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Questions and Answers
What is a primary mode of transmission for hepatitis C?
What is a primary mode of transmission for hepatitis C?
Which symptoms are commonly associated with hepatitis C infection?
Which symptoms are commonly associated with hepatitis C infection?
What is the significance of the 'starry night' sign in ultrasound findings?
What is the significance of the 'starry night' sign in ultrasound findings?
How long does acute hepatitis typically last?
How long does acute hepatitis typically last?
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What laboratory values are typically elevated in a patient with hepatitis?
What laboratory values are typically elevated in a patient with hepatitis?
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What distinguishes chronic hepatitis from acute hepatitis?
What distinguishes chronic hepatitis from acute hepatitis?
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Which hepatitis type has an available vaccination?
Which hepatitis type has an available vaccination?
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Which condition is typically associated with chronic active hepatitis?
Which condition is typically associated with chronic active hepatitis?
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What sign is referred to when distended collateral veins are visualized on the abdominal wall?
What sign is referred to when distended collateral veins are visualized on the abdominal wall?
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Which imaging technique is used to assess flow in the recanalized umbilical vein?
Which imaging technique is used to assess flow in the recanalized umbilical vein?
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What is the primary fluid characteristic identified in the patient's paracentesis?
What is the primary fluid characteristic identified in the patient's paracentesis?
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In a patient with cirrhosis, what might you observe in terms of liver capsule appearance on ultrasound?
In a patient with cirrhosis, what might you observe in terms of liver capsule appearance on ultrasound?
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Which of the following symptoms was noted in the patient with a history of hepatitis C and alcohol abuse?
Which of the following symptoms was noted in the patient with a history of hepatitis C and alcohol abuse?
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What is the relationship between ascites and the appearance of caput medusae?
What is the relationship between ascites and the appearance of caput medusae?
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What indicates a recanalized umbilical vein on an imaging study?
What indicates a recanalized umbilical vein on an imaging study?
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What notable physical finding might suggest cirrhosis in a patient during examination?
What notable physical finding might suggest cirrhosis in a patient during examination?
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What is the primary characteristic of liver parenchyma on ultrasound examination in chronic hepatitis?
What is the primary characteristic of liver parenchyma on ultrasound examination in chronic hepatitis?
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What is a common gross appearance of a fatty liver?
What is a common gross appearance of a fatty liver?
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Which of the following conditions is NOT a leading cause of fatty liver?
Which of the following conditions is NOT a leading cause of fatty liver?
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What ultrasound finding indicates moderate to severe fatty infiltration?
What ultrasound finding indicates moderate to severe fatty infiltration?
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Which statement best describes the effects of fatty infiltration on liver physiology?
Which statement best describes the effects of fatty infiltration on liver physiology?
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What happens to the size of the liver in chronic hepatitis?
What happens to the size of the liver in chronic hepatitis?
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Which of these factors is associated with the development of fatty infiltration?
Which of these factors is associated with the development of fatty infiltration?
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What symptom is most commonly reported by patients with fatty liver or NASH?
What symptom is most commonly reported by patients with fatty liver or NASH?
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What is the primary cause of cirrhosis in the United States?
What is the primary cause of cirrhosis in the United States?
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Which symptom is NOT typically associated with patients experiencing cirrhosis?
Which symptom is NOT typically associated with patients experiencing cirrhosis?
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Which imaging finding might indicate early-stage cirrhosis?
Which imaging finding might indicate early-stage cirrhosis?
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What complication can arise due to vascular changes in cirrhosis?
What complication can arise due to vascular changes in cirrhosis?
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Which of the following is a characteristic feature seen in late-stage cirrhosis?
Which of the following is a characteristic feature seen in late-stage cirrhosis?
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What can excessive alcohol consumption primarily lead to in the liver?
What can excessive alcohol consumption primarily lead to in the liver?
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What is likely to happen if the liver continues to receive hostile insults over time?
What is likely to happen if the liver continues to receive hostile insults over time?
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What impact can portal hypertension have due to cirrhosis?
What impact can portal hypertension have due to cirrhosis?
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What abnormality is indicated by the corkscrew appearance of the hepatic artery in a Color Doppler image?
What abnormality is indicated by the corkscrew appearance of the hepatic artery in a Color Doppler image?
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Which sign is indicative of portal hypertension in patients with cirrhosis?
Which sign is indicative of portal hypertension in patients with cirrhosis?
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What complication can arise from aliasing during Color Doppler imaging of the hepatic artery?
What complication can arise from aliasing during Color Doppler imaging of the hepatic artery?
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In patients with cirrhosis, what spectral trace change is commonly observed in the portal vein under elevated pressure?
In patients with cirrhosis, what spectral trace change is commonly observed in the portal vein under elevated pressure?
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What effect does recanalization of the ligamentum teres have in cirrhosis management?
What effect does recanalization of the ligamentum teres have in cirrhosis management?
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Which imaging finding is associated with splenomegaly in patients with portal hypertension?
Which imaging finding is associated with splenomegaly in patients with portal hypertension?
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What is the typical flow direction observed in the main portal vein in patients with advanced cirrhosis?
What is the typical flow direction observed in the main portal vein in patients with advanced cirrhosis?
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How is ascitic fluid typically characterized in ultrasound images of patients with cirrhosis?
How is ascitic fluid typically characterized in ultrasound images of patients with cirrhosis?
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What is a characteristic feature of micromodular cirrhosis?
What is a characteristic feature of micromodular cirrhosis?
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Which complication of cirrhosis involves increased pressure within the portal venous system?
Which complication of cirrhosis involves increased pressure within the portal venous system?
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What is the significance of the paraumbilical vein during cirrhosis?
What is the significance of the paraumbilical vein during cirrhosis?
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Which imaging finding is typically associated with advanced cirrhosis?
Which imaging finding is typically associated with advanced cirrhosis?
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How does the caudate lobe appear in patients with advanced cirrhosis?
How does the caudate lobe appear in patients with advanced cirrhosis?
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What is a common consequence of cirrhosis related to cancer development?
What is a common consequence of cirrhosis related to cancer development?
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Which of the following describes commonly observed varices in cirrhosis patients?
Which of the following describes commonly observed varices in cirrhosis patients?
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What echographic feature can be seen in a patient with early stages of cirrhosis?
What echographic feature can be seen in a patient with early stages of cirrhosis?
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Study Notes
Liver Pathology
- Liver pathology encompasses various diseases affecting the liver's parenchyma (functional tissue)
- These conditions can be focal (localized) or diffuse (affecting the entire organ)
- Diseases can be acute (short duration) or chronic (long-lasting)
Parenchymal Disease
- Parenchyma is the functional tissue of an organ, as distinct from connective/supporting tissues.
- Focal abnormalities are localized lesions within the organ.
- Diffuse abnormalities involve the entire organ.
- Acute diseases have a short duration.
- Chronic diseases persist for 3 months or more.
Diffuse Disease
- Diffuse hepatocellular disease affects hepatocytes (liver cells), impairing liver function.
- Hepatocytes are parenchymal liver cells performing all liver functions.
Signs and Symptoms
- Common symptoms: Jaundice (yellowing of skin and eyes), pruritus (itching), dark urine, weight loss, muscle wasting, ascites (fluid buildup in the abdomen), decreasing energy, easy bruising/bleeding, vomiting blood, blood in the stool, mental confusion.
- Hepatomegaly: Enlarged liver, measured by ultrasound from the dome to the tip of the right lobe( if >15.5 cm), or extending beyond the inferior pole of the right kidney. Difficult to diagnose accurately with sonography.
Hepatitis
- Hepatitis refers to inflammation of the liver.
- Causes include alcohol, drugs, autoimmune diseases, metabolic diseases, and viruses.
- Viral hepatitis (types A, B, C, D, E, and G) accounts for most cases in the U.S.
- Types A, B, and C are the three most common.
- Hepatitis A: Fecal-oral transmission, rarely chronic, typically resolves in a few months. Vaccination available.
- Hepatitis B: Common worldwide, blood/body fluid transmission, can become chronic. Vaccination available.
- Hepatitis C: Blood transmission, most lead to chronic infection, but more likely to be chronic than Hepatitis B. No vaccine available.
Acute Hepatitis
- Damage to the liver can range from mild to massive necrosis (tissue death) and liver failure.
- Usually (99%) short-term and resolves within 2 months.
- Hepatitis A is a common cause of acute hepatitis.
Sonographic Findings (Ultrasound)
- Normal liver: Normal appearance, echogenicity.
- Hepatomegaly: Enlarged liver.
- Hypoechoic liver: Decreased brightness, often seen with attenuated blood vessels and ducts (“starry night”).
- Fatty infiltration: Increased echogenicity, coarse texture, often seen with possible focal sparing. Can be mild, moderate or severe.
- Different grades of severity exist from slight to severe diffuse increase in echogenicity.
Glycogen Storage Disease
- Autosomal recessive genetic disorder.
- Defects affect glycogen processing in liver, muscles, and other cells leading to glycogen accumulation.
- Von Gierke's disease (Type 1) is a common example.
- Clinical features include hepatomegaly, hypoglycemia, and impaired growth. Frequently associated with liver cell adenomas.
Cirrhosis
- Chronic, degenerative liver disease.
- Scar tissue replaces normal liver tissue, blocking blood flow.
- Progressive and irreversible, leading to liver failure and portal hypertension.
- Common causes include chronic alcohol abuse, hepatitis, and nutritional deprivation.
- Clinical findings: Enlarged liver in early stages but often shrunken in advanced stages, ascites, increased or decreased vascularity, potentially hepatospelenomegaly, and possibly a "caput medusae" sign.
- Different types of cirrhosis: Biliary Cirrhosis (nodular), Macronodular cirrhosis (large nodules), and Micronodular cirrhosis (small nodules).
Portal Hypertension
- Increased pressure in vessels draining blood to liver.
- Sonographic findings:
- Increased diameter of the portal vein.
- Reversed/or decreased blood flow in portal/hepatic veins.
- Dilated splenic vein.
- Spleen >13cm in size
Management
- Management of portal hypertension depends on the cause and patient condition.
- Management involves: endoscopic techniques to control bleeding; paracentesis for diagnostic or therapeutic fluid removal; and transjugular intrahepatic portosystemic shunts (TIPS) for blood diversion.
Budd-Chiari Syndrome
- Obstruction of hepatic veins or inferior vena cava (IVC).
- Causes include congenital abnormalities, tumor extension, hematological disorders.
- Clinical presentation includes right upper quadrant (RUQ) pain, hepatomegaly, ascites, hematemesis, and splenomegaly.
- Sonographic findings depend on degree of obstruction.
Passive Liver Congestion
- Liver edema due to vascular congestion from right heart failure.
- The hepatic veins are dilated and flow may reverse (W-type pattern).
Hepatic Vein Thrombosis
- Blood clot within the hepatic veins.
- Signs/symptoms depend on the degree of obstruction.
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Description
This quiz covers key concepts in liver pathology, focusing on diseases that affect the liver's functional tissue. It differentiates between focal and diffuse diseases, along with acute and chronic conditions. Test your knowledge on the signs, symptoms, and implications of liver pathology.
