You are scanning a patient with a known mass in the left medial segment of the liver. What anatomic landmark can you use to identify the left medial
... [Show More] segment separate from the right anterior segment of the liver?
Middle Hepatic Vein
Which organ is the largest visceral organ in the body ?
Liver
Where is the major portion of the liver, the right lobe located?
in the right upper quadrant of the abdomen
What organ is covered in large part by the peritoneum , except for a small area posterior to the dome known as the bare area?
the Liver
Which organ is covered in a layer of fibrous tissue, glisson's capsule?
the Liver
You suspect enlargement of the caudate lobe in a patient with liver disease. What structure located at the anterior border of the caudate lobe will help you to identify this lobe of the liver?
Fissure for the ligamentum venosum
You are asked to rule out the presence of a recannalized paraumbilical. Which anatomic structure is a useful landmark in location of this structure?
Ligamentum teres
What is the left portal vein in contact with?
Ligamentum teres
Where does the paraumbilical vein begins?
begins at the left portal vein and exits the liver at the ligamentum teres
Which vessel course within the main lobar fissure?
middle hepatic vein
Oxygenated blood is supplied to the liver via the:
Portal vein and hepatic artery
You are performing a sonogram on a slender female and notice a long, thin extension of the inferior aspect of the right lobe of the liver. The most likely represents:
Reidel's lobe
What forms the caudal border of the left portal vein?
Ligamentum teres
What ligament divides the left lobe of the liver into medial and lateral segments?
Ligamentum teres
You are asked to perform a Doppler study on the hepatic veins in the liver. What differentiates the hepatic veins from the portal veins?
the portal veins are accompanied by branches of the biliary tree and hepatic artery
You have detected a mass anterior and to the left of ligamentum venosum. This mass is located in what lobe of the liver ?
Left Lobe
The thin capsule surrounding the liver is known as:
Glisson's capsule
What courses interlobar and intersegmental within the liver?
Hepatic veins
You are performing an ultrasound exam of the liver on a small patient with a 5MHz curved linear array. Although you have increased the overall gain to its maximum setting, the posterior border of the liver and diaphragm are not visualized. What should you do?
Rescan the liver with a lower frequency transducer.
Correctly describe the probe placement and imaging plane you would use to demonstrate the three hepatic veins and inferior vena cava in the one view?
Subcostal oblique approach with the probe angled superiorly and to the patient's right.
You are performing a follow-up sonogram on a patient in which a 5 -mm cyst was previously identified at the anterior border of the left lobe liver. Although you are using a 3.5 MHz curved linear array probe, you do not see the cyst. What would be most helpful in improving visibility of this cyst?
Rescan the left lobe with a higher frequency transducer. Visibility of small cysts is limited by spatial resolution. To improve spatial resolution, the best option is to increase the imaging frequency.
What do you need to do to improve spatial resolution to visualize small cysts (which has a limited spatial resolution)?
The best option is to increase the imaging frequency
You are imaging a patient with a high liver. Subcostal images do not clearly demonstrate the liver tissue. What should you do?
Scan the patient in deep inspiration
A patient is referred for ultrasound evaluation of a questionable mass in the dome of the liver seen on a CAT scan. What would improve visualization in this area of the liver?
Perform a subcostal scan with the probe angled superior and the patient in deep inspiration
A patient is referred for a liver ultrasound with the clinical history of a raised serum alpha-fetoprotein level. What should you look for?
Hepatocellular carcinoma
If a non pregnant person with elevated levels of serum alpha-fetoprotein AFP , what is associated with this?
Hepatocellular carcinoma, germ cell tumor of gonadal, retroperitoneal, or mediastinal origin. Sometimes with cancer of pancreas, stomach, or biliary system.
What may produce modest serum AFP elevations?
Hepatitis and cirrhosis
You are reviewing lab work prior to performing an abnormal ultrasound exam. Elevated lab values include Gamma- glutamyl transpeptidase -GGT and alkaline phosphatase. What would it be?
Concomitant elevation of both GGT and alkaline phosphate indicates the source of the elevated alkaline phosphatase is the liver.
what other reasons would alkaline phosphatase be elevated ?
skeletal disease, hyperparathyroidism, and acute hepatocellular disease
What is NOT a lab test use in evaluation of liver function out of the following GGT, AST, direct bilirubin, indirect bilirubin, or lipase?
Lipase - is used to evaluate acute pancreatitis
What does it mean when direct bilirubin is elevated?
usually indicates biliary obstruction, which may be intrahepatic due to hepatitis, cirrhosis, or extrahepatic due to gallstones, gallbladder or pancreatic cancer.
Why would indirect bilirubin be elevated?
with hepatocellular dysfunction such as hepatitis
What is Aspartate aminotransferase - AST used in evaluating?
used in evaluation of acute hepatic disease. May also be elevated with recent myocardial infarction.
What is Gamma- glutamyl transpeptidase - GGT is used with what to suggest the source of elevated alkaline phosphatase levels?
used with alkaline phosphatase
A patient is referred with right upper quadrant tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the right lobe of the liver. Color Doppler reveals hypervascularity of the mass. What is the scenario likely to be?
Hepatic Adenoma - the incidence of hepatic adenomas has increased in the united states since the 1970s. And are associated with use of oral contraceptives.
A liver ultrasound on a 49-year-old obese male demonstrates diffuse increased echogenicity with a focal hypoechoic area anterior to the portal vein. This most likely represents:
Fatty metamorphosis of the liver with focal sparing
What is commonly seen as a hypoechoic mass anterior to the portal vein?
Focal fatty sparring
A 52-year-old male with known liver cirrhosis presents for an abdominal ultrasound. You will carefully evaluate the liver to rule out the presence of any focal mass because of what?
Patients with liver cirrhosis are at increased risk for hepatocellular carcinoma [Show Less]