Lesson 1A (Part 3)

Question 1

Bilirubin

Answer 1

A product from the breakdown of hemoglobin in old red blood cells

Question 2

What can cause abnormal levels of bilirubin?

Answer 2

A disruption in the process

Question 3

What causes the skin to look yellow?

Answer 3

A leakage of bilirubin into the tissues

Question 4

What does bilirubin reflect the balance between? (2)

Answer 4

1. Production of bile

2. Excretion of bile

Question 5

What are elevated levels of direct or conjugated bilirubin associated with? (4)

Answer 5

1. Obstruction
2. Hepatitis
3. Cirrhosis
4. Liver metastases

Question 6

What are decreased levels of indirect of unconjugated bilirubin associated with?

Answer 6

Non-obstructive conditions

- eg. steatosis

Question 7

What are indications for an US of the liver? (5)

Answer 7

1. Abnormal LFT’s
2. Hepatocellular disease
3. Biliary disease
4. Abdominal /postprandial pain
5. Palpable liver or spleen
   pancreatitis

Question 8

What are 2 types of congenital abnormalities for development in the liver?

Answer 8

1. Agenesis

2. Partial agenesis

Question 9

Agenesis

Answer 9

No liver

- cant liver without it (but can live with a partial liver)

Question 10

Partial agenesis

Answer 10

Part of the liver

- typically have a larger right lobe if you don’t have a left lobe (one lobe compensatory)

Question 11

What are 2 types of congenital abnormalities for position in the liver?

Answer 11

1. Situs inversus totalis

2. Congenital (fetal US) diaphragmatic hernia or omphalocele

Question 12

Situs inversus totalis

Answer 12

Liver is found in the left hypochondrium

- opposite side

Question 13

Congenital (fetal US) diaphragmatic hernia or omphalocele

Answer 13

Liver may herniate into the thorax or outside the abdominal cavity
- break through the diaphragm

Question 14

What is a common appearance for granulomas?

Answer 14

Calcifications in parenchyma

Question 15

What is granulomas related to? (2)

Answer 15

1. Scarring

2. Infection

Question 16

What is the common appearance for hamaromas? (4)

Answer 16

1. Small
2. Focal
3. Solid
4. Hypoechoic

Question 17

What is the common appearance for cysts? (3)

Answer 17

1. Fluid filled
2. Epithelial lining
3. Posterior acoustic enhancement

Question 18

What are cysts related to?

Answer 18

Abnormal LFTs

• tumours
• infection
• biliary obstruction

Question 19

What is the common appearance for abscess forming from cysts? (4)

Answer 19

1. Internal echoes
2. Septations
3. Thick walls
4. Solid

Question 20

What is the common appearance for cavernous hemangioma? (4)

Answer 20

1. Homogenous
2. Hyperechoic
3. Tiny blood vessels but avascular on doppler
4. Well circumscribed

Question 21

What is the most common benign tumour?

Answer 21

Cavernous hemangioma

Question 22

What is the common appearance for focal nodular hyperplasia? (5)

Answer 22

1. Central scar
   - vascular malformation
2. Isoechoic
3. Well circumscribed
4. Contour abnormality to liver
5. Hypervascular/stellate pattern
   - spoke wheel appearance

Question 23

What is the second most common benign tumour?

Answer 23

Focal nodular hyperplasia

- FNH

Question 24

What is FNH related to? (3)

Answer 24

1. Hormones
2. Oral contraceptives
3. Child bearing years

Question 25

What is the common appearance for hepatic adenomas? (5)

Answer 25

1. Hyper vascular - periphery 2. Heterogenous - presence of fat, glycogen hemorrhagic products 3. Multiple feeding arteries 4. Shows central hepatic artery 5. Capsule in 1/3 of cases**

Question 26

What is a symptom of hepatic adenomas (2)

Answer 26

1. Pain - RUQ 2. Palpable mass if large enough

Question 27

What are hepatic adenomas related to?

Answer 27

Hormones

Question 28

What is the common appearance for fatty tumours? (2)

Answer 28

1. Broken diaphragm 2. Echogenic mass - well defined

Question 29

What are fatty tumours related to?

Answer 29

Renal angiomyolipomas