Test 2: Chapter 9 - Liver and Chapter 10 Gallbladder and Biliary System Flashcards
What is the disease that affects the hepatocytes and interferes with liver function?
A. Hepatitis
B. Diffuse hepatocellular disease
C. Hemochromatosis
D. Fatty inflitration
B. Diffues hepatocellular disease
What is the inflammation of the hepatocytes?
A. Portal hypertension
B. Hemochromatosis
C. Hepatitis
C. Hepatitis
What is hypoecoic, masslike area in an otherwise fatty liver, usually located anterior to the gallbladder or portal vein?
A. Focal fatty sparing
B. Fatty infiltration
A. focal fatty sparing
What is reversible disordere of metabolism resulting in intracellular accumulation of triglycerides within hepatocytes?
A. Focal fatty sparing
B. Fatty infiltration
B. fatty infiltration
What is the increased pressures within the portal system caused by increased resistance to flow through the liver?
A. portal hypertension
B. Portal triad
C. Hepatic cellular carcinoma
A. portal hypertension
What is a disease of iron metabolism characterized by excess iron deposits throughout the body?
A. Cavernous Hemangioma
B. Hemochromatosis
C. Budd-chiari syndrome
B. Hemochromatosis
What causes thrombis of the hepatic veins or inferior vena cava?
A. HCC
B. Pyogenic abscess
C. Renal cell carcinoma
D. Budd-chiari syndrome
Budd-chiari syndrome
What is a puss forming abscess?
A. Pyogenic abscess
B. Portal triad
C. Neoplasm
A. Pyogenic abscess
What is the term for “new growth” ?
Neoplasm
What is the most common benign neoplasm of the liver, patients are usually asymptomatic?
A. Focal Nodular Hyperlasia
B. Portal hypertension
C. Hepatic cellular carcinoma
D. Carvernous Hemangioma
D. Cavernous Hemangioma
What is the second most common benign liver mass composed of Kupffer cells, hepatocytes, biliary structures but lacks the typical features?
A. Cavernous Hemangioma
B. Focal Nodular Hyperplasia
C. Neoplasm
D. Hepatic cellular carcinoma
B. Focal Nodular Hyperplasia
What consists of the portal vein, biliary duct, hepatic artery traveling together throughout the liver?
Portal triad
What is the most common primary malignant mass strongly associated with chronic liver disease?
A. Varices
B. Pyogenic Abscess
C. Neoplasm
D. Hepatic Cellular Carcinoma
D. Hepatic cellular carcinoma
What is collateral venous flow to decompress the portal hypertension by redirecting blood flow away from liver circulation?
A. Portal triad
B. Varices
C. Hepatitis
Varices
What is the term for blood flow towards the liver?
Hepatopetal
What is the term for blood flow away from the liver?
Hepatofugal
What is the term for outside of the liver?
Extrahepatic
What is the term for inside the liver?
Intrahepatic
What structure separates the left lobe from the caudate lobe?
Ligamentum Venosum
Which vein is the larger of the two portal vein branches?
Right portal vein
What is the product of the breakdown of hemoglobin in tired red blood cells?
Bilirubin
An enzyme present in tissues that have a high rate of metabolic activity such as the liver. Enzyme released into the bloodstream?
A. Aspartate Aminotransferase
B. Alkaline Phosphatase
A. Aspartate Aminotransferase
What is produced by liver, bone, intestines, and placenta. May be a good indicator of intrahepatic or extrahepatic obstruction, hepatic?
A. Alkaline Phosphatase
B. Aspartate Aminotransferase
A. Alkaline Phosphatase
What is a group of laboratory tests established to analyze how the liver is performing under normal and diseased conditions?
Liver function tests
What is the liver enzyme part of the blood clotting mechanism?
Prothrombin Time
Fatty inflitration may be observed in all patients EXCEPT those with:
A. Diabetes Mellitus
B. Hepatoportal fistula
C. Hepatitis
D. Chronic alcoholism
B
Sonographic findings of acute hepatitis include:
A. Ascites, decresed brightness, and echogenicity
B. Decreased brightness and echogenicity of liver
C. Increased brightness and echogenicity of liver, and no demonstration of portal vein radicles
D. Accentuated brightness, more extensive deomstration of portal vein radicles, and an overall decreased echogenicity of liver
D
Budd-Chiari syndrome is a rare disorder caused by obstruction of the:
A. Hepatic veins
B. Superior mesenteric vein
C. Portal veins
D. Splenic veins
A.
Echinococcal cysts have the highest incidence in countries in which:
A. Fishing is common
B. Sheep herding is common
C. Rock climbing is prevalent
D. Poultry is abundant
B
The most common benign tumor of the liver is:
A. Infantile hemangioendothelioma
B. Mesenchymal hamartoma
C. Adenoma
D. Cavernous hemangioma
D.
What benign liver tumor has been found in patients with type 1 glycogen storage disease?
A. Hamartoma
B. Lipoma
C. Cavernous hemangioma
D. Adenoma
D
Patients who have hepatocellular carcinoma are more likely to have had:
A. Hemochromatosis
B. Carcinosis
C. Adenosis
D. Cirrhosis
D
The most common form of neoplastic involvement of the liver is:
A. Hepatocellular carcinoma
B. Hepatoma
C. Hamartoma
D. Metastases
D
Diminished vascular structures witin the liver parenchyma most likely represent:
A. Acute viral hepatitis
B. Budd-chiari syndrome
C. Cirrhosis
D. Obstructive portal disease
C
Elevation of serum bilirubin results in:
A. Jaundice
B. Hepatocellular disease
C. Ascites
D. Hemolysis
A
Typical symptoms a patient may have with an abscess formation include all of the following except:
A. Pain
B. increased white blood cell count
C. Decreased white blood cell count
D. Fever
C
Jim MacDonald, a sheep farmer, arrives at the hospital with right upper quadrant pain, fever, and an elevated white blood cell count. He states that 3 months earlier, he was kicked in the ribs. An irregular mass showing low level echoes is found on the sonogram. What is your differential diagnosis?
A. Hematoma
B. Echinococcal cyst
C. Amebic Abscess
D. Hepatic Abscess
B
Which one of the following tumors consists of large blood-filled spaces?
A. Cavernous hemangioma
B. Hamartoma
C. Adenoma
D. Ewing angioma
A
Dilated intrahepatic bile ducts may be seen with all of the following except:
A. Gallstones in the fundus of the gallbladder
B. Lymphadenopathy in the porta hepatis
C. Intrahepatic mass in the area of the porta hepatis
D. Obstructive stone in the cystic duct
A
Hepatocellular disease can be defined as a process that affects the:
A. Hepatocytes and interferes with liver function
B. Spherocytes and interferes with liver funtion
C. Phagocytes and interferes with liver function
D. Phagocytes and does not interfere with liver function
A.
In glycogen storage disease, type 1 is sthe most common and is also known as ________ disease:
A. von Gerpe
B. von Gussel
C. von Gierke
D. von Slurpie
C
All of the following describe normal portal venous flow except:
A. Phasic flow
B. Spontaneous flow
C. low-flow velocity
D. hepatofugal flow
D.
The amebic abscess may reach the liver through the:
A. Gastroduodenal artery
B. portal vein
C. Hepatic Artery
D. Hepatorectal artery
B
What benign liver tumor is located near the free edge of the liver and is solitary, well-circumscribed, and a nonencapsulated multinodular mass?
A. Adenoma
B. Lipoma
C. Cavernous hemangioma
D. Focal nodular hyperplasia (FHN)
D.
Common malignancies affecting the pediatric population include all of the following except:
A. Leukemia
B. Hepatoblastoma
C. Neuroblastoma
D. Wilms tumor
B
What is the most common liver mass?
A. HCC
B. Simple cyst
C. Focular Nodular Hyperplasia
D. Adenoma
B.
All of the following are sonographic findings for a cyst except:
A. thin walls
B. posterior acoustic enhancement
C. thin septations
D. Anechoic
E. smooth round borders
C
What is the most common lesions that can mimic a simple cyst?
A. Abcesses
B. Vascular lesions
C. Artifacts
D. Hemangioma
B
What is the most common solid liver lesion?
A. Hemangioma
B. Adenomas
C. Focal nodular hyperplasia
D. complex cysts
A
Hepatic hemangiomas are at a higher risk for malignancy when which of the following occurs (more than one answer):
A. increase in size
B. Current evidence of extrahepatic malignancy
C. prior history of extrahepatic malignancy
D. decrease in the echogenicity
E. Chronic liver disease (hepatitis, cirrhosis)
B, C, and E
______ and ______ are the most common sites for metastatic disease to occur.
A. Lung
B. Brain
C. Gastrointestinal
D. Liver
A and D
Liver function tests are unreliable for detecting liver metastatic disease and therefor, imaging play a critical role.
True or false
True
Hepatocellular cancer of HCC is associated with ______ liver disease.
A. Acute
B. Fatty
C. Cystic
D. Chronic
D
All of the following are characteristics of a HCC tumor (more than one answer possible)
A. Variable echogenicity
B. Anechoic
C. Hypovascularity
D. Hypervascularity
E. Diffusely infiltrating
F. Hyperechoic
A, D, and E
The second most common solid benign mass of the liver is _________?
A. simple cyst
B. focal nodular hyperplasia
C. Metastatic disease
D. Amebic abcess
B
The liver is suspended from the disphragm and anterior abdominal wall by the:
A. ligamentum teres
B. falciform ligament
C. round ligament
D. triangular ligament
B
The fossae of the right portal vein (RPV) and gallbladder are found in the:
A. Main lobar fissure
B. left intersegmental fissure
C. right intersegmental fissure
D. left lobar fissure
A
Elevation of alkaline phosphatase is associated with:
A. biliary obstruction
B. cavernous hemangioma
C. Fatty infiltration
D. simple hepatic cysts
A.
The falciform ligament extends from the umbilicus to the diaphragm in a parasagittal plane containing the:
A. Ligamentum venosum
B. ligamentum teres
C. quadratus ligamentum
D. ligamentum falciforme
B
Elevation of serum bilirubin results in:
A. hepatocellular disease
B. Ascites
C. Jaundice
D. Hemolysis
C.
Which one of the following actions should be done to image the near field of the liver?
A. Decrease transducer frequency
B. Use a sector transducer
C. Use a curved array transducer
D. Increase the near gain
C
All of the following describe normal portal venos flow except:
A. Low-flow velocity
B. hepatofugal flow
C. spontaneous flow
D. phasic flow
B
The liver is covered by a thin, connective tissue layer called:
A. Glisson’s capsule
B. Gerota’s fascia
C. Retroperitoneum
D. Media
A
The landmarks of the liver include all except:
A. Right hypochondrium
B. Left hypochondrium
C. Greater part of the epigastrium
D. right hypogastrium
D
Which statement is incorrect to distinguish hepatic veins from portal veins?
A. portal veins flow into the inferior vena cava
B. hepatic veins flow into the inferior vena cava
C. hepatic veins course between hepatic lobes and segments
D. portal veins are larger at the porta hepatis
A
Which ligament and fissures not found within the hepatic parenchyma?
A. transverse fissure
B. main lobar fissure
C. falciform ligament
D. ligamentum teres
A
Which of the characteristics of the right lobe of liver is untrue:
A. the right lobe exceeds the left lobe by a ration of 2:1
B. The falciform ligament boreders its upper surface
C. The inferior and posterior surfaces are marked by three fossa: the porta hepatis, the gallbladder fossa and the inferior vena cava fossa
D. left sagittal fossa borders the posterior surface
A
With a fatty liver, it is less hyperechoic than the spleen?
True or false
False
What liver condition can simualte a liver mass?
A. fatty sparing
B. Hepatits B
C. Hepatitis A.
D. Hemochromatosis
A
What is the gallbladder lumen size when there is suggestive wall thickening of the gallbladder wall with hepititis?
A. >15mm
B. >21mm
C. 18 mm
D. <15 mm
D
When documenting the liver for nodularity associated with cirrhosis, a sonographer shoulde use real-time or a cine video clip. True or false?
True
A cirrhotic nodular liver can be visualized by its edge next to what entity?
A. ascites
B. gas
C. ribs
D. bowel
A
What scanning method or approach should you use to best identify portosystemic collaterals seen with cirrhosis?
A. Intracostal
B. harmonics
C. Left lateral decubitus
D. Color flow doppler
D
In severe cases of fatty liver disease, the can be attenuation can be so severe it can make it difficult to visiualize the diaphragm.
True or false?
True
What can cause a “starry sky” appearance within the liver?
A. Air/gas in the portal system
B. Granulomas
C. Hepatits A
D. Accentuated brightness of the portal walls due to decreased echogenicity of the liver
A
All of the following are functions performed by the liver, except:
A. produce RBC’s
B. metabolize nutrients
C. produce bile
D. removal of toxins
A
The liver is the largest abdominal organ and occupies the right hypochondrium, epigastric, and left hypochondrium
True or false
True
Which liver lober is the largest?
Right
By using the __________, the liver can be divided into functional segments based on the vasculature, and a sonographer should be able to precisely isolate the location of a lesion for surgical resection.
A. Hepatic segmentation
B. Couinaud’s system
C. SNR calculation
D. Couinad’s formula
B
This anatomical structure separates the liver into right and left lobes:
A. ligamentum teres
B. main lobar fissure
C. falciform ligament
D. ligamentus venosum
B
The thin connective tissue that covers the liver and is the thickest around the IVC and portal hepatis, is known as Gilliad’s capsule
True or false
false
A group of lab tests established to analyze how the liver is performing under normal and abnormal conditions, is known as _____________
Liver function tests
This set of veins is responsible for draining blood out of the liver, returning it to the heart for recirculation:
A. hepatic arteries
B. portal veins
C. hepatic veins
D. IVC
C
The gallbladder serves as a reservoir for ________ that is excreted from the hepatic ducts of the liver?
A. plasma
B. hemoglobin
C. creatine
D.bile
D
The main pancreatic duct joins the common bile duct, and together they open through a small ampulla into the duodenal wall. This ampulla is known as the ampulla of ________.
A. vacuum
B. viseo
C. vader
D. vater
D
The distal ends of the common bile duct and main pancreatic duct and the ampulla are surrounded by circular muscle fibers known as the sphincter of _______
A. odisemus
B. oddity
C. oddi
D. odessa
C
The most classic symptom of gallbladder disease is __________ pain, usually occurring after ingestion of greasy foods
A RUQ
B. LLQ
C. mid hypogastric area
D. left shoulder
A
The normal wall thickness of the gallbladder is less than ______
A. 3mm
B. 1.5 mm
C. 3 cm
D. 0.3 mm
A
The ______ sign is described as a contracted echogenic gallbladder with posterior shadowing caused by a packed bag of stones
A. DROP
B. ABS
C. NORM
D. WES
D
All of the following are sonographic features with carcinoma of the gallbaldder except:
A. heterogenous mass
B. shadowing from the gallbladder fossa
C. thickened gallbladder wall
D. hilar area of the liver may demostrate heterogenous mass
E. mass completely fills the lumen
B
The majority of stones in the common bile duct have migrated from the gallbladder. Common duct stones are usually associated with ______ cholecystitis
A. calculous
B. acute
C. chronic
D. acalculous
A
On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in ______ disease.
A. bella’s
B. caroli’s
C. morrison’s
D. murphy’s
B
What is a small polypoid projections from the gallbladder wall?
A. jaundice
B. polyp
C. adenomyomatosis
D. choledochal cyst
C
What is the inflammation of the common bile duct?
A. cholangitis
B. cholecystitis
C. cholelithiasis
D. sludge
A
What is the inflammation of the gallbladder, may be acute or chronic
A. cholecystitis
B. cholangitis
C. cholelithiasis
D. choledocholithiasis
A
What is a cystic growth on the common duct that may cause obstruction?
A. choledochal cyst
B. choledocholithiasis
C. cholelithiasis
D. Polyp
A
What are stones in the bile ducts called?
A. cholangitis
B. polyp
C. choledocholithiasis
D. cholelithiasis
C
What are stones in the gallbladder called?
A. choledocholithiasis
B. cholelithiasis
C. cholangitis
D. sludge
B
What is a positive sign that implies exquisite tenderness over the area of the gallbladder upon palpation
Murphy’s sign
What is small, well defined soft tissue projection from the gallbladder wall
A. cyst
B. polyp
C. complex cyst
polyp
What is low-level echoes found along the posterior margin of the gallbladder, they move with change in position
Sludge
What is the hormone secreted into the blood by the mucosa of the upper small intestine that stimulates contraction of the gallbladder as:
A. Cholecystokinin
B. adenomyomatosis
C. cholecystitis
D. polyp
A
What is the gallbladder variant in which part of the fundus is bent back on itself?
Phrygian cap
What is the cancer at the bifurcation of the hepatic ducts; may cause asymmetic obstruction of the biliary tree
Klatskin’s tumor
What is the small outpouch of the gallbladder fundus that lies near the cyctic duct that may collect gallstones
hartmann’s pouch
