The Liver

kuppfer cells

specialized macrophages within the liver that engulf pathogens and damaged cells

decrease in ____________ can indicate chronic liver disease and cirrhosis

albumin

malignant degeneration

the deterioration of a benign mass into a malignancy

all of the following are clinical findings of... 1. hepatomegaly 2. RUQ or general abdominal pain 3. general malaise 4. fever 5. leukocytosis 6. elevated LFT's 7. mild anemia 8. possible recent travel abroad

amebic hepatic abscess (clinical)

mass effect

the displacement or alteration of normal anatomy that is located adjacent to a tumor

fibrosis

the formation of excessive fibrous tissue; the development of scar tissue within an organ

gastroesophageal junction

the junction between the stomach and the esophagus

the main lobar fissure contains the: a. RHV b. MHV c. MPV d. RPV

b. MHV

Pyogenic liver abscess

the liver abscess that can result from the spread of infection from inflammatory conditions such as appendicitis, diverticulitis, cholecystitis, cholangitis, and endocarditis

starry sky sign

the sonographic sign associated with the appearance of periportal cuffing in which there is an increased echogenicity of the walls of the portal triads

TIPS

transjugular intrahepatic portosystemic shunt; the therapy for portal vein hypertension that involved the placement of a stent between the portal vein and hepatic veins to reduce portal systemic pressure

serpiginous

twisted or snakelike pattern

Epstein-Barr virus

virus responsible for mononucleosis and other potential complications

hematemesis

vomiting blood

hepatocellular adenoma

benign liver mass associated with the use of oral contraceptives

hemopoiesis

blood cell formation

all of the following are sonographic findings of... 1. small, hyperechoic mass 2. typically in the right lobe (clinically asymptomatic)

cavernous hemangioma

all of the following are clinical findings of... 1. asymptomatic 2. alcohol abuse 3. chemotherapy 4. diabetes mellitus 5. elevated LFT's (specifically AST and ALT) 6. hyperlipidemia 7. obesity 8. pregnancy

fatty liver disease

all of the following are sonographic findings of... 1. isoechoic, hyperechoic, or hypoechoic mass 2. central scar may appear as hyperechoic or hypoechoic linear structure within the mass and will often reveal hypervascularity with color doppler (clinically asymptomatic)

focal nodular hyperplasia

increase in __________ can indicate diffuse liver disease and posthepatic obstruction

gamma-glutamyl transferase

all of the following are clinical findings of... 1. immunocompromised patients 2. RUQ pain 3. fever 4. hepatomegaly

hepatic candidiasis (clinical)

all of the following are clinical findings of... 1. trauma 2. recent surgery 3. pain 4. decreased hematocrit

hepatic hematoma (clinical)

budd-chiari syndrome leads to a reduction in the size of the...

hepatic veins and IVC

all of the following are sonographic findings of... 1. normal liver 2. enlarged, hypoechoic liver 3. periportal cuffing with "starry sky" 4. gallbladder wall thickening

hepatitis (sono)

all of the following are clinical findings of... 1. pediatric patient 2. may be asymptomatic 3. palpable abdominal mass 4. hepatomegaly 5. abdominal pain 6. weight loss 7. anorexia 8. elevated AFP 9. jaundice

hepatoblastoma (clinical)

all of the following are sonographic findings of... 1. solid, hyperechoic, or heterogeneous mass 2. mass may contain some calcifications

hepatoblastoma (sono)

all of the following are clinical findings of... 1. asymptomatic 2. oral contraceptive use 3. pain occurs with hemorrhage

hepatocellular adenoma (clinical)

cholangitis

inflammation of bile ducts

hepatitis

inflammation of the liver

hepatoma

malignant tumor associated with HCC

pseudocirrhosis

nodular appearance of the liver caused by multiple metastatic tumors

hepatocellular carcinoma (HCC)

primary tumor of the liver that usually develops in the setting of chronic liver disease => *chronic HBV and HCV*

total parental hyperalimentation

procedure in which an individual receives vitamin and nutrients through a vein, often the subclavian vein

caput medusa

recognizable dilation of the superficial veins of the abdomen

cystic fibrosis

genetic disorders linked with the development of scar tissue accumulation within the lungs, liver, pancreas, kidneys, and/or intestines

all of the following are sonographic findings of... 1. fresh clot may appear hyperechoic 2. older hemorrhage can appear anechoic or complex 3. may be intrahepatic or subcapsular

hepatic hematoma (sono)

all of the following are clinical findings of... 1. abnormal LFT's (possibly) 2. weight loss 3. jaundice 4. RUQ pain 5. hepatomegaly 6. abdominal swelling with ascites

hepatic metastases (clinical)

all of the following are sonographic findings of... 1. hyperechoic, hypoechoic, calcified, cystic, or heterogeneous masses 2. mass or masses demonstrating a hypoechoic rim and central echogenic region 3. diffusely heterogeneous liver 4. possible ascites

hepatic metastases (sono)

all of the following are clinical findings of... 1. chills 2. dark urine 3. elevated LFT's (specifically ALP, ALT, AST, LDH, total bilirubin, PT) 4. fatigue 5. fever 6. hepatosplenomegaly 7. jaundice 8. nausea 9. vomiting

hepatitis (clinical)

all of the following are sonographic findings of... 1. mostly hypoechoic 2. may be hyperechoic, isoechoic, or be comprised of mixed echogenicities

hepatocellular adenoma (sono)

all of the following are clinical findings of... 1. elevated AFP 2. abnormal LFT's (possibly) 3. cirrhosis 4. chronic hepatitis 5. unexplained weight loss 6. hepatomegaly 7. fever 8. palpable mass 9. abdominal swelling

hepatocellular carcinoma (clinical)

all of the following are sonographic findings of... 1. solitary, hypoechoic mass 2. heterogeneous masses scattered throughout the liver 3. mass with a hypoechoic halo and central echogenic portion ("target" or "bulls eye" lesion) 4. possible ascites

hepatocellular carcinoma (sono)

all of the following are clinical findings of... 1. leukocytosis 2. low-grade fever 3. nausea 4. obstructive jaundice 5. RUQ tenderness 6. possible recent travel abroad

hydatid liver cyst (clinical)

all of the following are sonographic findings of... 1. anechoic mass containing some debris 2. "water lily" sign appears as an endocyst floating within a pericyst 3. "mother" cyst containing one or more "daughter" cysts 4. mass may contain areas of dense calcification

hydatid liver cyst (sono)

all of the following are clinical findings of... 1. pediatric patient 2. may cause hepatomegaly 3. may be accompanied by hemangiomas of the skin

infantile hemangioendothelioma (clinical)

all of the following are sonographic findings of... 1. homogeneous or complex hepatic masses 2. may contain calcifications or cystic spaces

infantile hemangioendothelioma (sono)

dysentery

infection of the bowel which leads to diarrhea that may contain mucus and/or blood

hydatid liver cyst (echinococcal cyst)

liver cyst that develops from a tapeworm that lives in dog feces; also referred to as echinococcal cyst

hematoma

localized collection of blood

increase in ____________ can indicate cirrhosis, extrahepatic biliary obstruction, gallstones, hepatitis, metastatic liver disease, and pancreatic carcinoma

ALP

increase in __________ can indicate biliary tract obstruction, hepatitis, hepatocellular disease, obstructive jaundice

ALT

increase in __________ can indicate cirrhosis, fatty liver, hepatitis, and metastatic liver disease

AST

increase in __________ can indicate cirrhosis, hepatitis, and obstructive jaundice

LDH

all of the following are clinical findings of... 1. abnormal AFTs 2. ascites 3. fatigue 4. hepatomegaly 5. hepatic encephalopathy 6. caput medusa 7. tremors 8. gastrointestinal bleeding

portal hypertension (clinical)

all of the following are sonographic findings of... 1. hepatomegaly 2. shrunken right lobe of the liver 3. enlarged caudate lobe 4. nodular surface irregularity 5. coarse echotexture 6. splenomegaly 7. ascites 8. monophasic flow in hepatic veins 9. hepatofugal flow within PV's 10. enlarged portal vein diameter 11. enlargement of SMV 12. recanalized paraumbilical vein

portal hypertension (sono)

all of the following are clinical findings of... 1. abdominal pain 2. elevated LFT's 3. hypovolemia 4. leukocytosis 5. low-grade fever 6. nausea 7. vomiting

portal vein thrombosis (clinical)

all of the following are sonographic findings of... 1. echogenic thrombus in the portal vein 2. cavernous transformation of the portal veins will appear as wormlike or serpiginous vessels within the region of the PV

portal vein thrombosis (sono)

all of the following are clinical findings of... 1. fever 2. hepatomegaly 3. leukocytosis 4. possible abnormal LFT's 5. RUQ pain

pyogenic hepatic abscess (clinical)

all of the following are sonographic findings of... 1. complex cyst with thick walls 2. mass may contain debris, septations, and/or gas 3. the air within the abscess may produce dirty shadowing or ring-down artifact

pyogenic liver abscess (sono)

hepatic candidiasis

a hepatic mass that results from the spread of fungus in the blood to the liver

Echinococcus granulosus

a parasite responsible for the development of hydatid liver cysts

diaphragmatic slip

a pseudo mass of the liver seen on sonography resulting from hypertrophied diaphragmatic muscle bundles

fatty liver

a reversible disease characterized by deposits of fat within the hepatocytes, also referred to as hepatis steatosis

anastomosis

a surgical connection between two hollow or tubular structures

steatohepatitis

a type of fatty liver disease that causes inflammation of the liver

the right intersegmental fissure contains the: a. RHV b. MHV c. LPV d. RPV

a. RHV

which of the following is typically transmitted through contaminated water found in places such as Mexico, Central America, South America, Asia, India, and Africa? a. amebic liver abscess b. hydatid liver cyst c. candidiasis d. hepatoma

a. amebic liver abscess

the covering of the liver is referred to as: a. glisson's capsule b. gerota fascia c. morison pouch d. hepatic fascia

a. glisson capsule

the left lobe of the liver can be divided into: a. medial and lateral segments b. medial and posterior segments c. anterior and medial segments d. anterior and posterior segments

a. medial and lateral segments

the ligamentum teres can be used to separate the: a. medial and lateral segments of the left lobe b. medial and posterior segments of the right lobe c. anterior and medial segments of the left lobe d. anterior and posterior segments of the right lobe

a. medial and lateral segments of the left lobe

all of the following are sonographic findings of... 1. round, hypoechoic or anechoic mass or masses 2. may contain debris (with fluid-debris layering) 3. acoustic enhancement

amebic hepatic abscess (sono)

Amebic Hepatic Abscess

an abscess that develops from a parasite that grows in the colon and invades the liver via the portal vein

hemochromatosis

an inherited disease characterized by disproportionate absorption of dietary iron

right sided heart failure often leads to enlargement of the a. abdominal aorta b. IVC and HV's c. IVC and PV's d. PV's and spleen

b. IVC and HV's

which of the following is true about the portal veins? a. PV's carry deoxygenated blood away from the liver b. PV's have brighter walls than the HV's c. PV's should demonstrate hepatofugal flow d. PV's increase in diameter as they approach the diaphragm

b. PV's have brighter walls than the HV's

the TIPS shunt is placed: a. between the MHA and the MPV b. between a PV and HV c. between the CHD and the CBD d. between a PV and HA

b. between a PV and HV

the main portal vein divides into: a. middle, left, and right branches b. left and right branches c. anterior and posterior branches d. medial and lateral branches

b. left and right branches

normal flow within the HA should demonstrate a: a. high-resistant wave form pattern, with a slow upstroke, and gradual deceleration with diastole b. low resistance waveform pattern, with a quick upstroke, and a gradual deceleration with diastole c. low resistance waveform pattern, with a slow upstroke, and gradual acceleration with diastole d. high-resistant wave form pattern, with a quick upstroke, and a slow deceleration with diastole

b. low resistance waveform pattern, with a quick upstroke, and a gradual deceleration with diastole

the left lobe of the liver can be separated from the right lobe by the: a. right hepatic vein b. middle hepatic vein c. left hepatic vein d. falciform ligament

b. middle hepatic vein

kernicterus

brain damage from bilirubin exposure in a newborn with jaundice

all of the following are clinical findings of... 1. ascites 2. elevated LFT's 3. hepatosplenomegaly 4. upper abdominal pain

budd-chiari syndrome (clinical)

all of the following are sonographic findings of... 1. non-visualization or reduced visualization of the hepatic veins 2. thrombus within the hepatic veins 3. enlarged caudate lobe 4. lack of flow within the hepatic veins with color doppler 5. narrowing of the IVC

budd-chiari syndrome (sono)

the RPV divides into: a. middle, left, and right branches b. left and right branches c. anterior and posterior branches d. medial and lateral branches

c. anterior and posterior branches

which of the following benign liver masses is typically isoechoic and contains a central scar? a. hepatoblastoma b. cavernous hemangioma c. hamartoma d. focal nodular hyperplasia

c. focal nodular hyperplasia

the right lobe of the liver is divided into segments by the: a. middle lobar fissure b. middle hepatic vein c. left portal vein d. right portal vein

c. right hepatic vein

Hepatic encephalopathy

central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma

all of the following are clinical findings of... 1. ascites 2. elevated LFT's (specifically ALP, ALT, AST, bilirubin, partial PT, total protein, and decreased albumin) 3. fatigue 4. hepatomegaly 5. jaundice 6. splenomegaly 7. weight loss

cirrhosis (clinical)

all of the following are sonographic findings of... 1. hepatosplenomegaly 2. shrunken, echogenic right lobe of the liver 3. enlarged caudate and left lobes 4. nodular surface irregularity 5. coarse echotexture 6. splenomegaly 7. ascites 8. monophasic flow within the hepatic veins 9. hepatofugal flow within the portal veins

cirrhosis (sono)

cirrhosis

condition described as hepatocyte death, fibrosis, and necrosis of the liver, and the subsequent development of regenerating nodules

Von Geirke's Disease

condition in which the body does not have the ability to break down glycogen; also referred to as glycogen storage disease type 1

Wilson's disease

congenital disorder that causes the body to accumulate excess copper

the diameter of the portal vein should not exceed: a. 4mm b. 8mm c. 10mm d. 13mm

d. 13mm

all of the following are located within the porta hepatis except: a. MPV b. CBD c. HA d. MHV

d. MHV

the right lobe of the liver can be divided into: a. medial and lateral segments b. medial and posterior segments c. anterior and medial segments d. anterior and posterior segments

d. anterior and posterior segments

autoimmune disease

disorders in which the body's immune system attacks and destroys health tissues and/or organs

increase in __________ can indicate hepatocellular carcinoma (HCC) and hepatoblastoma

AFP

von Hippel-Lindau disease

An inherited disease that includes the development of cysts within the liver, pancreas, and other organs

echinococcal cyst

Hydatid liver cyst

cavernous hemangioma

MC benign liver tumor

focal nodular hyperplasia

a benign liver mass composed of a combination of hepatocytes and fibrous tissue that typically contains a central scar