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Flashcards in Liver Deck (97):
1

Where does the right lobe of liver get its blood supply?

right portal vein
pg. E 4

2

Where does the left lobe of liver get its blood supply?

left portal vein
pg. E 4

3

Where does the caudate lobe of the liver get its blood supply?

right and left portal veins
pg. E 4

4

Where is the caudate lobe located in reference to the ligamentum venosum?

posterior
pg. E 4

5

Where is the caudate lobe located in reference to the porta hepatis?

posterior
pg. E 4

6

Where is the caudate lobe located in reference to the IVC?

anterior and medial
pg. E 4

7

What is the caudate lobe located in reference to the lesser sac?

lateral
pg. E 4

8

Where is the caudate lobe located within the liver?

posterior superior surface
pg. E 4

9

What is the first order division of the liver?

lobar/hemilobar anatomy
pg. E 3

10

How is the liver divided in the first order division of the liver?

right and left lobes are divided by a plane between the GB and IVC
pg. E 3

11

What is the second order division of the liver?

sector/segment anatomy
pg. E 4

12

How is the liver divided in the second order division of the liver?

Left lateral
Left medial
Right anterior
Right posterior
pg. E 4

13

What is the third order division of the liver?

segment/subsegment anatomy
pg. E 5

14

How is the liver divided in the third order division of the liver?

Segment I - caudate lobe
Segment II - left lateral superior
Segment III - left lateral inferior
Segment IVa - left medial superior
Segment IVb - left medial inferior
Segment V - right anterior inferior
Segment VI - right posterior inferior
Segment VII - right posterior superior
Segment VIII - right anterior superior
pg. E 5

15

What is another name for hepatic veins?

intersegmental vessels
pg. E 7

16

What is another name for the portal triad?

intrasegmental vessels
pg. E 7

17

Why do the portal veins have hyperechoic walls?

encased by Glisson's capsule
pg. E 7

18

What are the vessels of the portal triad?

main portal vein
proper hepatic artery
common hepatic duct
pg. E 7

19

Where is the main lobar fissure located?

between the GB neck and junction of RPV and LPV
pg. E 8

20

What does the main lobar fissure divide?

right and left lobes between IVC and GB
pg. E 8

21

What is the ligamentum venosum?

remnant of the ductus venosus
separates the LT from the caudate lobe
pg. E 8

22

What is the ligamentum teres?

remnant of the umbilical vein to the LPV
pg. E 9

23

What can happen to the ligamentum teres in portal hypertension and cirrhosis?

it can recanalize to form a collateral
pg. E 9

24

What is the direction of circulation in a fetus?

umbilical vein
LPV
ductus venosus
IVC
pg. E 9

25

What is hepatopetal flow?

flow towards the liver
pg. E 10

26

What is hepatofugal flow?

flow away from the liver
pg. E 10

27

Which direction of flow should the portal vein be?

hepatopetal
pg. E 10

28

What does a normal portal vein waveform look like?

low velocity continuous flow toward the liver
above the baseline
pg. E 10

29

What is the upper limits of normal diameter of a portal vein?

13 mm
pg. E 10

30

What does a > 13 mm diameter of the portal vein suggest?

portal hypertension
pg. E 10

31

What does a normal hepatic vein waveform look like?

triphasic
below the baseline
pg. E 10

32

What does a normal hepatic artery waveform look like?

low resistive
above the baseline
pg. E 11

33

If a patient just had a liver transplant and the hepatic artery waveform is high resistive, what does it indicate?

possible organ rejection
pg. E 11

34

If a patient just had a liver transplant and the hepatic artery waveform is seen as a parvus tardus waveform, what does it indicate?

proximal anastomotic stenosis
pg. E 11

35

What does the RHV separate?

divides anterior and posterior segments of the RT lobe
pg. E 13

36

What does the MHV separate?

separates the LT and RT lobes
pg. E 13

37

What does the LHV separate?

divides medial and lateral segments of the LT lobe
pg. E 13

38

What is considered hepatomegaly?

15.5 cm or greater
pg. E 14

39

What is Riedel's lobe?

inferior projection of the RT lobe
pg. E 14

40

What is normal liver echotexture?

homogeneous and slightly hyperechoic compared to renal cortex
pg. E 14

41

What are hepatic granulomas?

calcifications in the liver
pg. E 14

42

What can hepatic granulomas be caused by?

histoplasmosis
tuberculosis
pg. E 15

43

What is hepatitis?

inflammation of the liver
pg. E 15

44

What can cause hepatitis?

viral, bacterial, fungal, parasitic organisms
medications, toxins, and autoimmune disorders
pg. E 15

45

In hepatitis, what liver enzymes are elevated?

ALT
AST
bilirubin
pg. E 15

46

What are the sonographic findings of acute hepatitis?

"starry night" periportal cuffing
hypOechoic liver parenchyma
enlarged liver
hyperechoic portal vein walls
pg. E 15

47

What are the sonographic findings of chronic hepatitis?

hypERechoic liver parenchyma
small liver
decreased echogenicity of portal vein walls
pg. E 15

48

What is the most common cause for hepatic abscesses?

biliary tract disease
pg. E 16

49

What is the most common type of abscess?

pyogenic abscess (pus-forming)
pg. E 16

50

What are the symptoms for a pyogenic abscess?

RUQ pain
Fever
elevated LFT's
elevated WBC's
pg. E 16

51

What are the sonographic findings of a pyogenic abscess?

Complex mass
Gas
Reverberation artifact
pg. E 16

52

What does a pyogenic abscess appear similar to?

amebic abscess
pg. E 17

53

How can you differentiate a pyogenic abscess from an amebic abscess?

sonographically you cannot tell
it is seen in patients who are immigrants or travelers
pg. E 17

54

What is the sonographic appearance of candidiasis?

changes over the course of the disease
"wheel within a wheel"
"bulls eye"
"uniformly hypoechoic"
"echogenic focus"
pg. E 17

55

How can you get an echinococcal cyst?

found in sheep herding countries from ingesting tapeworms eggs from an infected sheep
pg. E 18

56

What is the sonographic appearance of echinococcal cysts?

"cyst within a cyst"
"water lily" sign
pg. E 18 H 256

57

What is schistosomiasis and what can it cause?

parasite that can cause portal hypertension
pg. E 19

58

What are the sonographic findings of schistosomiasis?

thickened portal vein walls
occluded portal veins
pg. E 19

59

What is the most common organism that causes AIDS?

pneumocystic carinii
pg. E 20 H 256

60

What are the sonographic characteristics of pneumocystic carinii?

diffuse nonshadowing echogenic foci within the liver
pg. E 20 H 256

61

What are the sonographic findings of a patient with AIDS?

hepatomegaly
splenomegaly
lymphadenopathy
pneumocystis carinii
fatty liver
non-hodgkin's lymphoma
candidiasis
cholangitis (inflammed bile ducts)
cholecystitis
pg. E 20

62

What are some of the most common causes of fatty liver?

obesity
excessive alcohol intake
diabetes
pg. E 21 H 235

63

What is another name for fatty infiltration?

Fatty steatosis
pg. E 21

64

What is focal fatty infiltration?

focal areas of increased echogenicity within a normal liver parenchyma
pg. E 21

65

Where is focal fatty infiltration most common?

at the porta hepatis
pg. E 21

66

What is focal fatty sparing?

focal areas of decreased echogenicity in a fatty liver
pg. E 21

67

What are some common causes for cirrhosis?

Hepatitis
Alcoholism
Fatty Liver
pg. E 22

68

What liver function tests are elevated with cirrhosis?

AST
ALT
bilirubin
LDH
GGT
pg. E 22

69

What are the sonographic findings of cirrhosis?

Acute - hepatomegaly
Chronic - atrophic liver
caudate lobe enlargement
nodular surface
fatty infiltration
pg. E 22

70

What is the most common cause of cirrhosis today?

Hepatitis C
pg. E 22

71

What is the diameter of the portal vein when it is considered portal hypertension?

13 mm or greater
pg. E 23

72

What is the most common cause of portal hypertension?

cirrhosis
pg. E 23

73

What are the sonographic signs of portal hypertension?

increase in diameter of vessel
collateral vessels form
ascites
splenomegaly
pg. E 23

74

What are some techniques to lower portal hypertension?

portacaval shunt
splenorenal shunt
TIPS
pg. E 23

75

What are some of the physical signs of collaterals?

dilated veins on anterior abdominal wall
hemorrhoids
acites
pg. E 24

76

What is the role of a TIPS procedure?

lowers portal hypertension
pg. E 25

77

Where is a TIPS shunt placed?

inserted at the jugular and placed between a hepatic v and a portal v (right is most common)
E 25

78

Which direction should the flow of the RPV and LPV be with a patent shunt?

hepatofugal
E 25

79

What is the most common indication for a liver transplant in an adult?

cirrhosis
E 26

80

What is the most common indication for a liver transplant in children?

biliary atresia
E 26

81

What is the scoring system for staging liver disease?

MELD -The Model for End-Stage Liver Disease
E 26

82

What are the sonographic findings of portal vein thrombosis?

hypoechoic thrombus within the portal vein
increased portal vein caliber
cavernous transformation
portal systemic collaterals
E 27

83

What are the causes of portal vein thrombosis?

Hepatocellular carcinoma
Metastatic liver disease
pancreatic carcinoma
cirrhosis
E 27

84

What is Budd-Chiari Syndrome?

Disorder characterized by hepatic vein obstruction
E 28

85

What are the causes of Budd-Chiari Syndrome?

idopathic (50% of cases)
congenital
infection
pregnancy
tumors
E 28

86

What kind of cyst within the liver would cause RUQ pain and a decreasing hematocrit?

hemorrhagic cyst
E 29

87

What is the most common benign tumor of the liver?

cavernous hemangioma
E 30

88

What are the sonographic characteristics of a hemangioma?

hyperechoic
posterior acoustic enhancement
generally no flow
E 30

89

What are the sonographic characteristics of focal nodular hyperplasia?

solid mass with varying echogenicity
solitary
central fibrous scar
stellate vascularity
E 31

90

What is a cause for hepatic adenomas?

oral contraceptive use
E 31

91

What is a hepatic lipoma?

rare fatty tumor of the liver
E 32

92

What are the hyperechoic hepatic masses?

Hemangioma
Hepatic lipoma
Focal fatty infiltration
E 32

93

What is the most common malignancy of the liver?

Hepatocellular carcinoma
E 33

94

Hepatocellular carcinoma is seen in patients with ___.

cirrhosis
E 33

95

What malignant liver neoplasm is seen in infants and children?

hepatoblastoma
E 35

96

AST and ALT are increased in what diseases?

Fatty liver
excessive alcohol intake
Hepatitis
E 36

97

Alpha Fetoprotein (AFP) is increased in what diseases?

Hepatocellular Carcinoma
Germ Cell Tumors
Hepatoblastoma
Metastatic liver cancer
E 37