Liver Abnormalities Flashcards Preview

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Flashcards in Liver Abnormalities Deck (201):
1

_____ of the liver is incompatible with life (not having one).

Agenesis

2

Often, with agenesis of the RLL, the _____ lobe is also absent.

caudate

3

T or F? With agenesis, compensatory hypertrophy of the remaining lobes normally occurs and the LFTs are normal.

True

4

This position abnormality is when the liver is found in the left hypochondrium.

situs inversus totalis

5

In congenital diaphragmatic hernias or omphalocele, varying amounts of liver may herniate into the _____ or outside the _____ cavity.

thorax
abdominal

6

If someone has kidney cysts, they probably have _____ cysts too.

liver

7

T or F? Kidney cysts are more common than liver cysts.

True

8

Liver cysts occurrence increases past the age of _____.

80

9

Benign hepatic cysts are _____ (echogenicity) with well-demarcated _____ (thickness) walls and posterior acoustic enhancement.

anechoic
thin

10

Is active intervention of cysts recommended in patients without symptoms?

No

11

Occasionally, the patient may develop pain and fever secondary to cyst hemorrhage or infection. In this case, the cyst may contain internal _____ and _____, a _____ wall, or may appear _____ .

echoes
septations
thickened
solid

12

T or F? Cyst ablation with alcohol can be performed using U/S guidance.

True

13

Rather than ablation with alcohol, what is another treatment for cysts?

surgical excision

14

A hemorrhagic liver cyst will appear as a cyst with _____ _____, accompanied by (2)

internal echoes
acute RUQ pain
decreased hematocrit

15

If you see cysts in the kidneys, always check the _____ for cysts as well.

liver

16

The adult form of _____ _____ disease is inherited in an autosomal dominant pattern. The frequency with liver cysts in association with this disease is high.

polycystic kidney disease

17

_____ is a term for liver inflammation due to viruses or toxins.

Hepatitis

18

Hepatitis is _____ when it lasts for less than 6 months.

acute

19

This kind of hepatitis is more likely to be asymptomatic in younger people. The convalescent stage is 7 to 10 days, with the total illness lasting 2 to 6 weeks.

acute viral hepatitis

20

If you see a hypoechoic liver parenchyma, hepatomegaly, and hyperechoic PV walls, this is a sign of

acute hepatitis

21

This hepatitis shows diffuse swelling of the hepatocytes, proliferation of Kupffer cells, and infiltration of the portal areas by lymphocytes and monocytes.

acute hepatitis

22

More specific symptoms of acute hepatitis are (6)

profound loss of appetite
aversion to smoking (in smokers)
dark urine
yellowing of the eyes
jaundice
abdominal discomfort

23

These 2 symptoms of the most common presenting symptoms of acute hepatitis.

jaundice
hepatomegaly

24

What are the 6 kinds of hepatits?

A
B
C
D
E
G

25

Hepatitis A is also called

infectious jaundice

26

Hepatitis A is transferred by what route?

fecal-oral

27

Does Hepatitis A have an acute and chronic stage?

No, just acute

28

Hepatitis A occurs most frequently in _____ world countries. There is a vaccine that prevents it for up to _____ years. People with Hep A are advised to _____, _____, _____ . Hep A can spread through consumption of raw sea food or contaminated _____ .

third
10
rest
stay hydrated
avoid alcohol
water

29

Which hepatitis is the least serious?

A

30

The combination of these two forms of hepatitis can cause a _____, and even without cirrhosis, leading to a life-threatening form of fulminant hepatitis.

Hep A and Hep C
superinfection

31

Does Hep B have both acute and chronic versions?

yes

32

A vaccine for Hep B exists that prevents infection for how long?

life

33

This form of hepatitis can lead to hepatocellular carcinoma.

Hep B

34

The methods of transmission for Hep B are

blood and body fluids

35

Symptoms of this kind of hepatitis occur long after the initial infection, around 4 to 24 weeks and patients may not even experience them. The pain can resemble arthritis, affecting specific joints and accompanied by redness and swelling.

Hep B

36

5-10% of people with Hep B eventually develop

cirrhosis

37

Hep B poses a risk for _____ cancer.

liver

38

Hep C is also called

Non-A/Non-B

39

This is the most common blood-borne infection.

Hep C

40

People can get this type of hepatitis from inadequately sterilized medical or dental equipment.

Hep C

41

Hep C is spread by contact with

infected human blood

42

T or F? Hep C can be passed from an infected mother to her baby during birth.

True

43

Does breastfeeding increase transmission of Hep C?

No

44

Before 1990, Hep C was primarily transmitted by

blood transfusions

45

Most patients with Hep C _____ (do/do not) experience symptoms.

do not

46

If someone experiences symptoms from Hep C, it is often after _____ months of infection.

12

47

Chronic hepatitis C can be present for _____ - _____ years, and _____ or _____ can sometimes develop before patients experience any clear symptom.

10-30 years
cirrhosis
liver failure

48

Nearly 40% of liver transplant patients are infected with Hep _____.

C

49

Is liver transplantation a cure for Hep C?

No

50

This kind of hepatitis is only dangerous if you also have Hep B.

Hep D

51

Hep D is also called

hepatitis delta virus

52

T or F? Hep D was discovered as an antigen in Hep B virus by Dr. Mario Rizzetto in 1977.

True

53

Hep D is an uncommon infection in North America, but the people who are primarily infected are

IV drug users

54

How is Hep D spread?

thought to be similar to Hep B, blood

possibly sexual transmission

55

Is there any specific treatment for Hep D? But what is a possible alternative-type treatment that has been used in the past with some success? And what is another possible treatment?

No

High dose of interferon given for over 12 years

orthotopic liver transplant

56

Persistence of biochemical abnormalities beyond 6 months is

chronic hepatitis

57

What is the sonographic appearance of chronic hepatitis?

hyperechoic parenchyma
small, shrunken liver
decreased echogenecity of PV walls

(opposite of acute hepatitis)

58

Abscesses = ? and ?

leukocytosis
fever

59

This is a puss-filled area in the liver.

Pyogenic liver abcess

60

What are some of the causes of liver abscesses?

-Abdominal infection such as appendicitis, diverticulitis, or a perforated bowel
-Infection in the blood
-Infection of the liver secretion (biliary) tract
-Recent endoscopy of the biliary system
-Trauma that damages the liver

61

The most common presenting features of pyogenic liver abscess are:

Chalk-colored stool
Dark urine
Fever, chills, leukocytosis
Loss of appetite
Nausea, vomiting
Pain in right upper abdomen (more common) or throughout the abdomen (less common)
Unintentional weight loss
Weakness
Yellow skin (jaundice)

62

Pyogenic liver abscesses most commonly occur in the ______ lobe.

right lobe

63

How do pyogenic liver abscesses reach the liver (4)?

Bile ducts
PVs
HAs
lymphatic channels

64

Varied appearances of pyogenic liver abscesses are:

***There is “air” within the abscess***

Purulent abscesses appear cystic with the fluid ranging from echofree to highly echogenic

Early suppuration may appear solid with altered echogenicity, usually hypoechoic

The abscess wall can vary from well-defined to irregular and thick

Gas-producing organisms give rise to echogenic foci with a posterior reverberation artifact.

65

For true diagnosis of pyogenic liver abscesses, what must be done?

aspirate the abscess

66

Treatment for pyogenic liver abscesses is

surgery

draining the abscess
along with this procedure, you will receive long-term antibiotic therapy (usually 4 - 6 weeks).

sometimes antibiotics alone can cure the infection

67

With pyogenic liver abscesses, what life-threatening condition could develop?

sepsis

68

Even with treatment, pyogenic liver abscesses can be life-threatening in _____% to _____% of patients.

10% - 30%

69

When you hear "air in the abscess", you should automatically think

pyogenic liver abscess

70

This is a liver infection that occurs when a parasite that came from the intestines reaches the liver, and travels through the portal vein.

amebic abscess

71

This is the most common extraintestinal complication of amoebic dysentery

amebic abscess

72

Transmission of amebic abscess is by the _____-_____ route. The most common bacterial agent related to this is ______.

fecal-oral
e-coli

73

The most common presenting symptoms of amebic abscess are

right upper quadrant pain
diarrhea

74

Sonographic signs of amebic abscesses are (7)

Round or oval-shaped lesion

Absence of a prominent abscess wall

Hypoechoic compared to a normal liver

Fine low-level internal echoes

Distal enhancement

Contiguity with the diaphragm/liver capsule

Typically occurs in the dome of the liver (RLL)

75

T or F? For amebic abscesses, amebicidal drugs are effective and symptoms improve by 24-48 hours but complete resolution of the abscess varies from 1.5 – 23 months with a median of 7 months.

True

76

Possible dangerous risks of amebic abscesses are

may rupture into the abdominal cavity, the lining of the lungs, the lungs, or the sac around the heart

could spread to the brain

77

This is a mycotic (fungal) infection of the blood that results in small abscesses in the liver. The appearance of these lesions can change over the course of the disease process.

candidiasis

78

The ultrasonic appearance of Candida infection in the livers of immunosuppressed patients is quite characteristic:

"Wheel Within A Wheel”: a lesion with a peripheral hypoechoic zone, an inner echogenic wheel and a hypoechoic center. This is the earliest manifestation of a fungal infection and the most recognizable.

79

After some time, later the “wheel within a wheel” turns into a “______” appearance when the hypoechoic center ______.

It will then turn into a(n) uniformly ______ (echogenecity) focus and then a(n) ______ (echogenecity) focus representing scar formation.

“bullseye”
calcifies
hypoechoic
echogenic

80

What is the most common cause of hydatid disease?

echinococcal cyst

81

This is a result of a parasite infestation (tapeworm) associated with sheep and cattle raising countries.

echinococcal cyst

82

Eggs of Echinococcus granulosus are swallowed by the intermediate host (man) and pass into the ______ ______ system where the larva hatch and move into the ______.

portal venous system
liver

83

The tapeworm of the parasite infestation for an echinococcal cyst is ______-______ mm in length and usually lives in the intestines of the definitive host (dog), excreted in the dog’s feces and swallowed by the intermediate hosts (sheep, cattle, goats or humans).

3-6 mm

84

The sonographic signs for an echinococcal cyst are (5)

Simple cyst
Cysts with detached endocysts secondary to rupture (a cyst within a cyst)
Cyst with multiple daughter cysts
Cyst with detached membrane (water lily sign)
Calcified mass

85

An old test used to diagnose hydatid disease was called the ______. It was usually about ______% sensitive.

Casoni skin test
70%

86

For treatment of an echinococcal cyst, _____ is the conventional treatment, but success has been obtained with _____ as well.

surgery
percutaneous drainage

87

The fluid within the echinococcal cyst is very toxic, so if a cyst ruptures _____ can occur.

anaphylatic shock

88

This is one of the most common parasitic worm infections in humans, affecting 200 million people worldwide found in parts of the world where the water is contaminated.

It is a major cause of portal HTN worldwide.

Schistosomiasis

89

Explain how schistosomiasis occurs

Freshwater becomes contaminated by Schistosoma eggs when infected people urinate or defecate in the water. The eggs hatch, and if certain types of snails are present in the water, the parasites grow and develop inside the snails. The parasite leaves the snail and enters the water where it can survive for about 48 hours.

Adult worms are about 10 mm long.

Parasites reach maturity in 6 to 8 weeks, at which time they begin to produce eggs.

Up to half the eggs released by the worm pairs become trapped in the mesenteric veins, or will be washed back into the liver, where they will become lodged. Worm pairs can live in the body for an average of four and a half years, but may persist up to 20 years.

Eggs travel to the liver or pass into the intestine or bladder, causing inflammation or scarring.

90

Eggs from schistosomiasis reach the liver through the _____ inciting a _____ reaction resulting in _____ .

portal vein
granulomatous
peri-portal fibrosis

91

The peri-portal fibrosis caused by schistosomiasis causes _____ which will lead to _____.

thrombosis
portal HTN

92

What is seen sonographically with schistosomiasis? (5)

intrahepatic PVs occlude

resulting in
portal HTN
splenomegaly
varices
ascites

93

This is the most common fungal organism causing opportunistic infection in patients with AIDS.

It is the most common cause of life-threatening infection in patients with HIV.

pneumocystis carini

94

This condition also affects patients undergoing bone marrow and organ transplants, as well as those receiving corticosteroids or chemotherapy.

pneumocystis carini

95

The sonographic appearance and medical results of pneumocystis are (10)

Fatty liver infiltration
Hepatomegaly
Hepatitis
Non-hodgkins lymphoma
Candidiasis
Cholangitis
Acalculous cholecystitis
Kaposi’s sarcoma

May involve the liver with diffuse, nonshadowing hyperechoic foci.

May cause the bile ducts and GB wall to be thickened.

96

This infection and this malignancy can signal the final stages of HIV/AIDS.

pneumocytosis
Kaposi's sarcoma

97

Another word for pneumocystis carini is

pneumocytosis

98

2 other AIDS related findings are

cholangitis (thickend bile ducts)
Kaposi's sarcoma (intrahepatic mass)

99

A fatty liver is an acquired, reversible disorder of metabolism, resulting in an accumulation of _____ within the hepatocytes.

triglycerides

100

The most common causes of a fatty liver are ______ and ______.

obesity
alcohol abuse

101

The 2 patterns of a fatty liver are

focal fatty infiltration (diffuse)
focal fatty sparing (focal)

102

The echogenicity of the liver compared to the kidney is more ______ than the kidney.

hyperechoic

103

A potential problem in the presence of diffuse fatty infiltration is

misdiagnosis of a hypoechoic solid lesion as a simple cyst

104

How does the misdiagnosis of a hypoechoic solid lesion as a simple cyst occur?

Since the overall gain is turned down to compensate for a bright liver, low level echoes within a solid lesion may be missed. With the TGC turned up to compensate for reduced through transmission, the hypoechoic solid lesion may have posterior enhancement.

105

What visual finding can help distinguish between a solid lesion and simple cyst?

The solid lesion will lack the specular reflection seen in the posterior wall of a cyst, as it does not have a fluid tissue interface.

Fine-needle aspiration may be necessary if the ultrasound findings are equivocal.

106

Focal regions of increased echogenicity within normal liver parenchyma is

focal fatty infiltration

107

Focal regions of normal liver parenchyma within a fatty infiltrated liver.

focal fatty sparing

108

Sparing commonly occurs adjacent to the ______, in the porta hepatis, the ______, and at the liver margins.

GB
caudate lobe

109

A genetically acquired disorder that results in the excess deposit of glycogen in the liver and tubules of the kidney.

glycogen storage disease

110

This is associated with diffuse fatty infiltration and hepatic adenomas (well-demarcated, solid masses of variable echogenicity).

glycogen storage disease

111

______ is a diffuse process of fibrosis and distortion of normal liver architecture.

cirrhosis

112

Patients with cirrhosis are at an increased risk for ______.

hepatocellular carcinoma

113

With cirrhosis, initially there is ______ enlargement, but continued insult results in ______. Parenchymal changes compress the biliary and ______ channels resulting in ______ and ______.

liver
hepatic atrophy
vascular
jaundice
portal HTN

114

The 2 most common causes of cirrhosis are

ETOH abuse (alcohol abuse)
Hepatitis C

115

ETOH was once the main cause of cirrhosis in the U.S. ______ has emerged as the leading cause now

Hep C

116

The 3 major pathologic mechanisms which create cirrhosis are

Cell death
Fibrosis
Tissue Regeneration (bad kind)

117

Cirrhosis is classified as ______ (nodules 0.1 – 1 cm in diameter) or ______ (nodules up to 5 cm in diameter).

Micronodular
Macronodular

118

______ is the MOST COMMON cause of micronodular cirrhosis.

alcohol consumption

119

______ is the MOST FREQUENT cause of macronodular cirrhosis.

chronic viral hepatitis

120

Clinical presentations of cirrhosis are (3)

Hepatomegaly
Jaundice
Ascites

121

This condition can cause you to be "crazy" because the liver cannot get rid of the toxins and ammonia, which causes encephalopathy.

cirrhosis

122

Cirrhosis - match the volume distribution with the type:

Acute
Chronic
Small liver, large Caudate lobe
Hepatomegaly

Acute - Hepatomegaly
Chronic - Small liver, large Caudate lobe

123

The 3 sonographic patterns for cirrhosis are:

1) volume redistribution
2) coarse echotexture
3) nodular surface

124

The nodularity with cirrhosis corresponds to the presence of regenerating ______ and ______.

nodules
fibrosis

125

Late stages of cirrhosis characteristics are (2)

ascites
shrunken liver

126

This is defined as increased pressure in the portal venous system.

portal HTN

127

Normal portal pressure is ______-______ mm Hg which is slightly ______ than the normal IVC pressure.

5 - 10 mm Hg
higher

128

Normal portal vein diameter is < ______ mm

13 mm

129

______ flow in the MPV is a sign of portal HTN.

hepatofugal

130

What are the 2 major causes of portal HTN?

cirrhosis
schistosomiasis

131

Portal HTN is asymptomatic. Patients typically present with sudden painless upper GI ______ due to rupture of esophageal ______.

hemorrhage
varices

132

What are the 4 types of portal HTN?

A. Extrahepatic pre-sinusoidal = portal vein thrombosis

B. Intrahepatic pre-sinusoidal = schistosomiasis

C. Intrahepatic = cirrhosis (most common) accounting for 90% of the cases in the West

D. Intrahepatic post-sinusoidal = hepatic vein thrombosis

133

What is the most common type of portal HTN?

intrahepatic

134

What are the secondary signs of portal HTN? (3)

splenomegaly ( >13 cm)
ascites
portosystemic venous collaterals

135

What are 5 major sites of portosystemic venous collaterals?

1) Gastroesophageal junction

2) Paraumbilical vein

3) Splenorenal and gastrorenal

4) Intestinal

5) Hemorrhoidal

136

Gastroesophageal junction: between the coronary and ______and the ______ .

short gastric veins
esophageal veins

137

Paraumbilical vein: runs in the ______ ligament and connects the LPV to the ______ near the umbilicus, recanalizing the ______.

falciform ligament
epigastric veins
ligamentum teres

138

Splenorenal and gastrorenal: tortuous veins may be seen in the region of the ______ and ______.

splenic
left renal hilum

139

Intestinal: regions in which the gastrointestinal tract becomes ______, so that the veins of the ascending and descending ______, ______, ______, and ______ may anastomose with the renal, phrenic and ______ veins.

retroperitoneal
colon
duodenum
pancreas
liver
lumbar

140

Hemorrhoidal: ______ region where the superior rectal veins anastomose with the ______ and ______ rectal veins.

perianal
middle
inferior

141

These are created to decompress the portal system to avoid the development or rupture of gastroesophageal varices with portal HTN.

portosystemic shunts

142

The 3 types of traditional portosystemic shunts are

mesocaval
splenorenal (Warren)
portacaval

143

What does TIPS stand for?

Transjugular
Intrahepatic
Portal
Systemic shunting

144

A TIPS shunt is placed between a ______ and a ______. Usually the ______ (right/left).

HV
PV
right

145

______ ______ ______ is utilized to detect early shunt compromise for prompt shunt revision, usually every 3-6 months.

routine doppler evaluation

146

What are the 4 criteria for TIPS malfunction?

1. Shunt velocity < 50 cm/sec
2. Focal velocity increase (usually at the hepatic end)
3. Hepatopedal flow in the LPV or RPV
4. Hepatofugal flow in the MPV

147

Hepatopedal flow in the LPV or RPV is a sign of what (involving shunts)?

TIPS malfunction

148

Hepatofugal flow in the MPV is a sign of what (involving shunts)?

TIPS malfunction

149

Echogenic thrombus within the lumen of the portal vein

PV thrombosis

150

The 6 causes of PV thrombosis are

Hepatocellular Carcinoma
Pancreatic Carcinoma
Metastatic Liver Disease
Pancreatitis
Cirrhosis
Hypercoagulation (women on birth control pills)

151

With traditional shunts for lowering portal pressure, the mesocaval shunt connects the ______ and the ______.

SMV
IVC

152

With traditional shunts for lowering portal pressure, the splenorenal (Warren) shunt connects the ______ and the ______.

SV
RV

153

With traditional shunts for lowering portal pressure, the portacaval shunt connects the ______ and the ______.

PV
IVC

154

Wormlike vessels at the porta hepatis, which represent periportal collateral circulation, occurring in longstanding PV thrombosis, requiring up to 12 months to occur.

cavernomatous transformation

155

Cancer = ______ (increased/decreased) risk of blood clots.

increased

156

A relatively rare disorder characterized by occlusion of the hepatic veins with or without occlusion of the IVC by either thrombus or tumor. Typically seen in young adult women taking birth control pills.

Budd-Chiari syndrome

157

The main cause of Budd-Chiari syndrome is

Coagulation abnormalities

158

With Budd-Chiari syndrome, the ______ lobe is often spared. And why?

caudate lobe
because of emissary veins drain directly into the IVC at a lower level than the main HVs

159

These are sonographic signs of ______:

Ascites is an invariable observation.

Liver is typically large and bulbous acutely. Hemorrhagic infarction may produce significant altered regional echogenicity.

Membranous webs may be identified as echogenic or focal obliterations of the lumen.

Budd-Chiari syndrome

160

______ liver transplantation is performed to eliminate irreversible disease.

orthotopic

161

The main indication for liver transplants in adults is

Cirrhosis due to Hep C

162

The main indication for liver transplants in children is

biliary atresia

163

Before orthotopic liver transplant surgery is done, these details should be checked sonographically (4)

Liver size and extent of pathology
PV, HA, IVC patency/size
Presence of venous collaterals
Presence of complicating factors( like AAA or extrahepatic malignancies)

164

A postoperative U/S for orthotopic liver transplant should include (5)

Liver parenchyma
Biliary tree (CBD)
HA, PV, HV patency***
IVC patency
Perihepatic fluid collections

165

Unfortunately, in about _____ (fraction) of all patients with chronic hepatitis, the disease recurs after transplantation.

half

166

Most common benign tumor of the liver is

cavernous hemangioma

167

The majority of hemangiomas are asymptomatic and discovered incidentally, usually in the _____ lobe of the liver.

right

168

Is it possible to see the flow in the tiny vessels that make up hemangiomas on U/S?

no

169

Hyperechoic, homogeneous

Posterior enhancement

May appear hypoechoic within the background of a fatty infiltrated liver

Color or duplex Doppler does not routinely demonstrate flow

These are sonographic signs of what?




cavernous hemangioma

170

This liver mass may enlarge with pregnancy or administration of estrogens.

cavernous hemangioma

171

This is a benign solid liver mass that is believed to be related to an area of congenital vascular malformation. It is typically an incidentally detected liver mass in an asymptomatic patient.

focal nodular hyperplasia

172

Focal nodular hyperplasia is a mass more common in ______ (men/women).

women

173

Well defined solid mass

Central fibrous scar (liver mass with an echogenic line through it)

Stellate vascularity

It is often difficult to differentiate in echogenicity from the adjacent liver parenchyma

These are sonographic signs of what?

focal nodular hyperplasia

174

This is a solid liver mass associated with the use of oral contraceptive agents.

hepatic adenoma

175

Patient may present with pain due to tumor hemorrhage. Associated with glycogen storage disease.

These are signs of what liver mass?

hepatic adenoma

176

Surgical resection is recommended for hepatic adenomas due to the risk of

malignant transformation

177

Sonographic signs of hepatic adenoma are (3)

Nonspecific echogenicity

Cystic component with hemorrhage

Intraperitoneal blood

178

Hepatic Adenoma is often difficult to distinguish from ______ on an U/S.

focal nodular hyperplasia

179

Extremely rare fatty tumors in the liver are

hepatic lipoma

180

Tuberous sclerosis, a congenital familial disease, is associated with ______ and ______.

hepatic lipomas
angiomyolipomas

181

Hyperechoic mass
Propagation speed artifact

These are sonographic signs of

hepatic lipomas

182

This may be seen as a broken diaphragm posterior to the fatty mass on an U/S (and diaphragms don’t break).

hepatic lipomas

183

The MOST COMMON PRIMARY malignancy of the liver is

hepatocellular carcinoma

184

Another term for hepatocellular carcinoma is

hepatoma

185

Etiology factors:

Alcoholic cirrhosis and Hep B and C

Commonly invades PVs, HVs, and IVC

Variable sonographic appearance

Serum alpha-fetoprotein level will be increased

These are signs of what?

hepatoma (hepatocellular carcinoma)

186

One of the biggest signs of ______ is the increase of serum alpha-fetoprotein levels.

hepatocellular carcinoma (hepatoma)

187

______ are the most commonly encountered solid masses in the liver.

metastatic tumors

188

The most common source of metastatic involvement is from ______, ______, or ______ cancer.

gastrointestinal
breast
lung

189

Metastatic tumors:

Hyperechoic mets come from

the gastrointestinal tract

190

Metastatic tumors:

Hypoechoic mets come from

lymphoma

191

Metastatic tumors:

Bulls eye or target mets come from

lung

192

Metastatic tumors:

Calcified mets come from

mucinous adenocarcinoma

193

Metastatic tumors:

Cystic mets come from

sarcoma

194

Metastatic tumors can also present as mass of ______ echogenicity.

mixed

195

The most common malignant liver tumor in early childhood is

hepatoblastoma

196

Hepatoblastoma is the 3rd most common intra-abdominal childhood malignancy after ______ neuroblastoma and ______ tumor.

adrenal
Wilm's

197

With hepatoblastoma, most occurrences are prior to ______ years of age. Patients present with an enlarging ______ ______ ______ (10-12 cm). Non-specific sonographic appearance.

2
asymptomatic abdominal mass

198

What is the earliest manifestation of a fungal infection (and most easily seen) in the liver?

Wheel within a wheel

199

Since they are difficult to tell apart, how can you possibly distinguish between a pyogenic abscess and an amebic abscess?

If the patient has traveled outside the US it might be amebic abscess

200

Central fibrous scar =

Focal nodular hyperplasia

201

Echinococcal = ? = ?

Echinococcal =. sheep = water lily sign