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Abdominal Scanning > Liver > Flashcards

Liver Flashcards

1
Q

The liver is the ___ parencymal organ in the body.

A

largest

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2
Q

The primitive gut is formed during the ___ week of embryonic life and is compsed of 3 parts which are…

A

4th; foregut, midgut, hindgut

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3
Q

The ___ bring oxygenated blood from the placenta to the embryonic heart.

A

umbilical veins.

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4
Q

The ___ return blood from the yolk sac to the heart.

A

vitelline veins

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5
Q

The caudal ends of the vitelline veins become the primitive ___ and their cranial ends become the early ___.

A

portal veins; hepatic veins

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6
Q

The left umbilical vein and ___ connect to the ___ and the right atrium.

A

ductus venosus; IVC

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7
Q

The left umbilical vein and ductus venosus become the ___ and the ___ postnatally.

A

ligamentum teres; ligamentum venosum

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8
Q

The ___ is the vessel that allows blood to bypass the fetus’ liver.

A

ductus venosus

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9
Q

The ligamentum venosum runs from the ___ to the ___, separating the ___ from the ___.

A

LPV, IVC; LLL, caudate lobe

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10
Q

The umbilical vein connects to the ___, which connects to the ___, which connects to the ___.

A

LPV, ductus venosus, IVC

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11
Q

The liver is covered by a thin connective tissue layer called…

A

Glisson’s capsule.

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12
Q

Glisson’s capsule surrounds the entire liver except for the ___ near the ___ of the liver.

A

bare area, dome

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13
Q

Glisson’s capsule is thickest around the ___ and the ___.

A

IVC, porta hepatis

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14
Q

These cells remove bacteria, foreign matter, and weakened blood cells from the liver sinusoids.

A

Kupffer cells

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15
Q

The functional units of the liver are called…

A

lobules.

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16
Q

There are about ___ lobules in the liver.

A

1 million

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17
Q

Lobules are approximately ___ in size.

A

1-2 mm

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18
Q

The liver is an ___ structure in the ___ quadrant of the abdomen and occupies a major portion of the ___.

A

intraperitoneal, right upper, right hypochondrium

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19
Q

Inferiorly, the liver extends into the ___.

A

epigastrium

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20
Q

Laterally, the liver extends into the ___.

A

left hypochondrium

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21
Q

Superiorly, the liver extends into the ___.

A

dome of the diaphragm

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22
Q

Posteriorly, the liver borders the ___.

A

bony lumbar region of the muscular posterior abd wall.

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23
Q

The smallest lobe is the ___.

A

caudate lobe.

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24
Q

The caudate lobe is marked on the anterior border by the ___ and its posterior border is the ___.

A

posterior surface of the LPV, IVC

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25
Q

The posterior surface of the ___ is indented by the right kidney.

A

RLL

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26
Q

The ___ lies posterior to the liver and has a short ___ course just before entering the right atrium.

A

IVC, intrahepatic

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27
Q

The ___ lies adjacent to the pancreatic body, splenic vein, and splenic artery, and lies close to the stomach.

A

LLL

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28
Q

The blood received from the ___ delivers nutrients just absorbed from the intestines.

A

portal veins

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29
Q

Blood from the arteries and portal veins mix in the ___.

A

tiny hepatic sinusoids

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30
Q

The adult liver weighs from ___ grams in males and from 1200-1400 grams in females.

A

1400-1800

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31
Q

Hepatomegaly is indicated with a sup-inf dimension of ___ or when the RLL extends inferior to the ___.

A

greater than 15 cm, lower pole of the right kidney

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32
Q

The normal liver is ___geneous and slightly ___echoic compared to the renal cortex.

A

homo, hyper

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33
Q

This is the tongue-like projection of the RLL that may extend into the iliac crest.

A

Reidel’s lobe

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34
Q

Reidel’s lobe is usually postioned ___ and is more common in ___.

A

anteriorly, women

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35
Q

This classification system divides the liver into eight functional segments.

A

Couinaud

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36
Q

Because each Couinaud segment has its own ___, ___, and ___, it can be resected without damaging the remaining liver.

A

portal vein, hepatic artery, bile duct

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37
Q

The RLL is divided into ___ and ___ parts.

A

anterior, posterior

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38
Q

The LLL is divided into ___ and ___ parts.

A

medical, lateral

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39
Q

Which portal vein supplies the caudate lobe?

A

Trick question! Both right and left do.

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40
Q

Which hepatic vein drains the caudate lobe?

A

Trick question! It is drained by smaller emissary veins, which directly enter the IVC.

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41
Q

The ___ hepatic vein separates and drains the anterior and posterior segments of the RLL.

A

right

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42
Q

The ___ hepatic vein separates and drains the medial and lateral segments of the LLL.

A

left

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43
Q

The ___ hepatic vein separates and drains the right and medial LLL.

A

middle

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44
Q

Which vessels are intersegmental?

A

Hepatic veins - they course BETWEEN the segments and lobes.

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45
Q

Which vessels are intrasegmental?

A

Vessels of the portal triad - they course WITHIN each segment.

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46
Q

The ___ divides the right and left lobes of the liver.

A

main lobar fissure

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47
Q

The landmarks of the main lobar fissure are…

A

gallbladder, IVC, and the middle hepatic vein.

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48
Q

The ___ divides the right lobe into anterior and posterior segments.

A

right intersegmental fissure

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49
Q

The landmarks of the right intersegmental fissure are…

A

the right hepatic vein.

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50
Q

The ___ divides the left lobe into medial and lateral segments.

A

left intersegmental fissure

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51
Q

The landmarks of the left interesegmental fissure are…

A

the left hepatic vein, ascending left portal vein, falciform ligament, and the ligamentum teres.

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52
Q

Name the seven ligaments of the liver.

A
  1. coronary
  2. falciform
  3. round
  4. right triangular
  5. left triangular
  6. gastrohepatic
  7. hepatoduodenal
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53
Q

This ligament is made of peritoneal reflections which suspend the liver from the diaphragm.

A

The coronary ligament

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54
Q

This ligament surrounds the bare area.

A

The coronary ligament

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55
Q

This ligament appears as a bright echogenic focus demarcating the lateral border of the medial portion of the left lobe of the liver.

A

The falciform ligament

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56
Q

This ligament is a double-fold of peritoneum created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of the portal vein.

A

The falciform ligament

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57
Q

This ligament is a sickle-shaped fold that connects the liver to the anterior abdominal wall and to the diaphragm.

A

The falciform ligament

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58
Q

This ligament separates segment 3 from segment 4 and is the structure above the ligamentum teres.

A

The falciform ligament

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59
Q

This ligament is a remnant of the umbilical vein which runs from the umbilicus to the left portal vein.

A

The ligamentum teres

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60
Q

This ligament is recannalized to form a portosystemic venous collateral in cases of portal HTN.

A

The ligamentum teres

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61
Q

This ligament is a peritoneal reflection to the far right and far left of the bare area.

A

The triangular ligaments

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62
Q

This ligament is a portion of the lesser omentum that extends across the ligamentum venosum at the porta hepatis.

A

The gastrohepatic ligament

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63
Q

This ligament is a portion of the lesser omentum that extends as the right border of the gastrohepatic ligament.

A

The hepatoduodenal ligament

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64
Q

This ligament contains the porta hepatis in its peritoneal folds.

A

The hepatoduodenal ligament

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65
Q

Some functions of the liver are…

A
  • formation of bile
  • blood production
  • destruction of red blood cells
  • metabolism of carbs, lipids & proteins
  • storage depot for glycogen, amino acids, fats, vitamins A, D, & B complex, iron & copper
  • blood reservoir
  • heat production
  • detoxification
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66
Q

T/F? SGOT or AST increases specifically with liver disease or biliary tract obstruction.

A

False. It does increase with liver disease, but also with heart, skeletal muscle, kidney, and brain disease.

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67
Q

T/F? SGPT or ALT increases specifically with liver disease or biliary tract obstruction.

A

True.

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68
Q

An increase in AST without an increase in ALT is indicative of…

A

myocardial infarction.

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69
Q

(Direct/indirect) bilirubin increases with liver disease & biliary tract obstruction.

A

Direct

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70
Q

(Direct/indirect) bilirubin increases with liver dx & disorders that cause increased RBC hemolysis.

A

Indirect

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71
Q

Elevated levels of ___ can cause obstructive or non-obstructive jaundice.

A

bilirubin

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72
Q

If ___ is elevated in an adult they will ALWAYS have hepatocellular carcinoma.

A

AFP

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73
Q

This lab value decreases with liver disease, especially albumin.

A

serum protein

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74
Q

This lab value shows marked increase in nonpregnant adults with bone or liver abnormalities.

A

ALP (alkaline phosphatase)

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75
Q

This lab value may increase with liver damage but is also a tumor marker for scrotal cancer.

A

LDH (lactic dehydrogenase)

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76
Q

This lab value is present in over 50% of patients with hepatomas or hepatoblastomas.

A

AFP (alpha-fetal protein)

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77
Q

This lab value increases with liver disease.

A

PT (prothrombin time)

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78
Q

Prothrombin time measures…

A

the time in seconds it takes for blood to coagulate.

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79
Q

___ is needed to produce prothrombin.

A

Vitamin K

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80
Q

These three blood tests are drawn to measure blood clotting factors prior to doing invasive procedures.

A

PT, PPT, and INR

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81
Q

PPT stands for…

A

partial prothrombin time

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82
Q

INR stands for…

A

international normalized ratio

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83
Q

This test standardizes the PT test so that values may be compared between different labs.

A

INR - international normalized ratio

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84
Q

___ of the liver is incompatible with life.

A

Agenesis

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85
Q

If there is agenesis of the right lobe what else is absent?

A

caudate lobe

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86
Q

In ___ the liver is found in the left hypochondrium.

A

situs inversus totalis

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87
Q

In ___ varying amounts of liver may herniate into the thorax or outside the abdominal cavity.

A

congenital diaphragmatic hernias or omphalocele

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88
Q

A liver cyst is a ___ space having an ___ lining.

A

fluid-filled, epithelial

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89
Q

Benign hepatic cysts are ___echoic with well-demarcated thin ___ and posterior ___.

A

an, walls, acoustic enchancement.

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90
Q

___ and ___ may develop secondary to cyst hemorrage or infection.

A

Pain, fever

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91
Q

A hemorrhaged or infected cyst may contain internal ___, a thickened ___, or may appear ___.

A

echoes, wall, solid

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92
Q

When is active intervention recommended for hemorrhaged or infected cysts?

A

Only for symptomatic patients - ones with acute RUQ pain and decreased hematocrit.

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93
Q

Although cyst ___ will yield fluid for evaluation, the epithelial lined cyst will ___.

A

aspiration, recur

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94
Q

Cyst ablation with ___ can be performed using u/s guidance.

A

alcohol

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95
Q

The adult form of ___ disease is inherited in an autosomal dominant pattern.

A

polycystic kidney disease

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96
Q

If you see cysts in the kidney, you should always…

A

check the liver for cysts as well.

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97
Q

This is the general term for liver inflammation due to viruses or toxins.

A

hepatitis

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98
Q

Hepatitis is considered acute if…

A

it lasts for less than six months.

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99
Q

Hepatitis is considered chronic if…

A

persists for longer than six months.

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100
Q

Sonographically, a liver with hepatitis appears…

A

with coarse parenchyma and increased brightness of portal radicles (portal triad tracts).

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101
Q

Clinically, the course of acute hepatitis varies widely from mild symptoms requiring ___ to fulminant hepatic failure requiring ___.

A

no treament, liver transplantation

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102
Q

Acute hepatitis patients may present after a convalescent stage of ___ with the total illness lasting ___.

A

7-10 days, 2-6 weeks

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103
Q

Initial features of acute hepatitis are of non-specific ___ symptoms, like…

A

flu-like, malaise, muscle and joint aches, fever, N&V, diarrhea and headache.

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104
Q

More specific of acute hepatitis are symptoms of…

A

profound loss of appetite, aversion to smoking among smokers, dark urine, jaundice, and abdominal discomfort.

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105
Q

Physical findings are usually minimal in hepatitis apart from…

A

jaundice and hepatomegaly.

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106
Q

Sonographically, ACUTE hepatitis demonstrates a ___echoic liver panenchyma, hepato___, and ___echoic portal vein walls.

A

hypo, megaly (enlarged), hyper

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107
Q

Acute hepatitis causes ___ of the hepatocytes, ___ of Kupffer cells, and infiltration of the portal areas by ___ and ___.

A

swelling, proliferation, lymphocytes, monocytes

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108
Q

Symptoms of CHRONIC hepatitis include…

A

none at all (asymptomatic), mild (abnormal lab tests), or jaundice (extensive liver damage).

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109
Q

Physical features of CHRONIC hepatitis include ___ from an enlarged liver or spleen, ___ fever, and fluid retention (aka ___).

A

fullness, low-grade, ascites.

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110
Q

In CHRONIC hepatitis, extensive damage and scarring of the liver (aka ___) leads to weight ___, easy ___, and ___ tendencies.

A

cirrhosis, loss, bruising, bleeding.

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111
Q

Women with autoimmune CHRONIC hepatitis may have ___, ___ menstruation, lung ___, and inflammation of the ___ and ___.

A

acne, abnormal, scarring, thyroid, kidneys

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112
Q

This kind of hepatitis is common and occurs worldwide.

A

Viral

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113
Q

Recent medical advances have identified at least 6 distinct hepatitis viruses which are…

A

A, B, C, D, E, and G

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114
Q

Hep A (or ___ jaundice) is caused by ___.

A

infectious, hepatitis A virus

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115
Q

Hep A is transmitted by the ___ and associated with ___ and ___.

A

fecal-oral route, eating contaminated foods, anal-oral sex.

116
Q

T/F? Hep A causes a chronic form of hepatitis.

A

False. Hep A causes acute hepatitis.

117
Q

Patients with hep A are advised to…

A

rest, stay hydrated, and avoid alcohol.

118
Q

Hep A can be spread through the consumption of ___ and drinking ___.

A

raw seafood, contaminated water

119
Q

T/F? Hep A is the least serious form of hepatitis.

A

True.

120
Q

T/F? Have a hep A infection concurrently with a hep C infection is no big deal.

A

False. Even in the absense of cirrhosis, having both can cause a life-threatening superinfection and possible fulminant hepatitis.

121
Q

T/F? Hep B causes chronic hepatitis.

A

False (or only half true). Hep B causes both acute and chronic hepatitis.

122
Q

Hep B can be deadly due to complications from ___ hepatitis, ___, and ___ carcinoma.

A

chronic, cirrhosis, hepatocellular

123
Q

Hep B is transmitted through fluid transfer including blood ___, amateur and professional ___, ___ intercourse, and ___feeding.

A

transfusion, tattoos, sexual, breast

124
Q

Blood contact can occur by sharing ___ in IV drug users, ___ accessories, or touching ___.

A

syringes, shaving, open wounds

125
Q

Symptoms of hep B may not appear for as long as ___ after the inital infection. Some patients experience ___ symptoms or only ___ symptoms.

A

4-24 weeks, no, mild

126
Q

About ___% of hep B patients have a fever or rash, but ___ is not common.

A

10-20%, nausea

127
Q

T/F? Hep A patients present with arthritis-like joint pain.

A

False. Hep B patients can have red, swollen, painful joints.

128
Q

Non-A, Non-B Hepatitis is also known as…

A

Hep C.

129
Q

Common ways people are exposed to hep C are through…

A

inadequately or improperly sterilized medical or dental equipment, shared needles, and IV drug use.

130
Q

People in these professions are at risk of hep C exposure through accidental needlesticks and blood spatter in eyes and open mouth.

A

Medical/dental personnel, first responders (ie firefighters, paramedics, police, military combatants)

131
Q

T/F? The hep C virus is transmitted through blood only.

A

True.

132
Q

Most patients with hep C experience ___ symptoms or very ___ symptoms.

A

no, mild

133
Q

The most common symptom of hep C is ___. The first symptom may be ___.

A

fatigue, itchy skin

134
Q

Symptoms of hep C, if they appear at all, develop about ___ after a person is infected. It may be present for as long as ___ before cirrhosis or liver failure become the first indications.

A

12 months, 10-30 years

135
Q

If hep C becomes life-threatening a ___ may be performed, though it is not a ___.

A

liver transplant, cure

136
Q

Hep D is also known as…

A

Hepatitis delta virus.

137
Q

Hep D is ___viral or a ___ virus that requires hep ___ to provide envelope proteins.

A

sub, satellite, B

138
Q

T/F? Transmission of hep D is similiar to hep C.

A

False. It is similiar to hep B.

139
Q

Some at-risk groups for hep D exposure are…

A

IV drug users, health-care workers, blood transfusion receipients, or blood product (like anti-hemophilic factor) receipients.

140
Q

Treatments for hep D include…

A

Trick question! There are no specific treatments for hep D.

141
Q

Sonographically, CHRONIC hepatitis demonstrates a ___echoic liver parenchyma, ___ liver, decreased ___ of portal vein walls.

A

hyper, small, echogenicity (the opposite of an acute hepatitis).

142
Q

People with an abscess present with symptoms of…

A

fever and an increased white blood cell count.

143
Q

This is a pus-filled area in the liver.

A

pyogenic abscess

144
Q

Potential causes of liver abscess include abdominal infections like ___itis, ___itis, or perforated bowel, blood __, biliar tract ___, recent ___ of the biliary system, liver ___.

A

appendicitis, diverticulitis, infection, infection, endoscopy, trauma

145
Q

The most common features of pyogenic liver abscesses are ___ colored stool, ___ urine, fever & ___, loss of ___, N&V, RUQ ___, weight ___, weakness and jaundice.

A

chalk, dark, leukocytosis (increased WBC), pain, loss

146
Q

T/F? Pyogenic abscesses commonly occur in the RLL.

A

True.

147
Q

The pyogenic infection reaches the liver through the…

A

portal veins, bile ducts, hepatic arteries, and lymphtic channels.

148
Q

A ___ pyogenic abscess can appear cystic with the fluid ranging from echofree to highly ___.

A

purulent, echogenic

149
Q

Early suppuration of a pyogenic abscess can appear ___with altered echogenicity, usually ___echoic.

A

solid, hypo

150
Q

The walls of a pygogenic abscess can appear ___ or irregular and ___.

A

well-defined, thick

151
Q

Gas producing organisms give rise to ___ foci with a posterior ___ artifact.

A

echogenic, reverberation

152
Q

T/F? There may be air within a liver abscess.

A

True.

153
Q

Treatment for pyogenic abscess usually consists of ___ or draining the site with a ___ or ___ tube.

A

surgery, needle, percutaneous

154
Q

Even with treatment, life-threatening ___ will develop in 10-30% of pyogenic abscess patients.

A

sepsis

155
Q

This is a liver infection that occurs when a parasite reaches the liver via the intestines and then the portal veins.

A

Amebic abscess

156
Q

The most common bacterial agent related to amebic abscess is ___ and it’s usually transmitted via the ___.

A

E-coli, fecal-oral route

157
Q

T/F? RUQ pain and vomitting are the most common symptoms for amebic abscess.

A

False. RUQ pain and diarrhea are.

158
Q

Sonographically, an amebic abscess may look like an ___ shaped lesion, absence of a prominent abscess ___, be ___echoic compared to a normal liver.

A

round/oval, wall, hypo

159
Q

Sonographically, an amebic abscess may look have ___ internal echoes, ___ enhancement, ___ with the diaphragm/liver capsule, and typically occurs in the ___ of the liver.

A

low-level, distal, contiguity, dome

160
Q

T/F? A pyogenic abscess may rupture into the abd cavity, lung lining, lungs, the sac around the heart, or the brain.

A

False. That’s an amebic abscess.

161
Q

What piece of patient history can help you distinguish a pyogenic abscess from an amebic abscess?

A

Whether or not the patient has been traveling internationally. If so, it’s more likely to be an amebic abscess.

162
Q

This is a mycotic (fungal) infection of the blood that results in small abscesses of the liver.

A

candidiasis

163
Q

The ___ of candidiasis legions can change over the course of the disease.

A

appearance

164
Q

Early in the disease process, a candidiasis legion appears as…

A

a “wheel within a wheel”; a peripheral hypoechoic zone, an inner echogenic wheel, and a hypoechoic center.

165
Q

Later in the disease process, a candidiasis legion appears as…

A

a bullseye. The hypoechoic center calcifies.

166
Q

What is the most common cause of hydatid disease in humans?

A

echinococcal cyst

167
Q

An echinococcal cyst is the result of a ___ infestation associated with ___ raising countries.

A

parasite (tapeworm), sheep and cattle

168
Q

Eggs of the echinococcus granulosus are ___ and pass into the ___ where the larva hatch and move into the liver.

A

swallowed, portal venous system

169
Q

An echinococcus tapeworm is ___ in length.

A

3-6 mm

170
Q

How does echinococcal reach the cattle?

A

It’s excreted in dog’s feces and swallowed by intermediate hosts (sheep, cattle, goats, humans).

171
Q

T/F? Echinococcal cysts can look just like a simple cyst.

A

True.

172
Q

T/F? Echinococcal cysts can look just like a calcified mass.

A

Also true.

173
Q

Echinococcal cysts can look like a cyst with…

a. detached endocysts secondary to rupture
b. multiple daughter cysts
c. a detached membrane (water lily sign)

A

d. all of the above

174
Q

___ is the conventional treatment for echinococcal cysts, but success has been obtained with percutaneous ___ as well.

A

Surgery, drainage

175
Q

The fluid within the echinococcal cyst is very ___ so if it ruptures ___ can occur.

A

toxic, anaphylatic shock

176
Q

This is one of the most common parasitic worm infections in humans.

A

Say it with me… schistosomiasis

177
Q

Schistosomiasis is found in parts of the world where…

A

water is contaminated.

178
Q

How does schistomomiasis grow in the water?

A

They are incubated in certain freshwater snails after infected people urinate or defecate in it. They can only survive 48 hrs in the water after leaving their snail.

179
Q

Schistosomiasis parasites reach maturity in ___ and begin to produce eggs. Their worms can live in the body an average of ___, but may persist up to ___.

A

6-8 wks, 4.5 yrs, 20 yrs

180
Q

Up to half of the schistosomiasis worms become trapped in the ___ veins or will be washed back into the ___ and become lodged.

A

mesenteric, liver

181
Q

How does the liver respond to schistosomiasis worms?

A

It incites a granulomatous reaction resulting in peri-portal fibrosis.

182
Q

Peri-portal fibrosis causes the intrahepatic portal veins to ___ resulting in portal HTN, splenomegaly, varices and ascites.

A

occlude

183
Q

Pneumocystis carinii is the most common ___ organism causing opportunistic infection in patients with ___.

A

fungal, AIDS

184
Q

Pneumocystis carinii is the most ___ cause of life-threatening ___ in patients with AIDS.

A

common, infection

185
Q

Pneumocystis carinii also affects patients undergoing bone marrow and ___ as well as those receiving corticosteriods or ___.

A

organ transplants, chemotherapy

186
Q

___ may cause the bile ducts and GB wall to be thickened.

A

Pneumocystis carinii

187
Q

Pneumocystis carinii may involve the liver with ___, nonshadowing ___echoic foci.

A

diffuse, hyper

188
Q

Sonographically, pneumocystis carinii looks like ___ liver infiltration, hepato___, hepatitis, nonhodgkins lymphoms, ___iasis, cholangitis, acalcuous cholecystits, and ___ sarcoma.

A

fatty, megaly, candidiasis, Karposi’s

189
Q

Which disease thickens the bile ducts and may compromise the lumen causing biliary obstruction?

A

cholangitis - aka inflammation of the bile ducts

190
Q

What causes an intrahepatic mass (purple nodules)?

A

Karposi’s sarcoma in a patient with AIDS

191
Q

A ___ is an acquired, reversible metabolic disorder resulting in an accumulation of triglycerides within the hepatocytes.

A

fatty liver

192
Q

The most common causes of a fatty liver are…

A

obesity and alcohol abuse

193
Q

What are the two patterns of fatty liver?

A

focal fatty infiltration (diffuse) and focal fatty sparing (focal)

194
Q

The presence of a fatty liver can be determined by…

A

comparing the echogenicity of the liver to the kidney. (The liver will be more hyperechoic in fatty infiltration.)

195
Q

What is a focal region of increased echogenicity within an otherwise NORMAL LIVER?

A

focal fatty infiltration

196
Q

What are focal regions of normal liver parenchyma within a FATTY LIVER?

A

focal fatty sparing

197
Q

Sparing commonly occurs adjacent to the ___, in the ___, in the ___ lobe, and at the liver ___.

A

gallbladder, porta hepatis, caudate, margins

198
Q

This is a genetically acquired disorder that results in the excess deposit of glycogen in the liver and tubules of the kidney?

A

glycogen storage disease

199
Q

Glycogen storage disease is associated with…

A

diffuse fatty infiltration and hepatic adenomas.

200
Q

These are well-demarcated solid masses of variable echogenicity associated with glycogen storage disease.

A

hepatic adenomas

201
Q

___ is a diffuse process of fibrosis and distortion of normal liver architecture.

A

Cirrhosis

202
Q

In cirrhosis, parenchymal changes compress the bilary and vascular channels resulting in …

A

jaundice and portal HTN.

203
Q

T/F? A cirrhotic liver initially atrophies.

A

False. It initially enlarges. The atrophy occurs with continued insult.

204
Q

Patients with cirrhosis are at increased risk for…

A

hepatocellular carcinoma.

205
Q

The two most common causes of cirrhosis are ___ and ___.

A

ETOH abuse, hep C

206
Q

Name the three major pathologic mechanisms which create cirrhosis.

A

cell death, fibrosis, regeneration

207
Q

The length of micronodular cirrhosis and its most common cause.

A

.1-1 cm in diameter, alcohol consumption

208
Q

The length of macronodular cirrhosis and its most frequent cause.

A

up to 5 cm in diameter, chronic viral hepatitis

209
Q

The clinical presentation of cirrhosis includes…

A

hepatomegaly, jaundice, ascites

210
Q

In cirrhosis, liver cannot get rid of the toxins and ___ and it can cause ___, which literally makes you crazy.

A

ammonia, encephalopathy

211
Q

What happens in early stage cirrhosis?

A

hepatomegaly

212
Q

What happens in advanced stage cirrhosis?

A

smaller liver with a large (relatively) caudate lobe

213
Q

What do you call the large-then-small sonographic pattern for cirrhosis?

A

volume redistribution

214
Q

___ echotexture is a frequent observation in diffuse liver disease and may be confounded by inappropriate ___ settings and overall gain.

A

Coarse, TCG

215
Q

___ or irregularity of the liver surface has been appreciated as a sign of cirrhosis when the appearance is ___ or when ___ is present.

A

Nodular, gross, ascites

216
Q

Nodularity corresponds to the presence of…

A

regenerating nodules and fibrosis.

217
Q

This is an increased pressure in the portal venous system.

A

Portal HTN

218
Q

What is considered a normal pressure in the portal venous system?

A

5-10 mm of Hg (slightly higher than normal IVC pressure)

219
Q

The diameter of a normal portal vein is…

A

less than 13 mm.

220
Q

The diameter of a portal vein with HTN is…

A

greater than 13 mm.

221
Q

What is a clear sign of portal HTN?

A

hepatofugal flow in the MPV

222
Q

___ and ___ are the two major causes of portal HTN.

A

Cirrhosis, schistosomiasis

223
Q

Patients with portal HTN are ususally ___ but might present with sudden painless ___ due to rupture of ___.

A

upper GI hemorrhage, esophageal varices

224
Q

Name the 4 types of portal HTN.

A
  1. extrahepatic pre-sinusoidal (portal vein thrombosis)
  2. intrahepatic pre-sinusoidal (schistosomiasis)
  3. intrahepatic (cirrhosis)
  4. intrahepatic post-sinusoidal (hepatic vein thrombosis)
225
Q

The most common type of portal HTN is…

A

intrahepatic/cirrhosis, accounting for 90% of cases in the West.

226
Q

The secondary signs of portal HTN include…

A

splenomegaly, ascites, portosplenic collaterals.

227
Q

This is the p-s collateral between the coronary and short gastric veins and the esophageal veins.

A

GE junction

228
Q

This is the p-s collateral that runs in the falciform ligament and connects the left portal vein to the epigastric veins near the umbilicus recannalizing the ligamentum teres.

A

paraumbilical veins

229
Q

This is the p-s collateral of tortuous veins that may be seen in the region of the splenic and left renal hilam.

A

splenorenal and gastrorenal

230
Q

This is the p-s collateral in which the veins of the ascending and descending colon, duodenum, pancreas and liver may anastomose with the renal, phrenic and lumbar veins.

A

intestinal

231
Q

This is the p-s collateral in the perianal region where the superior rectal veins anastomose with the midle and inferior rectal veins.

A

hemmorhoidal

232
Q

Portosymtemic ___ are created to decompress the portal system to avoid the development or rupture of ___.

A

shunts, gastroesophageal varices

233
Q

What are the traditional shunts?

A
  1. mesocaval (SMA to IVC)
  2. splenorenal/Warren (splenic v to renal v)
  3. portacaval (portal v to IVC)
234
Q

What’s TIPS stand for?

A

Transjugular Intrahepatic Portal systemic Shunting

235
Q

TIPS is placed using a ___ access.

A

jugular

236
Q

The TIPS is placed between a ___ vein and a ___ vein.

A

hepatic, portal (usually the RHV and the RPV)

237
Q

The shunt is malfunctioning if the velocity gets below ___, the focal velocity ___, there’s ___ flow in the RPV or LPV, or there’s ___ flow in the MPV.

A

50 cm/s, increases, hepatopedal, hepatofugal

238
Q

Echogenic thrombus within the lumen of the portal vein? It might be…

A

portal vein thrombosis.

239
Q

Portal vein thrombosis is caused by…

A
  1. HCC
  2. pancreatic carcinoma
  3. metastatic liver disease
  4. pancreatitis
  5. cirrhosis
  6. hypercoagulation
240
Q

Wormlike vessels at the porta hepatis? Sounds like..

A

cavernomatous transformation

241
Q

Peri-portal collateral circulation, which occurs in longstanding ___ patients, requires up to ___ to occur.

A

portal vein thrombosis, 12 months

242
Q

___ is a rare disorder characterized by occlusion of the hepatic vein with or without occlusion of the IVC by either thrombus or tumor.

A

Budd-chiari syndrome

243
Q

Budd-chiari syndrome is typically seen in…

A

young women taking birth control pills.

244
Q

Other causes of Budd-chiari syndrome include ___ abnormalities, tumor extension from ___, renal ___, pregnancy, adrenal cortical ___, congential ___, and trauma.

A

coagulation, HCC, carcinoma,carcinoma, abnormalities

245
Q

In B-C syndrome, ___ is an invariable observation.

A

ascites

246
Q

In B-C syndrome, the liver is typically large and ___ acutely. Hemorrhagic ___ may produce significantly altered regional ___.

A

bulbous, infarction, echogenicity

247
Q

In B-C syndrome, the ___ lobe is often spared because of the ___ veins draining directly into the IVC. (Though, the increased blood flow may cause it to be enlarged.)

A

caudate, emissary

248
Q

In B-C syndrome a ___ may be identified as echogenic or focal obliterations of the lumen.

A

membranous web

249
Q

When is orthotopic liver transplantation performed?

A

To eliminate irreversible disease

250
Q

Some indications for liver transplant in adults are ___ due to hep C, inborn errors of ___, sclerosing ___, ___ syndrome, and unresectable ___.

A

cirrhosis, metabolism, cholangitis, Budd-chiari, hepatoma

251
Q

In children, the biggest reason for a liver transplant is…

A

biliary atresia.

252
Q

A pre-op u/s liver eval includes liver ___ and extent of ___, the presence of venous ___, and any complicating factors like ___ or extrahepatic malignancies.

A

size, pathology, collaterals, AAA

253
Q

A pre-op u/s liver eval also includes the patency and size of which vessels?

A

the portal vein, the hepatic artery, and the IVC

254
Q

The post liver transplant u/s eval includes as assessment of the liver ___, the ___ tree, and any perihepatic ___ collections.

A

parenchyma, biliary, fluid

255
Q

The post liver transplant u/s eval also includes the patency and size of which vessels?

A

the portal vein, the hepatic artery, and the IVC

256
Q

What is the most common benign tumor of liver?

A

cavernous hemangioma

257
Q

Hemangiomas consist of multiple vascular ___ which create multiple sonographic ___.

A

channels, interfaces

258
Q

Sonographically, cavernous hemangioma is ___echoic ___geneous and has posterior ___

A

hyper, homo, posterior acoustic

259
Q

In a fatty liver, a hemangioma may appear…

A

hypoechoic.

260
Q

T/F? Color or duplex doppler does not routinely demonstrate flow within the hemangioma.

A

True

261
Q

___ or the adminstration of ___ may enlarge a hemangioma.

A

Pregnancy, estrogens

262
Q

Focal nodular hyperplasia is a ___ condition believed to be a developmental hyperplastic lesion related to an area of ___ vascular malformation.

A

benign, congential

263
Q

Sonographically, focal nodular hyperplasia appears as a well-defined ___ mass with a central fibrous ___ and ___ vascularity.

A

solid, scar, stellate

264
Q

What is a solid liver mass associated with the use of oral contraceptive agents (and glycogen storage disease)?

A

hepatic adenoma

265
Q

A patient with hepatic adenoma may present with symptoms of…

A

pain due to tumor hemorrhage.

266
Q

Due to the risk of malignant transformation, the treatment for hepatic adenoma is often…

A

surgical resection.

267
Q

Hepatic adenomas appear with ___ echogenicity, a cystic component with ___, and intraperitoneal ___.

A

nonspecific, hemorrhage, blood

268
Q

What’s an extermemly rare fatty tumor of the liver?

A

hepatic lipoma

269
Q

What is associated with hepatic lipomas and angiomyolipomas?

A

tuberous sclerosis, congetial familial disease

270
Q

Sonographically, hepatic lipomas present as a ___echoic mass with ___ artifact.

A

hyper, propagation speed

271
Q

Objects posterior to a fatty mass will be placed farther away from the transducer. This may be seen as a “___” diaphragm.

A

broken

272
Q

The most common malignancy of the liver is…

A

hepatocellular carcinome (HCC aka hepatoma).

273
Q

People of increased risk for HCC have…

A

alcoholic cirrhosis and hep B & C.

274
Q

HCC commonly invades ___ and ___ and ___.

A

portal veins, hepatic veins, the IVC.

275
Q

Which lab value will be increased in a patient with HCC?

A

serum alpha fetoprotein levels

276
Q

What are the most commonly encountered solid masses in the liver?

A

metastatic tumors

277
Q

Metastatic involvement of the liver has usually spread from…

A

lung cancer, breast cancer or GI cancer

278
Q

Hyperechoic mets suggest…

A

gastrointestinal tract involvement.

279
Q

Hypoechoic mets suggest…

A

lymphoma involvement.

280
Q

A “bullseye” or target mets suggests…

A

lung involvement.

281
Q

A calcified mets suggests…

A

mucinous adenocarcinoma.

282
Q

A cystic mets suggests…

A

sarcoma.

283
Q

What is the most common malignant liver tumor in early chlidhood (the third most common childhood intra-abdominal malignancy)?

A

hepatoblastoma

284
Q

Patients with hepatoblastoma present with an enlarging asymptomatic abdominal ___ measuring ___.

A

mass, 10-12 cm

285
Q

Hepatomablastoma is associated with ___ mets and ___ invasion.

A

lung, portal vein

Abdominal Scanning (11 decks)

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