Anatomy Practice #1 Flashcards
Which of the following can be used to differentiate Riedel lobe from hepatomegaly?
the left lobe is normal in size with Reidel lobe but enlarged with hepatomegaly
the Lig Venosum is not visible in cases of Riedel lobe but well seen in hepatomegaly
the right lobe is normal in size in Reidel lobe but enlarged with hepatomegaly
the Lig Venosum is not visible in cases of Riedel lobe but well seen in hepatomegaly
the left lobe is normal in size with Riedel lobe but enlarged with hepatomegaly
What structure/vessel is indicated by #6?
SMA
splenic vein
SMV
splenic artery
SMA
What structure/vessel is indicative by #4?
caudate lobe
right lobe
medial left lobe
lateral left lobe
medial left lobe
Which statement best describes the location of the Lig Venosum?
forms the anterior border of the caudate lobe
lies between the right and left lobes of the liver
forms the posterior border of the right lobe
on ultrasound, it appears as a thick, triangular, echogenic foci in the left lobe of the liver
forms the anterior border of the caudate lobe
All of the following are intrasegmental vessels of the liver, EXCEPT?
PVs
hepatic arteries
bile ducts
HVs
HVs
course between the liver segments (intersegmental)
The Lig Venosum travels between:
the RPV and IVC
the MPV and IVC
the LPV and IVC
caudate lobe and right lobe
the LPV and IVC
Which of the following statements correctly describes imaging of the dome of the liver?
intercostal scanning is the preferred scanning approach to evaluate the dome of the liver
the portal confluence should be used to locate the dome of the liver
because the dome is bordered superiorly by the diaphragm, lobe artifact commonly inhibits complete evaluation of this portion of the liver
deep inspiration is required to evaluate this portion of the liver
deep inspiration is required to evaluate this portion of the liver
(subcostal approach with deep inspiration)
Which of the following structures is labeled #6?
anterior right lobe
lateral left lobe
medial left lobe
posterior right lobe
medial left lobe
What structure/vessel is indicated by #7?
splenic vein
splenic artery
SMV
SMA
splenic vein
The pancreatic duct should normally be less than ____ in diameter in children and young adults.
0.5mm
1 mm
2mm
4mm
2mm
The ____ is located within the inferior margin of the falciform ligament.
Lig Teres
Lig Venosum
MHV
LHV
Lig Teres
During an abdominal ultrasound, a 4mm circular anechoic structure is identified at the posterior portion of the pancreas head. Color flow is not identified in the structure. What is it?
common hepatic duct
IMA
CBD
gastroduodenal artery
CBD
What structure is indicative by the purple circle?
Caroli disease
MPV
chledochal cyst
portal triad
portal triad
Which of the following structures is labeled #7?
medial left lobe
anterior right lobe
lateral left lobe
posterior right lobe
anterior right lobe
A normal portal vein will:
increase in diameter after exercise
increase in diameter by placing patient in the upright position
decrease in diameter after eating
increase in diameter by more than 20% with deep inspiration
increase in diameter by more than 20% with deep inspiration
The yellow arrow on the images represents which of the following structures?
medial left lobe
caudate lobe
Lig Teres
Lig Venosum
caudate lobe
The MLF:
separates the IVC and medial left lobe
separates the anterior and posterior right lobes
separates anterior right lobe and medial left lobe
separates the medial and lateral left lobes
separates the anterior right lobe and medial left lobe
The caudate lobe lies between what two structures?
MLF and GB
right and left PVs
IVC and medial left lobe
IVC and lateral left lobe
IVC and medial left lobe
The ___ can be identified anterior to the pancreas tail
stomach
SMA
hepatic flexure of the colon
left kidney
stomach
Which of the following hepatic ligaments separate the medial and lateral left lobes of the liver?
Lig Venosum
broad ligament
triangular ligament
falciform ligament
falciform ligament
Which waveform represents a normal IVC waveform?
A
Which of the following structures is labeled #1?
RHV
IVC
LHV
LPV
LHV
What structure prevents free fluid in Morison pouch from moving into subphrenic space?
Lig Teres
falciform ligament
right hepatoduodenal ligaments
right coronary ligament
right coronary ligament
Which structure is the MPV?
MPV = posterior vessel
hepatic artery = circular structure
dilated CBD = anterior vessel
Which of the following structures is labeled #2?
gastroduodenal artery
SMA
hepatic artery
CBD
gastroduodenal artery
The caudate lobe occupies much of the ___ surface of the liver
anterior superior
posterior superior
posterior inferior
anterior inferior
posterior superior
What structure/vessel is indicated by #2?
left lobe of the liver
stomach
head of pancreas
duodenum
head of pancreas
In the porta hepatis, what structure is anterior to the PV and lateral to the proper hepatic artery?
common hepatic duct
common hepatic artery
cystic duct
duct of wirsung
common hepatic duct
What liver vessel is indicated by the yellow arrow?
medial LPV
anterior RPV
posterior RPV
lateral LPV
anterior RPV
Which of the following is located between the transversalis fascia and the posterior parietal peritoneum?
pancreas
stomach
spleen
linea alba
pancreas
the retroperitoneal cavity is located between the transversalis fascia and posterior parietal peritoneum - pancreas is a retroperitoneal organ
What structure/vessel is indicated by #9?
air within the intestines
SMA
spine
AO
IVC
spine
Which of the following ligaments separates the medial and lateral left lobes of the liver?
Lig Teres
Lig Venosum
coronary ligament
broad ligament
Lig Teres
Which of the following blood vessels delivers the majority of oxygenated blood that enters the liver?
MPV
proper hepatic artery
HVs
common hepatic artery
MPV (80%)
A patient presents for an abdominal sonogram due to a history of hepatic congestion. What structure (s) should be closely evaluated for related findings?
RAs
portal system
LRV
celiac axis
portal system
A small rounded prominence on the anteroinferior aspect of the normal caudate lobe is called
Reidel lobe
distal papillary process
quadrate lobe
elongated left lobe
distal papillary process
What structure/vessel is indicated by #8?
Lig Teres
caudate lobe
Lig Venosum
medial left lobe
lateral left lobe
medial left lobe
Branches of which of the following vessels supply the pancreas with blood?
SMA and right gastric artery
proper hepatic artery and SMA
gastroduodenal artery and proper hepatic artery
SMA and gastroduodenal artery
SMA and gastroduodenal artery
____ merge to form the ampulla of Vater just prior to the duct entering the second portion of the duodenum
CBD and CHD
CBD and duct of Wirsung
CBD and cystic duct
CHD and cystic duct
CBD and duct of Wirsung
Which of the following structures is labeled #3?
LHV
IVC
MHV
LPV
IVC
Which of the following hormones is responsible for causing the GB to contract?
cholecystokinin
trypsin
insulin
lipase
cholecystokinin
Which portions of the GB and/or biliary tree are involved in the formation of a phrygian cap?
neck and cystic duct
body and fundus
cystic duct and CBD
neck and body
body and fundus
Hepatomegaly in a 5 year old is diagnosed using which of the following criteria?
divide the patient’s age in years by the number 2 to obtain the max normal liver length for the patient’s age
normal liver should not extend more than 1 cm below the costal margin
multiply the patient’s age in years by the number 2 to obtain the max normal liver length for the patient’s age
divide the patient’s height in inches by the number 10 to obtain the max normal liver length for the patient’s age
normal liver should not extend more than 1 cm below the costal margin
The right and left hepatic ducts come together to form the common hepatic duct:
deep within the liver parenchyma
at the level of the ampulla of vater
at the pancreas head
inside the liver, near the porta hepatis
inside the liver, near the porta hepatis
What structure is marked with the X on the image?
splenic vein
SMV
CBD
main pancreatic duct
main pancreatic duct
What structure/vessel is indicated by #6?
medial rigth lobe
caudate lobe
anterior right lobe
medial left lobe
lateral left lobe
caudate lobe
If a liver mass is located between the MHV and RPV, in what lobe of the liver is the mass located?
posterior right lobe
anterior right lobe
caudate lobe
medial left lobe
anterior right lobe
Sonographically, the ___ appears to connect the GB neck and junction of right and left portal veins
Lig Teres
Lig Venosum
intersegmental fissure
MLF
MLF
Which of the numbered vessels is a part of the portal system?
1
2
3
1 and 3
2
What liver vessel is indicated by the green arrow?
lateral LPV
anterior RPV
posterior RPV
medial LPV
posterior RPV
Which liver segment is located immediately lateral to the Lig Teres?
anterior right lobe
medial left lobe
caudate lobe
lateral left lobe
lateral left lobe
Which of the following correctly lists the structures found in an intrahepatic portal triad?
PV, HV, and bile duct
PV, proper hepatic artery, and bile duct
HV, proper hepatic artery, and bile duct
common hepatic artery, HV, and PV
PV, proper hepatic artery, and bile duct
What structure/vessel is indicated by #5?
caudate lobe
lateral left lobe
right lobe
medial left lobe
lateral left lobe
A patient presents with a history of choledocholithiasis. How will you assess the CBD for the presence of a stone?
locate the MPV and look for the CBD posterior to it
demonstrate a long axis GB image and look for the CBD superior to it
demonstrate a TV view of the pancreatic head and look for the CBD entering the anterior aspect
demonstrate a longitudinal view of the MPV and look for the CBD anterior to it
demonstrate a longitudinal view of the MPV and look for the CBD anterior to it
the CBD is formed by:
cystic duct + duct of Wirsung
CHD + cystic duct
varies per patient
rght and left hepatic ducts + cystic duct
CHD + cystic duct
During an abdominal ultrasound, a small circular anechoic structure is identified at the anterior portion of the pancreas head. Color flow is identifies in the structure. What is it?
CBD
gastroduodenal artery
celiac axis
IMA
gastroduodenal artery
Trypsin breaks down ____, amylase breaks down ____ and lipase breaks down ____ during digestion
protein, carbs, fat
sugar, carbs, fat
carbs, protein, fat
fat, carbs, protein
protein, carbs, fat
The normal GB is usually less than __ in TRV diameter
3 mm
8 cm
5 cm
3 cm
5 cm
The liver is divided in the TRV plane by the:
branching of the PVs
course of the biliary vessels through the tissue
branching of the HVs
course of the fissures through the tissue
branching of the PVs
All of the following are true regarding Couinaud liver segmentation EXCEPT
allows for liver resection/surgery without negatively affecting other segments
each of the 8 segments has its own branch of the PV, HV, and bile duct
divides the liver into 8 functional segments
right and left lobes are divided by the branches of the MHV
right and left lobes are divided by the branches of the MHV
What structure/vessel is indicated by #3?
MPV
lateral branch of LPV
medial branch of LPV
LPV
lateral branch of LPV
The ___ lobe of the liver is located between the right and middle hepatic vein
medial left
lateral left
anterior right
caudate
anterior right
What vessels drain the blood from the caudate lobe?
LPV
coronary vein
emissary veins
umbilical vein
emissary veins
Which waveform represents a normal PV waveform?
D
___ is produced by the exocrine function of the pancreas and ___ is produced by the endocrine function of the pancreas
sodium bicarbonate, amylase
sodium bicarbonate, insulin
insulin, trypsin
amylase, lipase
sodium bicarbonate, insulin
Islets of Langerhans secrete ___ into ___
cholecystokinin, GB
sodium bicarbonate, duodenum
lipase, pancreatic duct
insulin, bloodstream
insulin, bloodstream
The IVC is located posterior to the pancreatic ___
body
tail
neck
head
head
What causes the HV flow to have a triphasic waveform?
left atrial contraction and relaxation
PHTN
right atrial contraction and relaxation
hepatic congestion
right atrial contraction and relaxation
What structure is indicated by the red arrow?
MPV
CBD
proper hepatic artery
common hepatic artery
proper hepatic artery
The accessory duct of the pancreas is called
duct of santorini
duct of heister
duct of vater
duct of wirsung
duct of santorini
Which of the following structures is labeled #4?
RHV
IVC
MHV
RPV
RHV
What lobe of the liver is indicated by #2?
anterior right lobe
medial left lobe
posterior right lobe
caudate lobe
anterior right lobe
An ERCP is commonly performed to evaluate:
LRV
RRV
pyloric stenosis
the Ampulla of Vater
Ampulla of Vater
ERCP is used to diagnose and treat certain problems of the biliary or pancreatic ductal systems
What structure/vessel is indicated by #2?
MPV
medial branch of LPV
lateral branch of LPV
LPV
LPV
What structure is indicated by the blue arrow?
LPV
LHV
MHV
RPV
RPV
What structure/vessel is indicated by #12?
spine
SMA
AO
IVC
spine
What portion of the pancreas is indicated by the letter O?
head
neck
uncinate process
tail
head
Which of the following terms can be used to describe a normal Doppler tracing form the hepatic veins?
triphasic
monophasic
non-pulsatile
continuous
triphasic
What structure/vessel is indicated by #4?
LLL
body of pancreas
tail of pancreas
head of pancreas
body of pancreas
The medial segment of the left lobe lies between
MHV and Lig Teres
Lig Teres and spleen
RHV and MHV
Lig Venosum and IVC
MHV and Lig Teres
Which of the following structures is labeled #2?
LHV
IVC
MHV
LPV
MHV
What structure/vessel is indicated by #7?
cadate lobe
medial left lobe
Lig Venosum
Lig Teres
lateral left lobe
Lig Venosum
While discussing the medical history with a patient, he tells you that the doctor recommended that he increase his intake of vitamin K due to some recent abnormal lab results. Which of the following lab values was abnormal?
AFP
PT
RBC count
ALP
PT
What organ produces sodium bicarbonate?
kidneys
adrenal glands
pancreas
parathyroid gland
pancreas
What lobe of the liver is indicated by #1?
posterior right lobe
caudate lobe
anterior right lobe
medial left lobe
posterior right lobe
Which of the following terms can be used to describe the normal flow in the PV?
continuous
biphasic
pulsatile
hepatofugal
continuous
The cystic artery originates at the ____ and the cystic vein empties into the ___
common hepatic artery, MPV
RHA, RPV
RHA, RHV
LHA, LPV
RHA, RPV
What structure/vessel is indicated by #3?
SMA
CBD
gastroduodenal artery
celiac
gastroduodenal artery
All of the following are true regarding the Lig Teres, EXCEPT
round, hyperechoic foci near the porta hepatis
located in the left intersegmental fissue
recanalizes with cirrhosis
is a remnant of the umbilical vein
round, hyperechoic foci near the porta hepatis
What structure is indicated by the yellow arrow?
falciform ligament
Lig Teres
MLF
Lif Venosum
MLF
In a normal adult patient, the CHD lumen measure less than or equal to ___
6mm
2mm
2cm
4mm
4mm
The pancreatic tail is anterior to all of the following EXCEPT
lesser omental sac
splenic hilum
upper pole of the left kidney
left adrenal gland
lesser omental sac is anterior to the panceas
Which of the following statements is true regarding the Doppler tracing displayed?
could represent a Doppler tracing of normal flow in the RHV
could represent a Doppler tracing of normal flow in the MPV
could represent a Doppler tracing of normal flow in the portal or hepatic venous system
could represent a Doppler tracing of normal flow in the proximal AO
could represent a Doppler tracing of normal flow in the RHV
The majority of the liver is covered by a thick capsule composed of fibrous and elastic elements called ___
Morrison pouch
Glisson capsule
Bowman capsule
Gerota fascia
Glisson capsule
Normal hepatic venous flow will demonstrate
two large antegrade diastolic and systolic waves followed by a small antegrade component that corresponds with the atrial contraction
two large antegrade diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction
two large retrograde diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction
two large retrograde diastolic and systolic waves followed by a small antegrade component that corresponds with the atrial contraction
two large antegrade diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction
What blood vessel separates the right and left lobes of the liver?
common hepatic artery
LHV
MHV
RPV
MHV
Which abdominal vessel is the best landmark to identify the body and tail of the pancreas?
LRV
RRV
splenic vein
SMV
splenic vein
Which lobe of the liver receives blood from the left and right portal veins?
anterior right lobe
medial left lobe
caudate lobe
posterior right lobe
caudate lobe
The ___ are called intersegmental vessels of the liver
PVs
HAs
HVs
HAs and HVs
HVs
On a TRV sonogram, the CBD enters at ___ aspect of the head of the pancreas and lays ___ to the IVC
anterior, medial
posterior, anterior
posterior, posterior
none of the above
posterior, anterior
The ___ separates the caudate lobe from the left lobe of the liver
falciform ligament
MLF
Lig Venosum
Lig Teres
Lig Venosum
Which of the following statements is true regarding the image displayed?
GB has a normal variant called a phrygian cap near the fundal area
GB has a normal variant called a phrygian cap near the neck
GB has a septation within the fundus
GB has a normal variant called Hartmann pouch near the fundal area
GB has a normal variant called phrygian cap near the fundal area
The formation of a Hartmann pouch usually occurs in what portion of the GB?
cystic duct
neck
fundus
body
neck
Which of the following produces insulin?
islets of langerhans
Kupffer cells in the liver
pituitary gland
acini glands of the pancreas
islets of langerhans
The purple arrow on the images represents which of the following structures?
Lig Teres
medial left lobe
caudate lobe
Lig Venosum
Lig Venosum
All of the following are true regarding the spiral valves of Heister EXCEPT
located in the CBD
may simulate stone
located in the cystic duct
may simulate shadow
located in the CBD
The bare area of the liver is in direct contact with
right kidney
diaphragm
IVC
RPV
diaphragm
What structure is indicated by the blue arrow?
common hepatic artery
MPV
CHD
CBD
CBD
A patient presents with a history of Reidel lobe. What are the expected findings on the ultrasound exam?
caudate lobe will be at least 2x greater in size than the left
right lobe of the liver will have a tongue-like extension that extends inferior to the lower pole of the right kidney
liver will demonstrate diffuse fatty infiltration of the right lobe only
left lobe will extend across the midline to touch the upper pole of the spleen
right lobe of the liver will have a tongue-like extension that extends inferior to the lower pole of the right kidney
In the porta hepatis, what structure is anterior to the PV and medial to the CBD?
common hepatic artery
cystic duct
proper hepatic artery
duct of Wirsung
proper hepatic artery
What structure is indicated by the green arrow?
MPV
common hepatic artery
CBD
porta hepatis
MPV
What structure/vessel is indicated by #5?
tail of pnacreas
left lobe of liver
body of pacreas
head of pancreas
tail of pancreas
The hepatoduodenal ligament contains which of the following structures?
umbilical arteries and vein
RPV, RHA, and cystic duct
emissary veins
MPV, proper hepatic artery, and CBD
MPV, proper hepatic artery, CBD
The right lobe of the liver is divided into ___ segments, while the left lobe is divided into ___ segments
medial/lateral and anterior/posterior
anterior/posterior and medial/lateral
caudate/anterior and quadrate/posterior
caudate/posterior and quadrate/anterior
anterior/posterior and medial/lateral
What causes the appearance of this normal variant of the uncinate process?
hyperbilirubinemia
polycythemia vera
higher concentration of fat in the area of interest
reduced concentration of fat in the area of interest
reduced concentration of fat in the area of interest
The first branch of the common hepatic artery is the
gastroduodenal artery
duodenal artery
pancreatic artery
cystic artery
gastroduodenal artery
Which of the following correctly describes the ducts of Luschka?
associated with porcelain GB and GB carcinoma
only visible in obese patients
located within the 3rd segment of the duodenum
bile thickening occurs within them
bile thickening occurs within them
located in the GB wall
can result in the stasis of bile/debris which leads to inflammatory disease
A Reidel lobe is a normal liver variant defined as
tongue-like extension of right lobe
tongue-like extension of caudate lobe
elongated right lobe that comes in contract with the spleen
elongated left lobe that comes in contact with the spleen
tongue-like extension of right lobe
Which of the following structures is labeled #5?
anterior right lobe
lateral left lobe
medial left lobe
posterior right lobe
lateral left lobe
In the normal liver, which of the following correctly describes the changes in flow in the hepatic artery after eating?
increased end diastolic flow velocities
decreased peak and end diastolic flow velocities
no change occurs in the hepatic artery after eating
increased RI
increased RI
What structure/vessel is indicated by #1?
medial branch of LPV
lateral branch of LPV
medial left lobe
LPV
medial branch of LPV
The abdominal organ that produces the majority of ALP is?
liver
spleen
pancreas
gallbladder
liver
The liver’s exocrine function includes producing:
hemoglobin
urea
bile
heparin
bile
Which lab value is associated with the development of jaundice?
BUN
hematocrit
leukocytes
bilirubin
bilirubin
All of the following lab tests are used to evaluate the liver function EXCEPT
sodium bicarbonate
prothrobin time
bilirubin
AST
sodium bicarbonate
The purple arrows point to which of the following liver structures?
Lig Venosum
falciform ligament
Lig Teres
MLF
Lig Teres
The SMV:
lies to the left of the SMA
joins the PV to form the splenic vein
joins the splenic vein posterior to the neck of the pancreas
joins the splenic vein anterior to the neck of the panceas
joins the splenic vein posterior to the neck of the pancreas
A patient presents with intermittent RUQ pain for several months. A complete abdominal exam is performed with an image displayed from the spleen evaluation. What is the most likely finding displayed by the blue arrows?
fractured spleen due to unknown trauma
elongated left lobe of the liver adjacent to spleen
Riedel lobe
loculated ascites
elongated left lobe of the liver adjacent to spleen
The pancreas is found in what retroperitoneal space?
perirenal
retrofascial
posterior pararenal
anterior pararenal
anterior pararenal
In a patient with complete situs inversus, the liver will be:
located in the LUQ
located in the RLQ
divided into 3 separate lobes
absent
located in the LUQ
Which of the following is an acquired abnormality of the biliary system?
sclerosing cholangitis
Caroli disease
choledochal cyst
biliary atresia
sclerosing cholangitis
Which of the following structures is labeled #8?
medial left lobe
anterior right lobe
lateral left lobe
posterior right lobe
posterior right lobe
In a normal fasting adult, blood sugar levels should not exceed ____ of blood
50mg/100ml
100mg/100ml
150mg/100ml
200mg/100ml
100mg/100ml
Which liver vessel courses within the MLF?
common hepatic artery
RHV
MPV
MHV
MHV
Which of the following correctly describes the location of the RHV?
courses inferiorly through the right intersegmental fissure
courses inferiorly through the falciform ligament
courses superiorly through the MLF
courses superiorly through the right intersegmental fissure
courses superiorly through the right intersegmental fissure
Which of the following correctly describes the pediatric pancreas?
the ducts are dilated at >2mm at birth and decrease in size throughout the first year
cystic fibrosis leads to the production of mucus and the gland is reduced in echogenicity
pancreatic echogenicity increases with age
it normally decreases in echogenicity as the patient reaches adulthood
pancreatic echogenicity increases with age
Which vessel is the MPV?
the MPV is the large circular vessel that is anterior to the IVC