Ch2 Liver

Question 1

Amebic hepatic abscess

Answer 1

an abscess that develops from a parasite that grows in the colon and invades the liver via the portal vein

Question 2

anastomosis

Answer 2

the surgical connection between two structures

Question 3

arteriovenous fistula

Answer 3

an abnormal passageway between an artery and a vein

following trauma to the liver, an abnormal passageway between an after & vein

may also be discovered following a liver biopsy, cholangiography, or hepatic surgery

Question 4

autoimmune disorders

Answer 4

disorders in which the body’s immune system attacks and destroys health tissues and/or organs

Question 5

autosomal dominant polycystic kidney disease

AKA?

Answer 5

an inherited disease that results in the development of renal, liver, and pancreatic cysts late in life
also referred to as ADULT POLYCYSTIC KIDNEY DISEASE

Question 6

bare area

Answer 6

the region of the liver not covered by peritoneum

Question 7

Beckwith-Wiedmann syndrome

Answer 7

a growth disorder syndrome synonymous with enlargement of several organs, including the skull, tongue, and liver

Question 8

Budd-Chiari syndrome

Answer 8

a syndrome described as the occlusion of the hepatic veins with possible coexisting occlusion of the inferior vena cava

Question 9

caput medusa

Answer 9

recognizable dilation of the superficial veins of the abdomen

Question 10

cavernous hemangioma

Answer 10

the most common benign liver tumor
they can be found in men, but are more common in women
are asymptomatic

is within the rt lobe of the liver
will appear small, hyperechoic mass measuring less than 3cm, although some may be quite large and referred to as “giant hemangiomas”
occasionally, posterior enhancement may be seen

although hemangiomas are comprised of blood vessels, detectable flow may not be seen with color Doppler because the flow within the vessels tend to be exceedingly slow

they may also appear hypoechoic or complex, and therefore can be monographically indistinguishable from metazoic liver disease

there may also be multiple hemangiomas present, further complicating the sonographic diagnosis and consequently leading to other imagining or biopsy

Question 11

cholangitis

Answer 11

inflammation of the bile ducts

Question 12

cirrhosis

Answer 12

condition defined as hepatocyte death, fibrosis and necrosis of the liver, and the subsequent development of regenerating nodules

cirrhosis can also be caused by Wilson disease, primary biliary cirrhosis, hepatitis, cholangitis, and hemochromatosis

lab findings include: elevation of AST, LDH, ALT & Bilirubin

patients may also present with jaundice, fatigue, weight loss, diarrhea, initial hepatomegaly, and ascites

sonographic findings include an echogenic small right lobe, an enlarged caudate and left lobe, nodular surface irregularity, coarse echo texture ascites, and splenomegaly

NORMAL nodules typically measure less than 1 cm (micro nodular) \
Cirrhosis caused nodules measure between 1 - 5 cm (macro nodular)

Doppler findings in patients WITH cirrhosis: monophonic flow within the hepatic veins & hepatofugal flow within the portal veins

Question 13

cystic fibrosis

Answer 13

genetic disorder linked with the development of scar tissue accumulation within the lungs, liver, pancreas, kidneys, and or intestines

Question 14

diaphragmatic slip

Answer 14

a pseudo mass of the liver seen on sonography resulting from hypertrophied diaphragmatic muscle bundles

Question 15

dystentery

Answer 15

infection of the bowel which leads to diarrhea that may contain mucus and/or blood

Question 16

echinococcal cyst

AKA?

Answer 16

aka hydatid liver cyst
which is a liver cyst that develops from a tapeworm that lives in dog feces; also referred to as ECHINOCOCCAL CYST because it originates from the parasite ECHINOCOCCUS GRANULOSUS

Question 17

Echinococcus granulosus

Answer 17

a parasite responsible for the development of hydatid liver cysts

Question 18

Epstein-Barr virus

Answer 18

the virus responsible for the mononucleosis and other potential complications

Question 19

fatty liver
AKA?
types?

Answer 19

a reversible disease characterized by deposits of fat within the hepatocytes
AKA: HEPATIC STEATOSIS
Types:
Nonalcoholic fatty liver disease - has been cited as the MOST common liver disorder in the western world & the MOST common cause of chronic liver disease
Alcoholic fatty liver disease - caused from heavy life long drinking
Causes of NONALCOHOLIC: starvation, obesity, chemotherapy, diabetes mellitus, hyperlipidemia, pregnancy, glycogen storage disease or VON GIERKE DISEASE (glycogen storage disease type 1), total parental hyperalimentation, severe hepatitis, cystic fibrosis, intestinal bypass surgery for obesity, and the use of some drugs such as corticosteroids

Question 20

fibrosis

Answer 20

the formation of excessive fibrous tissue; the development of scar tissue within an organ

Question 21

focal fatty infiltration

Answer 21

manifestation of fatty liver disease in which fat deposits are localized
it will appear as an area of increased echogenicity and can thus appear much like a solid, hyperechoic mass

Question 22

focal fatty sparing

Answer 22

manifestation of fatty liver disease in which an area of the liver is spared from fatty infiltration
it is much more likely that the signs of sparing and infiltration are seen adjacent to the gallbladder, near the portal hepatic , and the left medial segment

Question 23

focal nodular hyperplasia

Answer 23

a benign liver mass composed of combination of hepatocytes and fibrous tissue that typically contains a central scar
are asymptomatic

it is the SECOND most common benign liver tumor and MORE COMMONLY incidentally discovered in women

mass is composed of a combination of hepatocytes and fibrous tissue

most patients are asymptomatic, but if the mass impinges upon surrounding anatomy or hemorrhage occur, pain will most likely ensue

not caused by oral contraceptives, it can enlarge because of them (masses are estrogen dependent)

may appear isoechoic, echogenic, and hypoechoic

the central scar, when seen, will appear as a hypoechoic or hyperechoic, linear structure within the mass

hypervascularity within the scar can be identified by using color doppler

Question 24

gastroesophageal junction

Answer 24

the junction between the stomach and the esophagus

Question 25

Glisson capsule

Answer 25

the thin fibrous casing of the liver

Question 26

hematemesis

Answer 26

vomiting blood

Question 27

hematoma

Answer 27

a localized collection of blood can appear solid or complex depending on their age

Question 28

hemochromatosis

Answer 28

an inherited disease characterized by disproportionate absorption of dietary iron

Question 29

hepatic candidiasis

Answer 29

a hepatic mass that results from the spread of fungus (primarily Candida albicans) in the blood to the liver affects those that are immunocompromised patient may have right RUQ pain, fever & hepatomegaly findings include multiple hyperechoic (central portion) masses with hypoechoic boarders these masses may be described as "target," "halo," or "bull's-eye" lesions and are typically 1 cm or smaller older lessons may calcify

Question 30

hepatic encephalopathy

Answer 30

a condition in which a patient becomes confused or suffers from intermittent loss of consciousness secondary to the overexposure of the brain to toxic chemicals that the liver would normally remove from the body in a newborn, brain damage can occur with severe jaundice, as a result of bilirubin exposure, a condition referred to as kernicterus

Question 31

hepatic steatosis

Answer 31

aka fatty liver | a reversible disease characterized bad deposits of fat within the hepatocytes

Question 32

hepatitis | types?

Answer 32

inflammation of the liver Types: Acute - is said to resolve within 4 months Chronic - persists beyond 6 months A, B, C, D, E & G; the 2 MOST common are: hepatitis A & B Currently, hepatitis C is the leading indication for liver transplantation in the US

Question 33

hepatocellular adenoma | AKA?

Answer 33

a RARE benign liver mass often associated with the use of oral contraceptives AKA HEPATIC ADENOMA or LIVER CELL ADENOMA pt is typically asymptomatic, but hemorrhage of the tumor leads to abdominal pain and because of the hemorrhage and a small propensity to become malignant (termed malignant degeneration), hepatic adenomas are often surgically removed and although a solid, hypoechoic echogenicity is common, they may be hyperechoic, isoechoic, or have mixed echogenicities *it is mostly hypoechoic*

Question 34

hepatofugal | hepatopetal

Answer 34

hepatofugal - blood flow AWAY from the liver | hepatopetal - blood flow TOWARDS the liver

Question 35

hepatoma

Answer 35

the malignant tumor associated with hepatocellular carcinoma

Question 36

hepatomegaly

Answer 36

enlargement of the liver

Question 37

hepatosplenomegaly

Answer 37

enlargement of the spleen and liver

Question 38

hydatid liver cyst | AKA?

Answer 38

a liver cyst that develops from a tapeworm that lives in dog feces also referred to as an echinococcal cyst because it originates from the parasite Echinococcus granulosus may appear as an anechoic mass containing some debris (aka hydatid sand) may have the "water lily" sign, or "mother" cyst containing the "daughter" cysts the mass may also contain some elements of dense calcification

Question 39

hyperlipidemia

Answer 39

abnormally high levels of fats within the blood (i.e. high cholesterol and high triglycerides)

Question 40

hypovolemia

Answer 40

decreased blood volume

Question 41

idiopathic

Answer 41

no recognizable cause; from an unknown origin

Question 42

immunocompromised

Answer 42

a patient who has a weakened immune system

Question 43

jaundice

Answer 43

the yellowish discoloration of the skin, mucous membranes, and sclerae; found with liver disease and/or biliary obstruction

Question 44

kernicterus

Answer 44

brain damage from bilirubin exposure in a newborn with jaundice

Question 45

Kupffer cells

Answer 45

specialized macrophages within the liver that engulf pathogens and damaged cells

Question 46

leukocytosis

Answer 46

an elevated WBC count

Question 47

lipoma

Answer 47

a benign fatty tumor

Question 48

liver hilum

Answer 48

the area of the liver where the common bile duct exits the liver and portal vein and hepatic artery enter the liver; also referred to as the portal hepatis

Question 49

low-resistance flow

Answer 49

a flow patter that characteristically has integrate flow throughout the cardiac cycle

Question 50

malaise

Answer 50

feeling of uneasiness

Question 51

malignant degeneration

Answer 51

the deterioration of a benign mass into malignancy

Question 52

mass effect

Answer 52

the displacement or alteration of normal anatomy that is located adjacent to a tumor

Question 53

monophasic

Answer 53

vascular flow yielding a single phase

Question 54

necrosis

Answer 54

death of tissue

Question 55

periportal cuffing

Answer 55

an increase in the echogenicity of the portal triads as seen in hepatitis and other conditions the sonographic manificstation of this phenomenon is referred to as the "starry sky" sign

Question 56

porta hepatis

Answer 56

the area of the liver where the portal vein and hepatic artery enter an dot hepatic duct exit; also referred to as the liver hilum

Question 57

portal hypertension

Answer 57

the elevation of blood pressure within the portal venous system with portal hypertension, the coronary vein will demonstrate abnormal flow toward the esophagus and will measure greater than 6mm

Question 58

portal triads

Answer 58

an assembly of a small branch of portal vein, bile duct, and hepatic artery that surround each liver lobule

Question 59

portal vein thrombosis

Answer 59

the development of clot within the portal vein is seen in conditions such as HCC, portal hypertension, pancreatitis, cholecystitis, pregnancy, oral contraceptive use, and surgery the development of collaterals within the portal vein region will occur; these small vessels try to shunt blood around the clot.

Question 60

pseudocirrhosis

Answer 60

nodular appearance of the liver caused by multiple metastatic tumors

Question 61

pseudomass

Answer 61

false mass

Question 62

pyogenic liver abscess

Answer 62

a liver abscess that can result from the spread of infection from inflammatory conditions such as appendicitis, diverticulitis, cholecystitis, cholangitis, and endocarditis the bacteria enter the liver through the PV, HA, Biliary tree, or from an operative procedure clinical symptoms: fever, leukocytosis, possible abnormal liver function tests, right upper quadrant pain, and hepatomegaly it may appear as a complex cyst with thick walls, debris, separation, and/or gas. the air within the abscess may produce dirty shadowing or ring-down artifacts

Question 63

quadrate lobe

Answer 63

the medial segment of the left lobe

Question 64

recanalization

Answer 64

the reopening of canals or pathways

Question 65

Riedel lobe

Answer 65

a tonguelike extension of the right hepatic lobe

Question 66

sequela

Answer 66

an illness resulting from another disease, trauma, or injury

Question 67

serpiginous

Answer 67

twisted or snakelike pattern

Question 68

situs inversus

Answer 68

condition in which the organs of the abdomen and chest are on the opposite sides of the body (i.e. the liver is within the left upper quadrant instead of the right upper quadrant)

Question 69

splenomegaly

Answer 69

enlargement of the spleen

Question 70

starry sky sign

Answer 70

the sonographic sign associated with the appearance of perioportal cuffing in which there is an increased echogenicity of the walls of the portal triads

Question 71

steatohepatitis

Answer 71

a type of fatty liver disease that causes inflammation of the liver is a precursor for chronic liver disease, leading to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) in some individuals

Question 72

total parental hyperalimentation

Answer 72

procedure in which an individual receives vitamin and nutrients through a vein, often the subclavian vein

Question 73

transjugular intrahepatic portosystemic shunt (TIPS)

Answer 73

the therapy for portal hypertension that involves the placement of stent between the portal veins and hepatic veins to reduce portal systemic pressure

Question 74

triphasic

Answer 74

vascular flow yielding three phases

Question 75

von Gierke disease

Answer 75

condition in which the body does not have the ability to break down glycogen; also referred to as glycogen storage disease type 1

Question 76

von Hippel-Lindau disease

Answer 76

a inherited disease that includes the development of cysts within the liver, pancreas, and other organs

Question 77

Wilson disease

Answer 77

a congenital disorder that causes the body to accumulate excess copper

Question 78

associated abnormalities if you have a decrease of albumin:

Answer 78

chronic liver disease | cirrhosis

Question 79

associated abnormalities if you have an increase of ALP (alkaline phosphatase):

Answer 79

``` cirrhosis extra hepatic biliary obstruction gallstones hepatitis metastatic liver disease pancreatic carcinoma ```

Question 80

associated abnormalities if you have an increase of ALT (alanine aminotransferase)

Answer 80

biliary tract obstruction hepatitis hepatocellular disease obstructive jaundice

Question 81

associated abnormalities if you have increase of AST (aspartate aminotransferase)

Answer 81

cirrhosis fatty liver hepatitis metastatic liver disease

Question 82

associated abnormalities if you have increase gamma-Glutamyl transferase

Answer 82

diffuse liver disease | post hepatic obstruction

Question 83

associated abnormalities if you have increase LDH (lactate dehydrogenase)

Answer 83

cirrhosis hepatitis obstructive jaundice

Question 84

associated abnormalities if you have increase of Serum bilirubin

Answer 84

unconjugated (direct) bilirubin: acute hepatocellular disease conjugated (indirect) bilirubin: biliary tract obstruction total bilirubin: cirrhosis, hepatitis, and other liver cell diseases

Question 85

associated abnormalities if you have PT (prothrombin)

Answer 85

prolonged PT: metastasis of the liver and hepatitis | shortened PT: extra hepatic duct obstruction

Question 86

associated abnormalities if you have increase AFP (a-Fetoprotein)

Answer 86

``` hepatocellular carcinoma (hepatoma) hepatoblastoma ```

Question 87

clinical findings of fatty liver disease:

Answer 87

``` asymptomatic alcohol abuse chemotherapy diabetes mellitus elevated liver function est (specifically AST & ALT) hyperlipidemia obesity pregnancy ```

Question 88

sonographic findings of diffuse fatty liver disease:

Answer 88

diffusely echogenic liver increased attenuation of the sound beam wall of the hepatic vasculature and diaphragm will not be easily imaged

Question 89

sonographic findings of focal fatty infiltration

Answer 89

hyperechoic area adjacent to the gallbladder, near the port hepatic, or part of a lobe may appear echogenic

Question 90

sonographic findings of focal fatty sparing

Answer 90

hypoechoic area adjacent to the gallbladder, near the portal hepatic, or part of a lobe or an entire lobe may be spared can appear much like pericholecystic fluid when identified adjacent to the gallbladder.

Question 91

Clinical findings of Hepatitis

Answer 91

``` chills dark urine elevated liver function sets (ALP, ALT, AST, LDH, total bilirubin, prothrombin (PT)) fatigue fever hepatosplenomegaly jaundice nausea vomiting ```

Question 92

sonographic findings of hepatitis

Answer 92

normal liver enlarged hypoechoic liver periportal cuffing with "starry sky" gallbladder wall thickening

Question 93

clinical findings of cirrhosis

Answer 93

``` ascites diarrhea abnormal liver function tests (specifically elevated ALP, ALT, AST, bilirubin, PT, partial prothrombin time (PTT), total protein, and decreased albumin) fatigue hepatomegaly (initial) jaundice splenomegaly weight loss ```

Question 94

sonographic findings of cirrhosis

Answer 94

``` hepatosplenomegaly (initial) shrunken, echogenic right lobe of th eliver enlarged caudate and left lobes nodular surface irregularity coarse echotexture splenomegaly ascites monophonic flow within the hepatic veins hepatofugal flow within the portal veins ```

Question 95

examples of portosystemic collaterals that may result from portal hypertension

Answer 95

``` coronary vein short gastric vein gastrorenal pathway splenorenal pathway umbilical vein anterior abdominal wall vein superior mesenteric vein ```

Question 96

clinical findings of portal hypertension

Answer 96

``` abnormal liver function tests ascites diarrhea fatigue hepatomegaly (initially) hepatic encephalopathy caput medusa tremors gastrointestinal bleeding ```

Question 97

Sonographic findings of portal hypertension

Answer 97

hepatomegaly (initially) shrunken right lobe of the liver enlarged caudate lobe of the liver nodular surface irregularity coarse echotexture splenomegaly ascites monophonic flow within the hepatic veins hepatofugal flow within the portal veins enlargement o the portal vein (diameter will exceed 13 mm in the anteroposterior dimension) enlargement of the superior mesenteric vein enlargement and reversed flow within the coronary vein enlarged hepatic arteries abdominal varicosities at the splenic hilum, renal hilum, and gastroesophageal junction patent paraumbilical vein (also called a reanalyzed paraumbilical vein)

Question 98

clinical findings of portal vein thrombosis

Answer 98

``` abdominal pain elevated liver function tests hypovolemia leukocytosis low-grade fever nausea vomiting ```

Question 99

sonographic findings of portal vein thrombosis

Answer 99

echogenic thrombus within the portal vein cavernous transformation of the portal veins will appear as wormlike or serpiginous vessels within the region of the portal vein

Question 100

clinical findings of portal venous gas

Answer 100

recent bout of diverticulitis, appendicitis, inflammatory bowel disease, bowel obstruction, ulcers within the bowel, gastrointestinal cancer, and invasive procedures that involve stent placement (TIPS) or endoscopic analysis of the bowel

Question 101

sonographic findings of portal venous gas

Answer 101

small, bright reflectors noted within the circulating blood inside the portal vein large air collections may produce ring-down artifact

Question 102

clinical finding of budd-chiari syndrome

Answer 102

``` ascites elevated liver function test hepatomegaly splenomegaly upper abdominal pain ```

Question 103

sonographic findings of Budd chiari syndrome

Answer 103

nonvisualization or reduced visualization of the hepatic veins thrombus within the hepatic veins enlarged caudate lobe lack of flow within the hepatic veins with color doppler narrowing of the IVC

Question 104

diffuse infiltration

Answer 104

will cause the liver to appear diffusely echogenic, and it will be more difficult to penetrate the walls of the hepatic vasculature and diaphragm will not be easily imaged, secondary to the attenuation of the sound beam

Question 105

hemopoiesis

Answer 105

the formation and development of blood cells

Question 106

Portosystemic collaterals & vericosities

Answer 106

can consequently develop within the abdomen as a result of the body's attempt to repair itself by channeling blood away from the damaged liver

Question 107

clinical findings of hepatic cysts

Answer 107

asymptomatic possible normal liver function tests ADPKD (autosomal dominant polycystic kidney disease) Hemorrhagic or large cysts may cause right upper quadrant pain

Question 108

sonographic findings of hepatic cysts

Answer 108

anechoic mass or masses with posterior enhancement may have irregular shapes clusters of cysts may be noted

Question 109

clinical findings of hydatid liver cyst

Answer 109

``` leukocytosis low-grade fever nausea obstructive jaundice RUQ tenderness possible recent travel abroad ```

Question 110

sonographic finding of a hydatid liver cyst

Answer 110

anechoic mass containing some debris (hydatid sand) "water lily" sign appears as an endocyst floating within the pericyst "mother" cyst containing one or more smaller "daughter" cyst mass may contain some elements of dense calcification

Question 111

clinical findings of an amebic hepatic abscess

Answer 111

``` hepatomegaly RUQ or General abdominal pain general malaise diarrhea (possibly bloody) fever leukocytosis elevated liver function tests mild anemia possible recent travel abroad ```

Question 112

sonographic findings of amebic hepatic abscess

Answer 112

round hypoechoic or anechoic mass or masses may contain debris (with fluid-debris layering) acoustic enhancement

Question 113

clinical findings of a pyogenic hepatic abscess

Answer 113

``` fever hepatomegaly leukocytosis possible abnormal liver function tests right upper quadrant pain ```

Question 114

sonographic findings of a pyogenic hepatic abscess

Answer 114

complex cyst with thick walls mass may contain debris, separations, and/or gas the air within the abscess may produce dirty shadowing or ring-down artifact

Question 115

clinical findings of hepatic candidiasis

Answer 115

immunocompromised patients including cancer patients, recent organ transplant patients, and patients w/ human immunodeficiency virus RUQ pain fever hepatomegaly

Question 116

sonographic findings of hepatic candidiasis

Answer 116

multiple masses with hyperechoic center portions & hypoechoic boarders (may be described as "target," "halo," or "bull's-eye" lesions) these masses are typically 1 cm or smaller in size older lesions may calcify

Question 117

hepatic lipoma

Answer 117

is rarely encountered; patients are asymptomatic, and its sonographic appearance is that of hyperechoic mass

Question 118

Hepatic Hematoma

Answer 118

can be consequence of trauma or surgery pts will have pain and a decreased hematocrit can be located within the liver parenchyma, termed INTRAHEPATIC, or around the liver, which is termed SUBCAPSULAR (under Glisson capsule). they can appear solid or complex depending on their age initial hemorrhage appears echogenic with the development of clot, and over time as it resolves, it may appear more cystic or complex

Question 119

Focal Hematoma

Answer 119

have been known to calcify

Question 120

hepatocellular carcinoma

Answer 120

HCC is the MOST COMMON primary form of liver cancer (although it's not encountered as often as metastatic liver disease) Is found most often in men, and accompanied by cirrhosis, or chronic hepatitis the malignant mass associated w/ HCC is referred to as HEPATOMA other causes: hemochromatosis, von Gierke disease, and Wilson disease pts w/ HCC will have possible abnormal liver function tests, signs of cirrhosis, history of chronic hepatitis, unexplained weight loss, hepatomegaly, fever, abdominal swelling with ascites, and perhaps a palpable mass a tumor marker for HCC is serum alpha-fetoprotein (AFP) in the fetus, AFP is produced in lg amounts by the liver in an adult, low levels of AFP exist MOST patients w/ HCC will have an ELEVATED AFP - this occurs because AFP is produced in excess by the malignant hepatocytes that make up the tumor there may be an individual mass, or multiple masses, it may appear as a solitary, small, hypoechoic mass, or as heterogeneous masses scattered throughout the liver a hypoechoic halo MAY BE noted around the hepatoma as well, yielding the "target" or "bull's-eye" pattern - - the target lesion will yield a hypoechoic rim, with the center of the mass often isoechoic to normal liver tissue

Question 121

Hepatic Metastasis

Answer 121

It is the MOST COMMON form of liver cancer; it is much MORE COMMON than primary liver cancer BECAUSE malignant cells from OTHER SITES enter the liver through the PV or Lymphatic channels. Primary cancers that metastasize to the liver include: gallbladder, colon, stomach, pancreas, breast, & lung (lung being the most common primary source). Patients w/ hepatic metastasis may present w/ weight loss, jaundice, RUQ pain, hepatomegaly, and ascites; HOWEVER, about half of patients there are no signs/symptoms INCLUDING normal liver function tests. Mastatic cancer -- from the gastrointestinal tract & pancreas tends to be calcified tumors Hyperechoic Masses -- tend to arise from the gastrointestinal tract as well, most commonly the colon, but they may also be from the kidney, pancreas, or biliary tree. Hypoechoic Masses -- may be from the breast, lung, or lymphoma Cystic Metastatic Masses -- within the liver have also been seen with ovarian cancers Metastatic disease -- in the liver can appear as an individual mass, several large masses, or diffuse involvement Target lesions -- are also common w/ metastasis and may be the expression of lung or colon metastasis within the liver, although they may be the manifestation of many forms of cancer Diffuse metastasis -- can produce an appearance of a nodular liver (PSEUDOCIRRHOSIS) Masses can appear: hyperechoic, hypoechoic, calcified, cystic, or heterogeneous masses mass or masses demonstrating a hypoechoic rim & central echogenic region diffusely heterogeneous liver possible ascites

Question 122

Normal flow w/in the PV should be? Normal HV flow? Normal HA flow?

Answer 122

PV: Hepatopetal, continuous, monophonic, & have low velocity (between 20-40 cm/sec). HV: typically demonstrate a triphasic flow pattern (assessment should be obtained at the END of respiration) HA: should demonstrate a continuous, low-resistance wave form pattern, with a quick upstroke, and gradual deceleration with diastole (normal resistive index of the HA is between 0.5-0.8)