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ARRT > Liver > Flashcards

Liver Flashcards

1
Q

the liver is suspended from the diaphragm and anterior abdominal wall by the _____ ligament and from the diaphragm by the reflections of the peritoneum

A

falciform

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2
Q

most of the liver is covered by peritoneum but a large area rests directly on the diaphragm, this is called the _____

A

bare area

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3
Q

the _____ space between the liver (or spleen) and diaphragm is a common site for abscess formation

A

subphrenic; the right subperenic space is between the right lobe, the right kidney and the right colic flexure

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4
Q

the _____ is an enclosed portion of the peritoneal space posterior to the liver and stomach

A

lesser sac; communicates near the head of the pancreas

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5
Q

the right _____ space is located inferior to the right lobe of the liver and includes morison’s pouch

A

subhepatic

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6
Q

the caudate lobe is situated one the ____ surface of the left lobe

A

posteriosuperior

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7
Q

the right, middle, and left hepatic veins divide the liver _____ into four sections

A

longitudinally; each of these sections is divided transversely by an invisible plane through right and left portal veins (8 sections all together)

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8
Q

the liver is covered by a thin connective tissue layer called _____

A

glisson’s capsule

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9
Q

the _____ is the boundary between the right and left lobes of the liver; in long it may be seen as a line from the portal vein to the neck of the gallbladder

A

main lobar fissure

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10
Q

the _____ extends from the umbilicus to the diaphragm in the parasagittal plane and contains the ligamentum teres

A

falciform ligament

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11
Q

the _____ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament; they both divide the medial and lateral segments of the left lobe of the liver

A

ligamentum teres

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12
Q

the fissure for the _____ separates the left lobe from the caudate lobe

A

ligamentum venosum

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13
Q

______ is a pigment released when the red blood cells are broken down

A

bilirubin

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14
Q

disease affecting the liver may be classified as _____, when the liver cells or hepatocytes are immediate problem; _____ when bile excretion is blocked

A

hepatocellular; obstructive

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15
Q

the liver functions as a major site for conversion of dietary sugars into _____, which is released into the bloodstream for general use

A

glucose; with liver disease the body may become glucose deficient (hypoglycemia)

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16
Q

in severe liver disease, abnormally low blood levels of ______ may be noted because the liver is the principal site for cholesterol synthesis

A

cholesterol

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17
Q

when the liver is chronically diseased, clinical laboratory results may reveal a significant lowering of the serum albumin (produced by the liver), a condition called _____

A

hypoalbuminemia

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18
Q

what laboratory test detect clotting deficiencies related to liver disease?

A

prothrombin time (pro-time) and partial thromboplastin time (PTT); percentage of time required for certain coagulation steps to occur in the patient’s blood compared to normal blood

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19
Q

the presences of increased quantities of enzymes in the blood is a sensitive indicator of a hepatocellular disorder., _____, _____ and _____ are of particular interest

A

aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; they are also included in biliary obstruction

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20
Q

in severe hepatocellular destruction, such as acute viral or toxic hepatitis, a striking elevation of ___ and ___ may be seen (exceeding 1000) but not elevated in biliary obstruction

A

AST and ALT

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21
Q

Marked elevation of _____ is typically associated with biliary obstruction or the presence of mass lesions in the liver

A

alkaline phosphatase

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22
Q

_____ is somewhat more specific for liver disease than AST

A

ALT; therefore elevation of ALT about AST suggest a hepatic cause

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23
Q

the level of urea in the blood is measured as the _____, and in severe liver disease this may be abnormally low because of falloff of urea production

A

blood urea nitrogen (BUN); failure of ammonium detoxification is a serious consequence of liver failure

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24
Q

measurement of the concentration of bilirubin in the blood is a standard laboratory test for hepatocellular disease, what are the two fractions of bilirubin that is measured?

A

direct-acting, consists of conjugated bilirubin, and indirect-acting, which consists of unconjugated bilirubin released from the reticuloendothelial system

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25
Q

biliary obstruction result in elevation of the _____; as wall as hepatocellular disease

A

direct-acting bilirubin; results in jaundice

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26
Q

indirect bilirubin predominates in _____

A

hemolysis

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27
Q

vitamin _____ is an essential precursor for the hepatic production of several clotting factors

A

K

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28
Q

any disease that injures the cells causes an elevation in _____ levels; this enzyme is also produced in other high metabolic tissues

A

AST; seen in acute hepatitis, cirrhosis, hepatic necrosis and infectious mononucleosis

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29
Q

hepatocellular disease and infectious or toxic hepatitis produces moderate to highly increased levels of _____

A

ALT

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30
Q

_____ primary use is in detection of myocardial or pulmonary infarction

A

lactic acid dehydrogenase

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31
Q

a _____ prothrombin time indicates a poor prognosis, chronic liver disease commonly show an elevation of gamma globulins

A

prolonged

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32
Q

the average adult abdomen usually requires at least a broadband _____ frequency, whereas the more obese adult may require a lower frequency _____ transducer

A

2.5 MHz to 5 MHz; 2.25MHz
children may need 5 to 7 MHz
neonates may need 7.5 to 12 MHz

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33
Q

the right lobe of the liver is divided into anterior and posterior segments by the _____

A

right intersegmental fissure

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34
Q

the _____ divides the left lobe into medial and lateral segments

A

left intersegmental fissure

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35
Q

the hepatic veins course between the lobes and segments this is called _____

A

interlobar and intersegmental

36
Q

the major branches of the portal veins run centrally within the segments this is called _____

A

intrasegmental

37
Q

generally the liver measures less than _____ in long view

A

15 cm with 15 to 20 cm representing the upper limits of normal; hepatomegaly is when liver exceeds 20 cm

38
Q

in a congenital diaphragmatic _____ or omphalocele, where varying amounts of liver tissue may herniate into the thorax or outside the abdominal cavity

A

hernia

39
Q

variations in the branching of the hepatic veins are common, with the most common being when the accessory vein drains the _____ segment of the right lobe

A

superoanterior

40
Q

_____ is an acquired, reversible disorder of metabolism, resulting in an accumulation of triglycerides within the hepatocytes

A

fatty liver

41
Q

_____ implies increased lipid accumulation in the hepatocytes and results from major injury to the liver or a systemic disorder leading to impaired or excessive metabolism of fat

A

fatty infiltration

42
Q

what are the three grades of liver texture for classification of fatty infiltration?

A

mild-minimal diffuse increase in hepatic echgenicity
moderate- increased echogenicity, impaired visualization of the diaphragm and intrahepatic vascular borders
severe- marked increase in echogenicity, decrease penetration, poor visualization of the diaphragm and hepatic vessels

43
Q

the most common areas for focal sparing are anterior to the _____ or the portal vein and the periportal region of the medial segment of the left lobe of the liver

A

gallbladder

44
Q

_____ is the general name for inflammatory and infectious disease of the liver

A

hepatitis; may result from a local infection (viral hepatitis); or from an infection elsewhere in the body (mononucleosis or amebiasis); or from chemical or drug toxicity

45
Q

patients with _____ and _____ hepatitis may initially present with flulike and gastrointestinal symptoms, including loss of appetite, nausea, vomiting, and fatigue

A

acute and chronic

46
Q

_____ hepatitis may be fatal with secondary acute hepatic necrosis or chronic hepatitis, which may lead to portal hypertension, cirrhosis, and hepatocellular carcinoma

A

viral

47
Q

hepatitis _____ spreads primarily by fecal contamination, because the virus lives in the alimentary tract

A

A

48
Q

hepatitis _____ can spread by transfusions of infected blood or plasma or through the use of contaminated needles; it is also found in body fluids such as saliva and semen, and may be spread by sexual contact

A

B

49
Q

hepatitis _____ is diagnosed by the presence in blood of the antibody to HCV

A

C

50
Q

with acute hepatitis texture may appear normal or the portal vein borders are more _____ than usual and the liver is slightly echogenic; hepatosplenomegaly is present, and gallbladder wall is thickened

A

prominent

51
Q

with chronic hepatitis the liver is coarse with _____ brightness of the portal triads, but the degree of attenuation is not as great as in fatty liver; no increase in size, fibrosis may be evident

A

decrease

52
Q

_____ is a chronic degenerative disease of the liver in which the lobes are covered with fibrous tissue, and the parenchyma degenerates, and the lobules are infiltrated with fat

A

cirrhosis; micronodular cirrhosis is most commonly teh result of chronic alcohol abuse, where as macronodular cirrhosis is caused by chronic viral hepatitis or other infection

53
Q

patients with _____ cirrhosis may seem asymptomatic or may have symptoms that include nausea, flatulence, ascites, light-colored stools, weakness, abdominal pain, varicosities, and spider angiomas

A

acute

54
Q

_____ cirrhosis patients symptoms include nausea, anorexia, weight loss, jaundice, dark urine, fatigue, or varicosities; may progress to liver failure and portal hypertension

A

chronic

55
Q

as cirrhosis becomes more severe, the liver volume ____ in the right lobe, with ______ of the left and caudate lobe

A

decreases; enlargement; a C/RL value of 0.65 is considered cirrhosis

56
Q

_____ cirrhosis may show nudularity of the liver edges, especially well demonstrated with ascites; isoechoic regenerating nodules may be seen throughout the liver parenchyma

A

chronic

57
Q

_____ nodules or _____ hyperplastic nodules are larger than the regenerating nodules and are considered premalignant; these nodules contain well differentiated hepatocytes, portal venous blood supply, and a typical or frankly malignant cells

A

dysplastic or adenomatous

58
Q

_____ is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissued, especially the liver and kidneys

A

glycogen storage disease; there are 6 different types

59
Q

the most common type of glycogen storage disease is _____, this is a form in which abnormally large amounts of glycogen are deposited in the liver and kidneys

A

type 1 or von Gierke’s disease

60
Q

_____ is associated with hepatic adenomas, focal nodular hyperplasia, and hepatomegaly; the adenoma presents as a well-demarcated, round, homogeneous, echogenic tumors

A

glycogen storage disease

61
Q

_____ is a rare disease of iron metabolism characterized by excess iron deposits throughout the body; may lead to cirrhosis and portal hypertension

A

hemochromatosis

62
Q

_____ exists when the portal venous pressure is above 10 mmHg or the hepatic venous gradient is more than 5mmHg

A

portal venous hypertension; secondary to liver disease

63
Q

_____ develops when the normal venous channels become obstructed; this diverted blood flow causes embryologic channels to reopen

A

collateral circulation; the most common are through the coronary and esophageal veins

64
Q

normal portal vein waveform is _____ with low velocity; the flow should be smooth and laminar

A

monophasic; obstruction of the portal venous system is recognized by turbulence within the vessel

65
Q

what are the 3 types of portal shunts

A

portacaval shunt- attaches the main portal vein at the SMV-splenic confluence to the anterior IVC
mesocaval shunt- attaches the middistal SMV to the IVC
splenorenal shunt- attaches the splenic vein to the left renal vein

66
Q

the primary type of Budd-Chiari syndrome is caused by _____ of the hepatic veins or IVC by membranous webs across the upper vena cava at or just about the entrance of the left and middle hepatic vein

A

congenital obstruction; ascites is the most common characteristic of this disease; others is URQ pain and hepatomegaly

67
Q

in Budd-Chiari the _____ lobe is enlarge and there is often atrophy of the right hepatic lobes

A

caudate; has an independent vascular supply; in late stages of this disease the liver appears hyperechoic and inhomogeneous with fibrosis

68
Q

a _____ mass in the area of the porta hepatis causes the same clinical signs as seen in biliary obstruction

A

extrahepatic

69
Q

a _____ is a pus-forming abscess; bacteria gets into the liver through the biliary tree, the portal vein, or the hepatic artery

A

pyogentic abscess; clinically present with fever, pain pleuritis, nausea, vomiting, and diarrhea

70
Q

_____ is caused by a species of Candida, usually occurs in immunocompromised hosts; the fungus invades the bloodstream

A

hepatic candidiasis; may present as multiple small hypoechoic masses with echogenic central core (bulls-eye or target lessions)

71
Q

_____ is a collection of pus formed by disintegrated tissue in a cavity, usually in the liver, caused by the protozoan parasite Entamoeba histolytica; reaches the liver via the portal vein

A

amebic abscess; ingested by contaminated water; usually affects the colon and cecum; the lesion is hypoechoic compared with normal liver and may be some enhancement

72
Q

hepatic _____ is an infectious cystic disease common in sheep-herding areas of the world; its a tapeworm

A

echinococcal; has 2 layers, the smaller daughter cysts may develop from the inner layer; may rupture and lead to vascular thrombosis and infarction

73
Q

echinococcal cysts have a _____ appearance with fluid collections and sometimes calcifications

A

honeycomb; water lily sign shows a detachment and collapse of the germinal layer

74
Q

_____ is a common life-threatening infection in patients with human immunodeficiency virus

A

pneumocystis carinii; diffuse, tiny, nonshadowing, echogenic foci to extensive replacement of parenchyma by various echogenic clumps of calcification

75
Q

a _____ is a benign, congenital tumor consisting of large, blood-filled cystic spaces

A

hemangioma

76
Q

_____ hemangioma is the most common benign tumor of the liver

A

cavernous; frequently in women; large masses may show necrosis, degeneration, calcification; hyperechoic w/ enhancement

77
Q

a liver cell _____ consists of normal and slightly atypical hepatocytes, frequently containing areas of bile stasis and focal hemorrhage or necrosis

A

adenoma; more common in women; ruq pain secondary to rupture with bleeding; hyperechoic with central echogenic areas caused by hemorrage; fluid may be present

78
Q

____ lesion consists of normal hepatocytes, Kupffer cells , bile duct elements, and fibrous connective tissue, which separate into multiple nodules

A

focal nodular hyperplasia; more frequent in women less than 40; frequently found in right lobe of liver

79
Q

the most common malignant tumor is _____

A

hepatocellular carcinoma; clinical symptoms to liver cancer include nausea, vomiting, fatigue, weight loss, and hepatomegaly; portal hypertension and splenomegaly is common

80
Q

_____ may present in one of 3 patterns; solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltrative masses in the liver

A

Hepatocelluar carcinoma; indications of cirrhosis, may invade hepatic veins, thrombus

81
Q

what are the primary sites for metastatic disease of the liver?

A

colon, breast, and lung; elevated LFT’s; diffuse distortion of the bulls eye pattern; typically multiple nodes throughout the liver

82
Q

_____ are malignant neoplasms involving lymphocyte proliferation in the lymph nodes; 2 main disorders, hodgkins lymphoma (hypoechoic or diffuse patterns) and non-hodgkins lymphoma ( target or echogenic lesions)

A

lymphoma; elevated LFT’s; intrahepatic and lucent multiple small, discrete solid lesions without enhancement

83
Q

with _____ intraperitonial fluid should be assessed along the flanks and into the pelvis; septations and internal echoes develop 1 to 4 weeks after

A

hepatic laceration

84
Q

the presents of portal vein _____ is a predictor of a higher risk in liver transplants

A

thrombosis; the primary function of the sonographic examination is to evaluate the portal vein, hepatic artery, the IVC, and the liver parenchymal pattern

85
Q

complications of live transplant include rejection, thrombosis or leak, biliary stricture or infarction, and neoplasia; ______ is the most common cause of hepatic dysfunction

A

rejection; during the postoperative period, hepatic artery thrombosis is the most serious complication of liver transplantation

ARRT (9 decks)

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