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ARDMS Abdomen Review > Liver > Flashcards

Liver Flashcards

1
Q

What is hemopoiesis?

A

In early embryonic life the liver is responsible for the formation and development of blood cells

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2
Q

What is the name of the thin layer that covers the liver?

A

Glisson Capsule

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3
Q

Although the liver is considered an intraperitoneal organ, what 5 areas are left uncovered?

A
  1. Bare area
  2. Galbladder area
  3. Falciform ligament
  4. Porta hepatis
  5. Area adjacent to the IVC
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4
Q

What are the 3 main lobes of the liver?

A
  1. Right lobe
  2. Left lobe
  3. Caudate lobe
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5
Q

What is a portal triad composed of?

A
  1. Portal vein
  2. hepatic artery
  3. Bile duct
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6
Q

What is the name of the system used to separate the liver into eight surgical segments?

A

Couinaud system

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7
Q

What ligament separates the liver into the left medial lobe and the right lateral lobe?

A

Falciform ligament

also know as Umbilical fissure

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8
Q

Where is the quadrate lobe located?

A

Between the gallbladder fossa and the round ligament

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9
Q

What divides the right lobe of the liver into anterior and posterior segments?

A

Right hepatic vein

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10
Q

What separates the right lobe from the left lobe?

A

Middle hepatic vein and also by the gallbladder fossa

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11
Q

What separates the left lobe into medial and lateral parts?

A

Left hepatic vein

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12
Q

The main portal vein is created by the union of the ____________ and ____________.

A
  1. SMV- superior mesenteric vein

2. Splenic vein

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13
Q

What does the image illustrate?

A

The Portal Confluence

  1. SMV
  2. IMV
  3. Splenic vein
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14
Q

Enlargement of the portal vein is called what? and what is the measurement?

A

Portal hypertension

More than 13mm abnormal

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15
Q

Do portal veins increase or decrease as they approach the diaphragm?

A

Decrease

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16
Q

What should normal flow be within the portal veins?(hepatopetal/fugal & monophasic/triphasic)

A

Monophasic and hepatopetal

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17
Q

How many hepatic veins do we have and what do they drain into?

A

3 (right,middle, left) and they drain into the IVC

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18
Q

Hepatic veins(increase/decrease?) as they approach the diaphragm? and what blood flow pattern do they have?

A

Increase

Triphasic—>because of their association with the right atrium and atrial contraction

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19
Q

what is Budd-Chiari syndrome?

A

The occlusion of the hepatic veins with possible coexisting occlusion of the inferior vena cava

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20
Q

What are the three structures located within the porta hepatis?

A

Main portal vein
Common bile duct
Hepatic artery–>carries oxygenated blood to the liver from aorta

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21
Q

Are hepatic arteries low or high resistance??

A

Low resistance flow pattern

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22
Q

In early embryonic life the umbilical vein bifurcates into what?

A

Left and right branch

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23
Q

What is the right branch referred as? and what does it turn into?

A

The right branch is referred as the DUCTUS VENOSUS and after it collpases becomes the ligamentum venosum

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24
Q

What does the left umbilical vein turn into?

A

It is referred to as the LIGAMENTUM TERES/ROUND LIGAMENT

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25
Q

Where can the ligamentum venosum be noted? What does it look like in the transverse plane?

A

Anterior to the caudate lobe

In transverse it appears as a hyperechoic triangular shape b/w right and left hepatic lobe

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26
Q

Where is the main lobar fissure?

A

It houses the middle hepatic vein and and appears to connect the neck of the GB to the right portal vein

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27
Q

What is a diaphragmatic slip?

A

A pseudomass of the liver seen on sonography resulting from hypertrophied diaphragmatic muscle bundles

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28
Q

What is a reidel lobe?

A

it is a tonguelike extension of the right hepatic lobe, moslty seen in women and may extend all the way down to iliac crest

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29
Q

What is situs inversus?

A

Condition in which the organs of the body are on the opposite side

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30
Q

What is the normal measurement of the liver?

A

13 to 15 cm

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31
Q

At what measurement is hepatomegaly suspected?

A

larger than 15.5 cm

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32
Q

What is fatty liver disease?

A

It is referred to as hapatic steatosis and is charecterized by fatty deposits (triglycerides) within the hepatocytes

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33
Q

What are the two types of fatty liver disease?

A

Nonalcoholic fatty liver disease

Alcoholic fatty liver disease

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34
Q

Which is more common? (Alcoholic or Nonalcoholic liver disease)

A

Nonalcoholic fatty liver disease is the most common in the western world and most common cause of chronic liver disease

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35
Q

Which is more common? (Alcoholic or Nonalcoholic liver disease)

A

Nonalcoholic fatty liver disease is the most common in the western world and most common cause of chronic liver disease

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36
Q

What causes Nonalcoholic fatty liver disease?

A
  1. starvation
  2. obesity
  3. chemotherapy
  4. diabetes mellitus
  5. hyperlipidemia
  6. pregnancy
  7. glycogen storage disease
  8. Von Gierke disease
  9. severe hepatitis
  10. cystic fibrosis
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37
Q

What is steatohepatitis?

A

It is an inflammation of the liver and a precursor for chronic liver disease.

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38
Q

What is the appearance of diffuse fatty infiltration?

A

It will cause the liver to appear diffusely echogenic and will be more difficult to penetrate and the walls of the hepatic vasculature will not be easily imaged

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39
Q

What does focal fatty infiltration appear like?

A

It will appear as an area of increased echogenicity—>like a solid hyperechoic mass

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40
Q

What is focal fatty sparing and what does it look like?

A

The area of sparing can appear like a solid hypoechoic mass or even fluid

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41
Q

Where is focal fatty infiltration and sparing likely to be seen?

A
  1. seen adjacent to the GB
  2. near the porta hepatis
  3. in the left medial segement
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42
Q

What is hepatitis and what can it lead to?

A

It is an inflammation of the liver and can lead to cirrhosis, portal hypertension and HCC

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43
Q

How long does it take acute hepatitis to resolve?

A

within 4 months

44
Q

How long does it take chronic hepatitis to resolve?

A

More than 6 months

45
Q

What are the two most common forms of hepatitis?

A

Hepatitis A and Hepatitis B

46
Q

How is hepatitis A acquired?

A

It is spread to by fecal-oral route in contaminated water or food

47
Q

How is hepatitis B spread?

A

It is spread by contact with contaminated body fluids, mother to infant transmission , or inadvertent blood contact as seen in case of intravenous drug abuse.

48
Q

What is Wilson disease?

A

It is a congenital disorder that causes the body to accumulate excess copper

49
Q

What are symptoms of hepatitis?

A

Fever, chills, nausea, vomiting, fatigue, hepatosplenomegaly, dark urine and jaundice

50
Q

Which common liver function tests are elevated in patients with hepatitis?

A
  1. Alkaline phosphate (ALP)
  2. Aspartate amino’’ “ (AST)
  3. Alanine amino” “ (ALT)
  4. Lactate Dehydrogenase (LDH)
  5. Serum bilirubin
51
Q

What is hepatic encephalopathy?

A

It is a condition in which a patient becomes confused or suffers from intermittent loss of consciousness due to the overexposure of the brain to toxic chemicals that the liver would normally remove.

52
Q

What is kernicterus?

A

Brain damage from bilirubin exposure in a newborn with jaundice

53
Q

Sonographic appearance of hepatitis?

A

Hepatosplenomegaly, enlarged hypoechoic liver and gallbladder wall may be thickened

54
Q

What is cirrhosis?

A

A liver disorder, necrosis of the liver and the development of regenerating nodules

55
Q

Most common cause of cirrhosis?

A

Alcoholism

56
Q

What is the sonographic appearance of cirrhosis?

A

Echogenic small right lobe, an enlarged caudate and left lobe, nodular surface irregularity, coarse echotecture, ascites and splenomegaly

57
Q

Cirrhosis caused by alcoholism will lead to the development of nodules that measure less than ____ cm

A

1 cm—>termed micronodular

58
Q

Cirrhosis caused by hepatitis will cause nodules that measure between ____ and ____ cm

A

1 to 5 cm—->Macronodular

59
Q

What are the doppler findings in patients with cirrhosis?

A
  1. monophasic flow within the hepatic veins

2. hepatofugal flow within the portal veins

60
Q

What is portal hypertension?

A

It is the elevation of blood pressure within the portal venous system

61
Q

What is the most common cause of portal hypertension?

A

Cirrhosis

62
Q

What is the most common sonographically identifiable collateral of portal hypertension?

A

The recanalization of the paraumbilical vein—-> patent paraumbilical vain

63
Q

What is hematemesis?

A

Vomiting blood

64
Q

What is caput medusa?

A

Dilation of the superficial veins of the abdomen

65
Q

What is portal vein thrombosis?

A

The development of a clot within the portal vein

66
Q

What is leukocytosis?

A

An elevated white blood cell count

67
Q

T/F: Gas within the portal veins or mesenteric veins typically fatal.

A

true

68
Q

T/F: Gas within the portal veins or mesenteric veins typically fatal.

A

true

69
Q

What is Budd Chiari syndrome?

A

Its described as the occlusion of the hepatic veins , with possible coexisting occlusion of the IVC

70
Q

What are the clinical findings of budd chiari?

A
  1. Ascites
  2. elevated liver function tests
  3. hepatomegaly
  4. splenomegaly
  5. upper abdominal pain
71
Q

What are the sonographic findings of budd chiari syndrome?

A
  1. Nonvisualization or reduced visualization of the hepatic veins
  2. thrombus within the hepatic veins
  3. enlarged caudate lobe
  4. lack of flow within the hepatic veins with color
  5. narrowing of the ivc
72
Q

What are hepatic cysts usually associated with and when are they encountered?

A
  1. middle age

2. are associated with autosomal polycystic kidney disease

73
Q

What is the sonographic appearance of hepatic cysts?

A

Simple cyst appearance, shape may be irregular, , they might be in clusters, anachoic

74
Q

What is the appearance of complex hepatic cysts?

A

usually associated with hemorrhage , will have internal echoes, thick walls, calcifications, or solid componenets

75
Q

What are the clinical findings of hepatic cysts?

A
  1. asymptomatic
  2. possible normal liver function tests
  3. ADPKD
  4. hemorrhagic or large cysts may cause right RUQ pain
76
Q

What is a hydatid liver cyst aka echinococcal cyst?

A

These are cysts that develop from the parasite Echinococcus granulosus, which is a tape worm that lives in dog feces. It is insted by eating contaminated foods and is common in sheep/cattle raising countries—>middle east, australia, mediterranean

77
Q

What are the clinical findings of hydatid cysts?

A
  1. leukocytosis
  2. low grade fever
  3. nausae
  4. obstructive jaundice
  5. RUQ tenderness
  6. possible recent travel abroad
78
Q

What are the sonographic appearance of hydatid cysts?

A
  1. anechoic containing some debris
  2. “water lily” sign
  3. mother cyst containing daughter cysts
  4. may contain dense calcifications
79
Q

What is an amebic hepatic cyst and what causes it?

A

it comes from the parasite Entamoeba histolytica that grows in the colon and invades the liver via the portal vein. It is typically transmitted through contaminated water

80
Q

What are the clinical findings of an amebic abscess?

A
  1. hepatomegaly
  2. RUQ or abd pain
  3. General malaise
  4. Diarrhea
  5. fever
  6. Leukocytosis
  7. Elevated liver function tests
  8. mild anemia
  9. possible recent travel abroad
81
Q

What is the sonographic apperance of amebic abscess?

A
  1. round hypoechoic or anechoic mass
  2. may contain debris
  3. acoustic enhancement
82
Q

What is a pyogenic hepatic abscess?

A

It can result from the spread of infection from inflammatory conditions such as appendicitis, cholecystitis, cholangitis, endocarditis because bacteria enter the liver through the portal vein, hepatic artery, biliary tree or from op procedure

83
Q

What are the clinical findings of a pyogenic hepatic abscess?

A
  1. fever
  2. hepatomegaly
  3. leukocytosis
  4. abnormal liver function tests
  5. RUQ pain
84
Q

What is the sonographic appearance of pyogenic hepatic abscess?

A
  1. complex cyst with thick walls
  2. mass m ay contain debris, septations, or gas
  3. if it contains gas—> dirty shadowing
85
Q

What is hepatic candidiasis?

A

It results from the spread of fungus, candida albicans in the blood to the liver

86
Q

In which group of people is hepatic candidiasis prone?

A

the immunocompromised—> cancer pts, transplant pts, hiv pts

87
Q

What are the clinical findings of hepatic candidiasis?

A
  1. immunocompromised
  2. RUQ pain
  3. fever
  4. hepatomegaly
88
Q

What is the sonographic appearance of hepatic candidiasis?

A
  1. multiple massesw/ hyperechoic central portions and hypoechoic borders—>”target” “halo” “bulls eye” sign
  2. usually 1 cm or smaller
  3. older lesions may calcify
89
Q

What is a cavernous hemangioma?

A

The most common benign liver tumor, more common in women, and are typically found in the right lobe of the liver

90
Q

What are the clinical findings of the cavernous hemangioma?

A

asymptomatic

91
Q

What is the sonographic appearance of the cavernous hemagioma?

A
  1. small hyperechoic mass

2. usually in the right lobe

92
Q

What is focal nodular hyperplasia?

A

It is the second most common benign liver tumor, typically discovered in women, and is composed of hepatocytes an d fibrous tissue

93
Q

What are the clinical findings of focal nodular hyperplasia?

A
  1. asymptomatic
94
Q

What is the sonographic appearance of focal nodular hyperplasia?

A
  1. can vary, isoechoic, hyperechoic, hypoechoic mass

2. central scar may appear as hyperechoic or hypoechoic, will have hypervascularity with doppler

95
Q

What is hepatocellular adenoma?

A

Aka hepatic adenoma or liver cell adenoma is a RARE benign liver tumor and associated with the use of oral contraceptives. It may be prone to hemorrhage and has a propensity to become malignant, they are often removed

96
Q

What is malignant degradation?

A

The deterioration of a benign mass into malignancy

97
Q

What is the sonographic appearance of hepatocellular adenoma?

A
  1. variable—>solid and hypoechoic appearance, hyperechoic, isoechoic, mixed echogenicities
98
Q

What is a hepatic hematoma?

A

Can be caused by injury or trauma, pts will have pain and decreased hematocrit

99
Q

What is a intrahepatic hematoma?

A

hematoma within the liver

100
Q

What is subcapsular hematoma?

A

hematoma outside of the liver, around the liver–> glisson capsule

101
Q

What is an arteriovenous fistula?

A

An abnormal passageway b/w an artery and a vein

102
Q

What are the clinical findings of hepatic hematomas?

A
  1. trauma/injury
  2. recent surgery
  3. pain
  4. decreased hematocrit
103
Q

What is the sonographic appearance of hepatic hematoma?

A
  1. fresh clot may appear hyperechoic

2. older hemorrhage may appear anechoic or complex

104
Q

What is hepatocellular carcinoma?

A

HCC is the most common primary form of liver cancer, most often seen in men and accompanied by cirrhosis and chronic hepatitis

105
Q

The malignant mass associated with HCC is referred to as a _________.

A

Hepatoma

106
Q

What is the tumor marker for HCC?

A

AFP—-> alpha-fetoprotein

107
Q

What are the clinical findings of HCC?

A
  1. elevated AFP
  2. abnormal liver function tests
  3. Cirrhosis
  4. chronic hepatitis
  5. unexplained weight loss
  6. hepatomegaly
  7. fever
  8. palpable mass
  9. abdominal swelling w/ ascites

ARDMS Abdomen Review (2 decks)

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