Abdomen Chapter 5 The Liver

How many measurements should be acquired when completing an elastography examination?

10

What is the normal liver length along the right surface?

15-17 cm

As a blood reservoir, the liver has the capacity to enlarge and store how much blood?

200-400 ml

Approximately what percentage of the liver's blood is supplied by the hepatic artery?

25%

What is the correct patient position for patient undergoing an elastography examination?

30 degrees left lateral decubitis

Approximately what percentage of the liver's blood is supplied by the portal system?

75%

What benign hepatic condition is associated with a long history of oral contraceptive usage?

Adenoma

What laboratory test may be used in the diagnosis of bone as well as liver diseases?

Alkaline phosphatase

On a longitudinal image, which major vessel courses posterior to the left lobe and is to the left of the midline?

Aorta

In addition to a central portal vein branch and hepatic artery, what other structure is contained in each of the eight segments described by Couinard?

Bile duct

What straddles the midline, is superior to the head of the pancreas, and is anterior to the inferior vena cava?

Caudate lobe

What structure has been confused as a pancreatic head mass?

Caudate lobe

Fatty infiltrative disease has the same appearance as which pathology?

Cirrhosis

Severe sound attenuation is associated with which pathology?

Cirrhosis

The porta hepatis (portal triad) contains the portal vein, hepatic artery, and what other structure?

Common hepatic duct Gastrohepatic ligament Liver lobule

What structure sometimes makes the lateral aspect of the right lobe of the liver difficult or challenging to visualize?

Costal margin

What structure can present as a thick lucent band sometimes identified anterior to the spine, inferior vena cava, or aorta?

Crus of the diaphragm

What is the relationship for the amount of AST in the blood compared to the number of cells damaged and to the time interval between injury and the test?

Direct proportion Arbitrary measure No specified amount

Which of the following statements regards fatty infiltration of the liver?

Focal fatty infiltration may be mistaken for a liver mass.

What vascular tumor is composed of blood vessel cells with a nonspecific sonographic appearance?

Hemangioma

Which vessel branches off the celiac axis and supplies the liver with oxygenated blood?

Hepatic artery

Which vessel supplies the liver with oxygen-rich blood?

Hepatic artery

Using Couinauds method of liver segmentation, what provides the boundaries for each segment?

Hepatic veins

Which vessels converge to form 3 large trunks that drain into the IVC?

Hepatic veins

Which vessels converge to form three large trunks that drain into the inferior vena cava?

Hepatic veins

Which of the following statements differentiates between hepatic and portal veins?

Hepatic veins are intersegmental while portal veins are intrasegmental.

What are the clinical implications for a 52-year-old man with a liver sonography examination suggesting long-standing liver disease and the presence of alpha-fetoprotein?

Hepatitis Vitamin K deficiency primary carcinoma

What Doppler signal would be expected in the portal vein of a patient with portal hypertension?

Hepatofugal flow

A 36-year-old woman is sonographically being examined for gestational dating. She has a high level of alpha fetoprotein in an abnormal hepatocellular function which are inconsistent with the normal progress and normal echo appearance of the pregnancy. Clinically, she has nausea, weight loss, and palpable right upper quadrant mass. What is the most likely explanation?

Hepatoma

What is the most common primary liver malignancy in an adult?

Hepatoma

What term describes the enlargement of the liver?

Hepatomegaly

What enhancement characteristic is common among almost all metastases?

Hopoenhancement in the arterial phase Hypoenhancement in the late phase Hyperenhancement in the late phase

Which term describes a degree of enhancement visualized through CEUS that is less than the liver parenchyma?

Hypoenhancing

On a longitudinal image, which of the following major vessels is located to the right of midline with the cephalic portion curving ventrally?

Inferior vena cava

The functional or true right and left intrahepatic lobar divisions are between which structures?

Left sagittal fossa and porta hepatis Inferior vena cava and gallbladder fossa Gallbladder fossa and porta hepatis

When assessing the quality of the data during an elastography examination, what value should the interquartile ratio (IQR) measure?

Less than 0.30

What structure along with the left hepatic vein separates the left hepatic lobe from the caudate lobe?

Ligamentum venosum fissure

Where does colon carcinoma usually metastasize?

Liver

What is the location of a mass detected anterior and to the left of the ligamentum venosum?

Lt lobe

What separates the intrahepatic right lobe from the left lobe?

Main lobar fissure

What are homogeneous masses with cystic internal echo patterns usually attributed to?

Necrosis

What is the most likely explanation when a 43-year-old woman is clinically jaundiced and has a marked elevated serum conjugated (direct reading) bilirubin level?

Obstructive jaundice

On a supine longitudinal section, what organ should be visualized posterior to the Lt hepatic lobe and anterior to the splenic vein?

Pancreas

On a supine longitudinal section, what organ should be visualized posterior to the left hepatic lobe and anterior to the splenic artery in vein?

Pancreas

What is the normal echo amplitude relationship between the pancreas, kidney, and liver parenchyma (not cortex) starting with the most hyperechoic and progressing to the least hyperechoic?

Pancreas, liver, kidney

In which vessels does the right branch bifurcate into an anterior branch and a posterior branch?

Portal vein

Which vessel is formed by the junction of the splenic and superior mesenteric veins?

Portal vein

Which vessel is formed by the junction of the splenic and the superior mesenteric vein?

Portal vein

A 61-year-old man with elevated bilirubin has several gallbladder calculi and dilated hepatic ducts. What is a likely explanation when sonography visualizes that the right lobe has a normal echo pattern but extends quite far into the abdominal cavity?

Reidel's lobe

What anatomy is associated with the term costal?

Ribs

What anatomy is associated with the word costal?

Ribs

Which scanning plane should the sonographer initially select to best visualize the lower liver segment?

Right anterior oblique

On a transverse scan, the right portal vein is the landmark because it separates what liver structures?

Right hepatic anterior and posterior segments

Which of the following imaging modalities is considered noninvasive?

Sonography

What is the main clinical indication for liver elastography?

Staging the degree of fibrosis in cases of chronic liver disease.

Which characteristic of liver parenchyma is assessed with elastography?

Stiffness

What organ on the left lateral border of the liver is often demarcated by strong C-shaped echoes?

Stomach

To visualize the normal or abnormal anatomical areas of the subdiaphragmatic, subhepatic, and hepatorenal spaces, the sonographer would select what anatomic scanning location?

Subcostal

If a malignant neoplasm appears as an anechoic mass, what is a likely explanation for this echo characteristic?

The central liquefaction of necrosis

How are hepatic veins distinguished from portal veins?

They can be seen draining into the IVC

How are hepatic veins distinguished from the portal venous systems?

They can be seen draining into the inferior vena cava

Which of the following is a disadvantage of using contrast enhanced ultrasound?

Two or three people are required to perform the study.

What is a disadvantage of using contrast-enhanced ultrasound (CEUS)?

Typical reactions include a transient headache and nausea. Renal function tests are not completed prior to the exam. Large real-time vascular video clips are recorded and stored.

Which benign liver tumor commonly occurs in patients with glycogen storage disease?

adenoma

Which of the following laboratory tests evaluates liver function?

alkaline phosphatase

What is the most likely diagnosis if a 30-year-old woman presents for an abdominal sonogram to rule out the presence of gallstones and the examination reveals a well-defined, 2 cm, solitary, echogenic mass in the posterior right lobe?

cavernous hemangioma

A 65-year-old man presents with elevated liver function tests. The sonography examination reveals a shrunken, echogenic right lobe, a relatively enlarged caudate lobe, and the liver contour is irregular. What is the most likely diagnosis?

cirrhosis

What is a typical characteristic of an intrahepatic mass?

displaces hepatic vessels

Which of the following would rule-out either a congenital or acquired hepatic cystic lesions?

distal acoustic shadowing

What is the most likely diagnosis when the sonographic appearance is a mother cyst containing multiple daughter cysts?

echinococcal cyst

Patients with AIDS are at greater risk of acquiring which liver pathology?

fatty liver infiltration

What is the term that describes embryonic production of blood cells?

hematopoiseis

Which of the following supplies oxygenated blood to the liver?

hepatic artery

What is the most likely diagnosis of a well-defined, highly echogenic liver mass in the right posterior segment with an artifact causing the portion of the diaphragm directly distal to the mass to appear discontinuous with the remainder of the diaphragm?

hepatic lipoma

Which of the following are both interlobar and intersegmental?

hepatic veins

Which of the following is a diffuse liver disease?

hepatitis

What is the most likely diagnosis for a 60-year-old man with a history of alcoholic cirrhosis, increasing abdominal girth, and jaundice with the sonography examination revealing ascites, multiple hyperechoic lesions seen throughout the liver, and a tumor within the portal vein?

hepatocellular carcinoma

What pathology should the sonographer look for specifically on an abdominal sonography examination on a patient with an indication of an elevated AFP?

hepatocellular carcinoma

What does a person with cirrhosis have a higher incidence of developing?

hepatoma

What separates the left lobe from the caudate lobe?

ligamentum venosum

What is the basic functional unit of the liver?

liver lobule

If you are having trouble visualizing the posterior portion of the liver in a patient with fatty infiltration, which of the following may help?

lowering the frequency

What determines why contrast images are obtained at a lower acoustic pressure setting?

mechanical Index

What is the liver segment location for an echogenic mass consistent with a hemangioma if it is seen just anterior to the middle hepatic vein?

medial segment left lobe

What is the normal echo amplitude relationship between the pancreas, kidney cortex, and liver parenchyma starting with the most hyperechoic and ending with the least hyperechoic?

pancreas, liver, kidney

Which of the following supplies the liver with blood that is rich in nutrients?

portal vein

Which vessels are usually identified first by the fibrous connective tissue that surrounds them and provides a bright echogenic pattern?

portal veins

A 38-year-old woman presents postcholecystectomy with RUQ pain, fever, and an elevated white count. What is the most likely diagnosis if the sonography examination reveals an irregular, hypoechoic mass with posterior enhancement in the region of the porta hepatis?

pyogenic abscess

In focal fatty sparing, normal tissue appears more hypoechoic than the surrounding liver tissue and may be mistaken for a mass. What is the typical location for this to occur?

region of the porta hepatis near the gallbladder

If the sonographer is locating a mass within the right posterior segment of the liver, which vessel separates the right anterior liver segment from the right posterior liver segment?

rt hepatic vein

What is the most likely diagnosis on a patient with RUQ pain and a normal sonography examination except in the right liver lobe there is a single, well-circumscribed anechoic lesion with posterior enhancement?

simple liver cyst