Steatosis of the liver (different names may be: fatty hepatosis, fatty infiltration, fatty liver), which occurs on liver ultrasound, is an etiologically and pathogenetically heterogeneous syndrome, which is characterized by a prolonged and significant accumulation of triglycerides in hepatocytes. The main factor of steatosis is alcohol abuse, diabetes, obesity, unbalanced nutrition (protein deficiency), chronic diseases of the gastrointestinal tract, accompanied by impaired absorption (enteritis, pancreatitis, ulcerative colitis, etc.), chronic debilitating diseases (cancer, anemia, cardiac and pulmonary insufficiency, etc.), toxic (hepatotropic, medicinal) and bacterial factors.
Ultrasound test with a diffuse form of fatty hepatosis, as a rule, reveals an increase in the size of the liver, an unclear contour. The edges of the liver are rounded. Characteristic features include increased echogenicity of the parenchyma. Its structure is in most cases homogeneous, however, sometimes on the background of hyperechoic tissue, it is possible to detect areas of reduced reflection with uneven, fuzzy contours that do not deform the vascular pattern.
These are areas of unchanged parenchyma, which, as a rule, are detected in the portal fissure of the liver, in the projection of I, IV, V segments. The sound conduction of the liver is often reduced; the vascular pattern is depleted. In addition to diffuse, ultrasound of the liver also produces local and focal forms, when fatty infiltration extends only to limited segments and sectors of the liver, and sometimes manifests itself in the form of individual small zones, resembling focal education.
Ultrasound picture of fatty hepatosis does not always allow to clearly differentiate it from other diffuse organ lesions (chronic hepatitis, the initial stage of cirrhosis). Crucial importance in the diagnosis of steatosis and its delimitation from chronic hepatitis belongs to the puncture biopsy of the liver.
How does hepatitis show on ultrasound?
Acute hepatitis is an acute degenerative and inflammatory lesion of the liver. Hepatitis can be alcoholic or viral etiology, develop as a result of exposure to toxic or metabolic factors. The main ultrasound sign of this disease is hepatomegaly. In a significant number of observations, moreover, an increase in the size of the spleen is found. The contour of the liver usually remains clear and smooth.
Edges can be both sharp and rounded. In the severe course, accompanied by the presence of foci of necrosis, the parenchyma has a heterogeneous structure due to the appearance of multiple areas of reduced echogenicity alternating with fragments of unchanged parenchyma. With significant swelling of the liver tissue, its echogenicity is reduced to a greater extent.
Organ conduction is often increased; as a result, the vascular pattern becomes clearer, and the walls of the portal vein more contrasting. Detection of enlarged lymph nodes in the area of the hepatoduodenal ligament may be of some help in making a diagnosis.
As a rule, on ultrasound in chronic hepatitis, an increase in the size of the liver due to the right and left lobes is observed, a rounding of the edges and an increase in the angles formed by them can be observed. The contour of the liver often remains clear and smooth. The structure of the parenchyma is usually diffusely heterogeneous, the echo is increased, and the sound conductivity is reduced in most cases. There is also a progressive impoverishment of the vascular pattern. In chronic hepatitis, diffuse liver damage was found only in 2/3 cases, which, according to the ultrasound labs, is due to the absence in most cases of fairly pronounced fibrosis and/or steatosis.