Liver

Question 1

the liver is suspended from the diaphragm and anterior abdominal wall by the _____ ligament and from the diaphragm by the reflections of the peritoneum

Answer 1

falciform

Question 2

most of the liver is covered by peritoneum but a large area rests directly on the diaphragm, this is called the _____

Answer 2

bare area

Question 3

the _____ space between the liver (or spleen) and diaphragm is a common site for abscess formation

Answer 3

subphrenic; the right subperenic space is between the right lobe, the right kidney and the right colic flexure

Question 4

the _____ is an enclosed portion of the peritoneal space posterior to the liver and stomach

Answer 4

lesser sac; communicates near the head of the pancreas

Question 5

the right _____ space is located inferior to the right lobe of the liver and includes morison’s pouch

Answer 5

subhepatic

Question 6

the caudate lobe is situated one the ____ surface of the left lobe

Answer 6

posteriosuperior

Question 7

the right, middle, and left hepatic veins divide the liver _____ into four sections

Answer 7

longitudinally; each of these sections is divided transversely by an invisible plane through right and left portal veins (8 sections all together)

Question 8

the liver is covered by a thin connective tissue layer called _____

Answer 8

glisson’s capsule

Question 9

the _____ is the boundary between the right and left lobes of the liver; in long it may be seen as a line from the portal vein to the neck of the gallbladder

Answer 9

main lobar fissure

Question 10

the _____ extends from the umbilicus to the diaphragm in the parasagittal plane and contains the ligamentum teres

Answer 10

falciform ligament

Question 11

the _____ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament; they both divide the medial and lateral segments of the left lobe of the liver

Answer 11

ligamentum teres

Question 12

the fissure for the _____ separates the left lobe from the caudate lobe

Answer 12

ligamentum venosum

Question 13

______ is a pigment released when the red blood cells are broken down

Answer 13

bilirubin

Question 14

disease affecting the liver may be classified as _____, when the liver cells or hepatocytes are immediate problem; _____ when bile excretion is blocked

Answer 14

hepatocellular; obstructive

Question 15

the liver functions as a major site for conversion of dietary sugars into _____, which is released into the bloodstream for general use

Answer 15

glucose; with liver disease the body may become glucose deficient (hypoglycemia)

Question 16

in severe liver disease, abnormally low blood levels of ______ may be noted because the liver is the principal site for cholesterol synthesis

Answer 16

cholesterol

Question 17

when the liver is chronically diseased, clinical laboratory results may reveal a significant lowering of the serum albumin (produced by the liver), a condition called _____

Answer 17

hypoalbuminemia

Question 18

what laboratory test detect clotting deficiencies related to liver disease?

Answer 18

prothrombin time (pro-time) and partial thromboplastin time (PTT); percentage of time required for certain coagulation steps to occur in the patient’s blood compared to normal blood

Question 19

the presences of increased quantities of enzymes in the blood is a sensitive indicator of a hepatocellular disorder., _____, _____ and _____ are of particular interest

Answer 19

aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; they are also included in biliary obstruction

Question 20

in severe hepatocellular destruction, such as acute viral or toxic hepatitis, a striking elevation of ___ and ___ may be seen (exceeding 1000) but not elevated in biliary obstruction

Answer 20

AST and ALT

Question 21

Marked elevation of _____ is typically associated with biliary obstruction or the presence of mass lesions in the liver

Answer 21

alkaline phosphatase

Question 22

_____ is somewhat more specific for liver disease than AST

Answer 22

ALT; therefore elevation of ALT about AST suggest a hepatic cause

Question 23

the level of urea in the blood is measured as the _____, and in severe liver disease this may be abnormally low because of falloff of urea production

Answer 23

blood urea nitrogen (BUN); failure of ammonium detoxification is a serious consequence of liver failure

Question 24

measurement of the concentration of bilirubin in the blood is a standard laboratory test for hepatocellular disease, what are the two fractions of bilirubin that is measured?

Answer 24

direct-acting, consists of conjugated bilirubin, and indirect-acting, which consists of unconjugated bilirubin released from the reticuloendothelial system

Question 25

biliary obstruction result in elevation of the _____; as wall as hepatocellular disease

Answer 25

direct-acting bilirubin; results in jaundice

Question 26

indirect bilirubin predominates in _____

Answer 26

hemolysis

Question 27

vitamin _____ is an essential precursor for the hepatic production of several clotting factors

Answer 27

K

Question 28

any disease that injures the cells causes an elevation in _____ levels; this enzyme is also produced in other high metabolic tissues

Answer 28

AST; seen in acute hepatitis, cirrhosis, hepatic necrosis and infectious mononucleosis

Question 29

hepatocellular disease and infectious or toxic hepatitis produces moderate to highly increased levels of _____

Answer 29

ALT

Question 30

_____ primary use is in detection of myocardial or pulmonary infarction

Answer 30

lactic acid dehydrogenase

Question 31

a _____ prothrombin time indicates a poor prognosis, chronic liver disease commonly show an elevation of gamma globulins

Answer 31

prolonged

Question 32

the average adult abdomen usually requires at least a broadband _____ frequency, whereas the more obese adult may require a lower frequency _____ transducer

Answer 32

2.5 MHz to 5 MHz; 2.25MHz children may need 5 to 7 MHz neonates may need 7.5 to 12 MHz

Question 33

the right lobe of the liver is divided into anterior and posterior segments by the _____

Answer 33

right intersegmental fissure

Question 34

the _____ divides the left lobe into medial and lateral segments

Answer 34

left intersegmental fissure

Question 35

the hepatic veins course between the lobes and segments this is called _____

Answer 35

interlobar and intersegmental

Question 36

the major branches of the portal veins run centrally within the segments this is called _____

Answer 36

intrasegmental

Question 37

generally the liver measures less than _____ in long view

Answer 37

15 cm with 15 to 20 cm representing the upper limits of normal; hepatomegaly is when liver exceeds 20 cm

Question 38

in a congenital diaphragmatic _____ or omphalocele, where varying amounts of liver tissue may herniate into the thorax or outside the abdominal cavity

Answer 38

hernia

Question 39

variations in the branching of the hepatic veins are common, with the most common being when the accessory vein drains the _____ segment of the right lobe

Answer 39

superoanterior

Question 40

_____ is an acquired, reversible disorder of metabolism, resulting in an accumulation of triglycerides within the hepatocytes

Answer 40

fatty liver

Question 41

_____ implies increased lipid accumulation in the hepatocytes and results from major injury to the liver or a systemic disorder leading to impaired or excessive metabolism of fat

Answer 41

fatty infiltration

Question 42

what are the three grades of liver texture for classification of fatty infiltration?

Answer 42

mild-minimal diffuse increase in hepatic echgenicity moderate- increased echogenicity, impaired visualization of the diaphragm and intrahepatic vascular borders severe- marked increase in echogenicity, decrease penetration, poor visualization of the diaphragm and hepatic vessels

Question 43

the most common areas for focal sparing are anterior to the _____ or the portal vein and the periportal region of the medial segment of the left lobe of the liver

Answer 43

gallbladder

Question 44

_____ is the general name for inflammatory and infectious disease of the liver

Answer 44

hepatitis; may result from a local infection (viral hepatitis); or from an infection elsewhere in the body (mononucleosis or amebiasis); or from chemical or drug toxicity

Question 45

patients with _____ and _____ hepatitis may initially present with flulike and gastrointestinal symptoms, including loss of appetite, nausea, vomiting, and fatigue

Answer 45

acute and chronic

Question 46

_____ hepatitis may be fatal with secondary acute hepatic necrosis or chronic hepatitis, which may lead to portal hypertension, cirrhosis, and hepatocellular carcinoma

Answer 46

viral

Question 47

hepatitis _____ spreads primarily by fecal contamination, because the virus lives in the alimentary tract

Answer 47

A

Question 48

hepatitis _____ can spread by transfusions of infected blood or plasma or through the use of contaminated needles; it is also found in body fluids such as saliva and semen, and may be spread by sexual contact

Answer 48

B

Question 49

hepatitis _____ is diagnosed by the presence in blood of the antibody to HCV

Answer 49

C

Question 50

with acute hepatitis texture may appear normal or the portal vein borders are more _____ than usual and the liver is slightly echogenic; hepatosplenomegaly is present, and gallbladder wall is thickened

Answer 50

prominent

Question 51

with chronic hepatitis the liver is coarse with _____ brightness of the portal triads, but the degree of attenuation is not as great as in fatty liver; no increase in size, fibrosis may be evident

Answer 51

decrease

Question 52

_____ is a chronic degenerative disease of the liver in which the lobes are covered with fibrous tissue, and the parenchyma degenerates, and the lobules are infiltrated with fat

Answer 52

cirrhosis; micronodular cirrhosis is most commonly teh result of chronic alcohol abuse, where as macronodular cirrhosis is caused by chronic viral hepatitis or other infection

Question 53

patients with _____ cirrhosis may seem asymptomatic or may have symptoms that include nausea, flatulence, ascites, light-colored stools, weakness, abdominal pain, varicosities, and spider angiomas

Answer 53

acute

Question 54

_____ cirrhosis patients symptoms include nausea, anorexia, weight loss, jaundice, dark urine, fatigue, or varicosities; may progress to liver failure and portal hypertension

Answer 54

chronic

Question 55

as cirrhosis becomes more severe, the liver volume ____ in the right lobe, with ______ of the left and caudate lobe

Answer 55

decreases; enlargement; a C/RL value of 0.65 is considered cirrhosis

Question 56

_____ cirrhosis may show nudularity of the liver edges, especially well demonstrated with ascites; isoechoic regenerating nodules may be seen throughout the liver parenchyma

Answer 56

chronic

Question 57

_____ nodules or _____ hyperplastic nodules are larger than the regenerating nodules and are considered premalignant; these nodules contain well differentiated hepatocytes, portal venous blood supply, and a typical or frankly malignant cells

Answer 57

dysplastic or adenomatous

Question 58

_____ is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissued, especially the liver and kidneys

Answer 58

glycogen storage disease; there are 6 different types

Question 59

the most common type of glycogen storage disease is _____, this is a form in which abnormally large amounts of glycogen are deposited in the liver and kidneys

Answer 59

type 1 or von Gierke's disease

Question 60

_____ is associated with hepatic adenomas, focal nodular hyperplasia, and hepatomegaly; the adenoma presents as a well-demarcated, round, homogeneous, echogenic tumors

Answer 60

glycogen storage disease

Question 61

_____ is a rare disease of iron metabolism characterized by excess iron deposits throughout the body; may lead to cirrhosis and portal hypertension

Answer 61

hemochromatosis

Question 62

_____ exists when the portal venous pressure is above 10 mmHg or the hepatic venous gradient is more than 5mmHg

Answer 62

portal venous hypertension; secondary to liver disease

Question 63

_____ develops when the normal venous channels become obstructed; this diverted blood flow causes embryologic channels to reopen

Answer 63

collateral circulation; the most common are through the coronary and esophageal veins

Question 64

normal portal vein waveform is _____ with low velocity; the flow should be smooth and laminar

Answer 64

monophasic; obstruction of the portal venous system is recognized by turbulence within the vessel

Question 65

what are the 3 types of portal shunts

Answer 65

portacaval shunt- attaches the main portal vein at the SMV-splenic confluence to the anterior IVC mesocaval shunt- attaches the middistal SMV to the IVC splenorenal shunt- attaches the splenic vein to the left renal vein

Question 66

the primary type of Budd-Chiari syndrome is caused by _____ of the hepatic veins or IVC by membranous webs across the upper vena cava at or just about the entrance of the left and middle hepatic vein

Answer 66

congenital obstruction; ascites is the most common characteristic of this disease; others is URQ pain and hepatomegaly

Question 67

in Budd-Chiari the _____ lobe is enlarge and there is often atrophy of the right hepatic lobes

Answer 67

caudate; has an independent vascular supply; in late stages of this disease the liver appears hyperechoic and inhomogeneous with fibrosis

Question 68

a _____ mass in the area of the porta hepatis causes the same clinical signs as seen in biliary obstruction

Answer 68

extrahepatic

Question 69

a _____ is a pus-forming abscess; bacteria gets into the liver through the biliary tree, the portal vein, or the hepatic artery

Answer 69

pyogentic abscess; clinically present with fever, pain pleuritis, nausea, vomiting, and diarrhea

Question 70

_____ is caused by a species of Candida, usually occurs in immunocompromised hosts; the fungus invades the bloodstream

Answer 70

hepatic candidiasis; may present as multiple small hypoechoic masses with echogenic central core (bulls-eye or target lessions)

Question 71

_____ is a collection of pus formed by disintegrated tissue in a cavity, usually in the liver, caused by the protozoan parasite Entamoeba histolytica; reaches the liver via the portal vein

Answer 71

amebic abscess; ingested by contaminated water; usually affects the colon and cecum; the lesion is hypoechoic compared with normal liver and may be some enhancement

Question 72

hepatic _____ is an infectious cystic disease common in sheep-herding areas of the world; its a tapeworm

Answer 72

echinococcal; has 2 layers, the smaller daughter cysts may develop from the inner layer; may rupture and lead to vascular thrombosis and infarction

Question 73

echinococcal cysts have a _____ appearance with fluid collections and sometimes calcifications

Answer 73

honeycomb; water lily sign shows a detachment and collapse of the germinal layer

Question 74

_____ is a common life-threatening infection in patients with human immunodeficiency virus

Answer 74

pneumocystis carinii; diffuse, tiny, nonshadowing, echogenic foci to extensive replacement of parenchyma by various echogenic clumps of calcification

Question 75

a _____ is a benign, congenital tumor consisting of large, blood-filled cystic spaces

Answer 75

hemangioma

Question 76

_____ hemangioma is the most common benign tumor of the liver

Answer 76

cavernous; frequently in women; large masses may show necrosis, degeneration, calcification; hyperechoic w/ enhancement

Question 77

a liver cell _____ consists of normal and slightly atypical hepatocytes, frequently containing areas of bile stasis and focal hemorrhage or necrosis

Answer 77

adenoma; more common in women; ruq pain secondary to rupture with bleeding; hyperechoic with central echogenic areas caused by hemorrage; fluid may be present

Question 78

____ lesion consists of normal hepatocytes, Kupffer cells , bile duct elements, and fibrous connective tissue, which separate into multiple nodules

Answer 78

focal nodular hyperplasia; more frequent in women less than 40; frequently found in right lobe of liver

Question 79

the most common malignant tumor is _____

Answer 79

hepatocellular carcinoma; clinical symptoms to liver cancer include nausea, vomiting, fatigue, weight loss, and hepatomegaly; portal hypertension and splenomegaly is common

Question 80

_____ may present in one of 3 patterns; solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltrative masses in the liver

Answer 80

Hepatocelluar carcinoma; indications of cirrhosis, may invade hepatic veins, thrombus

Question 81

what are the primary sites for metastatic disease of the liver?

Answer 81

colon, breast, and lung; elevated LFT's; diffuse distortion of the bulls eye pattern; typically multiple nodes throughout the liver

Question 82

_____ are malignant neoplasms involving lymphocyte proliferation in the lymph nodes; 2 main disorders, hodgkins lymphoma (hypoechoic or diffuse patterns) and non-hodgkins lymphoma ( target or echogenic lesions)

Answer 82

lymphoma; elevated LFT's; intrahepatic and lucent multiple small, discrete solid lesions without enhancement

Question 83

with _____ intraperitonial fluid should be assessed along the flanks and into the pelvis; septations and internal echoes develop 1 to 4 weeks after

Answer 83

hepatic laceration

Question 84

the presents of portal vein _____ is a predictor of a higher risk in liver transplants

Answer 84

thrombosis; the primary function of the sonographic examination is to evaluate the portal vein, hepatic artery, the IVC, and the liver parenchymal pattern

Question 85

complications of live transplant include rejection, thrombosis or leak, biliary stricture or infarction, and neoplasia; ______ is the most common cause of hepatic dysfunction

Answer 85

rejection; during the postoperative period, hepatic artery thrombosis is the most serious complication of liver transplantation