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Miranda's Flash Cards > ABD Board-liver > Flashcards

ABD Board-liver Flashcards

1
Q

small organized collection of macrophages that appear in the liver and spleen

A

hepatic granulomas

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2
Q

what causes hepatic granulomas

A

tuberculosis infection and fungus in the air from bird and bat poop (reaction to a forien body)

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3
Q

liver inflamation

A

hepatitis

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4
Q

most cases of hepatitis

A

viral
A (HAV) fecor/oral

B (HBV) blood/body fluids

C (HCV) blood/body fluids

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5
Q

most freq indication for liver transplantation

A

HCV (hepatitis C)

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6
Q

Starry Night (periportal cuffing), hypochic liver parenchyma, liver enlargement, hyperechoic portal veins

A

acute hepatitis

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7
Q

hyperechoic liver panenchyma, small liver, decreased echogenicity of portal vein walls

A

chronic hepatitis

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8
Q

most common source of pyogenic liver abscess

A

billiary tract disease

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9
Q

causes of billiary tract disease

A

obstruction of the bile flow allows for bacterial proliferation

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10
Q

lobe most affected by billiary tract disease causing pyogenic liver abscess

A

right by 2:1

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11
Q

complex mass, gas, reverberation artifact

A

pyogenic bacterial abscess

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12
Q

RUQ pain, leukocytosis, fever, and elevated liver function tests

A

symptoms of pyogenic bacterial abscess (aspiration is needed to confirm)

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13
Q

3 major forms of liver abscess

A

pyogenic
amebic abscess
fungal abscess

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14
Q

polymicrobial, accounts for 80%

A

pyogenic abscess

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15
Q

entamoeba histolytica 10%

A

amebic abscess

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16
Q

candida species less than 10%

A

fungal abscess (candidiasis)

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17
Q

cyst within a cyst

A

echinococcal cyst aka hydatid disease, tape worm

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18
Q

most common parasitic infection in humans, occluded intrahepatic portal veins, thickening of portal vein walls

A

schistosomiasis

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19
Q

hepatitis, spenomegaly, lymphadenopathy, pneumocystis, fatty liver, non hodkins lymphoma, candidiasis, cholangitis, acalculous cholecystisis, kaposi’s sarcoma, nephropathy are all sonographic findings of what

A

sonographic findings of acquired immunodeficiency syndrome (AIDS)

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20
Q

accumulation of triglycerides within the hepatocytes

A

fatty infiltration (steatosis)

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21
Q

focal regions of increased echogenicity within normal liver parenchyma. Commonly occurs at the porta hepatis

A

focal fatty infiltration

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22
Q

focal regions of normal liver parenchyma within a fatter infiltrated liver. Commonly occurs adjacent to the GB in the porta hepatis, in the caudate lobe and at the liver margins

A

focal fatty sparing

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23
Q

rt hepatic vein location and usefulness

A

location, rt intersegmental fissure

usefulness, divides anterior and posterior segments of rt lobe

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24
Q

main hepatic vein location and usefulness

A

location, main lobar fissure

usefulness, separates rt and lt lobes

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25
Q

lt hepatic vein location and usefulness

A

location, lt intersegmental fissure

usefulness, divides medial and lateral segments of the lt lobe

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26
Q

rt portal vein anterior branch location and usefulness

A

location, intrasegmental in anterior segment of rt lobe

usefulness, courses centrally in anterior segment of rt lobe

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27
Q

rt portal vein, posterior branch location and usefulness

A

location, intrasegmental in posterior segment of the rt lobe

usefulness, courses centrally in posterior segment of rt lobe

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28
Q

lt portal vein, horizontal segment location and usefulness

A

location, anterior to caudate lobe

usefulness, separates caudate lobe from medial segment of lt lobe

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29
Q

lt portal vein ascending segment location and usefulness

A

location, lt intersegmental fissure

usefulness, divides medial from lateral segment of lt lobe

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30
Q

gb fossa location and usefulness

A

location, main lobar fissure

usefulness, separates rt and lt lobes

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31
Q

ligamentum teres location and usefulness

A

location, lt intersegmental fissure

usefulness, divides caudal aspect of lt lobe into medial and lateral segments

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32
Q

ligamentum venosum location and usefulness

A

location, lt anterior margin of the caudate lobe

usefulness, separates caudate lobe from lt lobe

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33
Q

caudate lobe lies

A

posterior superior surface of the liver between the ivc and medial lt lobe

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34
Q

caudate lobe venous drainage is by

A

small veins called emissary veins which enter directly into ivc

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35
Q

the hepatic veins are __________ and ___________because they course between the lobes and segments

A

interlobar and intersegmental

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36
Q

the portal triad vessels are ___________ cause they course to the center of each segment

A

intrasegmental

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37
Q

the portal triad is encased by a fibrofatty sheath called

A

glisson’s capsule

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38
Q

portal triad vessels include

A

main portal vein
proper hepatic artery
common hepatic duct

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39
Q

midplane of the liver AKA

A

cantlie line

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40
Q

rt intersegmental fissure divides

A

the rt lobe into anterior and posterior segments, land mark is rt hepatic vein

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41
Q

lt intersegmental fissure divides

A

lt lobe into medial and lateral segments, land marks are lt hepatic vein, ascending lt portal vein, falciform ligament, and ligamentum teres

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42
Q

ligamentum venosum is a remnant of ______ _______ and separates the

A

ductus venosus

lt lobe from the caudate lobe

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43
Q

the ligamentum teres is a remnant of what

A

umbilical vein (after birth it contracts but with portal hypertension it recanalizes to form a venous collateral)

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44
Q

ligamentum venosum is a remanant of

A

ductus venosus (runs from lt portal vein to the ivc)

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45
Q

direction of fetal circulation

A

umbilical vein to lt portal vein to ductus venosus to IVC

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46
Q

upper limits of normal for portal vein diameter

A

1.3mm

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47
Q

hepatic vein waveforms

A

above (lil bit) and below baseline

triphasic, reflecting rt atrial filling, contraction, and relaxation

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48
Q

hepatic artery location

A

runs parrallel to the main portal vein

anterior and to the lt of the main portal vein (in 55% of ppl)

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49
Q

doppler hepatic artery waveforms

A

flow throughout diastole, indication a low resistance system

high resistance waveform suggests venous congestion or possible organ rejection

parvus tardus artery waveform suggest a proximal anastomotic stenosis >50%

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50
Q

suspends the liver from the diaphragm and surround the bare area

A

coronary ligament

51
Q

not part of peritoneal space, no ascites seen here, liver is in direct contact with the diaphragm

A

bare area

52
Q

hepatomegaly

A

in 75% of ppl

sup to inf >15.5cm

53
Q

diffuse process of fibrosis and distortion of normal liver architecture. Initially liver is enlarged but continued insult results in atrophy and blood coagulopathy, hepatic encephalopathy and portal hypertension

A

cirrhosis

54
Q

causes of cirrhosis

A

hep c

alcoholic liver disease

non alcoholic fattly liver disease

non alcoholic steatohepatitis

hep b

55
Q

increased liver functions for cirrhosis

A

AST

ALT

GGT

LDH

conjugated bilirubin

56
Q

sonographic findings of cirrosis

A

hepatomegaly (acute)

liver atrophy (chronic)

enlarged caudate lobe

regenerative nodules

fatty infiltration

portal hypertension changes

57
Q

what causes an increased incidence of hepatocellular carcinoma

A

cirrosis

58
Q

portal vein diameter suggesting portal hypertension

A

> 13mm (15mm/hg)

59
Q

major cause of portal hypertension

A

cirrhosis

60
Q

symtoms of portal hypertension

A

asymptomatic but some presents with upper GI hemorrhage due to rupture of esophageal varicies that extend from the rt and lt gastric veins

61
Q

4 types of portal hypertension

A

extrahepatic presinusoidal (portal vein thrombosis)

intrahepatic presinusoidal (schistosomiasis)

intrahepatic (most common) (cirrhosis)

intrahepatic postsinusoidal (hepatic vein thrombosis)

62
Q

sonographic appearance of portal vein thrombosis

A

splenomegaly

ascites

portal systemic venous collaterals

63
Q

surgical techniques to lower portal pressure

A

portacaval shunt

splenorenal shunt/linton shunt

distal spenorenal shunt/ warren shunt (TIPS)

64
Q

TIPS

A

used to releive portal pressure

transjugular intrahepatic portal systemic shunting

placed between a hepatic vein and a portal vein (typically RHV and RPV)

65
Q

criteria for TIPS

A

low shunt velocity 90 cm/sec

hepatopetal LPV or RPV

Hepatofugal MPV

Absent shunt flow

66
Q

orthotopic liver transplantation

A

occuring in the same place s original organ

aprox 5000 livers in us each year

67
Q

tumoral causes of portal vein thrombosis

A

hepatocellular carcinoma

metastatic liver disease

pancreatic carcinoma

68
Q

non tumoral causes of portal vein thrombosis

A

pancreatitis

cirrhosis/hepatitis (most common)

inflammatory bowel disease

trauma

spenectomy

hypercoagulation

portal lymphadenopathy

69
Q

cavernous transformation

A

numerous wormlike venous collaterals that parallel the chronically thrombosed portal vein. typically seen with benign causes

70
Q

hepatic vein abstruction

A

budd chiari syndrome (signs and symptoms assiciated with portal hypertension)

71
Q

fluid filled space surrounded by billiary epithelial tissue

A

liver cyst

%5 of ppl have them especially after age 50

if before age 50 evaluate kidneys to check for polycystic kidney disease

72
Q

most benign tumor of the liver

A

cavernous hemangioma

73
Q

cavernous hemangioma appearance

A

hyperechoic with posterior enhancement

may enlarge with pregnancy or adminstration of estrogen

may appear hypoechic in background of fatty linver

no color flow

contrast enhanced imaging demonstrates characteristic centripetal flow

74
Q

a benign solid liver mass that is believed to be a developmental hyperplastic lesion rather than true neoplasm

A

focal nodular hyperplasia

75
Q

appearance of focal nodular hyperplasia

A

solid mass with varying echogenicity

solitary lesion (80-95%)

central fibrous scar (20% hallmark)

stellate vascularity

76
Q

focal nodular hyperplasia histology

A

hyperplastic hepatocytes in an abnormal arrangement with dense fibrous tissue

mass contains proliferating bile ducts, kupffer cells, connective tissue, and central stellate scar

77
Q

focal nodular hyperplasia appearance

A

echogenicity = to surrounding liver parenchyma and are known as the stealth lesion, mass effect, displacing intrahepatic blood vessels

78
Q

liver mass associated with oral contraceptive and glycogen storage disease

A

hepatic adenoma (non specific echogenicity, look for hemorrhage)

79
Q

with hepatic adenoma patients present with pain due to

A

tumor hemorrhage

80
Q

rare fatty liver tumors

A

hepatic lipoma

81
Q

congenital familial disease associated with hepatic lipomas and angiomyolipomas

A

tuberous sclerosis

82
Q

hepatic lipoma appearance

A

hyperechoic mass

propagation speed artifact (fatt slows down speed and displaces objects posterior to mass)

83
Q

most common primary malignancy of liver

A

hepatocellular carcinoma (can be focal or diffuse growth which is hard to see with cirrhotic tissue and nodules)

84
Q

hepatocellular carcinoma occurs predominantly in patients with

A

underlying chronic liver disease and cirrhosis

85
Q

hepatocellular carnicomas commonly invades

A

venous structures like portal veins, hepatic veins, and IVC

86
Q

hepatocellular carcinoma appearance

A

variable appearance mostly hypoechoic

87
Q

lab values for hepocellular carcinoma

A

increased alpha fetoprotein, AST, and ALT

88
Q

easily established in liver due to dual blood supply and factors that promote cell growth, mostly multiple

A

metastatic disease of liver

89
Q

hyperechoic metastases in liver

A

gastrointestinal tract

90
Q

hypoechoic metastases in liver

A

lymphoma

91
Q

bulls eye or taget metastases in liver

A

lung

92
Q

cacified metastases in liver

A

mucinour adenocarcinoma of the colon

93
Q

cystic metastases of liver

A

leimyosarcoma

94
Q

uncommon malignant liver neoplasm occurring in infants and children

A

hepatoblastoma

95
Q

hepatoblastoma usually occurs before

A

2 yrs old (patient presents with asymptomatic abd mass 10 to 12 cm at diagnosis)

96
Q

hepatoblastoma associated with

A

beckwith wiedemann and familial adenomatous polyposis

lung metastases and portal vein invasion

97
Q

hepatoblastoma lab values

A

increased levels of serum alpha fetoprotein

98
Q

liver uses these enzymes to metabolize amino acids and make proteins. when liver cells are damaged they spill them into the blood stream.

A

aminotransferases

99
Q

enzym that has a wide tissue distribution. It is present in the liver, heart, skeletal muscle, kidey, and brain.

A

aspartate aminotransferase (AST) AKA serum glutamic oxaloacetic transaminase (SGOT)

100
Q

enzym high concentration within the liver tissue, liver specific

A

alanine aminotransferase (ALT) AKA serum glutamic pyruvic transaminase (SGPT)

101
Q

enzyme in hepatocytes and bile duct epithelium

A

gamma glutamyl transpeptidase (GGT)

102
Q

increased GGT + Increased ALP =

A

biliary obstruction

103
Q

increased GGT + increased ALT =

A

hepatocellular disease

104
Q

enzyme found in cells of many body tissues, cellular damage causes an elevation of the total serum ___

A

lactic dehydrogenase (LDH)

105
Q

elevated alpha fetoprotein (AFP) occurs with

A

hepatocellular carcinoma (hepatoma)

germ cell rumors (testes or ovaries)

metastatic liver cancer

hepatoblasoma

moderate levels can be seen with benign over disease, very high levels >500 ng/ml is HCC (the higher the worse the HCC)

106
Q

lab screens for abnormalities in the extrinsic and common pathways of coagulation

A

prothrombin time (PT)

107
Q

screens plasma for abnormalities and clotting factors

A

partial thromboplastin time (PTT)

108
Q

alpha fetoprotein (AFP) is a tumor marker for

A

hepatocellular carcinoma

acute chronic hepatitis

testicular carcinoma (non seminoma)

109
Q

chromogranin A is a timor marker for

A

neuroendocrine tumors (carcinoid tumors)

110
Q

beta 2 microglobulin (B2M) is a tumor marker for

A

multiple myeloma

lymphoma

111
Q

serum gamma globulin is a tumor marker for

A

bone marrow cancers

multiple myeloma

macroglobulinemia

112
Q

ca 15-3 and ca 27.29 are tumor markers for

A

breast cancer but can be elevated in other cancers

113
Q

human chorionic gonadotropin (HCG) os a tumor marker for

A

testicular cancer (seminoma and non seminoma)

choriocarcinoma

114
Q

ca 125 is a tumor marker for

A

ovarian cancer

endometriosis

jung cancer

115
Q

neuro specific enolase (NSE) is a tumor marker for

A

lung cancer (small cell)

116
Q

ca 72-4 is a tumor marker for

A

ovarian cancer

gastrointestinal cancers

117
Q

prostatic acid phosphatase (PAP) is a tumor marker for

A

prostate cancer

118
Q

prostatic specific antigen (PSA) is a tumor marker for

A

prostate cancer

benign prostatic hypertrophy (BPH)

119
Q

ca 19-9 is a tumor marker for

A

pancreatic cancer

can be elevated with colorectal and bile duct cancers

120
Q

s-100 and ta-90 is a tumor marker for

A

malignant melanoma

121
Q

calcitonin is a tumor marker for

A

medullary thyroid cancer

122
Q

bladder tumor antigen and nmp22 are tumor markers for

A

bladder cancer (transitional cell carcinoma)

123
Q

carcinoembryonic antigen (CEA) is a tumor marker for

A

colorectal cancer, also elevated with other cancers

Miranda's Flash Cards (14 decks)

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