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ABD Board Review > Liver > Flashcards

Liver Flashcards

1
Q

What did the medial aspect of the left liver used to be called?

A

Quadrate

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2
Q

Does a single worldwide accepted classification of the liver exist?

A

No

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3
Q

The lobes are supplied by what veins?

A

rt lobe: rt portal vein

lt lobe: lt portal vein

caudate lobe: receives branches from rt and lt

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4
Q

where does the caudate lobe lie?

A

posterior-superior surface of liver between IVC and medial lt lobe

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5
Q

where do the emissary vein drain?

A

caudate lobe

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6
Q

left lobe:

segment I

segment II

segment III

A

caudate

left lat sup

left lat inf

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7
Q

left lobe

segment IVa

segment IVb

A

left med sup

left med inf

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8
Q

right lobe

segment V

segment VI

segment VII

segmentVIII

A

right anterior inf

rt post inf

rt post sup

rt anterior sup

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9
Q

portal triad encased by what fibrofatty sheath

A

glissons capsule

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10
Q

rt intersegmental fissure divides rt lobe into what segments?

lt intersegmental fissure divides lt lobe into what segments?

A

rt: anterior and posterior seg

lt medial and lateral seg

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11
Q

ligamentum venosum

A

remnant of ductus venosus and separates let lobe from caudate

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12
Q

what ligament is a remnant of the umbilical vein which runs from the umbilicus to the left portal vein?

A

ligamentum teres

with portal hypertension, can recanalize to form a portosystemic venous collateral

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13
Q

portal vein doppler and blood flow

A

hepatopetal

low-velocity continuous flow

velocity can increase after eating

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14
Q

upper limit of portal vein diameter and approx blood circulation

A

13mm

25% proper hepatic artery

75% portal vein

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15
Q

hepatic vein doppler and blood flow

A

hepatofugal

triphasic due to rt atrial filling and contraction

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16
Q

spectral presentation of hepatopetal and hepatofugal

A

flow toward transducer= above baseline

flow away from transducer= below baseline

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17
Q

rt hepatic artery may orginate from what vessel

A

SMA 11%

repalced RHA is seen post to head of pancreas and main portal

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18
Q

doppler hepatic artery wave forms

A

low resistance

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19
Q

post operative liver transplant hepatic artery waveform

A

high resistance suggest venous congestion of liver or possible rejection

parvus tardus waveform suggests prox anastomic stenosis

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20
Q

what ligament suspends liver from diaphragm

A

coronary ligament

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21
Q

liver measurement

A

measured sup-inf dimension

> 15.5 cm is hepatomegaly

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22
Q

inferior projection of rt lobe commonly seen in women

A

riedel’s lobe

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23
Q

liver echogenicity

A

homogeneous and slightly more hyperechoic to renal cortex

24
Q

small collection of macrophages that appear in liver and spleen caused by histoplamosis and tuberculosis?

A

hepatic granulomas

histoplasmosis caused by spores in the air from droppings of birds and bats

25
Q

elevated lab values in hepatitis

A

ALT, AST, conjugated and unconjugated bilirubin

26
Q

acute hepatitis appearence

A

starry night (periportal cuffing)

hypoechoic liver parenchyma

liver enlargement

hyperechoic portal vein walls

27
Q

chronic hepatitis appearence

A

hyperechoic liver parenchyma

small liver

decreased echogenicity of portal vein walls

28
Q

pyogenic abscess

A

most common source is biliary tract disease

accounts for 80% of abscesses

rt lobe affected more than lt

sono findings: complex mass, gas, reverberation artifact

29
Q

amebic abscess

A

parasite from intestines reaches liver via portal vein

sono findings: round hypoechoic/ complex mass, typically rt lobe dome

30
Q

candidiasis- fungal abscess

A

infection of blood results in small abscesses in liver

wheel within wheel pattern: hypoechoic, inner echogenic, hypo center

can be bulls eye

31
Q

adult tapeworms common in sheep herding areas

cyst within a cyst appearence

A

echinococcal cyst

32
Q

most common parasitic infection in humans and major cause of portal hypertension worldwide

A

schistosomiasis

sono findings: occluded intrahepatic portal veins, thickening of portal vein walls

33
Q

pneumocystic jiroveci

A

most common infection in persons with HIV

diffuse, hyperechoic foci

34
Q

genetic disorder of excess deposition of glycogen in the liver

A

glycogen storage disease or von Gierkes disease

associated woth fatty inflitrate and hepatic adenomas

35
Q

increased liver lab values for cirrhosis

A

AST

ALT

GGT

LDH (lactate dehydrogenase)

conjugated bilirubin

36
Q

sono findings of cirrhosis

A

hepatomegaly (acute)

liver atrophy (chronic)

caudate enlargement

nodulatity

fatty infiltrate

changes related to portal hypertension

37
Q

major cause of portal hypertension

A

cirrhosis

38
Q

four types of portal hypertension

A
  • extrahepatic presinusoidal: portal thrombosis
  • intrahepatic presinusoidal: schistosomiasis
  • intrahepatic: cirrhosis
  • intrahepatic postsinusoidal: hepatic vein thrombosis
39
Q

sono findings of portal hypertension

A

splenomegaly

ascites

portal systemic venous collaterals

40
Q

portal systemic collaterals connecting the portal system to the IVC, bypassing the liver

A

gastroesophageal varices

recanalized umbilical vein

splenorenal varices

intestinal varcies

rectal varices

41
Q

transjugular intrahepatic portal systemic shunting (TIPS)

A

hepatofugal flow normal

placed between rt hepatic vein and rt portal

42
Q

cavernous transformation

A

numerous wormlike venous collaterals parallel the thrombosed portal vein

43
Q

terminal causes of portal thrombosis

A

hepatocellular carcinoma

metastatic liver disease

pancreatic carcinoma

44
Q

hepatic vein obstruction, frequently idiopathic

A

budd-chiari

ascities, hepatomegaly, splenomegaly

caudate lobe often spared due to emissary veins

45
Q

what type of liver cyst will present with internal echoes, RUQ pain and decreasing hematocrit

A

hemorrhagic cyst

46
Q

most common benign liver tumor, majority asymptomatic, hyperechoic with posterior enhancement

A

cavernous hemangioma

may enlarge with pregnancy or estrogen

47
Q

benign solid liver mass believed to be a hyperplastic lesion rather than true neoplasm

A

focal nodular hyperplasia

varying echogenicity

central fibrous scar

stealth lesion

48
Q

associated with oral contraceptives and glycogen storage disease, pain due to tumor hemorrhage

A

hepatic adenoma

49
Q

most common primary liver malignancy, often with underlying chronic liver disease and cirrhosis

A

hepatocellular carcinoma

invades venous structures

variable appearence, most hypoechoic

increased alpha fetoprotein, AST, ALT

50
Q

metastic liver disease

A

most are multiple

hyperechoic: GI tract
hypoechoic: lymphoma

bulls eye: lung

calcified: mucinous adenocarcinoma of colon

cystic metastases: leiomyosarcoma

51
Q

estimated cancer deaths for 2014

A

lung 159,000

colon/rectal 50,000

breast 40,000

pancreatic 39,000

prostate 29,000

non-hodgkins lymphoma 18,000

bladder 15,000

kidney 14,000

thyroid 1900

52
Q

uncommon malignant liver neoplasm occuring in infants and children

A

hepatoblastoma

most occur 2 years of age

enlarging asymptomatic mass

increased serum alpha fetoprotein

lung metastases and portal vein invasion

53
Q

alpha fetoprotein increase associated with what tumors?

A

hepatocellular carcinoma

acute and chronic hepatitis

testicular cancer

54
Q

hCG increase for what tumors?

A

testicular cancer

choriocarcinoma

55
Q

elevated CA 19-9 is a marker for what

A

pancreatic cancer

colorectal and bile duct cancers

56
Q

prostate-specific antigen and prostatic acid phosphatase

A

prostate cancer

benign prostatic hypertrophy

57
Q

elevated carcinoembryonic antigen indicates

A

colorectal cancer

elevated with other cancers

ABD Board Review (8 decks)

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