Liver Flashcards by lindsay crouse

which benign liver mass is typically isoechoic and contains a central scar?

hepatoblastoma
cavernous hemangioma
hamartoma
focal nodular hyperplasia

focal nodular hyperplasia (FNH)

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the covering of the liver is referred to as:

Glisson capsule
Gerota fascia
Morison pouch
Hepatic fascia

Glisson capsule

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the left lobe of the liver can be separated from the right lobe by the:

RHV
MHV
LHV
falciform ligament

MHV

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the TIPS shunt is placed:

between the MHA and MPV
between a PV and HV
between the CHD and CBD
between a PV and HA

between a PV and HV

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the right lobe of the liver is divided into segments by the:

MLF
MHV
RHV
LHV

RHV

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the right intersegmental fissure contains the:

RHV
MHV
LPV
RPV

RHV

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the MPV divided into:

middle, left and right branches
left and right branches
anterior and posterior branches
medial and lateral branches

left and right branches

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the Lig Teres can be used to separate the:

medial and lateral segments of the LLL
medial and posterior segments of the RLL
anterior and medial segments of the LLL
anterior and posterior segments of the RLL

medial and lateral segments of the LLL

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the MLF contains the:

RHV
MHV
MPV
RPV

MHV

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all of the following are located within the porta hepatis EXCEPT:

MPV
CBD
HA
MHV

MHV

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right-sided heart failure often leads to enlargement of the:

abdominal AO
IVC and hepatic veins
IVC and porta veins
portal veins and spleen

IVC and hepatic veins

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Which is typically transmitted through contaminated water found in places such as Mexico, Central America, South America, Asia, India, and Africa?

amebic liver abscess
hydatid liver cyst
candidiasis
hepatoma

amebic liver abscess

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the RPV divides into:

middle, left, and right branches
left and right branches
anterior and posterior branches
medial and lateral branches

anterior and posterior branches

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diameter of the PV should not exceed:

4mm
8mm
10mm
13mm

13mm

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the RLL can be divided into:

medial and lateral segments
medial and posterior segments
anterior and medial segments
anterior and posterior segments

anterior and posterior segments

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which is true about the portal veins?

carry deoxygenated blood away from the liver

have brighter walls than the hepatic veins

should demonstrate hepatofugal flow

increase in diameter as the approach the diaphragm

have brighter walls than the hepatic veins

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the LLL can be divided into:

medial and lateral segments
medial and posterior segments
anterior and medial segments
anterior and posterior segments

medial and lateral segments

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normal flow within the hepatic artery should demonstrate a:

high resistance waveform pattern with a slow upstroke and gradual deceleration with diastole

low resistance waveform pattern with a quick upstroke and gradual deceleration with diastole

low resistance waveform pattern with a slow upstroke and gradual acceleration with diastole

high resistance waveform pattern with a quick upstroke and gradual deceleration with diastole

low resistance waveform pattern with a quick upstroke and gradual deceleration with diastole

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Budd Chiari syndrome leads to a reduction in the size of the:

hepatic arteries
portal veins
hepatic veins
CBD

hepatic veins

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a tonguelike extenstion of the RLL is termed:

papillary lobe
focal hepatomegaly
Riedel lobe
Morison lobe

Riedel lobe

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the LPV divides into:

middle, left and right branches
left and right branches
anterior and posterior branches
medial and lateral branches

medial and lateral branches

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the umbilical vein after birth becomes the:

falciform ligament
MLF
Lig Teres
Lig Venosum

Ligamentum Teres

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normal flow within the hepatic veins is:

biphasic
irregular
high resistant
triphasic

triphasic

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the inferior extension of the caudate lobe is:

papillary process
focal hepatomegaly
Riedel process
Morison lobe

papillary process

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which is the most common reason for a liver transplant? HCC Hep C Hep B hepatic metastasis

Hep C

clinical findings of fatty infiltration of the liver include: elevated LFTs fever fatigue weight loss

elevated LFTs

Sonographically, when the liver is difficult to penetrate and diffusely echogenic, this is a indicative of: portal vein thrombosis metastatic liver disease primary liver carcinoma fatty liver disease

fatty liver disease

the most common cause of cirrhosis is: portal hypertension hepatitis alcoholism cholangitis

alcoholism

clinical findings of hepatitis include all of the following EXCEPT: jaundice fever chills pericholescystic fluid

pericholescystic fluid

what form of hepatic abnormality are immunocompromised patients more prone to develop? hepatic adenoma amebic abscess hydatid liver abscess candidiasis

candidiasis

all of the following are sequela of cirrhosis EXCEPT: portal vein thrombosis hepatic artery contraction portal hypertension splenomegaly

hepatic artery contraction

normal flow towards the liver in the portal veins is termed: hepatopetal hepatofugal

hepatopetal

which mass would be most worrisome for malignancy? echogenic mass cystic mass with posterior enhancement isoechoic mass with a central scar hyperechoic mass with a hypoechoic halo

hyperechoic mass with a hypoechoic halo

which is the most common form of liver cancer? HCC adenocarcinoma metastatic liver disease hepatoblastoma

metastatic liver disease

which mass is closely associated with oral contraceptive use? hepatic adenoma hepatic hypernephroma hepatic hamartoma hepatic hemangioma

hepatic adenoma

which is considered the most common benign childhood hepatic mass? hepatoblastoma hepatoma hematoma hemangioendothelioma

hemangioendothelioma

all of the following are clinical findings of HCC EXCEPT: reduction in AFP unexplained weight loss fever cirrhosis

reduction in AFP

Beckwith-Weidemann is associated with an increased risk for developing: hepatoblastoma cirrhosis portal hypertension hepatitis

hepatoblastoma

which is associated with E. granulosus? candidiasis amebic liver abscess hydatid liver cyst HCC

hydatid liver cyst

You are scanning a patient with a known mass in the left medial segment of the liver. What anatomic landmark can you use to identify the left medial segment separate from the right anterior segment of the liver? LPV Lig Teres Lig Venosum MHV LHV

MHV

what structure is located at the anterior border of the caudate lobe that will help you to identify this lobe of the liver? LPV fissure for the Lig Venosum IVC fissure for the Lig Teres MLF

fissure for the Lig Venosum

You are asked to rule out the presence of a recanalized paraumbilical. Which anatomic structure is a useful landmark in location of this structure? Lig Teres Lig Venosum coronary ligament hepatodudenal ligament Glisson's ligament

Lig Teres

which vessel courses within the MLF? MPV LPV MHV proper HA RHV

MHV

oxygenated blood is supplies to the liver via: PV and HV HV and HA PV and HA HA only

PV and HA

which forms the caudal border of the LPV? Lig Venosum hepatoduodenal ligament MLF coronary ligament Lig Teres

Lig Teres

what differentiates the hepatic veins from the portal veins? HVs converge toward the porta hepatis HVs have brightly echogenic walls PVs are largest near the dome of the liver PVs are accompanied by branches of the biliary tree and HA PVs normally exhibit a triphasic flow pattern

PVs are accompanied by branches of the biliary tree and HA

You have detected a mass anterior and to the left of the Lig Venosum. This mass is located in what lobe of the liver? left lobe caudate lobe Riedel's lobe right lobe quadrate lobe

left lobe

which course interlobar and intersegmental within the liver? bile ducts PVs HAs lymphatics HVs

HVs

what lobe of the liver does the letter A represent? left lobe caudate lobe posterior right lobe anterior right lobe quadrate lobe

left lobe

what structure does the letter B represent? Lig Teres falciform ligament hepatodudenal ligament Lig Venosum MLF

Lig venosum

what lobe does the letter C represent? left lobe caudate lobe posterior right lobe anterior right lobe quadrate lobe

caudate lobe

identify the structure labeled A in this image of the liver Lig Venosum Lig Teres hepatoduodenal ligament coronary ligament Glisson's capsule

Lig Teres

identify the anatomy labeled A MPV right posterior portal vein branch LPV RHV MHV

right posterior portal vein branch

vessel A is located in what lobe of the liver? caudate lobe medial segment left lobe lateral segment left lobe posterior segment right lobe anterior segment right lobe

posterior segment right lobe

identify the anatomy labeled C MPV right posterior portal vein LPV RHV MHV

LPV

the arrow labeled D is pointing to what lobe of the liver? medial segment left lobe lateral segment left lobe posterior segment right lobe anterior segment right lobe caudate lobe

caudate lobe

You are performing an ultrasound exam of the liver on a small patient with a 5MHz curved linear array. Although you have increased the overall gain to its max setting, the posterior borders of the liver and diaphragm are not visualized. What should you do? call the service representative to repair decreased the transmit power move the focal zone into the near field rescan with a higher frequency rescan with a lower frequency

rescan with a lower frequency lower frequency = increase penetration

which correctly describes the probe placement and imaging plane you would use to demonstrate the three HVs and IVC in one view? subcostal oblique approach with the probe angled superiorly and to the patient's right intercostal approach with the probe angled inferiorly to the patient's left intercostal approach with the probe oriented in a coronal plane subcostal oblique approach with the probe angled inferiorly to the patient's left sag subcostal approach with the probe just to the right of midline

subcostal oblique approach with the probe angled superiorly and to the patient's right

You are performing a follow up sonogram on a patient in which a 5mm cyst was previously identified at the anterior border of the LLL. Although you are using a 3.5MHz curved linear array probe, you do not see the cyst. Which would be most helpful in improving visibility of this cyst? increase the overall gain increase the dynamic range increase the transmit power rescan with a higher frequency rescan with a lower frequency

rescan with a higher frequency visibility of small cysts is limited by spatial resolution - to improve spatial resolution the best option is to increase frequency

You are imaging a patient with a high liver. Subcostal images do not clearly demonstrate the liver tissue. What should you do? scan patient in deep inspiration scan patient in expiration place patient in trendelenberg position have patient drink 32oz of water scan patient in quiet respiration

scan patient in deep inspiration

A patient is referred for ultrasound evaluation of a questionable mass in the dome of the liver scan on a CT scan. Which method would improve visualization in this area of the liver? subcostal scan with probe angled superior and patient in deep inspiration intercostal scan with probe in the coronal plane and patient in expiration subcostal scan with the patient performing valsalva roll patient into right lateral decubitus and scan from the subcostal approach with patient in expiration some of the liver cannot be seen with ultrasound

subcostal scan with probe angled superior and patient in deep inspiration

a patient is referred for a liver ultrasound with the clinical history of a raised serum AFP level, what should you look for? FNH fatty liver HCC hydatid disease increased AFP levels are not associated with liver disease

HCC

elevation of both GGT and ALP: suggest the source of elevated ALP is due to metastatic bone cancer is a sensitive indicator of pancreatitis indicate lab work is invalid and must be repeated indicate the source of elevated ALP is the liver is highly specific for HCC

indicate the source of elevated ALP is the liver

which lab test is NOT used in evaluation of liver function? GGT AST direct bilirubin indirect bilirubin lipase

lipase

A patient is referred with RUQ tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the RLL. Color doppler reveals hypervascularity of the mass. Which is most likely? hydatid liver disease hepatic lipoma hepatic abscess hepatic adenoma HCC

hepatic adenoma

A liver ultrasound on a 49 year old obese male demonstrates diffuse increased echogenicity with focal hypoechoic area anterior to the PV. This most likely represents: liver cirrhosis with HCC hydatid disease fatty metamorphosis with focal sparing metastatic disease due to colon normal life parenchyma with a simple cyst

fatty metamorphosis with focal sparing

A 52 year old male with known liver cirrhosis presents for an ultrasound. You will carefully evaluate the liver to rule out the presence of any focal mass because of which true statement? patients with liver cirrhosis are at increased risk for HCC patients with liver cirrhosis tend to develop multiple cysts in their liver and pancreas metastasic disease occurs commonly with cirrhosis the presence of regenerative nodules rules out cirrhosis all of the above are correct

patients with liver cirrhosis are at an increased risk for HCC

you are scanning a patient with suspected liver cirrhosis, all of the following are sonographic features of cirrhosis EXCEPT: surface nodularity shrunken caudate lobe altered echo texture ascites regenerative nodules

shrunken caudate lobe in cirrhosis, the caudate lobe is most commonly enlarged compared to the RLL due to sparing

an ultrasound evaluation of liver cirrhosis should include a search for which associated complication? biliary dilatation mesentery ischemia splenic infarction Kaposi's sarcoma portal hypertension

portal hypertension

Ultrasound findings of an abdominal study on a 51 year old female include enlargement of the HVs and IVC in an otherwise normal appearing liver. These findings are most consistent with: Budd Chiari syndrome right-sided heart failure liver cirrhosis portal hypertension sarcoidosis

right sided heart failure

focal fatty liver is most commonly found in which location? medial to the ascending branch of the LPV posterior to the RHV lateral, inferior tip of the right lobe adjacent to the fissure for the Lig venosum anterior to the PV at the porta hepatis

anterior to the PV at the porta hepatis

You have performed an ultrasound on a patient with an enlarged caudate lobe, shrunken right lobe, and splenomegaly. The HVs could not be identified. No other abnormalities were discovered. What should you do? scan the pelvis to rule out pelvic mass have the patient perform valsalva and re-examine the HVs evaluate the HVs and IVC with color doppler to confirm patency have the patient return in a week for a repeat study nothing

evaluate the HVs and IVC with color doppler to confirm patency

A patient is referred to rule out hepatomegaly, all of the following are useful indicators EXCEPT: rounding of the inferior border of the liver longitudinal measurement of the right lobe exceeding 15.5cm extension of the right lobe inferior to the lower pole of the right kidney increased diameter of the MPV greater than 1cm increased AP measurement of the right lobe

increased diameter of the MPV greater than 1cm

You have identified a single homogenous hyperechoic lesion measuring 2.4 cm in the posterior aspect of the RLL. What is the most common etiology of a mass fitting this description? cyst hepatic adenoma cavernous hemangioma HCC focal fatty sparing

cavernous hemangioma

A patient is referred for a sonogram of the liver to rule out metastatic disease. Which describes the sonographic appearance of liver metastasis? single hypoechoic mass multiple hyperechoic masses masses of mixed echogenicity cystic masses all of the above

all of the above

which is NOT a feature of hepatic cysts? thin wall posterior acoustic enhancement anechoic increased attenuation increased through transmission

increased attenuation attenuation through a cyst is decreased

A single large, well defined mass with smooth walls and homogenous low level echoes is seen within the anterior RLL in a 48 year old female. No doppler signals could be obtained within the mass. Which of the following conditions is the most likely etiology of this mass? Kaposi's sarcoma focal nodular hyperplasia hemorrhagic cyst PV aneurysm HCC

hemorrhagic cyst

You are scanning a patient with a history of fever, abnormal LFTs, and RUQ tenderness. The liver is enlarged with decreased echogenicity, GB wall thickness, and thick echogenic bands are noted surrounding the PVs. Which of the following conditions is most likely? fatty liver cirrhosis Budd-Chiari hepatitis normal liver

hepatitis bright bands = "periportal cuffing"

You are evaluating a suspicious lesion and look for gas bubbles to confirm the presence of liver abscess in a patient with fever and increased WBC count. What is the sonographic appearance of the gas bubbles? brightly echogenic echoes with clean distal acoustic shadow brightly echogenic foci associated with echogenic ring down artifact hypoechoic area within the mass associated with increased through transmission anechoic foci with distal acoustic enhancement hyperechoic foci with distal acoustic enhancement

brightly echogenic foci associated with echogenic ringdown artifact

which is associated with infestation by a parasite and is most prevalent in sheep and cattle raising countries? Budd-Chiari hydatid disease candidiasis Hep A Kaposi's sarcoma

hydatid disease

You are scanning the liver and notice irregularity of the surface. A nodular liver surface is associated with: cirrhosis acute hepatitis fatty liver polycystic liver disease hepatomegaly

cirrhosis

which is NOT true regarding fatty liver? it is irreversible it may be caused by obesity it may be diffuse or focal it may show a rapid change in appearance it commonly causes increased attenuation of the sound beam through liver

fatty liver is a reversible disorder

You are scanning through the liver and notice luminal narrowing of the HVs. Color and spectral doppler reveal high velocities through the strictures. These findings are most commonly associated with: diffuse fatty liver acute hepatitis cirrhosis focal fatty infiltration glycogen storage disease

cirrhosis

which is most commonly associated with invasion of the PV? HCC cavernous hemangioma liver metastasis hepatic adenoma focal nodular hyperplasia

HCC

You have been asked to perform a liver sonogram on a patient with AIDS. Which is most commonly associated with this history? HCC Kaposi's sarcoma Budd-Chiari syndrome hemangiosarcoma hepatic adenoma

Kaposi's sarcoma

You are scanning a 53 year old female with a history of recent weight loss and vague abdominal pain. The liver is markedly heterogenous and contains numerous calcified lesions. This most likely represents metastasis disease from which primary? Non-Hodgkin lymphoma cystadenocarcinoma of the ovary lung adenocarcinoma of the colon breast

adenocarcinoma of the colon

During ultrasound evaluation of the liver, a bulls-eye or target lesion is identified in the anterior right lobe. The most likely etiology of this mass is: liver abscess hepatic adenoma FNH HCC liver metastasis from lung cancer

liver metastasis from lung cancer

You are performing an ultrasound exam on a young female and notice a well defined solitary mass with a central scar measuring 4 cm in diameter. Color doppler reveals prominent blood vessels coursing within the scar. This most likely represents: liver abscess hepatic adenoma FNH HCC liver metastasis from lung cancer

FNH

You are performing a liver sonogram on a young female with RUQ pain, sudden onset ascites, and hepatomegaly. You have obtained TRV and SAG images of the liver, CBD, and GB according to your protocol. What else should you do? nothing expand the study to include kidneys to rule out associated hydronephrosis use color and special doppler to determine patency of the portal and hepatic venous systems give the patient a fatty meal and then measure the PV diameter at 1,2,5, and 10mins call the referring physician to get an order to perform a pelvic study to see if the patient's pain is referred from an ovarian mass

use color and special doppler to determine patency of the portal and hepatic venous systems

which is NOT true regarding cavernous hemangiomas? small, well defined, hyperechoic consist of a vascular network more common in women usually asymptomatic show prominent, high velocity color doppler signals

they DO NOT show prominent, high velocity color doppler signals

A patient is referred for ultrasound with a history of liver transplantation. You identify an extrahepatic fluid collection. What is the likely etiology of this finding? biloma hematoma loculated ascites abscess any of the above

any of the above

what significant complication following liver transplantation is NOT detectable with ultrasound? rejection malignant disease HA thrombosis PV thrombosis pseudoaneurysm

rejection liver biopsies are frequently performed to rule out rejection

You are scanning a patient with a history of liver transplantation. You should search for all of the following complications EXCEPT: biliary sludge acute cholecystitis PV thrombosis HA thrombosis liver malignancy

acute cholecsytitis the donor GB is excised during the transplant surgery

You have been asked to provide ultrasound imaging during liver surgery. What transducer would be best suited for this purpose? 3.5MHz curved linear 10MHz linear 2.25MHz phased 7MHz linear 12MHx curved linear

7MHz linear During intraoperative scanning, the sterile transducer is placed directly on the exposed liver. For this reason, a transducer with higher than usual frequency can be used to image the liver nonsurgically. Typically, a 5-7 MHz linear array is used.

You are scanning through the RLL and notice that although you have maximized the far field TGC, the parenchyma in the far field and diaphragm are not clearly visualized. What should you do? decrease the transmission power increase the compression curve decrease the transmit frequency decrease the overall gain increase the dynamic range

decrease transmit frequency

hepatofugal flow in the PV is a sign of: normalcy HA thrombosis PHTN acute cholecystitis HCC

PHTN

A patient is referred for abdominal ultrasound with a high fever and RUQ pain. You document the presence of a large, rounded, homogeneous mass with low-level internal echoes and poorly defined borders. The mass is located in the RLL, adjacent to the capsule, and shows increased through transmission. This most likely represents: hemorrhagic cyst abscess hematoma choledochal cyst loculated ascites

abscess

You are scanning a patient with known liver cirrhosis and notice a focal mass within the posterior right lobe. What lab test would be most helpful in determining if this mass is HCC? serum AFP ALP serum bilirubin serum creatine lactate dehydrogenase (LD)

serum AFP

You have been asked to perform an ultrasound to rule out the presence of Budd-Chiari syndrome. You will tailor your exam to include: volume measurement of spleen doppler analysis of HVs both supine and upright views of porta hepatis oblique view of the RLL to include right hemidiaphragm careful search for periaortic lymphadenopathy

dopple analysis of HVs

the majority of the blood supply to the liver is provided from the: HVs PV HA SMV gastroduodenal artery

following liver transplantation, which of the following anatomical locations has an anastomotic connection that should be evaluated with ultrasound? IVC PV HA bile duct all of the above

all of the above

You are scanning a patient with liver cirrhosis and suspected PHTN. In this study, assessment of the size of which of the following is most important? spleen CBD abdominal AO RHV IVC

spleen the spleen is enlarged in nearly all cases of PHTN

What is the best sonographic window to view a recanalized paraumbilical vein? intercostal oblique view through the right lobe subcostal oblique view through the right lobe saggital subcostal view through the left lobe at the level of the Lig Teres saggital subcostal view through the right lobe at the level of the MLF saggital subcostal view to the left of midline

saggital subcostal view through the left lobe at the level of the Lig Teres

You are evaluating a patient with PHTN. Enlargement of which of the following structures is diagnostic of this condition? coronary vein HV renal vein CBD Lig Teres

coronary vein coronary or left gastric vein normally empties flow from the esophageal veins into the splenic vein. It can become dilated with portal hypertension. Flow direction may become reversed forming dangerous esophageal varices.

regenerating nodules are a feature associated with: hepatitis HCC hydatid disease cirrhosis polycystic liver disease

cirrhosis

You are performing an ultrasound exam on a patient with a history of alcoholic liver cirrhosis. You have documented the presence of splenomegaly and dilated veins at the splenic hilum. Considering the patient's history and findings, what else should you do? search for signs of acute cholecystitis carefully scan the spleen for the presence of infarcts search for the presence of portosystemic collaterals check the pelvis for a left side mass rule out the presence of an AAA

search for the presence of portosystemic collaterals

what is the best view for ultrasound demonstration of the coronary vein? TRV scan under the RLL oblique subcostal scan under the RLL with the probe oriented toward the patient's head SAG view of the splenic vein near the midline SAG view through the splenic hilum TRV view along the long axis of the LRV

SAG view of the splenic vein near the midline

You are performing a follow up study on a patient with a history of cavernous transformation. Where should you look to evaluate this condition? splenic hilum pancreatic head porta hepatis renal hilum LLL

porta hepatis

You are scanning a patient with an enlarged caudate lobe and shrunken right lobe. What diffuse liver process should you suspect? cirrhosis acute hepatitis fatty infiltration candidiasis HCC

cirrhosis

You are scanning an obese patient to rule out fatty liver. Which of the following describes a common sonographic appearance of this condition? increased through transmission throughout the hypoechoic liver increased echogenicity of the liver compared to normal focal hypoechoic masses throughout both lobes of the liver surrounded by normal liver echotexture shrunken liver with surface nodularity enlarged, hypoechoic right lobe compared to a small and shrunken left lobe

increased echogenicity of the liver compared to normal

A patient presents with acute RUQ pain and decreasing hematocrit. What is the possible diagnosis? simple cyst abscess hemorrhagic cyst parasitic cyst

hemorrhagic cyst