Liver

Question 1

which of these is the least accurate marker of hepatomegaly?
a) Extending beyond the costal arches
b) rounded liver margins
c) the liver extends beyond the right kidney
d) the liver margin reaching the left kidney

Answer 1

A- depends on conformation of the breed, in puppies it is also usually beyond the costal arches

Question 2

the liver is usually ___ to the falciform fat?
a) hyperechoic
b) isoechoic
c) hypoechoic

Answer 2

B. in fat cats it is hyperechoic
Its echogenicity relative to the renal cortices is more variable, although usually hyperechoic to isoechoic.

Question 3

which is true about a small volume of gallbladder sludge?
a) in dogs it is a marker of increased liver enzymes
b) in cats it can be predictive of increased liver enzymes and increased bilirubin
c) in dogs it usually means delayed gallbladder emptying
d) in cats it is always incidental

Answer 3

B
Biliary sludge is often recognized in the GB of asymptomatic dogs , although there is growing evidence that this may indicate a delay in GB emptying. GB sludge in cats can be predictive of increased liver enzymes and total bilirubin, but it may also be encountered
without evidence of biliary disease.

paper of cats 2022: seen in 44% of cats (out of 192) having ultrasound. Gallbladder sludge was not associated with other ultrasonographic abnormalities of the liver, gallbladder, bile duct or
pancreas. Gallbladder sludge is common in cats undergoing abdominal ultrasound and appears to be a non-specific finding. The clinical significance of concurrent gallbladder sludge and gallbladder wall thickening present on ultrasound in cats remains to be
determined.

Question 4

what is the normal wall thickness of the gallbladder in dogs <40kg?
a) 0.5mm- 1.8mm
b) 1mm (CI up to 1.5)
c) up to 1.3mm (confidence interval up to 1.41)
c) 2-3mm

Answer 4

C. JVIM 2023

Question 5

what is the normal gallbladder wall thickness in cats?

Answer 5

less than 1mm.

Question 6

what is the normal maximal luminal diameter of the common bile duct in dogs and cats (dog, cat)?
a) 4mm,5mm
b) 3mm, 4mm
c) 2mm, 3mm
d) 4mm, 4mm

Answer 6

B
the wall of the CBD should not exceed 1mm.
above 4-5mm in cats considered obstructive

Question 7

how can you work out the mean portal flow velocity (2 options)?

a) using the uniform insonation technique, the sample gat is angled perpendicular to the vessel trajectory. the sample gate must be the same diameter as the portal vein.
b) using the uniform insonation technique and an angle of less than or equal to 60 degrees, a sample gate volume that fills approximately half of the main portal vessel lumen placed in its center, multiplied by 0.57.
c) using the uniform insonation technique and an angle of more than or equal to 60 degrees, which requires the application of a sample gate volume that fills the entire width of the main PV.
d) using the uniform insonation technique and an angle of less than or equal to 60 degrees, which requires the application of a sample gate volume that fills the entire width of the main PV.

Answer 7

B, D

Portal flow mean velocity can be calculated by the ultrasound
system by using the uniform insonation technique, which requires the application of a sample gate volume that fills the entire width of the main PV. Alternatively, a sample gate volume that fills approximately half of the vessel lumen placed in its center can be used to obtain maximal flow velocity. Because of the parabolic behavior of the portal flow, mean portal flow velocity can then be estimated by multiplying this result by 0.57. Mean portal flow velocities have been reported to vary between 15 ± 3 and 18 ± 8 cm/s in normal dogs and 10–18 cm/s in normal cats
flowing away from you so value is negative

Question 8

Which of the following is more likely to represent as a small liver?
a) acute cholangiohepatitis
b) lymphomatous infiltration of the liver
c) chronic hepatitis
d) vacuolar hepatopathy

Answer 8

C

Question 9

A liver with amyloidosis is usually…?
a) hyperechoic
b) can be any echogenicity
c) mixed or hypoechoic
d) isoechoic to hyperechoic

Answer 9

C according to table 6.1

Question 10

which is true regarding hepatic ultrasound?
a) histiocytic neoplasms are more commonly associated with with hypoechoic nodules and masses
b)Lymphoma always causes detectable ultrasonographic changes
c) Mast cell tumour infiltration tends to cause diffuse hypoechogenicity
d) hepatic carcinomas are always focal mass lesions

Answer 10

A it true
b- can be very variable
c- hyperechogenic liver usually, but can be any
d- Hepatic carcinomas can also be diffuse, or involve multiple
lobes, with a variable ultrasonographic appearance
that depends on the presence of necrosis, inflammation,
hemorrhage, or cavitation. A mixed pattern of
echogenicity is common with these malignant tumors

Question 11

which breed of dog is more commonly affected by amyloidosis?
a) pug
b) chow chow
c) Abyssinian
d) shar pei

Answer 11

D
cats- Siamese and Abyssinian

Question 12

a 11yo dog presents with raised liver enzymes and dermatitis around the eyes, with thickening of the footpads, which image is more likely to represent what this dog liver will look like on ultrasound?

Answer 12

A hepatocutaneous syndrome
superficial necrolytic dermatitis

Question 13

multiple target lesions are most commonly associated with what disease?
a) metastasis
b) primary neoplasia
c) nodular hyperplasia
d) ecchinococcosis

Answer 13

A.
PPV 74% it at least one in the liver or spleen but only out of 21 dogs and 1 cat

Question 14

which of the following features make a malignant disease more likely (2)?
a) lesion 5-15mm
b) lesion more than 30mm
c) hyperechoic falciform fat
d)peritoneal effusion

Answer 14

b,d

Question 15

mineralised cystic hepatic lesions are are common with what disease?
a) FIP
b) parasitic disease such as ecchinococcus
c) abscesses
d) biliary carcinoma

Answer 15

B

Question 16

which two features can help distinguish a hepatic haematoma from neoplastic disease
a) decreasing size over a period of time
b) more heterogeneous over a period of time
c) development of a thick irregular rim
d) development of a cystic component

Answer 16

A, D

Question 17

image of the liver on ultrasound
a) metal clips
b) neoplasia
c) dystrophic mineralisation
d) abscess

Answer 17

D

Question 18

liver of a febrile cat, which is least likely
a) granuloma
b) mast cell tumour
c) multifocal infarction
d) myelolipoma

Answer 18

C
this was granulomas in this case

Question 19

which of the following is false regarding ultrasound of the biliary tract?
a) a choledochal cyst is a congenital cystic disease involving the pancreatico-biliary ductal junction
b) dilation of the CBD more and 5mm indicates obstruction in cats
c) the too many tubes sign is seen within 2 days of a complete obstruction of the CBD
d) the absence of gallbladder dilatation should not rule out biliary tract obstruction

Answer 19

c- usually within 5-7 days in the study

Question 20

the most common neoplasia of the biliary system is?
a) sarcoma
b) carcinoma
c) round cell
d) neuroendocrine

Answer 20

B

Question 21

Which of the following conditions is not a cause of gallbladder wall thickening (>1mm)?
A) Cholecystitis
B) Portal hypertension
C) Biliary obstruction
D) Neoplasia
E) Giardia

Answer 21

E. can be caused by inflammation (cholecystitis/cholangitis/ cholangiohepatitis), edema (portal hypertension, hypoalbuminemia, biliary obstruction, or inflammation), cystic mucosal hyperplasia, or, rarely, neoplasia

Question 22

which is true regarding the difference between dogs and cats with regard to extrahepatic biliary obstruction?
a) In cats, gallbladder distention is more commonly seen than in dogs
b) In dogs the common bile duct is always easy to trace when it is obstructed
c) the most common cause of extrahepatic biliary tract obstruction in dogs is pancreatitis
d) the most common cause of extrahepatic biliary tract obstruction in cats is cholelithiasis

Answer 22

C (42% of cases in one study)
dogs are more likely to have gallbladder distension than cats
in a study from 2007 neoplasia was the most common cause of EHBO in cats, followed by inflammation in 11/30 cats, and a cholelith in 7/30 cats. in another study 7/22 had neoplasia, 15 cats had at least one of a complex of inflammatory diseases including pancreatitis, cholangiohepatitis, cholelithiasis and cholecystitis.

https://pubmed.ncbi.nlm.nih.gov/12074289/
https://journals.sagepub.com/doi/full/10.1177/1098612X17706465#bibr23-1098612X17706465
https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1740-8261.2007.00275.x?saml_referrer

Question 23

which breed is over-represented for cholelithiasis
a) GSD
b) Maltese
c) cavalier king Charles
d) Cocker spaniel

Answer 23

C, usually incidental

Question 24

which is true about the portal vasculature?
a) to assess for a congenital EHPSS, the minimal diameter of the aorta and the diameter of the portal vein are compared at the level of the porta hepatis
b) a PV:Ao ratio between 0.65-1 is a grey area where EHPSS may be possible
c) in portal vein hypoplasia, the extra hepatic portal vein is always normal in diameter
d) a PV:Ao ratio less than or equal to 0.65 means a EHPSS or congenital portal hypoplasia is very likely

Answer 24

D is correct
a- maximal aortic diameter needed
b- 0.65-0.8 is unclear. more than 0.7-0.8 excludes an EHPSS
c- can be small

Question 25

define hepatofugal

Answer 25

blood flowing away from the liver

Question 26

portal hypertension is suspected when portal velocity is more than what value (mean)? a) -10cm/s b) -20 cm/s c) -18 cm/s d) -15m/s

Answer 26

A in the book it says less than 10cm/s but normal portal flow is usually negative (blue, away from the probe) normal velocity in dogs is -15 to -25 ish cm/s technically flow is reversed if the value is positive

Question 27

which of the following traces is most likely to be seen in the portal vein of a patient with an arterioportal venous fistula?

Answer 27

D arterial pulsatile flow away from the liver

Question 28

which doppler pattern would be found in a normal hepatic vein?

Answer 28

C The waveform consists of two retrograde waves (a and v), which represent blood flow away from the heart, and two antegrade waves (S and D), which represent blood flow toward the heart. The various wave components are a result of pressure differences within the right atrium and the hepatic veins. The A wave (a in the figure) occurs after the P wave on the ECG. It results from elevated right atrial pressure caused by right atrial contraction that creates a burst of reversed flow into the hepatic veins. The S wave occurs after the QRS complex. It results from a negative pressure in the right atrium with corresponding flow from the hepatic veins to the heart. This negative pressure is created by right atrial relaxation and movement of the tricuspid annulus toward the cardiac apex. The V wave (v in the figure) occurs toward the end of the T wave on the ECG tracing. It results from increased right atrial pressure secondary to overfilling against a closed tricuspid valve. The D wave is a diastolic wave that results from negative pressure created in the right atrium secondary to blood flowing into the right ventricle (away from the hepatic veins) through an open tricuspid valve. pulsatile flow within the hepatic veins and caudal vena cava is referred to as triphasic because there are two antegrade pulses (S and D waves) and one retrograde pulse (A wave). The A wave is so named because it occurs during atrial systole, whereas the S and D waves are named because they occur during ventricular systole and diastole, respectively.

Question 29

a) cholecystoliths b) parasitic disease c) inspissated bile d) fungal disease

Answer 29

B flukes

Question 30

In cats with extrahepatic biliary obstruction, what percentage of cases was gall bladder dilatation seen? Less than 25% Less than 50% More than 60% More than 90%

Answer 30

B

Question 31

When evaluating a suspected choledochal cyst, which finding is critical for differentiation from obstructive biliary disease? A. Presence of echogenic bile within the common bile duct B. Connection of the extrahepatic ducts to the common bile duct C. Concurrent inflammation of the bile ducts D. Hypoechoic thickening of the gallbladder wall

Answer 31

B

Question 32

What is a characteristic finding on ultrasound for arterioportal fistulas? A. Thickened bile ducts with hyperechoic walls B. Markedly tortuous intrahepatic vessels with turbulent flow C. Enlarged caudal vena cava with hepatopetal flow D. Multiple acquired shunting vessels around the mesentery

Answer 32

B