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ABDOMEN REVIEW > Liver > Flashcards

Liver Flashcards

1
Q

Where does the right lobe of liver get its blood supply?

A

right portal vein

pg. E 4

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2
Q

Where does the left lobe of liver get its blood supply?

A

left portal vein

pg. E 4

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3
Q

Where does the caudate lobe of the liver get its blood supply?

A

right and left portal veins

pg. E 4

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4
Q

Where is the caudate lobe located in reference to the ligamentum venosum?

A

posterior

pg. E 4

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5
Q

Where is the caudate lobe located in reference to the porta hepatis?

A

posterior

pg. E 4

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6
Q

Where is the caudate lobe located in reference to the IVC?

A

anterior and medial

pg. E 4

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7
Q

What is the caudate lobe located in reference to the lesser sac?

A

lateral

pg. E 4

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8
Q

Where is the caudate lobe located within the liver?

A

posterior superior surface

pg. E 4

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9
Q

What is the first order division of the liver?

A

lobar/hemilobar anatomy

pg. E 3

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10
Q

How is the liver divided in the first order division of the liver?

A

right and left lobes are divided by a plane between the GB and IVC
pg. E 3

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11
Q

What is the second order division of the liver?

A

sector/segment anatomy

pg. E 4

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12
Q

How is the liver divided in the second order division of the liver?

A 
Left lateral 
Left medial
Right anterior
Right posterior
pg. E 4
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13
Q

What is the third order division of the liver?

A

segment/subsegment anatomy

pg. E 5

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14
Q

How is the liver divided in the third order division of the liver?

A 
Segment I - caudate lobe
Segment II - left lateral superior
Segment III - left lateral inferior
Segment IVa - left medial superior
Segment IVb - left medial inferior
Segment V - right anterior inferior
Segment VI - right posterior inferior
Segment VII - right posterior superior
Segment VIII - right anterior superior
pg. E 5
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15
Q

What is another name for hepatic veins?

A

intersegmental vessels

pg. E 7

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16
Q

What is another name for the portal triad?

A

intrasegmental vessels

pg. E 7

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17
Q

Why do the portal veins have hyperechoic walls?

A

encased by Glisson’s capsule

pg. E 7

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18
Q

What are the vessels of the portal triad?

A

main portal vein
proper hepatic artery
common hepatic duct
pg. E 7

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19
Q

Where is the main lobar fissure located?

A

between the GB neck and junction of RPV and LPV

pg. E 8

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20
Q

What does the main lobar fissure divide?

A

right and left lobes between IVC and GB

pg. E 8

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21
Q

What is the ligamentum venosum?

A

remnant of the ductus venosus
separates the LT from the caudate lobe
pg. E 8

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22
Q

What is the ligamentum teres?

A

remnant of the umbilical vein to the LPV

pg. E 9

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23
Q

What can happen to the ligamentum teres in portal hypertension and cirrhosis?

A

it can recanalize to form a collateral

pg. E 9

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24
Q

What is the direction of circulation in a fetus?

A 
umbilical vein 
LPV
ductus venosus
IVC
pg. E 9
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25
Q

What is hepatopetal flow?

A

flow towards the liver

pg. E 10

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26
Q

What is hepatofugal flow?

A

flow away from the liver

pg. E 10

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27
Q

Which direction of flow should the portal vein be?

A

hepatopetal

pg. E 10

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28
Q

What does a normal portal vein waveform look like?

A

low velocity continuous flow toward the liver
above the baseline
pg. E 10

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29
Q

What is the upper limits of normal diameter of a portal vein?

A

13 mm

pg. E 10

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30
Q

What does a > 13 mm diameter of the portal vein suggest?

A

portal hypertension

pg. E 10

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31
Q

What does a normal hepatic vein waveform look like?

A

triphasic
below the baseline
pg. E 10

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32
Q

What does a normal hepatic artery waveform look like?

A

low resistive
above the baseline
pg. E 11

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33
Q

If a patient just had a liver transplant and the hepatic artery waveform is high resistive, what does it indicate?

A

possible organ rejection

pg. E 11

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34
Q

If a patient just had a liver transplant and the hepatic artery waveform is seen as a parvus tardus waveform, what does it indicate?

A

proximal anastomotic stenosis

pg. E 11

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35
Q

What does the RHV separate?

A

divides anterior and posterior segments of the RT lobe

pg. E 13

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36
Q

What does the MHV separate?

A

separates the LT and RT lobes

pg. E 13

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37
Q

What does the LHV separate?

A

divides medial and lateral segments of the LT lobe

pg. E 13

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38
Q

What is considered hepatomegaly?

A
  1. 5 cm or greater

pg. E 14

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39
Q

What is Riedel’s lobe?

A

inferior projection of the RT lobe

pg. E 14

40
Q

What is normal liver echotexture?

A

homogeneous and slightly hyperechoic compared to renal cortex
pg. E 14

41
Q

What are hepatic granulomas?

A

calcifications in the liver

pg. E 14

42
Q

What can hepatic granulomas be caused by?

A

histoplasmosis
tuberculosis
pg. E 15

43
Q

What is hepatitis?

A

inflammation of the liver

pg. E 15

44
Q

What can cause hepatitis?

A

viral, bacterial, fungal, parasitic organisms
medications, toxins, and autoimmune disorders
pg. E 15

45
Q

In hepatitis, what liver enzymes are elevated?

A

ALT
AST
bilirubin
pg. E 15

46
Q

What are the sonographic findings of acute hepatitis?

A 
"starry night" periportal cuffing
hypOechoic liver parenchyma
enlarged liver
hyperechoic portal vein walls
pg. E 15
47
Q

What are the sonographic findings of chronic hepatitis?

A

hypERechoic liver parenchyma
small liver
decreased echogenicity of portal vein walls
pg. E 15

48
Q

What is the most common cause for hepatic abscesses?

A

biliary tract disease

pg. E 16

49
Q

What is the most common type of abscess?

A 
pyogenic abscess (pus-forming)
pg. E 16
50
Q

What are the symptoms for a pyogenic abscess?

A 
RUQ pain
Fever
elevated LFT's
elevated WBC's
pg. E 16
51
Q

What are the sonographic findings of a pyogenic abscess?

A

Complex mass
Gas
Reverberation artifact
pg. E 16

52
Q

What does a pyogenic abscess appear similar to?

A

amebic abscess

pg. E 17

53
Q

How can you differentiate a pyogenic abscess from an amebic abscess?

A

sonographically you cannot tell
it is seen in patients who are immigrants or travelers
pg. E 17

54
Q

What is the sonographic appearance of candidiasis?

A 
changes over the course of the disease
"wheel within a wheel"
"bulls eye"
"uniformly hypoechoic"
"echogenic focus"
pg. E 17
55
Q

How can you get an echinococcal cyst?

A

found in sheep herding countries from ingesting tapeworms eggs from an infected sheep
pg. E 18

56
Q

What is the sonographic appearance of echinococcal cysts?

A

“cyst within a cyst”
“water lily” sign
pg. E 18 H 256

57
Q

What is schistosomiasis and what can it cause?

A

parasite that can cause portal hypertension

pg. E 19

58
Q

What are the sonographic findings of schistosomiasis?

A

thickened portal vein walls
occluded portal veins
pg. E 19

59
Q

What is the most common organism that causes AIDS?

A

pneumocystic carinii

pg. E 20 H 256

60
Q

What are the sonographic characteristics of pneumocystic carinii?

A

diffuse nonshadowing echogenic foci within the liver

pg. E 20 H 256

61
Q

What are the sonographic findings of a patient with AIDS?

A 
hepatomegaly
splenomegaly
lymphadenopathy
pneumocystis carinii
fatty liver
non-hodgkin's lymphoma
candidiasis
cholangitis (inflammed bile ducts)
cholecystitis
pg. E 20
62
Q

What are some of the most common causes of fatty liver?

A

obesity
excessive alcohol intake
diabetes
pg. E 21 H 235

63
Q

What is another name for fatty infiltration?

A

Fatty steatosis

pg. E 21

64
Q

What is focal fatty infiltration?

A

focal areas of increased echogenicity within a normal liver parenchyma
pg. E 21

65
Q

Where is focal fatty infiltration most common?

A

at the porta hepatis

pg. E 21

66
Q

What is focal fatty sparing?

A

focal areas of decreased echogenicity in a fatty liver

pg. E 21

67
Q

What are some common causes for cirrhosis?

A

Hepatitis
Alcoholism
Fatty Liver
pg. E 22

68
Q

What liver function tests are elevated with cirrhosis?

A 
AST
ALT
bilirubin
LDH
GGT
pg. E 22
69
Q

What are the sonographic findings of cirrhosis?

A 
Acute - hepatomegaly
Chronic - atrophic liver
caudate lobe enlargement
nodular surface
fatty infiltration
pg. E 22
70
Q

What is the most common cause of cirrhosis today?

A

Hepatitis C

pg. E 22

71
Q

What is the diameter of the portal vein when it is considered portal hypertension?

A

13 mm or greater

pg. E 23

72
Q

What is the most common cause of portal hypertension?

A

cirrhosis

pg. E 23

73
Q

What are the sonographic signs of portal hypertension?

A 
increase in diameter of vessel
collateral vessels form
ascites
splenomegaly
pg. E 23
74
Q

What are some techniques to lower portal hypertension?

A

portacaval shunt
splenorenal shunt
TIPS
pg. E 23

75
Q

What are some of the physical signs of collaterals?

A

dilated veins on anterior abdominal wall
hemorrhoids
acites
pg. E 24

76
Q

What is the role of a TIPS procedure?

A

lowers portal hypertension

pg. E 25

77
Q

Where is a TIPS shunt placed?

A

inserted at the jugular and placed between a hepatic v and a portal v (right is most common)
E 25

78
Q

Which direction should the flow of the RPV and LPV be with a patent shunt?

A

hepatofugal

E 25

79
Q

What is the most common indication for a liver transplant in an adult?

A

cirrhosis

E 26

80
Q

What is the most common indication for a liver transplant in children?

A

biliary atresia

E 26

81
Q

What is the scoring system for staging liver disease?

A

MELD -The Model for End-Stage Liver Disease

E 26

82
Q

What are the sonographic findings of portal vein thrombosis?

A 
hypoechoic thrombus within the portal vein
increased portal vein caliber 
cavernous transformation
portal systemic collaterals
E 27
83
Q

What are the causes of portal vein thrombosis?

A 
Hepatocellular carcinoma
Metastatic liver disease
pancreatic carcinoma
cirrhosis 
E 27
84
Q

What is Budd-Chiari Syndrome?

A

Disorder characterized by hepatic vein obstruction

E 28

85
Q

What are the causes of Budd-Chiari Syndrome?

A 
idopathic (50% of cases)
congenital
infection
pregnancy
tumors
E 28
86
Q

What kind of cyst within the liver would cause RUQ pain and a decreasing hematocrit?

A

hemorrhagic cyst

E 29

87
Q

What is the most common benign tumor of the liver?

A

cavernous hemangioma

E 30

88
Q

What are the sonographic characteristics of a hemangioma?

A

hyperechoic
posterior acoustic enhancement
generally no flow
E 30

89
Q

What are the sonographic characteristics of focal nodular hyperplasia?

A 
solid mass with varying echogenicity
solitary
central fibrous scar
stellate vascularity
E 31
90
Q

What is a cause for hepatic adenomas?

A

oral contraceptive use

E 31

91
Q

What is a hepatic lipoma?

A

rare fatty tumor of the liver

E 32

92
Q

What are the hyperechoic hepatic masses?

A

Hemangioma
Hepatic lipoma
Focal fatty infiltration
E 32

93
Q

What is the most common malignancy of the liver?

A

Hepatocellular carcinoma

E 33

94
Q

Hepatocellular carcinoma is seen in patients with ___.

A

cirrhosis

E 33

95
Q

What malignant liver neoplasm is seen in infants and children?

A

hepatoblastoma

E 35

96
Q

AST and ALT are increased in what diseases?

A

Fatty liver
excessive alcohol intake
Hepatitis
E 36

97
Q

Alpha Fetoprotein (AFP) is increased in what diseases?

A 
Hepatocellular Carcinoma
Germ Cell Tumors
Hepatoblastoma
Metastatic liver cancer
E 37

ABDOMEN REVIEW (7 decks)

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