Affects the hepatocytes and interferes with liver function.

LFT's - Alt, Ast, and Alk Phos

• Fatty liver
• Hepatitis
• Cirrhosis
• Portal Hypertension
• hepatocellular carcinoma
• Lymphoma
• Glycogen storage disease
• Hemochromatosis

• Implies increased lipid accumulation in the hepatocytes.
• Result of injury, a systemic disorder, or excessive metabolism of fat.

MAY BE REVERSIBLE

Grade 1

Fatty Liver

Slight diffuse increase in fine echoes in the hepatic parenchyma, with normal visualization of the diaphragm and intrahepatic vessel borders.

Grade 2

Fatty Liver

There is moderate diffuse increase in fine echpes with slightly impaired visualization of vessels and diaphragm.

Grade 3

Fatty Liver

There is marked increase in fine echoes with poor or no visualization of the intrahepatic vessel borders, diaphragm, and posterior portion of the right lobe of the liver.

This condition should be suspected in patients with masslike hypoechoic areas in typical locations in a liver that is otherwise increased in echogenicity.

• Anterior to the gallbladder
• Anterior to the portal vein
• the posterior portion of the left lobe of the liver

• Virus attacks liver cells and damages or destroys them.
• Alters liver function
• General name for inflammatory and infectious disease of the liver.
• Increase in Alt, Ast, and bilirubin

Viral Hepatits

Clinical Signs

• Flu like symptoms
• loss of appetite
• nausea
• vomiting
• fatigue

• Most common type
• Spread by transfusions of infected blood or plasma and contaminated needles

• Damage to liver
• Increased Ast, Alt, bilirubin, and leukopenia
• Clinical signs - Hepatosplenomegaly, thickened gallbladder wall, and more prominent portal vein borders

• Exists when there is clinical evidence of hepatic inflammation for at least 3 to 6 months.
• Benign
• Clinical signs - Parenchyma appears coarse, with decreased brightness of the portal triads.

• A progressive disorder and leads to liver failure.
• Most commonly caused by alcohol abuse
• enlarged caudate lobe

Cirrhosis

Second stage

Cirrhosis

Third stage

Glycogen Storage

disease

• Most common is type 1 or von Gierke's disease
• Clinical findings - Hepatomegaly, increased echogenicity with increased attenuation, and adenomas.

Biliary Obstruction:

Proximal

• Obstruction proximal to the cystic duct
• Gallbladder cannot empty
• LFT's - elavated direct bilirubin and alk phos

Biliary Obstruction:

Distal

• Obstruction distal to cystic duct
• May be caused by stones in common duct, an extrahepatic mass in porta hepatis, or stricture of the common duct
• Clinical signs - RUQ pain, jaundice, pruritus, and increase in direct bilirubin and alk phos

• Anechoic
• Smooth walled
• Thin walled
• Posterior Enhancement
• Round or oval shaped
• Good through transmission (fluid)

• Pus forming
• LFT's - elavated leukocytosis and anemia
• Clinical signs - Fever, pain, nausea, vomiting, and diarrhea

• Caused by a species of Candida (fungus)
• Candidal fungus invades the bloodstream and may affect any organ
• Usually occurs in immunocompromised hosts such as pts on chemo, HIV, or organ transplants.

Chronic Granulomatous

Disease

Recessive trait related to a congenital defect in the leukocyte

• Collection of pus formed by disintegrated tissue in the liver caused by the protozoan parasite Entamoeba histolytica
• Primarily a colon disease
• Contracted by ingesting the cysts through contaminated water and food
• Reaches liver via portal vein

• Infectious cystic disease common in sheep herding areas. A tapeworm
• Septations are frequent (honeycomb appearance)

• Most common benign tumor of liver
• Composed of a large network of vascular endothelium-lined spaces filled with red blood cells

Increased incidence with oral contraceptives

A cystic adenoma contains cystic structures within the lesion.

Rare

Focal Nodular

Hyperplasia

• Second most common after hemangioma
• Mostly in right lobe

Clinical signs - nausea, vomiting, fatigue, weight loss, and hepatomegaly

• Approx. 80% of HCC occurs in livers with preexisting cirrhosis
• HCC tends to invade hepatic veins, causing Budd-Chiari syndrome
• Can also invade the PV and Biliary Tree
• 70% have elevated alpha-fetoprotein level

• Most common form of neoplastic involvement of the liver
• Primary sites of Mets include the colon, breast, and lung
• Dissemination of the tumor to the liver occurs via the portal vein, lymphatics, and hepatic artery
• High correlation between hyperechoic metastases and colon cancer

• Malignant neoplasms involving the lymph nodes
• Two main types: Hodgkin's and non-Hodgkin's
• Clinical signs - enlarged, nontender lymph nodes, fever, night sweats, weight loss, or an abdominal mass.

The most common are:

• neuroblastomas
• Wilms' tumor
• leukemia

• Liver is the third most common organ injured in the abdomen after the spleen and kidney
• Right lobe more common

• Performed to eliminate irreversible disease
• Complications - rejection, thrombus, biliary stricture, infection, and neoplasm
• Most common complication is hepatic artery thrombosis

• Development of increased pressure in the portal-splenic venous system
• Acute or chronic hepatocellular disease can block the flow of blood
• In an effort to relieve the pressure, collateral veins are formed that connect to systemic veins

Portal Venous

Hypertension

• Develops when hepatopetal flow is impeded by thrombus or tumor invasion
• Collateral circulation may develop or a recannalized umbilical vein with hepatofugal flow

• Transjugular intrahepatic portosystemic shunt
• Intrahepatic shunt

Budd-Chiari

Syndrome

• Thrombus of the hepatic veins or IVC
• Characterized by mostly Ascites
• High mortality rate
• Blood is unable to be drained by the liver, or flow to the heart