The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm, and on top of the stomach, right kidney, and intestines. It is divided by the falciform ligament into the bigger right lobe and smaller left lobe. Abdominal ultrasound Is the first-line imaging modality used to examine liver diseases. It is a safe, painless, and non-invasive procedure. Ultrasound is highly sensitive in detecting diffuse and focal lesions within the liver including cysts tumors and abscesses.
Hepatomegaly: Hepatomegaly is the enlargement of the liver beyond its normal size. Hepatomegaly itself is not a disease, it is an indicator of the potential of underlying liver diseases such as cirrhosis, hepatitis, and fatty infiltration of the liver.
Hepatic cysts: Hepatic cysts are fluid-filled lesions within the liver parenchyma. They are usually discovered incidentally. Simple hepatic cysts are mostly congenital cysts. They can also be seen in polycystic liver disease. Complex cysts are defined as lesions that contain complex features. They can occur due to Trauma (hematoma), parasites (echinococcal cysts), and inflammation (abscess). A hematoma is caused by blunt abdominal trauma injuring the liver. A liver abscess is a mass filled with puss in the liver that can develop from injury or infection. Patients present with fever and right upper quadrant pain.
Fatty liver: Fatty infiltration of the liver can either be focal or diffuse. Diffuse fatty Liver is the most common liver pathology. it is the build-up of fat in the liver. It is commonly found in the right lobe of the liver and the most common cause is likely to be obesity. Other causes include excessive intake of alcohol, diabetes, hepatitis, chemotherapy, and pregnancy. It can also be a precursor to liver disease and hepatocellular carcinoma. Fatty liver can be mild, moderate, or severe. Conversely, focal fatty sparing is a condition where there is normal liver parenchyma within a fatty infiltrated liver.
Cirrhosis: Cirrhosis is a diffuse process that destroys the liver. This damage to the liver is characterized by the replacement of normal liver tissue with scar tissue. There are various causes of liver cirrhosis. Alcohol consumption is the most common cause which leads to the early stages. Excessive consumption of alcohol over a longer period can lead to end-stage liver disease where the liver becomes scarred. Other causes include viral hepatitis B and C, toxic drugs, and biliary obstruction. Patients with cirrhosis have an increased risk of developing hepatocellular carcinoma. Focal liver masses can be visualized on ultrasound in several clinical situations, from incidental findings to identification in a symptomatic patient as part of a targeted search in a patient that is at risk for a hepatic neoplasm. Haemangiomas, Focal nodular hyperplasia (FNH), and adenomas are the most common benign neoplasms seen in the liver, whereas hepatic cellular carcinoma and metastases make up the majority of malignant tumors.
Haemangioma: Haemangiomas are the most common solid benign tumor in the liver. They can occur at any age but are more common in adults, particularly women. They are usually incidental findings, and most patients are asymptomatic. However, during pregnancy, it can grow and cause pain.
Focal nodular hyperplasia (FNH): FNH is the second most common benign tumor of the liver. It is mainly found in younger women and is usually found incidentally; therefore, most patients are asymptomatic. Hormonal effects might play a role as FNH is more common in women than men.
Adenoma: Adenoma is a rare benign liver tumor. It is a true hepatic encapsulated neoplasm containing atypical hepatocytes which have areas of hemorrhage and necrosis. They are linked to long-term oral contraceptive use therefore it is more common in women (90%). However, it can shrink once the contraceptives are stopped. It can be asymptomatic, or the patient can present with right upper quadrant pain.
Angiomyolipoma: kidney tumor is made up of fat, blood vessels, and smooth muscle tissue. They often develop in people with tuberous sclerosis, a genetic condition that causes non-cancerous tumors to form in many organs, including the eyes, skin, brain, lungs, heart, and kidneys.
Hepatocellular carcinoma: Hepatocellular carcinoma (HCC) is the most common primary liver cancer. It is more common in men than women with a ratio of 5:1. HCC occurs at a later age and is unusual under the age of 40. It is hugely associated with Hepatitis, alcoholism, and cirrhosis. It can occur in 3 forms, a solitary tumor, multiple nodules, or diffuse infiltration. It causes biliary obstruction, jaundice, portal vein thrombosis, and ascites. Symptoms of HCC include right upper quadrant pain, a palpable mass, hepatomegaly, and fever.
Liver metastases: Liver metastasis is the spread of a cancerous tumor to the liver. Its incidence is 20x greater than HCC. The most common primary tumors resulting in liver metastases include colon, breast, lung, and pancreas. The liver is vulnerable due to the large amounts of blood received from the portal vein and the high nutrient level and large lymphatic reserve. Metastases can be symptomatic or asymptomatic. Symptomatic patients present with pain, jaundice, and hepatomegaly. In addition, liver function tests are abnormal.