Davies Review Questions For Liver

Glisson's capsule is the correct answer. Glisson's capsule is a thin connective tissue capsule that surrounds the liver. It is named after the English physician Francis Glisson, who first described it. This capsule provides support and protection to the liver, enclosing it and helping to maintain its shape. It also contains blood vessels, lymphatics, and nerves that supply the liver. The other options, Reidels capsule and Teres capsule, do not refer to the thin capsule surrounding the liver.

The long, thin extension of the inferior aspect of the right lobe of the liver most likely represents Reidels lobe. This is because Reidels lobe is a rare anatomical variant where there is an elongation of the right lobe of the liver towards the pelvis. It is important to note that the other options, caudate lobe and quadrate lobe, do not fit the description given in the question.

The most likely scenario in this case is a hepatic adenoma. The patient's history of oral contraceptive use is significant because hepatic adenomas are commonly associated with hormonal factors, such as the use of oral contraceptives. The presence of a solid, hypoechoic mass in the right lobe of the liver further supports this diagnosis. Additionally, the hypervascularity of the mass on color doppler is consistent with a hepatic adenoma, as these tumors are known to have increased blood flow.

The correct answer is the subcostal oblique approach with the probe angled superiorly and to the patient's right. This approach allows for visualization of the 3 hepatic veins and the inferior vena cava (IVC) in one view. By angling the probe superiorly and to the patient's right, the ultrasound beam is directed towards the liver, enabling clear visualization of the hepatic veins and IVC. The subcostal oblique approach provides a comprehensive view of these structures, aiding in the diagnosis and assessment of hepatic pathology.

An ultrasound evaluation of liver cirrhosis should include a search for portal hypertension. This is because portal hypertension is a common complication of liver cirrhosis. It is characterized by increased pressure in the portal vein, which can lead to various complications such as ascites (accumulation of fluid in the abdomen), varices (enlarged veins in the esophagus or stomach), and splenomegaly (enlarged spleen). Therefore, it is important to assess for the presence of portal hypertension during an ultrasound evaluation of liver cirrhosis.

A nodular liver surface is associated with cirrhosis. Cirrhosis is a condition where there is scarring of the liver tissue, leading to the formation of nodules. This scarring is usually a result of long-term liver damage from conditions such as chronic alcohol abuse, hepatitis B or C infection, or nonalcoholic fatty liver disease. The nodules on the liver surface can cause the liver to become enlarged and may lead to symptoms such as jaundice, fatigue, and fluid accumulation in the abdomen.

The correct answer is fatty metamorphosis of the liver with focal sparing. Fatty metamorphosis of the liver, also known as hepatic steatosis, is a condition characterized by the accumulation of fat in the liver cells. It is commonly associated with obesity and can be detected through ultrasound as diffuse increased echogenicity. The focal hypoechoic area anterior to the portal vein suggests focal sparing, which is a phenomenon where certain areas of the liver have less fat accumulation compared to the rest of the liver. This finding is consistent with fatty metamorphosis of the liver with focal sparing.

Lipase is not used in the evaluation of liver function because it is an enzyme primarily produced by the pancreas, not the liver. GGT (gamma-glutamyl transferase), AST (aspartate aminotransferase), direct bilirubin, and indirect bilirubin are all lab tests commonly used to assess liver function.

The ligamentum teres is a useful landmark in locating a recannalized paraumbilical. The ligamentum teres, also known as the round ligament of the liver, is a remnant of the fetal umbilical vein. It extends from the umbilicus to the liver and can be used as a reference point to identify the paraumbilical region. Therefore, ruling out the presence of a recannalized paraumbilical can be done by examining the ligamentum teres.

The hepatic veins course interlobar and intersegmental within the liver. These veins drain deoxygenated blood from the liver and carry it back to the heart. They run between the liver lobes and segments, allowing for the efficient drainage of blood from all parts of the liver. The portal veins, on the other hand, bring nutrient-rich blood to the liver from the digestive organs, while the bile ducts carry bile from the liver to the gallbladder and small intestine.

When a patient has a raised serum alpha-fetoprotein level, it is important to look for hepatocellular carcinoma (HCC) during a liver ultrasound. HCC is a common type of liver cancer that often causes an increase in alpha-fetoprotein levels. Therefore, it is crucial to investigate for any signs or abnormalities suggestive of HCC during the ultrasound examination.

The correct answer is to evaluate the hepatic veins and IVC with color doppler to confirm patency. This is because the ultrasound study has already identified several abnormalities, including enlarged caudate lobe, shrunken right lobe, and splenomegaly. The inability to identify the hepatic veins suggests a potential issue with their patency, which should be further evaluated using color doppler. This will help confirm whether the hepatic veins are functioning properly or if there is any obstruction or abnormal blood flow.

The fissure for the ligamentum venosum is located at the anterior border of the caudate lobe of the liver. By identifying this fissure, one can confirm the presence of the caudate lobe and potentially diagnose its enlargement in a patient with liver disease.

The presence of a mass anterior and to the left of the ligamentum venosum indicates that the mass is located in the left lobe of the liver. The ligamentum venosum is a fibrous remnant of the fetal ductus venosus, which connects the umbilical vein to the inferior vena cava. The left lobe of the liver is situated to the left of the ligamentum venosum, making it the most likely location for the detected mass.

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The ultrasound findings of enlargement of hepatic veins and IVC in an otherwise normal appearing liver are most consistent with right sided heart failure. Right sided heart failure occurs when the right side of the heart is unable to effectively pump blood, leading to fluid buildup in the veins and organs, including the liver. This can cause enlargement of the hepatic veins and IVC. Liver cirrhosis and portal hypertension may also cause liver enlargement, but they typically present with additional abnormalities on ultrasound, such as liver nodularity or ascites.

A cavernous hemangioma is the most common benign tumor in the liver. It is a type of vascular tumor that consists of a collection of blood-filled spaces. These tumors are usually asymptomatic and are often discovered incidentally during imaging tests. Cavernous hemangiomas are typically small in size and do not require treatment unless they cause symptoms or complications such as rupture or bleeding. Hepatic lipoma, hepatic adenoma, and hepatoma are other types of liver tumors, but they are less common than cavernous hemangiomas.

A cavernous hemangioma is the most common etiology of a mass fitting the description of a single homogeneous hyperechoic lesion in the liver. Cavernous hemangiomas are benign tumors composed of blood-filled spaces and are typically well-defined and hyperechoic on ultrasound imaging. They are the most common benign liver tumor and are often incidentally found during imaging studies. Other etiologies such as cysts, hepatic adenomas, hepatocellular carcinoma (HCC), and focal fatty sparing may have different characteristics on imaging and are less common in this context.

The hepatic veins and portal veins have differentiating characteristics. One of the main differences is that portal veins are accompanied by branches of the biliary tree and hepatic artery, while the hepatic veins are not. This means that the portal veins carry not only blood but also branches of the biliary tree and hepatic artery, which are important for the liver's function. This is what sets the portal veins apart from the hepatic veins in terms of their anatomical composition.

Hepatic cysts are fluid-filled sacs that occur in the liver. They typically have a thin wall, are anechoic (appear black on ultrasound), and show posterior acoustic enhancement (increased sound transmission through the cyst). Increased attenuation refers to a decrease in the strength of the ultrasound signal as it passes through a structure, which is not a feature of hepatic cysts. Therefore, increased attenuation is not a feature of hepatic cysts.

Oxygenated blood is supplied to the liver primarily through the hepatic artery, which delivers oxygen-rich blood from the heart to the liver. The portal vein carries nutrient-rich but oxygen-poor blood from the digestive organs to the liver, while the hepatic vein carries blood away from the liver to the heart.

Focal fatty liver refers to the accumulation of fat in specific areas of the liver. In this case, it is most commonly found anterior to the portal vein at the porta hepatis. The porta hepatis is the central area of the liver where the portal vein, hepatic artery, and common bile duct enter and exit. Therefore, it makes sense that focal fatty liver would be located in this area, as it is in close proximity to the portal vein.

Fatty liver is a reversible disorder, meaning it can be treated and the condition can be improved. This is because fatty liver is characterized by the accumulation of fat in the liver cells, and with lifestyle changes such as weight loss and a healthy diet, the fat can be reduced and the liver can heal. Therefore, it is not true that fatty liver is an irreversible disorder.

Liver metastasis can have various sonographic appearances. It can present as a single hypoechoic mass, multiple hyperechoic masses, cystic masses, or masses of mixed echogenicity. Therefore, all of the above appearances may be encountered with liver metastasis.

Hepatocellular carcinoma is most commonly associated with invasion of the portal vein. This is because hepatocellular carcinoma is a primary liver cancer that arises from hepatocytes, the main type of liver cells. As the tumor grows, it can invade nearby blood vessels, including the portal vein, which is responsible for carrying blood from the intestines to the liver. This invasion of the portal vein is a characteristic feature of hepatocellular carcinoma and can lead to the spread of cancer cells to other parts of the body.

Liver cirrhosis is a chronic liver disease characterized by the replacement of healthy liver tissue with scar tissue. Sonographic features of cirrhosis include surface nodularity, altered echo texture, ascites, and regenerative nodules. However, a shrunken caudate lobe is not a typical sonographic feature of cirrhosis.

The ligamentum teres is the correct answer because it is a fibrous remnant of the fetal umbilical vein, which runs along the free edge of the falciform ligament. It divides the left lobe of the liver into medial and lateral segments by attaching to the liver at the porta hepatis. The ligamentum venosum is a fibrous remnant of the fetal ductus venosus and is not involved in dividing the left lobe of the liver. The main lobar fissure is a large fissure that separates the right and left lobes of the liver, not the medial and lateral segments of the left lobe.

The middle hepatic vein can be used as an anatomical landmark to identify the left medial segment separate from the right anterior segment of the liver. This vein divides the liver into two main lobes, the right lobe and the left lobe. The left medial segment is located on the left lobe of the liver, and the middle hepatic vein serves as a boundary between this segment and the right anterior segment.

Patients with liver cirrhosis are at increased risk for hepatocellular carcinoma. This is because liver cirrhosis is a known risk factor for the development of hepatocellular carcinoma, a type of liver cancer. The chronic inflammation and scarring of the liver that occurs in cirrhosis can lead to the development of cancerous cells. Therefore, it is important to carefully evaluate the liver for any focal mass during an abdominal ultrasound in order to rule out the presence of hepatocellular carcinoma in patients with liver cirrhosis.

The given findings of luminal narrowing of the hepatic veins with high velocities through the strictures are most commonly associated with cirrhosis. Cirrhosis is a chronic liver disease characterized by fibrosis and scarring of the liver tissue. The narrowing of hepatic veins can occur due to the fibrotic changes in cirrhosis, leading to increased blood flow velocities. Diffuse fatty liver and glycogen storage disease are not typically associated with these specific findings.

The middle hepatic vein courses with the main lobar fissure.

Elevated lab values in GGT (gamma-glutamyl transferase) and ALP (alkaline phosphatase) indicate liver dysfunction. GGT is primarily found in the liver and is elevated in conditions such as liver disease and alcohol abuse. ALP is an enzyme found in various tissues, including the liver and bones. However, when both GGT and ALP are elevated together, it suggests that the source of the elevated ALP is the liver. Therefore, the correct statement is that the concomitant elevation of both GGT and ALP indicates the source of the elevated ALP is the liver.

The increased diameter of the main portal vein greater than 1 cm is not a useful indicator of hepatomegaly. Hepatomegaly refers to an enlarged liver, which can be caused by various conditions such as liver disease or congestion. The other options listed are all potential indicators of hepatomegaly, such as rounding of the inferior border of the liver, longitudinal measurement of the right lobe exceeding 15.5 cm, extension of the right lobe inferior to the lower pole of the kidney, and increased anteroposterior measurement of the right lobe. However, an increased diameter of the main portal vein is not directly related to the size or enlargement of the liver.

The ligamentum teres forms the caudal border of the left portal vein. The ligamentum teres is a remnant of the fetal umbilical vein and runs along the free edge of the falciform ligament. It extends from the umbilicus to the liver and helps to divide the left and right lobes of the liver.