Chapter 2: The Liver Flashcards
1
Q
an abscess that develops from a parasite that grows in the colon and invades the liver via the portal vein
A
amebic (liver) abscess
2
Q
an inherited disease that results in the development of renal, liver, and pancreatic cysts late in life
A
autosomal dominant polycystic kidney disease
adult polycystic kidney disease
3
Q
a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver
A
Beckwith-Wiedemann syndrome
4
Q
a syndrome described as the occlusion of the hepatic veins, with possible co-existing occlusion of the IVC
A
Budd-Chiari syndrome
5
Q
the most common benign liver tumor
A
cavernous hemangioma
6
Q
condition defined as hepatocyte death, fibrosis and necrosis of the liver, and subsequent development of regenerating nodules
A
cirrhosis
7
Q
a parasite responsible for the development of hydatid liver cysts
A
echinococcus granulosus
8
Q
a benign liver mass composed of a combination of hepatocytes and fibrous tissue that typically contains a central scar
A
focal nodular hyperplasia
9
Q
the thin fibrous casing of the liver
A
Glisson capsule
10
Q
an inherited disease characterized by disproportionate absorption of dietary iron
A
hemochromatosis
11
Q
the formation and development of blood cells
A
hemopoiesis
12
Q
a hepatic mass that results from the spread of fungus in the blood to the liver
A
hepatic candidiasis
13
Q
inflammation of the liver
A
hepatitis
14
Q
a benign liver mass often associated with the use of oral contraceptives
A
hepatocellular adenoma
15
Q
the primary form of liver cancer
A
hepatocellular carcinoma
16
Q
blood flowing away from the liver
A
hepatofugal
17
Q
blood flowing toward the liver
A
hepatopetal
18
Q
the malignant tumor associated with hepatocellular carcinoma
A
hepatoma
19
Q
a liver cyst that develops from a tapeworm that lives in dog feces
A
hydatid cyst
echinococcal cyst
20
Q
specialized macrophages within the liver that engulf pathogens and damaged cells
A
Kupffer cells
21
Q
a benign fatty tumor
A
lipoma
22
Q
the area of the liver where the common bile duct exits the liver and where the portal vein and hepatic artery enter the liver
A
liver hilum
porta hepatis
23
Q
an increase in the echogenicity of the portal triads as seen in hepatitis
A
periportal cuffing
24
Q
an assembly of a small branch of the portal vein, bile duct, and hepatic artery that surround each liver lobule
A
portal triads
25
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
26
the medial segment of the left lobe of the liver
quadrate lobe
27
a tonguelike extension of the right hepatic lobe
Riedel lobe
28
an illness resulting from another disease, trauma, or injury
sequela
29
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
30
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)
31
separates the anterior segment of the right lobe from the posterior segment of the right lobe
right hepatic vein
| right intersegmental fissure
32
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
33
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
34
the main portal vein enters the liver at the:
porta hepatis (liver hilum)
35
the portal vein provides the liver with approximately __% of its total blood supply
70%
36
the RIGHT portal vein is separated into a(n) ________ and _________ division
anterior
| posterior
37
the LEFT portal vein is separated into a(n) ________ and _________ division
medial
| lateral
38
the diameter of the main portal vein should measure less than ____ in the anteroposterior dimension
13mm
39
enlargement of the portal vein is indicative of:
portal hypertension
40
normal portal veins ________ in size as they approach the diaphragm
decrease
41
normal blood flow within the portal veins should be:
hepatopetal and monophasic, with some variation with respiration and after meals
42
the three hepatic veins drian into the:
IVC
43
hepatic veins ________ in size as they approach the diaphragm
increase
44
hepatic veins have a ____________ blood flow pattern secondary to their association with the right atrium and atrial contraction
triphasic
45
enlargement of the hepatic veins is seen with:
right-sided heart abnormalities
46
occlusion of the hepatic veins is seen with:
Budd-Chiari syndrome
47
3 structures located within the porta hepatis
main portal vein
common bile duct
hepatic artery
48
what carries oxygenated blood to the liver from the abdominal aorta?
common hepatic artery
49
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)
50
shortly after birth, the ductus venosus (right umbilical vein) collapses and becomes the:
ligamentum venosum
51
after birth, the left umbilical vein becomes the:
ligamentum teres
52
which ligament seems to connect the gallbladder to the right portal vein?
main lobar fissure
53
normal liver measurement
13-15cm in length (in an adult)
54
hepatomegaly measurement
greater than 15cm in the midhepatic line
55
```
Clinical findings:
asymptomatic
alcohol abuse
chemotherapy
diabetes mellitus
elevated liver function test
obesity
pregnancy
```
fatty liver disease
56
2 most common forms of hepatitis
A and B
57
how are hepA and hepB spread?
hepA - contaminated food
| hepB - body fluids
58
as the liver enlarges, it tends to become more:
hypoechoic
59
```
Clinical findings:
chills
dark urine
elevated liver function tests
fatigue
fever
hepatosplenomegaly
jaundice
nausea
vomiting
```
hepatitis
60
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)
61
monophasic flow within the hepatic veins and hepatofugal flow within the portal veins are both findings consistent with:
advanced cirrhosis and portal hypertension
62
```
Clinical findings:
ascites
diarrhea
elevated liver function tests
fatigue
hepatomegaly (initially)
jaundice
splenomegaly
weight loss
```
cirrhosis
63
the most common cause of portal hypertension is:
cirrhosis
64
one of the most commonly identified collaterals in portal hypertension is:
the recanalization of the paraumbilical vein
| patent paraumbilical vein
65
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
66
what is the interventional treatment for portal hypertension?
transjugular intrahepatic portosystemic shunt (TIPS shunt)
67
```
Clinical findings:
abnormal liver function tests
ascites
diarrhea
fatigue
hepatomegaly
jaundice
weight loss
```
portal hypertension
68
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
69
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
70
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
71
```
Sonographic findings:
normal liver
enlarged, hypoechoic liver
periportal cuffing with "starry sky"
gallbladder wall thickening
```
hepatitis
72
```
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
73
```
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
74
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
75
```
Clinical findings:
abdominal pain
elevated liver function tests
hypovolemia
leukocytosis
low-grade fever
nausea
vomiting
```
portal vein thrombosis
76
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
77
```
Clinical findings:
ascites
elevated liver function tests
hepatomegaly
splenomegaly
upper abdominal pain
```
Budd-Chiari syndrome
78
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
79
true hepatic cysts are usually not encountered until:
middle age
80
true hepatic cysts are most often associated with:
autosomal dominant polycystic kidney disease
81
Clinical findings:
asymptomatic
normal liver function tests
polycystic kidney disease
hepatic cysts
82
Sonographic findings:
anechoic mass or masses with smooth walls and posterior enhancement
may have irregular shapes
clusters of cysts may be noted
hepatic cysts
83
```
Clinical findings:
leukocytosis
low-grade fever
nausea
obstructive jaundice
RUQ tenderness
```
hydatid (echinococcal) cyst
84
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
85
```
Clinical findings:
fever
hepatomegaly
leukocytosis
possible abnormal liver function tests
RUQ pain
```
pyogenic hepatic abscess
86
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
87
typically transmitted through contaminated water
amebic hepatic abscess
88
```
Clinical findings:
hepatomegaly
RUQ or general abdominal pain
general malaise
diarrhea (possibly bloody)
fever
leukocytosis
elevated liver function tests
mild anemia
```
amebic hepatic abscess
89
Sonographic findings:
round, hypoechoic or anechoic mass or masses
may contain debris
acoustic enhancement
amebic hepatic abscess
90
```
Clinical findings:
immunocompromised patients including cancer patients, recent organ transplant patients, and patients with HIV
RUQ pain
fever
hepatomegaly
```
hepatic candidiasis
91
Sonographic findings:
| multiple hyperechoic masses with hypoechoic halos ("halo" or "bulls-eye" lesions)
hepatic candidiasis
92
Clinical findings:
asymptomatic
oral contraceptive use
hepatocellular adenoma
93
Sonographic findings:
| hypoechoic, hyperechoic, isoechoic, or areas of mixed echogenicities
hepatocellular adenoma
94
Clinical findings:
trauma
recent surgery
decreased hematocrit
hepatic hematoma
95
Sonographic findings:
fresh clot is more echogenic than the surrounding liver
may appear cystic or complex
hepatic hematoma
96
the most common benign liver tumor
cavernous hemangioma
97
Sonographic findings:
| small, hyperechoic mass
cavernous hemangioma
98
second most common benign liver tumor that is more common in women
focal nodular hyperplasia (FNH)
99
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
100
the most common primary form of liver cancer, though not encountered as often as metastatic liver disease
hepatocellular carcinoma (HCC)
101
the malignant mass associated with hepatocellular carcinoma is:
hepatoma
102
```
Clinical findings:
elevated AFP
abnormal liver function tests
cirrhosis
chronic hepatitis
unexplained weight loss
hepatomegaly
fever
palpable mass
ascites
```
hepatocellular carcinoma
103
Sonographic findings:
solitary, small, hypoechoic mass
heterogeneous masses scattered throughout the liver
mass with a hypoechoic halo
hepatocellular carcinoma
104
most common primary source of metastatic liver cancer
lung
105
```
Clinical findings:
weight loss
jaundice
RUQ pain
hepatomegaly
ascites (abdominal swelling)
```
hepatic metastasis
106
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
107
the most common malignant tumor of childhood
hepatoblastoma
108
```
Clinical findings:
pediatric patient
palpable abdominal mass
hepatomegaly
abdominal pain
weight loss
anorexia
elevated AFP
jaundice
```
hepatoblastoma
109
Sonographic findings:
solid, hyperechoic, or heterogeneous mass
mass may contain some calcifications
hepatoblastoma
110
```
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
111
```
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
112
```
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
113
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
114
```
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
115
```
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
116
```
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
117
```
The diameter of the portal vein should not exceed:
A. 4 mm
B. 8 mm
C. 10 mm
D. 13 mm
```
13 mm
118
```
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
119
```
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
120
```
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
121
```
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
122
```
The left umbilical vein after birth becomes the:
A. falciform ligament
B. main lobar fissure
C. ligamentum teres
D. ligamentum venosum
```
ligamentum teres
123
```
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
124
```
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
125
```
Clinical findings of hepatitis include all of the following except:
A. jaundice
B. fever
C. chills
D. pericholecystic fluid
```
pericholecystic fluid
126
```
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
127
```
Which hepatic mass is closely associated with oral contraceptive use?
A. hepatic adenoma
B. hepatic hypernephroma
C. hepatic hamartoma
D. hepatic hemangioma
```
hepatic adenoma
128
```
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
