18 liver and portal vein

Question 1

How could you identify a common bile duct obstruction on a cholangiogram?

Answer 1

no contrast in second part of duodenum; may also notice the superior portion dilated and the inferior portion constricted

Question 2

What organ might cause a common bile duct obstruction?

Answer 2

pancreas

Question 3

echo

Answer 3

image acquisition

Question 4

what determines the intensity of the echo

Answer 4

-difference in acoustic impedance -angle at which beam hits surface

Question 5

what determines acoustic impedence

Answer 5

tissue density

Question 6

greater dif in density btwn two structures…

Answer 6

stronger the resulting interface echoes defining the boundaries btwn two structures on the ultrasound image

Question 7

anechoic

Answer 7

also known as sonolucent fluid filled structure that transmits sound easily vascular structures, distended bladder, gallbladder

Question 8

echogenic

Answer 8

also known as hyperechoicic echo producing structure that reflects sound w/ a brighter intensity bone, gallstones, kidney stones, fat, fissures, ligaments

Question 9

hypoechoic

Answer 9

low level echoes within a structure lung fields,GI tract

Question 10

Shadowing

Answer 10

beam attenuated by solid / calcified obj

Question 11

Answer 11

1. stomach
2. omental bursa
3. transverse mesocolon
4. transverse colon

Question 12

Whats the normal inferior border of the liver

Answer 12

Liver is usually not palpable inferior to the right costal margin

Question 13

ascites

Answer 13

fluid within the peritoneal cavity; can be felt by percussing the abdomen

Question 14

Describe the normal path for return of the portal blood to the caval system?

Answer 14

Through the liver

(portal vein –> liver –> hepatic veins –> IVC)

Question 15

List the four major tributaries of the portal vein

Answer 15

1. left splenic
2. splenic artery
3. inferior mesenteric artery
4. superior mesenteric artery

Question 16

formation of the portal vein occurs posterior to what part of what organ

Answer 16

neck of pancreas

Question 18

Four major collateral pathways that allow for collateral circulation around the portal vein

Answer 18

paraumbilical veins along ligamentum teres (communicates with SUPERFICIAL epigastric)

left gastric vein (communicates with esophageal veins)

left and right colic veins (communicates with retroperitoneal veins)

superior rectal vein (communicates with middle and lower rectal veins)

Question 19

Where are the esophageal veins found?

Answer 19

esophageal submucosal venous plexus

*included this card just becuase thats a buzzword term for clinical questions stems - if you see something that indicates varicoeles in the esophageal submucosal venous plexus –> think potential portal vein obstruction

Question 20

Increased blood flow through which collateral pathway could result in caput medusae?

Answer 20

paraumbilical veins along ligamentum teres communicating with SUPERFICIAL epigastric veins

Question 21

Increased blood flow through what pathway could result in enlarged retroperiotneal veins?

Answer 21

right and left colic communicate with renal and lumbar branches of IVC,thus would cause enlargment of retroperiotneum, as that is the location of the anastomosis