Liver Flashcards
In what plane is the liver typically measured and what measurement is considered hepatomegaly?
SAG plane
> 16
What is the name of the capsule that covers the liver?
Glissons
What is the potential space between the liver and right kidney?
Morrisons
What is the fibrous cord resulting from the obliterated left umbilical vein?
Ligamentum Teres
What ligament separates RT and LT lobes?
Falciform
What vessels are intersegmental and intrasegmental?
Inter = between = Hepatic V
Intra = within = PV, Hepatic Artery, Bile duct
What lobes does the ligamentum venosum separate?
Lt lobe and caudate lobe
The hepatic artery branches off what?
CT
What measurement constitutes intrahepatic duct dilation?
> 2mm
What LFT is the most indicative of alcoholism?
GGT
What causes increase in AFP in adults and paediatrics?
Adults = HCC
Pediatrics = Hepatoblastoma
HCC is associated with what kind of cirrhosis?
A) Micronodular
B) Chronic
C) Macronodular
D) Acture
Macrodnodular
What type of hepatitis is contracted via the fecal-oral route?
Hep A
What type of hepatitis is contracted via contaminated drinking water?
Hep E
What type of hepatitis is contracted via mother/infant route?
Hep B
What pathology is seen with the “starry sky” sign and GB wall thickening?
Acute Hepatitis
What is the m/c type of glycogen storage disease?
Von Gierk’s
What kind of solid liver masses may be seen with glycogen storage disease?
A) Adenoma
B) Lipoma
C) Angiomyoma
D) Sarcoma
Adenoma - hyperechoic with hypoechoic halo
What is Budd Chiari?
Occlusion of some or all HV’s and IVC
Budd Chiari triad?
Hepatomegaly
Ascites
Abdominal pain
Sonographic features on the screen show cavernous transformation in portal vein and a dilated SMV and SV, what is the possible diagnosis?
Portal venous thrombosis
Caput Medusa sign is seen in what pathology?
PV hypertension - severe cases seen around umbilicus
What is the most common cause of intra-hepatic portal hypertension?
Cirrhosis
SF = comma-shaped portal trunk, increased periportal echogenicity, dilated SMV & SV, ascites, splenomegaly. What is the most likely diagnosis?
PV hypertension
What does TIPS stand for and what is the vessel connection?
Transjugular Intrahepatic Portosystemic Shunt - connects PV and HV
Congenital liver cysts most commonly affect what side?
RT
With polycystic liver disease, what other organs should be assessed? (3)
Kidneys, pancreas, spleen - most commonly detected in 30’s and 40’s and most common in women
What are the stages of a clot?
Freshly echogenic, then will become complex, then will become anechoic (seroma)
What pathology is known as a cluster of tubular-appearing cysts that parallel the bile ducts and PV’s in the center of the liver?
Peribiliary cysts
SF of pyogenic abscess?
Hypoechoic
Homogenous
Round or ovoid
What kind of hepatic infection causes black tarry stools?
A) Pyogenic abscess
B) Amebic Abscess
C) Schistosomiasis
D) Hydatid disease
Amebic
What abnormality has a “clay pipe stem” appearance and echogenic thickened PV walls?
A) Pyogenic abscess
B) Amebic Abscess
C) Schistosomiasis
D) Hydatid disease
Schistosomiasis
What abnormality has a “water lily sign”
A) Pyogenic abscess
B) Amebic Abscess
C) Schistosomiasis
D) Hydatid disease
Hydatid - patient may experience anaphylactic shock
What pathology consists of numerous tiny bright reflective parenchymal echoes (“starry sky” pattern), may find multi-organ calcification?
HIV/AIDS and hepatitis
What kind of liver lesion contains a “wheel within a wheel” sign?
Fungal
Patient presents with no symptoms. You see an isoechoic lesion with a central stellate scar that is 3cm. The patient currently uses OCP. What may be this pathology?
FNH
What liver lesion is associated with long term OCP use but can go away with cessation of OCP and has malignant potential?
Liver adenoma
SF of liver adenoma?
Hyperechoic with hypoechoic halo - has peripheral and central vascularity
What two pathologies are linked to hepatic AML’s?
Tuberous sclerosis and renal AML’s
What is typical of a patient to have when HCC is diagnosed?
Cirrhosis
What is the m/c liver malignancy?
Hepatoma / HCC - most commonly occurs in men in 6th decade - Increased AFP!
SF of HCC?
Can vary but in cirrhotic livers, it is hypoechoic and has chaotic vascularity.
Will invade PV in 60% of cases and HV in 15%
What are hemangiosarcomas and angiosarcomas usually associated with?
Carcinogens - aggressive tumor and typically present in 60-80’s
What is the M/C source of mets in the liver?
Colon
Where do METS come from based on the SF in liver?
Hyperechoic
Cystic
Hypoechoic
Target/bulls eye
Calcified
1) RCC, colon, neuroendocrine
2) leiomyosarcomas, ovarian cancer
3) Lymphoma
4) Lung
5) Colon, stomach, ovary, breast
Which of the following is seen in patients with late stage cirrhosis?
A) Less sound attenuation
B) Caudate lobe atrophy
C) Hepatofugal flow in the PV
D) Shrunken, strophic spleen
Hepatofugal flow in PV
What is the obliterated fetal remnant of the left umbilical vein known as and where on ultrasound can it be seen?
Ligamentum teres - lower left segment continuous with the falciform ligament
What separates the left lobe from the caudate lobe?
Ligamentum venosum - remnant of ductus venosus
What fissure separates the left lobe into medial and lateral?
A) Ligamentum venosum
B) Ligamentum teres
C) Falciform ligament
D) Main lobar fissure
Ligamentum teres in TRV plane
What vessel courses within the MLF?
A) Rt HV
B) Main PV
C) Lt HV
D) Middle HV
Middle hepatic V
