Liver

Question 1

In what plane is the liver typically measured and what measurement is considered hepatomegaly?

Answer 1

SAG plane
> 16

Question 2

What is the name of the capsule that covers the liver?

Answer 2

Glissons

Question 3

What is the potential space between the liver and right kidney?

Answer 3

Morrisons

Question 4

What is the fibrous cord resulting from the obliterated left umbilical vein?

Answer 4

Ligamentum Teres

Question 5

What ligament separates RT and LT lobes?

Answer 5

Falciform

Question 6

What vessels are intersegmental and intrasegmental?

Answer 6

Inter = between = Hepatic V

Intra = within = PV, Hepatic Artery, Bile duct

Question 7

What lobes does the ligamentum venosum separate?

Answer 7

Lt lobe and caudate lobe

Question 8

The hepatic artery branches off what?

Answer 8

CT

Question 9

What measurement constitutes intrahepatic duct dilation?

Answer 9

> 2mm

Question 10

What LFT is the most indicative of alcoholism?

Answer 10

GGT

Question 11

What causes increase in AFP in adults and paediatrics?

Answer 11

Adults = HCC
Pediatrics = Hepatoblastoma

Question 12

HCC is associated with what kind of cirrhosis?

A) Micronodular
B) Chronic
C) Macronodular
D) Acture

Answer 12

Macrodnodular

Question 13

What type of hepatitis is contracted via the fecal-oral route?

Answer 13

Hep A

Question 14

What type of hepatitis is contracted via contaminated drinking water?

Answer 14

Hep E

Question 15

What type of hepatitis is contracted via mother/infant route?

Answer 15

Hep B

Question 16

What pathology is seen with the “starry sky” sign and GB wall thickening?

Answer 16

Acute Hepatitis

Question 17

What is the m/c type of glycogen storage disease?

Answer 17

Von Gierk’s

Question 18

What kind of solid liver masses may be seen with glycogen storage disease?

A) Adenoma
B) Lipoma
C) Angiomyoma
D) Sarcoma

Answer 18

Adenoma - hyperechoic with hypoechoic halo

Question 19

What is Budd Chiari?

Answer 19

Occlusion of some or all HV’s and IVC

Question 20

Budd Chiari triad?

Answer 20

Hepatomegaly
Ascites
Abdominal pain

Question 21

Sonographic features on the screen show cavernous transformation in portal vein and a dilated SMV and SV, what is the possible diagnosis?

Answer 21

Portal venous thrombosis

Question 22

Caput Medusa sign is seen in what pathology?

Answer 22

PV hypertension - severe cases seen around umbilicus

Question 23

What is the most common cause of intra-hepatic portal hypertension?

Answer 23

Cirrhosis

Question 24

SF = comma-shaped portal trunk, increased periportal echogenicity, dilated SMV & SV, ascites, splenomegaly. What is the most likely diagnosis?

Answer 24

PV hypertension

Question 25

What does TIPS stand for and what is the vessel connection?

Answer 25

Transjugular Intrahepatic Portosystemic Shunt - connects PV and HV

Question 26

Congenital liver cysts most commonly affect what side?

Answer 26

RT

Question 27

With polycystic liver disease, what other organs should be assessed? (3)

Answer 27

Kidneys, pancreas, spleen - most commonly detected in 30's and 40's and most common in women

Question 28

What are the stages of a clot?

Answer 28

Freshly echogenic, then will become complex, then will become anechoic (seroma)

Question 29

What pathology is known as a cluster of tubular-appearing cysts that parallel the bile ducts and PV’s in the center of the liver?

Answer 29

Peribiliary cysts

Question 30

SF of pyogenic abscess?

Answer 30

Hypoechoic Homogenous Round or ovoid

Question 31

What kind of hepatic infection causes black tarry stools? A) Pyogenic abscess B) Amebic Abscess C) Schistosomiasis D) Hydatid disease

Answer 31

Amebic

Question 32

What abnormality has a "clay pipe stem" appearance and echogenic thickened PV walls? A) Pyogenic abscess B) Amebic Abscess C) Schistosomiasis D) Hydatid disease

Answer 32

Schistosomiasis

Question 33

What abnormality has a "water lily sign" A) Pyogenic abscess B) Amebic Abscess C) Schistosomiasis D) Hydatid disease

Answer 33

Hydatid - patient may experience anaphylactic shock

Question 34

What pathology consists of numerous tiny bright reflective parenchymal echoes (“starry sky” pattern), may find multi-organ calcification?

Answer 34

HIV/AIDS and hepatitis

Question 35

What kind of liver lesion contains a "wheel within a wheel" sign?

Answer 35

Fungal

Question 36

Patient presents with no symptoms. You see an isoechoic lesion with a central stellate scar that is 3cm. The patient currently uses OCP. What may be this pathology?

Answer 36

FNH

Question 37

What liver lesion is associated with long term OCP use but can go away with cessation of OCP and has malignant potential?

Answer 37

Liver adenoma

Question 38

SF of liver adenoma?

Answer 38

Hyperechoic with hypoechoic halo - has peripheral and central vascularity

Question 39

What two pathologies are linked to hepatic AML's?

Answer 39

Tuberous sclerosis and renal AML's

Question 40

What is typical of a patient to have when HCC is diagnosed?

Answer 40

Cirrhosis

Question 41

What is the m/c liver malignancy?

Answer 41

Hepatoma / HCC - most commonly occurs in men in 6th decade - Increased AFP!

Question 42

SF of HCC?

Answer 42

Can vary but in cirrhotic livers, it is hypoechoic and has chaotic vascularity. Will invade PV in 60% of cases and HV in 15%

Question 43

What are hemangiosarcomas and angiosarcomas usually associated with?

Answer 43

Carcinogens - aggressive tumor and typically present in 60-80's

Question 44

What is the M/C source of mets in the liver?

Answer 44

Colon

Question 45

Where do METS come from based on the SF in liver? Hyperechoic Cystic Hypoechoic Target/bulls eye Calcified

Answer 45

1) RCC, colon, neuroendocrine 2) leiomyosarcomas, ovarian cancer 3) Lymphoma 4) Lung 5) Colon, stomach, ovary, breast

Question 46

Which of the following is seen in patients with late stage cirrhosis? A) Less sound attenuation B) Caudate lobe atrophy C) Hepatofugal flow in the PV D) Shrunken, strophic spleen

Answer 46

Hepatofugal flow in PV

Question 47

What is the obliterated fetal remnant of the left umbilical vein known as and where on ultrasound can it be seen?

Answer 47

Ligamentum teres - lower left segment continuous with the falciform ligament

Question 48

What separates the left lobe from the caudate lobe?

Answer 48

Ligamentum venosum - remnant of ductus venosus

Question 49

What fissure separates the left lobe into medial and lateral? A) Ligamentum venosum B) Ligamentum teres C) Falciform ligament D) Main lobar fissure

Answer 49

Ligamentum teres in TRV plane

Question 50

What vessel courses within the MLF? A) Rt HV B) Main PV C) Lt HV D) Middle HV

Answer 50

Middle hepatic V