URR Clinical Liver, Gallbladder, Pancreas

Budd chiari syndrome, portal thrombosis and splenomegaly are complications of

polycythemiea vera

a pt with multiple gastrinomas will usually present with what other GI tract issue

peptic ulcer formation

the best way to differentiate hepatic jaundice is

evaluate the diameter of the biliary duct

which of the following is associated with hypoglycemia

islet cell tumor

what type of hepatic abscess causes a fever and leukopenia

fungal

which of the following will help to differentiate hepatocellular carcinoma invasion of the portal vein from portal thrombosis on ultrasound exam

apply power doppler to the portal vein

____ is a hemolytic disorder that causes increased indirect bilirubin levels in the blood

anemia

a pt presents for an abdominal us with an order that states "r/o pancreatic endocrine tumor. Which of the following pancreatic tumors can be described as an endocrine tumor

gastrinoma

applying compression using a curvilinear transducer with a large footprint is the key method used to best evaluate

the body of the pancreas

while scanning in the transverse plane of the abdomen you notice a round anechoic structure just anterior to pancreatic head. which of the following should be the next step in evaluating this finding

apply color doppler

the most important structure to eval with a liver transplant is

hepatic artery

a 60yo male presents for an abdominal us for recurrent epigastric pain. the pt tells you this is the fourth time he has been hospitalized for pancreatitis and the medications are just not working what is the expected finding on the us exam

acute pancreatitis and pseudocyst

you are scanning the gb and you obtain images of several echogenic foci within the lumen, what should you do next to better eval the findings

change the pt position and rescan

serum amylase will be increased with all of the following except

parathyroid adenoma

dark urine an dpale stool are indications of

hyperbilirubinemia

which of the following will lead to increased levels of indirect bilirubin in the blood

cirrhosis

alkaline phosphatase is normally produced by all of the following except

pancreas tissue

alanine aminotransferase levels are

used to eval the degree of jaundice and monitor hepatitis and cirrhosis

what is an absolute contraindication for ethanol ablation of a liver nodule

pt allergy to injectate

which of the following liver abnormalities can be related to the use of oral contraceptives

hepatic adenoma and budd chiari syndrome

which of the following is an appropriate indication for a liver transplant

cholangiocarcinoma

what lab values will me monitored in pts undergoing treatment for primary liver cancer

alpha fetoprotein

a pt presents for a ruq us due to a postive casoni skin test what are you looking for on the exam

schistosomaiaiss

anemia is a complication of cirrhosis due to associated abnormality of which of the following

esophagus

a pt presents for an abdominal us due to loss of appetite, weight loss and epigastric pain. a hypoechoic mass is identified in the anterior aspect of the head of the pancreas. which of the following best describes the next step in evaluating this pt

eval the surrounding areas for lymphadenopathy

what lab test is used to eval the endocrine function of a pancreas transplant

glucoselevels

before performing a liver transplant eval the sonographer must review the surgical history to determine

more than one of the above

increased serum levels of ____usually provide the first indication of an extrahepatic biliary obstruction

alkaline phosphatase

which of the following liver disorders will result in increased levels of iron stored in the liver

hemochromatosis

which of the following describes th ebest technique to differentiate a polyp in the gb wall from a stone within the lumen

roll the pt into the left lateral decubitus position

which of the following will cause an increase in alpha fetoprotein values in pediatric pts

hepatoblastoma

alpha fetoprotein values will be increased with

malignancy and pregnancy

which of the following lab values is usually unaffected by an isolated biliary duct obstruction

aspartate aminotransferase

the primary indication for a liver transplant in an adult is ____ and in children___ is the most common indication for liver transplant

cirrhosis, biliary atresia

a 28yo male present for an abdominal us exam. the chart states he has elevated uring copper levels and kayser-fleischer rings noted on physical exam what organ should be closely evaluated for findings related to the clinical findings

liver

a pt presents for a presurgical eval of a know pancreatic mass. what is the most important info you need to document for the surgeon

if any vessels around the pancreas demonstrate tumor invasion

the liver measurement normally used to assess liver size is

the superior inferior dimension

Which probe position is used to demonstrate all three hepatic veins entering the IVC?

oblique subcostal approach angled superior toward the right shoulder

a pts chart indicates they have a history of cavernous transformation where does this abnormality form

porta hepatis

which of the following describes a technique that can be used to locate a collapsed gb in a pt with chronic cholecystitis

locate the right portal vein and the main lobar fissure, trace the fissure to the gb neck

a 55yo male present with a history of budd chiari syndrome what vessels should be evaluated with doppler on his exam

hepatic veins

a pt presents for an abdominal us due to elevated lactiv dehydrogenase and a low grade fever which of the following is the most likely finding on the exam

hepatitis

which of the following organs should be evaluated when looking for a tumor of the endocrine system

pancreas and adrenal glands

what is the proper pt position and respiration for assessing the portal vein diameter

supine with quite respiration

a pt present for an abdominal us to verify findings identified on a ct exam. the ct report indicates numerous cystic structures throughout the liver that do not communicated with the biliary tree or the vascular system which of the following best describes the expected us findings

polycystic disease

a female pt presents with 8 days of abdominal pain fever and nausea. the symptoms started 2 days after returning from a business trip to hong kong. recent lab values demonstrate increased levels of direct serum bilirubin alkaline phosphatase and wbcs. these clinical findings are most suggestive of

cholangitis

alcoholic fatty liver disease demonstrates what difference in lab values from nonalcoholic causes

alcoholic fatty liver disease demonstrates a much greater increase in lft levels with an ast/alt ratio>2

jaundice is not a clinical symptom of

fatty infiltration

when evaluating the venous outflow of a liver transplant pt it is most important to check the surgical history to find ____before scanning

the type of surgical anastomosis

what lab value increases with gb cancer, cholecystitis or prolonged biliary obstruction

prothrombin time

all of the following correctly describe alpha-fetoprotein except

liver metastasis causes the most significant increase in afp levels

you are trying to scan the liver from a midline window but there is excessive gas in the gi tract all of the following techniques can ain in better visualization of the liver except

give the pt cholecystokinin

which of the following will typically demonstrate normal values on liver function tests

adenoma

which of the following us exam requires the pt to be npo for accurate results

ruq us for possible cholecystitis

which of the following blood tests will aid in diagnosis of a hydatid cyst in the liver

indirect hemagglutination test and the enzyme linked immunosorbent assay (elisa)

what is the proper caliper placement for assessing the portal vein diameter

inner wall to inner wall at the point the portal vein crosses the ivc

which of the following is associated with hyperglycemia

diabetes mellitus

what liver mass is associated with glycogen storage disease

adenoma

Which probe position is used to demonstrate a longitudinal view of the main portal vein entering the liver?

oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more superiorly than the side of the probe without the notch

what lab test is used to eval the exocrine function of a pancreas transplant

amylase levels

which of the following pancreatic abnormalities will cause an increase in insulin levels in the blood

islet cell tumor

which liver function level is the most sensitive indicator for alcoholism

gamma glutamyl transpeptidase-ggtp

hypersplenism and anemia are common findings in cases of

cirrhosis

which of the following doppler parameters is most commonly used when evaluating the common hepatic artery in pt with a liver transplant

resistive index

when scanning the pancreas, which of the following techniques will not assist in reducing the gas artifact around the pancreas

ask pt to perform the valsalva maneuver

while scanning the liver you identify a small focal area of intrahepatic ductal dilatation in the right lobe of the liver. the cbd measures 5mm in diameter and the gb appears normal. the liver demonstrates mild fatty infiltration and the pancreas and kineys appear within normal limits. which of the following correctly describes the lab findings that correlate with these findings

increased lfts, normal direct bilirubin

all of the following are reasons for a pt to be npo prior to an abdominal us except

decrease blood sugar for better pancreas visualization

charcot triad is used to describe the classic clinical presentation of

acute cholangitis

. Several simple cysts are identified in the liver of a 38yr old male patient. What structures in the abdomen should also be evaluated for related findings?

kidneys and pancreas

a pt presents for an abdominal us exam with a history of a recent single episode of significant indigestion. the lab results demonstrate increased levels of ast and normal levels of alt, alkaline phosphatase and bilirubin. these clinical findings are most consistent with

myocardial infarction

which of the following is a contraindication for a liver transplant in a pt with hepatocellular carcinoma

a single primary tumor >5cm

in cases of acute pancreatitis, which enzyme level increases first

amylase

a pt presents for an abdominal sonogram due to a history of esophageal varices. what structure should be closely evaluated for related findings

portal system

sulfur colloid imaging is

used to evaluate suspected focal nodular hyperplasia

which of the following will cause an increase in alpha fetoprotein values

hepatocellular carcinoma

acetic acid injection, ethanol injection, and radiofrequency ablation are techniques used to treat?

hepatocellular carcinoma

steatorrhea is a clinical finding with

pancreatitis or celiac disease

a low albumin/globulin ratio usually indicates

cirrhosis

which of the following lab values would be elevated with a biliary obstruction due to a hepatocellular carcinoma but not with a biliary obstruction due to choledocholithiasis

alpha feto protein

which of the following can be found on urinalysis of a pt with choledocholithiasis

conjugated bilirubin

decreased serum albumin levels are associated with the development of

ascites

a pt presents for an abdominal us due to abdominal pain and bloating the script for their exam reads r/o cholangiocarcinoma what structure should you closely eval to answer the question

biliary tree

which of the following correctly describes the method used to measure the wall thickness of the gb

with the us beam as perpendicular to the gb wall as possible measure the ap thickness of the anterior wall

a 56yo male presents with a 4yr history of cirrhosis when performing the us exam on this pt the size of which of the following structures should be assessed to evaluate the effects of cirrhosis

right lobe, portal vein and caudate lobe

which of the following will cause a moderate increase in alpha fetoprotein values in an adule

hepatocellular carcinoma

which of the following serum levels would be unaffected by a benign obstruction of the biliary tree

alpha feto protein

which of the following is the most likely cause for an increase in alpha fetoprotein levels in a 7 month old bot

hepatoblastoma

What lab value increases with GB cancer, cholecystitis, or prolonged biliary obstruction?

Prothrombin time

Which of the following serum levels would be unaffected by a benign obstruction of the biliary tree?

alpha feto-protein

What lab test is used to evaluate the endocrine function of pancreas transplant?

glucose level

Which of the following is required when performing liver elastography?

Patient should perform a neutral breath hold for a few seconds when recording measurements

Which of the following liver disorders will result in increased levels of iron stored in the liver?

Hemochromatosis

Which of the following would cause an increase in serum AST levels with normal serum ALT levels?

congestive heart failure

A ____ abscess will result in leukopenia while a ____ abscess will result in leukocytosis

fungal ; pyogenic

Which of the following lab values is usually unaffected by an isolated biliary duct obstruction?

Aspartate Aminotransferase

Left medial superior segment

A patient is referred for an abdominal ultrasound due to an abnornal CT scan. Refer to the image to determine where will you find the mass marked #3?

Which of the following is associated with persistent hypoglycemia?

islet cell tumor

A patient presents for an abdominal US to verify findings identified on a CT exam. The CT report indicates numerous cystic structures throughout the liver that do not communicate with the biliary tree or the vascular system. Which of the following best describes the expected US findings?

Polycystic disease

Several simple cyst are identified in the liver of a 38yr old male patient. What structures in the abdomen should also be evaluated for related findings?

kidneys and pancreas

Dark urine and pale stool are indications of:

hyperbilirubinemia