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URR 19 Flashcards

1
Q

most common benign vascular tumor in infancy

A

infantile hemangioendothelioma

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2
Q

have a strong association with oral contraceptives

A

liver adenomas

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3
Q

most common primary malignancy of the liver

A

hepatocellular carcinoma

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4
Q

HCC is most commonly associated with

A

cirrhosis

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5
Q

HCC tumoral invasion most commonly affects the ____

A

portal vein

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6
Q

____ is 20X more common than primary liver cancer and is the most common solid mass of the liver

A

Liver metastasis

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7
Q

most common primary cancer to metastasize to the liver

A

GI cancer

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8
Q

A liver mass with a hypoechoic rim is usually:

A

metastatic lesion

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9
Q

most common liver malignancy seen with HIV/AIDS

A

Kaposi Sarcoma

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10
Q

most common finding in hepatic congestion

A

dilated IVC

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11
Q

most commonly caused by cirrhosis from alcoholism

A

portal hypertension

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12
Q

common sign of portal hypertension due to retrograde flow in the coronary

A

esophageal varices

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13
Q

Visualization of a _____ is a common finding in portal hypertension

A

dilated coronary (left gastric) vein

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14
Q

A TIPS shunt is most commonly placed between the ___ and ___

A

Right portal vein
right hepatic vein

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15
Q

The most common cause of TIPS stenosis is ____

A

neointimal hyperplasia at the hepatic vein anastomosis

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16
Q

Liver transplant is most commonly performed due to cirrhosis caused by ____ or ___ in adults and ____ in children

A

hepatitis C
alcoholism
biliary atresia

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17
Q

Transplant complications are common at anastamosis sites, ____ is most common

A

biliary stricture

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18
Q

A bulge in the liver capsule indicates ____, while an indented liver capsule indicates ____
a. malignant mass, benign mass
b. benign mass, malignant mass
c. intrahepatic mass, extrahepatic mass
d. extrahepatic mass, intrahepatic mass

A

c

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19
Q

All of the following describe a hemangioma, except:
a. most common benign liver mass of the liver
b. decreases in size with pregnancy
c. most commonly seen in the right lobe
d. isovascular contrast enhancement

A

b

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20
Q

A hemangioma typically appears ___ in the normal liver, while it can appear ____ in a fatty liver.
a. hyperechoic, hypoechoic
b. isoechoic, hyperechoic
c. hypoechoic, isoechoic
d. hyperechoic, isoechoic

A

a

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21
Q

Kasabach-Merritt Syndrome is associated with the formation of what benign liver mass?
a. adenoma
b. hemangioma
c. focal nodular hypoplasia
d. infantile hemangioendothelioma

A

b

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22
Q

What benign liver masses are associated with use of oral contraceptives?
a. focal nodular hypoplasia, hemangioma
b. lipoma, adenoma
c. hepatocellular carcinoma, lymphoma
d. focal nodular hypoplasia, adenoma

A

d

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23
Q

Which of the following usually have normal liver function testing?
a. hemangioma
b. focal nodular hypoplasia
c. hepatic lipoma
d. all the above

A

d

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24
Q

Focal nodular hyperplasia is demonstrated by ultrasound as:
a. solid mass with a central scar with radial vascularity
b. complex mass with thick septations
c. solid mass with calcifications
d. complex mass with internal debris that shifts with patient position

A

a

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25
A liver adenoma is typically: a. hypoechoic b. hypervascular c. surgically removed d. all the above
d
26
What acoustic artifact is commonly seen with a larger hepatic lipoma? a. mirror imaging b. propagation speed c. side lobe d. posterior enhancement
b
27
What is the most common risk factor for hepatocellular carcinoma? a. cirrhosis b. biliary obstruction c. lymphoma d. chronic parasitic infection
a
28
The presence of which of the following in blood testing indicates hepatocellular carcinoma is present in cases of cirrhosis. a. alkaline phosphatase b. direct bilirubin c. alpha feto-protein d. prothrombin time
c
29
Which of the following sonographic characteristics of a liver mass should cause a strong suspicion of malignancy? a. posterior enhancement b. hypervascularity c. calcifications d. hypoechoic halo
d
30
How can focal fatty sparing be differentiated from a hepatoma? a. fatty sparing is typically hyperechoic, while a hepatoma is typically hypoechoic b. fatty sparing has no mass effect on the vasculature, while a hepatoma will invade vasculature c. fatty sparing is typically hypervascular, while a hepatoma will be hypovascular d. fatty sparing will not demonstrate any uptake of ultrasound contrast, while a hepatoma will demonstrate marked contrast pooling
b
31
Which of the following is a sign of Fibrolamellar Carcinoma, but is not seen with other types of hepatocellular carcinoma? a. FLC demonstrates punctate calcifications b. FLC demonstrates a central echogenic scar c. no coexisting liver disease d. all the above
d
32
A hepatoblastoma is associated with: a. Beckwith-Wiedemann Syndrome b. alcoholism c. AIDS d. biliary atresia
a
33
What liver malignancy is most common? a. hepatocellular carcinoma b. fibrolamellar carcinoma c. metastasis d. hepatoblastoma
c
34
A patient history of primary cancer in the body + liver mass with halo = ____. A patient history of chronic liver disease + liver mass with halo = _____. a. hepatocellular carcinoma, hepatoblastoma b. metastasis, hepatocellular carcinoma c. hepatoblastoma, hepatocellular carcinoma d. hepatocellular carcinoma, metastasis
b
35
A liver mass with a target or bull's eye appearance is most commonly: a. hepatoma b. adenoma c. focal nodular hyperplasia d. metastasis
d
36
If liver metastasis is suspected after an upper abdominal ultrasound, the entire abdomen should be evaluated for associated: a. mesenteric stenosis b. appendicitis c. lymphadenopathy d. biloma
c
37
What two liver malignancies are commonly seen with AIDS? a. lymphoma and Kaposi sarcoma b. metastasis and fibrolamellar carcinoma c. infantile hemangioendothelioma d. lymphoma and leukemia
a
38
obstruction of the hepatic veins by thrombus or tumor
Budd-Chiari Syndrome
39
Budd-Chiari Syndrome is associated with ____, ____, ___, ___, and _____
oral contraceptives HCC renal ca adrenal ca polycythemia vera
40
Clinical symptoms of Budd-Chiari Syndrome
pain jaundice hematemesis ascites hepatomegaly portal hypertension
41
Budd-Chiari Syndrome affects the right and left lobes of the liver because:
they are dranined by the hepatic veins
42
_____ occurs in Budd-Chiari Syndrome due to the compensatory response to decreased venous drainage through the right and left lobes
Caudate lobe hypertrophy
43
In the later stages of Budd-Chiari disease, the right and left lobes will atrophy, but the caudate lobe does not reduce in size because the ____ drain the blood from this lobe
emissary veins
44
Sonographic appearance of Budd-Chiari Syndrome
varies with degree of obstruction hepatic veins thick walled, difficult to see due to atrophy hepatomegaly caudate lobe hypertrophy right and left lobe atrophy compression of the IVC ascites splenomegaly PV slow flow or reversed Hepatic veins demonstrate absent, reversed, turbulent, or continuous flow Intrahepatic collateralization results in "bicolored" hepatic veins - opposing flow directions seen in adjacent veins
45
Free are in the hepatic venous system can lead to ____
pulmonary embolism
46
Air in the hepatic veins can be caused by:
bacterial infection releasing air into the bloodstream
47
Sonographic appearance of air in the hepatic veins
mobile echogenic foci with dirty shadowing and/or ring down artifact
48
loss of arterial blood supply to a portion of the liver tissue
hepatic infarct
49
Hepatic infarct affects all vessels ___ to the obstruction
distal
50
Usually causes wedge shaped abnormality, widest part of defect towards periphery of liver; appears as a hypoechoic area with absence of flow
hepatic infarct
51
Hepatomegaly due to poor venous outflow
hepatic congestion
52
Hepatic congestion is associated with:
congestive heart failure reduced cardiac function significant tricuspid regurgitation
53
Hepatic congestion shows ___ LFTs
increased
54
Sonographic appearance of hepatic congestion
hepatomegaly dilated IVC (most common finding) dilated hepatic veins more pulsatile flow in hepatic veins dilated portal vein ascites splenomegaly
55
Most common finding of hepatic congestion
dilated IVC
56
The ___ will act as a reservoir for the blood if there are other circulatory issues
IVC
57
If the IVC measures more than ___cm, it is abnormal
2.5
58
The IVC should collapse and expand with:
respiration
59
A quick sniff should collapse the IVC by more than ___%
50
60
Loss of respiratory phasicity in the IVC can be caused by:
CHF pulmonary HTN decreased cardiac function severe tricuspid regurgitation
61
The systolic component of flow will ___ as congestion increases until it reverses direction completely
decrease
62
____ can form with blood stasis
thrombus
63
defined as a pressure gradient of 12 mmHg or greater between the main portal vein and IVC and/or hepatic veins
portal hypertension
64
Elevated pressure in the portal system due to flow obstruction
portal hypertension
65
Portal hypertension is most commonly caused by:
cirrhosis from alcoholism
66
In portal hypertension, ____ occurs causing varices to form
collateral formation
67
_____ are a common sign of portal hypertension due to retrograde flow in the coronary (left gastric vein.
esophageal varices
68
retrograde flow in the coronary (left gastric vein) causes:
hematemesis
69
Rupture of gastroesophageal varices can lead to:
life threatening hemorrhage
70
A _____ may cause the left portal vein to remain hepatopetal due to blood exiting the liver through the collateral pathway
recanalized umbilical vein
71
tortuous vessels around the umbilicus due to portal HTN
Caput Medusae
72
Extrahepatic presinusoidal HTN is caused by:
portal thrombosis
73
Intra-hepatic presinusoidal HTN is caused by:
schistomiasis
74
Most common type of portal hypertension
Intra-hepatic HTN
75
Intrahepatic hypertension is caused by:
cirrhosis
76
Intrahepatic postsinusoidal HTN is caused by:
hepatic vein obstruction Budd-Chiari Syndrome
77
Measure portal vein with patient ____ and ____, __ wall to ___ wall
supine quiet respiration inner inner
78
The measurement of the portal vein should be obtained at the point the:
portal vein crosses the iVC
79
Deep held inspiration should caused up to __% increase in the portal vein diameter in normal patients
50
80
In _____, there will be little diameter change with deep inspiration
portal hypertension
81
Portal hypertension can lead to _____
portal vein thrombosis
82
What is the preferred treatment for portal hypertension?
Porto-Caval shunts
83
pathways carry portal system blood directly into the systemic veins, bypassing the liver
collateralization with portal hypertension
84
varies form between the coronary and short gastric veins and the systemic esophageal vein
gastroesophageal collateralization
85
umbilical vein lies in the falciform ligament and connects the left portal vein to the systemic epigastric veins near the umbilicus
umbilical collateralization
86
varices form between the splenic, coronary, and short gastric veins and the left adrenal or renal veins
splenorenal/gastrorenal collateralization
87
varies from between the veins of the ascending and descending colon, duodenum, pancreas, and liver and the renal, phrenic, and lumbar veins
intestinal collateralization
88
blood from the IMV empties into the superior rectal veins which anastamose with the systemic middle and inferior rectal veins
hemorrhoidal collateralization
89
Dilated portal vein <=>__mm
13
90
As _____ increases, portal flow will become more continuous and lose ass respiration variation in flow
portal hypertension
91
In portal hypertension, portal flow can become ____ and even reverse direction (hepatofugal) in severe cases
biphasic
92
The ___ and ___ significantly increase in size, even more so with deep inspiration
SMV splenic vein
93
If the Splenic vein or SMV >__cm in diameter = portal hypertension
1
94
The splenic vein should be measured in ___ plane
transverse
95
The SMV should be measured in ____ plane
sagittal
96
The coronary vein is a branch of the ____, near the liver hilum
portal vein
97
The coronary vein normally has ____ flow.
hepatofugal
98
The coronary vein drains into the ____ near the portal confluence
splenic vein
99
dilated tubular structure connected to left portal vein and extending toward the umbilicus; flow is hepatofugal
umbilical vein recanalization
100
formation of venous varices/collaterals at the porta hepatis
cavernous transformation

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