Chapter 2: The Liver Flashcards
liver injury resulting from alcohol abuse
alcoholic liver disease
an abscess that develops from a parasite that grows in the colon and invades the liver via the portal vein
amebic hepatic abscess
the surgical connection between two structures
anastamosis
an abnormal passageway between an artery and a vein
arteriovenous fistula
disorders in which the body’s immune system attacks and destroys healthy tissues and/or organs
autoimmune disorders
an inherited disease that results in the development of renal, liver, and pancreatic cysts typically late in life; also referred to as adult polycystic kidney disease
autosomal dominant polycystic kidney disease
the region of the liver not covered by the peritoneum
bare area
a growth disorder syndrome synonymous with enlargment of several organs, including the skull, tongue, and liver; children with this disorder are prone to several childhood cancers, including within the liver and kidney
Beckwith-Wiedemann syndrome
a collection of bile within the abdomen; can be intrahepatic or extrahepatic in location
bilomaj
a syndrome described as the occlusion of the hepatic veins, with possible coexisting occlusion of the inferior vena cava
Budd-Chiari Syndrome
recognizable dilation of the superficial veins of the abdomen
caput medusae
the most common benign liver tumor
cavernous hemangioma
inflammation of the bile ducts
cholangitis
condition defined as hepatocyte death, fibrosis, and necrosis of the liver, and the subsequent development of regenerating nodules
cirrhosis
the water soluble form of bilirubin that is excreted into the intestines in bile and excreted in the stool; also referred to as direct bilirubin
conjugated bilirubin
sonographic imaging that includes the injection of a contrast agent intravenously to better enhance the borders of liver lesions and to analyze those lesions for possible signs of malignancy
contrast enhanced liver ultrasound
system used to separate the liver into eight surgical segments; used to describe functional liver anatomy
couinaud classification
syndrome characterized by cirrhosis, portal hypertension, and dilation of the umbilical and paraumbilical veins
Cruveihler-Baumgarten Syndrome
genetic disorder linked with the development of scar tissue accumulation within the lungs, liver, pancreas, kidneys, and/or intestines
cystic fibrosis
a pseudomass of the liver seen on sonography resulting from hypertrophied diaphragmatic muscle bundles
diaphragmatic slip
infection of the bowel which leads to diarrhea that may contain mucus and/or blood
dysentery
hydatid liver cyst
echinoccal cyst
a parasite responsible for the development of hydatid liver cysts
Echinococcus granulosus
the virus responsible for mononucleosis and other potential complications
Epstein-Barr virus
dilated or broken vessels located near the surface of the skin on the face that appears as threadlike red lines; commonly referred to as spider veins
Facial telangiesctasia
ligament that attaches the liver to the anterior abdominal wall
falciform ligament
a reversible disease characterized by deposits of fat within the hepatocytes; also referred to as hepatic steatosis
fatty liver
bad breath secondary to end-stage liver disease and the livers inability to filter toxins; often accompanies cirrhosis, portal hypertension, and hepatic encephalopathy
fetor hepaticus
manifestation of fatty liver disease in which fat deposits are localized
focal fatty infiltration
manifestation of fatty liver disease in which fat deposits are localised
focal fatty infiltration
manifestation of fatty liver disease in which an area of the liver is spared from fatty infiltration
focal fatty sparing
a benign liver mass composed of a combination of hepatocytes and fibrous tissue that typically contains a central scar
focal nodular hyperplasia
the junction between the stomach and the esophagus
gastroesophageal junction
the thin fibrous casing of the liver
Glisson capsule
enlargement of the male breast
gynecomastia
vomiting blood
hematemesis
a localized collection of blood
hematoma
an inherited disease characterized by disproportionate absorption of dietary iron
hemochromatosis
the formation and development of blood cells
hemopoeisis
a hepatic mass that results from the spread of fungus in the blood to the liver
hepatic candidiasis
a condition in which a patient becomes confused or suffers from intermittent loss of conciousness secondary to the overexposure of the brain to toxic chemicals that the liver would normally remove from the body
hepatic encephalopathy
jaundice resulting from the liver’s inability to conjugate bilirubin, may be caused by conditions such as viral hepatitis, toxins, drugs, cirrhosis, and liver cancer
hepatic jaundice
fatty liver
hepatic steatosis
inflammation of the liver
hepatitis
a benign liver mass often associated with the use of oral contraceptives
hepatocellular adenoma
the primary form of liver cancer
hepatocellular carcinoma
blood flow away from the liver
hepatofugal
the malignant tumor associated with hepatocellular carcinoma; primary liver cancer
hepatoma
enlargement of the liver
hepatomegaly
blood flow toward the liver
hepatopetal
the development of renal impairment and possible renal failure because of chronic liver disease
hepatorenal syndrome
concurrent enlargement of the liver and spleen
hepatosplenomegaly
a liver cyst that develops from a tapeworm that lives in dog feces; also referred to as an echinococcal cyst because it originates from the parasite Echinococcus granulosus
hydatid liver cyst
elevated levels of serum bilirubin
hyperbilirubinemia
abnormally high levels of fat within the blood
hyperlipidemia
decreased blood volume
hypovolemia
no recognizable cause; from an unknown origin
idiopathic
a patient who has a weakened immune system
immunocompromised
rare condition characterized by obstruction of the inferior vena cava by membranous or fibrous bands; can cause obstruction of the hepatic veins leading to Budd-Chiari syndrome
inferior vena cava web
chronic inflammation of all or parts of the bowel
inflammatory bowel disease
condition that results from decreased blood flow to the intestines resulting in damaged bowel tissue owing to inadequate oxygenation; also referred to as intestinal ischemia
ischemic bowel disease
broad clinical term referring to the yellowish discoloration of the skin, mucous membranes, and sclerae; found with liver disease and/or biliary obstruction
jaundice
brain damage from bilirubin exposure in a newborn with jaundice
kernicterus
specialized macrophages within the liver that engulf pathogens and damaged cells
Kupffer cells
an elevated white blood count
leukocytosis
ligament that forms part of the edge of the falciform ligament of the liver, connecting the liver to the umbilicus; a remnant of the left umbilical vein; also referred to as the round ligament of the liver
ligamentum teres
remnant of the fetal ductus venosus; appears as a hyperechoic linear ligament between the caudate lobe and left lobe of the liver
ligamentum venosum
a benign fatty tumor
lipoma
the development of scar tissue within the liver as a result of the liver repeatedly trying to repair itself
liver fibrosis
the area of the liver where the common bile duct exits the liver and portal vein and hepatic artery enter the liver; also referred to as the porta hepatitis
liver hilum
a flow pattern that characteristically has antegrade flow throughout the cardiac cycle
low-resistance flow
feeling of uneasiness
malaise
the deterioration of a benign mass into a malignancy
malignant deterioration
the displacement of alteration of normal anatomy that is located adjacent to a tumor
mass effect
condition that includes hypertension, hyperglycemia, excessive body fat around the waist, elevated cholesterol, and nonalcoholic fatty liver disease
metabolic syndrome
vascular flow yielding a single phase
monophasic
death of tissue
necrosis
redding of the palms
palmar erythema
an increase in the echogenicity of the portal triads as seen in hepatitis and other conditions
periportal cuffing
air within the biliary tree
pneumobilia
the area of the liver where the portal vein and hepatic artery enter and the hepatic duct exit; also referred to as the liver hilum
porta hepatis
the elevation of blood pressure within the portal venous system
portal hypertension
an assembly of a small branch of the portal vein, bile duct, and hepatic artery that surround each liver lobule
portal triads
the development of clot within the portal vein
portal vein thrombosis
elevation in bilirubin caused by an obstruction of bile flow, typically by either a gallstone lodged in the biliary tract or a pancreatic mass
posthepatic jaundice
when the liver cannot process the amount of hemolysis of the red blood cells, resulting in a buildup of circulating bilirubin in the bloodstream
prehepatic jaundice
nodular appearance of the liver caused by multiple metastatic tumors
pseudocirrhosis
false mass
pseudomass
blood spots under the skin that may appear purple
purpura
a liver abscess that can result from the spread of infection from inflammatory conditions such as appendicitis, diverticulitis, cholecystitis, cholangitis, and endocarditis
pyogenic liver abscess
the medial segment of the left lobe
quadrate lobe
the reopening of canals or pathways
recanalization
a tongue-like extension of the right hepatic lobe
Riedel’s lobe
an illness resulting from another disease, trauma, or injury
sequela
twisted or snake like pattern
serpignous
elastography technique that utilizes a standard ultrasound transducer with elastography technology to obtain information about the stiffness of tissue as in the case of liver fibrosis or cirrhosis
shear wave elastography
condition in which the organs of the abdomen and chest are on the opposite sides of the body
situs inversus
a cluster of vessels noted on the skin that have a web-like pattern;
spider nevi
blood flow to the major gastrointestinal organs including the stomach, liver, spleen, pancreas, and small and large intestines; consists of the celiac artery, superior mesenteric artery, and inferior mesenteric artery
splanchnic circulation
enlargement of the spleen
splenomegaly
the sonographic sign associated with the appearance of periportal cuffing in which there is an increased echogenicity of the walls of the portal triads that may be associated with hepatitis
starry sky sign
a type of fatty liver disease that causes inflammation of the liver
steatohepatitis
obtained by adding unconjugated and conjugated bilirubin
total bilirubin
procedure in which an individual receives vitamin and nutrients though a vein, often the subclavian vein
total parental hyperalimentation
imaging technique that utilizes a special transducer to assess the liver and other organs for signs of fibrosis and cirrhosis; used to measure the stiffness of tissue
transient elastography
the therapy for portal hypertension that involves the placement of a stent between the portal veins and hepatic veins to reduce portal systemic pressure
transjugular intrahepatic portosystemic shunt (TIPS)
vascular flow yielding three phases
triphasic
the non-water soluble form of bilirubin that travels to the liver via the bloodstream eventually converted to conjugated bilirubin by the liver; also referred to as indirect bilirubin
unconjugated bilirubin
condition in which the body does not have the ability to break down glycogen; also referred to as glycogen storage disease
Von Gierke disease
an inherited disease that includes the development of cysts within the liver, pancreas, and other organs
von-Hippel Lindau disease
a congenital disorder that causes the body to accumulate excess copper
Wilson disease
Vital functions of the liver
carbohydrate metabolism
Fat (lipid) metabolism
amino acid metabolism
removal of waste products
vitamin and mineral storage
drug inactivation
synthesis and secretion of bile
blood reservoir
lymph production
detoxification
decrease in albumin
chronic liver disease
cirrhosis
increase in ALP
cirrhosis
extrahepatic biliary obstruction
gallstones
hepatitis
metastatic liver disease
pancreatic carcinoma
increase in ALT
biliary tract obstruction
hepatitis
hepatocellular disease
obstructive jaundice
increase in AST
cirrhosis
fatty liver
hepatitis
metastatic liver disease
increase in Gamma-glutamyl transferase
diffuse liver disease
posthepatic obstruction
increase in LDH
cirrhosis
obstructive jaundice
increase in serum bilirubin
direct bilirubin: acute hepatocellular disease
indirect bilirubin: biliary tract obstruction
total bilirubin: cirrhosis, hepatitis, and other liver cell diseases
Prolonged PT
metastasis of the liver and hepatitis
Shortened PT
extrahepatic duct obstruction
increase in AFP
hepatocellular carcinoma
hepatoblastoma
separates the anterior segment of the right lobe from the posterior segment of the right lobe
Right hepatic vein/right intersegmental fissure
separates the right lobe from the left lobe (these are located between the anterior segment of the right lobe and the medial segment of the left lobe)
middle hepatic vein/main lobar fissure/ gallbladder fossa
separates the left lateral segment of the left lobe form the left medial segment of the left lobe
left hepatic vein/ left intersegmental fissure/ ligamentum teres/ falciform ligament
Portal vein waveform
hepatopetal and monophasic
Hepatic vein waveform
hepatofugal and triphasic
transports blood to the liver from the intestines and other organs
portal veins
drain blood from the liver and deposits it into the IVC
hepatic veins
Portal veins are ____segmental
intra
Hepatic veins are ____segmental
inter
Portal veins _____ in size as they approach the diaphragm
decrease
Hepatic veins ____ in size as they approach the diaphragm
increase
Portal veins have _____ walls
hyperechoic
Extension of right lobe beyond the lower pole of the right kidney (without evidence of Reidel’s lobe)
Rounding of the inferior tip of the right lobe
extension of the left lobe well into the LUQ
hepatomegaly
diffusely echogenic liver
increased attenuation of the sound beam
wall of the hepatic vasculature and diaphragm will not be easily imaged
Diffuse Fatty Liver Disease
hyperechoic area adjacent to the gallbladder, near the porta hepatis, or part of a lobe may appear echogenic
focal fatty infiltration
hypoechoic area adjacent to the gallbladder, near the porta hepatis, or part of a lobe or an entire lobe
focal fatty sparing
Normal or enlarged hypoechoic liver
periportal cuffing with starry sky
gallbladder wall thickening
hepatitis
Hepatosplenomegaly
shrunken, echogenic right lobe of the liver
enlarged caudate and left lobes
nodular surface irregularity
coarse echotexture
splenomegaly
ascites
monophasic flow within the hepatic veins
hepatofugal flow within the portal veins
cirrhosis
hepatomegaly
shrunken right lobe of the liver
enlarged caudate lobe of the liver
nodular surface irregularity
coarse echotexture
splenomegaly
ascites
monophasic flow within the hepatic veins
hepatofugal flow within the portal veins
enlargement of the portal vein (diameter will exceed 13 mm in the AP dimension)
enlargement of the SMV
Enlargement and reversed flow within the coronary vein
enlarged hepatic arteries
abdominal varicosities at the splenic hilum, renal hilum, and gastroesophageal junction
patent paraumbilical vein (also called a recanalized paraumbilical vein)
Portal hypertension
Echogenic thrombus within the portal vein
cavernous transformation of the portal veins will appear as wormlike or serpignous vessels within the region of the portal vein
portal vein thrombosis
small, bright reflectors are noted within the circulating blood inside the portal vein
larger air collections may produce ring-down artifact
Portal venous gas
nonvisualization or reduced visualization of the hepatic veins
thrombus within the hepatic veins
enlarged caudate lobe
lack of flow within the hepatic veins with color Doppler
Narrowing of the IVC
Budd-Chiari syndrome
sonographic findings consistent with cirrhosis
kidneys may appear normal
hepatorenal syndrome
anechoic mass or masses with posterior enhancement
may have irregular shapes
clusters of cysts may be noted
located in the liver
hepatic cysts
anechoic mass containing some debris (hydatid sand)
water lily sign appears as an endocyst floating within the pericyst
mother cyst containing one or more smaller daughter cysts
mass may contain some elements of dense calcification
Hydatid liver cyst
round, hypoechoic or anechoic mass or masses
may contain echoes (with fluid-debris layering)
acoustic enhancement
amebic hepatic abscess
bulls eye lesion
anechoic center surrounded by hyperechoic ring
periportal thickening
turtleback sign (chronic appearance)
schistomosomiasis
complex cyst with thick walls
mass may contain debris, septations, and/or gas
the air within the abscess may produce dirty shadowing or ring-down artifact
Pyogenic hepatic abscess
multiple masses with hyperechoic central portions and hypoechoic borders (may be described as target, halo, or bulls eye lesions)
these masses are typically 1 cm or smaller in size
older lesions may calcify
hepatic candidiasis
small, hyperechoic mass
may be found in the right lobe
cavernous hemangioma
isoechoic, hyperechoic, or hypoechoic mass
central scar may appear as hyperechoic or hypoechoic linear structure within the mass and will often reveal hypervascularity with color Doppler
Focal Nodular Hyperplasia
fresh clot may be hyperechoic
older hemorrhage can appear anechoic or complex
may be intrahepatic or subcapsular
assess for signs of an ateriovenous fistula
hepatic hematoma
solitary, hypoechoic mass
heterogenous masses scattered throughout the liver
mass with a hypoechoic halo and central echogenic portion (target or bulls-eye lesion)
possible ascites
hepatocellular carcinomas
hyperechoic, hypoechoic, calcified, cystic, or heterogeneous masses
mass or masses demonstrating a hypoechoic rim and central echogenic region
diffusely heterogeneous liver
possible ascites
hepatic metastasis
homogeneous or complex hepatic mass
may contain calcification or cystic spaces
infantile hemangioendothelioma
solid, hyperechoic, or heterogeneous mass
mass may contain calcifications
hepatoblastoma
In early embryonic life, the liver is responsible for:
hematopoeisis
largest parenchymal organ
liver
located within the epigastrium and may traverse through midline and extend into left hypochondrium
left lobe of liver
The liver is ____peritoneal
intra
The ____ is the only part of the liver that is retroperitoneal.
bare area
thin fibrous casing surrounding the liver
Glisson capsule
Liver lobules contain:
hepatocytes
biliary epithelial cells
Kupffer cells
Portal triads consist of:
small branches of portal vein
bile duct
hepatic artery
system used to separate liver into eight surgical segments and to describe functional liver anatomy
couinaud classification
located between the gallbladder fossa and round ligament
quadrate lobe
referred to as the medial segment of the left liver lobe
quadrate lobe
large lobe of liver
right hepatic lobe
can divided into an anterior and posterior segment by right hepatic vein, whicih lies within right intersegmental fissue
right hepatic lobe
separated from left lobe by middle hepatic vein which lies within the main lobar fissue
right hepatic lobe
located with the epigastrium and may extend into the left hypochondrium
left lobe
divided into medial and lateral segments by left hepatic vein, which lies within the left intersegmental fissue
left lobe
can be separated by ligamentum teres and falciform ligament
left lobe
smallest hepatic lobe, has its own blood supply and venous drainage
caudate lobe
located within epigastrium and is bounded anteriorly by ligamentum venosum and posteriorly by IVC
caudate lobe
can be separated from left lobe by ligamentum venosum
caudate lobe
provides majority of hepatic perfusion
Main portal vein
describes blood flow to major gastrointestinal organs
splanchnic circulation
Primary vessels of splanchnic circulation
celiac artery (common hepatic artery)
superior mesenteric artery
inferior mesenteric artery
The main portal vein enters the liver at _____
porta hepatis
The main portal vein is created the union of the ____ and ____
superior mesenteric vein
splenic vein
The main portal vein supplies about ___% of blood supply to the liver
75
The right portal vein is separated into ____ and ____ divisions
anterior
posterior
The left portal vein is separated into _____ and ____ divisions.
medial
lateral
The normal diameter of the main portal vein
less than 13 mm
enlargement of the portal vein indicates:
portal hypertension
Normal portal veins ____ in size as they approach the diaphragm
decrease
Portal veins are ____segmental
intra
Normal flow of portal veins
hepatopetal and monophasic
Hepatic veins are ____segmental and ____lobar.
inter
inter
Hepatic veins _____ in size as they approach the diaphram
increase
Hepatic veins demonstrate _____ flow
triphasix
enlargement of the hepatic veins and IVC indicate:
right sided heart failure
occlusion or narrowing of hepatic veins
Budd-Chiari syndrome
3 structures located within the porta hepatis
main portal vein
common bile duct
hepatic artery
carries oxygenated blood to liver from abdominal aorta
common hepatic artery
1st main branch of the abdominal artery as it passes below the diagphragm
celiac artery
The common hepatic artery has a __-resistance flow pattern
low
describes transverse image taken of porta hepatis
Mickey sign
The _____ supplies the fetus with oxygenated blood
umbilical vein
right branch of umbilical vein
ductus venosus
Shortly after birth the ductus venosus collapses and becomes the _______
ligamentum venosum
Recanalization of paraumbilical vein in ligamentum teres can occur in presence of ______
portal hypertension
hyperechoic linear structure, anterior to caudate lobe, between caudate and left hepatic lobe
ligamentum venosum
hyperechoic; triangular shaped structure between right and left hepatic lobes
falciform ligament
houses middle hepatic vein; hyperechoic line which seems to connect neck of GB to right portal vein; used to separate right and left hepatic lobes
main lobar fissure
tongue like extension of the right hepatic lobe, more often seen in women, may extend inferiorly as far as iliac crest
Reidel lobe
inferior extension of the caudate lobe
papillary process of caudate lobe
The liver measures approximately ___-____ cm in adults
15-15
____ cm is considered hepatomegaly
15.5
yellowish discoloration of the skin, mucous membranes, and sclerae of the eyes because of hyperbilirubinemia
jaundice
yellowish compound that results from the breakdown of hemoglobin that is found in red blood cells
bilirubin
non-water soluble form of bilirubin that travels to the liver via bloodstream; eventually converted to conjugated bilirubin by the liver
unconjugated bilirubin
water soluble form of bilirubin that is excreted into the intestines in bile and passed in the stool
conjugated (direct) bilirubin
calculated by adding the direct and indirect bilirubin levels
total bilirubin
occurs when liver cannot process the amound of hemolysis in the red blood cells, resulting in a buildup of circulating unconjugated bilirubin in the blood stream
prehepatic jaundice
results from liver’s inability to conjugate bilurubin and thus my be caused be conditions such as viral hepatitis, toxins, drugs, cirrhosis, and liver cancer
hepatic jaundicw
caused by an obstruction of bile flow; elevation in conjugated bilirubin
posthepatic jaundice
disorder characterized by fatty deposits (triglycerides) within hepatocytes
fatty liver disease (hepatic steatosis)
cause liver to appear diffusely echogenic
diffuse infiltration
area of increased echogenicity
focal infiltration
involved with fatty infiltration with certain areas spared
focal fatty sparing
inflammation of the liver
hepatitis
Two most common forms of hepatits
A
B
Hepatitis A is passed by:
fecal-oral route, contaminated food or water
Hepatitis B is passed by:
contact with contaminated body fluids or mother to infant transmission
Hepatitis C is passed by:
contact with blood and body fluids
Leading indication for liver transplant in the USA
hepatitis C
autosomal recessive disorder, excessive accumulation of copper in the liver, brain, and other tissues
Wilson’s disease
disproportionate absorption of dietary iron
hemochromatosis
Impaired liver function, as a result of hepatitis and other hepatic diseases may lead to:
hepatic encephalopathy
kernicterus
condition in which a patient becomes confused or suffers from intermittent loss of consciousness secondary to the overexposure of brain to toxic chemicals that liver would normally remove from body
hepatic encephalopathy
brain damage in newborns that can occur with severe jaundice as a result of bilirubin exposure
kernictus
increase in echogenicity of walls of portal triads; starry sky sign
periportal cuffing
devastating liver disorder that is defined as: hepatocyte death, liver fibrosis, necrosis of liver, subsequent development of regeneration of nodules
cirrhosis
Most common cause of cirrhosis
alcoholism
Sonographic findings of cirrhosis of the liver
echogenic small right lobe
enlarged caudate and left lobe
nodular surface irregularity
coarse echotexture
ascites
splenomegaly
Cirrhosis causes _____ flow in hepatic veins
monophasic
Cirrhosis causes ______ flow in portal vein
hepatofugal
results in development of scar tissue within the liver as it attempts to repair itself
liver fibrosis
If the amount of fibrosis increases, the stiffness ______
increases
2 types of elastography
transient elastography
shear-wave elastography
elevation of blood pressure within portal venous system
portal hypertension
Most common cause of portal hypertension
cirrhosis
Most common sonographically identifiable collaterals in portal hypertension
recanalization of paraumbilical vein
In portal hypertension, the portal vein diameter exceed __ mm
13
ominous sign of ruptured esophageal varices; markedly increases mortality and morbidity
hematemesis
involves placement of a stent between the portal veins and hepatic veins to shunt blood and reduce portal systemic pressure
TIPS
development of clot within the portal vein
portal vein thrombosis
appear as wormlike or serpiginous vessels within region of portal vein
cavernous transformation
gas within portal veins or mesenteric veins that results from ischemic bowel disease is typically fatal
portal venous gas
air located within the biliary ducts
pneumobilia
occlusion of the hepatic veins, with possible co-existing occlusion of IVC
Budd-Chiari syndrome
development of renal impairment and possible renal failure as a result of chronic liver disease and liver failure
hepatorenal syndrome
may also be referred to as an echinococcal cyst
hydatid liver cyst
develop most commonly from a parasite referred to as echinococcus granulosus
hydatid liver cyst
comes from parasite Entamoeba histolytica
amebic hepatic abscess
grows in colon and invades liver via portal vein
amebic hepatic abscess
hepatic infestation of the parasite schistoma, fundamentally a flatworm parasite, may also be referred to as snal fever or biharzia
schistomiasis
one of the most common causes of hepatic fibrosis in the world
schistomiasis
anechoic center surrounded by hyperechoic rim, associated with schisotmiasis
bulls-eye lesion
calcified septa and fibrosis resembling rounded part of a turteshell
turtleback sign
can result from the spread of infection from inflammatory conditions such as appendicitis, diverticulitis, cholecystitis, cholangitis, endocarditis
pyogenic hepatic abscess
results from spread of fungus, namely candida albicans in the blood to the liver
hepatic candidiasis
most common benign liver tumor
cavernous hemangioma
second most common benign liver tumor
focal nodular hyperplasia
rare benign liver tumor, often associated with use or oral contraceptives
hepatocellular adenoma
can be a consequence of surgery or trauma, can be intrahepatic or subcapsular, changes echogenicity over time
hepatic hematoma
abnormal passageway between an artery and vein, flow typically from higher pressure to venous system
arteriovenous fistula
most common primary form of liver cancer, most often seen in men
hepatocellular carcinoma
Malignant mass associated with hepatocellular carcinoma is called:
hepatoma
occlusion of the hepatic veins, with possible tumor invasion into the IVC
Budd-Chiari syndrome
Most common form of liver cancer
hepatic metastasis
Primary cancers that metastasize to the liver:
gallbladder
colon
stomach
pancreas
breast
lung
Portal vein normal Doppler waveforms
hepatopetal
continuous
monophasic
low velocity
hepatic veins normal Doppler waveforms
triphasic
Hepatic artery normal Doppler waveforms
continuous, low-resistance waveform pattern, quick upstroke and gradual deceleration with diastole
Normal resistive index or hepatic artery
0.5 and 0.8
The TIPS stent is most often created between the _____ and _____ and bridging stent is lieft in place
right portal vein
right hepatic vein
Normal flow velocity within TIPS shunt
90-190 cm per second
Most common disease that leads to liver transplant
Hepatitis C
most common vascular complication of a liver transpland
hepatic artery thrombosis
hypoechoic wedge-shaped area scattered throughout periphery of liver
infarction
most common benign liver childhood tumor, typically identified in the first few weeks/month
infantile hemangioendothelioma
most common malignant tumor of childhood, aggressive, most often discovered before 5 years old
hepatoblastoma
utilizes a contrast that is injected into the patient intravenously in order to aid in identification of liver lesions and to assess those lesions for signs of malignancy
contrast enhanced ultrasound
3 phases assessed during CEUS of liver
initial arterial
early portal venous phases
contrast washout
Which of the following benign liver masses is typically isoechoic and contains a central scar?
a. hepatoblastoma
b. cavernous hemangioma
c. hamartoma
d. focal nodular hyperplasia
d
The covering of the liver is referred to as the:
Glisson capsule
The left lobe of the liver can be separated from the right lobe by the:
middle hepatic vein
The TIPS shunt is placed:
between a portal vein and hepatic vein
The right lobe of the liver is divided into segments by the:
right hepatic vein
The right intersegmental fissure contains the:
right hepatic vein
The main portal vein divides into:
left and right branches
The ligamentum teres can be used to separate the:
medial and lateral segments of the left lobe
The main lobar fissure contains the:
middle hepatic vein
All of the following are located within the porta hepatis except:
a. main portal vein
b. common bile duct
c. hepatic artery
d. middle hepatic vein
d
Right-sided heart failure often leads to enlargement of the:
IVC and hepatic veins
Which of the following is typically transmitted through contaminated water found in places such as Mexico, Central America, South America, Asia, India, and Africa?
a. amebic liver abscess
b. hydatid liver cyst
c. candidiasis
d. hepatoma
a
The right portal vein divides into:
anterior and posterior branches
The diameter of the portal vein should not exceed:
13 mm
The right lobe of the liver can be divided into:
anterior and posterior segments
Which of the following is true about the portal veins?
a. Portal veins carry deoxygenated blood away from the liver
b. Portal veins have brighter walls than the hepatic veins
c. Portal veins should demonstrate hepatofugal flow
d. Portal veins increase in diameter as they approach the diaphragm
b
The left lobe of the liver can be divided into:
medial and lateral segments
Normal flow within the hepatic artery should demonstrate a:
low-resistance waveform pattern, with a quick upstroke, and gradual deceleration with diastole
Budd-Chiari syndrome leads to a reduction in the size of the:
hepatic veins
A tongue-like extension of the right lobe of the liver is termed:
Riedel lobe
The left portal vein divides into:
medial and lateral branches
The left umbilical vein after birth becomes the:
ligamentum teres
Normal flow within the hepatic veins is said to be:
triphasic
The inferior extension of the caudate lobe is referred to as:
papillary process
Which of the following is the most common reason for a liver transplant?
a. hepatocellular carcinoma
b. hepatitis C
c. hepatitis B
d. hepatic metastasis
b
Clinical findings of fatty infiltration of the liver include:
elevated liver function labs
Shortly after birth, the ductus venosus collapses and becomes the;
ligamentum venosum
Sonographically, when the liver is difficult to penetrate and diffusely echogenic, this is indicative of:
fatty liver disease
The most common cirrhosis is:
alcoholism
Clinical findings of hepatitis include all of the following except:
a. jaundice
b. fever
c. chills
d. pericholecystic fluid
d
What form of hepatic abnormality are immunocompromised patients more prone to develop?
candidiasis
All of the following are sequela of cirrhosis except:
a. portal vein thrombosis
b. hepatic artery contraction
c. portal hypertension
d. splenomegaly
b
Normal flow toward the liver in the portal vein is termed:
hepatopetal
Which of the following masses would be most worrisome for malignancy?
a. echogenic mass
b. cystic mass with posterior enhancement
c. isoechoic mass with a central scar
d. hyperechoic mass with a hypoechoic halo
d
Which of the following statements is true of hepatic adenoma?
a. hepatic adenomas are more common in males
b. hepatic adenomas are also referred to as a stealth lesion
c. Hepatic adenomas typically contain air owing to bacterial formation
d. hepatic adenomas can undergo malignant degeneration
d
Which of the following is the most common cancer found in the liver?
a. hepatocellular carcinoma
b. adenocarcinoma
c. metastatic liver disease
d. hepatoblastoma
c
Which hepatic mass is closely associated with oral contraceptive use?
hepatic adenoma
Which of the following is considered the most common benign childhood hepatic mass?
a. hepatoblastoma
b. hepatoma
c. hematoma
d. hemangioendothelioma
d
All of the following are clinical findings of hepatocellular carcinoma except:
a. reduction in AFP
b. unexplained weight loss
c. fever
d. cirrhosis
a
The childhood syndrome Beckwith-Wiedemann is associated with an increased risk for developing:
hepatoblastoma
Which of the following is associated with E. granulosus?
a. candidiasis
b. amebic liver abscess
c. hydatid liver cyst
d. hepatocellular carcinoma
c
Which of the following laboratory findings would be most likely associated with a decrease in albumin?
a. hepatic stenosis
b. hepatic steatohepatitis
c. cirrhosis
d. hepatitis
c
Which of the following are the cells of the liver responsible for engulfing pathogens and damaged cells?
a. Kupffer
b. Morrison
c. Hepatocytes
d. Epstein
a
What liver pathology is associated with periportal cuffing?
hepatitis
Which of the following is an inherited disease characterized by disproportionate absorption of dietary iron?
a. Wilson disease
b. Hemochromatosis
c. von gierke disease
d. von Hippel-Lindau disease
b
What inherited disease is linked with the development of cysts in the liver and other organs?
von Hippel-Lindau syndrome
Wilson disease will present sonographically similar to what disorder?
Hepatitis
Cavernous transformation of the portal vein is found in the presence of:
portal vein thrombosis
Which of the following hepatic lesions may occur following a recent bout of appendicitis, diverticulitis, or cholecystitis?
a. focal nodular hyperplasia
b. pyogenic hepatic abscess
c. echinococcal abscess
d. amebic liver abscess
b
