URR 2

Question 1

What is the normal waveform in hepatic A.?

Answer 1

Normal flow represents a low resistance waveform with an RI value of 0.55-0.8.

Question 2

What RI value indicates increased resistance in hepatic flow?

Answer 2

Increased resistance is indicated by RI > 0.8.

Question 3

What conditions are suspected with an Hepatic A. RI >0.8?

Answer 3

Conditions include PHTN, hepatic congestion, Budd-Chiari syndrome, transplant rejection, hepatocellular disease and cirrhosis.

Question 4

What is the most common cause of intrahepatic cholestasis?

Answer 4

The most common cause of intrahepatic cholestasis is hepatitis equivalent to livers disease.

Question 5

What is extrahepatic cholestasis?

Answer 5

Extrahepatic cholestasis is caused by obstruction.

Question 6

What is a piggyback technique in liver transplantation?

Answer 6

In the piggyback technique, the hepatic confluence of the transplant liver is attached to the native IVC with a single anastomosis.

Question 7

What is the interposition technique in liver transplantation?

Answer 7

In the interposition technique, a donor IVC segment replaces a segment of the native IVC with two anastomotic sites.

Question 8

What is a characteristic ultrasound finding in acute viral hepatitis?

Answer 8

Ultrasound shows increased echogenicity with a ‘starry night’ appearance and scattered bright portal reflections.

Question 9

What is the direction of blood flow in hepatic A. and portal V.?

Answer 9

Both hepatic A. and portal V. are hepatopetal.

Question 10

What is Kasabach-Merritt syndrome?

Answer 10

Kasabach-Merritt syndrome is associated with hemangioma thrombocytopenia in infants.

Question 11

What should be checked in infants suspected of Kasabach-Merritt syndrome?

Answer 11

Check the liver and spleen for hemangiomas.

Question 12

How do benign nodules appear on contrast imaging?

Answer 12

Benign nodules demonstrate isovascular enhancement, similar to normal liver tissue.

Question 13

How do malignant tumors typically appear on contrast imaging?

Answer 13

Malignant tumors usually demonstrate hypervascular enhancement with rapid uptake.

Question 14

What does a fungal liver abscess present as?

Answer 14

A whees within a wheel appearance

Question 15

What is glycogen storage disease associated with?

Answer 15

Adenomas, hepatomegaly, increased echogenicity, hepatic adenoma

Question 16

What type of contrast enhancement does FNH (focal nodular hyperplasia) exhibit?

Answer 16

Centrifugal enhancement (fills center first).

Question 17

What type of enhancement is associated with adenomas?

Answer 17

Centripetal enhancement (peripherally to centrally)

Question 18

What is the most common malignancy of the liver in AIDS patients?

Answer 18

Kaposi sarcoma

Question 19

What is the most common infection in the liver associated with AIDS?

Answer 19

Pneumocystis carinii

Question 20

What is caput medusae?

Answer 20

Dilated, tortuous vessels around the umbilicus caused by portal hypertension

Question 21

What is the most common parasitic infection in humans?

Answer 21

Schistosomiasis

Question 22

Where is schistosomiasis commonly found?

Answer 22

In polluted waters and infested shellfish/snails

Question 23

What is true about most hemangiomas?

Answer 23

They demonstrate some level of posterior enhancement

Question 24

What is not effective in assessing hemangiomas?

Answer 24

Doppler

Question 25

What does cavernous transformation lead to?

Answer 25

Formation of varices from increased portal pressure

Question 26

What does low velocity and very low resistance indicate?

Answer 26

Tardus parvus

Question 27

What are findings associated with cirrhosis?

Answer 27

* Right lobe atrophied * Irregular contour * Caudate hypertrophied * Ascites present

Question 28

What is glycogen storage disease?

Answer 28

Excess storage of glycogen occurs in hepatocytes

Question 29

What are the direct complications of esophageal varices?

Answer 29

Portal hypertension, cirrhosis, PVT, right-sided heart failure, schistosomiasis.

Question 30

What does reduced glycogen storage within hepatocytes indicate?

Answer 30

It diffuses hypoechogenicity of parenchyma and shows a prominent appearance of portal walls. Similar to 'starry sky' appearance in acute viral hepatitis.

Question 31

What does jaundice indicate?

Answer 31

Chronic liver malfunction.

Question 32

What is an hemangioma composed of?

Answer 32

Highly vascularized tissue that appears hyperechoic. It has smooth borders and posterior enhancement.

Question 33

What does cirrhosis cause in terms of plasma levels?

Answer 33

Impaired plasma levels of albumin, which is a precursor to ascites and peripheral edema.

Question 34

How does ulcerative colitis affect the bloodstream?

Answer 34

It allows bacteria to invade the bloodstream through the portal venous system.

Question 35

What happens when bacteria enter the liver?

Answer 35

They produce gas.

Question 36

What does ERCP evaluate?

Answer 36

The pancreas and the ampulla of Vater.

Question 37

What can happen during the ERCP procedure?

Answer 37

A small amount of air may enter the ductal system through the ampulla of Vater.

Question 38

What does it indicate if the right lobe is rounded inferiorly?

Answer 38

It extends below the lower pole of the kidney.

Question 39

What happens to air after shunt placement?

Answer 39

Air is retained within the shunt, limiting evaluation for the first 3-5 days after the procedure.

Question 40

Where does fatty infiltration most commonly happen?

Answer 40

Fatty infiltration most commonly happens at the porta hepatis.

Question 41

What demonstrates respiratory changes in the portal vein?

Answer 41

The portal vein normally demonstrates respiratory changes.

Question 42

What respiratory changes do you see in the PV with cirrhosis.

Answer 42

Cirrhosis causes volume overload in the portal vein.

Question 43

What effect does inspiration have on portal vein diameter with cirrhosis?

Answer 43

Inspiration will have little effect on portal vein diameter.

Question 44

What is the subcapsular space?

Answer 44

The subcapsular space is located between the liver capsule and liver parenchyma.

Question 45

What is micronodular cirrhosis associated with?

Answer 45

Micronodular cirrhosis is associated with multiple nodules <1cm in size due to alcoholism.

Question 46

What is macronodular cirrhosis associated with?

Answer 46

Macronodular cirrhosis is associated with multiple nodules 1-5cm due to chronic viral hepatitis.

Question 47

What does a fungal liver abscess appear as on ultrasound?

Answer 47

A fungal liver abscess appears as a wheel within a wheel mass.

Question 48

Klatskin tumor is associated with elevated lab values of?

Answer 48

Bilirubin, alkaline phosphatase, and AF

Question 49

What is a clinical symptom of a hepatic klatskin tumor?

Answer 49

Nausea and vomiting are clinical symptoms.

Question 50

What is diastolic flow reversal in RT & LT Hepatic A. indicative of?

Answer 50

Diastolic flow reversal in the right and left hepatic arteries indicates a newly placed liver allograft malfunction or rejection.

Question 51

What does a positive HCC demonstrate in contrast ultrasound?

Answer 51

A positive HCC demonstrates hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase.

Question 52

What is a characteristic of hepatoblastoma on ultrasound evaluation?

Answer 52

Hepatoblastoma appears as a large solid heterogeneous mass.

Question 53

What is schistosomiasis?

Answer 53

Schistosomiasis is a parasite that causes narrowing and occlusion of smaller portal vessels, leading to portal hypertension.

Question 54

What is the most common infection in humans?

Answer 54

The most common infection in humans is schistosomiasis.