URR 14 Flashcards
1
Q
How is indirect bilirubin usually calculated?
A
subtracting the direct bilirubin value from the total bilirubin value
2
Q
% RBCs in blood
A
hematocrit
3
Q
Decrease in hematocrit indicates:
A
internal bleeding
4
Q
protein produced in the liver to control water distribution and osmotic pressure
A
albumin
5
Q
Albumin increases with ____ and ____
A
dehydration
hemolytic anemia
6
Q
Albumin is decreased with ____, ____, and ____
A
chronic liver disease
CHF
inflammation
7
Q
____ albumin levels are associated with ascites formation and other fluid collections
A
reduced
8
Q
____/____ ratio decreases with cirrhosis (and also kidney disease or autoimmune disease)
A
albumin/globulin
9
Q
CT liver scan
A
evaluate size, structure, and blood flow information
10
Q
Nuclear medicine liver scan
A
evaluate radioactive tracer uptake within liver tissues, mass characterization
11
Q
MRI liver scan
A
evaluate size, structure, and blood flow information
12
Q
A __ MHz to ___ MHZ adult probe is used to scan the liver.
A
2.5
6
13
Q
A ___ MHz to ___ MHz pediatric probe is used to scan the liver
A
4
8
14
Q
NPO status for liver scan
A
8-12 hours
15
Q
___ and ___ positions used for hepatic scanning
A
supine
left lateral decubitus
16
Q
Liver imaging techniques include ____ and ____
A
deep inspiration
drinking water
17
Q
The ____ approach with _____ will provide the best views of the dome of the liver in most patients
A
subcostal
deep inspiration
18
Q
Intercostal views of the liver are obscured by:
A
rib shadowing
19
Q
____ view at the _____ is preferred to assess liver length
A
sagittal
mid clavicular
20
Q
Indications for liver US
A
RUQ pain
palpable mass
hepatomegaly
hx of alcohol abuse
abnormal LFTs
possible metastasis
21
Q
What is jaundice?
A
elevated serum bilirubin
22
Q
Clinical symptoms of jaundice
A
yellowed skin and eyes
pale stool
dark urine
23
Q
The best way to different hepatic jaundice from obstructive jaundice is to:
A
measure CBD
24
Q
Hepatic jaundice is caused by:
A
liver disease
25
Obstructive jaundice is caused by ____
biliary obstruction
26
If the bile ducts are normal size, the cause of jaundice is:
not obstructive
27
_____ elevated in both types of jaundice
total bilirubin
28
Liver tumor formation can cause:
hepatic or obstructive jaundice
29
_____ jaundice is caused by hemolytic disease
pre-hepatic jaundice
30
excessive destruction of hepatocytes
pre-hepatic jaundice
31
____ jaundice is caused by:
hepatocellular disease
32
abnormally functioning liver cells, unable to conjugate bilirubin
hepatic jaundice
33
____ jaundice is caused by:
mechanical obstruction of biliary tree
34
Relative echogenicities in abdomen hyperechoic to hypoechoic
renal sinus
pancreas
spleen
liver
renal parenchyma
35
What structures can be used to located the dome of the liver?
a. portal veins
b. hepatic veins
c. bile ducts
d. hepatic arteries
b
36
What portion of the liver is partially covered by Glisson capsule?
a. gallbladder fossa
b. left lobe
c. caudate lobe
d. porta hepatis
d
37
The portal triad contains:
a. portal vein
b. hepatic artery
c. bile duct
d. all the above
d
38
If the right lobe of the liver extends past the lower pole of the right kidney, hepatomegaly should be considered and ____ should be closely evaluated for changes.
a. liver echotexture
b. course of the main portal vein
c. flow in the superior vena cava
d. biliary duct size
a
39
____ courses within the right segmental fissure which divides the right lobe into anterior and posterior segments
right hepatic vein
40
Lateral left lobe of the liver is located between the ____
a. ligamentum venosum and the spleen
b. ligamentum teres and middle hepatic vein
c. ligamentum teres and the spleen
d. ligamentum venosum and IVC
c
41
Venous drainage of the caudate lobe occurs through what vessel?
a. middle hepatic vein
b. right and middle hepatic vein
c. left and middle hepatic vein
d. emissary veins
d
42
The distal papillary process of the liver is a rounded prominence on the anteroinferior aspect of the:
a. anterior right lobe
b. caudate lobe
c. posterior right lobe
d. medial left lobe
b
43
Which hepatic ligament prevents free fluid from moving from Morison pouch to subphrenic space?
a. triangular
b. coronary
c. falciform
d. round
b
44
The inferior margin of what ligament contains the ligamentum teres?
a. triangular
b. coronary
c. falciform
d. round
c
45
Which hepatic ligament contains the remnant of the umbilical vein that has the potential to recanalize with portal hypertension?
a. ligamentum venosum
b. ligamentum teres
c. triangular ligament
d. hepatoduodenal ligament
b
46
Which of the following is found within the left intersegmental fissure?
a. left hepatic vein
b. falciform ligament
c. ligamentum teres
d. all the above
d
47
The Rex-Cantlie line is an imaginary line that extends from the ____ in the liver.
a. right to left portal vein
b. GB neck to right portal vein
c. GB fossa to IVC
d. middle hepatic vein to the main portal vein
c
48
The liver is divided into 4 segments by the longitudinal course of the:
a. hepatic veins
b. hepatic arteries
c. portal veins
d. bile ducts
a
49
The common hepatic artery becomes the proper hepatic artery after the origin of the:
a. right gastric artery
b. splenic artery
c. suprarenal artery
d. gastroduodenal artery
d
50
The cystic artery normally branches from the:
a. left hepatic artery
b. gastroduodenal artery
c. right hepatic artery
d. right gastric artery
c
51
In a normal liver the ____ increases with digestion, but it is unchanged post-prandially in patients with cirrhosis
a. acceleration time
b. resistive index
c. liver function tests
d. diastolic flow
b
52
Which of the following correctly describes the portal system of the liver?
a. branches divide the liver into lobes (intersegmental veins)
b. increase in size as the near the diaphragm to exit the liver
c. portal veins have thicker walls than hepatic veins
d. all the above
c
53
Which of the following correctly describes measurement of the portal vein diameter?
a. measure the portal vein with the patient supine and in quiet respiration
b. the measurement should be obtained at the point the portal vein crosses the IVC
c. the inner wall to inner wall diameter is reported
d. all the above
d
54
>20% change in portal vein diameter with deep inspiration indicates:
a. normal flow
b. suspected cirrhosis
c. suspected portal thrombosis
d. suspected Budd Chiari syndrome
a
55
What vessel joins the splenic vein posterior to the neck of the pancreas to form the main portal vein?
a. inferior mesenteric vein
b. superior mesenteric vein
c. mid hepatic vein
d. right and left portal vein
b
56
What is the most common variation in hepatic vein anatomy?
a. duplicated middle hepatic vein
b. duplicated left hepatic vein
c. accessory right hepatic vein
d. hepatoportal fistula
c
57
Why is the flow in the hepatic veins triphasic?
a. because of the valves in the IVC
b. because of the pressure changes in the liver
c. because the motion of the right ventricle
d. because the motion of the right atrium
d
58
Isolated elevation of Aspartate Aminotransferase levels is most suggestive of:
a. cirrhosis
b. hepatitis
c. myocardial infarction
d. Reye syndrome
c
59
Higher AST/ALT ratios with elevated AST and ALT levels indicate:
a. cirrhosis
b. alcoholic liver disease
c. liver metastasis
d. all the above
d
60
Increased GGTP + Increased ALP =
Increased GGTP + increased ALT =
a. biliary obstruction, hepatocellular disease
b. cirrhosis, hepatitis
c. hepatitis, cirrhosis
d. hepatocellular disease, biliary obstruction
a
61
Increased prothrombin time means:
a. a patient has a primary malignant in the body
b. a patient has an increased risk of pulmonary embolism
c. a patient has an increased risk of hemorrhage
d. a patient has an increased risk of abscess formation
c
62
Alpha-fetoprotein levels are monitored in patients with:
a. hepatocellular carcinoma
b. liver metastasis
c. hepatitis
d. all the above
d
63
____ approach with deep inspiration will provide the best views of the dome of the liver in most patients
a. intercostal
b. subcostal
c. coronal
d. perumbilical
b
64
absence of liver formation
agenesis
65
rare, caused by infolding of the peritoneum
accessory fissures
66
Vascular abnormalities of the liver
artery anatomy variation
atresia
stricture
valve formation in portal vein
hepatic vein branch formations
67
abdomen contents reversed, liver LUQ
partial situs invertus
68
chest and abdomen contents reversed, liver LUQ and heart in right chest
complete situs inversus
69
extension of the right lobe below the lower pole of the right kidney
Reidel lobe
70
Reidel's lobe is more common in ___
women
71
Reidels lobe can be mistaken for ____
hepatomegaly
72
The left lobe will be ____ with Reidel lobe
normal
73
The AP dimension of the right lobe will be ____ with Reidel lobe
normal
74
elongated left lobe extends into LUQ
extended left lobe
75
With an extended left lobe, it may be seen immediately adjacent to the medial and superior ____
spleen
76
With an extended left lobe, the left extends anterolateral across the ___ to the LUQ
aorta
77
fluid filled space with endothelial lining
simple cyst
78
With a simple cyst, LFTs will be ____
normal
79
Simple cysts in the liver usually don't occur until after the age of:
50
80
Simple cysts identified in the liver before age 50 are usually related to ______ and cysts in the ____, ____, and ____ are also identified
polycystic disease
kidneys
pancreas
ovaries
81
Cyst criteria
smooth borders
regular walls
no internal echoes
through transmission
posterior enhancement
82
blood leaks into an existing cyst; thrombus forms within cyst
hemorrhagic cyst
83
Hemorrhagic cysts clinical symptoms
pain secondary to hemorrhage/infection
84
What lab tests may be abnormal with hemorrhagic cysts?
reduced hematocrit levels
85
Thrombus causes irregular appearance of internal echoes in cyst; fluid/blood levels; septations with fluid levels
hemorrhagic cyst
86
Polycystic liver disease is an _______ disorder
autosomal dominant
87
Polycystic liver disease usually presents age __-__ years
30
40
88
Multiple cysts in the liver that do NOT communicate with biliary tree
polycystic liver disease
89
Polycystic disease has ____ LFTs
normal
90
Biliary hamartomas are also known as
von Meyenburg Complexes
91
Focal developmental lesions of the liver; composed of groups of dilated intrahepatic ducts within dense stroma
biliary hamartomas
92
Small ____ usually appear echogenic and cause a diffusely heterogeneous appearance of liver tissue
biliary hamartomas
93
Larger ____ are most commonly hypoechoic, well-defined solid nodules
biliary hamartomas
94
Biliary hamartomas can show as numberous echogenic foci with ____ throughout the liver
ringdown artifact
95
Biliary hamartomas are associated with ____, ____, and ____
congenital hepatic fibrosis
autosomal dominant polycystic disease
cholangiocarcinoma
96
How is a Reidel lobe differentiated from hepatomegaly?
a. evaluate the size of the left lobe
b. evaluate the liver echotexture
c. evaluate the size of the right lobe
d. all the above
d
97
Simple cysts identified in the liver before age 50 are usually related to:
a. multicystic kidney disease
b. polycystic disease
c. biliary leakage
d. cirrhosis
b
98
A large hemorrhagic cyst in the liver will have what abnormal lab value that is not seen with simple cysts?
a. reduced prothrombin time
b. elevated alkaline phosphatase
c. elevated white blood cell count
d. reduced hematocrit levels
d
99
If autosomal dominant polycystic liver disease is suspected, what organs should be evaluated for cyst formation?
a. pancreas
b. kidneys
c. ovaries
d. all the above
d
100
Aside from comet tail artifact, what other acoustic artifact is commonly seen with biliary hamartoma formation throughout the liver?
a. twinkle
b. mirror image
c. side lobe
d. propagation speed error
a
