Textbook of Diagnostic Sonography: Chapter 10: The Liver Flashcards

bare area

bilirubin

blood urea nitrogen (BUN)

bull’s eye (target) lesion

caudate lobe

collateral circulation

diffuse hepatocellular disease

epigastrium

extrahepatic

falciform ligament

hepatocellular disease

hepatocyte

hepatofugal

hepatopetal

hyperglycemia

hypoglycemia

intrahepatic

left hypochondrium

left lobe of the liver

left portal vein

ligamentum teres

ligamentum venosum

liver function tests

main lobar fissure

main portal vein

metastatic disease

neoplasm

obstructive disease

pyogenic abscess

right hypochondrium

right lobe of the liver

right portal vein

area superior to the liver that is not covered by peritoneum so that inferior vena cava may enter the chest

smallest lobe of the liver situated on the posteriosuperior surface of the left lobe; the ligamentum venosum is the anterior border

area between the right and left hypochondrium

extends from the umbilicus to the diaphragm in a sagittal plane and contains the ligamentum teres

left hypochondrium

liver lobe that lies in the epigastium and left hypochondium

supplies the left lobe of the liver

appears as bright echogenic foci on transverse image; along with falciform ligament, it divides medial and lateral segments of left lobe of the liver

separates left lobe from caudate lobe; shown as echogenic line on the transverse and sagittal

boundary between the right and left lobes of the liver; seen as hyperechoic line on the sagittal image extending from the portal vein to the neck of the gallbladder

enters the liver at the porta hepatis

right upper quadrant of the abdomen that contains the liver and gallbladder

largest lobe of the liver

supplies the right lobe of the liver; branches into anterior and posterior segments

alkaline phosphate

ALT

AST

Yellow pigment in bile formed by the breakdown of red blood cells; excreted by liver and stored in the gallbladder

BUN

classification of liver disease where hepatocytes are the primary problem

parenchymal liver cell that performs all functions ascribed to the liver

hepatofugal

hepatopetal

uncontrolled increase in blood glucose levels

hypoglycemia

specific laboratory tests that look at liver function (aspartate or alanine aminotransferase, lactic acid dehydrogenase, alkaline phosphatase, and bilirubin

classification of liver disease where the main problem is blocked bile excretion within the liver of biliary

hypoechoic mass with an echogenic central core (abscess, metastases)

develops when normal venous channels become obstructed

affects hepatocytes and interferes with liver function

extrahepatic

intrahepatic

most common form of neoplasm of the liver; primary sites are colon, breast, and lung

any new growth (benign or malignant)

pus-forming collection of fluid

A congenital variant, ___________________, can sometimes be seen as an anterior projection of the liver and may extend inferiorly as far as the iliac crest.

The liver is covered by a thin connective tissue layer called _____________ capsule.

The ________ fissure is the boundary between the right and left lobes of the liver.

The ____________ ligament extends from the umbilcus to the diaphragm in a parasagittal plane and contains the ligamentum teres

The ___________ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament.

The fissure for the ____________ separates the left lobe from the caudate lobe.

The hepatic veins are divided into three components: _____________, _____________, and ______________

The liver is a major center of _______________, which may be defined as the physical and chemical process whereby foodstuffs are synthesized into complex elements.

Through the process of __________, the liver expels these waste products from the body via its excretory product, bile, which plays an important role in fat absorption.

A pigment released when the red blood cells are broken down is __________.

The liver is a _________ site for several compounds used in a variety of physiologic activities throughout the body.

The liver is also a center for __________ of the waste products of metabolism accumulated from other sources in the body and foreign chemicals that enter the body.

Diseases affecting the liver may be classified as ______________ when the liver cells or hepatocytes are the immediate problem; or _____________ when bile excretion is blocked.

Raw materials in the form of ____________, _____________, and _______ are absorbed from the intestine and transported to the liver via the circulatory system.

Sugars may be absorbed from the blood in several forms, but only _________ can be used by cells throughout the body as a source of energy.

Dietary fats are converted in the hepatocytes to ____________, in which form fats are transproted throughout the body to sites where they are used by other organs or stored,

The accompanying loss of oncotic pressure in vascular system allows fluid to migrate into the interstitial space, resulting in ___________ dependent areas.

Because the liver is a major center of metabolism, large quantities of _______ are present in hepatocytes, and these leak into the bloodstream when the liver cells are damages of destroyed by disease.

In severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of ____________ and ____________ may be seen.

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

Hemoglobin released from the red cells is converted to _____________ within the reticuloendothelial system and is then released into the bloodstream.

Elevation of serum of serum bilirubin results in ________________, which is a yellow coloration of the skin, sclerae, and body secretions.

Embryology

What is the liver derived from?

Embryology

When does hepatopoiesis begin and end?

Explain the microanatomy of the hepatic parenchyma

What is a Kupffer cell?

What is another name for ligament teres?

What is the ligamentum venosum originate from?

How is the right lobe subdivided?

How is the left lobe subdivided?

What does the portal venous system drain?

What is the relationship between the stomach and the liver

What is the reticuloendothelial activity of the liver?

What are the 7 functions of the liver?

What is stored in the liver?

What does the liver detoxify?

What is AST?

What is the significance of AST?

What is ALT

What is the significance of ALT?

Which is more specific to liver disease, AST ot ALT?

Diffuse liver disease

What is GDS?

What is the most common type of GDS to affect the liver?

What is Pompe DIsease?

What are the common lab values for hepatitis?

A caudate lobe/ right lobe (C/RL) ratio meaurement increases to greater than .65 What does this imply?

What is presinusoidal portal hypertension?

What is intrahepatic portal hypertension?

What is the most common cause of intrahepatic portal hypertension?

What is posthepatic portal hypertension?

True liver cysts are

What is the significance of a liver cyst without an epithelial lining?

What is a pyogenic cyst?

What is the sonographic appearance of pyogenic cysts?

What is Amebic abscess

Liver candidiasis

What is the sonographic appearance of echinococcal cysts?

What are benign neoplasms of the liver?

adenoma

What benign lesion is associated with oral contraceptives?

Hemangioma

hemangioendothelioma

Mesenchymal hamartoma

What are malignant tumors of the liver?

hepatoblastoma

Most common malignant tumor occurring in 3 years and younger

What is hepatoblastoma associated with?

hepatocellular carcinoma (HCC) hepatoma

What is the most common predisposing factor for hepatocellular carcinoma (HCC) hepatoma?

What is the most common site to metastasize?

hepatic angiosarcoma

Hematoma

What is the term for a malignant lesion of the liver?

A) hepatoma

B) focal nodular hyperplasia

C) cavernous hemangioma

D) fibroma

Caudate lobe enlargement may be due to:

A) fatty infiltration

B) hepatitis

C) cirrhosis

D) hypertension

Which is the most predisposing factor of hepatocellular carcinoma in Western civilization?

A) biliary disease

B) echinococcal cyst

C) cirrhosis

D) portal hypertension

Hepatofugal blood flow may be seen in the main portal vein in patients with:

A) cavernous hemangioma

B) biliary disease

C) fatty infiltration

D) portal hypertension

The portal triad consists of the:

A) main portal vein, common bile duct, hepatic artery

B) main portal vein, hepatic duct, common bile duct

C) main portal vein, hepatic artery, hepatic vein

D) main portal vein, hepatic artery, hepatic duct

A patient presents with weight loss, increased alpha fetal protein (AFP), and abdominal distention. This is most characterisitic of:

A) focal nodular hyperplasia

B) liver adenoma

C) hepatoma

D) lymphoma

Which vessels increase in size as they course superiorly toward the diaphragm?

A) hepatic arteries

B) hepatic veins

C) portal veins

D) patent umbilical veins

A small hyperechoic nodular liver best describes:

A) acute viral hepatitis

B) chronic viral hepatitis

C) cirrhosis

D) normal pediatric liver

Which of the following is a characteristic of Budd-Chiari syndrome?

A) thrombus in the hepatic and portal vein

B) thrombus in the hepatic artery and vein

C) thrombus in the hepatic vein and inferior vena cava

D) thrombus in the hepatic artery and aorta

Which of the following are pathological states of the liver does not demonstrate mass- effect on surrounding hepatic vascularity?

A) fatty infiltration

B) diffuse metastasis

C) focal nodular hyperplasia

D) cavernous hemangioma

A 30 year old patient presents with abdominal pain and abnormal liver function tests. The abdominal ultrasound reveals a dilated portal and superior mesenteric vein with hepatofugal blood flow. This is most characteristic of:

A) portal aneurysm

B) portal atresia

C) portal fistula

D) portal hypertension

Normal dimension for the common hepatic duct is considered to be:

A) less than 2 mm

B) less than 3 mm

C) less than 5 mm

D) less than 7 mm

The lesser omentum ligament is also referred to as the :

A) left triangular

B) gastrohepatic

C) falciform

D) ligamentum teres

Sonographic findings with acute hepatitis can include all of the following except:

A) periportal cuffing

B) normal liver parenchymal echogenicity

C) decreased liver parenchymal echogenicity

D) decreased echogenicity of portal vein walls

The liver function laboratory test which is most specific to hepatocellular disease is:

A) ALP

B) AST

C) ALT

D) bilirubin

A cyst within a cyst (daughter cyst) is a characteristic of:

A) polycystic liver disease

B) echinococcal cyst

C) hepatoma

D) pseudocyst

When using Brisbane’s liver segmentation, how many segments is the liver divided into?

A) 4

B) 8

C) 9

D) 10

The following carries the majority of the oxygen and nutrients to the liver?

A) hepatic artery

B) portal vein

C) common duct

D) celiac axis

The patient preparation necessary to examine the liver is:

A) drink 16 ounces of water

B) NPO for 6 hours

C) clear liquids

D) no specific preparation

What is the reticuloendothelial function of the liver?

A) phagocytosis of Kupffer cells

B) formation of bile

C) blood reservoir

D) synthesis of amino acids

What is the most common predisposing condition for a bacterial abscess of the liver?

A) portal vein thrombosis

B) biliary obstruction

C) hepatic artery aneurysm

D) surgical procedure

The fissure of the ligamentum venosum divides the liver into:

A) right and left lobes

B) left lobe and caudate lobe

C) left medial and lateral segments

D) right lobe and caudate lobe

A 50 year old diabetic patient presents with abdominal pain and slightly elevated liver function tests. Hepatomegaly and diffuse increase in the liver parenchymal echogenicity are present. This is characteristic of:

A) cirrhosis

B) hepatocellular carcinoma

C) pyogenic infection

D) fatty infiltration

A 20 year old asymptomatic woman presents for an abdominal ultrasound. A round hyperechoic, subcapsular mass is identified in the right lobe of the liver. This is most characteristic of:

A) hepatoblastoma

B) cavernous hemangioma

C) echinococcal cyst

D) solitary metastatic lesion

Normal Doppler waveform of the hepatic veins demonstrate a “w” appearance. This appearance is attributes to changes in:

A) respiration

B) right ventricular pressure

C) right atrial pressure

D) left ventricular pressure

What is the waveform of the portal vein?

What is the waveform of the hepatic vein?

What is the waveform of the hepatic artery?

What is the most common Glycogen storage disease?

What is type 2 Glycogen storage disease?