American Journal of Medicine and Medical Sciences

p-ISSN: 2165-901X    e-ISSN: 2165-9036

2022;  12(3): 241-242

doi:10.5923/j.ajmms.20221203.01

Received: Feb. 6, 2022; Accepted: Mar. 2, 2022; Published: Mar. 9, 2022

 

Multiparametric Ultrasound Diagnosis of Hepatosis

Rashidova Khurshida Abduvokhidovna

Basic Doctoral Student of the Department of Radiation Diagnostics and Therapy of the Samarkand Medical Institute

Correspondence to: Rashidova Khurshida Abduvokhidovna, Basic Doctoral Student of the Department of Radiation Diagnostics and Therapy of the Samarkand Medical Institute.

Copyright © 2022 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract

At present, it becomes necessary to select a non-invasive, highly informative and scient research method for solving diagnostic problems, staging and treating focal liver lesions. Ultrasound examination using modern technologies has advantages in the diagnosis of focal liver disease. The review highlights ultrasound differential and diagnostic signs of focal liver tumors when using various methods of ultrasound diagnostics.

Keywords: Hepatosis, Liver disease, Ultrasound, Echogenicity, Ultrasonic permeability, Parenchymal structure, Sonographically

Cite this paper: Rashidova Khurshida Abduvokhidovna, Multiparametric Ultrasound Diagnosis of Hepatosis, American Journal of Medicine and Medical Sciences, Vol. 12 No. 3, 2022, pp. 241-242. doi: 10.5923/j.ajmms.20221203.01.

Article Outline

An ultrasound is one of the methods that allows a doctor to suspect liver disease. Ultrasound shows changes in echogenicity, ultrasonic permeability, parenchymal structure, which can lead to the conclusion that the patient has diffuse liver changes. The ultrasound picture may vary somewhat depending on the stage and severity of the process, the type of fatty infiltration, as well as the combination of this disease with other concomitant liver changes.
Ultrasonography (ultrasound) is usually the first and most commonly used diagnostic method. It is widely available, non-invasive and offers real-time assessment of the liver in several anatomical planes using various ultrasound techniques such as such as grayscale imaging, Doppler, elastography, and contrast-enhanced ultrasound. This multiparametric ultrasound (MPUS) provides more information about the examined structures and allows for faster and more accurate diagnosis, typically at the point of care, thereby reducing the need for some invasive and more expensive methods.
Ultrasound of the liver allows you to verify the presence of hepatomegaly, indirectly assess the severity of liver steatosis, and also identify signs of the formation of portal hypertension. Signs of hepatosis on ultrasound are: a diffuse increase in the hepatic parenchyma (while the echogenicity of the liver is higher than that of the kidneys), blurred vascular pattern and distal attenuation of the echo signal. If the fat content in the liver exceeds 30%, this method is characterized by high diagnostic accuracy in identifying pathology, determining the degree of steatosis.
Considering the most common complications of hepatosis, such as hepatitis, with the replacement of normal parenchymal liver tissue with fibrous - functionally inoperative tissue with the formation of liver cirrhosis, and also taking into account the possibilities of ultrasound in the chosen direction of dissertation work, we plan to comprehensively study hepatoses clinically and sonographically.
The review summarizes current data on MPUS in hepatology, mainly focused on its use for non-invasive liver fibrosis staging, detection and classification portal hypertension and varicose veins of the esophagus, prognosis in chronic liver diseases and characterization of focal liver lesions (FLL). Based on the available data, we propose practical algorithms for the clinical use of MPUS in chronic liver diseases and FLL.
Fatty liver or non-alcoholic fatty liver disease (steatosis) is a disease in which there is an excessive accumulation of fats (mainly triglycerides) in the liver. Normally, there is a certain amount of fat in the liver, but under the influence of certain pathological factors, the balance between the synthesis and utilization of fats can be disturbed1. The content of triglycerides in non-alcoholic fatty liver disease can reach 40% of the mass of the liver (at a rate of about 5%).
Hepatosis is a non-inflammatory liver disease caused by exogenous or hereditary factors, accompanied by a violation of metabolic processes in the liver, hepatocyte dystrophy and necrosis of liver cells. Fatty liver disease is the most common liver disease in our time worldwide.
Most people over 40 years old and young age and not only overweight disease often occurs in the practice of a therapist. According to the results of observation, "thin" patients had fewer risk factors associated with the metabolic syndrome, but, despite this, non-alcoholic fatty hepatosis proceeded much more severely in them in terms of the severity of fibrosis, progression of liver disease, the development of complications and overall mortality compared to persons who are overweight or obese.
Obesity, diabetes mellitus, dyslipidemia, rapid weight loss, lack of protein in the diet, congenital defects in β-oxidation of fatty acids, deficiency of α-antitrypsin and some other factors are considered to be the causes of fatty liver disease. Hepatosis can be both an independent disease and a manifestation of other diseases. and therefore, they are not the result of bad behavior, poor lifestyle, including nutrition and physical activity. In most patients, this disease is asymptomatic in the early stages - this is the great danger.
In 50-75% of patients, symptoms of a general (chronic) fatigue, decreased performance, malaise, weakness, heaviness in the right hypochondrium, weight gain, prolonged fever for no reason, red dots on the skin in the chest and abdomen. The liver is often enlarged. There are digestive disorders, increased gas formation, skin itching, rarely - jaundice, "liver signs". Often, hepatosis is accompanied by diseases of the gallbladder: chronic cholecystitis, cholelithiasis. Less commonly, in advanced cases, there are signs of portal hypertension: enlargement of the spleen, esophageal varicose veins and ascites (accumulation of fluid in the abdominal cavity). As a rule, these symptoms are observed at the stage of cirrhosis of the liver.
With ultrasound diagnostics, there is a diffuse increase in its echogenicity (sometimes pronounced), while maintaining its homogeneity (although with the progression of the process, a characteristic “granularity” of the parenchyma appears, indicating the onset of the development of steatohepatitis and hepatitis), etc.
Computed tomography reveals a diffuse decrease in the densitometric parameters of the liver parenchyma to varying degrees (below 55 HU, sometimes up to negative values corresponding to the density of fat), as a rule, an increase in the size of the organ is noted. It is possible to identify limited areas of fatty infiltration, surrounded by unchanged liver tissue. More often, local fatty infiltration is observed in S4 of the liver, it has fairly even, straight contours, the course of blood vessels in the tissue infiltrated with fat is not changed, there is no mass effect (volumetric effect on surrounding structures).
Blood tests may show an increase in liver enzymes. This does not confirm the diagnosis of fatty liver. However, this may be a signal for further tests that are needed to find the cause of the inflammation.
Liver biopsy. A definitive diagnosis of fatty liver disease can only be confirmed with a liver biopsy. A needle is inserted into the liver through the abdominal wall to obtain a piece of tissue that is analyzed under a microscope.
Some diagnoses for which the liver should be checked:
• visceral abdominal obesity
• insulin resistance
• hyperinsulinemia
• microalbuminuria
• hemostasis disorders
Contrast-enhanced ultrasound (CEUS) is used to characterize focal liver disease lesions (FLL), especially liver tumors. The basic principle of this indication is based on dual blood supply to the liver (about 70% of the blood volume is provided portal vein and 30% hepatic artery). After intravenous contrast microbubbles enter the liver through the hepatic artery, and then gradually through portal vein. These temporal dynamics of contrast enhancement can be divided into three phases: arterial phase (15-30 seconds after contrast injection), portal the venous phase (30–120 seconds after contrast injection) and the late phase, which begins >120 seconds after contrast injection.
Analyzing the dynamics flow of contrast and the time required for the release of contrast from the lesion can be differentiate between benign and malignant FLL and even predict histological type tumors. The contrast is maintained throughout the late phase of benign FLL, whereas disappears (“washed out”) from malignant tumors with venous or late phase. The nature of the flow and distribution of contrast in the arterial phase helps to predict the histological subtype of the lesion within benign/malignant categories. For example, hemangiomas have a characteristic nodular peripheral amplification in the arterial phase with progressive centripetal filling, while increased hyperplasia begins in the central part of the focus with centrifugal progression.

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