🔴Liver 1 Review Q's

Some of the functions of the liver are ____, ____, ____, _____, and ____.

Detoxification, production of bile & proteins, phagocytosis, storage of glycogen, hematopoiesis in fetus

Elevated alpha-fetoprotein in blood suggests:

Liver malignancy

Elevated alkaline phosphatase and direct bilirubin in blood suggests:

biliary obstruction

What is prothrombin? What is prothrombin time?

protein/clotting factor, time it takes to clot

BUN and albumin _____ in the case of diffuse hepatocellular disease

decrease

_____ is acquired and reversible liver disease resulting in increased lipid accumulation in the hepatocytes.

diffuse fatty infiltration/hepatic steatosis

Most common causes of fatty infiltration are:

Obesity and alcohol abuse

Sonographic features of fatty infiltration are:

Increase in liver echogenicity, hepatomegaly, increased attenuation, impaired visualization of intrahepatic vessels, and impaired visualization of diaphragm

If you are unable to show the posterior surface of the liver because of attenuation, then what should you do?

Use a low frequency transducer for penetration

10. The signs and symptoms for fatty infiltration are:

Depends on which type or level of severity: Usually asymptomatic (mild cases), some patients present with

jaundice, nausea, & vomiting, abdominal tenderness (in severe cases), elevated LFTs (AST, ALT)

Fatty infiltration is a reversible disease. T/F?

true

Hyperechoic focal area of fat present within a background of normal echo texture is a case of:

Focal fatty infiltration

13. Focal fatty infiltration & focal fatty sparing are commonly seen at:

13. Commonly seen at the porta hepatis, GB area, medial segment of the left lobe

A hypoechoic area in the area of the porta hepatis, GB, or medial segment of the left lobe within a dense, fatty liver is called

Focal fatty sparing

Focal fatty sparing is commonly seen at:

Porta hepatis, GB area, medial segment of the left lobe

Inflammation of the liver is called:

Hepatitis

Lab values that indicate acute hepatitis are:

increased AST (SGOT), ALT (SGPT), indirect bilirubin (unconjugated bilirubin), in severe cases conjugated); decreased albumin, BUN, amylase

Patients signs and symptoms for acute hepatitis are

Fever, chills, increased WBCC, Anorexia, Nausea, Fatigue, Hepatomegaly, jaundice, dark urine

19. Hepatitis can be caused by:

19. 1. Infectious agents and 2. Noninfectious agents

Some of the infectious agents that cause hepatitis are:

Viral, bacterial, fungal, and parasitic organisms

21. _____ infection is responsible for most cases of hepatitis.

viral

Give some examples of viral hepatitis:

A, B, C, D, E or G

Some of the noninfectious agents that cause hepatitis are:

Medications, toxins, autoimmune disorders

_____ is a disease that is typically spread through fecal-oral route.

hepatitis a

25. Hepatitis B or C is spread by contact with contaminated body fluids/blood. T/F?

true

Healthcare workers need to be especially aware of their risk for contracting hepatitis _____ and _____.

B and C

Acute hepatitis is inflammation of the liver lasting:

Less than six months

Sonographic findings associated with acute hepatitis include:

enlarged liver, decreased echogenicity, increased blood vessels visualization--prominent portal veins (periportal cuffing) and starry sky sign, gallbladder wall thickening, splenomegaly

Sonographic findings associated with chronic hepatitis are:

Decreased size of the liver, increased echo texture, decreased visualization blood vessels, coarse liver texture

Sonographic findings associated with chronic hepatitis include irregular contour and ascites. T/F?

false

_____ is a general term used for chronic and severe attack to the liver cells leading to fibrosis, scarring and formation of regenerating nodules and scarring leading to liver failure and PHTN.

cirrhosis

32. Cirrhosis is a progressive hepatocellular disease that could be caused:

Alcoholism (most common, predominates in western & industrialized countries), hepatitis, obstruction, drug abuse, cholangitis, hemochromatosis (too much iron), Wilson’s disease (too much copper)

Lab values that indicates cirrhosis is:

Elevated AST, ALT, Jaundice, increased conjugated and unconjugated bilirubin

Cirrhosis is a reversible disease. T/F?

false

The 2 benign pathologies (hepatocellular diseases) from which the patients might develop regenerating nodules (HCC/Hepatoma) are:

35. Cirrhosis and chronic hepatitis

Hepatic encephalopathy is:

Brain toxicity –causing confusion, altered level of consciousness, and coma as a result of liver failure (no blood filtration)

Hepatic encephalopathy is seen in what kind of patients:

cirrhosis

38. Untreated hepatitis eventually leads to:

cirrhosis

Sonographic findings associated with chronic cirrhosis are:

A small liver with increased echogenicity, diminished vascular structures within the liver parenchyma, a nodular outline to the liver (irregularity/nodularity of the surface), course liver texture, nodules (increased risk of HCC in alcoholic cirrhosis)

. What are some of the complications of cirrhosis?

Portal hypertension (PV>13mm)-cirrhosis is most common cause of intrahepatic portal hypertension, recanalization of the ligamentum teres, reversal flow in PV, Collaterals develop in portal system (serpiginous, varices, twisted or snakelike pattern), splenomegaly, ascites, hepatoma (HCC)/regenerating nodules, PV thrombosis

41. Collaterals are also called:

varices

42. A nodular liver surface is associated with which abnormality?

cirrhosis

Another name for glycogen storage disease is:

Von Gierke’s disease

Define glycogen storage disease.

Excess glycogen (glucose) deposits in the liver & kidneys

Hypoglycemia is an indication for which pathology?

Glycogen storage disease

46. Sonographic finding associated with Von Gierke’s disease is:

46. An echogenic enlarged liver

Glycogen storage disease is associated with what liver tumor?

Adenomas (LCA)

Hemochromatosis is:

Disease of iron metabolism characterized by excess iron deposits

Sonographic finding of acute hemochromatosis of the liver is:

Hepatomegaly

Chronic hemochromatosis may lead to:

Cirrhosis and portal hypertension

_____ an autosomal recessive inherited disorder that causes too much copper to accumulate in the liver, brain and other vital organs

Wilson's disease

52. U/S appearance of early stage Wilson's disease is:

52. Small hypoechoic nodules less than 20 mm and hepatomegaly

53. In end-stage hemochromatosis and Wilson’s disease resembles liver _____.

cirrhosis

54. The symptoms for simple liver cyst is:

asymptomatic

55. U/S appearance of liver cyst is:

55. Well defined, smooth-walled, anechoic, w/posterior enhancement (no attenuation)

_____ and _____ (liver abnormalities) are associated with long-term use of oral contraceptives.

FNH, adenoma

57. Polycystic liver is in an autosomal dominant disease. T/F?

true

Patients with polycystic liver disease may also have:

Polycystic renal, pancreas & spleen disease

Polycystic liver disease is common in older males. T/F?

false

Hemangioma is also called:

Cavernous hemangioma

The most common benign liver tumor in adults is:

hemangioma

infantile hemangioendothelioma demonstrate high-velocity color Doppler signals. T/F?

true

The vascular tumor composed of blood vessel cells with hyperechoic and avascular sonographic findings is:

hemangioma

64. _____ is a benign lesion of the liver composed of fat cells.

lipoma

. Ultrasound appearance of a lipoma is:

Well defined echogenic mass

66. What are 4 types of hyperechoic hepatic masses?

66. Hemangioma, focal fatty infiltration, Hepatic Lipoma, echogenic metastasis tumors (from GI, kid, panc)

67. The most common vascular tumor in infancy is:

67. Infantile hemangioendothelioma

Infantile hemangioendothelioma is common in females less than 6 months of age. T/F?

true

Ultrasound appearance of infantile hemangioendothelioma is:

nonspecific

70. The second most common benign tumor after hemangioma is:

70. Focal nodular hyperplasia (FNH)

_____ is often termed the "stealth" lesion of the liver.

Focal nodular hyperplasia

FNH is a diffuse liver disease. T/F?

false (it is discrete nodular lesion)

73. Focal nodular hyperplasia can be differentiated from LCA by demonstrating:

73. Fibrous septations or central scar (echogenic linear structure)

Ultrasound appearance of FNH is:

Isoechoic or hypoechoic to the liver

Other names for Liver adenoma is:

Liver cell adenoma, hepatocellular adenoma

Liver adenoma commonly seen in what patients?

1. Females taking oral contraceptive

2. Men using steroids

3. Type I glycogen storage disease (Von Gierke's disease)

Sign and symptom for liver cyst, Hemangioma, lipoma, FNH and LCA usually are:

asymptomatic

. _____ is a rapidly growing tumor (tendency to rupture and hemorrhage).

liver adenoma

. _____ has a potential to become malignant, so they are often removed surgically for that reason.

liver adenoma

U/S appearance of liver cell adenoma is:

Isoechoic or hypoechoic to the liver

Differentials for LCA could be:

FNH, focal fatty sparing, metastatic disease, hepatoma

. _____ and _____ are associated with the use of oral contraceptives.

Focal nodular hyperplasia and liver cell adenoma (LCA)

For hepatic adenoma, why is surgical resection recommended?

Due to risk of malignant transformation