Davies Review Questions For Liver
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Questions and Answers
- 1.
You are scanning a patient with a known mass in the left medial segment of the liver. What anatomical landmark can you use to identify the left medial segment separate from the right anterior segment of the liver?
- A.
Left portal vein
- B.
Ligamentum teres
- C.
Ligamentum venosum
- D.
Middle hepatic vein
- E.
Left hepatic vein
Correct Answer
D. Middle hepatic veinExplanation
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.Rate this question:
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- 2.
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 identify this lobe of the liver?
- A.
Left portal vein
- B.
Fissure for the ligamentum venosum
- C.
IVC
- D.
Fissure for the ligamentum teres
- E.
Main lobar fissure
Correct Answer
B. Fissure for the ligamentum venosumExplanation
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.Rate this question:
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- 3.
You are asked to rule out the presence of a recannalized paraumbilical. Which anatomic structure is a useful landmark in location of this structure?
- A.
Ligamentum teres
- B.
Ligamentum venosum
- C.
Coronary ligament
- D.
Glissons ligament
Correct Answer
A. Ligamentum teresExplanation
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.Rate this question:
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- 4.
Which vessel courses with the main lobar fissure?
- A.
Main portal vein
- B.
Left portal vein
- C.
Middle hepatic vein
- D.
Proper hepatic artery
- E.
Right hepatic vein
Correct Answer
C. Middle hepatic veinExplanation
The middle hepatic vein courses with the main lobar fissure.Rate this question:
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- 5.
Oxygenated blood is supplied to the liver via the :
- A.
Portal vein and hepatic vein
- B.
Hepatic vein and hepatic artery
- C.
Portal vein and hepatic artery
- D.
Hepatic artery only
Correct Answer
C. Portal vein and hepatic arteryExplanation
The liver receives oxygenated blood from both the portal vein and the hepatic artery. The portal vein carries nutrient-rich blood from the intestines to the liver, while the hepatic artery supplies oxygenated blood from the heart to the liver. This dual blood supply is important for the liver's metabolic functions, as it allows for the processing of nutrients and the removal of waste products from the blood.Rate this question:
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- 6.
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. This most likely represents:
- A.
Caudate lobe
- B.
Quadrate lobe
- C.
Reidels lobe
Correct Answer
C. Reidels lobeExplanation
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.Rate this question:
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- 7.
Which of the following forms the caudal border of the left portal vein?
- A.
Ligamentum venosum
- B.
Hepatodoudenal ligament
- C.
Main lobar fissure
- D.
Coronary ligament
- E.
Ligamentum teres
Correct Answer
E. Ligamentum teresExplanation
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.Rate this question:
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- 8.
What ligament divides the left lobe of the liver into medial and lateral segments?
- A.
Ligamentum venosum
- B.
Main lobar fissure
- C.
Ligamentum teres
Correct Answer
C. Ligamentum teresExplanation
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.Rate this question:
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- 9.
You are asked to perform a doppler study on the hepatic veins in the liver. What differentiates the hepatic veins from the portal veins?
- A.
Hepatic veins converge toward the porta hepatis
- B.
Hepatic veins have brightly echogenic walls
- C.
Portal veins are largest near the dome of liver
- D.
Portal veins normally exhibit a triphasic flow pattern
- E.
Portal veins are accompanied by branches of the biliary tree and hepatic artery
Correct Answer
E. Portal veins are accompanied by branches of the biliary tree and hepatic arteryExplanation
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.Rate this question:
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- 10.
You have detected a mass anterior and to the left of the ligamentum venosum. This mass is located in what lobe of the liver?
- A.
Left lobe
- B.
Caudate lobe
- C.
Right lobe
Correct Answer
A. Left lobeExplanation
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.Rate this question:
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- 11.
The thin capsule surrounding the liver is known as:
- A.
Reidels capsule
- B.
Glissons capsule
- C.
Teres capsule
Correct Answer
B. Glissons capsuleExplanation
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.Rate this question:
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- 12.
Which of the following course interlobar and intersegmental within the liver?
- A.
Hepatic veins
- B.
Portal veins
- C.
Bile ducts
Correct Answer
A. Hepatic veinsExplanation
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.Rate this question:
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- 13.
You are performing an ultrasound exam of the liver on a small patient with a 5 MHz 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?
- A.
Rescan the liver with a lower frequency transducer
- B.
Move the focal zone into the near field
- C.
Decrease the transmit power on the ultrasound unit
Correct Answer
A. Rescan the liver with a lower frequency transducer -
- 14.
Which of the following correctly describes the probe placement and imaging plane you would use to demonstrate the 3 hepatic veins and IVC in one view?
- A.
Subcostal oblique approach with the probe angled superiorly and to the patients right
- B.
Sagittal subcostal approach with the probe just to the right of midline
Correct Answer
A. Subcostal oblique approach with the probe angled superiorly and to the patients rightExplanation
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.Rate this question:
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- 15.
A patient is referred for a liver ultrasound with the clinical history of a raised serum alpha-fetoprotein level. What should you look for?
- A.
HCC
- B.
Fatty liver
- C.
Focal nodular hyperplasia
Correct Answer
A. HCCExplanation
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.Rate this question:
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- 16.
You are reviewing lab work prior to performing an abdominal ultrasound exam. Elevated lab values in GGT and ALP. Which statement is true?
- A.
Elevations in both of these lab values is highly specific for HCC
- B.
Elevation of both ALP and GGT is a sensitive indicator of pancreatitis
- C.
Concomitant elevation of both GGT and ALP indicates the source of the elevated ALP is the liver
Correct Answer
C. Concomitant elevation of both GGT and ALP indicates the source of the elevated ALP is the liverExplanation
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.Rate this question:
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- 17.
Which of the following lab tests is NOT used in the evaluation of liver function?
- A.
GGT
- B.
AST
- C.
Lipase
- D.
Direct bilirubin
- E.
Indirect bilirubin
Correct Answer
C. LipaseExplanation
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.Rate this question:
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- 18.
A patient is referred with right upper quadrant pain and tenderness. Patient has 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. Which of the following scenarios is most likely?
- A.
Hepatic lipoma
- B.
Hepatic adenoma
- C.
Hepatic abscess
Correct Answer
B. Hepatic adenomaExplanation
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.Rate this question:
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- 19.
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:
- A.
Liver cirrhosis with HCC
- B.
Fatty metamorphosis of the liver with focal sparing
- C.
Metastatic disease most likely due to a colon primary
Correct Answer
B. Fatty metamorphosis of the liver with focal sparingExplanation
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.Rate this question:
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- 20.
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 which TRUE statement below?
- A.
Patients with liver cirrhosis are at increased risk for hepatocellular carcinoma
- B.
Metastatic disease occurs commonly with cirrhosis
- C.
Patients with liver cirrhosis tend to develop multiple cysts in their liver and pancreas
- D.
The presence of regenerative nodules rules out cirrhosis
- E.
All the above are correct
Correct Answer
A. Patients with liver cirrhosis are at increased risk for hepatocellular carcinomaExplanation
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.Rate this question:
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- 21.
You are scanning a patient with suspected liver cirrhosis. All of the following are sonographic features of cirrhosis EXCEPT:
- A.
Surface nodularity
- B.
Shrunken caudate lobe
- C.
Altered echo texture
- D.
Ascites
- E.
Regenerative nodules
Correct Answer
B. Shrunken caudate lobeExplanation
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.Rate this question:
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- 22.
An ultrasound evaluation of liver cirrhosis should include a search for which associated complication?
- A.
Biliary dilatation
- B.
Mesenteric ischemia
- C.
Portal hypertension
Correct Answer
C. Portal hypertensionExplanation
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.Rate this question:
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- 23.
Ultrasound findings of an abdominal study on a 51 year old female include enlargement of hepatic veins and IVC in an otherwise normal appearing liver. These findings are most consistent with which of the following?
- A.
Liver cirrhosis
- B.
Right sided heart failure
- C.
Portal hypertension
Correct Answer
B. Right sided heart failureExplanation
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.Rate this question:
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- 24.
Focal fatty liver is most commonly found in which location?
- A.
Medial to the ascending branch of the left portal vein
- B.
Posterior to the right hepatic vein
- C.
Adjacent tot he fissure for the ligamentum venosum
- D.
Anterior to the portal vein at the porta hepatis
Correct Answer
D. Anterior to the portal vein at the porta hepatisExplanation
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.Rate this question:
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- 25.
You have performed an ultrasound study on a patient with enlarged caudate lobe. shrunken right lobe and splenomegaly. The hepatic veins could not be identified. No other abnormalities were discovered. What should you do?
- A.
Have the patient return in a week for a repeat study to evaluate the hepatic veins
- B.
Evaluate the hepatic veins and IVC with color doppler to confirm patency
- C.
Nothing, you have completed the exam
- D.
Have patient perform a valsalva maneuver and reexamine the hepatic veins
Correct Answer
B. Evaluate the hepatic veins and IVC with color doppler to confirm patencyExplanation
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.Rate this question:
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- 26.
A patient is referred to rule out hepatomegaly. All of the following are useful indicators of hepatomegaly EXCEPT:
- A.
Rounding of the inferior border of the liver
- B.
Longitudinal measurement of the right lobe exceeding 15.5 cm
- C.
Extension of the right lobe inferior to the lower pole of the kidney
- D.
Increased diameter of the main portal vein greater than 1 cm
- E.
Increased anteroposterior measurement of the right lobe
Correct Answer
D. Increased diameter of the main portal vein greater than 1 cmExplanation
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.Rate this question:
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- 27.
You have identified a single homogeneous hyperechoic lesion measuring 2.4 cm in the posterior aspect of the right lobe of the liver. What is the most common etiology of a mass fitting this description?
- A.
Cyst
- B.
Cavernous hemangioma
- C.
Hepatic adenoma
- D.
HCC
- E.
Focal fatty sparing
Correct Answer
B. Cavernous hemangiomaExplanation
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.Rate this question:
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- 28.
A patient is referred for a sonogram of the liver to rule out metastatic disease. Which of the following described the sonographic appearance of liver metastasis?
- A.
Single hypoechoic mass
- B.
Multiple hyperechoic masses
- C.
Cystic masses
- D.
All of the above appearances may be encountered with liver metastasis
- E.
Masses of mixed echogenicity
Correct Answer
D. All of the above appearances may be encountered with liver metastasisExplanation
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.Rate this question:
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- 29.
Which of the following is NOT a feature of hepatic cysts?
- A.
Thin wall
- B.
Posterior acoustic enhancement
- C.
Anechoic
- D.
Increased attenuation
- E.
Increased through transmission
Correct Answer
D. Increased attenuationExplanation
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.Rate this question:
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- 30.
You are scanning the liver and notice irregularity of the surface. A nodular liver surface is associated with which of the following abnormalities?
- A.
Cirrhosis
- B.
Hepatomegaly
- C.
Fatty liver
- D.
Acute hepatitis
Correct Answer
A. CirrhosisExplanation
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.Rate this question:
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- 31.
Which of the following is NOT TRUE regarding fatty liver?
- A.
It is an irreversible disorder
- B.
May be caused by obesity
- C.
May be diffuse or focal
- D.
May show a rapid change in appearance with time
- E.
Commonly causes increased attenuation of the sound beam through liver
Correct Answer
A. It is an irreversible disorderExplanation
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.Rate this question:
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- 32.
The most common benign tumor in the liver is:
- A.
Hepatic lipoma
- B.
Hepatic adenoma
- C.
Cavernous hemangioma
- D.
Hepatoma
Correct Answer
C. Cavernous hemangiomaExplanation
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.Rate this question:
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- 33.
You are scanning through the liver and notice luminal narrowing of the hepatic veins. Color and spectral doppler reveal high velocities through the strictures. These findings are most commonly associated with which of the following?
- A.
Diffuse fatty liver
- B.
Cirrhosis
- C.
Glycogen storage disease
Correct Answer
B. CirrhosisExplanation
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.Rate this question:
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- 34.
Which of the following is most commonly associated with invasion of the portal vein?
- A.
Hepatocellular carcinoma
- B.
Hepatic adenoma
- C.
Liver metastases
Correct Answer
A. Hepatocellular carcinomaExplanation
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.Rate this question:
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