1
Q
What are the 4 functions of the liver?
A
- Metabolism
- Digestion
- Storage
- Detoxification
2
Q
In patients with known liver disease, what type of test can help in the diagnosis?
A
Liver Function Test
3
Q
What refers to a group of laboratory tests established to analyze how the liver is performing under normal and diseased conditions
A
Liver Function Tests
4
Q
Name of the enzyme present in tissues with a high rate of metabolic activity?
A
Aspartate Aminotransferase (AST)
5
Q
What causes AST to be released into the bloodstream in abnormally high levels?
A
Death or injury to producing cells
6
Q
Any disease that injures the cells causes an elevation in _____ levels
A
AST
7
Q
In what 6 cases pertaining to the liver is AST elevated?
A
- Hepatitis
- Fatty liver
- Hepatic necrosis
- Mononucleosis
- Cirrhosis
- Metastatic liver disease
8
Q
Alanine Aminotransferase is mildly elevated in what?
A
- Acute cirrhosis
- Hepatic metastasis
- Pancreatitis
9
Q
Alanine Aminotransferase is mild to moderately elevated in cases of?
A
Obstructive Jaundice
10
Q
Alanine Aminotransferase is moderate to highly elevated in what 3 cases?
A
- Hepatocellular disease
- infections hepatitis
- Toxic hepatitis
11
Q
__________ is produced by the liver, bone, intestines and placenta
A
Alkaline Phosphatase
12
Q
Alkaline Phosphatase is a good indicator of what 5 diseases?
A
- Obstruction
- Hepatic carcinoma
- Abscess
- Cirrhosis
- Hepatitis
13
Q
__________is secreted as bile by the liver cells into the bile ducts
A
Bilirubin
14
Q
What is bilirubin?
A
Product of the breakdown of hemoglobin in tired red blood cells
15
Q
The Bilirubin process can be disturbed in what 3 ways
A
- Excessive amount of red blood cell destruction
- Malfunction of liver cells
- Blockage of ducts leading from cells
16
Q
Conjugated bilirubin name?
A
Direct bilirubin
17
Q
Unconjugated bilirubin name?
A
Indirect bilirubin
18
Q
Indirect bilirubin is elevated in what 3 cases?
A
- Anemias
- Trauma from hematoma
- Hemorrhagic pulmonary infarct
19
Q
Elevation of direct bilirubin is usually related to obstructive jaundice from ________ or _________.
A
stones; neoplasm
20
Q
Hepatic metastisis, hepatitis, lymphoma, cholestasis secondary to drug use, and cirrhosis will elevate both ________ and _________ ___________.
A
direct; indirect; bilirubin
21
Q
____________ is increased in the presence of liver disease?
A
Prothrombin time
22
Q
__________ is part of the blood clotting mechanism?
A
Prothrombin time
23
Q
Prothrombin time is increased in the presence of liver disease with cellular damage in what two cases?
A
- Cirrhosis
2. Metastatic disease
24
Q
_________ affects the hepatocytes and interferes with liver function
A
Diffuse disease
25
________are parenchymal liver cells that performs all the functions?
Hepatocytes
26
7 common causes of diffuse disease?
1. Alcoholic liver disease
2. Diabetes
3. Obesity
4. Pregnancy
5 Severe hepatitis
6. Chronic illness
7. Steroids
27
Diffuse disease patients are usually asymptomatic, however some may present with these 4 symptoms
1. Jaundice
2. Nausea
3. Vomiting
4. Abdominal pain
28
________increases lipid accumulation in the hepatocytes
Fatty infiltration
29
Sonographic findings of fatty infiltration?
- increased echogenicity
- Enlargement of affected lobe
- difficulty penetrating the entire liver
- portal veins may be difficult to visualize due to attenuation
30
General term for inflammatory and infectious disease of the liver?
Hepatitis
31
What are the three causes of hepatitis?
1. local infection (viral hepatitis)
2. infection elsewhere in the body (mono)
3. Chemical or dug toxicity
32
Mild inflammation impairs hepatocyte fuction, whereas more severe inflammation may lead to obstruction of ________ and _______ flow in the liver and impaired liver cell function.
blood; bile
33
what are the 5 types of hepatitis?
1. hav
2. hbv
3. hcv
4. hdv
5. hev
34
HBV is ___ % in the US
60
35
HAV is _____% in the US
20
36
Other types of hepatitis is _____% in the US
20
37
What type of hepatitis is found in saliva, semen, and can spread through sexual contact or through blood?
HBV
38
What type of hepatitis is at greatest risk for healthcare workers?
HBV
39
HBV symptoms? (4)
1. flu-like
2. loss of appetite
3. vomiting
4. fatigue
40
What disease can range from mild damage to massive necrosis and liver failure?
Acute hepatitis
41
Acute Hepatitis sonographic findings (4)
1. liver texture may be normal
2. attenuation may be present
3. hepatosplenomegaly
4. gallbladder wall thickening
42
_________ exists when there is evidence of hepatic inflammation for at least 3-6 months
chronic hepatitis
43
what are symptoms of chronic hepatitis? (7)
1. nausea
2. anorexia
3. weightloss
4. tremors
5. jaundice
6. dark urine
7. fatigue
44
Diagnosis these symptoms: nausea, anorexia, weight loss, tremors, jaundice, dark urine, fatigue
chronic hepatitis
45
Chronic hepatitis sonographic findings (3)
1. Liver texture is coarse
2. Decreased brightness of portal triad
3. No increase in size
46
Diagnose these sonographic findings:
1. liver texture may be normal
2. attenuation may be present
3. hepatosplenomegaly
4. gallbladder wall thickening
Acute hepatitis
47
________ is a chronic degenerative disease of the liver
cirrhosis
48
Diagnose these sonographic findings:
1. lobes are covered with a fibrous tissue
2. the parenchyma degenerates
3. the lobes are infiltrated with fat
cirrhosis
49
What disease is most commonly the result of chronic alcohol abuse but can also be the result of nutritional deprivation, hepatitis, or infection
cirrhosis
50
Name 3 types of cirrhosis
1. biliary
2. fatty
3. posthepatic
51
Name the acute cirrhosis symptoms? (9)
1. possibly asymptomatic
2. nausea
3. flatulence
4. ascities
5. light colored stool
6. weakness
7. abdominal pain
8. varicosities
9. spider angiomas
52
diagnosis these symptoms:
1. possibly asymptomatic
2. nausea
3. flatulence
4. ascities
5. light colored stool
6. weakness
7. abdominal pain
8. varicosities
9. spider angiomas
Acute Cirrhosis
53
what type of cirrhosis has a symptom of dark urine?
chronic cirrhosis
54
_______ may lead to liver failure and portal hypertension?
Chronic cirrhosis
55
diagnosis these sonographic finding:
1. diagnosis with ultrasound may be difficult
2. coarsening of the liver parenchyma
3. nodularity
4. increased attenuation
5. decreased vascular markings
6. hepatosplenomegaly
7. Ascites surrounding the liver
8. portal hypertension with or without abnormal doppler
9. increased incidence of hepatic tumors
10. late stage may show atrophy of liver
Cirrhosis
56
Cirrhosis sonographic findings
1. diagnosis with ultrasound may be difficult
2. coarsening of the liver parenchyma
3. nodularity
4. increased attenuation
5. decreased vascular markings
6. hepatosplenomegaly
7. Ascites surrounding the liver
8. portal hypertension with or without abnormal doppler
9. increased incidence of hepatic tumors
10. late stage may show atrophy of liver
57
________ can occur anywhere in the liver
cysts
58
Are cyst more common in men or women with increasing age?
women
59
Enlarging simple cyst may cause ______?
pain
60
Walls of simple cyst are _____ and ______?
thin; well defined
61
T or F
| Simple Cyst are asymptomatic?
T
62
T or F
| Cyst are large (4-5 cm)
False
| cyst are small (less than 2-3 cm)
63
_____% have associated polyycystic renal disease
60
64
T or F
| 1 in 500 with polycystic renal disease
T
65
Sonographic findings of cysts
```
Anechoic
well defined borders
posterior enhancement
ultrasound may be used for guided aspiration
multiple cyst throughout the liver
cysts are small (2-3 cm)
```
66
_______ is parasitic or infectious collections in the liver
Abscesses
67
_______ contains seous fluid, pus, degris or blood clots
abscesses
68
Tiny gas forming organisms may develop within ________
Abscesses
69
T or F
| Abscesses have regular or irregular edges
True
70
Symptoms of Abscesses (7)
1. Patients are usually very ill
2. RUQ pain
3. Tender hepatomegaly
4. Fever
5. Nausea
6. Vomitting
7. Weightloss
71
Diagnosis these symptoms
1. Patients are usually very ill
2. RUQ pain
3. Tender hepatomegaly
4. Fever
5. Nausea
6. Vomitting
7. Weightloss
Abscesses
72
_______ are pus forming abscess, usually caused by bacteria.
pyogenic abscess
73
Pyogenic abscess gains abscess to the liver, from the ______,_______ or _______
biliary tree, portal vein, hepatic artery
74
Diagnosis this symptom:
1. fever
2. pain
3. pleuritis
4. nausea
5. vomiting
6. diarrhea
7. leukocytosis
phyogenic abscess
75
phyogenic abscess symptoms
1. fever
2. pain
3. pleuritis
4. nausea
5. vomiting
6. diarrhea
7. leukocytosis
76
what treatment is used for pyogenic abscess
antibiotic and/or drainage
77
pyogenic abscesses size vary from__cm to _____
1cm to very large
78
```
diagnosis these sonographic findings
variable
size varies 1cm to very large
rt. central lobe is the most common site
may be hypoechoic or complex
may have fluid level
may be hyperechoic with dirty shadow due to gas
```
pyogenic abscess
79
pyogenic abscess sonographic findings
```
variable
size varies 1cm to very large
rt. central lobe is the most common site
may be hypoechoic or complex
may have fluid level
may be hyperechoic with dirty shadow due
```
80
Bowel is most commonly infected in?
Amebic abscess
81
Amebic abscess infection may spread to the ____, ____ or _____ by the bloodstream
liver, brain or lungs
82
Amebic Abscess symptoms
```
Low fever
leukocytosis
GI symptoms
-abd. pain
-diarrhea
```
83
__________ is an infectious cystic disease common in sheep hearding areas of the world
Echinococcal cyst
84
________ is a tapeworm that resides in the small intestines of dogs
echinococcus
85
What type of cyst has larvae enter the small intestine and burrow through the mucosa then enters the portal circulation and travels to the liver
Echinococcal cyst
86
a ______ cyst has two layers, may enlarge and rupture, may impinge onthe blood vessels and lead to vasculaqr thrombosis and infarctions
Echinococcal cyst
87
Sonographic Findings
- may be simple or complex
- oval or spherical
- may contain calcifications
- septations are frequent- honeycomb appearance
Echinococcal Cyst
88
A benign congenital tumor consisting of a large blood filled cystic spaces
Cavernous Hemangioma
89
What is the most commone benign tumor in the liver, most common in females, and most common in the right lobe
Cavernous Hemangioma
90
Name symptoms of Cavernous Hemangioma
- Asymptomatic
| - small percentage mayb bleed causing RUQ pain
91
Sonographic Findings
- Hyperechoic
- Posterior Enhancement
- Round or oval
- May be lobulated
- Well defined borders
- May have mixed echo patterns due to necrosis
Cavernous hemangioma
92
Benign mass of epithelial cells, more commonly in women and are related to long term oral contraceptives
Adenoma
93
Name symptoms of Adenoma
- usually asymptomatic
| - have RUQ pain to hemorage
94
Name turmor that is asymptomatic, with RUQ pain to hemorage
Adenoma
95
Name tumor for these sonographic findings:
- usually well circumscribed
- variable in size and shape
- similar appearance to hemangiomas or metastatic massses
Adenoma
96
What is the second most common benign liver mass after hemangioma
Focal nodular hyperplasia
97
What tumor is asymptomatic, hemorrrhage is rare, and no malignant potential?
Focal nodular hyperplasia
98
Name the tumor most commonly seen in females under the age of 40
Focal nodular hyperplasia
99
Name tumor with these sonographic findings:
- well defined
- hyperechoic or isoechoic to surrounding liver tissue
- ulually less than 5 cm
- Can be mistake for an adenoma or hemangioma
Focal nodular hyperplasia
100
Name the three Benign Hepatic Tumors
Cavernous hemangioma
adenoma
Focal nodular hyperplasia
101
Name the two malignant hepatic tumors
hepatocellular carcinoma
| Metastatic disease
102
clinical sign of a malignant hepatic tumor (7)
-nausea
-vomiting
-fatigue
-weight loss
-hepatomegally
-portal hypertension
splenomegaly
103
Which tumor is related to cirrhosis
Hepatocellular carcinoma
104
80% of patients with preexisting cirrhosis develop _________. Occurs more frequently in men.
Hepatocellular carcinoma
105
Symptoms of ____________.
- hx of cirrhosis
- palpable mass
- appetite disorder
- hepatomegally
- fever
Hepatocellular carcinoma
106
Which tumor is present in three patterns?
- solitary massive tumor
- Multiple nodules throughout the liver
- Diffuse infiltrative masses in the liver
Hepatocellular carcinoma
107
________tumor may invade the hepatic veins to produce __________. Portal venous system may also be invaded.
Hepatocellular carcinoma, Budd-Chiari syndrome
108
Sonographic appearence:
- Solid discrete masses
- diffuse parenchyma involvement
- combination
Hepatocellular carcinoma
109
_________ is more common than primary liver tumors
Metastatic disease
110
Metastatic disease is most common _____ of the liver
neoplasm
111
Metastatic disease most common primaries _______,_________,_________.
Colon
Breast
Lung
112
Metastatic spread occurs as the tumor ______ the wall and travels through the ______ ________ or through the bloodstream to the portal vein or hepatic artery to the liver.
erodes, lymphatic system
113
Sonographic appearence:
- varies
- typically there are multiple lesions throughout both lobes
Metastatic disease
114
What are the four patterns of Metastatic disease
- well defined hypoechoic mass
- well defined echogenic mass
- diffuse distortion of the normal liver parenchyma
- Targey or Bull's Eye lesion
115
Which disease has the target or Bull's eye lesion?
metastatic disease
116
Metastatic disease is a result due to _____ around the tumor or _______or _________ within the tumor
edema, necrosis, or hemorrhage
117
Metastatic disease as the tumor grows rapidly in size they outgrow their _____ _____ and _________ or hemorrhage can occur within the tumor.
blood supply,necrosis
118
_______ and _________ _________ present a complex waveform, which flows above and below the baseline, relecting the reflux of blood from the right atrium during systome and variations with the respiratory cycle
IVC & Hepatic Veins
119
Thrombosis of the ___________ is called Budd-Chiari Syndrome
hepatic vein
120
Sonograpically with hepatic vascular flow abnormalities the hepatic veins appear?
reduced in size and may contain echogenic thrombotic material
121
The presence of _______blood flow in the hepatic veins permits the exclusion of _____________
typical, Budd-Chiari syndrome
122
Budd Chiari syndrome is associated with?
- hematologic disorder
- oral contraceptives
- Collagen disease
- Echinococcus
- Before and after pregnancy
123
What syndrom is associated with oral contraceptives?
Budd Chiari syndrome
124
In portal veins the flow is ___________.
Hepatopetal(towards the liver)
125
Flow is hepatopetal, relatively continuous, and varies slightly with respirations with what vein?
portal vein
126
Sonographic findings:
- lack of doppler signal indicates absence of blood flow
- in cirrhotic patiens, thrombosis is often supsected when ascitese suddenly worsens
Portal vein thrombosis
127
What are the indirect signs of a portal vein thrombosis?
-loss of normal portal venous landmarks
-dilation of the SMV and splenic veins
venous collaterals in the porta hepatis
128
Portal veins may be ________to visualize in patients with cirrhosis.
difficult
129
The portal vein should be examined in what kind of patients?
cirrhotic patients
130
An increase in portal venous pressure or hepatic venous gradient
Portal venous hypertension
131
Majority of the time an increase in portal venous pressure or hepatic venous gradient is a result of ?
intrinsic liver disease
132
Portal venous pressure can also be obstructed by _______,______ and _________or prolonged congestive heart failure
protal vein, hepatic vein, IVC
133
_______or ________ hepatocellular disease can block the flow of blood throughout the liver, causing it to back up into the ___________.
Acute or Chronic, hepatic portal circulation
134
In portal venous hypertension doppler techniques are used to determine ?
wheter blood flow in the portal vein is hepatopeta (towards) or hepatofugal(away)
135
What are the doppler findings of Portal Venous Hypertension?
- portal vein shows low velocity
- patent paraumblical vein
- respiratory variations of the vessel is uaually lost vecause the veins do not collapse with breathing
136
Sonographic Findings:
- Dilated PV, SV, and SMV
- patent umbilical vein
- varicies
- splenomegaly with dilated splenci radicles
- dimished response to respiration
- dilated SA and HA
- Ascities-f
- small liver with irregularities
Portal Venous Hypertension
137
In patients with portal venous hypertension the blood flow may take one of seveal paths through? (5)
- coronary-esophagealvarices
- Splenic varices
- Splenorenal shunts
- Recanalized umbilical vein
- Surgical Shunts
138
Splenic varices the flow in main, right and left portal vein is _________? Flow in splenic vein is __________? Flow in the SMV is ________?
reversed/ hepatofugal, reversed, normal
139
In Splenorenal Shunts flow in main, right and left portal vein is _______? Flow in splenic vein is __________? Flow in SMV is __________?
reversed/hepatofugal, reversed, normal
140
In recanalized umbilical vein flow in the main and left portal vein is ________. flow in the right portal vein is __________? flow in the SMV and splenic vein is ________?
normal/hepatopetal, reversed/hepatofugel, normal
141
What are the four spontaneious shunting sites?
1. coronary-gastroesphageal
2. paraumbilical vein
3. hemorrhoidal anastomoses
4. retroperitoneal anastomoses
142
which spontaneous shunting spot is most common?
coronary gastroesophageal
143
the spontaneous shunting of the coronary gastroesophageal occurs where the esophageal branches of the ________ form anastomeses with branches of the _______ and _______veins in the lower esophagus.
left gastric vein, azygos, hemiazygos vein
144
appears as a continuation of the left portal vein and extends to the anterior abdominal wall near the umbilicus?
paraumbilical vein
145
__________ sponatneous shunting occurs between the superior and middle hemorrhoidal veins?
Hemorrhoidal anastomoses
146
Vascular structures withing the lesser omentum may cause thickening of the omentum. Small vessels may be seen around the pancreas.
Retroperitoneal anastomoses
147
TIPS
Transjugular intrhpetic portosystemic shunt
148
Mesocaval
SMV and IVC
149
Splenorenal
Splenic vein and renal vein
150
Portacaval
Portal vein and IVC
151
Four liver function tests?
1. Alanine Aminotransferase
2. alkaline Phosphatase
3. Bilirubin
4. Prothrombin time
152
Alkaline phosphatase is moderately elevated in what 2 cases?
1. Cirrhosis
| 2. Hepatitis
