Liver Flashcards
The liver is the ___ parencymal organ in the body.
largest
The primitive gut is formed during the ___ week of embryonic life and is compsed of 3 parts which are…
4th; foregut, midgut, hindgut
The ___ bring oxygenated blood from the placenta to the embryonic heart.
umbilical veins.
The ___ return blood from the yolk sac to the heart.
vitelline veins
The caudal ends of the vitelline veins become the primitive ___ and their cranial ends become the early ___.
portal veins; hepatic veins
The left umbilical vein and ___ connect to the ___ and the right atrium.
ductus venosus; IVC
The left umbilical vein and ductus venosus become the ___ and the ___ postnatally.
ligamentum teres; ligamentum venosum
The ___ is the vessel that allows blood to bypass the fetus’ liver.
ductus venosus
The ligamentum venosum runs from the ___ to the ___, separating the ___ from the ___.
LPV, IVC; LLL, caudate lobe
The umbilical vein connects to the ___, which connects to the ___, which connects to the ___.
LPV, ductus venosus, IVC
The liver is covered by a thin connective tissue layer called…
Glisson’s capsule.
Glisson’s capsule surrounds the entire liver except for the ___ near the ___ of the liver.
bare area, dome
Glisson’s capsule is thickest around the ___ and the ___.
IVC, porta hepatis
These cells remove bacteria, foreign matter, and weakened blood cells from the liver sinusoids.
Kupffer cells
The functional units of the liver are called…
lobules.
There are about ___ lobules in the liver.
1 million
Lobules are approximately ___ in size.
1-2 mm
The liver is an ___ structure in the ___ quadrant of the abdomen and occupies a major portion of the ___.
intraperitoneal, right upper, right hypochondrium
Inferiorly, the liver extends into the ___.
epigastrium
Laterally, the liver extends into the ___.
left hypochondrium
Superiorly, the liver extends into the ___.
dome of the diaphragm
Posteriorly, the liver borders the ___.
bony lumbar region of the muscular posterior abd wall.
The smallest lobe is the ___.
caudate lobe.
The caudate lobe is marked on the anterior border by the ___ and its posterior border is the ___.
posterior surface of the LPV, IVC
The posterior surface of the ___ is indented by the right kidney.
RLL
The ___ lies posterior to the liver and has a short ___ course just before entering the right atrium.
IVC, intrahepatic
The ___ lies adjacent to the pancreatic body, splenic vein, and splenic artery, and lies close to the stomach.
LLL
The blood received from the ___ delivers nutrients just absorbed from the intestines.
portal veins
Blood from the arteries and portal veins mix in the ___.
tiny hepatic sinusoids
The adult liver weighs from ___ grams in males and from 1200-1400 grams in females.
1400-1800
Hepatomegaly is indicated with a sup-inf dimension of ___ or when the RLL extends inferior to the ___.
greater than 15 cm, lower pole of the right kidney
The normal liver is ___geneous and slightly ___echoic compared to the renal cortex.
homo, hyper
This is the tongue-like projection of the RLL that may extend into the iliac crest.
Reidel’s lobe
Reidel’s lobe is usually postioned ___ and is more common in ___.
anteriorly, women
This classification system divides the liver into eight functional segments.
Couinaud
Because each Couinaud segment has its own ___, ___, and ___, it can be resected without damaging the remaining liver.
portal vein, hepatic artery, bile duct
The RLL is divided into ___ and ___ parts.
anterior, posterior
The LLL is divided into ___ and ___ parts.
medical, lateral
Which portal vein supplies the caudate lobe?
Trick question! Both right and left do.
Which hepatic vein drains the caudate lobe?
Trick question! It is drained by smaller emissary veins, which directly enter the IVC.
The ___ hepatic vein separates and drains the anterior and posterior segments of the RLL.
right
The ___ hepatic vein separates and drains the medial and lateral segments of the LLL.
left
The ___ hepatic vein separates and drains the right and medial LLL.
middle
Which vessels are intersegmental?
Hepatic veins - they course BETWEEN the segments and lobes.
Which vessels are intrasegmental?
Vessels of the portal triad - they course WITHIN each segment.
The ___ divides the right and left lobes of the liver.
main lobar fissure
The landmarks of the main lobar fissure are…
gallbladder, IVC, and the middle hepatic vein.
The ___ divides the right lobe into anterior and posterior segments.
right intersegmental fissure
The landmarks of the right intersegmental fissure are…
the right hepatic vein.
The ___ divides the left lobe into medial and lateral segments.
left intersegmental fissure
The landmarks of the left interesegmental fissure are…
the left hepatic vein, ascending left portal vein, falciform ligament, and the ligamentum teres.
Name the seven ligaments of the liver.
- coronary
- falciform
- round
- right triangular
- left triangular
- gastrohepatic
- hepatoduodenal
This ligament is made of peritoneal reflections which suspend the liver from the diaphragm.
The coronary ligament
This ligament surrounds the bare area.
The coronary ligament
This ligament appears as a bright echogenic focus demarcating the lateral border of the medial portion of the left lobe of the liver.
The falciform ligament
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.
The falciform ligament
This ligament is a sickle-shaped fold that connects the liver to the anterior abdominal wall and to the diaphragm.
The falciform ligament
This ligament separates segment 3 from segment 4 and is the structure above the ligamentum teres.
The falciform ligament
This ligament is a remnant of the umbilical vein which runs from the umbilicus to the left portal vein.
The ligamentum teres
This ligament is recannalized to form a portosystemic venous collateral in cases of portal HTN.
The ligamentum teres
This ligament is a peritoneal reflection to the far right and far left of the bare area.
The triangular ligaments
This ligament is a portion of the lesser omentum that extends across the ligamentum venosum at the porta hepatis.
The gastrohepatic ligament
This ligament is a portion of the lesser omentum that extends as the right border of the gastrohepatic ligament.
The hepatoduodenal ligament
This ligament contains the porta hepatis in its peritoneal folds.
The hepatoduodenal ligament
Some functions of the liver are…
- 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
T/F? SGOT or AST increases specifically with liver disease or biliary tract obstruction.
False. It does increase with liver disease, but also with heart, skeletal muscle, kidney, and brain disease.
T/F? SGPT or ALT increases specifically with liver disease or biliary tract obstruction.
True.
An increase in AST without an increase in ALT is indicative of…
myocardial infarction.
(Direct/indirect) bilirubin increases with liver disease & biliary tract obstruction.
Direct
(Direct/indirect) bilirubin increases with liver dx & disorders that cause increased RBC hemolysis.
Indirect
Elevated levels of ___ can cause obstructive or non-obstructive jaundice.
bilirubin
If ___ is elevated in an adult they will ALWAYS have hepatocellular carcinoma.
AFP
This lab value decreases with liver disease, especially albumin.
serum protein
This lab value shows marked increase in nonpregnant adults with bone or liver abnormalities.
ALP (alkaline phosphatase)
This lab value may increase with liver damage but is also a tumor marker for scrotal cancer.
LDH (lactic dehydrogenase)
This lab value is present in over 50% of patients with hepatomas or hepatoblastomas.
AFP (alpha-fetal protein)
This lab value increases with liver disease.
PT (prothrombin time)
Prothrombin time measures…
the time in seconds it takes for blood to coagulate.
___ is needed to produce prothrombin.
Vitamin K
These three blood tests are drawn to measure blood clotting factors prior to doing invasive procedures.
PT, PPT, and INR
PPT stands for…
partial prothrombin time
INR stands for…
international normalized ratio
This test standardizes the PT test so that values may be compared between different labs.
INR - international normalized ratio
___ of the liver is incompatible with life.
Agenesis
If there is agenesis of the right lobe what else is absent?
caudate lobe
In ___ the liver is found in the left hypochondrium.
situs inversus totalis
In ___ varying amounts of liver may herniate into the thorax or outside the abdominal cavity.
congenital diaphragmatic hernias or omphalocele
A liver cyst is a ___ space having an ___ lining.
fluid-filled, epithelial
Benign hepatic cysts are ___echoic with well-demarcated thin ___ and posterior ___.
an, walls, acoustic enchancement.
___ and ___ may develop secondary to cyst hemorrage or infection.
Pain, fever
A hemorrhaged or infected cyst may contain internal ___, a thickened ___, or may appear ___.
echoes, wall, solid
When is active intervention recommended for hemorrhaged or infected cysts?
Only for symptomatic patients - ones with acute RUQ pain and decreased hematocrit.
Although cyst ___ will yield fluid for evaluation, the epithelial lined cyst will ___.
aspiration, recur
Cyst ablation with ___ can be performed using u/s guidance.
alcohol
The adult form of ___ disease is inherited in an autosomal dominant pattern.
polycystic kidney disease
If you see cysts in the kidney, you should always…
check the liver for cysts as well.
This is the general term for liver inflammation due to viruses or toxins.
hepatitis
Hepatitis is considered acute if…
it lasts for less than six months.
Hepatitis is considered chronic if…
persists for longer than six months.
Sonographically, a liver with hepatitis appears…
with coarse parenchyma and increased brightness of portal radicles (portal triad tracts).
Clinically, the course of acute hepatitis varies widely from mild symptoms requiring ___ to fulminant hepatic failure requiring ___.
no treament, liver transplantation
Acute hepatitis patients may present after a convalescent stage of ___ with the total illness lasting ___.
7-10 days, 2-6 weeks
Initial features of acute hepatitis are of non-specific ___ symptoms, like…
flu-like, malaise, muscle and joint aches, fever, N&V, diarrhea and headache.
More specific of acute hepatitis are symptoms of…
profound loss of appetite, aversion to smoking among smokers, dark urine, jaundice, and abdominal discomfort.
Physical findings are usually minimal in hepatitis apart from…
jaundice and hepatomegaly.
Sonographically, ACUTE hepatitis demonstrates a ___echoic liver panenchyma, hepato___, and ___echoic portal vein walls.
hypo, megaly (enlarged), hyper
Acute hepatitis causes ___ of the hepatocytes, ___ of Kupffer cells, and infiltration of the portal areas by ___ and ___.
swelling, proliferation, lymphocytes, monocytes
Symptoms of CHRONIC hepatitis include…
none at all (asymptomatic), mild (abnormal lab tests), or jaundice (extensive liver damage).
Physical features of CHRONIC hepatitis include ___ from an enlarged liver or spleen, ___ fever, and fluid retention (aka ___).
fullness, low-grade, ascites.
In CHRONIC hepatitis, extensive damage and scarring of the liver (aka ___) leads to weight ___, easy ___, and ___ tendencies.
cirrhosis, loss, bruising, bleeding.
Women with autoimmune CHRONIC hepatitis may have ___, ___ menstruation, lung ___, and inflammation of the ___ and ___.
acne, abnormal, scarring, thyroid, kidneys
This kind of hepatitis is common and occurs worldwide.
Viral
Recent medical advances have identified at least 6 distinct hepatitis viruses which are…
A, B, C, D, E, and G
Hep A (or ___ jaundice) is caused by ___.
infectious, hepatitis A virus
Hep A is transmitted by the ___ and associated with ___ and ___.
fecal-oral route, eating contaminated foods, anal-oral sex.
T/F? Hep A causes a chronic form of hepatitis.
False. Hep A causes acute hepatitis.
Patients with hep A are advised to…
rest, stay hydrated, and avoid alcohol.
Hep A can be spread through the consumption of ___ and drinking ___.
raw seafood, contaminated water
T/F? Hep A is the least serious form of hepatitis.
True.
T/F? Have a hep A infection concurrently with a hep C infection is no big deal.
False. Even in the absense of cirrhosis, having both can cause a life-threatening superinfection and possible fulminant hepatitis.
T/F? Hep B causes chronic hepatitis.
False (or only half true). Hep B causes both acute and chronic hepatitis.
Hep B can be deadly due to complications from ___ hepatitis, ___, and ___ carcinoma.
chronic, cirrhosis, hepatocellular
Hep B is transmitted through fluid transfer including blood ___, amateur and professional ___, ___ intercourse, and ___feeding.
transfusion, tattoos, sexual, breast
Blood contact can occur by sharing ___ in IV drug users, ___ accessories, or touching ___.
syringes, shaving, open wounds
Symptoms of hep B may not appear for as long as ___ after the inital infection. Some patients experience ___ symptoms or only ___ symptoms.
4-24 weeks, no, mild
About ___% of hep B patients have a fever or rash, but ___ is not common.
10-20%, nausea
T/F? Hep A patients present with arthritis-like joint pain.
False. Hep B patients can have red, swollen, painful joints.
Non-A, Non-B Hepatitis is also known as…
Hep C.
Common ways people are exposed to hep C are through…
inadequately or improperly sterilized medical or dental equipment, shared needles, and IV drug use.
People in these professions are at risk of hep C exposure through accidental needlesticks and blood spatter in eyes and open mouth.
Medical/dental personnel, first responders (ie firefighters, paramedics, police, military combatants)
T/F? The hep C virus is transmitted through blood only.
True.
Most patients with hep C experience ___ symptoms or very ___ symptoms.
no, mild
The most common symptom of hep C is ___. The first symptom may be ___.
fatigue, itchy skin
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.
12 months, 10-30 years
If hep C becomes life-threatening a ___ may be performed, though it is not a ___.
liver transplant, cure
Hep D is also known as…
Hepatitis delta virus.
Hep D is ___viral or a ___ virus that requires hep ___ to provide envelope proteins.
sub, satellite, B
T/F? Transmission of hep D is similiar to hep C.
False. It is similiar to hep B.
Some at-risk groups for hep D exposure are…
IV drug users, health-care workers, blood transfusion receipients, or blood product (like anti-hemophilic factor) receipients.
Treatments for hep D include…
Trick question! There are no specific treatments for hep D.
Sonographically, CHRONIC hepatitis demonstrates a ___echoic liver parenchyma, ___ liver, decreased ___ of portal vein walls.
hyper, small, echogenicity (the opposite of an acute hepatitis).
People with an abscess present with symptoms of…
fever and an increased white blood cell count.
This is a pus-filled area in the liver.
pyogenic abscess
Potential causes of liver abscess include abdominal infections like ___itis, ___itis, or perforated bowel, blood __, biliar tract ___, recent ___ of the biliary system, liver ___.
appendicitis, diverticulitis, infection, infection, endoscopy, trauma
The most common features of pyogenic liver abscesses are ___ colored stool, ___ urine, fever & ___, loss of ___, N&V, RUQ ___, weight ___, weakness and jaundice.
chalk, dark, leukocytosis (increased WBC), pain, loss
T/F? Pyogenic abscesses commonly occur in the RLL.
True.
The pyogenic infection reaches the liver through the…
portal veins, bile ducts, hepatic arteries, and lymphtic channels.
A ___ pyogenic abscess can appear cystic with the fluid ranging from echofree to highly ___.
purulent, echogenic
Early suppuration of a pyogenic abscess can appear ___with altered echogenicity, usually ___echoic.
solid, hypo
The walls of a pygogenic abscess can appear ___ or irregular and ___.
well-defined, thick
Gas producing organisms give rise to ___ foci with a posterior ___ artifact.
echogenic, reverberation
T/F? There may be air within a liver abscess.
True.
Treatment for pyogenic abscess usually consists of ___ or draining the site with a ___ or ___ tube.
surgery, needle, percutaneous
Even with treatment, life-threatening ___ will develop in 10-30% of pyogenic abscess patients.
sepsis
This is a liver infection that occurs when a parasite reaches the liver via the intestines and then the portal veins.
Amebic abscess
The most common bacterial agent related to amebic abscess is ___ and it’s usually transmitted via the ___.
E-coli, fecal-oral route
T/F? RUQ pain and vomitting are the most common symptoms for amebic abscess.
False. RUQ pain and diarrhea are.
Sonographically, an amebic abscess may look like an ___ shaped lesion, absence of a prominent abscess ___, be ___echoic compared to a normal liver.
round/oval, wall, hypo
Sonographically, an amebic abscess may look have ___ internal echoes, ___ enhancement, ___ with the diaphragm/liver capsule, and typically occurs in the ___ of the liver.
low-level, distal, contiguity, dome
T/F? A pyogenic abscess may rupture into the abd cavity, lung lining, lungs, the sac around the heart, or the brain.
False. That’s an amebic abscess.
What piece of patient history can help you distinguish a pyogenic abscess from an amebic abscess?
Whether or not the patient has been traveling internationally. If so, it’s more likely to be an amebic abscess.
This is a mycotic (fungal) infection of the blood that results in small abscesses of the liver.
candidiasis
The ___ of candidiasis legions can change over the course of the disease.
appearance
Early in the disease process, a candidiasis legion appears as…
a “wheel within a wheel”; a peripheral hypoechoic zone, an inner echogenic wheel, and a hypoechoic center.
Later in the disease process, a candidiasis legion appears as…
a bullseye. The hypoechoic center calcifies.
What is the most common cause of hydatid disease in humans?
echinococcal cyst
An echinococcal cyst is the result of a ___ infestation associated with ___ raising countries.
parasite (tapeworm), sheep and cattle
Eggs of the echinococcus granulosus are ___ and pass into the ___ where the larva hatch and move into the liver.
swallowed, portal venous system
An echinococcus tapeworm is ___ in length.
3-6 mm
How does echinococcal reach the cattle?
It’s excreted in dog’s feces and swallowed by intermediate hosts (sheep, cattle, goats, humans).
T/F? Echinococcal cysts can look just like a simple cyst.
True.
T/F? Echinococcal cysts can look just like a calcified mass.
Also true.
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)
d. all of the above
___ is the conventional treatment for echinococcal cysts, but success has been obtained with percutaneous ___ as well.
Surgery, drainage
The fluid within the echinococcal cyst is very ___ so if it ruptures ___ can occur.
toxic, anaphylatic shock
This is one of the most common parasitic worm infections in humans.
Say it with me… schistosomiasis
Schistosomiasis is found in parts of the world where…
water is contaminated.
How does schistomomiasis grow in the water?
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.
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 ___.
6-8 wks, 4.5 yrs, 20 yrs
Up to half of the schistosomiasis worms become trapped in the ___ veins or will be washed back into the ___ and become lodged.
mesenteric, liver
How does the liver respond to schistosomiasis worms?
It incites a granulomatous reaction resulting in peri-portal fibrosis.
Peri-portal fibrosis causes the intrahepatic portal veins to ___ resulting in portal HTN, splenomegaly, varices and ascites.
occlude
Pneumocystis carinii is the most common ___ organism causing opportunistic infection in patients with ___.
fungal, AIDS
Pneumocystis carinii is the most ___ cause of life-threatening ___ in patients with AIDS.
common, infection
Pneumocystis carinii also affects patients undergoing bone marrow and ___ as well as those receiving corticosteriods or ___.
organ transplants, chemotherapy
___ may cause the bile ducts and GB wall to be thickened.
Pneumocystis carinii
Pneumocystis carinii may involve the liver with ___, nonshadowing ___echoic foci.
diffuse, hyper
Sonographically, pneumocystis carinii looks like ___ liver infiltration, hepato___, hepatitis, nonhodgkins lymphoms, ___iasis, cholangitis, acalcuous cholecystits, and ___ sarcoma.
fatty, megaly, candidiasis, Karposi’s
Which disease thickens the bile ducts and may compromise the lumen causing biliary obstruction?
cholangitis - aka inflammation of the bile ducts
What causes an intrahepatic mass (purple nodules)?
Karposi’s sarcoma in a patient with AIDS
A ___ is an acquired, reversible metabolic disorder resulting in an accumulation of triglycerides within the hepatocytes.
fatty liver
The most common causes of a fatty liver are…
obesity and alcohol abuse
What are the two patterns of fatty liver?
focal fatty infiltration (diffuse) and focal fatty sparing (focal)
The presence of a fatty liver can be determined by…
comparing the echogenicity of the liver to the kidney. (The liver will be more hyperechoic in fatty infiltration.)
What is a focal region of increased echogenicity within an otherwise NORMAL LIVER?
focal fatty infiltration
What are focal regions of normal liver parenchyma within a FATTY LIVER?
focal fatty sparing
Sparing commonly occurs adjacent to the ___, in the ___, in the ___ lobe, and at the liver ___.
gallbladder, porta hepatis, caudate, margins
This is a genetically acquired disorder that results in the excess deposit of glycogen in the liver and tubules of the kidney?
glycogen storage disease
Glycogen storage disease is associated with…
diffuse fatty infiltration and hepatic adenomas.
These are well-demarcated solid masses of variable echogenicity associated with glycogen storage disease.
hepatic adenomas
___ is a diffuse process of fibrosis and distortion of normal liver architecture.
Cirrhosis
In cirrhosis, parenchymal changes compress the bilary and vascular channels resulting in …
jaundice and portal HTN.
T/F? A cirrhotic liver initially atrophies.
False. It initially enlarges. The atrophy occurs with continued insult.
Patients with cirrhosis are at increased risk for…
hepatocellular carcinoma.
The two most common causes of cirrhosis are ___ and ___.
ETOH abuse, hep C
Name the three major pathologic mechanisms which create cirrhosis.
cell death, fibrosis, regeneration
The length of micronodular cirrhosis and its most common cause.
.1-1 cm in diameter, alcohol consumption
The length of macronodular cirrhosis and its most frequent cause.
up to 5 cm in diameter, chronic viral hepatitis
The clinical presentation of cirrhosis includes…
hepatomegaly, jaundice, ascites
In cirrhosis, liver cannot get rid of the toxins and ___ and it can cause ___, which literally makes you crazy.
ammonia, encephalopathy
What happens in early stage cirrhosis?
hepatomegaly
What happens in advanced stage cirrhosis?
smaller liver with a large (relatively) caudate lobe
What do you call the large-then-small sonographic pattern for cirrhosis?
volume redistribution
___ echotexture is a frequent observation in diffuse liver disease and may be confounded by inappropriate ___ settings and overall gain.
Coarse, TCG
___ or irregularity of the liver surface has been appreciated as a sign of cirrhosis when the appearance is ___ or when ___ is present.
Nodular, gross, ascites
Nodularity corresponds to the presence of…
regenerating nodules and fibrosis.
This is an increased pressure in the portal venous system.
Portal HTN
What is considered a normal pressure in the portal venous system?
5-10 mm of Hg (slightly higher than normal IVC pressure)
The diameter of a normal portal vein is…
less than 13 mm.
The diameter of a portal vein with HTN is…
greater than 13 mm.
What is a clear sign of portal HTN?
hepatofugal flow in the MPV
___ and ___ are the two major causes of portal HTN.
Cirrhosis, schistosomiasis
Patients with portal HTN are ususally ___ but might present with sudden painless ___ due to rupture of ___.
upper GI hemorrhage, esophageal varices
Name the 4 types of portal HTN.
- extrahepatic pre-sinusoidal (portal vein thrombosis)
- intrahepatic pre-sinusoidal (schistosomiasis)
- intrahepatic (cirrhosis)
- intrahepatic post-sinusoidal (hepatic vein thrombosis)
The most common type of portal HTN is…
intrahepatic/cirrhosis, accounting for 90% of cases in the West.
The secondary signs of portal HTN include…
splenomegaly, ascites, portosplenic collaterals.
This is the p-s collateral between the coronary and short gastric veins and the esophageal veins.
GE junction
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.
paraumbilical veins
This is the p-s collateral of tortuous veins that may be seen in the region of the splenic and left renal hilam.
splenorenal and gastrorenal
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.
intestinal
This is the p-s collateral in the perianal region where the superior rectal veins anastomose with the midle and inferior rectal veins.
hemmorhoidal
Portosymtemic ___ are created to decompress the portal system to avoid the development or rupture of ___.
shunts, gastroesophageal varices
What are the traditional shunts?
- mesocaval (SMA to IVC)
- splenorenal/Warren (splenic v to renal v)
- portacaval (portal v to IVC)
What’s TIPS stand for?
Transjugular Intrahepatic Portal systemic Shunting
TIPS is placed using a ___ access.
jugular
The TIPS is placed between a ___ vein and a ___ vein.
hepatic, portal (usually the RHV and the RPV)
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.
50 cm/s, increases, hepatopedal, hepatofugal
Echogenic thrombus within the lumen of the portal vein? It might be…
portal vein thrombosis.
Portal vein thrombosis is caused by…
- HCC
- pancreatic carcinoma
- metastatic liver disease
- pancreatitis
- cirrhosis
- hypercoagulation
Wormlike vessels at the porta hepatis? Sounds like..
cavernomatous transformation
Peri-portal collateral circulation, which occurs in longstanding ___ patients, requires up to ___ to occur.
portal vein thrombosis, 12 months
___ is a rare disorder characterized by occlusion of the hepatic vein with or without occlusion of the IVC by either thrombus or tumor.
Budd-chiari syndrome
Budd-chiari syndrome is typically seen in…
young women taking birth control pills.
Other causes of Budd-chiari syndrome include ___ abnormalities, tumor extension from ___, renal ___, pregnancy, adrenal cortical ___, congential ___, and trauma.
coagulation, HCC, carcinoma,carcinoma, abnormalities
In B-C syndrome, ___ is an invariable observation.
ascites
In B-C syndrome, the liver is typically large and ___ acutely. Hemorrhagic ___ may produce significantly altered regional ___.
bulbous, infarction, echogenicity
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.)
caudate, emissary
In B-C syndrome a ___ may be identified as echogenic or focal obliterations of the lumen.
membranous web
When is orthotopic liver transplantation performed?
To eliminate irreversible disease
Some indications for liver transplant in adults are ___ due to hep C, inborn errors of ___, sclerosing ___, ___ syndrome, and unresectable ___.
cirrhosis, metabolism, cholangitis, Budd-chiari, hepatoma
In children, the biggest reason for a liver transplant is…
biliary atresia.
A pre-op u/s liver eval includes liver ___ and extent of ___, the presence of venous ___, and any complicating factors like ___ or extrahepatic malignancies.
size, pathology, collaterals, AAA
A pre-op u/s liver eval also includes the patency and size of which vessels?
the portal vein, the hepatic artery, and the IVC
The post liver transplant u/s eval includes as assessment of the liver ___, the ___ tree, and any perihepatic ___ collections.
parenchyma, biliary, fluid
The post liver transplant u/s eval also includes the patency and size of which vessels?
the portal vein, the hepatic artery, and the IVC
What is the most common benign tumor of liver?
cavernous hemangioma
Hemangiomas consist of multiple vascular ___ which create multiple sonographic ___.
channels, interfaces
Sonographically, cavernous hemangioma is ___echoic ___geneous and has posterior ___
hyper, homo, posterior acoustic
In a fatty liver, a hemangioma may appear…
hypoechoic.
T/F? Color or duplex doppler does not routinely demonstrate flow within the hemangioma.
True
___ or the adminstration of ___ may enlarge a hemangioma.
Pregnancy, estrogens
Focal nodular hyperplasia is a ___ condition believed to be a developmental hyperplastic lesion related to an area of ___ vascular malformation.
benign, congential
Sonographically, focal nodular hyperplasia appears as a well-defined ___ mass with a central fibrous ___ and ___ vascularity.
solid, scar, stellate
What is a solid liver mass associated with the use of oral contraceptive agents (and glycogen storage disease)?
hepatic adenoma
A patient with hepatic adenoma may present with symptoms of…
pain due to tumor hemorrhage.
Due to the risk of malignant transformation, the treatment for hepatic adenoma is often…
surgical resection.
Hepatic adenomas appear with ___ echogenicity, a cystic component with ___, and intraperitoneal ___.
nonspecific, hemorrhage, blood
What’s an extermemly rare fatty tumor of the liver?
hepatic lipoma
What is associated with hepatic lipomas and angiomyolipomas?
tuberous sclerosis, congetial familial disease
Sonographically, hepatic lipomas present as a ___echoic mass with ___ artifact.
hyper, propagation speed
Objects posterior to a fatty mass will be placed farther away from the transducer. This may be seen as a “___” diaphragm.
broken
The most common malignancy of the liver is…
hepatocellular carcinome (HCC aka hepatoma).
People of increased risk for HCC have…
alcoholic cirrhosis and hep B & C.
HCC commonly invades ___ and ___ and ___.
portal veins, hepatic veins, the IVC.
Which lab value will be increased in a patient with HCC?
serum alpha fetoprotein levels
What are the most commonly encountered solid masses in the liver?
metastatic tumors
Metastatic involvement of the liver has usually spread from…
lung cancer, breast cancer or GI cancer
Hyperechoic mets suggest…
gastrointestinal tract involvement.
Hypoechoic mets suggest…
lymphoma involvement.
A “bullseye” or target mets suggests…
lung involvement.
A calcified mets suggests…
mucinous adenocarcinoma.
A cystic mets suggests…
sarcoma.
What is the most common malignant liver tumor in early chlidhood (the third most common childhood intra-abdominal malignancy)?
hepatoblastoma
Patients with hepatoblastoma present with an enlarging asymptomatic abdominal ___ measuring ___.
mass, 10-12 cm
Hepatomablastoma is associated with ___ mets and ___ invasion.
lung, portal vein
