ARDMS Abdomen Ultrasound Registry Review 100% Correct

How many segments does the Couinaud system divide the liver into? -ANSWER Eight surgical segments What divides the right lobe of the liver into an anterior and posterior segment? -ANSWER Right hepatic vein What vessel separates the right and left lobe? Where does it lie (fissure)? -ANSWER Middle hepatic vein, which lies in the main lobar fissure LLL is divided into medial and lateral segments by: -ANSWER Left hepatic vein The caudate lobe is separated from the LLL by which ligament? -ANSWER ligamentum venosum Main portal vein is created by the merging of which two vessels? What is this area referred to as? -ANSWER Superior mesenteric vein and splenic vein. Known as the splenic portal confluence What is the name of the capsule surrounding the liver? -ANSWER Glisson capsule Normal AP measurement of the MPV? -ANSWER 13mm or less What is an enlarged (13mm) portal vein signify? -ANSWER Portal hypertension Normal MPV flow? -ANSWER Hepatopetal and monophasic w/ some respiratory variation Where do the hepatic veins drain? -ANSWER IVC These veins are considered both interlobar and intersegmental -ANSWER hepatic veins. They are located between the segments and the lobes normal hepatic vein flow -ANSWER -Hepatofugal - away from liver -pulsatile, triphasic due to right atrial pressure changes -respiratory variation Narrowing or occlusion of the hepatic veins is indicative of: -ANSWER Budd-Chiari syndrome The liver hilum is also know as -ANSWER The porta hepatis flow pattern of the hepatic artery should be -ANSWER low resistance since it is feeding the liver After birth the umbilical vein becomes -ANSWER ligamentum teres aka round ligament -runs along with the falciform ligament -will usually be seen near left portal vein in left liver Where can the main lobar fissure be seen? -ANSWER -in sag plane -will appear to connect the neck of the GB with the RPV -also separates right and left hepatic veins hepatic steatosis -ANSWER fatty liver Causes of fatty liver disease -ANSWER Fatty deposits within the hepatocytes. Once it becomes cirrhosis, it is non-reversible. 1. Alcoholic fatty liver disease 2. Non-alcoholic fatty liver disease: -obesity -starvation -chemotherapy -diabetes mellitus -hyperlipidemia -pregnancy -von Gierke disease (glycogen storage dx) -total parental nutrition -cystic fibrosis steatohepatitis -ANSWER inflammation of the liver associated with fat precursor for chronic liver dx leading to fibrosis, cirrhosis, and HCC hepatomegaly size -ANSWER 15cm need to correlate with clinical hx don't confused Riedel's lobe as hepatomegaly Fatty liver symptoms and labs -ANSWER Symptoms: -usually asymptomatic Labs: -Increased LFTs (especially AST and ALT) Sono appearance of fatty liver dx and focal fatty infiltration -ANSWER -Diffusely echogenic liver -Increased attenuation of sound beam -Walls of hepatic vasculature and diaphragm will not be easily imaged due to increased attenuation -Fatty changes will be diffuse or focal Focal fatty infiltration sono app: -hyperechoic area next to the GB, near the porta hep, or part of lobe may appear echogenic Focal fatty sparing sonographic appearance -ANSWER -entire liver is involved with diffuse fatty infiltration with certain areas spared -Area of sparing can look like a solid hypoechoic mass -Hypoechoic area will be near GB, porta hep, or entire lobe may be spared -Can appear to look like pericholecystic fluid Two most common types of hepatitis: -ANSWER A and B A: Fecal-oral route: contaminated water or food B: Contact with body fluids, mother-to-infant transmission, blood contact (IV drugs) Most common type of hepatitis in healthcare workers -ANSWER Hep C -Spread by blood and body fluid contact Which type of hepatitis is the leading indication for liver transplantation in US? -ANSWER Hepatitis C Wilson disease Hemochromatosis Autoimmune disorders Drugs All of the above can be causes for chronic ________ of the liver -ANSWER Hepatitis What is Wilson disease? -ANSWER -An inherited disorder that causes too much copper to accumulate in the liver, brain and other vital organs. -Also called hepatolenticular degeneration. -Causes fatty changes & fibrosis in the liver. Leads to chronic hepatitis Trademark feature: Copper ring around iris What is hemochromatosis? -ANSWER Iron overload disease resulting in abnormal deposition of iron Can lead to fatty changes and chronic hepatitis Clinical signs and symptoms of hepatitis -ANSWER -Nonobstructive Jaundice (related to hep on a cellular level NOT biliary obstruction) -Hepatosplenomegaly -Dark urine -F/N/V -Elevated LFTs -Fatigue -Chills Hepatic encephalopathy -ANSWER -central nervous system dysfunction resulting from overexposure of brain to toxins -causes confusion and intermittent loss of consciousness What is refractory hypertension? -ANSWER Hypertension that is unresponsive to medication - is related to renal artery stenosis Clinical signs and symptoms of renovascular hypertension and renal artery stenosis (RAS)? -ANSWER -Refractory HTN (doesn't respond to meds -Very high systemic blood pressure (malignant HTN) -Abd bruit -Elevated creatinine and cholesterol -Unexplained CHF or pulmonary edema Most common cause of RAS and location? -ANSWER Most common: Atherosclerosis -loc: Proximal segment 2nd most common: FMD -loc: distal 2/3 of artery What is the kidneys response when they receive less blood flow (due to RAS) -ANSWER -Perceive the body as having reduced systemic BP -will activate renin-angiotensin aldosterone system this will raise BP to try to increase flow to the kidneys, ultimately causing systemic HTN What can long standing RAS lead to? -ANSWER -Renal parenchymal damage -Renal failure Most common indication for a renal transplant -ANSWER End stage renal disease caused by diabetes Allograft -ANSWER transplantation of healthy tissue from one person or cadaver to another person; also called homograft Where will a transplant kidney mostly be placed? -ANSWER In pelvis The donor renal artery is usually connected to the recipients: (which artery)? What about the renal vein? -ANSWER External iliac artery (EIA) and external iliac vein (EIV) Contraindications to renal transplant -ANSWER -preexisting infection -serious cardiac dx -peripheral artery dx -metastatic dx Normal pancreas anatomy -ANSWER -nonencapsulated -retroperitoneal structure between duodenal loop and splenic hilum Exocrine function of pancreas -ANSWER Secretes: -trypsin -lipase -amylase Through the ductal system Endocrine function of pancreas -ANSWER *non-ductal* Secretes: insulin via islets of Langerhans Normal AP measurement of pancreas -ANSWER ≤3mm What supplies blood to the pancreas? -ANSWER -Celiac axis -SMA -Splenic A Spatial relationship of pancreas -ANSWER -Anterior to IVC -Head is medial to duodenum -CBD is posterior/lateral to panc head -GDA is anterior/lateral to panc head -SMA and SMV are posterior to neck of panc -SMA and SMV are anterior to uncinate process -Tail is anterior/medial to splenic hilum Spatial relationship of panc and its vessels -ANSWER -Ao is posterior to body -Celiac axis arises from ao @ superior border of panc -SMA arises from ao @ inferior border of panc Branches of the celiac axis -ANSWER Gives off left gastric artery and then divides into CHA and splenic artery splenic artery follows along superior border of body/tail of panc What does the common hepatic artery divide into? -ANSWER Divides into proper hepatic A (PHA) and gastroduodenal arteries Where does PHA course? -ANSWER superiorly from CHA toward the liver (anterior to portal vein) and left of the bile duct Two ducts of the pancreas -ANSWER main duct: duct of Wirsung accessory: duct of santorini 50% of the population has complete regression of this duct What two ducts join to form the ampulla of vater, which empties into duodenum (at the major papilla)? -ANSWER CBD and duct of wirsung Which is NOT a branch of the celiac axis? a. common hepatic artery b. right gastric artery c. splenic artery d. left gastric artery -ANSWER b. right gastric artery in most people, the right gastric artery arises from the proper hepatic artery Superior mesenteric VEIN origin and termination -ANSWER Origin: Ascends from small bowel Courses superior and then anterior to uncinate process Termination: splenic portal confluence -joins the splenic vein to form portal vein Inferior mesenteric VEIN origin and termination -ANSWER origin: large bowel termination: ascends and terminates into splenic vein (which will eventually join SMV and become portal vein) The portal vein divides into the _________ and __________ branch inside the liver -ANSWER left and right What is ALT and where is it found? -ANSWER Alanine aminotransferase. Concentrated in the liver High levels of ALT indicate -ANSWER Liver damage or disease Cholecystokinin (CCK) is produced by the __________ and released in response to __________ in the stomach -ANSWER duodenum; food (especially fatty)