URR 21 Flashcards by Billie Harney

A hepatic infarct will be demonstrated as:
a. distinct area of hypervascularity near the porta hepatis
b. wedge shaped area with the widest part facing the periphery of the liver
c. area of cystic degeneration near the right kidney
d. free fluid between the liver tissue and Glisson capsule

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How does severe hepatic congestion affect the flow in the systemic veins?
a. IVC and hepatic veins are dilated
b. Flow in the hepatic veins and IVC will be more pulsatile as congestion increases
c. the systolic peak of the Doppler tracing will decrease until it reverses direction
d. all the above

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A dilated IVC will demonstrate all of the following, except:
a. loss of respiratory phasicity
b. increased cardiac pulsatility
c. reversal of flow in systole
d. collapsibility with quick inspiration

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The most common cause of portal hypertension is:
a. cirrhosis
b. splenomegaly
c. hepatitis
d. biliary obstruction

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What complication of portal hypertension is known to cause life threatening hemorrhage?
a. splenomegaly
b. caput medusae
c. gastroesophageal varices
d. dilated umbilical vein

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Which of the following describes the correct way to measure the portal vein diameter?
a. measure the portal vein with the patient in RLD position
b. measure the portal vein at deep respiration
c. measure the outer wall to outer wall dimension
d. the measurement should be obtained at the point the portal vein crosses the IVC

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Collateral flow due to portal hypertension results in the formation of:
a. caput medusae
b. cavernous transformation
c. esophageal varices
d. all the above

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How are the splenic and superior mesenteric veins affected by portal hypertension?
a. atrophied and difficult to demonstrate on color Doppler evaluation
b. dilated greater than 1 cm in diameter
c. wall thickening with irregular lumens
d. high velocity flow

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How is the hepatic artery flow affected by late-stage portal hypertension?
a. dilated artery
b. increased resistance to flow
c. decreased diastolic flow
d. all the above

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Flow in the portal vein is normally moving in the same direction as ____ but the opposite direction of ____
a. hepatic artery, hepatic veins
b. splenic vein, SMV
c. hepatic vein, splenic vein
d. hepatic veins, IVC

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Acute portal vein thrombosis will demonstrate a portal vein diameter greater than ____, while chronic portal vein thrombosis will demonstrate a contracted vein.
a. 10mm
b. 12mm
c. 13mm
d. 15mm

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How can portal vein thrombus be differentiated from tumoral invasion of the portal vein?
a. diameter of the portal vein
b. internal vascularity of the obstruction
c. location of the obstruction
d. liver length measurement

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A TIPS is used to:
a. alleviate portal hypertension
b. allow blood flow to bypass liver
c. prolong the need for a liver transplant
d. all the above

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A TIPS is typically placed with a connection between:
a. the main portal vein and SMV
b. the left and right portal veins
c. the right portal vein and the right hepatic vein
d. the left portal vein and the left hepatic vein

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Angle correction is needed for which vessels when performing Doppler of the liver with a TIPS shunt?
a. Hepatic artery
b. main portal vein
c. right and left portal vein
d. all the above

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Which of the following are direct signs of TIPS failure?
a. recanalization of the umbilical vein
b. hepatofugal flow in the main portal vein
c. reaccumulation of ascites
d. reappearance of varices

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High-intensity transient signals (HITS) are seen on Doppler tracings from the portal vein in patients with:
a. portal hypertension
b. portal venous gas
c. Budd-Chiari Syndrome
d. Portal vein thrombosis

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Hereditary Hemorrhagic Telangiectasia is associated with all of the following except:
a. dilated hepatic artery
b. AV malformations
c. Dilated hepatic veins
d. portal vein aneurysms

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The most common indication for a liver transplant in children is ____, while the most common indication for a liver transplant in adults is ____.
a. biliary atresia, cirrhosis
b. hepatoblastoma, hepatoma
c. hepatitis, cirrhosis
d. hepatoblastoma, metastasis

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Which of the following is most important to evaluate in a patient with a recent liver transplant?
a. biliary tree
b. hepatic artery
c. portal vein
d. hepatic vein

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What Doppler values are evaluated in most organs, including the liver, when assessing a transplant organ for rejection?
a. pulsatility index
b. resistive index
c. S/D ratio
d. reflux time

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Which of the following is a potential cause of liver transplant failure?
a. biliary stricture
b. stenosis at the hepatic artery anastamosis
c. hepatic vein stenosis
d. all the above

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A liver hematoma that forms between the capsule and the parenchyma is called:
a. subcapsular
b. intraparenchymal
c. extracapsular
d. supracapsular

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The GB is located in the:

RUQ

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Normal transverse diameter is <__cm

Normal length of GB is <__cm

The GB fossa is located:

on the posteroinferior right lobe of liver

The GB is bordered by the ___ and ___

right kidney duodenum

The GB is located at the inferior end of the:

main lobar fissure

Sonographically, the main lobar appears to connect the ____ to the ____

right portal vein gallbladder neck

The GB is supplied by the ____ that originates from the _____

cystic artery right hepatic artery

The GB is drained by the ____ into the ____

cystic vein right portal vein

inner GB wall layer

mucosa

middle GB wall layer

muscle

Outer GB wall layer

serosa

<__mm GB wall thickness is normal

Increased GB wall thickness is seen with:

-itis

Systemic issues like ___ and ___ can cause GB wall thickening

congestive heart failure, AIDS

The ____ are located within the gallbladder wall

Ducts of Luschka

The Ducts of Luschka are where ____ occurs

bile thickening

The Ducts of Luschka can be associated with stasis of bile/debris, which leads to ____

inflammatory disease

smallest and most proximal component of the collecting system

bile canalculi

Intrahepatic ducts merge to form the:

right and left hepatic ducts

Because the biliary branches course through the liver adjacent to the portal vein branches and hepatic artery branches, they are considered _____ or ____ vessels

intrasegmental intralobar

Biliary ducts should be measured with calipers placed from:

inner wall to inner wall

____ supply intrahepatic ducts and the middle part of common duct

hepatic arteries

The cystic artery supplies ____ and ___

proximal common duct GB

The _____ and _____ supply distal common duct

gastroduodenal and pancreaticoduodenal arcade

The ____ carries bile to and from the gallbladder

cystic duct

The cystic duct is located:

on the posteroinferior surface of the liver

The cystic duct is located ____ to the neck of the gallbladder

superior

The cystic duct is located ____ to the CBD

superior

The cystic duct is located ____ to the common hepatic duct

inferior

The ____ regulate flow in the cystic duct

spiral valves of Heister

also referred to as the common duct

common hepatic duct

The common hepatic duct is formed by the junction of the:

right and left hepatic ducts

The common hepatic duct joins with the cystic duct to form the ____

common bile duct

The common hepatic duct is located ____ to the split of the main portal vein

The common hepatic duct usually measures __mm or less

___+___ = common bile duct

cystic duct common hepatic duct

The ____ segment of the CBD is located anterior to the right hepatic artery inside the liver

proximal

The ___ segment of the CBD is located just outside of the liver

mid

The ___ segment of the CBD dilates first with any type of distal obstruction

mid

The ____ segment of the CBD is located at the head of the pancreas

distal

The CBD courses posterior to the _____ to meet the _____ posterior to the pancreas head

1st segment of the duodenum duct of Wirsung

The duct of Wirsung connects to the ____ at the ____

Ampulla of Vater duodenum

The ____ controls the flow of bile and pancreatic fluid through the ____

sphincter of Oddi Ampulla of Vater

Measurements of the CHD and CBD vary with ___ and _____

age presence of absence of gallbladder

CBD >__mm is considered dilated with GB present

CBD >__mm is considered dilated in patients without GB

The CBD size can be correlated with ___

patient age

Ductal wall thickness is normal at __mm or less

Bile is secreted by the ___

liver

Bile contains:

bilirubin biliverdin bile salt acids cholesterol

acts as a fat emulsifier/vehicle for bilirubin excretion

bile

breaks down red blood cells to release bilirubin from hemoglobin

Reticuloendothelial system

____ + ____= unconjugated bilirubin

bilirubin albumin

The liver breaks down ____ to remove the bilirubin

unconjugated bilirubin

____ + ____ = conjugated bilirubin

bilirubin gluconoride

Bilirubin passes into the ____ system

biliary

Symptoms and indications to scan the biliary system

RUQ pain abnormal labs contrast allergy nausea/vomiting bloating/belching pregnancy jaundice

abnormal bilirubin ___ and ___ can cause jaundice

metabolism excretion

Jaundice is related to ___, ___, and ___

red blood cell destruction hepatocellular disease biliary obstruction

can cause yellowing of the sclera of the eyes and fingernail beds, dark colored urine, and pale stool

hyperbilirubinemia

RBC destruction occurs rapidly, seen with anemia

Hemolytic jaundice

liver disease reduces its ability to process conjugate bilirubin; hepatitis, cirrhosis

hepatic jaundice

obstruction of the biliary tree increases bilirubin in blood and urine

obstructive jaundice

Jaundice + dilated intrahepatic ducts =

obstructive cause

Jaundice + normal intrahepatic ducts =

non-obstructive cause

lab that is increased with choledocholithiasis

ALT

If the biliary obstruction only partially blocks the duct or occludes the drainage of only one segment of the biliary tree, ___ can increase while ____ remains unchanged

ALT bilirubin

aka conjugated bilirubin

direct bilirubin

In direct bilirubin, ____ is removed from the bilirubin

albumin

Serum levels of direct bilirubin are increased with:

obstructive jaundice biliary tree obstruction hepatitis other causes of cholestasis within liver

Direct bilirubin is normal found in ____ and can be used to assess the amount of conjugated bilirubin in the body

urine

Indirect bilirubin is increased with:

abnormal liver function hemolytic disease genetic disorders

____ bilirubin is related to increased hemolysis

indirect

How is indirect bilirubin calculated?

subtracting direct bilirubin from total bilirubin

_____ is not normally found in urine of a patient with normal liver function

indirect bilirubin

combined conjugated and unconjugated bilirubin

total bilirubin