Quiz 2 Flashcards
Where is the falciform ligament located?
Abdomen
What is the falciform ligament attached to?
Liver, diaphragm, and anterior abdominal wall
What structure attaches the liver to the diaphragm and anterior wall?
Falciform ligament
What is the smooth fibrous covering of the liver called?
Glisson’s Capsule
Which vessel separates the left lobe from the right lobe of the liver?
Middle hepatic vein
Which vessel separates the right lobe of the liver into two segments?
Right hepatic vein
Which liver function lab values are most important?
Aspartate aminotransferase (AST), Alanine aminotransferase (ALT)
The medial and lateral segments of the left lobe of the liver are separated by what structures?
Lt hepatic vein
What does the main lobar fissure connect?
Connects gallbladder fossa to the IVC
What are the branches of the left portal vein?
Medial and lateral
What are the branches of the right portal vein?
Anterior and posterior
Which vein carries blood into the liver from the digestive organs?
Portal veins
Which vein carries blood out of the liver towards the inferior vena cava in the shape of a ‘V’?
Hepatic
Which liver function test indicates liver cell necrosis if increased?
Aspartate Aminotransferase (AST)
Which liver function test indicates liver cell necrosis if increased and enzymes are present?
Alanine aminotransferase (ALT)
Which liver test value provides insight on how well the liver is processing & excreting waste?
Bilirubin
Which liver test value is part of the blood clotting mechanism?
Prothrombin
Which liver test values are plasma proteins made by the liver, and a decrease in level signifies liver cell damage?
Albumin & globulins
Which liver test value are enzymes found in the liver?
Alpha fetoprotein
Which liver test value is increased in alcoholism?
Gamma glutamyl transferase
What is the anterior border of the caudate lobe?
IVC
Describe where each of the liver segments is located.
Segment 1: caudate lobe, Segment 2-4: left lobe, Segment 5-8: right lobe
Where does the blood in the portal vein come from?
SMA & Splenic vein
This is where the splenic vein and superior mesenteric vein join to form the portal vein.
Portal confluence
This is a group of three structures that include the portal vein, hepatic vein, and bile duct.
Portal triad
What is the bare area of the liver?
Only part of the liver not covered by peritoneum
Where is the bare area of the liver located?
It is located on the posterior and superior portion
Homogeneous parenchyma, interruptions in homogeneous appearance, normal echo brightness, slightly greater than renal cortex, slightly less than pancreas, hypoechoic to spleen is the appearance of ?
Normal liver
Digestion, storage, blood clotting, metabolism, detoxification, immune response, hormone & protein production, and bilirubin processing are the functions of ?
The liver
What is bilirubin?
The breakdown product of hemoglobin in red blood cells
What are the 3 ways bilirubin can occur?
• Excessive destruction of RBC
• Malfunction of liver cells
• Obstruction in biliary system
Where is Morrison’s pouch?
Between the posterior right liver lobe and the right kidney
What is the difference between visceral and parietal peritoneum?
Parietal peritoneum lines the wall of the cavity while visceral envelopes the organs except at hilum.
This is describing which omentum: Is the primary compartment of the peritoneal cavity, extends across the anterior abdomen and from the diaphragm to the pelvis, and contains all intraperitoneal organs of the abdominal cavity?
Greater sac
This is describing which omentum: 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?
Lesser sac (Omental burse)
What are the potential spaces in the peritoneal cavity?
• 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
This is a scanning technique that focuses specifically on the peritoneal.
FAST
Why is the FAST technique used?
Assess the peritoneal potential spaces for free fluid in trauma situations
The FAST technique can detect as little as how much free fluid?
200 mL
What are the two types of ascites?
Transudative & Exudative
This is what type of ascites: Characterized by a lack of protein, has a simple appearance (anechoic) and is often associated with portal hypertension and congestive cardiac disease?
Transudative
This is what type of ascites: 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?
Exudative
Transudative is what type of fluid collection?
Passive
Exudative is what type of fluid collection?
Active
What is it called when blood is collecting into the peritoneal cavity caused by trauma including iatrogenic trauma (biopsy)?
Hemoperitoneum
What is diffuse hepatocellular disease?
Group of disorders
This is the area/areas of increased echogenicity within normal liver tissue?
Focal fatty infiltration
This is the area of the liver parenchymal tissue that is spared?
Focal fatty spring
Obesity, excessive alcohol intake, poorly controlled hyperlipidemia, diabetes, excess corticosteroids, pregnancy, total parenteral hyperalimentation (excessive eating), severe hepatitis, glycogen storage disease, cystic fibrosis, & pharmaceutical are the causes of ?
Fatty infiltration
What does diffuse hepatocellular affect and interfere with?
Affects hepatocytes & interferes with function of the liver
True or False: Diffuse hepatocellular affects the entire liver parenchyma, and produces overall change in echogenicity and size?
True
What lab values are associated with fatty infiltration?
Aspartate Aminotransferase (AST) & Alanine Aminotransferase (ALT)
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 are the appearance of ?
Fatty infiltration
Which disease is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissue, especially in the liver and kidneys?
Glycogen storage disease
Which glycogen storage disease is most common?
Von Gierke’s
What is hepatitis?
Inflammation of the liver
How is hepatitis spread?
Reactions to viruses or toxins
This hepatitis is spread by eating infected food or water?
Hepatitis A
This hepatitis is spread by sexual contact, blood transfusions, or sharing contaminated needles?
Hepatitis B
This hepatitis is spread through direct contact with the blood or body fluid of a person who has the disease?
Hepatitis C
This hepatitis is spread through contact with infected blood, unprotected sex, and infected needles?
Hepatitis D
Jaundice, anorexia, GI symptoms, fatigue, joint pain, flu symptoms, dark urine are the symptoms of ?
Hepatitis
What type of hepatitis on ultrasound may show 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?
Acute hepatitis
What type of hepatitis on ultrasound may show liver echo pattern may be coarse, liver echogenicity may be increased, portal vein walls may be decreased in echogenicity in comparison to liver?
Chronic hepatitis
What is a diffuse process in which liver parenchyma is replaced by fibrosis and abnormal nodules, it is irreversible and progressive?
Cirrhosis
Ascites, dilated portal vein, portosystemic varices, hepatofugal portal flow, increased hepatic arterial flow, splenomegaly, & recanalized ligamentum teres are the findings of ?
Cirrhosis
What is the normal measurement of the portal vein?
13 mm
What is the normal measurement of the splenic vein?
10 mm
What are the liver segments called?
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
What was the ligamentum teres in fetal life?
It was the obliterated umbilical vein of fetal circulation
Describe Riedel’s lobe of the liver.
A tongue-like extension of the right lobe, more common in females
What are the first two levels of branches of the main portal vein?
Left portal vein and right portal vein
This is defined as the occlusion of some or all of the hepatic veins and/or occlusion of the IVC?
Budd Chiari
Primary or secondary: Is the resultant occlusion of the hepatic veins or IVC by a congenital web or fibrous cord?
Primary
Primary or secondary: It is the occlusion of the hepatic veins and/or IVC occurs by tumor or thrombus formation?
Secondary
They are cysts that are usually small, less than 2-3cm, and are multiple throughout the liver parenchyma are an appearance of ?
Polycystic liver disease
What is a hydatid cyst caused by?
Taenia echinococcus or Echinococcus granulosus - parasitic tapeworm
What is a typical ultrasound of an echinococcal cyst?
• Mother cyst with daughter cyst
• Honeycomb cyst
• Water lily cyst
How could you define inflammatory disease of the liver?
Pus forming mass within the liver usually due to bacterial or parasitic infection
Pain, fever, pleuritis, nausea, vomiting, diarrhea, & hepatomegaly are the symptoms of ?
Pyogenic abscess
What lab values are associated with a pyogenic abscess?
Leukocytosis, increased LFTs, & anemia
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 is the appearance of ?
Pyogenic abscess
Who is at risk for an amoebic abscess?
Patients that have had a history of GI infections
What are the symptoms of an amoebic abscess?
Abdominal pain, diarrhea, melena
What will happen if a patient with an amoebic abscess does not get medical treatment?
Mortality rate is 100%
Typically subcapsular, low amplitude cyst fill in, thickened irregular walls, & good through transmission is the appearance of ?
Amoebic disease
What is the most common organism that causes infection in patients who are immunocompromised?
Pneumocystis carinii
What is hepatic candidiasis?
Liver complication on HIV or other immunocompromised patients
What is the cause of hepatic candidiasis?
Species of candida albicans
What is the most common benign liver tumor?
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 is the appearance of ?
Cavernous hemangioma
What is the second most common benign liver tumor?
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 is the appearance of?
Focal nodular hyperplasia
Which benign liver tumor is made up of hepatocytes, Kupffer cells, and fibrous connective tissue and bile duct elements?
Focal Nodular Hyperplasia
Who is at risk for a liver adenoma?
People who take oral contraceptives and men who take steroids
What is the typical treatment for a liver adenoma?
Surgery
What is a liver lipoma made of?
Fat cells
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 Is the appearance of ?
Liver adenoma
Who is most at risk to develop HCC?
People 60 or over, three times more in men than women
Which lab value is most significant for HCC?
AFP
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 are the symptoms of ?
HCC
What is the most common liver malignancy?
Liver metastases
What is the most common site for metastatic cancer in the body?
• GI tract
• Breast & lung
• Pancreas
• Colorectal
• Ovaries
No specific ultrasound appearance – variable, may be a solitary tumor or multiple tumors, may be focal may be hypoechoic, hyperechoic, isoechoic, or complex, & ascites may be present is the appearance of ?
HCC
Which labs might be elevated with metastatic disease?
CEA & AFP may be normal or elevated
A patient with liver metastases may present with which symptoms?
• Jaundice
• Pain
• Hepatomegaly
• Weight loss
• Abdominal swelling or bloating
• RUQ or abdominal pain
• Asymptomatic
Bulls eye sign (Target sign) and ‘Patchy pattern’ or ‘moth eaten’ is the appearance of ?
Liver metastatic disease
What is CEUS?
A medical imaging technique that uses an intravenous contrast agent to improve clarity of scans.
What is CEUS used for?
To detect diseases and conditions, evaluate organ function, monitor cancer therapy, and detect heart diseases.
