Liver Flashcards
In the normal dog liver on ultrasound, the echogenicity of the liver parenchyma is usually:
A. Less echogenic than the spleen
B. More echogenic than the spleen
C. Equal in echogenicity to the spleen
D. Markedly hypoechoic compared to the renal cortex
A
Which hepatic lobe in dogs is typically extends the most, often extending beyond the costal arch?
A. Caudate lobe
B. Right lateral lobe
C. Left lateral lobe
D. Quadrate lobe
C
On ultrasound, how do portal veins typically appear in comparison to hepatic veins in dogs?
A. Portal veins have thin walls and run longitudinally
B. Portal veins have thicker, more echogenic walls and travel within lobes toward the porta hepatis
C. Hepatic veins have more echogenic walls than portal veins
D. There is no difference between them on ultrasound
B
In dogs, the caudate lobe of the liver has two processes: the caudate process and the papillary process. Which statement is true regarding their ultrasound appearance?
A. The papillary process extends to the left and may be mistaken for a small separate structure
B. The caudate process is always larger and located on the left side
C. Both processes are identical in shape and cannot be differentiated
D. The papillary process is found adjacent to the gallbladder fossa
A
Which liver lobe in the dog closely contacts the right kidney, sometimes creating an impression on the renal cortex seen sonographically?
A. Left medial lobe
B. Quadrate lobe
C. Right medial lobe
D. Caudate process of the caudate lobe
D
The wall of the normal GB is thin and smooth, measuring less than ____ thick in cats and dogs
1mm, 1.3 mm
CBD can measure up to
___ wide in normal cats and is
considered normal by the authors when up to ____ in dogs.
4mm
3mm
Mean portal flow velocities have been reported to vary between 15 ± 3 and 18 ± 8 cm/s in normal ___ and 10–18 cm/s in normal ___
dogs
cats
Which of the following statements regarding the correlation between ultrasound findings and cytological/histopathological results for diffuse liver disease is most accurate?
A. They correlate very closely, making biopsy rarely necessary
B. There is generally poor correlation, so tissue sampling is recommended
C. Fine-needle aspiration is contraindicated for diffuse disease
D. Ultrasound findings alone are usually definitive
B
Which of the following is not a typical cause of diffuse hyperechogenicity of the liver?
A. Hepatic lipidosis
B. Steroid hepatopathy
C. Passive congestion
D. Fibrosis
C
Passive congestion (often secondary to right-sided heart failure) typically causes diffuse hypoechogenicity
Which condition frequently leads to diffuse hypoechogenicity of the liver in cats?
A. Lipidosis
B. Cholangiohepatitis (cholangitis)
C. Cirrhosis
D. Steroid hepatopathy
B
In cats, cholangiohepatitis although the text notes that it can also appear normal or hyperechoic in some cases.
Which statement about round-cell neoplasia (e.g., lymphoma, mast cell disease) involving the liver is true?
A. Lymphoma of the liver always appears hyperechoic
B. Mast cell infiltration typically causes diffusely hypoechoic liver
C. Round-cell tumors can appear hypoechoic, hyperechoic, or mixed in echogenicity
D. These infiltrative tumors never cause hepatomegaly
C
Which of the following best characterizes cirrhosis on ultrasound?
A. Always large, hypoechoic liver with smooth borders
B. Typically small, hyperechoic or heterogeneous liver with irregular contours
C. Uniformly hypoechoic liver with rounded margins
D. Markedly anechoic parenchyma that mimics abscess formation
B
Peritoneal effusion is also common.
In dogs with acute hepatitis, such as leptospirosis, the liver on ultrasound is most often:
A. Markedly hyperechoic
B. Normal in appearance
C. Diffusely hypoechoic with prominent portal vein walls
D. Nodular and irregular in contour
C
Acute hepatitis (including leptospiral infection) typically presents with diffuse hypoechogenicity. The result is increased visibility of the portal walls
Which condition commonly causes diffuse hyperechogenicity and may also include small, hypoechoic nodules due to concurrent nodular hyperplasia?
A. Acute hepatitis
B. Steroid-induced vacuolar hepatopathy
C. Passive congestion
D. Leptospiral infection
B
Which sonographic finding is most indicative of extrahepatic biliary obstruction in a dog with gallbladder mucocele?
A. A thin common bile duct (CBD) wall with no dilatation
B. A thickened CBD wall with a dilated lumen
C. Uniform liver echogenicity with normal intrahepatic ducts
D. A gravity dependent Gallbladder material
B. typical sign of extrahepatic biliary obstruction.
In the ultrasound evaluation of a cat with extrahepatic biliary obstruction, which of the following is observed?
A. Tortuous hypoechoic to anechoic tubular structures representing dilated bile ducts
B. A uniformly hyperechoic gallbladder without sludge
C. A thickened hepatic parenchyma and a contracted gallbladder
D. A completely normal-appearing extrahepatic biliary system
A
Which of the following ultrasound features is considered pathognomonic for a mature gallbladder mucocele in dogs?
A. A stellate pattern in the gallbladder lumen
B. A kiwi fruit–like pattern of radiating hyperechoic striations with an immobile central area
C. A double rim sign on the gallbladder wall indicating edema
D. A homogeneously anechoic gallbladder lumen
B
Which type of portosystemic shunt is most commonly encountered in small‐breed dogs and cats?
A. Intrahepatic left-divisional shunt (patent ductus venosus)
B. Extrahepatic shunts arising from the main portal vein or a tributary
C. Multiple acquired shunts from cirrhosis
D. Arterioportal fistula
B
On color Doppler ultrasound, what characteristic finding is seen at the termination of a portocaval shunt into the caudal vena cava (CVC)?
A. Uniform laminar flow without turbulence
B. A mosaic pattern indicative of flow turbulence
C. Absence of flow signal in the CVC
D. Increased color signal in the hepatic parenchyma
B A mosaic pattern seen on color Doppler at the site of shunt termination is indicative of flow turbulence as the aberrant vessel enters the CVC.
When evaluating a dog with clinical signs of pancreatitis and biliary obstruction, which finding on ultrasound may suggest extension of inflammation?
A. A uniformly thin common bile duct (CBD) wall
B. The presence of marked hyperechoic peripheral fat and a thickened CBD wall near the duodenal papilla
C. No change in echogenicity in adjacent tissues
D. A strictly anechoic gallbladder lumen with no sludge
B
Regarding portal venous thrombosis on ultrasound, which of the following features is most commonly observed?
A. Marked vascular flow within the thrombus on color Doppler
B. An immobile, mildly echogenic structure within the vessel lumen with absent flow
C. A uniformly hypoechoic, mobile thrombus with strong flow signals
D. Increased luminal diameter with hyperdynamic flow in the affected region
B
Which of the following complications is most frequently encountered after an ultrasound-guided hepatic biopsy?
A. Infection of the biopsy site
B. Hemorrhage along the needle tract
C. No complications
D. Accidental splenic puncture resulting in splenomegaly
B
In cases of suspected arterioportal fistula, which set of Doppler findings would most convincingly support the diagnosis based on the information provided?
A. A normal-appearing portal vein with steady, laminar hepatopetal flow
B. A markedly distended portal vein exhibiting reversed (hepatofugal) flow with abnormal pulsatility, along with a disproportionately enlarged celiac artery
C. A portal vein with uniform low flow velocity and an indistinct spectral Doppler waveform
D. Increased peripheral arterial flow with no change in portal vein spectral Doppler characteristics
B
Explanation: Arterioportal fistulas are characterized by abnormal connections between the hepatic artery and the portal vein. The resultant findings include a distended portal vein with reversed (hepatofugal) flow and abnormal pulsatility on spectral Doppler evaluation, as well as an enlarged celiac artery relative to the cranial mesenteric artery. These combined features strongly support the diagnosis of an arterioportal fistula.
A small-breed dog presents with clinical signs of portal hypertension. Which of the following ultrasonographic findings would be most specific for identifying an acquired splenorenal shunt?
A. A vessel connecting directly to the left renal vein, appearing as a dilated gonadal vein
B. Multiple small tortuous vessels in the mesentery with no visible connection to the renal vasculature
C. A uniformly enlarged portal vein without any focal dilatation of tributaries
D. A vessel with exclusively hepatopetal flow connecting the splenic vein and the CVC
A Visualization of a vein connecting to the left renal vein (or to the CVC near the junction with the left renal vein), especially if it appears as an enlarged gonadal vein, is considered specific for acquired portosystemic shunting due to splenorenal anastomosis. Other findings are less specific.
When performing ultrasound-guided freehand fine-needle aspiration of the liver, what are the advantages of using the freehand technique over the assisted (biopsy guide) technique for diffuse hepatic lesions?
A. It allows for a fixed needle path ensuring reproducibility
B. It reduces the risk of inadvertent puncture of adjacent structures such as the gallbladder
C. It ensures more precise targeting of small, deep lesions
D. It provides better control over needle gauge selection
B
A 6-month-old small dog is being evaluated for suspected congenital portosystemic shunt (PSS). On ultrasonography, the main portal vein (PV) diameter is markedly reduced compared to its tributaries. Which of the following additional findings would best support the diagnosis of an extrahepatic PSS? (2 correct)
A. Enlarged intrahepatic portal branches with homogenous flow
B. A large, tortuous vessel emerging from a portal tributary and terminating in the caudal vena cava (CVC) with hepatofugal flow
C. Uniform dilation of the main portal vein with a ratio ≥ 0.8
D. PV-aorta ratio of 0.57 is calculated
B and D
