Chapter 2: The Liver Flashcards
an abscess that develops from a parasite that grows in the colon and invades the liver via the portal vein
amebic (liver) abscess
an inherited disease that results in the development of renal, liver, and pancreatic cysts late in life
autosomal dominant polycystic kidney disease
adult polycystic kidney disease
a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver
Beckwith-Wiedemann syndrome
a syndrome described as the occlusion of the hepatic veins, with possible co-existing occlusion of the IVC
Budd-Chiari syndrome
the most common benign liver tumor
cavernous hemangioma
condition defined as hepatocyte death, fibrosis and necrosis of the liver, and subsequent development of regenerating nodules
cirrhosis
a parasite responsible for the development of hydatid liver cysts
echinococcus granulosus
a benign liver mass composed of a combination of hepatocytes and fibrous tissue that typically contains a central scar
focal nodular hyperplasia
the thin fibrous casing of the liver
Glisson capsule
an inherited disease characterized by disproportionate absorption of dietary iron
hemochromatosis
the formation and development of blood cells
hemopoiesis
a hepatic mass that results from the spread of fungus in the blood to the liver
hepatic candidiasis
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 flowing away from the liver
hepatofugal
blood flowing toward the liver
hepatopetal
the malignant tumor associated with hepatocellular carcinoma
hepatoma
a liver cyst that develops from a tapeworm that lives in dog feces
hydatid cyst
echinococcal cyst
specialized macrophages within the liver that engulf pathogens and damaged cells
Kupffer cells
a benign fatty tumor
lipoma
the area of the liver where the common bile duct exits the liver and where the portal vein and hepatic artery enter the liver
liver hilum
porta hepatis
an increase in the echogenicity of the portal triads as seen in hepatitis
periportal cuffing
an assembly of a small branch of the portal vein, bile duct, and hepatic artery that surround each liver lobule
portal triads
a liver abscess that can result from the spread of infection from inflammatory conditions such as appendicitis, diverticulitis, cholecystitis, cholangitis, and endocarditis
pyogenic hepatic abscess
the medial segment of the left lobe of the liver
quadrate lobe
a tonguelike extension of the right hepatic lobe
Riedel lobe
an illness resulting from another disease, trauma, or injury
sequela
the sonographic sign associated with the appearance of periportal cuffing in which there is an increased echogenicity of the walls of the portal triads
starry sky sign
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)
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 (located between the anterior segment of the right lobe and medial segment of the left lobe)
middle hepatic vein
main lobar fissure
gallbladder fossa
separates the left lateral segment of the left lobe from the left medial segment of the left lobe
left hepatic vein
left intersegmental fissure
ligamentum teres
falciform ligament
the main portal vein enters the liver at the:
porta hepatis (liver hilum)
the portal vein provides the liver with approximately __% of its total blood supply
70%
the RIGHT portal vein is separated into a(n) ________ and _________ division
anterior
posterior
the LEFT portal vein is separated into a(n) ________ and _________ division
medial
lateral
the diameter of the main portal vein should measure less than ____ in the anteroposterior dimension
13mm
enlargement of the portal vein is indicative of:
portal hypertension
normal portal veins ________ in size as they approach the diaphragm
decrease
normal blood flow within the portal veins should be:
hepatopetal and monophasic, with some variation with respiration and after meals
the three hepatic veins drian into the:
IVC
hepatic veins ________ in size as they approach the diaphragm
increase
hepatic veins have a ____________ blood flow pattern secondary to their association with the right atrium and atrial contraction
triphasic
enlargement of the hepatic veins is seen with:
right-sided heart abnormalities
occlusion of the hepatic veins is seen with:
Budd-Chiari syndrome
3 structures located within the porta hepatis
main portal vein
common bile duct
hepatic artery
what carries oxygenated blood to the liver from the abdominal aorta?
common hepatic artery
Mickey Mouse sign
face is the:
left ear is the:
right ear is the:
portal vein
hepatic artery
common bile duct
(in some people, the ears may be reversed)
shortly after birth, the ductus venosus (right umbilical vein) collapses and becomes the:
ligamentum venosum
after birth, the left umbilical vein becomes the:
ligamentum teres
which ligament seems to connect the gallbladder to the right portal vein?
main lobar fissure
normal liver measurement
13-15cm in length (in an adult)
hepatomegaly measurement
greater than 15cm in the midhepatic line
Clinical findings: asymptomatic alcohol abuse chemotherapy diabetes mellitus elevated liver function test obesity pregnancy
fatty liver disease
2 most common forms of hepatitis
A and B
how are hepA and hepB spread?
hepA - contaminated food
hepB - body fluids
as the liver enlarges, it tends to become more:
hypoechoic
Clinical findings: chills dark urine elevated liver function tests fatigue fever hepatosplenomegaly jaundice nausea vomiting
hepatitis
cirrhosis caused by alcoholism will lead to the development of ______ nodules while cirrhosis caused by hepatitis will cause _______ nodules
small (less than 1cm)
large (1-5cm)
monophasic flow within the hepatic veins and hepatofugal flow within the portal veins are both findings consistent with:
advanced cirrhosis and portal hypertension
Clinical findings: ascites diarrhea elevated liver function tests fatigue hepatomegaly (initially) jaundice splenomegaly weight loss
cirrhosis
the most common cause of portal hypertension is:
cirrhosis
one of the most commonly identified collaterals in portal hypertension is:
the recanalization of the paraumbilical vein
patent paraumbilical vein
what will the measurements of the portal vein and SMV be with portal hypertension?
the portal vein will be greater than 13mm in diameter and the SMV will be greater than 10 mm
what is the interventional treatment for portal hypertension?
transjugular intrahepatic portosystemic shunt (TIPS shunt)
Clinical findings: abnormal liver function tests ascites diarrhea fatigue hepatomegaly jaundice weight loss
portal hypertension
Sonographic findings:
diffusely echogenic liver
increased attenuation of the sound beam
walls of the hepatic vasculature and diaphragm will not be easily imaged
diffuse fatty liver
Sonographic findings:
hyperechoic area adjacent to the gallbladder, near the porta hepatis, or the entire medial segment of the left lobe may appear echogenic
focal fatty infiltration
Sonographic findings:
hypoechoic area adjacent to the gallbladder, near the porta hepatis, or the entire medial segment of the left lobe may be spared
can appear much like pericholecystic fluid when seen adjacent to the gallbladder
focal fatty sparing
Sonographic findings: normal liver enlarged, hypoechoic liver periportal cuffing with "starry sky" gallbladder wall thickening
hepatitis
Sonographic findings: hepatomegaly (initial) shrunken right lobe of the liver enlarged caudate and left lobe nodular surface irregularity coarse echotexture splenomegaly ascites monophasic flow within the hepatic veins hepatofugal flow within the portal veins
cirrhosis
Sonographic findings: hepatomegaly (initial) shrunken right lobe of the liver enlarged caudate and left lobe 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 13mm in the anteroposterior dimension) enlargement of the SMV enlargement and reversed flow within the coronary vein abdominal varicosities at the splenic hilum, renal hilum, and gastroesophageal junction patent (recanalized) paraumbilical vein collateral development at the splenic and renal hilum
portal hypertension
a mesh of tiny blood vessels (collaterals) (termed cavernous formation of the portal vein) in the area of the portal vein are seen with:
portal vein thrombosis
Clinical findings: abdominal pain elevated liver function tests hypovolemia leukocytosis low-grade fever nausea vomiting
portal vein thrombosis
Sonographic findings:
echogenic thrombus within the portal vein
cavernous transformation of the portal veins will appear as wormlike or serpiginous vessels within the region of the portal vein
portal vein thrombosis
Clinical findings: ascites elevated liver function tests hepatomegaly splenomegaly upper abdominal pain
Budd-Chiari syndrome
Sonographic findings:
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
true hepatic cysts are usually not encountered until:
middle age
true hepatic cysts are most often associated with:
autosomal dominant polycystic kidney disease
Clinical findings:
asymptomatic
normal liver function tests
polycystic kidney disease
hepatic cysts
Sonographic findings:
anechoic mass or masses with smooth walls and posterior enhancement
may have irregular shapes
clusters of cysts may be noted
hepatic cysts
Clinical findings: leukocytosis low-grade fever nausea obstructive jaundice RUQ tenderness
hydatid (echinococcal) cyst
Sonographic findings:
anechoic mass containing some debris (sand)
“water lily” sign - wall of the endocyst seen floating within the pericyst
“mother” cyst containing one or more smaller “daughter” cysts
mass may contain some elements of dense calcification
hydatid (echinococcal) cyst
Clinical findings: fever hepatomegaly leukocytosis possible abnormal liver function tests RUQ pain
pyogenic hepatic abscess
Sonographic findings:
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
typically transmitted through contaminated water
amebic hepatic abscess
Clinical findings: hepatomegaly RUQ or general abdominal pain general malaise diarrhea (possibly bloody) fever leukocytosis elevated liver function tests mild anemia
amebic hepatic abscess
Sonographic findings:
round, hypoechoic or anechoic mass or masses
may contain debris
acoustic enhancement
amebic hepatic abscess
Clinical findings: immunocompromised patients including cancer patients, recent organ transplant patients, and patients with HIV RUQ pain fever hepatomegaly
hepatic candidiasis
Sonographic findings:
multiple hyperechoic masses with hypoechoic halos (“halo” or “bulls-eye” lesions)
hepatic candidiasis
Clinical findings:
asymptomatic
oral contraceptive use
hepatocellular adenoma
Sonographic findings:
hypoechoic, hyperechoic, isoechoic, or areas of mixed echogenicities
hepatocellular adenoma
Clinical findings:
trauma
recent surgery
decreased hematocrit
hepatic hematoma
Sonographic findings:
fresh clot is more echogenic than the surrounding liver
may appear cystic or complex
hepatic hematoma
the most common benign liver tumor
cavernous hemangioma
Sonographic findings:
small, hyperechoic mass
cavernous hemangioma
second most common benign liver tumor that is more common in women
focal nodular hyperplasia (FNH)
Sonographic findings:
isoechoic, hyperechoic, or hypoechoic mass
central scar will appear as an hyperechoic or hypoechoic linear structure within the mass and will reveal hypervascularity with color Doppler imaging
focal nodular hyperplasia
the most common primary form of liver cancer, though not encountered as often as metastatic liver disease
hepatocellular carcinoma (HCC)
the malignant mass associated with hepatocellular carcinoma is:
hepatoma
Clinical findings: elevated AFP abnormal liver function tests cirrhosis chronic hepatitis unexplained weight loss hepatomegaly fever palpable mass ascites
hepatocellular carcinoma
Sonographic findings:
solitary, small, hypoechoic mass
heterogeneous masses scattered throughout the liver
mass with a hypoechoic halo
hepatocellular carcinoma
most common primary source of metastatic liver cancer
lung
Clinical findings: weight loss jaundice RUQ pain hepatomegaly ascites (abdominal swelling)
hepatic metastasis
Sonographic findings:
GI tract and pancreas tend to have calcified tumors
hypoechoic masses may be from the breast, lung, or lymphoma
hyperechoic masses may be from the kidney and pancreas
“target” or “bulls-eye” lesion may be from lung or colon
hepatic metastasis
the most common malignant tumor of childhood
hepatoblastoma
Clinical findings: pediatric patient palpable abdominal mass hepatomegaly abdominal pain weight loss anorexia elevated AFP jaundice
hepatoblastoma
Sonographic findings:
solid, hyperechoic, or heterogeneous mass
mass may contain some calcifications
hepatoblastoma
The left lobe of the liver can be separated from the right lobe by: A. right hepatic vein B. Middle hepatic vein C. Left hepatic vein D. Falciform ligament
middle hepatic vein
The right lobe of the liver is divided into segments by the: A. middle lobar fissure B. middle hepatic vein C. right hepatic vein D. left hepatic vein
right hepatic vein
The right intersegmental fissure contains the: A. right hepatic vein B. middle hepatic vein C. left portal vein D. right portal vein
right hepatic vein
The ligamentum teres can be used to separate the:
A. medial and lateral segments of the left lobe
B. medial and posterior segments of the right lobe
C. anterior and medial segments of the left lobe
D. anterior and posterior segments of the right lobe
medial and lateral segments of the left lobe
The main lobar fissure contains the: A. right hepatic vein B. middle hepatic vein C. main portal vein D. right portal vein
middle hepatic vein
Right-sided heart failure often leads to enlargement of the: A. abdominal aorta B. IVC and hepatic veins C. IVC and portal veins D. portal veins and spleen
IVC and hepatic veins
The right portal vein divides into: A. middle, left, and right branches B. left and right branches C. anterior and posterior branches D. medial and lateral branches
anterior and posterior branches
The diameter of the portal vein should not exceed: A. 4 mm B. 8 mm C. 10 mm D. 13 mm
13 mm
The right lobe of the liver can be divided into: A. medial and lateral segments B. medial and posterior segments C. anterior and medial segments D. anterior and posterior segments
anterior and posterior segments
The left lobe of the liver can be divided into: A. medial and lateral segments B. medial and posterior segments C. anterior and medial segments D. anterior and posterior segments
medial and lateral segments
Budd-Chiari syndrome leads to a reduction in the size of the: A. hepatic arteries B. portal veins C. hepatic veins D. common bile duct
hepatic veins
The left portal vein divides into: A. middle, left, and right branches B. left and right branches C. anterior and posterior branches D. medial and lateral branches
medial and lateral branches
The left umbilical vein after birth becomes the: A. falciform ligament B. main lobar fissure C. ligamentum teres D. ligamentum venosum
ligamentum teres
Clinical findings of fatty infiltration of the liver include: A. elevated liver function tests B. fever C. fatigue D. weight loss
elevated liver function tests
Shortly after birth, the ductus venosus collapses and becomes the: A. falciform ligament B. main lobar fissure C. ligamentum teres D. ligamentum venosum
ligamentum venosum
Clinical findings of hepatitis include all of the following except: A. jaundice B. fever C. chills D. pericholecystic fluid
pericholecystic fluid
All of the following are sequela of cirrhosis except: A. portal vein thrombosis B. hepatic artery enlargement C. portal hypertension D. splenomegaly
hepatic artery enlargement
Which hepatic mass is closely associated with oral contraceptive use? A. hepatic adenoma B. hepatic hypernephroma C. hepatic hamartoma D. hepatic hemangioma
hepatic adenoma
All of the following are clinical findings of hepatocellular carcinoma except: A. reduction in AFP B. unexplained weight loss C. fever D. cirrhosis
reduction in AFP
