Liver Anatomy and Functions Quiz
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Questions and Answers

What separates the caudate lobe from the left lobe according to Couinaud classification?

  • Ligamentum venosum (correct)
  • Main lobar fissure
  • Falciform ligament
  • Left hepatic vein
  • What is the primary supply of blood to the liver?

  • Inferior vena cava
  • Portal vein and hepatic artery (correct)
  • Hepatic veins
  • Gallbladder
  • Which of the following statements about hepatic veins is accurate?

  • Hepatic veins drain into the liver
  • They display minimal pulsatility
  • They are intersegmental in nature (correct)
  • They are Hepatopetal
  • What is the role of the liver described in the study guide?

    <p>It synthesizes bile and processes nutrients (C)</p> Signup and view all the answers

    How are the branches of the portal vein and hepatic artery categorized in relation to liver segments?

    <p>Intra-segmental (D)</p> Signup and view all the answers

    Which structure is located at the porta hepatis?

    <p>Portal vein and proper hepatic artery (D)</p> Signup and view all the answers

    What characterizes the blood flow from the portal vein to the liver?

    <p>Hepatopetal and steady (C)</p> Signup and view all the answers

    What defines the couinaud classification in terms of liver segmentation?

    <p>Functional and anatomical division (B)</p> Signup and view all the answers

    What is the primary distinction between visceral and parietal peritoneum?

    <p>Visceral is the organs' 'skin', and parietal is the outer sac. (A)</p> Signup and view all the answers

    Which statement accurately describes the lesser sac?

    <p>It is also known as the omental bursa, between the pancreas and stomach. (D)</p> Signup and view all the answers

    How is ascites defined in a medical context?

    <p>It is the presence of benign free fluid in the intraperitoneal cavities. (A)</p> Signup and view all the answers

    Which of the following is NOT considered an intraperitoneal organ?

    <p>Kidneys (B)</p> Signup and view all the answers

    What is Morison's pouch?

    <p>It is the right posterior subhepatic space. (D)</p> Signup and view all the answers

    Which of the following best describes exudate ascites?

    <p>It is associated with malignant conditions. (A)</p> Signup and view all the answers

    What anatomical space is located between the bladder and uterus in females?

    <p>Anterior CDS (C)</p> Signup and view all the answers

    Where are retroperitoneal organs located?

    <p>Covered anteriorly by peritoneum. (B)</p> Signup and view all the answers

    What is the most common primary liver cancer?

    <p>Hepatocellular carcinoma (HCC) (D)</p> Signup and view all the answers

    What tumor marker is associated with hepatocellular carcinoma (HCC)?

    <p>AFP (alphafetoprotein) (C)</p> Signup and view all the answers

    Which of the following is a characteristic sonographic appearance of metastasis in the liver?

    <p>Multiple masses with variable appearance (D)</p> Signup and view all the answers

    In the case of liver transplantation, what is the most common reason for requiring a transplant?

    <p>Hepatitis C (B)</p> Signup and view all the answers

    Which of the following is NOT characteristic of hepatoblastoma?

    <p>Common in adults (A)</p> Signup and view all the answers

    Which hepatic artery flow pattern indicates rejection after a liver transplant?

    <p>Hepatofugal and high resistance (A)</p> Signup and view all the answers

    Which primary cancer is most commonly associated with hyperechoic liver lesions in metastasis?

    <p>Colorectal cancer (C)</p> Signup and view all the answers

    What clinical sign is NOT commonly associated with hepatocellular carcinoma (HCC)?

    <p>Severe abdominal distention (D)</p> Signup and view all the answers

    What is the most common type of cholangiocarcinoma?

    <p>Klatskin tumor (B)</p> Signup and view all the answers

    What clinical symptoms are typically associated with cholangiocarcinoma?

    <p>Weight loss and jaundice (D)</p> Signup and view all the answers

    What condition is characterized by the absence of the biliary tree in newborns?

    <p>Biliary atresia (C)</p> Signup and view all the answers

    Which imaging finding is likely associated with cholangiocarcinoma?

    <p>Dilated intrahepatic ducts that abruptly terminate (A)</p> Signup and view all the answers

    What differentiates obstructive jaundice from non-obstructive jaundice?

    <p>Obstructive jaundice is caused by biliary obstruction (B)</p> Signup and view all the answers

    Which statement is true regarding pancreatic carcinoma?

    <p>It commonly leads to biliary obstruction due to mass at the pancreatic head. (D)</p> Signup and view all the answers

    What is the congenital condition characterized by cystic dilatation of the common bile duct?

    <p>Choledochal cyst (D)</p> Signup and view all the answers

    Which physiological process primarily causes jaundice in obstructive conditions?

    <p>Increased conjugated bilirubin due to blockage (A)</p> Signup and view all the answers

    What is the primary purpose of a vena caval filter?

    <p>To reduce the risk of pulmonary embolism (D)</p> Signup and view all the answers

    Which syndrome is associated with the left renal vein?

    <p>Nutcracker syndrome (C)</p> Signup and view all the answers

    In which location is a vena caval filter placed?

    <p>Infrarenal IVC (C)</p> Signup and view all the answers

    What is a common feature of normal bowel during ultrasound scanning?

    <p>It has a target sign appearance when abnormal (A)</p> Signup and view all the answers

    What layer of the gastrointestinal tract is the outer hypoechoic layer?

    <p>Muscularis (D)</p> Signup and view all the answers

    What is chronic inflammation of the vermiform appendix called?

    <p>Appendicitis (D)</p> Signup and view all the answers

    What is the echogenicity of the deep mucosa layer in the gastrointestinal tract?

    <p>Hypoechoic (C)</p> Signup and view all the answers

    Which condition is indicated by post-prandial pain?

    <p>Superior mesenteric artery issues (C)</p> Signup and view all the answers

    Which imaging angle is most effective for visualizing smooth interfaces such as vessel walls?

    <p>90 degrees (C)</p> Signup and view all the answers

    What frequency range is recommended for superficial imaging?

    <p>9-12 MHz (C)</p> Signup and view all the answers

    Which of the following artifacts is considered beneficial during diagnosis?

    <p>Posterior shadowing (D)</p> Signup and view all the answers

    When evaluating flow in a vessel using Color Doppler, what adjustment should be made to the size of the box?

    <p>It should cover the area of interest. (D)</p> Signup and view all the answers

    What does the red color indicate in a Color Doppler image?

    <p>Flow towards the probe (A)</p> Signup and view all the answers

    Which frequency choice should be used for deeper imaging?

    <p>2-6 MHz (D)</p> Signup and view all the answers

    What should be avoided when adjusting color gain in a Color Doppler image?

    <p>Bleed out of the vessel walls (C)</p> Signup and view all the answers

    Which of the following artifacts should be avoided or corrected during imaging?

    <p>Grating lobes in a cyst (B)</p> Signup and view all the answers

    Flashcards

    Intraperitoneal organs

    Organs enclosed within the peritoneum, covered by visceral and parietal peritoneum.

    Visceral peritoneum

    The membrane covering the organs.

    Parietal peritoneum

    The membrane lining the abdominal wall.

    Intraperitoneal cavities

    Spaces in the abdomen that can hold fluids.

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    Ascites

    Free fluid in the intraperitoneal cavities.

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    Retroperitoneal organs

    Organs behind the peritoneum.

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    Retroperitoneum

    The space behind the peritoneum.

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    Subphrenic space

    Space beneath the diaphragm.

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    Liver Lobes

    The liver is divided into 3 main lobes: right, left, and caudate.

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    Portal Triads

    Structures of portal vein, hepatic artery, and bile duct, which deliver blood and bile into the hepatocytes (liver cells).

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    Couinaud Classification

    A system for dividing the liver into segments based on its vasculature (blood vessels).

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    Hepatopetal Blood Flow

    Blood flow directed towards the liver (portal vein and hepatic artery).

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    Hepatofugal Blood Flow

    Blood flow directed away from the liver (hepatic veins).

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    Ligamentum Teres

    Round ligament formed by the closure of the umbilical vein, an in-utero blood vessel.

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    Ligamentum Venosum

    Ligament formed by the closure of the ductus venosus, an in-utero vessel.

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    Caudate Lobe

    Liver lobe separated from the left lobe by the ligamentum venosum and bordered by the inferior vena cava.

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    Hepatocellular Carcinoma (HCC)

    The most common primary liver cancer. It's associated with chronic liver disease, cirrhosis, and hepatitis. Elevated AFP (alphafetoprotein) is a tumor marker.

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    HCC Sono Appearance

    Usually a solitary, hypoechoic mass on ultrasound.

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    Liver Metastasis

    The most common type of liver cancer, arising from other parts of the body. Often multiple masses are present.

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    Metastasis Sono Appearance

    Multiple masses with variable appearance on ultrasound. Hypoechoic for breast, lung, and lymphoma. Hyperechoic for colorectal cancer.

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    Hepatoblastoma

    A childhood form of HCC, also associated with elevated AFP. Common in Beckwith-Wiedemann syndrome.

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    Liver Transplant Doppler - Normal

    Doppler flow patterns in a transplanted liver should resemble those of a normal native liver. Portal vein: hepatopetal flow with minimal phasicity. Hepatic artery: hepatopetal flow with low resistance. Hepatic veins: hepatofugal flow with pulsatile appearance.

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    Liver Transplant Doppler - Rejection

    Abnormal Doppler patterns suggest rejection. Elevated resistance in hepatic artery, thrombosed or hepatofugal flow in portal vein.

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    Liver Transplant Doppler - Post-operative

    A transient increase in RI (resistive index) in the hepatic artery is common shortly after transplant.

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    Cholangiocarcinoma

    Cancer within the bile ducts, often at the junction of right and left hepatic ducts (Klatskin tumor). It causes ductal dilation above the tumor, leading to jaundice, RUQ pain, and weight loss.

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    Obstructive Jaundice

    Yellowing of the skin/eyes and elevated direct bilirubin caused by a blockage in the bile ducts. Often comes with pain and elevated ALP.

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    Non-obstructive Jaundice

    Yellowing of the skin/eyes and elevated direct bilirubin caused by liver dysfunction. Often has elevated ALP, ALT, and AST, but not necessarily pain.

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    Biliary Atresia

    Narrowing or absence of the biliary tree, seen in newborns/infants. Causes neonatal jaundice and liver failure, incompatible with life.

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    Choledochal Cyst

    Cystic dilatation of the common bile duct (CBD), found in infants and children.

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    Pancreatic Carcinoma

    Cancer in the pancreas, often in the head, causing biliary obstruction. Similar clinical and sonographic findings as cholangiocarcinoma, including jaundice and dilated ducts.

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    Phrygian Cap

    A congenital variant of the gallbladder, typically a fold in the fundus.

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    Junctional Folds

    Congenital folds in the gallbladder, located near the neck.

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    Gut signature

    The layered appearance of normal bowel wall on ultrasound, seen as alternating echogenic and hypoechoic layers. This is a pattern specific to the bowel, hence the name 'gut signature'.

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    What does compressibility tell you about the bowel wall?

    Normal bowel is compressible with ultrasound pressure, while abnormal bowels may be non-compressible. This is a key indicator of bowel pathology.

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    Target sign

    A characteristic finding on ultrasound of the bowel with alternating echogenicity and non-compressible layers. This indicates thickened bowel wall, which is abnormal.

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    Acute Appendicitis

    Inflammation of the appendix, a small blind-ended tube that extends from the cecum, causing intense abdominal pain. Often leads to surgery.

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    Why target sign in GI sonography?

    It suggests a thickened bowel wall, likely indicating inflammation, blockage, or other pathology in the GI tract.

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    Graded compression sonography

    A specialized technique used in GI sonography to assess bowel wall thickness and compressibility to determine if it's normal or abnormal.

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    IVC filter purpose

    A device placed in the inferior vena cava (IVC) to trap blood clots from the legs and prevent them from travelling to the lungs, reducing the risk of pulmonary embolism.

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    Nutcracker syndrome

    Compression of the left renal vein between the aorta and the superior mesenteric artery, causing symptoms like pain and blood in the urine.

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    What is the ideal angle for B-mode scanning?

    The ideal angle for B-mode scanning is 90 degrees, also known as perpendicular imaging angle. This ensures optimal visualization of smooth interfaces, such as vessel walls or biopsy needles.

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    How does transducer frequency affect imaging depth?

    Higher frequency transducers provide better resolution but have shallower penetration. Lower frequency transducers offer deeper penetration but with less detail. Choosing the right frequency depends on the imaging depth and the area of interest.

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    What is the red color on Doppler?

    In most Doppler systems, red on the color scale indicates flow towards the probe or transducer. This means the blood is moving towards the top of the screen.

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    What is the blue color on Doppler?

    In most Doppler systems, blue on the color scale indicates flow away from the probe or transducer. This means the blood is moving towards the bottom of the screen.

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    What is the purpose of the color box in Doppler?

    The color box should be adjusted to cover the area of interest. It helps to focus the Doppler signals and analyze blood flow within a specific region.

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    What is the correct way to adjust the Doppler scale?

    The Doppler scale should be adjusted to fit the type of flow being evaluated. This ensures the flow is appropriately represented on the color scale.

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    How to adjust the color gain in Doppler?

    The color gain should be adjusted to fill the vessel with color without 'bleeding' out of the vessel walls. This helps in accurately visualizing the flow and boundaries.

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    What are the types of artifacts that are helpful for diagnosis?

    Some artifacts can be beneficial for diagnosis, such as posterior shadowing or the twinkle sign, which can help confirm the presence of a stone.

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    Study Notes

    Abdominal/General Ultrasound Registry Review

    • This study guide covers abdominal and general ultrasound registry review topics, including anatomy and pathology.
    • It details different anatomical regions and pathologies within the abdomen, including the liver, gallbladder and biliary system, pancreas, spleen, renal and urinary systems, adrenal glands, and abdominal vascular structures.
    • It also covers miscellaneous abdominal topics, gastrointestinal system, chest and retroperitoneum, small parts, thyroid and neck, musculoskeletal and superficial areas, testicles, and prostate.
    • A table of contents is presented, detailing the different sections within the study guide.
    • Section related to Introduction to Abdominal Imaging provides descriptions for terms like anterior/superficial, posterior/deep, superior/cephalad, inferior/caudal, medial, lateral, proximal, and distal.
    • There is information on peritoneum, intraperitoneal and retroperitoneal organs.
    • Different pathology categories are included: diffuse, focal benign, infections, obstruction, trauma, and cancer.
    • Detailed information about the liver, including facts, anatomy, intersegmental/hepatic, intrasegmental/hepatic, and method of division is given.
    • The document also discusses liver variants, like Reidel's lobe and papillary process.
    • Different pathologies like diffuse liver disease and labs, and the role of different enzymes (ALT, ALP, AST) are included.
    • Information is provided on fatty liver infiltration (hepatic steatosis) and its clinical and sonographic manifestations.
    • The guide includes a section on cirrhosis and its clinical and sonographic characteristics, including nodular surface, micronodular, and macronodular types.
    • Details on portal hypertension, its causes, symptoms, and treatment (TIPSS) are included.
    • Portal vein compression (thrombosis) and Budd-Chiari syndrome are discussed.
    • The guide covers different types of infections like acute and chronic hepatitis, and liver abscesses.
    • Sections about various masses including focal benign masses (cysts, cavernous hemangioma, hepatocellular adenoma, lipoma, focal nodular hyperplasia), and malignant masses (hepatoma, metastasis, hepatoblastoma) are included.
    • Liver transplants, including the method and the most common cause (hepatitis C), are described.
    • Sections are devoted to gallbladder and biliary functions and anatomy, including flow of bile and components of biliary tree.
    • Sonographic findings for gallbladder and biliary pathologies are enumerated, such as variants, pathology introduction, polyps, adenomyomatosis, gallbladder sludge, cholelithiasis, and choledocholithiasis.
    • The study guide also covers symptomatic GB/biliary disease, including cholelithiasis, choledocholithiasis, and Mirizzi syndrome.
    • Different causes of splenomegaly, including portal hypertension, infection, and infarction.
    • Different types of splenic trauma are listed, including subcapsular hemorrhage, intraparenchymal, clinical findings, and sonographic appearances.
    • The study guide provides information related to renal anatomy and physiology, including filtering the blood, collecting system, and anatomical relationships.
    • It also includes renal variants, such as duplicated collecting system, dromedary hump, and hypertrophic column of Bertin.
    • Sections devoted to various renal pathologies, including acute renal failure, chronic renal failure, cystic conditions, congenital conditions (like multicystic renal dysplasia, autosomal dominant PKD), and acquired cystic diseases, are included.
    • Pathology of the pancreas (acute pancreatitis, chronic pancreatitis, pancreatic adenocarcinoma, pancreatic cystadenomas, and islet cell tumors), and information on different pathologies like acute pyelonephritis, and chronic pyelonephritis, is given.
    • Sections on vascular anatomy, such as arterial flow patterns and patterns of low resistance and high resistance, and arterial pathology, such as abdominal aortic aneurysms, aortic dissection, and pseudoaneurysm.
    • Different types of venous pathology, such as IVC tumor thrombus and IVC filter, are listed.
    • Information regarding gastrointestinal, musculoskeletal, and superficial structures, including different pathologies/lesions of the abdomen and their corresponding examinations findings are outlined.
    • Detailed discussion regarding the thyroid and neck structures, including sonography findings, anatomy, and pathology (goiter, Graves disease, Hashimoto's thyroiditis, and other nodules) are present
    • The study guide also provides important information on vascular, and related pathologies of the testes, scrotum, and penis like hydrocele, epididymitis, orchitis, testicular torsion, and penile trauma.
    • The study guide concludes with a physics review, which covers different artifacts, image optimization techniques, and principles/details of Doppler optimization..

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    Description

    Test your knowledge on liver anatomy, blood supply, and segmentation according to the Couinaud classification. This quiz covers various aspects of the liver, including its roles, vascular structures, and associated medical terminology. Perfect for students in medical or anatomical studies!

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