Liver Pathology / Vascular Abnormalities Of The Liver Part 2

1.

___________ syndrome is caused by thrombosis of the main hepatic veins.

Explanation
Budd-Chiari syndrome is a condition that occurs when there is a blockage or thrombosis in the main hepatic veins, which are responsible for draining blood from the liver. This blockage can lead to liver damage and can cause symptoms such as abdominal pain, ascites (fluid accumulation in the abdomen), and liver enlargement. The thrombosis can be caused by various factors, including blood disorders, liver diseases, and certain medications. Prompt diagnosis and treatment are necessary to prevent further liver damage and complications.

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2.

Check all that apply to the clinical and lab data of Budd-Chiari Syndrome:
- A.
  
  Ascites
- B.
  
  RUQ pain
- C.
  
  Jaundice
- D.
  
  Hepatosplenomegaly
Correct Answer(s)
A. Ascites
B. RUQ pain
C. Jaundice
D. Hepatosplenomegaly

Explanation
Budd-Chiari Syndrome is a condition characterized by the obstruction of the hepatic veins, which leads to impaired blood flow from the liver. Ascites, or the accumulation of fluid in the abdominal cavity, is a common manifestation of this syndrome due to increased pressure in the liver. RUQ (right upper quadrant) pain is also a symptom, as the liver becomes enlarged and causes discomfort in that area. Jaundice occurs when there is a buildup of bilirubin in the bloodstream, resulting in yellowing of the skin and eyes. Hepatosplenomegaly, the enlargement of the liver and spleen, is another common finding in Budd-Chiari Syndrome.

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3.

Sonographic appearance of Budd-Chiari syndrome depends on the degree of venous ________ and the underlying cause.

Correct Answer(s)
obstruction

Explanation
The sonographic appearance of Budd-Chiari syndrome can vary depending on the degree of venous obstruction and the underlying cause. Budd-Chiari syndrome is a condition characterized by the blockage or narrowing of the veins that carry blood from the liver. This obstruction can lead to various changes in the liver, such as enlargement, congestion, and the formation of collateral vessels. The severity and extent of these changes can vary, depending on the degree of venous obstruction and the specific cause of the syndrome.

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4.

With Budd-Chiari syndrome, hepatic veins may appear anechoic to __________ depending on the stage of thrombus.

Correct Answer(s)
hyperechoic

Explanation
With Budd-Chiari syndrome, hepatic veins may appear anechoic to hyperechoic depending on the stage of thrombus. This means that on an ultrasound image, the hepatic veins may have different levels of brightness or echogenicity. Anechoic means that the veins appear black or without echoes, while hyperechoic means that the veins appear brighter or with increased echoes. The stage of thrombus refers to the severity or progression of the blood clot within the hepatic veins.

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5.

Check all that apply to the etiology of Budd-Chiaris syndrome:
- A.
  
  Tumor invasion
- B.
  
  Pregnancy
- C.
  
  Oral contraceptives
- D.
  
  Mechanical compression from liver tumor or cirrhosis
- E.
  
  Hypercoagulation states
Correct Answer(s)
A. Tumor invasion
B. Pregnancy
C. Oral contraceptives
D. Mechanical compression from liver tumor or cirrhosis
E. Hypercoagulation states

Explanation
Budd-Chiari syndrome is a condition characterized by the obstruction of hepatic veins, leading to liver congestion. The etiology of Budd-Chiari syndrome can include several factors. Tumor invasion refers to the spread of cancer cells into the hepatic veins, causing obstruction. Pregnancy can lead to increased blood volume and hormonal changes, which can contribute to the development of blood clots and subsequent hepatic vein obstruction. Oral contraceptives, particularly those containing estrogen, can also increase the risk of blood clot formation. Mechanical compression from liver tumors or cirrhosis can physically obstruct the hepatic veins. Finally, hypercoagulation states, such as inherited thrombophilias or acquired conditions, can promote blood clot formation and contribute to the development of Budd-Chiari syndrome.

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6.

Check all that apply to the clinical and lab data of portal vein thrombosis:
- A.
  
  Abdominal pain
- B.
  
  Hypovolemia
- C.
  
  Fever
- D.
  
  Leukocytosis
- E.
  
  Hepatomegaly
Correct Answer(s)
A. Abdominal pain
B. Hypovolemia
C. Fever
D. Leukocytosis

Explanation
Portal vein thrombosis is a condition characterized by the formation of a blood clot in the portal vein, which carries blood from the digestive organs to the liver. The clinical and lab data associated with portal vein thrombosis include abdominal pain, as the clot can cause obstruction and lead to pain in the abdomen. Hypovolemia, or low blood volume, can occur due to the clot obstructing blood flow and causing decreased blood supply to the liver. Fever may be present as a result of inflammation caused by the clot. Leukocytosis, an increase in the number of white blood cells, can be seen as the body's response to the clot. Hepatomegaly, or enlargement of the liver, may also be present due to the obstruction of blood flow.

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7.

_______ ______ thrombosis is associated with HCC, metastatic liver disease, carcinoma of the pancreas, hepatitis, trauma, hypercoagulable state, and PHTN.

Correct Answer(s)
portal vein

Explanation
Portal vein thrombosis is a condition characterized by the formation of a blood clot within the portal vein, which carries blood from the intestines, spleen, and pancreas to the liver. This condition is associated with various underlying causes, including hepatocellular carcinoma (HCC), metastatic liver disease, pancreatic carcinoma, hepatitis, trauma, hypercoagulable state, and pulmonary hypertension (PHTN). These conditions can lead to changes in blood flow and increased risk of clot formation within the portal vein, ultimately leading to portal vein thrombosis.

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8.

Check all of the following that apply to the causes of portal vein thrombosis in infants:
- A.
  
  Sepsis
- B.
  
  Umbilical vein catherization
- C.
  
  Acute dehydration
Correct Answer(s)
A. Sepsis
B. Umbilical vein catherization
C. Acute dehydration

Explanation
Portal vein thrombosis in infants can be caused by several factors, including sepsis, umbilical vein catheterization, and acute dehydration. Sepsis, which is a severe infection, can lead to the formation of blood clots in the portal vein. Umbilical vein catheterization, a procedure in which a catheter is inserted into the umbilical vein, can also increase the risk of thrombosis. Additionally, acute dehydration can cause blood to become more concentrated, increasing the likelihood of clot formation. Therefore, all of the listed options (sepsis, umbilical vein catheterization, and acute dehydration) are potential causes of portal vein thrombosis in infants.

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9.

Thrombus/tumor must be visualized within the lumen in order to make the diagnosis.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
In order to make a diagnosis of thrombus or tumor, it is necessary to visualize them within the lumen. This means that they must be seen within the space or cavity of a blood vessel or organ. Without direct visualization, it would be difficult to confirm the presence of a thrombus or tumor. Therefore, the statement "Thrombus/tumor must be visualized within the lumen in order to make the diagnosis" is true.

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10.

Put the following stages of portal vein thrombosis in order as they appear sonographically:1. cavernous transformation of the portal vein2. when thrombus is fresh it appears anechoic, making it hard to visualize3. thrombus becomes more echogenic and there is a dilation of the PV at and proximal to the thrombus or occlusion

Correct Answer
2, 3, 1
11.

The caudate lobe is often ______ in Budd-Chiari syndrome. The _____ veins drain directly into the IVC at the level lower than the main hepatic veins. The increased blood flow through the caudate lobe leads to caudate __________ or hypertrophy.

Correct Answer
spared, emissary, enlargement

Explanation
In Budd-Chiari syndrome, there is obstruction of the hepatic veins, leading to impaired blood flow out of the liver. However, the caudate lobe is often spared from this obstruction due to its unique venous drainage. The emissary veins, which are small veins that connect the hepatic veins to the inferior vena cava (IVC) at a lower level, allow blood to bypass the obstructed hepatic veins and drain directly into the IVC. This increased blood flow through the caudate lobe can result in caudate enlargement or hypertrophy.

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12.

Check all that apply to the sono appearance of Budd-Chiari syndrome:
- A.
  
  Ascites
- B.
  
  Splenomegaly
- C.
  
  Hepatomegaly
- D.
  
  Dilation of the HV at and proximal to the thrombus or occlusion
- E.
  
  Intrahepatic collaterals or hepatofugal flow in the branches of the PV
Correct Answer(s)
A. Ascites
B. Splenomegaly
C. Hepatomegaly
D. Dilation of the HV at and proximal to the thrombus or occlusion
E. Intrahepatic collaterals or hepatofugal flow in the branches of the PV

Explanation
Budd-Chiari syndrome is a condition characterized by the obstruction of hepatic venous outflow, leading to impaired blood flow from the liver. The sono appearance of Budd-Chiari syndrome includes ascites, which is the accumulation of fluid in the abdominal cavity. Splenomegaly, the enlargement of the spleen, and hepatomegaly, the enlargement of the liver, are also observed. Dilation of the hepatic vein (HV) at and proximal to the thrombus or occlusion is another characteristic finding. Additionally, intrahepatic collaterals or hepatofugal flow in the branches of the portal vein (PV) can be seen.

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Liver Pathology / Vascular Abnormalities Of The Liver Part 2

___________ syndrome is caused by thrombosis of the main hepatic veins.

Check all that apply to the clinical and lab data of Budd-Chiari Syndrome:

Sonographic appearance of Budd-Chiari syndrome depends on the degree of venous ________ and the underlying cause.

With Budd-Chiari syndrome, hepatic veins may appear anechoic to __________ depending on the stage of thrombus.

Check all that apply to the etiology of Budd-Chiaris syndrome:

Check all that apply to the clinical and lab data of portal vein thrombosis:

_______ ______ thrombosis is associated with HCC, metastatic liver disease, carcinoma of the pancreas, hepatitis, trauma, hypercoagulable state, and PHTN.

Check all of the following that apply to the causes of portal vein thrombosis in infants:

Thrombus/tumor must be visualized within the lumen in order to make the diagnosis.

The caudate lobe is often ______ in Budd-Chiari syndrome. The _____ veins drain directly into the IVC at the level lower than the main hepatic veins. The increased blood flow through the caudate lobe leads to caudate __________ or hypertrophy.

Check all that apply to the sono appearance of Budd-Chiari syndrome:

_ thrombosis is associated with HCC, metastatic liver disease, carcinoma of the pancreas, hepatitis, trauma, hypercoagulable state, and PHTN.

The caudate lobe is often ____ in Budd-Chiari syndrome. The _ veins drain directly into the IVC at the level lower than the main hepatic veins. The increased blood flow through the caudate lobe leads to caudate ________ or hypertrophy.