Podcast
Questions and Answers
What is a primary mode of transmission for hepatitis C?
What is a primary mode of transmission for hepatitis C?
- Airborne particles
- Insect bites
- Saliva contamination
- Contact with infested blood (correct)
Which symptoms are commonly associated with hepatitis C infection?
Which symptoms are commonly associated with hepatitis C infection?
- Severe abdominal pain
- Nausea and fatigue (correct)
- Constant headaches
- High fever and chills
What is the significance of the 'starry night' sign in ultrasound findings?
What is the significance of the 'starry night' sign in ultrasound findings?
- Represents edema from acute hepatitis (correct)
- Suggests cirrhosis
- Indicates normal liver function
- Sign of liver tumors
How long does acute hepatitis typically last?
How long does acute hepatitis typically last?
What laboratory values are typically elevated in a patient with hepatitis?
What laboratory values are typically elevated in a patient with hepatitis?
What distinguishes chronic hepatitis from acute hepatitis?
What distinguishes chronic hepatitis from acute hepatitis?
Which hepatitis type has an available vaccination?
Which hepatitis type has an available vaccination?
Which condition is typically associated with chronic active hepatitis?
Which condition is typically associated with chronic active hepatitis?
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?
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?
What is the primary fluid characteristic identified in the patient's paracentesis?
What is the primary fluid characteristic identified in the patient's paracentesis?
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?
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?
What is the relationship between ascites and the appearance of caput medusae?
What is the relationship between ascites and the appearance of caput medusae?
What indicates a recanalized umbilical vein on an imaging study?
What indicates a recanalized umbilical vein on an imaging study?
What notable physical finding might suggest cirrhosis in a patient during examination?
What notable physical finding might suggest cirrhosis in a patient during examination?
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?
What is a common gross appearance of a fatty liver?
What is a common gross appearance of a fatty liver?
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?
What ultrasound finding indicates moderate to severe fatty infiltration?
What ultrasound finding indicates moderate to severe fatty infiltration?
Which statement best describes the effects of fatty infiltration on liver physiology?
Which statement best describes the effects of fatty infiltration on liver physiology?
What happens to the size of the liver in chronic hepatitis?
What happens to the size of the liver in chronic hepatitis?
Which of these factors is associated with the development of fatty infiltration?
Which of these factors is associated with the development of fatty infiltration?
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?
What is the primary cause of cirrhosis in the United States?
What is the primary cause of cirrhosis in the United States?
Which symptom is NOT typically associated with patients experiencing cirrhosis?
Which symptom is NOT typically associated with patients experiencing cirrhosis?
Which imaging finding might indicate early-stage cirrhosis?
Which imaging finding might indicate early-stage cirrhosis?
What complication can arise due to vascular changes in cirrhosis?
What complication can arise due to vascular changes in cirrhosis?
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?
What can excessive alcohol consumption primarily lead to in the liver?
What can excessive alcohol consumption primarily lead to in the liver?
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?
What impact can portal hypertension have due to cirrhosis?
What impact can portal hypertension have due to cirrhosis?
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?
Which sign is indicative of portal hypertension in patients with cirrhosis?
Which sign is indicative of portal hypertension in patients with cirrhosis?
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?
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?
What effect does recanalization of the ligamentum teres have in cirrhosis management?
What effect does recanalization of the ligamentum teres have in cirrhosis management?
Which imaging finding is associated with splenomegaly in patients with portal hypertension?
Which imaging finding is associated with splenomegaly in patients with portal hypertension?
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?
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?
What is a characteristic feature of micromodular cirrhosis?
What is a characteristic feature of micromodular cirrhosis?
Which complication of cirrhosis involves increased pressure within the portal venous system?
Which complication of cirrhosis involves increased pressure within the portal venous system?
What is the significance of the paraumbilical vein during cirrhosis?
What is the significance of the paraumbilical vein during cirrhosis?
Which imaging finding is typically associated with advanced cirrhosis?
Which imaging finding is typically associated with advanced cirrhosis?
How does the caudate lobe appear in patients with advanced cirrhosis?
How does the caudate lobe appear in patients with advanced cirrhosis?
What is a common consequence of cirrhosis related to cancer development?
What is a common consequence of cirrhosis related to cancer development?
Which of the following describes commonly observed varices in cirrhosis patients?
Which of the following describes commonly observed varices in cirrhosis patients?
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?
Flashcards
Hepatitis C
Hepatitis C
A viral infection that can cause inflammation of the liver, spread through contact with infected blood, and can lead to chronic liver disease, cirrhosis, and liver failure.
Hepatitis
Hepatitis
An inflammation of the liver that can be caused by viruses, alcohol abuse, or other factors.
Acute Hepatitis
Acute Hepatitis
A type of hepatitis that is usually a short-term infection and clears up on its own within two months. Vaccination can prevent Hepatitis A.
Chronic Hepatitis
Chronic Hepatitis
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Cirrhosis
Cirrhosis
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Transmission
Transmission
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Vaccination
Vaccination
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Hepatomegaly
Hepatomegaly
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Fatty Liver
Fatty Liver
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Ultrasound Finding in Fatty Liver
Ultrasound Finding in Fatty Liver
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Liver Size in Fatty Liver
Liver Size in Fatty Liver
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Portal Vein Visualization in Fatty Liver
Portal Vein Visualization in Fatty Liver
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Border Definition in Fatty Liver
Border Definition in Fatty Liver
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Gross Appearance of Fatty Liver
Gross Appearance of Fatty Liver
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Reversibility of Fatty Liver
Reversibility of Fatty Liver
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Symptoms of Fatty Liver
Symptoms of Fatty Liver
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Liver Regeneration
Liver Regeneration
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Liver Enlargement
Liver Enlargement
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Liver Atrophy
Liver Atrophy
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Portal Hypertension
Portal Hypertension
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Collateral Shunts
Collateral Shunts
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Jaundice
Jaundice
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Liver Failure
Liver Failure
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Micronodular Cirrhosis
Micronodular Cirrhosis
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Macronodular Cirrhosis
Macronodular Cirrhosis
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Splenomegaly
Splenomegaly
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Varices
Varices
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Collaterals
Collaterals
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Ascites
Ascites
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Splenorenal Shunt
Splenorenal Shunt
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Caput Medusae - What is it?
Caput Medusae - What is it?
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What is cirrhosis?
What is cirrhosis?
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What are collateral shunts?
What are collateral shunts?
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What is a paracentesis?
What is a paracentesis?
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What is the superficial epigastric vein and why is it important?
What is the superficial epigastric vein and why is it important?
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What is ascites?
What is ascites?
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What is hepatomegaly?
What is hepatomegaly?
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What are spider angiomas?
What are spider angiomas?
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What is a sonogram and how is it used to diagnose cirrhosis?
What is a sonogram and how is it used to diagnose cirrhosis?
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What is a corkscrew appearance of the hepatic artery and why does it occur?
What is a corkscrew appearance of the hepatic artery and why does it occur?
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What is the caput medusa sign and why does it occur?
What is the caput medusa sign and why does it occur?
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How does cirrhosis affect blood flow direction in the portal vein and hepatic artery?
How does cirrhosis affect blood flow direction in the portal vein and hepatic artery?
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Why is splenomegaly often present in patients with cirrhosis?
Why is splenomegaly often present in patients with cirrhosis?
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What are esophageal varices and how are they detected on an ultrasound?
What are esophageal varices and how are they detected on an ultrasound?
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What is a shunt tube and what is its function?
What is a shunt tube and what is its function?
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What is the relationship between cirrhosis, an enlarged gallbladder, and ascitic fluid?
What is the relationship between cirrhosis, an enlarged gallbladder, and ascitic fluid?
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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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