Liver Pathology Overview

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Questions and Answers

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?

  • 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?

  • Represents edema from acute hepatitis (correct)
  • Suggests cirrhosis
  • Indicates normal liver function
  • Sign of liver tumors

How long does acute hepatitis typically last?

<p>Usually clears in up to two months (B)</p> Signup and view all the answers

What laboratory values are typically elevated in a patient with hepatitis?

<p>Elevated ASP, AST, and bilirubin (B)</p> Signup and view all the answers

What distinguishes chronic hepatitis from acute hepatitis?

<p>Duration of hepatic inflammation (D)</p> Signup and view all the answers

Which hepatitis type has an available vaccination?

<p>Hepatitis A (A)</p> Signup and view all the answers

Which condition is typically associated with chronic active hepatitis?

<p>Cirrhosis and liver failure (C)</p> Signup and view all the answers

What sign is referred to when distended collateral veins are visualized on the abdominal wall?

<p>Caput Medusae sign (A)</p> Signup and view all the answers

Which imaging technique is used to assess flow in the recanalized umbilical vein?

<p>Color Doppler (D)</p> Signup and view all the answers

What is the primary fluid characteristic identified in the patient's paracentesis?

<p>Transudate (B)</p> Signup and view all the answers

In a patient with cirrhosis, what might you observe in terms of liver capsule appearance on ultrasound?

<p>Irregular and heterogeneous (A)</p> Signup and view all the answers

Which of the following symptoms was noted in the patient with a history of hepatitis C and alcohol abuse?

<p>Enlarged parotid glands (A)</p> Signup and view all the answers

What is the relationship between ascites and the appearance of caput medusae?

<p>Ascites causes caput medusae appearance (B)</p> Signup and view all the answers

What indicates a recanalized umbilical vein on an imaging study?

<p>Color Doppler signal showing venous flow (A)</p> Signup and view all the answers

What notable physical finding might suggest cirrhosis in a patient during examination?

<p>Spider angiomas (A)</p> Signup and view all the answers

What is the primary characteristic of liver parenchyma on ultrasound examination in chronic hepatitis?

<p>Coarse texture with decreased brightness of the portal triads (A)</p> Signup and view all the answers

What is a common gross appearance of a fatty liver?

<p>Pale yellow with a greasy texture (C)</p> Signup and view all the answers

Which of the following conditions is NOT a leading cause of fatty liver?

<p>Bacterial infections (B)</p> Signup and view all the answers

What ultrasound finding indicates moderate to severe fatty infiltration?

<p>Increased echogenicity (D)</p> Signup and view all the answers

Which statement best describes the effects of fatty infiltration on liver physiology?

<p>It does not disrupt physiological processes. (D)</p> Signup and view all the answers

What happens to the size of the liver in chronic hepatitis?

<p>The liver does not increase in size. (B)</p> Signup and view all the answers

Which of these factors is associated with the development of fatty infiltration?

<p>Cystic fibrosis (D)</p> Signup and view all the answers

What symptom is most commonly reported by patients with fatty liver or NASH?

<p>Persistent fatigue (B)</p> Signup and view all the answers

What is the primary cause of cirrhosis in the United States?

<p>Hepatitis C (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with patients experiencing cirrhosis?

<p>Extreme abdominal enlargement (C)</p> Signup and view all the answers

Which imaging finding might indicate early-stage cirrhosis?

<p>Coarsening of liver parenchyma (D)</p> Signup and view all the answers

What complication can arise due to vascular changes in cirrhosis?

<p>Portal venous bypass (C)</p> Signup and view all the answers

Which of the following is a characteristic feature seen in late-stage cirrhosis?

<p>Smaller heterogeneous liver lobes (B)</p> Signup and view all the answers

What can excessive alcohol consumption primarily lead to in the liver?

<p>Cirrhosis (D)</p> Signup and view all the answers

What is likely to happen if the liver continues to receive hostile insults over time?

<p>Liver atrophy (B)</p> Signup and view all the answers

What impact can portal hypertension have due to cirrhosis?

<p>Potential liver necrosis (C)</p> Signup and view all the answers

What abnormality is indicated by the corkscrew appearance of the hepatic artery in a Color Doppler image?

<p>Decreased portal vein flow (D)</p> Signup and view all the answers

Which sign is indicative of portal hypertension in patients with cirrhosis?

<p>Caput medusa sign (C)</p> Signup and view all the answers

What complication can arise from aliasing during Color Doppler imaging of the hepatic artery?

<p>Detection of portal vein thrombosis (C)</p> Signup and view all the answers

In patients with cirrhosis, what spectral trace change is commonly observed in the portal vein under elevated pressure?

<p>Monophasic hepatic venous flow (B)</p> Signup and view all the answers

What effect does recanalization of the ligamentum teres have in cirrhosis management?

<p>Increases collateral circulation (A)</p> Signup and view all the answers

Which imaging finding is associated with splenomegaly in patients with portal hypertension?

<p>Enlarged spleen noted on transverse imaging (D)</p> Signup and view all the answers

What is the typical flow direction observed in the main portal vein in patients with advanced cirrhosis?

<p>Hepatofugal flow (A)</p> Signup and view all the answers

How is ascitic fluid typically characterized in ultrasound images of patients with cirrhosis?

<p>Anechoic and free-floating (C)</p> Signup and view all the answers

What is a characteristic feature of micromodular cirrhosis?

<p>Nodules are small with uniform size (C)</p> Signup and view all the answers

Which complication of cirrhosis involves increased pressure within the portal venous system?

<p>Portal hypertension (C)</p> Signup and view all the answers

What is the significance of the paraumbilical vein during cirrhosis?

<p>It is recanalized in certain cases of portal hypertension (C)</p> Signup and view all the answers

Which imaging finding is typically associated with advanced cirrhosis?

<p>Increased liver echogenicity and ascites (A)</p> Signup and view all the answers

How does the caudate lobe appear in patients with advanced cirrhosis?

<p>It may be enlarged due to portal blood flow alterations (A)</p> Signup and view all the answers

What is a common consequence of cirrhosis related to cancer development?

<p>Increased incidence of hepatoma tumors (B)</p> Signup and view all the answers

Which of the following describes commonly observed varices in cirrhosis patients?

<p>Esophageal and splenic varices (A)</p> Signup and view all the answers

What echographic feature can be seen in a patient with early stages of cirrhosis?

<p>Hepatomegaly with decreased vasculature (A)</p> Signup and view all the answers

Flashcards

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

An inflammation of the liver that can be caused by viruses, alcohol abuse, or other factors.

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

A type of hepatitis that persists for at least 3 to 6 months and can lead to chronic liver disease and liver failure.

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Cirrhosis

A serious liver condition that can develop from chronic hepatitis. It results in scarring of the liver and can lead to liver failure.

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Transmission

The process of spreading a disease from one person to another.

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Vaccination

A substance that is used to prevent a particular disease. It stimulates the body's immune system to fight off the disease.

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Hepatomegaly

An abnormal increase in the size of the liver, which can be a symptom of liver disease.

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Fatty Liver

A condition where fat accumulates in the liver cells, often caused by factors like alcohol abuse, obesity, diabetes, and steroid use.

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Ultrasound Finding in Fatty Liver

Ultrasound imaging shows increased brightness in the liver, indicating fat deposition.

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Liver Size in Fatty Liver

The liver may become enlarged due to fat accumulation within the cells.

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Portal Vein Visualization in Fatty Liver

The portal veins, which carry blood to the liver, can be harder to see on ultrasound due to increased fat content.

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Border Definition in Fatty Liver

The boundary between the portal vein and hepatic vein can be less defined due to fat accumulation.

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Gross Appearance of Fatty Liver

The liver is pale yellow and has a greasy texture due to the accumulation of fat.

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Reversibility of Fatty Liver

Fatty liver is a reversible condition, meaning the liver can return to a healthy state with proper treatment.

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Symptoms of Fatty Liver

Most patients with fatty liver experience no symptoms, although some may experience fatigue, malaise, or upper abdominal discomfort.

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Liver Regeneration

The liver's ability to regenerate new, healthy tissue when the damaging environment is removed.

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Liver Enlargement

An increase in liver size, often caused by initial changes in response to damage.

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Liver Atrophy

Shrinkage of the liver due to prolonged damage or insult.

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Portal Hypertension

High blood pressure in the portal vein, which carries blood from the digestive system to the liver.

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Collateral Shunts

New blood vessels that form to bypass the liver, allowing blood to flow directly to the heart without being filtered.

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Jaundice

A yellowing of the skin and whites of the eyes, caused by a buildup of bilirubin in the blood.

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Liver Failure

A condition where the liver is no longer able to function properly.

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Micronodular Cirrhosis

A type of cirrhosis where the liver develops small, evenly sized nodules.

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Macronodular Cirrhosis

A type of cirrhosis where the liver develops larger nodules, often irregular in size.

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Splenomegaly

An enlarged spleen, often seen in patients with cirrhosis due to portal hypertension.

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Varices

Abnormal, enlarged veins, often in the esophagus, stomach, or rectum, that develop due to portal hypertension and can rupture and cause bleeding.

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Collaterals

Collateral blood vessels that develop in the body to bypass the portal vein system when it's blocked, often seen in patients with cirrhosis.

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Ascites

Fluid buildup in the abdomen, often seen in patients with cirrhosis due to portal hypertension and reduced protein production by the liver.

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Splenorenal Shunt

An abnormal connection between the portal vein system and the systemic venous system, often seen in patients with cirrhosis.

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Caput Medusae - What is it?

An enlarged network of veins that appear like Medusa's snakes around the umbilicus. This is caused by portal hypertension, where high pressure in the portal vein forces blood to seek alternative routes.

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What is cirrhosis?

A chronic liver disease characterized by scarring and fibrosis, leading to decreased liver function. This can be caused by chronic hepatitis, alcohol abuse, or other factors.

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What are collateral shunts?

These are veins that develop to bypass the liver, allowing blood to flow directly to the heart. This is a consequence of portal hypertension in conditions like cirrhosis.

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What is a paracentesis?

A medical procedure that involves draining fluid from the abdominal cavity. This can be done to relieve pressure from ascites, which is a buildup of fluid in the abdomen commonly seen in liver diseases.

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What is the superficial epigastric vein and why is it important?

The superficial epigastric vein is a large vein that drains into the external iliac vein. This vein is often seen enlarged in patients with portal hypertension and can contribute to the formation of Caput Medusae

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What is ascites?

A common finding in cirrhosis, this is a buildup of fluid in the abdominal cavity. It can cause abdominal swelling and discomfort.

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What is hepatomegaly?

This is a condition where the liver becomes enlarged, often due to inflammation or other underlying causes.

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What are spider angiomas?

These are small, red, spider-like blood vessels that appear on the skin. They are often seen in patients with liver disease.

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What is a sonogram and how is it used to diagnose cirrhosis?

A sonogram is a type of ultrasound used to create images of internal organs, in this case, the liver. It is used to identify irregularities in the liver's capsule and parenchyma, which are signs of cirrhosis.

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What is a corkscrew appearance of the hepatic artery and why does it occur?

The hepatic artery, which provides blood to the liver, can appear twisted or corkscrew-shaped in patients with cirrhosis. This is due to decreased portal vein flow, increased arterial flow, and shrinkage of liver tissue.

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What is the caput medusa sign and why does it occur?

Increased pressure within the portal venous system caused by cirrhosis forces blood to flow through collateral pathways. This creates visible distended veins on the abdominal wall, known as the "caput medusa sign."

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How does cirrhosis affect blood flow direction in the portal vein and hepatic artery?

Cirrhosis changes the flow and direction of blood in the liver. Blood flow in the portal vein becomes reversed (hepatofugal), meaning it travels away from the liver. The hepatic artery, meanwhile, will flow towards the liver (hepatopetal).

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Why is splenomegaly often present in patients with cirrhosis?

The splenomegaly is an enlarged spleen which is a common finding in patients with cirrhosis due to portal hypertension.

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What are esophageal varices and how are they detected on an ultrasound?

Esophageal varices are swollen veins in the esophagus, often caused by portal hypertension. They can be seen as multiple cyst-like areas superior to the aorta on a sagittal ultrasound image.

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What is a shunt tube and what is its function?

A shunt tube is surgically placed in the venous channels of the liver to redirect blood flow, relieving portal hypertension.

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What is the relationship between cirrhosis, an enlarged gallbladder, and ascitic fluid?

Liver cirrhosis leads to an enlarged gallbladder that floats in the ascitic fluid, which is an accumulation of fluid within the abdomen.

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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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