Liver Abnormalities Quiz

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Questions and Answers

What ultrasound characteristic is commonly associated with gallstones?

Uniformly echogenic throughout

Anechoic appearance

Hypoechoic appearance

Hyperechoic appearance with posterior acoustic shadow (correct)

Which condition is likely indicated by a dilated inferior vena cava (IVC) during a scan?

Aortic stenosis

Left ventricular failure

Pulmonary embolism

Right ventricular heart failure (correct)

What laboratory findings typically indicate passive hepatic congestion?

Completely normal liver function tests

Markedly elevated liver function tests

Normal to slightly elevated liver function tests (correct)

Severely decreased liver function tests

Which characteristic is most commonly observed in intrahepatic masses?

Displacement of hepatic vascular radicles Signup and view all the answers

What is the typical appearance of a simple hepatic cyst on ultrasound?

Anechoic with well-defined borders Signup and view all the answers

Which of the following can be a characteristic of cystic lesions in the liver?

Fluid-filled mass with an epithelial lining Signup and view all the answers

What might internal echoes in a hepatic cyst indicate?

Hemorrhage or infection Signup and view all the answers

In which lobe is a simple hepatic cyst more frequently found?

Right lobe Signup and view all the answers

What is the main cause of an amebic abscess in the liver?

Protozoan parasite Signup and view all the answers

Which symptom is commonly associated with amebiasis?

Leukocytosis Signup and view all the answers

How does the Entamoeba histolytica parasite reach the liver?

Through the blood circulation Signup and view all the answers

What is a common characteristic of the ultrasound appearance of an amebic abscess?

Round or oval shape Signup and view all the answers

What type of abscess is associated with a high mortality rate in diabetic patients?

Gas-forming pyogenic liver abscess Signup and view all the answers

Which of the following describes the transmission of echinococcal cysts?

Through contaminated food or water Signup and view all the answers

In which geographical area is hepatitis echinococcosis most commonly found?

Shepherding areas Signup and view all the answers

What ultrasound finding is indicative of gas-forming pyogenic liver abscesses?

Bright white reflectors Signup and view all the answers

What is the typical ultrasound finding for a cavernous hemangioma?

Hyperechoic with well-defined walls Signup and view all the answers

Which statement accurately describes a malignant mass?

It is characterized by uncontrolled growth and potential metastasis. Signup and view all the answers

Which of the following is NOT a benign hepatic neoplasm?

Carcinoma in situ Signup and view all the answers

How often do multiple hemangiomas occur in patients?

In 10% to 20% of patients Signup and view all the answers

What is a characteristic feature of cavernous hemangiomas?

They consist of a large network of blood-filled vascular spaces. Signup and view all the answers

Who are hemangiomas more commonly found in?

Women Signup and view all the answers

Which feature is true about the growth pattern of cavernous hemangiomas?

They enlarge slowly and can undergo degeneration. Signup and view all the answers

What is a key characteristic of a simple hepatic cyst?

It has well-defined borders and is anechoic Signup and view all the answers

What is the term used to describe an incidentally found tumor mass?

Incidentaloma Signup and view all the answers

Which of the following is true regarding polycystic liver disease?

It shows multiple cysts in the liver and kidneys Signup and view all the answers

Which animals are commonly infected with echinococcal cysts?

Dogs, foxes, and wolves Signup and view all the answers

What is the most common route for bacteria to access the liver and cause a pyogenic abscess?

Via the biliary tree Signup and view all the answers

What sonographic appearance is specific for echinococcal disease when daughter cysts are present?

Large cyst with daughter cysts Signup and view all the answers

Which of the following clinical features is NOT typically associated with pyogenic liver abscess?

Severe abdominal distension Signup and view all the answers

What is a common sonographic pattern for hepatic candidiasis?

Target lesions Signup and view all the answers

What ultrasound appearance is indicative of a pyogenic liver abscess?

Hypoechoic with round or ovoid margins Signup and view all the answers

What is indicated by the term 'daughter cyst' in the context of echinococcal cysts?

A cyst that is specifically associated with echinococcal disease Signup and view all the answers

What proportion of patients with polycystic liver disease also have polycystic renal disease?

60% Signup and view all the answers

What type of infection is hepatic candidiasis primarily associated with?

Fungal infections Signup and view all the answers

What complication can arise from cysts within the porta hepatis in polycystic liver disease?

Biliary obstruction Signup and view all the answers

In patients with hepatic candidiasis, the most affected organs are typically the:

Kidneys, brain, and heart Signup and view all the answers

Which organism is most commonly associated with pyogenic liver abscesses?

Escherichia coli Signup and view all the answers

What feature is NOT commonly associated with echinococcal cysts on ultrasound?

Hypoechoic masses with echogenic centers Signup and view all the answers

What common presentation might indicate an echinococcal cyst in a patient?

RUQ pain and hepatomegaly Signup and view all the answers

What characteristic differentiates liver cell adenoma from focal nodular hyperplasia?

Absence of bile ducts Signup and view all the answers

Which clinical factor is associated with an increased incidence of liver cell adenoma?

Use of oral contraceptives Signup and view all the answers

What is the typical appearance of a liver cell adenoma on ultrasound examination?

Well-defined lesion with a central hyperechoic area and halo Signup and view all the answers

Which of the following symptoms might a patient with a ruptured liver cell adenoma experience?

Severe right upper quadrant pain Signup and view all the answers

During a Color Doppler ultrasound, what is expected in a cavernous hemangioma?

Hypovascularity with no flow visualization Signup and view all the answers

What is a common demographic characteristic of focal nodular hyperplasia?

More frequently occurs in females Signup and view all the answers

What is a potential complication of liver cell adenoma if it causes bleeding?

Lucent appearance of the mass Signup and view all the answers

What significant structural characteristic is associated with liver cell adenoma?

Solitary or multiple hyperechoic solid lesion Signup and view all the answers

Study Notes

Diffuse Abnormalities of the Liver Parenchyma

Biliary obstruction is the blockage of any bile duct.
Obstruction can be proximal or distal.
Causes of proximal obstruction include gallstones, carcinoma of the common bile duct, and metastatic tumor invasion.
Causes of distal obstruction include stones in the common bile duct and stricture of the common bile duct. Chronic pancreatitis or injury during cholecystectomy can lead to strictures.
Clinically, patients may present with jaundice, itching (pruritus), and elevated levels of direct bilirubin and alkaline phosphatase in liver function tests.
Sonograms show a tubular branching appearance with dilated intrahepatic ducts (in peripheral areas of the liver) for carcinoma of the common bile duct.
Imaging a discrete mass lesion may be difficult.
The gallbladder is often normal in size.

Passive Hepatic Congestion

Passive hepatic congestion arises secondarily from congestive heart failure.
Signs include hepatomegaly (an enlarged liver).
Lab data usually show normal to slightly elevated liver function tests.
Ultrasound can show a dilated inferior vena cava (IVC) and hepatic veins (HV).

Focal Hepatic Disease

Few hepatic lesions display specific sonographic features.
Differential diagnosis may include primary tumors, metastases, abscesses, hematomas, and cysts.

Cystic Lesions

A hepatic cyst is usually a solitary, nonparasitic cyst of the liver.
It's a fluid-filled mass with an epithelial lining.
These cysts can be congenital or acquired, and can be solitary or multiple.
Patients are often asymptomatic and don't require treatment.
Sonographic appearance typically shows an anechoic, thin-walled structure, with well-defined borders and posterior acoustic enhancement. In some cases, polycystic liver disease may be suspected and evaluation of the kidneys and other organs might be necessary.

Simple Hepatic Cysts

Sonographic findings are often incidental due to asymptomatic nature.
Growth can sometimes cause pain or a mass effect suggestive of serious conditions.
Female affectation is more common, and the right lobe is affected twice as often than the left.
Sonographic appearance shows a lack of internal echoes, with well-defined thin walls, and oval or rounded shape. Posterior acoustic enhancement is often evident.

Pyogenic Abscess

About 80% of hepatic abscesses are pus-forming.
Bacteria, often Escherichia coli, can access the liver through the biliary tree, portal vein, hepatic artery, or by contiguous infection and trauma.
Clinical signs may include fever, pain, pleuritis, nausea, vomiting, diarrhea, elevated liver function tests, leukocytosis, and anemia.
On ultrasound, abscesses appear as hypoechoic lesions with round or oval shapes, possibly without well-defined walls; size may range from 1 cm to very large.
Abscesses might exhibit acoustic enhancement; debris might be evident along the posterior margin, and walls might be irregular and thick.

Amebic Abscess

An amebic abscess forms from disintegrated tissue in a cavity, usually in the liver parenchyma, caused by the protozoan parasite Entamoeba histolytica.
Parasites reach the liver via the portal vein.
The condition is primarily a disease of the colon, but can spread to the liver, lungs, or brain.
Amebiasis is contracted through ingesting contaminated water or food.
Patients can be asymptomatic or experience gastrointestinal discomfort. Clinical symptoms can include pain, diarrhea, leukocytosis, and fever.
Ultrasound appearance varies but is typically round or oval, with a lack of well-defined wall echoes and hypoechoic when compared to normal liver parenchyma. The abscess may exhibit low-level echoes that are easier to see with higher-sensitivity imaging.

Hepatic Tumors

A neoplasm refers to any new growth of tissue, either benign or malignant.
Benign growths are usually contained locally; they don't spread to other places or enter surrounding structures.
Malignant masses lack controls, and can spread to surrounding tissue or other body parts via blood or lymph.

Benign Hepatic Neoplasm

Cavernous hemangioma: Benign congenital tumors containing large, blood-filled spaces; common in liver.
Liver cell adenoma: Often associated with oral contraceptives; can rupture and bleed causing severe pain.
Hepatic cystadenoma: Benign tumors; usually appear as cysts.
Focal nodular hyperplasia: Second most common benign liver mass after hemangioma; develops in younger women, and has no known cause or risk factor.

Hepatocellular Carcinoma (HCC)

HCC or Hepatoma is a common malignant liver tumor, frequently found in Southeast Asia, parts of Africa, Japan, Greece, and Italy; it's the fifth most prevalent cancer worldwide.
Its development is often linked to cirrhosis, ingestion of hepatocarcinogens, and chronic hepatitis B viral infection.
In the United States, approximately 80% of HCC cases feature pre-existing cirrhosis.
The incidence of HCC in cirrhotic patients in the US is about 5%.
Hepatocellular Carcinoma tends to invade hepatic veins leading to Budd-Chiari syndrome..
Liver function tests may reveal little abnormalities, except in cirrhosis.
Clinical symptoms can include nausea, vomiting, fatigue, weight loss, and hepatomegaly.
There are several morphological patterns, including; solitary massive tumor, multiple nodules, and diffuse infiltrated types. Different appearances on ultrasound include (1) hypoechoic (2) complex (3) echogenic.

Liver Hemangiosarcoma/Angiosarcoma

Rare; highly aggressive malignant tumor arising from liver blood vessels.
Associated with thoratrast, chemical carcinogens.
Symptoms often take decades to appear
Mostly found in patients over 60 years; frequently shows rapid metastasis
Common metastatic sites include the lung, spleen, lymph nodes, bone marrow, thyroid gland, and peritoneal cavity
Sonographic appearance depends on presentation time and is not specific, but generally appears as large solid or mixed lesions.

Metastatic Disease

Metastatic liver disease is more common than hepatocellular cancer.
Metastasis usually begins in lymph nodes, and the liver is the most common site for this.
Primary cancers that affect the liver include those in the gallbladder, colon, stomach, pancreas, kidneys, ovaries, breast and lung.
A common range for the incidence of metastatic liver tumors is 18-20 times more frequent than HCC
Approximately 40% of cancer patients show liver metastasis

Hepatoblastoma

Hepatoblastoma is the most common primary malignant tumor in children under the age of 5.
It's frequently connected to Beckwith-Wiedemann syndrome that shows patterns of overgrowth in body areas; it may also appear in children affected by HIV.
High serum alpha-fetoprotein levels are observed.
Clinical symptoms usually include hepatomegaly, palpable abdominal mass, jaundice, abdominal pain, weight loss, and anorexia.
Sonographic imaging often shows a solid mass with an abnormal hyperechoic or heterogeneous echotexture.

Hepatic Trauma

The liver is the third most common organ damaged during abdominal injuries after the spleen and kidneys.
The right lobe is the most frequently injured.
Sonographic imaging helps detect intraperitoneal or subcapsular/intrahepatic abnormalities that indicate injuries, to locate broken solid lines or fluid collections. A crescent-shaped echogenic collection along the right lateral aspect of the liver, suggests a subcapsular hematoma resulting from blunt trauma.

Liver Transplantation

A diseased liver that is too large due to polycystic liver disease, may be replaced surgically.

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Description

Test your knowledge on diffuse abnormalities of the liver parenchyma, including biliary obstruction and passive hepatic congestion. This quiz covers causes, symptoms, and imaging findings related to these liver conditions.