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Abdomen > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Where is the falciform ligament located?

A

Abdomen

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2
Q

What is the falciform ligament attached to?

A

Liver, diaphragm, and anterior abdominal wall

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3
Q

What structure attaches the liver to the diaphragm and anterior wall?

A

Falciform ligament

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4
Q

What is the smooth fibrous covering of the liver called?

A

Glisson’s Capsule

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5
Q

Which vessel separates the left lobe from the right lobe of the liver?

A

Middle hepatic vein

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6
Q

Which vessel separates the right lobe of the liver into two segments?

A

Right hepatic vein

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7
Q

Which of the liver function lab values is most important?

A

Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)

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8
Q

The medial and lateral segments of the left lobe of the liver are separated by what structures?

A

Lt intersegmental fissure & Lt hepatic vein

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9
Q

What does the main lobar fissure connect?

A

Connects gallbladder fossa to the IVC

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10
Q

What are the branches of the left portal vein?

A

Medial and lateral

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11
Q

What are the branches of the right portal vein?

A

Anterior and posterior

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12
Q

What is the anterior border of the caudate lobe?

A

IVC

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13
Q

Describe where each of the liver segments is located.

A

Segment 1: caudate lobe, Segment 2-4: left lobe, Segment 5-8: right lobe

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14
Q

Where does the blood in the portal vein come from?

A

SMA & Splenic vein

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15
Q

This is where the splenic vein and superior mesenteric vein join to form the portal vein?

A

Portal confluence

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16
Q

This is a group of three structures that include the portal vein, hepatic vein, and bile duct?

A

Portal triad

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17
Q

What is the bare area of the liver?

A

It is the only part of the liver not covered by peritoneum

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18
Q

Where is the bare area of the liver located?

A

It is located on the posterior and superior portion

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19
Q

These are the sonographic appearance of?

A

Normal liver

  • Homogeneous Parenchyma
  • Interruptions in Homogeneous appearance: vascular structures, ligaments, overlying bowel gas
  • Normal echo brightness
  • Slightly greater than renal cortex
  • Slightly less than pancreas
  • Hypoechoic to spleen
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20
Q

What is bilirubin?

A

It causes jaundice

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21
Q

What are the 3 ways bilirubin can occur?

A

• Excessive destruction of RBC
• Malfunction of liver cells
• Obstruction in biliary system

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22
Q

Where is Morrison’s pouch?

A

Located between the posterior right liver lobe and the right kidney

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23
Q

What is the difference between visceral and parietal peritoneum?

A

Parietal peritoneum lines the wall of the cavity while visceral envelopes the organs except at hilium.

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24
Q

This is describing which omentum?

A

GREATER SAC

• Is the primary compartment of the peritoneal cavity
• Extends across the anterior abdomen and from the diaphragm to the pelvis
• Contains all intraperitoneal organs of the abdominal cavity

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25
Q

This is describing which omentum?

A

Lesser sac (Omental burse)

• Is the primary compartment of the peritoneal cavity
• Extends across the anterior abdomen and from the diaphragm to the pelvis
• Contains all intraperitoneal organs of the abdominal cavity

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26
Q

What are the potential spaces in the peritoneal cavity?

A

• Left anterior subphrenic space
• Right anterior subphrenic space
• Left posterior subhepatic space
• Right posterior subhepatic space
• Right and left para colic gutters spaces
• Vesicorectal space / vesicouterine pouch
• Rectouterine space

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27
Q

This is a scanning technique that focuses specifically on the peritoneal?

A

FAST technique

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28
Q

Why is the FAST technique used?

A

Assess the peritoneal potential spaces for free fluid in trauma situations

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29
Q

The FAST technique can detect as little as how much free fluid?

A

200 ml

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30
Q

What are the two types of ascites?

A

Transudative & Exudative

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31
Q

This is what type of ascites?

A

Transudative

• Characterized by a lack of protein and cellular materials in the fluid
• Typically has a simple appearance (anechoic) and is often associated with portal hypertension and congestive cardiac disease

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32
Q

This is what type of ascites?

A

Exudative

• Fluid contains a large amount of protein and cellular material, appears anechoic with debris, associated with renal failure, inflammatory or ischemic bowel disease, peritonitis, and malignancy

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33
Q

Transudative is what type of fluid collection?

A

Passive

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34
Q

Exudative is what type of fluid collection?

A

Active

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35
Q

What is it called when blood is collecting into the peritoneal cavity caused by trauma including iatrogenic trauma (biopsy)?

A

Hemoperitoneum

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36
Q

What is diffuse hepatocellular disease?

A

Group of disorders

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37
Q

What does diffuse hepatocellular affect and interfere with?

A

Affects hepatocytes and interferes with function of the liver

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38
Q

T/F: Diffuse hepatocellular affects the ENTIRE liver parenchyma, and produces overall change in echogenicity and size?

A

True

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39
Q

This is the area/ areas of increased echogenicity within normal liver tissue?

A

Focal fatty infiltration

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40
Q

This is the area of the liver parenchymal tissue that is spared?

A

Focal fatty spring

41
Q

What are the causes of fatty infiltration of the liver?

A

Obesity, Excessive alcohol intake, Poorly controlled hyperlipidemia, Diabetes, Excess corticosteroids, Pregnancy, Total parenteral hyperalimentation (excessive eating), Severe hepatitis, Glycogen storage disease, Cystic fibrosis, Pharmaceutical

42
Q

What lab values are associated with fatty infiltration?

A

Aspartate Aminotransferase (AST) & Alanine Aminotransferase (ALT)

43
Q

This is a sonographic appearance of?

A

Fatty Infiltration

• Hepatomegaly or NL in size
• Increased echogenicity
• Granular texture
• Obscurity of portal veins
• Paucity of hepatic vessels
• Difficulty in penetration
• Liver/ kidney echo brightness disparity

44
Q

Which disease is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissue, especially in the liver and kidneys?

A

Glycogen storage disease

45
Q

Which glycogen storage disease is most common?

A

Von Gierke’s

46
Q

What is hepatitis?

A

Inflammation of the liver

47
Q

How is hepatitis spread?

A

Reactions to viruses or toxins

48
Q

This hepatitis is spread by eating infected food or water?

A

Hepatitis A

49
Q

This hepatitis is spread by sexual contact, blood transfusions, or sharing contaminated needles?

A

Hepatitis B

50
Q

This hepatitis is spread through DIRECT contact with the blood or body fluid of person who has disease?

A

Hepatitis C

51
Q

This hepatitis is spread through contact with infected blood, unprotected sex, and infected needles?

A

Hepatitis D

52
Q

What are the symptoms of hepatitis?

A

• Jaundice
• Anorexia
• GI symptoms
• Fatigue
• Joint pain
• Flu symptoms
• Dark urine

53
Q

This is explaining what type of hepatitis on ultrasound?

A

ACUTE HEPATITIS

• Liver may appear normal
• Liver echogenicity may be decreased
• Accentuation of portal vein walls
• Liver may be enlarged and tender
• GB wall may be thickened

54
Q

This is explaining what type of hepatitis on ultrasound?

A

Chronic Hepatitis

• Liver echo pattern may be coarse
• Liver echogenicity may be increased
• Portal vein walls may be decreased in echogenicity in comparison to liver

55
Q

This is a diffuse process in which liver parenchyma is REPLACED by fibrosis and abnormal nodules?

A

Cirrhosis

56
Q

These are the associated findings of:

A

Cirrhosis

• Ascites
• Dilated portal vein
• Portosystemic varices
• Hepatofugal portal flow
• Increased hepatic arterial flow
• Splenomegaly
• Recanalized ligamentum teres

57
Q

What is the normal measurement of the portal vein?

A

13 mm

58
Q

What is the normal measurement of the splenic vein?

A

10 mm

59
Q

What are the liver segments called?

A

1: caudate, 2: Lt lateral superior, 3: Lt lateral inferior, 4a: Lt medial superior, 4b: Lt medial inferior, 5: Rt inferior anterior, 6: Rt inferior posterior, 7: Rt superior posterior, 8: Rt superior anterior

60
Q

What was the ligamentum teres in fetal life?

A

It was the obliterated umbilical vein of fetal circulation

61
Q

Describe Riedel’s lobe of the liver.

A

A tongue-like extension of the right lobe, may extend to the iliac crest, more common in females

62
Q

What are the first two levels of branches of the main portal vein?

A

Left portal vein and right portal vein

63
Q

This is defined as the OCCLUSION of some or all of the hepatic veins and/or occlusion of the IVC?

A

Budd Chiari

64
Q

Primary or secondary: is the resultant occlusion of the hepatic veins or IVC by a congenital web or fibrous cord?

A

Primary

65
Q

Primary or secondary: it is the occlusion of the hepatic veins and/or IVC occurs by tumor or thrombus formation.

A

Secondary

66
Q

This is an ultrasound appearance of: They are cysts that are usually small, less than 2-3cm, and are multiple throughout the liver parenchyma?

A

Polycystic liver disease

67
Q

What is a hydatid cyst caused by?

A

It is caused by Taenia echinococcus or Echinococcus granulosus - parasitic tapeworm

68
Q

This is an ultrasound appearance of?

A

Echinococcal cyst

• Mother cyst with daughter cyst
• Honeycomb cyst
• Water lily cyst

69
Q

How could you define inflammatory disease of the liver?

A

It is a pus forming mass within the liver usually due to bacterial or parasitic infection

70
Q

What are the symptoms of a pyogenic abscess?

A

• Pain
• Fever
• Pleuritis
• Nausea
• Vomiting
• Diarrhea
• Hepatomegaly

71
Q

What lab values are associated with a pyogenic abscess?

A

• Leukocytosis
• Increased LFTs
• Anemia

72
Q

This is defining what on ultrasound?

A

Pyogenic abscess

• More common in right lobe
• 1 cm to very large
• Shape variable (usually round or oval)
• Irregular poorly defined walls
• Anechoic to very echogenic
• 1/2 have posterior enhancement
• May have shadowing, or comet tail artifact
• Peripheral hypervascularity

73
Q

Who is at risk for an amoebic abscess?

A

Patients that have had a history of GI infections

74
Q

What are the symptoms of an amoebic abscess?

A

• Abdominal pain
• Diarrhea
• Melena

75
Q

What will happen if a patient with amoebic abscess does not get medical treatment?

A

Mortality rate is 100%

76
Q

What does an amoebic abscess look like on ultrasound?

A

• Typically subcapsular
• Low amplitude cyst fill in
• Thickened irregular walls
• Good through transmission

77
Q

Most common organism that causes infection in patients who are immunocompromised which is pneumonia. Life threatening is?

A

Pneumocystis carinii

78
Q

What is hepatic candidiasis?

A

Liver complication on HIV or other immunocompromised patients

79
Q

What is the cause of hepatic candidiasis?

A

Species of candida albicans

80
Q

What is the most common benign liver tumor?

A

Cavernous hemangioma

81
Q

This is describing what on ultrasound?

A

Cavernous hemangioma

• Classically round, highly echogenic, well defined, solid mass
• Some have posterior enhancement
• Homogeneous, however, larger hemangiomas are more heterogeneous and may have posterior enhancement
• Avascular

82
Q

What is the second most common benign liver tumor?

A

Focal nodular hyperplasia

83
Q

This is describing what on ultrasound?

A

Focal nodular hyperplasia

• Variable echotextures
• More or less echogenic than liver or isoechoic to the liver
• More common in the right lobe
• Mass is well circumscribed and many have a central scar
• Multiple nodules are separated by fibrous bands
• SIZE: .5 - 20 CM
• Color shows vessels radiating in a stellate configuration from the center of the mass

84
Q

Which benign liver tumor is made up of hepatocytes, Kupffer cells, and fibrous connective tissue and bile duct elements?

A

Focal Nodular Hyperplasia

85
Q

Who is at risk for a liver adenoma?

A

People who take oral contraceptives and men who take steroids

86
Q

What is the typical treatment for a liver adenoma?

A

Surgery

87
Q

What is a liver lipoma made of?

A

Fat cells

88
Q

This is describing what on ultrasound?

A

Liver adenoma

• More echogenic than liver
• Hypoechoic to liver
• Isoechoic to liver
• Typically 8-15 cm by detection
• May contain peripheral halo
• Increased vascularity throughout mass and surrounding mass

89
Q

Who is most at risk to develop HCC?

A

People 60 or over, three times more in men than women

90
Q

What are the symptoms of HCC? (8)

A

• Weight loss
• Low grade fever
• Nausea, vomiting
• RUQ pain
• Jaundice caused by bile ducts obstruction
• Pruritis caused by jaundice
• Ascites
• Portal hypertension, tumor invasion causing portal vein obstruction

91
Q

Which lab value is most significant for HCC?

A

AFP

92
Q

What is the most common liver malignancy?

A

Liver metastases

93
Q

What is the most common site for metastatic cancer in the body?

A

• GI tract
• Breast & lung
• Pancreas
• Colorectal
• Ovaries

94
Q

What does the ultrasound describe for?

No specific ultrasound appearance - variable
• May be a solitary tumor or multiple tumors
• May be focal (affecting only one area) or diffuse (liver texture becomes heterogeneous)
• May distort liver parenchyma
• May be hypoechoic, hyperechoic, isoechoic, or complex
• May cause hepatomegaly
• Tendency to invade portal veins and hepatic veins
• Ascites may be present

A

HCC

95
Q

Which labs might be elevated with metastatic disease?

A

CEA & AFP may be normal or elevated

96
Q

A patient with liver metastases may present with which symptoms? (7)

A

• Jaundice
• Pain
• Hepatomegaly
• Weight loss
• Abdominal swelling or bloating
• RUQ or abdominal pain
• Asymptomatic

97
Q

What does the ultrasound describe for liver metastatic disease?

A

• Bull’s eye sign (target sign)
• “Patchy pattern” or “moth eaten pattern”

98
Q

What is a medical imaging technique that uses an intravenous contrast agent to improve clarity of scans?

A

CEUS

99
Q

What is CEUS used for?

A

To detect diseases and conditions, evaluate organ function, monitor cancer therapy, and detect heart diseases.

Abdomen (4 decks)

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