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Abdomen Registry > Liver > Flashcards

Liver Flashcards

0
Q

The right lobe is divided into what 2 segments?

A

Anterior & posterior

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1
Q

The left lobe is divided ________&_________.

A

Medial & lateral

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2
Q

The caudate lobe lies on the __________ surface btwn IVC and medial left lobe.

A

Posterior-superior

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3
Q

What supplies the caudate lobe?

A

Branches of left & right portal venous and hepatic arterial systems.

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4
Q

Segment I

A

Caudate

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5
Q

Segment II

A

Left lateral superior

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6
Q

Segment III

A

Left lateral-inferior

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7
Q

Segment IVa

A

Left medial superior

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8
Q

Segment IVb

A

Left medial inferior

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9
Q

Segment V

A

Right anterior inferior

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10
Q

Segment VI

A

Right posterior inferior

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11
Q

Segment VII

A

Right posterior superior

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12
Q

Segment VIII

A

Right anterior superior

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13
Q

Intersegmental vessels: Location____________ appearance__________

A

Hepatic veins Course btwn the lobes & segments Non-echogenic walls

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14
Q

Intrasegmental vessels: Location____________ appearance__________

A

Portal triad course to the center of each segment Hyperechoic walls

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15
Q

Fibrofatty sheath of portal triad

A

Glisson’s capsule

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16
Q

Portal triad

A

MPV PHA CHD (CBD)

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17
Q

Divides the ant. Segment of the rt lobe from the medial segment of the lt lobe.

A

Main lobar fissure

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18
Q

Located between the gb neck and the junction of the rt and lt Portal vein.

A

Main lobar fissure

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19
Q

Divides rt lobe into ant. and post. Segments Landmark is rt hepatic vein

A

Rt intersegmental fissure

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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

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21
Q

Remnant of ductus venosus Separates lt lobe from caudate

A

LIGAMENTUM venosum

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22
Q

Remnant of the umbilical vein

A

LIGAMENTUM TERES

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23
Q

Remnant of the ductus venosus Runs from lt portal v to IVC seep rating lt lobe from caudate lobe

A

LIGAMENTUM venosum

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24
Q

Direction of fetal circulation

A

Umbilical v, lt pv, ductus venosus, IVC

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25
Q

Flow towards the liver above the baseline

A

Hepatopetal (p for positive)

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26
Q

Flow away from the liver ( below the baseline )

A

Hepatofugal ( to flee)

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27
Q

Waveform toward liver with mild undulations

A

Low-velocity continuous flow

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28
Q

Portal triad

A

MPV, proper hep art, common hepatic duct

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29
Q

Hepatic vein waveforms are typically _______ reflecting rt atrial filling! contraction and relaxation.

A

Triphasic

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30
Q

Proper hepatic art runs parallel to the _____

A

MPV

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31
Q

Rt hep art (replaced) originates from the ______ and seen posterior to__________.

A

SMA MPV

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32
Q

Hepatic art waveform demonstrates flow in diastole indicating a _________system

A

Low-resistance

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33
Q

In a post liver tx a _________( no diastole) hep art waveform may suggest organ rejection.

A

High resistance

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34
Q

Parvus tardus hep art waveform suggests anatomic stenosis at Prox, mid , or dist

A

Proximal

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35
Q

Parasitic infection associated with sheep and cattle raising countries. Larvae hatch in portal system and move into the liver.

A

Echinococcal cyst ( hydatid disease)

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36
Q

Presents as a cyst within a cyst( water lily sign) and assoc. with anaphylactic shock

A

Echinococcal cyst ( hydatid disease)

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37
Q

Major cause of portal hypertension worldwide Endemic areas: tropical zones

A

Schistosomiasis

38
Q

Sonographic presentation for schistosomiasis

A

Thickening and increased echogenicity of portal vein walls

39
Q

Accumulation of triglycerides within hepatocytes.

A

Fatty infiltration

40
Q

Genetically acquired disorder that results in the excess deposition of glycogen in the liver. Associated with diffuse fatty infiltration and hepatic adenomas

A

Glycogen storage disease

41
Q

8 Miscellaneous causes of cirrhosis

A

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
Q

Abnormal liver functions include:

A

AST(sgot) ALT (sgpt) GGT LDH Conjugated bilirubin

43
Q

Pv diameter suggesting portal hypertension

A

Greater than 13mm

44
Q

2 major causes of portal hypertension

A

Cirrhosis and schistosomiasis

45
Q

Portal hypertension is asymptomatic. Pt usually present with:

A

Sudden painless upper gi hemorrhage d/t rupture of esophageal varies that extend fro rt and lt gastric veins

46
Q

Type of portal hypertension: Ex: blood cannot get to liver, pv thrombosis

A

Extrahepatic presinusoidal

47
Q

Type of portal hypertension: Ex: blood cannt get through parenchyma , schistosomiasis

A

Intrahepatic presinusoidal

48
Q

Type of portal hypertension: Ex: most common, cirrhosis

A

Intrahepatic

49
Q

Type of portal hypertension: Ex: blood can’t get out of the liver, hepatic vein thrombosis

A

Intranet attic postsinusoidal

50
Q

Sonographic findings of portal htn

A

Splenomegaly Ascites Portal systemic venous collaterals

51
Q

2 techniques to lower portal pressure

A

TIPS portacaval shunt

52
Q

Collaterals of the distal esophagus and gastric fundus and may lead to life threatening gi hemorrhage

A

Gastroesophageal varices

53
Q

Re opening of the umbilical vein( ligamentum TERES) to act as collateral from the left portal vie to epigastric veins to IVC

A

Recanalizwd umbilical vein

54
Q

Tortuous collateral veins seen in splenic and left renal hilum

A

Splenorenal varices

55
Q

The veins of the retro peritoneal structures such as colon, duodenum, and pancreas anastomose with systemic tributaries

A

Intestinal varices

56
Q

Physical signs of collaterals

A

Caput medusa ( tortuous collaterals arnd umbilicus) Hemorrhoids Ascites Dilated veins of ant. Abd wall

57
Q

TIPSS is placed btwn a ________vein and a ________ vein. Typically the _____&_______.

A

Hepatic vein and portal vein. RHV&RPV

58
Q

A petent TIPS should present with _________ flow.

A

Hepatafugal

59
Q

Criteria for TIPS MALFUNCTION

A

Focal velocity increase in TIPS hepatafugal of MPV Hepatpedal of RPV or LPV

60
Q

With TIPS and a recannalized umbilical vein flow of the LPV can be___________.

A

Hepatopetal or hepatofugal

61
Q

Indication for liver transplant

62
Q

Indications for liver transplantation in children

A

Biliary atresia

63
Q

MELD

A

Model for end stage liver disease

64
Q

Tumoral cause for portal vein thrombosis

A

HCC Mets Pancreatic carcinoma

65
Q

Non-Tumoral causes for portal vein thrombosis

A

1 cause -cirrhosis Pancrastis Portal lymphadenopathy Hypercoagulation IBS Splenectomy Trauma

66
Q

Numerous worm like venous collaterals that parallel the chronically thrombosis pv

A

Cavernous transformation

67
Q

Disorder characterized by hepatic vein obstruction by thrombus or tumor. Typically seen in women taking birth control

A

Budd-chiari

68
Q

Budd-chiari pt presents with: ascites, hepatosplenomegaly,enlarged caudate

A

Budd-chiari

69
Q

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.

A

Emissary veins Caudate lobe

70
Q

Portal vein gas is associated with these two ischemic bowel diseases

A

Ulcerative colitis Crohns dz

71
Q

In infants intrahepatic portal vein gas is caused by

A

Necrotizing entercolitis

72
Q

Sonographic criteria of liver cyst

A

Anechoic Thin walled Acoustic enhancement

73
Q

A hemorrhagic cysts presents with internal echoes, run pain and a decreasing ____________.

A

Hematocrit

74
Q

Differential diagnosis for liver cyst

A

Cystic tumor Abscess Polycystic liver diseas Hydadid Simple cyst

75
Q

Benign solid liver mass more common in women Hallmark sign- central scar Aka- stealth lesion

A

Focal nodular hyperplasia

76
Q

Liver lesion associated with birth control and/ or glycogen storage disease presenting with pain d/t tumor hemorrhage. Necrotic center is a key feature

A

Hepatic adenoma

77
Q

Hyperechoic mass with propagation speed artifact and associated with tuberous sclerosis

A

Hepatic lipoma

78
Q

Most common primary malignancy in the liver. Labs-increased AFP , ast,alt

A

Hepatocellular carcinoma

79
Q

Common sonographic patterns Hyperechoic mets

80
Q

Common sonographic patterns Hypoechoic mets

81
Q

Common sonographic patterns Bull’s eye

82
Q

Common sonographic patterns Calcified mets

A

Mucinous adenocarcinoma

83
Q

Common sonographic patterns Cystic

84
Q

Uncommon malignant liver neoplasm in infants and children most occurring prior to age 2. Incr. AFP Assoc. with beckwith-wiedemann and polyposis

A

Hepatoblastoma

85
Q

An increase in AST without increase in ALT is seen with__________, heart failure, muscle injury…

86
Q

AST aka_______

87
Q

ALT aka _______

88
Q

Most specific with liver disease

89
Q

GGT Elevation indicates ________&________

A

Hepatocellular disease & biliary obstruction

90
Q

Increased GGT+ increased ALP=

A

Biliary obstruction

91
Q

Increased GGT + increased ALT=

A

Hepatocellular disease

92
Q

elevated levels of _______ occurs with HCC

93
Q

_______&________&________ are monitored prior to an invasive procedure to insure proper clotting

A

PY, PTT(inr) and platelets

Abdomen Registry (4 decks)

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