Mosbys Review Question Liver

Alcohol abuse is the most common cause of cirrhosis. Prolonged and excessive alcohol consumption leads to inflammation and scarring of the liver, which eventually progresses to cirrhosis. This chronic liver disease is characterized by the replacement of healthy liver tissue with scar tissue, impairing liver function. Over time, cirrhosis can lead to complications such as liver failure, portal hypertension, and liver cancer. Other factors such as viral hepatitis, biliary obstruction, and congestive heart failure can also cause cirrhosis, but alcohol abuse is the primary cause.

Cirrhosis is a condition characterized by severe insult to liver cells, which causes them to undergo necrosis or cell death. This insult can be caused by various factors such as chronic alcohol abuse, viral hepatitis, or certain medications. Over time, the necrotic liver cells are replaced by scar tissue, leading to the formation of fibrous nodules in the liver. This disrupts the normal liver structure and function, resulting in symptoms such as jaundice, ascites, and liver failure. Therefore, cirrhosis is the correct answer that best describes the given scenario.

The ligament that separates the left lobe from the caudate lobe of the liver is the venosum. The coronary ligament attaches the liver to the diaphragm, the falciform ligament attaches the liver to the anterior abdominal wall, the gastrohepatic ligament connects the liver to the stomach, and the hepatoduodenal ligament connects the liver to the duodenum. However, the venosum ligament specifically separates the left and caudate lobes of the liver.

The falciform ligament attaches the liver to the anterior abdominal wall. It is a thin, crescent-shaped ligament that separates the liver into right and left lobes and attaches the liver to the diaphragm and the anterior abdominal wall.

Reidel lobe is a condition where there is a congenital extension of the liver anterior and inferior to the right kidney. This means that the liver extends towards the front and below the right kidney. The other options, such as sinus inversus, hepatomegaly, left lobe variant, and hyperplastic caudate lobe, do not accurately describe this specific condition.

Based on the given clinical history, the most suspicious diagnosis for the mass in the right lobe of the liver is adenoma. Adenomas are benign tumors that are more common in women of reproductive age, especially those who have been taking oral contraceptives for a long duration. The association between oral contraceptive use and the development of hepatic adenomas is well-established. The presence of gallstones along with the mass further supports the suspicion of adenoma, as there is a known association between gallstones and hepatic adenomas. Fatty infiltration and hepatoma are less likely based on the given information.

The adult liver is considered enlarged once the anteroposterior diameter exceeds 15 cm. This means that if the measurement from the front to the back of the liver exceeds 15 cm, it is considered enlarged.

The hepatic vein is interlobar in location because it runs between the liver lobes, draining blood from the liver and carrying it to the inferior vena cava (IVC). The hepatic artery and portal vein supply blood to the liver, but they are not interlobar structures. The biliary duct is responsible for carrying bile from the liver to the gallbladder or small intestine and is not interlobar in location. The IVC is a large vein that carries deoxygenated blood from the lower body to the heart and is not specific to the liver.

The left lobe of the liver is separated from the right lobe by the middle hepatic vein and the main lobar fissure. The middle hepatic vein is a large vein that runs vertically in the middle of the liver, dividing it into left and right lobes. The main lobar fissure is a deep groove that extends from the middle hepatic vein towards the back of the liver, further separating the left and right lobes. Together, these structures create a clear division between the left and right lobes of the liver.

Von Gierke disease, also known as glycogen storage disease type I, is a rare genetic disorder characterized by the accumulation of glycogen in various organs, particularly the liver and kidneys. It is caused by a deficiency in the enzyme glucose-6-phosphatase, which is essential for the breakdown of glycogen into glucose. This leads to an abnormal buildup of glycogen, resulting in hepatomegaly (enlarged liver), hypoglycemia (low blood sugar), and other symptoms. Therefore, the correct answer is glycogen storage disease.

Polycystic disease is a genetic disorder that causes the formation of cysts in various organs. It is most commonly associated with the liver, kidney, spleen, and pancreas. However, the adrenal gland is not typically involved in the development of polycystic disease. The adrenal gland is responsible for producing hormones and is not commonly affected by this disorder.

Patients with a history of hepatitis B have a predisposing risk factor for developing a hepatoma. Hepatitis B is a viral infection that primarily affects the liver. Chronic infection with hepatitis B can lead to liver inflammation, cirrhosis, and an increased risk of liver cancer, specifically hepatocellular carcinoma or hepatoma. Therefore, patients with a history of hepatitis B are more likely to develop a hepatoma compared to individuals without this risk factor.

Enlargement of the caudate lobe is most commonly associated with cirrhosis. Cirrhosis is a condition in which the liver becomes scarred and damaged due to long-term liver disease or injury. As the liver tries to compensate for the damage, it can result in the enlargement of certain lobes, including the caudate lobe. This enlargement is often seen in advanced stages of cirrhosis and can be detected through imaging studies such as ultrasound or CT scan. Other pathologies listed, such as candidiasis, fatty infiltration, liver metastasis, and polycystic disease, are not typically associated with caudate lobe enlargement.

Hepatocellular carcinoma is a type of liver cancer that is often associated with weight loss, hepatomegaly (enlarged liver), abdominal pain, and unexplained fever. However, elevated serum albumin levels are not typically seen in hepatocellular carcinoma. Serum albumin is a protein produced by the liver, and its levels may decrease in liver diseases due to impaired liver function. Therefore, the absence of elevated serum albumin in this context is consistent with the symptoms commonly associated with hepatocellular carcinoma.

Metastatic lesions involving the liver most commonly originate from a primary malignancy of the colon. This is because the liver receives blood directly from the colon through the portal vein, making it a common site for the spread of colon cancer cells. Additionally, colon cancer is one of the most common types of cancer worldwide, further contributing to the likelihood of metastasis to the liver.

The right lobe of the liver is divided into anterior and posterior segments by the right hepatic vein. The hepatic veins drain the liver and carry blood back to the heart. The right hepatic vein specifically separates the two segments of the right lobe. The other options listed, such as the right hepatic artery, main portal vein, right portal vein, and middle hepatic vein, do not play a role in dividing the right lobe of the liver into segments.

The hepatic veins are characterized by multiphasic flow types on spectral doppler. This means that the flow in the hepatic veins has multiple phases or components, including both forward and backward flow. This is typically seen due to the complex anatomy and physiology of the liver, which receives blood from multiple sources and has a unique venous drainage system.

Sonographic findings commonly associated with portal hypertension include hepatomegaly, splenomegaly, dilated main portal vein, and formation of venous collaterals. However, hypoechoic liver parenchyma is not typically associated with portal hypertension.

Hepatomegaly refers to an enlarged liver. Acute pancreatitis is not commonly associated with hepatomegaly. Acute pancreatitis is an inflammation of the pancreas, which is a different organ located near the liver. While hepatomegaly can be caused by conditions such as hepatitis, fatty infiltration, congestive heart failure, and polycystic liver disease, it is not typically associated with acute pancreatitis.

The normal blood flow pattern in the main portal vein is described as phasic. This means that the blood flow in the portal vein fluctuates in a rhythmic pattern. It alternates between periods of forward flow (antegrade) and periods of no flow or even backward flow (retrograde). This phasic flow is influenced by various factors, including the cardiac cycle and the resistance in the portal venous system.

The correct answer is 4 lobes because traditional lobar anatomy divides the liver into four main lobes: the right lobe, left lobe, quadrate lobe, and caudate lobe. Each lobe has its own specific functions and blood supply.

The caudate lobe is located posterior to the porta hepatis. The porta hepatis is a region on the inferior surface of the liver where the common bile duct, hepatic artery, and portal vein enter. Therefore, the caudate lobe is situated behind this area.

Ascending cholangitis is the most likely condition in which a hepatic abscess can develop in the United States. Ascending cholangitis is an infection of the bile ducts that occurs when bacteria from the intestines travel up the bile ducts. This can lead to the formation of an abscess in the liver. Acute pancreatitis, biliary obstruction, portal vein thrombosis, and Budd-Chiari Syndrome can also be associated with hepatic abscesses, but ascending cholangitis is the most common cause in the United States.

Based on the patient's symptoms (right upper quadrant pain, fever, leukocytosis) and history of recent travel, along with the identification of a complex mass in the right lobe of the liver, the most likely explanation is an abscess. Abscesses can occur in the liver due to bacterial infections, and the symptoms and imaging findings are consistent with this diagnosis. Hepatoma, adenoma, cystadenoma, and echinococcal cyst are less likely explanations based on the given information.

Acute thrombosis of the portal veins refers to the sudden formation of a blood clot in the veins that carry blood from the intestines to the liver. This can lead to severe abdominal pain as the blocked blood flow causes increased pressure in the portal veins. Jaundice, tachycardia, weight loss, and lower extremity edema are not typically associated with acute thrombosis of the portal veins, making severe abdominal pain the most common symptom.

Prominence of the portal veins is most commonly associated with hepatitis. In hepatitis, there is inflammation of the liver, which can lead to enlargement of the liver and increased blood flow through the portal veins. This increased blood flow causes the portal veins to become more prominent and visible on imaging studies such as ultrasound or CT scan. Cirrhosis, polycystic disease, fatty infiltration, and glycogen storage disease can also cause liver abnormalities, but they are not typically associated with prominence of the portal veins.