Liver

Question 1

What did the medial aspect of the left liver used to be called?

Answer 1

Quadrate

Question 2

Does a single worldwide accepted classification of the liver exist?

Answer 2

No

Question 3

The lobes are supplied by what veins?

Answer 3

rt lobe: rt portal vein

lt lobe: lt portal vein

caudate lobe: receives branches from rt and lt

Question 4

where does the caudate lobe lie?

Answer 4

posterior-superior surface of liver between IVC and medial lt lobe

Question 5

where do the emissary vein drain?

Answer 5

caudate lobe

Question 6

left lobe:

segment I

segment II

segment III

Answer 6

caudate

left lat sup

left lat inf

Question 7

left lobe

segment IVa

segment IVb

Answer 7

left med sup

left med inf

Question 8

right lobe

segment V

segment VI

segment VII

segmentVIII

Answer 8

right anterior inf

rt post inf

rt post sup

rt anterior sup

Question 9

portal triad encased by what fibrofatty sheath

Answer 9

glissons capsule

Question 10

rt intersegmental fissure divides rt lobe into what segments?

lt intersegmental fissure divides lt lobe into what segments?

Answer 10

rt: anterior and posterior seg

lt medial and lateral seg

Question 11

ligamentum venosum

Answer 11

remnant of ductus venosus and separates let lobe from caudate

Question 12

what ligament is a remnant of the umbilical vein which runs from the umbilicus to the left portal vein?

Answer 12

ligamentum teres

with portal hypertension, can recanalize to form a portosystemic venous collateral

Question 13

portal vein doppler and blood flow

Answer 13

hepatopetal

low-velocity continuous flow

velocity can increase after eating

Question 14

upper limit of portal vein diameter and approx blood circulation

Answer 14

13mm

25% proper hepatic artery

75% portal vein

Question 15

hepatic vein doppler and blood flow

Answer 15

hepatofugal

triphasic due to rt atrial filling and contraction

Question 16

spectral presentation of hepatopetal and hepatofugal

Answer 16

flow toward transducer= above baseline

flow away from transducer= below baseline

Question 17

rt hepatic artery may orginate from what vessel

Answer 17

SMA 11%

repalced RHA is seen post to head of pancreas and main portal

Question 18

doppler hepatic artery wave forms

Answer 18

low resistance

Question 19

post operative liver transplant hepatic artery waveform

Answer 19

high resistance suggest venous congestion of liver or possible rejection

parvus tardus waveform suggests prox anastomic stenosis

Question 20

what ligament suspends liver from diaphragm

Answer 20

coronary ligament

Question 21

liver measurement

Answer 21

measured sup-inf dimension

> 15.5 cm is hepatomegaly

Question 22

inferior projection of rt lobe commonly seen in women

Answer 22

riedel’s lobe

Question 23

liver echogenicity

Answer 23

homogeneous and slightly more hyperechoic to renal cortex

Question 24

small collection of macrophages that appear in liver and spleen caused by histoplamosis and tuberculosis?

Answer 24

hepatic granulomas

histoplasmosis caused by spores in the air from droppings of birds and bats

Question 25

elevated lab values in hepatitis

Answer 25

ALT, AST, conjugated and unconjugated bilirubin

Question 26

acute hepatitis appearence

Answer 26

starry night (periportal cuffing) hypoechoic liver parenchyma liver enlargement hyperechoic portal vein walls

Question 27

chronic hepatitis appearence

Answer 27

hyperechoic liver parenchyma small liver decreased echogenicity of portal vein walls

Question 28

pyogenic abscess

Answer 28

most common source is biliary tract disease accounts for 80% of abscesses rt lobe affected more than lt sono findings: complex mass, gas, reverberation artifact

Question 29

amebic abscess

Answer 29

parasite from intestines reaches liver via portal vein sono findings: round hypoechoic/ complex mass, typically rt lobe dome

Question 30

candidiasis- fungal abscess

Answer 30

infection of blood results in small abscesses in liver wheel within wheel pattern: hypoechoic, inner echogenic, hypo center can be bulls eye

Question 31

adult tapeworms common in sheep herding areas cyst within a cyst appearence

Answer 31

echinococcal cyst

Question 32

most common parasitic infection in humans and major cause of portal hypertension worldwide

Answer 32

schistosomiasis sono findings: occluded intrahepatic portal veins, thickening of portal vein walls

Question 33

pneumocystic jiroveci

Answer 33

most common infection in persons with HIV diffuse, hyperechoic foci

Question 34

genetic disorder of excess deposition of glycogen in the liver

Answer 34

glycogen storage disease or von Gierkes disease associated woth fatty inflitrate and hepatic adenomas

Question 35

increased liver lab values for cirrhosis

Answer 35

AST ALT GGT LDH (lactate dehydrogenase) conjugated bilirubin

Question 36

sono findings of cirrhosis

Answer 36

hepatomegaly (acute) liver atrophy (chronic) caudate enlargement nodulatity fatty infiltrate changes related to portal hypertension

Question 37

major cause of portal hypertension

Answer 37

cirrhosis

Question 38

four types of portal hypertension

Answer 38

* extrahepatic presinusoidal: portal thrombosis * intrahepatic presinusoidal: schistosomiasis * intrahepatic: cirrhosis * intrahepatic postsinusoidal: hepatic vein thrombosis

Question 39

sono findings of portal hypertension

Answer 39

splenomegaly ascites portal systemic venous collaterals

Question 40

portal systemic collaterals connecting the portal system to the IVC, bypassing the liver

Answer 40

gastroesophageal varices recanalized umbilical vein splenorenal varices intestinal varcies rectal varices

Question 41

transjugular intrahepatic portal systemic shunting (TIPS)

Answer 41

hepatofugal flow normal placed between rt hepatic vein and rt portal

Question 42

cavernous transformation

Answer 42

numerous wormlike venous collaterals parallel the thrombosed portal vein

Question 43

terminal causes of portal thrombosis

Answer 43

hepatocellular carcinoma metastatic liver disease pancreatic carcinoma

Question 44

hepatic vein obstruction, frequently idiopathic

Answer 44

budd-chiari ascities, hepatomegaly, splenomegaly caudate lobe often spared due to emissary veins

Question 45

what type of liver cyst will present with internal echoes, RUQ pain and decreasing hematocrit

Answer 45

hemorrhagic cyst

Question 46

most common benign liver tumor, majority asymptomatic, hyperechoic with posterior enhancement

Answer 46

cavernous hemangioma may enlarge with pregnancy or estrogen

Question 47

benign solid liver mass believed to be a hyperplastic lesion rather than true neoplasm

Answer 47

focal nodular hyperplasia varying echogenicity central fibrous scar stealth lesion

Question 48

associated with oral contraceptives and glycogen storage disease, pain due to tumor hemorrhage

Answer 48

hepatic adenoma

Question 49

most common primary liver malignancy, often with underlying chronic liver disease and cirrhosis

Answer 49

hepatocellular carcinoma invades venous structures variable appearence, most hypoechoic increased alpha fetoprotein, AST, ALT

Question 50

metastic liver disease

Answer 50

most are multiple hyperechoic: GI tract hypoechoic: lymphoma bulls eye: lung calcified: mucinous adenocarcinoma of colon cystic metastases: leiomyosarcoma

Question 51

estimated cancer deaths for 2014

Answer 51

lung 159,000 colon/rectal 50,000 breast 40,000 pancreatic 39,000 prostate 29,000 non-hodgkins lymphoma 18,000 bladder 15,000 kidney 14,000 thyroid 1900

Question 52

uncommon malignant liver neoplasm occuring in infants and children

Answer 52

hepatoblastoma most occur 2 years of age enlarging asymptomatic mass increased serum alpha fetoprotein lung metastases and portal vein invasion

Question 53

alpha fetoprotein increase associated with what tumors?

Answer 53

hepatocellular carcinoma acute and chronic hepatitis testicular cancer

Question 54

hCG increase for what tumors?

Answer 54

testicular cancer choriocarcinoma

Question 55

elevated CA 19-9 is a marker for what

Answer 55

pancreatic cancer colorectal and bile duct cancers

Question 56

prostate-specific antigen and prostatic acid phosphatase

Answer 56

prostate cancer benign prostatic hypertrophy

Question 57

elevated carcinoembryonic antigen indicates

Answer 57

colorectal cancer elevated with other cancers