Liver Chapter 2 PDF

tumors can invade surrounding vasculature and may also obstruct the biliary tree. Clinically, these young patients may be asymptomatic or present with hepatomegaly and/or a palpable abdominal mass. They may also suffer from jaundice, abdominal pain, weight loss, and anorexia. The sonographic finding...

tumors can invade surrounding vasculature and may also obstruct the biliary tree. Clinically, these young patients may be asymptomatic or present with hepatomegaly and/or a palpable abdominal mass. They may also suffer from jaundice, abdominal pain, weight loss, and anorexia. The sonographic findings of a hepatoblastoma are that of a solid, hyperechoic, or heterogeneous mass. This mass may also contain calcifications. CLINICAL FINDINGS OF HEPATOBLASTOMA 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 SONOGRAPHIC FINDINGS OF HEPATOBLASTOMA 1. Solid, hyperechoic, or heterogeneous mass 2. Mass may contain some calcifications SOUND OFF Children with Beckwith–Weidemann syndrome are often screened with sonography in order for the early detection of hepatoblastomas. REVIEW QUESTIONS 1. 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 2. The covering of the liver is referred to as: a. Glisson capsule b. Gerota fascia c. Morison pouch 118 http://radiologyeme.com d. Hepatic fascia 3. 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 4. The TIPS shunt is placed: a. Between the main hepatic artery and main portal vein b. Between a portal vein and hepatic vein c. Between the common hepatic duct and common bile duct d. Between a portal vein and hepatic artery 5. The right lobe of the liver is divided into segments by the: a. Middle lobar fissure b. Middle hepatic vein c. Right hepatic vein d. Left hepatic vein 6. The right intersegmental fissure contains the: a. Right hepatic vein b. Middle hepatic vein c. Left portal vein d. Right portal vein 7. 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 8. 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 9. The main lobar fissure contains the: a. Right hepatic vein b. Middle hepatic vein c. Main portal vein d. Right portal vein 119 http://radiologyeme.com 10. All of the following are located within the porta hepatis except: a. Main portal vein b. Common bile duct c. Hepatic artery d. Middle hepatic vein 11. Right-sided heart failure often leads to enlargement of the: a. Abdominal aorta b. IVC and hepatic veins c. IVC and portal veins d. Portal veins and spleen 12. 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 13. The right 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 14. The diameter of the portal vein should not exceed: a. 4 mm b. 8 mm c. 10 mm d. 13 mm 15. 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 16. Which of the following is true about the portal veins? a. Portal veins carry deoxygenated blood away from the liver. b. Portal veins have brighter walls than the hepatic veins. c. Portal veins should demonstrate hepatofugal flow. d. Portal veins increase in diameter as they approach the diaphragm. 120 http://radiologyeme.com 17. 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 18. Normal flow within the hepatic artery should demonstrate a: a. High-resistance wave form pattern, with a slow upstroke, and gradual deceleration with diastole b. Low-resistance wave form pattern, with a quick upstroke, and gradual deceleration with diastole c. Low-resistance wave form pattern, with a slow upstroke, and gradual acceleration with diastole d. High-resistance wave form patter, with a quick upstroke, and gradual deceleration with diastole 19. Budd–Chiari syndrome leads to a reduction in the size of the: a. Hepatic arteries b. Portal veins c. Hepatic veins d. Common bile duct 20. A tonguelike extension of the right lobe of the liver is termed: a. Papillary lobe b. Focal hepatomegaly c. Riedel lobe d. Morison lobe 21. The left 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 22. The left umbilical vein after birth becomes the: a. Falciform ligament b. Main lobar fissure c. Ligamentum teres d. Ligamentum venosum 23. Normal flow within the hepatic veins is said to be: a. Biphasic 121 b. Irregular c. High resistant d. Triphasic 24. The inferior extension of the caudate lobe is referred to as: a. Papillary process b. Focal hepatomegaly c. Riedel process d. Morison lobe 25. Which of the following is the most common reason for a liver transplant? a. Hepatocellular carcinoma b. Hepatitis C c. Hepatitis B d. Hepatic metastasis 26. Clinical findings of fatty infiltration of the liver include: a. Elevated liver function tests b. Fever c. Fatigue d. Weight loss 27. Shortly after birth, the ductus venosus collapses and becomes the: a. Falciform ligament b. Main lobar fissure c. Ligamentum teres d. Ligamentum venosum 28. Sonographically, when the liver is difficult to penetrate and diffusely echogenic, this is indicative of: a. Portal vein thrombosis b. Metastatic liver disease c. Primary liver carcinoma d. Fatty liver disease 29. The most common cause of cirrhosis is: a. Portal hypertension b. Hepatitis c. Alcoholism d. Cholangitis 30. Clinical findings of hepatitis include all of the following except: a. Jaundice 122 b. Fever c. Chills d. Pericholecystic fluid 31. What form of hepatic abnormality are immunocompromised patients more prone to develop? a. Hepatic adenoma b. Amebic abscess c. Hydatid liver abscess d. Candidiasis 32. All of the following are sequela of cirrhosis except: a. Portal vein thrombosis b. Hepatic artery contraction c. Portal hypertension d. Splenomegaly 33. Normal flow toward the liver in the portal veins is termed: a. Hepatopetal b. Hepatofugal 34. Which of the following masses would be most worrisome for malignancy? a. Echogenic mass b. Cystic mass with posterior enhancement c. Isoechoic mass with a central scar d. Hyperechoic mass with a hypoechoic halo 35. Which of the following is the most common form of liver cancer? a. Hepatocellular carcinoma b. Adenocarcinoma c. Metastatic liver disease d. Hepatoblastoma 36. Which hepatic mass is closely associated with oral contraceptive use? a. Hepatic adenoma b. Hepatic hypernephroma c. Hepatic hamartoma d. Hepatic hemangioma 37. Which of the following is considered the most common benign childhood hepatic mass? a. Hepatoblastoma 123 b. Hepatoma c. Hematoma d. Hemangioendothelioma 38. All of the following are clinical findings of HCC except: a. Reduction in AFP b. Unexplained weight loss c. Fever d. Cirrhosis 39. The childhood syndrome Beckwith–Weidemann is associated with an increased risk for developing: a. Hepatoblastoma b. Cirrhosis c. Portal hypertension d. Hepatitis 40. Which of the following is associated with E. granulosus? a. Candidiasis b. Amebic liver abscess c. Hydatid liver cyst d. Hepatocellular carcinoma SUGGESTED READINGS Curry RA, Tempkin BB. Sonography: Introduction to Normal Structure and Function. 4th Ed. St. Louis: Elsevier, 2016:181–190, 192–205, & 206–226. Federle MP, Jeffrey RB, Woodward PJ, et al. Diagnostic Imaging: Abdomen. 2nd Ed. Philadelphia: Amirsys, 2010:III-1-2–III-1-168. Henningsen C, Kuntz K, Youngs D. Clinical Guide to Sonography: Exercises for Critical Thinking. 2nd Ed. St. Louis: Elsevier, 2014:8–39. Hertzberg BS, Middleton WD. Ultrasound: The Requisites. 3rd Ed. Philadelphia: Elsevier, 2016:51–88. Kawamura DM, Lunsford B. Diagnostic Medical Sonography: Abdomen and Superficial Structures. 3rd Ed. Philadelphia: Wolters Kluwer, 2012:101–164 & 759–776. Krawczyk M, Bonfrate L, Portincasa P. Nonalcoholic fatty liver disease. Best Pract Res. 2010;24(5):695–708. Kupinski AM. Diagnostic Medical Sonography: The Vascular System. Philadelphia: Lippincott Williams & Wilkins, 2013:333–373. McCann C, Penny SM. Focal nodular hyperplasia: case study, imaging, and 124