Situs inversus totalis, the liver is found in the left hypochondrium

Congenital diaphragmatic hernias or omphalocele, varying amounts of liver may herniate into the thorax or outside the abdominal cavity

hypoechoic liver parenchyma

hepatomegaly

hyperechoic portal vein walls

Identified methods of transmission include blood transfusion, tatoos, sexually, breast feeding

Blood contact can occur by sharing syringes in intravenous drug use, shaving accessories such as razor blades or touching wounds on infected person

abd infection such as appendicitis, diverticulitis or a perforated bowel

infection in the blood

infection of the liver secretion (biliary) tract

recent endoscopy of the biliary system

trauma that damages the liver

chalk colored stool

dark urine

fever, chills, leukocytosis

loss of apetite

nausea, vomiting

pain in RU abd (more common) or throught the abd (less common)

Unintential weight loss

weakness

yellow skin (jaundice)

purulent abscesses appear cystic with the fluid ranging from echofree to highly echogenic

early suppuraion may appear solid with altered echogeniciy, usually hypoechoic

the abscess wall can vary form well defined to irregular and thick

gas producing organisms give rise to echogenic foci with a posterior reverberation artifact

there is air within the abcess

round or oval shaped lesion

absence of a prominent abscess wall

hypoechoic compared to a normal liver

fine low level internal echoes

distal enhancement

contiguity with the diaphragm/liver capsule

typically occurs in the dome of the liver

The ultrasonic appearance of candidiatis leasion is wheel within a wheel

A leasion with a peripheral hypoechoic zone, an inner echogenic wheel and a hypoechoic cener.

simple cyst

cysts with detached endocysts secondary to rupture (a cyst within a cyst)

cyst with multiple daughter cysts

cyst with detached membrane (water lily sign)

calcified mass

The fluid within the cyst is very toxic, so if a cyst ruptures anaphylatic shock can occur.

parasites reach maturity in 6-8 weeks at which time they begin to produce eggs

Up to half the eggs released by the work pairs become trapped in the mesenteric veins, or will be washed back into the liver, where they will become lodged. Worm pairs can live in the body for an average of four and a half years, but may persist upto 20 years

fatty liver infiltration

hepatomegaly

hepatitis

non-hodgkins lymphoma

candidiasis

cholangitis

acalculous cholecystitis

kaposi's sarcoma

focal fatty infiltration (diffuse)

focal fatty sparing(focal)

ETOH abuse

Hepatitis C

cell death

fibrosis

regeneration

micronodular (nodules 0.1-1 cm in diameter)

Macronodular (nodules upt ot 5cm in diamter)

hepatomegaly

jaundice

ascites

2. coarse echotexture - increased echogenicity and course echotexture

may be subjective confounded by inappropriate TGC settings and overall gain

3. nodular surface - irregularity of the liver surface during routine scanning

the nodularity corresponds to the presence of regenerating nodules and fibrosis

normal - less than 13mm

HTN - greater than 13mm

Extrahepatic pre-sinusoidal = portal vein thrombosis

intrahepatic pre-sinusoidal = schistosomiasis

intrahepatic = cirrhosis (most common)

intrahepatic post-sinusoidal = hepatic vein thrombosis

splenomegaly (spleen greater than 13cm)

ascites

portosystemic venous collaterals

1. GE junction - between the coronary and short gastric veins and the esohageal veins

2. Paraumbilical veins - runs in the falciform ligament and connects the left portal vein to the epigastric veins near the umbilicus recanalizing the ligamentum teres

3. splenorenal and gastrorenal - tortuous veins may be seen in the region of the splenic and left renal hilum

4. intestinal - regions in which the gastrointestinal tract becomes retroperitoneal so that the veins of the ascending and descending colon, duodeum, pancreas and liever may anastomose with the renal, phrenic and lumbar veins

5. hemorrhoidal - perianal region where the superior rectal veins anastomose with the middle and inferior rectal veins

1. mesocaval

2. splenorenal (warren)

3. portacaval

shunt velocity - lesser than 50 cm/sec

focal velocity increase

hepatopedal flow in the LPV or RPV

hepatofugal flow in the MPV

hepatocellular carcinoma

pancreatic carcinoma

metastatic liver disease

pancreatitis

cirrhosis

hypercoagulation

Coagulation abnormalities

tumor extension from HCC

renal carcinoma

pregnancy

adrenal cortical carcinoma

congenital abnormalities

trauma

1. ascites is an invariable observation

2. liver is typically large and bulbous acutely. hemorrhagic infarction may produce significant altered regional echogenicity

3.the caudate lobe is ofen spared because of emissary veins draining directly into the IVC at a lower level than the main hepatic veins. But this increases blood flow through the caudate may lead to caudate enlargement

4.membranous webs may be identified as echogenic or focal obliterations of the lumen

1.cirrhosis due to hep c

2. inborn errors of metabolism

3. sclerosing cholangitis

4. budd-chiari syndrome

5. unresectable hepatoma

liver size and extent of pathology

portal vein patency and size

hepatic artery atency and size

IVC patensy and size

presence of venous collaterals

presence of complicating factors like AAA or extrahepatic malignancies

liver parenchyma

biliary tree (CBD)

Hepatic artery patency

portal vein patency

hepatic vein patency

IVC patency

perihepatic fluid collections

anechoic

thin walls

acoustic enhancement

hyperechoic, homogeneous posterior enhancement

may appear hyoechoic within the background of a fatty infiltrated liver

color or duplex doppler does not routinely demonstate flow within the hemangioma

may enlarge with prenancy or administration of estrogens

well defined solid mass

central fibrous scar (liver mass with an echogenic line through it

nonspecific echogenicity

cystic component with hemorrhage

intraperitoneal blood

Hyperechoic mass propagation speed artifact

decreased speed of sound in fat – 1450 m/s, which results in a prolonged sound return time.  Thus, objects posterior to a fatty mass will be placed farther away from the transducer.  This may be seen as a broken diaphragm posterior to the fatty mass and diaphragms don’t break

hyperechoic mets: gastrointestinal tract

hypoechoic mets: lymphoma

bulls eye or target mets, lung

calcified mets, mucinous adenocarcinoma

cystic mets, sarcoma

masses of mixed echogenicity

patients present with an enlarging asymptomatic abdominal mass (10-12)cm