lies to the portal hepatis?

anterior to the portal hepatis

medial left lobe lies between?

ligament terres and the gallbladder fossa.

What lies at the anterior border of the caudate lobe?

left portal vein

What supplies the caudate lobe with blood?

hepatic artery

branches of the left portal vein

branches of the right portal vein

What drains the caudate lobe?

small veins to the IVC

What is the seagull?

Celiac axis

Explain the neonatal flow.

umbilical vein

ductus venosum

IVC

heart

Umbilical vein turns into what after birth?

ligament teres

Ductus venosum turns into what after birth?

ligament venosum

What is a possible problem with portal hypertension?

recanalization of the ligament teres

Why are portal veins echogenic?

they lie in fibrofatty tracks

Where is the ligament teres?

runs long outside of falciform ligament?

What is another name for the ligament teres?

round ligament

ligament teres

How do we locate the porta hepatis?

MPV kisses the IVC

Explain the direction of the main portal vein.

courses superiorly toward the right then posteriorly at the liver hylum

Main lobar fissure

A groove that divides the Rt lobe of the liver into anterior and posterior segment

Rt intersegmental fissure

Which anatomical structure is located within the Rt Intersegmental fissure?

Right hepatic vein

Which anatomical structure is located within the Lt Intersegmental fissure?

Left hepatic vein

Left Portal Vein

Ligamentum Teres

A groove that divides the Lt lobe of the liver into medial and lateral segment

Lt Intersegmental fissure

What seprates the caudate from the left liver lobe?

ligament venosum

What is the measurement of the MPV?

less than 13 mm

What is the # 1 cause of Portal Hypertension?

cirrhosis

What is possible if the MPV is more than 13 mm?

portal hypertension

Where is the right portal vein?

separates the right liver lobe into anterior and posterior sections

What does the horizontal segment of the left portal vein separate?

caudate from the medial left lobe

What does the ascending segment of the left portal vein separate?

separates the medial left lobe from the lateral left lobe.

What are the three major functions of the liver?

metabolism

detoxification

storage

What are the two types of metabolism in the liver?

gluconeogenesis

glucolysis

What is Hepatocellular?

hepatocytes are affected

treated medically

How is obstruction treated?

surgically

What does acute or chronic liver disease affect?

liver metabolism

Define metabolism.

chemical process that occur in the body that are necessary for matenance of life

catabolic - meow

anabolism - build

What happens to carbs in the liver?

catobolized to glucose to use as energy

What happens to the extra glucose not used as energy?

sent to the liver

converted to glycogen

stored

What happens to glycogen when energy is needed?

liver converts glycogen back to glucose

What is a possible cause of hyperglycemia and hypoglycemia?

liver disease

What happens to fats in the liver?

converted by hepatocytes to lipoproteins

What is a lipoproteins?

fats broken down to monoglycerides and diglycerides

What makes lipoproteins so fabulous?

they are soluble in plasma and may be transported by the blood.

What happens to stored fats sent to the liver?

liver converts them to glucose and cholesterol

What happens during liver disease to monoglycerides and diglycerides?

they are unable to convert to lipoproteins

instead are converted to triglycerides

Why are triglycerides not fabulous?

they are not soluble so they get stuck in the liver

FATTY LIVER disease

What is PT

Prothrombin time - the amount of time it takes for blood to clot

What is PTT?

partial thromboplastin is the time it takes for plasma to clot

Cogulopathy

disease condition of cogulation

Does IV therapy fix liver disease?

No

What is hypoalbuminemia?

not enough albumin

What can hypoalbuminemia cause?

edema & ascites

What is the primary cause of ascites?

portal hypertension

What happens to proteins when they are digested?

they are converted to amino acids then sent to the liver

What does the liver do with amino acids?

makes proteins

What is albumin?

important protein produced in large quantities in the liver.

What is albumin responsible for?

vascular fluid pressure

What are the fat soluble vitamins?

ADEK

What is the production source of proteins for blood coagulation?

The liver

What is needed for blood coagulation?

fibrinogen

prothrombin

factors V, VII, IX, X

What do you have to do before any invasive procedure?

check labs for

PT

PTT

INR

What is INR

international normalized ratio

only used when the patient is taking blood thinner

Why is vitamin K important

precursor to the production of factors V, VII, IX, X

No K no factors V, VII, IX, X, No clotting

True or False?

liver disease can decrease production of clotting factors V, VII, IX, X.

True

What will low clotting factors cause?

inadequate coagulation which results in uncontrolable hemorrhage.

How does biliary obstruction affect coagulation?

Bile emulsifies fat

No bile = no fat will be broken down

if fat is not broken down, fat soluble vitamins are not absorbed (K)

No K = No clotting factor.

True or False?

Protein ingestion plays a role in nitrogen metabolism

True

What is the importance of hepatic enzymes?

detection of liver disease

when hepatocytes are damaged hepatic enzymes leak into the blood and can be detected with lab tests.

What is NH4 Ammonia?

toxic byproduct of nitrogen metabolism

What happens if the detoxification does not exist?

toxic levels will rise

Ex. Ammonia NH4

What happens to to Ammonia NH4?

it is converted to urea then sent to then excreted by the kidneys

What is an accumulation of ammonia called?

Fetor Hepaticus

How can we tell if a patient has Fetor Hepaticus?

fruity breath

confusion

coordination loss

coma

tremor

Fetor Hepaticus

What are the two most important lab values to look at?

BUN

creatin

What is BUN?

Blood Urea Nitrogen

What happens when drugs are not detoxified?

drug dosages may need to be lowered because they are not removed by the liver

What happens when hormones are not detoxified?

hormones rise

What happens in men with cirrhosis?

liver can't break down estrogen

gynecomastia

testicular atrophy

What is in bile?

water

bile salts

bile pigments

cholesterol

lecithin

protein

What does the Liver function test consist of?

AST

ALT

LDH

Alkaline Phosphatase

Bilirubin (direct, indirect, total)

Prothrombin time

Albumin & Globlins

Aspartase Aminotransferase

AST

present in tissue but only released in blood when tissue is damaged

What is an old name for AST

SGOT

What would be a common cause for elevation of AST?

Acute hepatitis

Cirrhosis

Infectious Mononucleosis

What can cause splenomegaly?

Infectious Mononucleosis

True or False?

AST is elevated before jaundice occurs

True

What is one draw back with AST lab?

AST is non specific

it can be produced by any organ with a high metabolism rate.

Alanine Aminotransferase

ALT

tends to be used to monitor patients after jaundice has occured

liver specific

What are some causes of low levels of ALT?

acute cirrhosis

hepatic metastasis

pancreatis

What are some causes of mid levels of ALT?

obstruction

What are some causes of high levels of ALT?

hepatocellular disease

toxic hepatitis

Lactic Acid Dehydogenase

LDH

present in tissue but not released unless there has been cell death or damage

Why is LDH not a good liver test?

detects heart attacks

elevated in myocardial infarction & pulmonary infarction

What could be the cause of elevation of Alkaline Phosphatase

obstruction caused by gallstones

What is the patient prep for a liver exam?

fast for at least 6 hours

What should be explained to the patient for a liver exam?

The sonographer should explain to the patient that the exam is being performed to visualize the liver and interdependent organs.

How should the patient be dressed for the exam?

The patient should remove any restrictive clothing above the waist. A towel should be tucked around clothing to protect them from gel.

What transducer should be used to visualize the liver?

3.25 MHz sector or curved linear array.

What transducer should be used to visualize the liver in an obese patient?

2.25 MHz sector or curved linear array.

What transducer should be used to visualize the liver on a pediatric patient?

5.0 MHz sector or curved linear array.

What transducer should be used to visualize the liver on a neonate?

7.4 MHz sector or curved linear array.

Explain the procedure of a liver exam.

Begin doing a full sweep through the liver. Starting sagittal, slightly to the left of midline. Change to a transverse view and sweep up and down the left lobe from a subcostal approach. Look in transverse through the right lobe subcostally or intercostally.
Look for:

• Parenchymal echogenicity
• Capsular contour (smooth, coarse, lobulated)
• Size
• Vascularity
• Fluid
• Masses

Start taking images.
Document the normal anatomy and any pathology found, including measurements and vascularity if indicated.

What is important medical history?

Sex

Age

Weight

Prior Hepatic Conditions

Family History of Hepatic Conditions

What position should be used for an exam on the liver?

Supine
left lateral decubitus, left posterior oblique, semi-erect, or prone may be used as necessary

What are the scan plans used during a liver exam?

Sagittal and Transverse

Explain the Sagittal plane for the liver exam.

The transducer may be swept under the intercostal margin to image the liver parenchyma from the anterior abdominal wall to the diaphragm.

Explain the Transverse plane for the liver exam.

The transducer should be angled in a steep cephalic direction to be as parallel to the diaphragm as possible. The transverse plan allows images of liver parenchyma, vascularity and ductal structures.

What are the Techniques used for the liver exam?

Deep inspiration and held.

Push belly out.

Alternate positions can be used to displace the bowel out of the field of view.

Place right arm above head to open intercostal spaces

Give an anatomical description of the liver.

The liver is the largest internal organ. It lies in the right upper quadrant, from the right hypochondria, extending through the epigastrum to the mammary line of the left hypochondria. Generally it lies from the diaphragm to the level of the 8th rib. Size and shape is variable. The liver is covered by the Glisson’s capsule (fibrous peritoneum), except for the bare area that is in contact with the diaphragm. The liver is dived into four lobes.

Give an anatomical description of the left liver lobe.

further divided into lateral and medial segments by the left intersegmental fissure.

Give an anatomical description of the right liver lobe.

divided from the left lobe by the main lobar fissure which passes from the gallbladder fossa to the inferior vena cava. The right lobe is further divided into anterior and posterior segments by the right intersegmental fissure.

Give an anatomical description of the caudate liver lobe.

found on the inferior, posterior side of the liver. The caudate lobe is bordered by the inferior vena cava posteriorly and the ligament venosum anteriorly. The hepatic veins run between the lobes and segments. The portal veins run centrally within the segments. The ascending portion of the left portal runs in the left intersegmental fissure.

Give an anatomical description of the medial left liver lobe.

also called the Quadrate lobe, is bordered by the porta hepatis posteriorly, laterally by the gallbladder fossa and ligament terres.

What are appropriate reasons to perform a liver exam?

Jaundice
Fatigue
Bruises
Nausea
Vomiting
Abdominal pain
Abnormal tenderness
Anorexia
Weight loss

Decreased appetite

Dark urine
Diarrhea
Blood in stool
Edema
Persistent fever
Bronze skin
Encephalopathy
Pruritus

Cholecystectomy

Congestive heart failure
Palpable mass
Tremors
Bloating
Swelling in the abdomen
Respiratory Infections

What are some appropriate history questions?

When was the last time you had something to eat or drink?

Are you in pain?

Where is your pain located?

How long have you been in pain?

How long does the pain last and does it go away?

Have you had a nausea or vomiting?

Are you experiencing any other symptoms?

Do you have a family history of cancer?

Have you had any lab work done?

What is the liver protocol?

Sagittal
Left lobe (wedge)
Left lobe W/ caudate lobe
Left lobe W/ aorta
Right lobe W/ IVC
Right lobe W/ dome
Right lobe W/ Morrison’s pouch
Liver/kidney comparison
Right lobe W/ gallbladder

Transverse
Left lobe (wedge)
Left lobe W/ portal vein
Left lobe W/ ligament teres
Right lobe W/ hepatic veins, IVC
Right lobe W/ dome
Right lobe W/ portal veins
Right lobe W/ kidney and gallbladder

Other Images
Transverse Pancreas
-head to tail
Abnormal findings
-Color Doppler
-Measurements
Measurements
-right lobe if indicate

What are the normal variants of the liver?

Riedel’s lobe

Absence of left lobe

Multiple sizes

Multiple shapes

What are proper measurements for the liver exam?

Liver size may be measured sagittal from the inferior tip of the liver to the dome

Length: 20 cm

Anterior Posterior: 15 cm

C/RL: <0.6

What are common pitfalls for the liver exam?

Obesity

The patient ate before the study

Metabolic disorders such as fatty infiltration will reduce detail

Shadowing

Gas

What is the liver function tests?

Aspartate aminotransferase (AST): 5 – 40 units per liter of serum
Alanine aminotransferase (ALT): 7 – 56 units per liter of serum
Lactic acid dehydrogenase (LDH): 122 – 222 U/L
Alkaline phosphatase (alk phos): 45 – 115 U/L
Bilirubin: 0.1 – 1.0 mg/dL
-Indirect: 0.2-0.7 mg/dL
-Direct: 0 – 0.3 mg/dl
-Total: 0.1 – 1.2 mg/dl
Prothrombin time: 9.5 – 13.8 seconds
Albumin: 3.5 – 5 g/dL
Globulins: 13.5 – 16.5

What are important labs used for a liver exam?

White blood count (WBC): 4,500 – 10,000

Red blood count (RBC): 4.5 – 5.5

Hemoglobin (hbg): 13.5 – 16.5

Hct: 41 – 50

Creatine: 0.5 – 1.4 mg/dl

Cholesterol: <200 mg/dl

Glucose: 60-110 mg/dl

Urinary bile and bilirubin: 1.2 mg/dl

Urinary urobilinogen: 0 – 8 mg/dl

Fecal urobilinogen: 57 to 200 mg./24 hours

Diffuse Hepatocellular disease

Affects the hepatocytes and interferes with liver function

What is the sonographic appearance of the Diffuse Hepatocellular disease?

Increased echogenicity
Enlargement of affected area
Decreased penetration
Difficult to identify liver structures
Presentation: Asymptomatic, jaundice, nausea, vomiting and abnormal tenderness

What are the presenting symptoms of Diffuse Hepatocellular disease?

Asymptomatic

jaundice

nausea

vomiting

abnormal tenderness

What are the presenting symptoms of acute Diffuse Hepatocellular disease?

Abnormal Liver Function Test

What is Fatty infiltration?

Fatty liver is an acquired but reversible disorder of metabolism. Fatty filtration implies increased lipid accumulation in the hepatocytes.

What is the sonographic appearance of fatty filtration?

Increased echogenicity
Increased echogenicity
Enlargement of the lobe.
Decreased penetration
Difficult to image
Increased echo texture

What are the presenting symptoms of fatty filtration?

Asymptomatic

jaundice

nausea

vomiting

abnormal tenderness.

What lab values would suggest fatty filtration?

↑Hepatic Enzymes

↑Alk Phos

↑Direct Bilirubin

What are common causes of fatty filtration?

ETOH abuse

Diabetes Mellitis

Obsesity

steroids

What is acute hepatitis?

Inflammatory and infectious disease of the liver caused by complications of liver damage. May be mild to severe.

What is the sonographic appearance of acute hepatitis?

Mild: Normal echogenicity
Slightly increased echogenicity
Echogenic portal radicals
Prominent portal walls
Hepatosplenomegaly
Thickened gallbladder wall

What are the presenting symptoms of acute hepatitis?

Asymptomatic

jaundice

nausea

vomiting

abnormal tenderness.

What are the lab values that would suggest acute hepatitis?

↑AST

↑ALT

↑Bilirubin

Leukopenia

What is Chronic hepatitis?

Hepatitis becomes chronic when the inflammation lasts longer than 6 months.

What is the sonographic appearance of chronic hepatitis?

Increased echogenicity
Hypoechoic portal triads.
Fibrosis
Soft posterior shadowing may be apparent.
Difficult to visualize liver structures

What are the presenting symptoms of chronic hepatitis?

nausea

vomiting

anorexia

weight loss

tremors

jaundice

dark urine

fatigue

varicosities

What are the lab values that would suggest chronic hepatitis?

↑AST

↑ALT

↑Bilirubin

Leukopenia

What is Cirrhosis?

A chronic degenerative disease in which there is parenchymal necrosis, regeneration and fibrous tissue resulting in disorganization of lobular architecture. Lobules are infiltrated with fat. Commonly caused by alcoholism.

What is the sonographic appearance of Cirrhosis?

Hepatomegaly
Increased echogenicity and attenuation
Size decrease of right lobe
Size increase of left and caudate lobe
Nodularity
Fibrosis
Hepatospenomegaly
Ascites
Portal hypertension
Hepatoma tumors
caudate lobe may be spared

What are the presenting symptoms of Cirrhosis?

fatigue

bruises

jaundice

edema

dark urine

blood in stool

fever

Echogenic portal radicals

flatulence.

What are the lab values that would suggest Cirrhosis?

↑Alk Phos

↑Direct Bilirubin

↑AST

↑ALT

Leukopenia

What is Glycogen storage disease?

Characterized by the abnormal storage and collection of glycogen in the tissue of the liver and kidneys. Most common type I – Von Gierke’s

What is the sonographic appearance of Glycogen storage disease?

Hepatomegaly
Increased echogenicity and attenuation
Hepatic adenomas
Focal nodular hyperplasia.
Round, homogenous, echogenic tumors

What are the presenting symptoms of Glycogen storage disease?

Non-Specific

What are the lab values that would suggest Glycogen storage disease?

Disturbances in Acid-Base Balance

What is Hemochromatosis?

This is a rare disease involving excess iron deposits. May lead to cirrhosis and portal hypertension

What is the sonographic appearance of Hemochromatosis?

Hepatomegaly
Cirrhotic changes
Increased echogenicity

What are the presenting symptoms of Hemochromatosis?

Bronze skin

What are the lab values that would suggest Hemochromatosis?

↑Iron levels

What is Portal venous hypertension?

This is an increase in portal venous pressure (above 10mmHg) or hepatic venous gradient (above 5mmHg).

What is the sonographic appearance of Portal venous hypertension?

Portal vein measures greater than 13mm
Collateral circulation
Flow reversal
Ascites
Hepatosplenomegaly

What are the presenting symptoms of Portal venous hypertension?

Gastrointestinal bleeding

blood in the stools

vomiting of blood

Encephalopathy

What are the lab values that would suggest Portal venous hypertension?

↑Liver Enzymes

↓Platelet Count

What is Portal Venous Thrombosis?

Portal Venous Thrombosis

What is the sonographic appearance of Portal Venous Thrombosis?

Portal flow absence
echogenic thrombosis
Worm-like structures near porta hepatis

What are the presenting symptoms of Portal Venous Thrombosis?

vague and non-specific

What is Budd-Chiari Syndrome?

A rare disease which is caused by a thrombosis of the hepatic veins or IVC. Has a high mortality rate.

What is the sonographic appearance of Budd-Chiari Syndrome?

Ascites
Hepatomegaly
Enlarged caudate lobe
Atrophy of right lobe
Hyperechoic
Inhomogeneous
Fibrosis
Thick Gallbladder wall
Stenosis
Disrupted flow

What are the presenting symptoms of Budd-Chiari Syndrome?

non-specific

abdominal pain

Where is Budd-Chiari syndrome most common?

asia

What are the lab values that would suggest Budd-Chiari Syndrome?

Albuminuria

↑Alk Phos

↑AFT

What is Proximal Biliary obstruction?

Proximal Biliary obstruction proximal to the cystic duct can be caused by gallstones.

What is the sonographic appearance of Proximal Biliary obstruction?

Dilated intrahepatic ducts
Carcinoma in the CDB
Gallstones
Gallbladder normal after fatty meal

What are the presenting symptoms of Proximal Biliary obstruction?

Jaundice

pruritus

What are the lab values that would suggest Biliary obstruction?

↑Direct Bilirubin

↑Alk Phos

What is Distal Biliary obstruction?

Biliary obstruction distal to the cystic duct

What is the sonographic appearance of Distal Biliary obstruction?

Stone in the common duct
Extrahepatic mass
Dilated intrahepatic ducts
Gallstones
Gallbladder usually small

What are the presenting symptoms of Distal Biliary obstruction?

Jaundice

pruritus

What are the lab values that would suggest Distal Biliary obstruction?

↑Direct Bilirubin

↑Alk Phos

What is Extrahepatic mass?

A mass in the area of the porta hepatis

What is the sonographic appearance of Extrahepatic mass??

Stone in the common duct
Extrahepatic mass
Dilated intrahepatic ducts
Gallstones
Gallbladder usually small

What are the presenting symptoms of Extrahepatic mass??

Jaundice

pruritus

What are the lab values that would suggest Extrahepatic mass??

↑Direct Bilirubin

↑Alk Phos

What is Common Duct Stricture?

Sonographic Appearance:

What is the sonographic appearance of Common Duct Stricture?

Common Duct Stricture

What are the presenting symptoms of Common Duct Stricture?

jaundice

past cholecystectomy

increase in direct bilirubin

What are the lab values that would suggest Common Duct Stricture?

↑Direct Bilirubin

↑Alk Phos

What is Passive hepatic congestion?

develops secondary to congestive heart failure.

What is the sonographic appearance of Passive hepatic congestion?

Dilated IVC, SMV, Portal and Splenic veins

Hepatomegaly

What are the presenting symptoms of Passive hepatic congestion?

congestive heart failure.

What are the lab values that would suggest Passive hepatic congestion?

↑ LFT

What is Simple hepatic cysts?

A hepatic cyst is usually a solitary, non-parasitic cyst of the liver. solitary or multiple. More common in females.

What is the sonographic appearance of hepatic cysts?

Solitary or multiple
Thin well-defined walls
Anechoic
Posterior enhancement
Rarely fine, linear internal septa, Calcification

What are the presenting symptoms of hepatic cysts?

Asymptomatic

localized pain

What is Congenital hepatic cysts?

A rare lesion that caused by developmental defects in the formation of bile ducts.

What is the sonographic appearance of Congenital hepatic cysts?

Usually solitary
Varying size
Thin well-defined walls
Anechoic
Posterior enhancement
Generally right lobe lesion

What is Peribiliary Cysts?

Very small cysts that range from .2 to 2.5 cm. They are most common in patients with severe liver disease.

What is the sonographic appearance of Peribiliary Cysts?

clusters with a tubular appearance
thin septations that run parallel to the bile ducts and portal veins

What is Polycystic liver disease?

This is an autosomal dominant genetic disease in which multiple small cysts cover the liver. 60% of patients with polycystic liver disease will have polycystic kidney disease.

What is the sonographic appearance of Polycystic liver disease?

Anechoic
Thin well-defined walls
Posterior enhancement
Multiple
Varying in small size

What are the presenting symptoms of Polycystic liver disease?

abdominal pain

bloating or swelling in the abdomen

feeling full

What are the lab values that would suggest Polycystic liver disease?

↑WBC

What is Pyogenic abscess?

A pus-forming abscess caused by bacteria. The most common bacteria is Escherichia coli and anaerobes.

The most frequent organism causing the infection is Escherichia coli or anaerobes

What is the sonographic appearance of Pyogenic abscess?

Sonographic Appearance:
Varying size
hyperechoic
round or oval margins
Internal debris
Posterior enhancement
Shadowing
Presentation: fever, pain, pleutitis, nausea, vomiting, diarrhea. Elevated liver function tests, leukocytosis, and anemia. The most frequent organism causing the infection is Escherichia coli or anaerobes
Lab Values: ↑WBC, LFT

What are the presenting symptoms of Pyogenic abscess?

fever

pain

pleutitis

nausea

vomiting

diarrhea

What are the lab values that would suggest Pyogenic abscess?

↑WBC

LFT

What is Hepatic candidiasis?

This is caused by a type of Candida fungus usually in immunocompromised patients.

What is the sonographic appearance of Hepatic candidiasis?

Multiple
small
bull’s-eyes or target lesions
Hypoechoic mass
echogenic core

What are the presenting symptoms of Hepatic candidiasis?

persistent fever and localized pain

What are the lab values that would suggest Hepatic candidiasis?

↑WBC

What is Chronic granulomatous disease?

a genetic disorder in which phagocytes are unable to kill certain bacteria.

What is the sonographic appearance of granulomatous disease?

Sonographic Appearance:
Poor borders
hypoechoic mass
Posterior enhancement
Calcifications
shadowing

What are the presenting symptoms of granulomatous disease?

reoccurring respiratory infections

What are the lab values that would suggest granulomatous disease?

What is Amebic abscess?

A collection of pus formed by disintegrated tissue. Primarily a disease of the colon

What is the sonographic appearance of Amebic abscess?

Hypoechoic
Ill-defined walls
Round or oval
Internal echoes
Posterior enhancement

What are the presenting symptoms of Amebic abscess?

asymptomatic

abdominal pain

diarrhea leukocytosis

fever.

What are the lab values that would suggest Amebic abscess?

↑Leukocytes

What is Echinococcal cyst?

Infectious cystic disease common in sheep herders, a tapeworm that infects.

What is the sonographic appearance of Echinococcal cyst?

Simple
Complex cyst
Posterior enhancement
Round
oval
Calcifications
Septations
Water lily sign (cyst within cyst)

What are the presenting symptoms of Echinococcal cyst?

asymptomatic

abdominal pain

abnormal abdominal tenderness

hepatomegaly

abdominal mass

jaundice

fever

anaphylactic reaction

What are the lab values that would suggest Echinococcal cyst?

↑WBC

What is Cavernous hemangioma?

Benign congenital tumor of the liver. Most common and most frequent in females.

What is the sonographic appearance of hemangioma?

Hyperechoic
Posterior enhancement
Round, oval or lobulated
Well-defined walls
Mixed echogenicity from necrosis
Heterogeneous
Calcifications

What are the presenting symptoms of hemangioma?

RUQ pain

What are the lab values that would suggest hemangioma?

What is Liver cell adenoma?

tumor of glandular epithelial tissue. More commonly in women taking oral contraceptives.

What is the sonographic appearance of Liver cell adenoma?

Sonographic Appearance:
Well defined
Hyperechoic with central hypoechoic area
Solitary
Multiple
Fluid may be present

What are the presenting symptoms of Liver cell adenoma?

RUQ pain

What are the lab values that would suggest Liver cell adenoma?

What is Hepatic cystadenoma?

rare neoplasm in middle aged women

What is the sonographic appearance of Hepatic cystadenoma?

Multi – loculated lesion
mucinous fluid

What are the presenting symptoms of Hepatic cystadenoma?

palpable mass

What are the lab values that would suggest Hepatic cystadenoma?

What is Focal nodular hyperplasia?

This is the second most common benign liver mass in women over 40 years of age.

What is the sonographic appearance of Focal nodular hyperplasia?

Sonographic Appearance:
Subtle contour abnormalities
Hyperechoic to linear areas
Multiple nodule

What are the presenting symptoms of Focal nodular hyperplasia?

Asymptomatic

What are the lab values that would suggest Focal nodular hyperplasia?

What is Hepatocellular carcinoma?

HCC - This is the most common primary malignant neoplasm.

What is the sonographic appearance of Hepatocellular carcinoma?

Sonographic Appearance:
hepatomegaly
Appearance varies
Solitary
Multiple
Hypoechoic
Hyperechoic
Vessel with tumor invasion

What are the presenting symptoms of Hepatocellular carcinoma?

palpable mass

appetite disorder

fever

What are the lab values that would suggest Hepatocellular carcinoma?

↑alpha-protein test

Liver function test

↑Alk Phos

↑Direct Bilirubin

↑AST, ↑ALT

Leukopenia

What is Metastatic disease?

This is the most common form of neoplastic involvement of the liver. The primary sites include colon, breast, and lung.

What is the sonographic appearance of Metastatic disease?

Appearance varies
Multiple nodes
Solitary
Well defined
Echogenic to hypoechoic mass
Homogenous
Calcification
Necrosis

What are the presenting symptoms of Metastatic disease?

jaundice

hepatomegaly

weight loss

decreased appetite

What are the lab values that would suggest Metastatic disease?

Abnormal LFT

What is Lymphoma?

This is a malignant neoplasm which involves a rapid increase of lymphocytes in the lymph nodes. Hodgkins, and Non-Hodgkins lymphoma.

What is the sonographic appearance of Lymphoma?

hepatomegaly
Hypoechoic target lesions
Anechoic
Solid with no enhancement
Hepatosplenomegaly

What are the lab values that would suggest Lymphoma?

abnormal LFTs

What is Hepatic trauma?

injury

What is the sonographic appearance of Hepatic trauma?

Hyperechoic hematomas
Hyperechoic to anechoic
Unilateral fluid along laceration
Septations
varies

What are the presenting symptoms of Hepatic trauma?

varies

What is Liver transplantation?

A liver transplant is performed when other conventional and surgical methods have failed the patient. The most common reason for a transplant is cirrhosis.

Scans should be performed 24, 48, and biweekly post operative

What is the sonographic appearance of transplantation?

Examine the portal venous system, hepatic arteries, the IVC, and parenchymal patterns
Examine the kidneys and the spleen
Asses the biliary system
Asses the vascular flow

What is the cause of the most common complication of a liver transplant?

hepatic arteries

What are the lab values that would suggest transplantation?

What is lymphadenopathy?

Swollen lymph nodes

What is lymphosarcoma?

lymphadenopathy in multiple organs

Pediatrics

What is Neuroblastomeas?

tumor of the adrenal

densely reflective

Pediatrics

What is Wilms tumor?

reflective with central lucency from necrosis

Pediatrics

What is Leukemia?

cancer of blood

reflective with central lucency from necrosis