ABD Board-liver Flashcards
1
Q
small organized collection of macrophages that appear in the liver and spleen
A
hepatic granulomas
2
Q
what causes hepatic granulomas
A
tuberculosis infection and fungus in the air from bird and bat poop (reaction to a forien body)
3
Q
liver inflamation
A
hepatitis
4
Q
most cases of hepatitis
A
viral
A (HAV) fecor/oral
B (HBV) blood/body fluids
C (HCV) blood/body fluids
5
Q
most freq indication for liver transplantation
A
HCV (hepatitis C)
6
Q
Starry Night (periportal cuffing), hypochic liver parenchyma, liver enlargement, hyperechoic portal veins
A
acute hepatitis
7
Q
hyperechoic liver panenchyma, small liver, decreased echogenicity of portal vein walls
A
chronic hepatitis
8
Q
most common source of pyogenic liver abscess
A
billiary tract disease
9
Q
causes of billiary tract disease
A
obstruction of the bile flow allows for bacterial proliferation
10
Q
lobe most affected by billiary tract disease causing pyogenic liver abscess
A
right by 2:1
11
Q
complex mass, gas, reverberation artifact
A
pyogenic bacterial abscess
12
Q
RUQ pain, leukocytosis, fever, and elevated liver function tests
A
symptoms of pyogenic bacterial abscess (aspiration is needed to confirm)
13
Q
3 major forms of liver abscess
A
pyogenic
amebic abscess
fungal abscess
14
Q
polymicrobial, accounts for 80%
A
pyogenic abscess
15
Q
entamoeba histolytica 10%
A
amebic abscess
16
Q
candida species less than 10%
A
fungal abscess (candidiasis)
17
Q
cyst within a cyst
A
echinococcal cyst aka hydatid disease, tape worm
18
Q
most common parasitic infection in humans, occluded intrahepatic portal veins, thickening of portal vein walls
A
schistosomiasis
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)
20
Q
accumulation of triglycerides within the hepatocytes
A
fatty infiltration (steatosis)
21
Q
focal regions of increased echogenicity within normal liver parenchyma. Commonly occurs at the porta hepatis
A
focal fatty infiltration
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
23
Q
rt hepatic vein location and usefulness
A
location, rt intersegmental fissure
usefulness, divides anterior and posterior segments of rt lobe
24
Q
main hepatic vein location and usefulness
A
location, main lobar fissure
usefulness, separates rt and lt lobes
25
lt hepatic vein location and usefulness
location, lt intersegmental fissure
usefulness, divides medial and lateral segments of the lt lobe
26
rt portal vein anterior branch location and usefulness
location, intrasegmental in anterior segment of rt lobe
usefulness, courses centrally in anterior segment of rt lobe
27
rt portal vein, posterior branch location and usefulness
location, intrasegmental in posterior segment of the rt lobe
usefulness, courses centrally in posterior segment of rt lobe
28
lt portal vein, horizontal segment location and usefulness
location, anterior to caudate lobe
usefulness, separates caudate lobe from medial segment of lt lobe
29
lt portal vein ascending segment location and usefulness
location, lt intersegmental fissure
usefulness, divides medial from lateral segment of lt lobe
30
gb fossa location and usefulness
location, main lobar fissure
usefulness, separates rt and lt lobes
31
ligamentum teres location and usefulness
location, lt intersegmental fissure
usefulness, divides caudal aspect of lt lobe into medial and lateral segments
32
ligamentum venosum location and usefulness
location, lt anterior margin of the caudate lobe
usefulness, separates caudate lobe from lt lobe
33
caudate lobe lies
posterior superior surface of the liver between the ivc and medial lt lobe
34
caudate lobe venous drainage is by
small veins called emissary veins which enter directly into ivc
35
the hepatic veins are __________ and ___________because they course between the lobes and segments
interlobar and intersegmental
36
the portal triad vessels are ___________ cause they course to the center of each segment
intrasegmental
37
the portal triad is encased by a fibrofatty sheath called
glisson's capsule
38
portal triad vessels include
main portal vein
proper hepatic artery
common hepatic duct
39
midplane of the liver AKA
cantlie line
40
rt intersegmental fissure divides
the rt lobe into anterior and posterior segments, land mark is rt hepatic vein
41
lt intersegmental fissure divides
lt lobe into medial and lateral segments, land marks are lt hepatic vein, ascending lt portal vein, falciform ligament, and ligamentum teres
42
ligamentum venosum is a remnant of ______ _______ and separates the
ductus venosus
lt lobe from the caudate lobe
43
the ligamentum teres is a remnant of what
umbilical vein (after birth it contracts but with portal hypertension it recanalizes to form a venous collateral)
44
ligamentum venosum is a remanant of
ductus venosus (runs from lt portal vein to the ivc)
45
direction of fetal circulation
umbilical vein to lt portal vein to ductus venosus to IVC
46
upper limits of normal for portal vein diameter
1.3mm
47
hepatic vein waveforms
above (lil bit) and below baseline
triphasic, reflecting rt atrial filling, contraction, and relaxation
48
hepatic artery location
runs parrallel to the main portal vein
anterior and to the lt of the main portal vein (in 55% of ppl)
49
doppler hepatic artery waveforms
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%
50
suspends the liver from the diaphragm and surround the bare area
coronary ligament
51
not part of peritoneal space, no ascites seen here, liver is in direct contact with the diaphragm
bare area
52
hepatomegaly
in 75% of ppl
sup to inf >15.5cm
53
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
cirrhosis
54
causes of cirrhosis
hep c
alcoholic liver disease
non alcoholic fattly liver disease
non alcoholic steatohepatitis
hep b
55
increased liver functions for cirrhosis
AST
ALT
GGT
LDH
conjugated bilirubin
56
sonographic findings of cirrosis
hepatomegaly (acute)
liver atrophy (chronic)
enlarged caudate lobe
regenerative nodules
fatty infiltration
portal hypertension changes
57
what causes an increased incidence of hepatocellular carcinoma
cirrosis
58
portal vein diameter suggesting portal hypertension
>13mm (15mm/hg)
59
major cause of portal hypertension
cirrhosis
60
symtoms of portal hypertension
asymptomatic but some presents with upper GI hemorrhage due to rupture of esophageal varicies that extend from the rt and lt gastric veins
61
4 types of portal hypertension
extrahepatic presinusoidal (portal vein thrombosis)
intrahepatic presinusoidal (schistosomiasis)
intrahepatic (most common) (cirrhosis)
intrahepatic postsinusoidal (hepatic vein thrombosis)
62
sonographic appearance of portal vein thrombosis
splenomegaly
ascites
portal systemic venous collaterals
63
surgical techniques to lower portal pressure
portacaval shunt
splenorenal shunt/linton shunt
distal spenorenal shunt/ warren shunt (TIPS)
64
TIPS
used to releive portal pressure
transjugular intrahepatic portal systemic shunting
placed between a hepatic vein and a portal vein (typically RHV and RPV)
65
criteria for TIPS
low shunt velocity 90 cm/sec
hepatopetal LPV or RPV
Hepatofugal MPV
Absent shunt flow
66
orthotopic liver transplantation
occuring in the same place s original organ
aprox 5000 livers in us each year
67
tumoral causes of portal vein thrombosis
hepatocellular carcinoma
metastatic liver disease
pancreatic carcinoma
68
non tumoral causes of portal vein thrombosis
pancreatitis
cirrhosis/hepatitis (most common)
inflammatory bowel disease
trauma
spenectomy
hypercoagulation
portal lymphadenopathy
69
cavernous transformation
numerous wormlike venous collaterals that parallel the chronically thrombosed portal vein. typically seen with benign causes
70
hepatic vein abstruction
budd chiari syndrome (signs and symptoms assiciated with portal hypertension)
71
fluid filled space surrounded by billiary epithelial tissue
liver cyst
%5 of ppl have them especially after age 50
if before age 50 evaluate kidneys to check for polycystic kidney disease
72
most benign tumor of the liver
cavernous hemangioma
73
cavernous hemangioma appearance
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
a benign solid liver mass that is believed to be a developmental hyperplastic lesion rather than true neoplasm
focal nodular hyperplasia
75
appearance of focal nodular hyperplasia
solid mass with varying echogenicity
solitary lesion (80-95%)
central fibrous scar (20% hallmark)
stellate vascularity
76
focal nodular hyperplasia histology
hyperplastic hepatocytes in an abnormal arrangement with dense fibrous tissue
mass contains proliferating bile ducts, kupffer cells, connective tissue, and central stellate scar
77
focal nodular hyperplasia appearance
echogenicity = to surrounding liver parenchyma and are known as the stealth lesion, mass effect, displacing intrahepatic blood vessels
78
liver mass associated with oral contraceptive and glycogen storage disease
hepatic adenoma (non specific echogenicity, look for hemorrhage)
79
with hepatic adenoma patients present with pain due to
tumor hemorrhage
80
rare fatty liver tumors
hepatic lipoma
81
congenital familial disease associated with hepatic lipomas and angiomyolipomas
tuberous sclerosis
82
hepatic lipoma appearance
hyperechoic mass
propagation speed artifact (fatt slows down speed and displaces objects posterior to mass)
83
most common primary malignancy of liver
hepatocellular carcinoma (can be focal or diffuse growth which is hard to see with cirrhotic tissue and nodules)
84
hepatocellular carcinoma occurs predominantly in patients with
underlying chronic liver disease and cirrhosis
85
hepatocellular carnicomas commonly invades
venous structures like portal veins, hepatic veins, and IVC
86
hepatocellular carcinoma appearance
variable appearance mostly hypoechoic
87
lab values for hepocellular carcinoma
increased alpha fetoprotein, AST, and ALT
88
easily established in liver due to dual blood supply and factors that promote cell growth, mostly multiple
metastatic disease of liver
89
hyperechoic metastases in liver
gastrointestinal tract
90
hypoechoic metastases in liver
lymphoma
91
bulls eye or taget metastases in liver
lung
92
cacified metastases in liver
mucinour adenocarcinoma of the colon
93
cystic metastases of liver
leimyosarcoma
94
uncommon malignant liver neoplasm occurring in infants and children
hepatoblastoma
95
hepatoblastoma usually occurs before
2 yrs old (patient presents with asymptomatic abd mass 10 to 12 cm at diagnosis)
96
hepatoblastoma associated with
beckwith wiedemann and familial adenomatous polyposis
lung metastases and portal vein invasion
97
hepatoblastoma lab values
increased levels of serum alpha fetoprotein
98
liver uses these enzymes to metabolize amino acids and make proteins. when liver cells are damaged they spill them into the blood stream.
aminotransferases
99
enzym that has a wide tissue distribution. It is present in the liver, heart, skeletal muscle, kidey, and brain.
aspartate aminotransferase (AST) AKA serum glutamic oxaloacetic transaminase (SGOT)
100
enzym high concentration within the liver tissue, liver specific
alanine aminotransferase (ALT) AKA serum glutamic pyruvic transaminase (SGPT)
101
enzyme in hepatocytes and bile duct epithelium
gamma glutamyl transpeptidase (GGT)
102
increased GGT + Increased ALP =
biliary obstruction
103
increased GGT + increased ALT =
hepatocellular disease
104
enzyme found in cells of many body tissues, cellular damage causes an elevation of the total serum ___
lactic dehydrogenase (LDH)
105
elevated alpha fetoprotein (AFP) occurs with
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
lab screens for abnormalities in the extrinsic and common pathways of coagulation
prothrombin time (PT)
107
screens plasma for abnormalities and clotting factors
partial thromboplastin time (PTT)
108
alpha fetoprotein (AFP) is a tumor marker for
hepatocellular carcinoma
acute chronic hepatitis
testicular carcinoma (non seminoma)
109
chromogranin A is a timor marker for
neuroendocrine tumors (carcinoid tumors)
110
beta 2 microglobulin (B2M) is a tumor marker for
multiple myeloma
lymphoma
111
serum gamma globulin is a tumor marker for
bone marrow cancers
multiple myeloma
macroglobulinemia
112
ca 15-3 and ca 27.29 are tumor markers for
breast cancer but can be elevated in other cancers
113
human chorionic gonadotropin (HCG) os a tumor marker for
testicular cancer (seminoma and non seminoma)
choriocarcinoma
114
ca 125 is a tumor marker for
ovarian cancer
endometriosis
jung cancer
115
neuro specific enolase (NSE) is a tumor marker for
lung cancer (small cell)
116
ca 72-4 is a tumor marker for
ovarian cancer
gastrointestinal cancers
117
prostatic acid phosphatase (PAP) is a tumor marker for
prostate cancer
118
prostatic specific antigen (PSA) is a tumor marker for
prostate cancer
benign prostatic hypertrophy (BPH)
119
ca 19-9 is a tumor marker for
pancreatic cancer
can be elevated with colorectal and bile duct cancers
120
s-100 and ta-90 is a tumor marker for
malignant melanoma
121
calcitonin is a tumor marker for
medullary thyroid cancer
122
bladder tumor antigen and nmp22 are tumor markers for
bladder cancer (transitional cell carcinoma)
123
carcinoembryonic antigen (CEA) is a tumor marker for
colorectal cancer, also elevated with other cancers
