Liver Flashcards
0
Q
The right lobe is divided into what 2 segments?
A
Anterior & posterior
1
Q
The left lobe is divided ________&_________.
A
Medial & lateral
2
Q
The caudate lobe lies on the __________ surface btwn IVC and medial left lobe.
A
Posterior-superior
3
Q
What supplies the caudate lobe?
A
Branches of left & right portal venous and hepatic arterial systems.
4
Q
Segment I
A
Caudate
5
Q
Segment II
A
Left lateral superior
6
Q
Segment III
A
Left lateral-inferior
7
Q
Segment IVa
A
Left medial superior
8
Q
Segment IVb
A
Left medial inferior
9
Q
Segment V
A
Right anterior inferior
10
Q
Segment VI
A
Right posterior inferior
11
Q
Segment VII
A
Right posterior superior
12
Q
Segment VIII
A
Right anterior superior
13
Q
Intersegmental vessels: Location____________ appearance__________
A
Hepatic veins Course btwn the lobes & segments Non-echogenic walls
14
Q
Intrasegmental vessels: Location____________ appearance__________
A
Portal triad course to the center of each segment Hyperechoic walls
15
Q
Fibrofatty sheath of portal triad
A
Glisson’s capsule
16
Q
Portal triad
A
MPV PHA CHD (CBD)
17
Q
Divides the ant. Segment of the rt lobe from the medial segment of the lt lobe.
A
Main lobar fissure
18
Q
Located between the gb neck and the junction of the rt and lt Portal vein.
A
Main lobar fissure
19
Q
Divides rt lobe into ant. and post. Segments Landmark is rt hepatic vein
A
Rt intersegmental fissure
20
Q
Divides lt lobe into medial and lateral segments Landmark: lt hep vein, ascending pv, FALCIFORM ligament and LIGAMENTUM TERES.
A
Lt intersegmental fissure
21
Q
Remnant of ductus venosus Separates lt lobe from caudate
A
LIGAMENTUM venosum
22
Q
Remnant of the umbilical vein
A
LIGAMENTUM TERES
23
Q
Remnant of the ductus venosus Runs from lt portal v to IVC seep rating lt lobe from caudate lobe
A
LIGAMENTUM venosum
24
Direction of fetal circulation
Umbilical v, lt pv, ductus venosus, IVC
25
Flow towards the liver above the baseline
Hepatopetal (p for positive)
26
Flow away from the liver ( below the baseline )
Hepatofugal ( to flee)
27
Waveform toward liver with mild undulations
Low-velocity continuous flow
28
Portal triad
MPV, proper hep art, common hepatic duct
29
Hepatic vein waveforms are typically _______ reflecting rt atrial filling! contraction and relaxation.
Triphasic
30
Proper hepatic art runs parallel to the \_\_\_\_\_
MPV
31
Rt hep art (replaced) originates from the ______ and seen posterior to\_\_\_\_\_\_\_\_\_\_.
SMA MPV
32
Hepatic art waveform demonstrates flow in diastole indicating a \_\_\_\_\_\_\_\_\_system
Low-resistance
33
In a post liver tx a \_\_\_\_\_\_\_\_\_( no diastole) hep art waveform may suggest organ rejection.
High resistance
34
Parvus tardus hep art waveform suggests anatomic stenosis at Prox, mid , or dist
Proximal
35
Parasitic infection associated with sheep and cattle raising countries. Larvae hatch in portal system and move into the liver.
Echinococcal cyst ( hydatid disease)
36
Presents as a cyst within a cyst( water lily sign) and assoc. with anaphylactic shock
Echinococcal cyst ( hydatid disease)
37
Major cause of portal hypertension worldwide Endemic areas: tropical zones
Schistosomiasis
38
Sonographic presentation for schistosomiasis
Thickening and increased echogenicity of portal vein walls
39
Accumulation of triglycerides within hepatocytes.
Fatty infiltration
40
Genetically acquired disorder that results in the excess deposition of glycogen in the liver. Associated with diffuse fatty infiltration and hepatic adenomas
Glycogen storage disease
41
8 Miscellaneous causes of cirrhosis
Wilson's disease (iron deposition) Autoimmune hepatitis Right side heart failure/tricuspid Primary biliary cirrhosis Primary sclerosing cholangitis Drug induced liver disease (Tylenol ) Venous outflow liver disease ( budd-chiari)
42
Abnormal liver functions include:
AST(sgot) ALT (sgpt) GGT LDH Conjugated bilirubin
43
Pv diameter suggesting portal hypertension
Greater than 13mm
44
2 major causes of portal hypertension
Cirrhosis and schistosomiasis
45
Portal hypertension is asymptomatic. Pt usually present with:
Sudden painless upper gi hemorrhage d/t rupture of esophageal varies that extend fro rt and lt gastric veins
46
Type of portal hypertension: Ex: blood cannot get to liver, pv thrombosis
Extrahepatic presinusoidal
47
Type of portal hypertension: Ex: blood cannt get through parenchyma , schistosomiasis
Intrahepatic presinusoidal
48
Type of portal hypertension: Ex: most common, cirrhosis
Intrahepatic
49
Type of portal hypertension: Ex: blood can't get out of the liver, hepatic vein thrombosis
Intranet attic postsinusoidal
50
Sonographic findings of portal htn
Splenomegaly Ascites Portal systemic venous collaterals
51
2 techniques to lower portal pressure
TIPS portacaval shunt
52
Collaterals of the distal esophagus and gastric fundus and may lead to life threatening gi hemorrhage
Gastroesophageal varices
53
Re opening of the umbilical vein( ligamentum TERES) to act as collateral from the left portal vie to epigastric veins to IVC
Recanalizwd umbilical vein
54
Tortuous collateral veins seen in splenic and left renal hilum
Splenorenal varices
55
The veins of the retro peritoneal structures such as colon, duodenum, and pancreas anastomose with systemic tributaries
Intestinal varices
56
Physical signs of collaterals
Caput medusa ( tortuous collaterals arnd umbilicus) Hemorrhoids Ascites Dilated veins of ant. Abd wall
57
TIPSS is placed btwn a \_\_\_\_\_\_\_\_vein and a ________ vein. Typically the \_\_\_\_\_&\_\_\_\_\_\_\_.
Hepatic vein and portal vein. RHV&RPV
58
A petent TIPS should present with _________ flow.
Hepatafugal
59
Criteria for TIPS MALFUNCTION
Focal velocity increase in TIPS hepatafugal of MPV Hepatpedal of RPV or LPV
60
With TIPS and a recannalized umbilical vein flow of the LPV can be\_\_\_\_\_\_\_\_\_\_\_.
Hepatopetal or hepatofugal
61
Indication for liver transplant
Cirrhosis
62
Indications for liver transplantation in children
Biliary atresia
63
MELD
Model for end stage liver disease
64
Tumoral cause for portal vein thrombosis
HCC Mets Pancreatic carcinoma
65
Non-Tumoral causes for portal vein thrombosis
#1 cause -cirrhosis Pancrastis Portal lymphadenopathy Hypercoagulation IBS Splenectomy Trauma
66
Numerous worm like venous collaterals that parallel the chronically thrombosis pv
Cavernous transformation
67
Disorder characterized by hepatic vein obstruction by thrombus or tumor. Typically seen in women taking birth control
Budd-chiari
68
Budd-chiari pt presents with: ascites, hepatosplenomegaly,enlarged caudate
Budd-chiari
69
With budd chiari the caudate lobe is often spared because the ________ drain directly into the inferior vena cava. Thus the ___________ enlarges with atrophy of rt and lt lobe.
Emissary veins Caudate lobe
70
Portal vein gas is associated with these two ischemic bowel diseases
Ulcerative colitis Crohns dz
71
In infants intrahepatic portal vein gas is caused by
Necrotizing entercolitis
72
Sonographic criteria of liver cyst
Anechoic Thin walled Acoustic enhancement
73
A hemorrhagic cysts presents with internal echoes, run pain and a decreasing \_\_\_\_\_\_\_\_\_\_\_\_.
Hematocrit
74
Differential diagnosis for liver cyst
Cystic tumor Abscess Polycystic liver diseas Hydadid Simple cyst
75
Benign solid liver mass more common in women Hallmark sign- central scar Aka- stealth lesion
Focal nodular hyperplasia
76
Liver lesion associated with birth control and/ or glycogen storage disease presenting with pain d/t tumor hemorrhage. Necrotic center is a key feature
Hepatic adenoma
77
Hyperechoic mass with propagation speed artifact and associated with tuberous sclerosis
Hepatic lipoma
78
Most common primary malignancy in the liver. Labs-increased AFP , ast,alt
Hepatocellular carcinoma
79
Common sonographic patterns Hyperechoic mets
Gi tract
80
Common sonographic patterns Hypoechoic mets
Lymphoma
81
Common sonographic patterns Bull's eye
Lung
82
Common sonographic patterns Calcified mets
Mucinous adenocarcinoma
83
Common sonographic patterns Cystic
Sarcoma
84
Uncommon malignant liver neoplasm in infants and children most occurring prior to age 2. Incr. AFP Assoc. with beckwith-wiedemann and polyposis
Hepatoblastoma
85
An increase in AST without increase in ALT is seen with\_\_\_\_\_\_\_\_\_\_, heart failure, muscle injury...
AST
86
AST aka\_\_\_\_\_\_\_
Sgot
87
ALT aka \_\_\_\_\_\_\_
SGPT
88
Most specific with liver disease
ALT
89
GGT Elevation indicates \_\_\_\_\_\_\_\_&\_\_\_\_\_\_\_\_
Hepatocellular disease & biliary obstruction
90
Increased GGT+ increased ALP=
Biliary obstruction
91
Increased GGT + increased ALT=
Hepatocellular disease
92
elevated levels of _______ occurs with HCC
AFP
93
\_\_\_\_\_\_\_&\_\_\_\_\_\_\_\_&\_\_\_\_\_\_\_\_ are monitored prior to an invasive procedure to insure proper clotting
PY, PTT(inr) and platelets
