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