Biology

MATCHING

Match the key terms with their defi nitions.

Key Terms Defi nitions

1. AFP

2. ALT

3. AST

4. Falciform ligament

5. Glisson’s capsule

6. Hepatofugal

7. Hepatomegaly

8. Hepatopetal

9. Jaundice

10. Ligamentum venosum

11. Ligamentum teres

12. Main lobar fi ssure

13. Porta hepatis

14. Reidel’s lobe

a. Remnant of ductus venosus seen as echogenic line separating caudate lobe from the left lobe

b. Fissure where the portal vein and hepatic artery enter the liver and the common hepatic duct exits

c. Tumor marker frequently elevated in cases of hepatocellular carcinoma and certain testicular cancers

d. Anatomic variant in which right lobe is enlarged and extends inferiorly

e. Blood fl ow toward the liver f. Enlarged liver g. Divides the right and left lobes of the liver; seen in

sagittal plane as an echogenic line between the neck of the gallbladder and the main portal vein

h. Liver enzyme most specifi c to hepatocellular damage i. Yellowish pigmentation of the skin and whites of the

eyes caused by increased levels of bilirubin in the blood

j. An enzyme found in all tissues but in largest amounts in the liver; increases with hepatocellular damage

k. Remnant of the left umbilical vein, seen in the transverse plane as a triangular echogenic foci dividing the medial and lateral segments of the left lobe of the liver

l. Fibroelastic connective tissue layer that surrounds the liver

m. Fold in the parietal peritoneum that extends from the umbilicus to the diaphragm and contains the ligamentum teres

n. Blood fl ow away from the liver

5 The Liver

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38 PART 1 — ABDOMINAL SONOGRAPHY

ANATOMY AND PHYSIOLOGY REVIEW

IMAGE LABELING

Complete the labels in the images that follow.

Right Common Carotid Artery

Superior Vena Cava Right Pulmonary Artery

Right Pulmonary Vein

Right Atrium Foramen Ovale

Valve of Inferior Vena Cava (Valve of Eustachii)

Inferior Vena Cava

Hepatic Vein

A. Liver Circulation

Liver Portal Vein

Renal Vein

Superior Mesenteric Vein

B.

Placenta

Umbilical Arteries

Internal Iliac Artery Internal Iliac Vein

Gut

Renal Artery

Aorta

Superior Mesenteric Artery

Celiac Trunk

Right Ventricle

Left Ventricle

Left Atrium

Left Pulmonary Vein

Left Pulmonary Artery

Ductus Arteriosus Aorta

Left Common Carotid Artery

1. Fetal circulation

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5 — The Liver 39

2. Liver anatomy

3. Liver anatomy

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40 PART 1 — ABDOMINAL SONOGRAPHY

4. Liver anatomy

5. Vascular anatomy

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5 — The Liver 41

CHAPTER REVIEW

MULTIPLE CHOICE

Complete each question by circling the best answer.

1. What is the normal liver length along the right surface? a. 10 to 12 cm

b. 11 to 14 cm

c. 15 to 17 cm

d. 19 to 22 cm

2. What separates the left lobe from the caudate lobe? a. Ligamentum teres

b. Ligamentum venosum

c. Falciform ligament

d. Coronary ligament

3. Which of the following lies within the main lobar fi ssure? a. Main portal vein

b. Right hepatic vein

C. Middle hepatic vein

d. Left hepatic vein

4. Based on the segmental division of the liver, the quadrate lobe is the: a. Lateral segment of the left lobe

b. Medial segment of the left lobe

c. Anterior segment of the right lobe

d. Posterior segment of the right lobe

5. You are asked to locate a mass found within the right posterior segment of the liver. Which vessel separates the right anterior segment of the liver from the right posterior segment? a. Left hepatic vein

b. Middle hepatic vein

c. Right hepatic vein

d. Main portal vein

6. Which of the following statements regarding the differences between hepatic and portal veins is FALSE? a. Hepatic veins are intersegmental while portal

veins are intrasegmental

b. The portal veins have highly echogenic walls

c. Portal veins decrease in caliber as they course away from the porta hepatis

d. Hepatic veins decrease in caliber as they course toward the diaphragm

7. Which of the following are both interlobar and intersegmental? a. Portal veins

b. Bile ducts

c. Hepatic veins

d. Hepatic arteries

8. Which of the following supplies oxygenated blood to the liver? A. Portal vein

B. Hepatic artery

C. Hepatic veins

D. Hepatoduodenal artery

9. Which of the following functions does the liver NOT perform? a. Formation of bile

b. Production of clotting factors

c. Production of digestive enzymes amylase and lipase

d. Storage of vitamins A, B12, and D

10. An echogenic mass consistent with a hemangioma is seen just anterior to the middle hepatic vein. In which liver segment is this mass located? a. Posterior segment right lobe

b. Anterior segment right lobe

c. Medial segment left lobe

d. Lateral segment left lobe

11. Which of the following laboratory tests CANNOT evaluate liver function? a. ALT

b. AST

c. ALP

d. BUN

12. You receive an order for an abdominal sonogram with an indication of an elevated AFP. Based on these results, what pathology are you looking for? a. Fatty infi ltration

b. Polycystic liver disease

c. Hepatocellular carcinoma

d. Cavernous hemangioma

13. An intrahepatic mass will typically: a. Cause an anterior displacement of the right kidney

b. Display internal displacement of the liver capsule

c. Cause an anterior shifting of the IVC

d. Displace hepatic vessels

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42 PART 1 — ABDOMINAL SONOGRAPHY

14. Which of the following is NOT a diffuse liver disease? a. Fatty infi ltration

b. Hepatoma

c. Cirrhosis

d. Hepatitis

15. Which of the following is FALSE regarding fatty infi ltration of the liver? a. Fatty infi ltration may be focal or diffuse

b. Visualization of the intrahepatic vessels becomes more diffi cult

c. Focal fatty infi ltration may be mistaken for a liver mass

d. The cortex of the right kidney will appear hyperechoic compared to the liver parenchyma

16. A 65-year-old man presents with elevated liver function tests. Your examination reveals a shrunken, echogenic right lobe and a relatively enlarged caudate lobe. The liver contour is irregular. What is the most likely diagnosis? a. Acute hepatitis

b. Cirrhosis

c. Chronic hepatitis

d. Hepatocellular carcinoma

17. Which benign liver tumor commonly occurs in patients with glycogen storage disease? a. Adenoma

b. Hepatoma

c. Hemangioma

d. Lipoma

18. If you are having trouble visualizing the posterior portion of the liver in a patient with fatty infi ltration, which of the following may help? a. Increasing the TGCs in the near fi eld

b. Decreasing the overall gain

c. Decreasing the depth

d. Lowering the frequency

19. In focal fatty sparing, normal tissue appears more hypoechoic than the surrounding liver tissue and may be mistaken for a mass. Where does this typically occur? a. Dome of the liver

b. Posterior liver near the right kidney

c. Region of the porta hepatis near the gallbladder

d. Lateral segment of the left lobe

20. What does a person with cirrhosis have a higher incidence of developing? a. Hepatoma

b. Cavernous hemangioma

c. Hepatic adenoma

d. Hepatic hemangiosarcoma

21. All of the following may be seen in patients with late stage cirrhosis EXCEPT: a. Ascites

b. Caudate lobe enlargement

c. Shrunken atrophic spleen

d. Hepatofugal fl ow in the portal vein

22. What is the sonographic appearance of a mother cyst containing multiple daughter cysts diagnostic of? A. Hepatic abscess

B. Echinococcal cyst

C. Polycystic liver disease

D. Chronic hematoma

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