Sanders Exam Prep (Liver)

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1. The liver is an intraperitoneal organ surrounded by
peritoneum. Which portion, if any, is NOT covered
by peritoneum?

Explanation

The correct answer is "Bare area". The liver is an intraperitoneal organ, meaning it is surrounded by peritoneum. However, the bare area of the liver is not covered by peritoneum. The bare area is a small portion on the posterior surface of the liver where it is in direct contact with the diaphragm, without any peritoneal covering.

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About This Quiz
Sanders Exam Prep (Liver) - Quiz

The Sanders Exam Prep (Liver) assesses knowledge of liver anatomy, physiology, and pathology. Topics include liver structure, vascular connections, and biochemical markers. Ideal for medical students or professionals... see morepreparing for exams. see less

2. Which of the following is a liver function test related
to a blood clotting mechanism?

Explanation

Prothrombin time is a measurement of
one of the factors involved in blood clotting; it is affected
by the amount of vitamin K. A prolonged
prothrombin time is often an indicator of poor liver
function

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3. With hepatopetal flow, the blood in the portal vein
and the blood in the hepatic artery?

Explanation

Blood in the normal portal vein and the
hepatic artery is detectable with Doppler. In both
vessels, the blood flows hi the same direction—hepatopetal
flow (i.e., toward the liver). Turbulence is
not a characteristic of the flow in either vessel.

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4. The vessel that typically runs between the portal
vein and the common bile duct is the??

Explanation

The hepatic artery normally runs between
the common bile duct and the portal vein.
It may have a tortuous course and usually bifurcates
proximal to the bifurcation of the common
hepatic duct.

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5. A remnant of the fetal ductus venosus that divides
the caudate lobe of the liver from the left lobe of the
liver is the?

Explanation

In the fetus, the right branch of the umbilical
vein becomes the ductus venosus, which goes
into the inferior vena cava. After birth, the ductus
venosus becomes a fibrous cord called the ligamentum
venosum.

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6. All of the following are characteristics of the hepatic
veins EXCEPT?

Explanation

Hepatic veins do not have echogenic walls.

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7. Which of the following is a rare malignant tumor,
most commonly found in infants and children, that
causes abdominal distention and hepatomegaly?

Explanation

Hepatoblastoma causes liver enlargement
and occurs in small children. Rhabdomyosarcoma
affects the same age-group, but most often
develops around the bladder. Hepatocellular carcinoma
is typically seen in an older population. Focal
nodular hyperplasia is a benign mass. A hematoma
is a benign, blood-filled mass secondary to trauma.

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8. The vessel that is responsible for supplying the liver
with the most nutrients is the?

Explanation

The main portal vein and the hepatic artery
are responsible for supplying the liver with oxygen
and nutrients; however, the main portal vein is the
larger contributor.

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9. Choppy, triphasic flow patterns are seen in the

Explanation

Because of their close proximity to the
right atrium, hepatic veins exhibit a pulsatile,
choppy flow. Normal portal veins have a nonpulsatile,
even flow. The hepatic arteries have a low-resistance
arterial pattern. In normal patients, the superior
mesenteric artery Doppler signal changes
from a high- to low-resistance arterial pattern when
the patient goes from a fasting to postprandial
state. The iliac veins do not normally pulsate, although
the veins vary with respiration.

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10. A highly vascular, benign tumor in the liver is referred
to as a?

Explanation

Hemangiomas are benign, vascular tumors

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11. A casual reading of an abdominal sonogram in apatient with a Riedel's lobe could result in which ofthe following misdiagnoses?

Explanation

A Riedel's lobe is a long, thin extension of
the right lobe of the liver that can put the liver edge
well below the lower pole of the right kidney. Sonologists
using this criterion to make a diagnosis of hepatomegaly
will be guilty of not seeing the forest for
the trees—the entire liver must be taken into account.
The left lobe is often small in patients with a
Riedel's lobe, and patients with a small anteroposterior
diameter have livers that extend more inferiorly
to compensate. A Reidels lobe is unlikely to be
mistaken for any of the other options.

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12. A 30-year-old man is referred to ultrasound forgeneralized right upper quadrant tenderness andearly signs of jaundice. His gallbladder appearsnormal, but there are bright focal areas withoutshadowing scattered throughout his liver. Onclose inspection, these areas are seen to be thewalls of the portal vein branches. What is first inthe list of differential diagnoses?

Explanation

Jaundice brings to mind obstruction from
choledocholithiasis, but with an absence of gallstones
or shadowing throughout the liver a nonobstructive
cause should be considered. A subtle increase
in echogenicity of the portal triads is one of
the few sonographic indications of hepatitis; however,
this finding is not always present. It is possible
that the increase in periportal echogenicity is
caused by the decreased parenchymal echogenicity
sometimes seen in hepatitis. Pneumobilia would
cause linear echogenicity with dirty shadowing.
Choledocholithiasis would be seen as one or more
echogenic densities with acoustic shadowing.

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13. Serum glutamic pyruvic transaminase (SGPT) is
also referred to as?

Explanation

Alanine aminotransferase (ALT) is also
known as serum glutamic pyruvic transaminase
(SGPT). It is the most specific laboratory test for
liver function. ALT is an enzyme produced in the
hepatocytes, and there are high concentrations of
ALT in the liver.

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14. A complex cystic area is seen in the liver. Which of
the following patients, whose occupations are
listed, is MOST at risk to contract this condition?

Explanation

Shepherds are at risk for hydatid disease.
The eggs of this parasite are excreted in the feces
of infected animals, predominantly sheep, resulting
in humans becoming hosts. The liver is the
most common site for cyst development.

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15. All of the following are possible causes of hyper-bilirubin-emia
EXCEPT??

Explanation

Presbyductia is a term used to describe
the normal enlargement of the common bile duct
with age. Although hyperbilirubinemia is usually
associated with liver disease or biliary obstruction,
it can occur in the presence of destruction of red
blood cells, as in hemolytic anemia.

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16. Fatty infiltration of the liver is associated with all of
the following EXCEPT?

Explanation

Of the choices listed, only intravenous
antibiotics are not a cause of fatty infiltration of the
liver. Isolated fatty infiltration of the liver is a benign,
reversible disorder that affects the hepatocytes
and may interfere with liver function.

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17. Which of the following decreases in Hepatocellular
disease?

Explanation

VitaminKlevels decrease inhepatocellular
disease, resulting in a prolonged prothrombin time
(PT). Prolonged PT carries a poor prognosis, but can
revert to normal if the liver damage is reversed.

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18. The vessel(s) in the liver that is(are) important in
denning lobar anatomy for hepatic resection is(are)
the?

Explanation

The hepatic veins define the separation
between the lobes and segments of the liver. The
umbilical vein is no longer patent after birth. There
is no portal artery. The portal vein and hepatic arteries
supply the liver with oxygen and nutrients but
do not separate the lobes. The inferior vena cava
does not separate the lobes of the liver.

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19. The porta hepatis contains all of the following EXCEPT??

Explanation

The sphincter of Oddi is at the entrance
of the common bile duct and pancreatic duct into
the duodenum; it does not lie in the porta hepatis.
Glisson's capsule refers to the fibrous tissue surrounding
the portal veins, bile ducts, and hepatic
arteries as they travel together in the liver. Glisson's
capsule also surrounds the liver. The common
hepatic duct becomes the common bile duct
at the point where it is joined by the cystic duct,
which is in the porta hepatis.

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20. In a patient with a highly echogenic liver, all of the
following laboratory values can help distinguish
between cirrhosis and a normal liver EXCEPT?

Explanation

Acetylcholinesterase is not a laboratory value that can help distinguish between cirrhosis and a normal liver. Acetylcholinesterase is an enzyme that breaks down acetylcholine, a neurotransmitter. It is not specific to liver function and therefore would not be useful in differentiating between cirrhosis and a normal liver.

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21. All of the following increase in hepatocellular disease
EXCEPT??

Explanation

Hepatocellular disease refers to liver cell damage or dysfunction. Bilirubin, prothrombin time (PT), and aspartate aminotransferase (AST) are all markers of liver function and can increase in hepatocellular disease. However, acid phosphatase is not specific to liver function and is not typically elevated in hepatocellular disease. Therefore, acid phosphatase is the exception among the given options.

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22. Cirrhosis of the liver can be caused by all of the following
EXCEPT?

Explanation

Cirrhosis of the liver is a chronic, progressive
disease caused by multiple factors that destroy the liver. Diabetes mellitus is caused by faulty insulin
production in the pancreas. If uncomplicated,
diabetes mellitus does not affect the liver.

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23. All of the following are typical of long-standing cirrhosis
EXCEPT?

Explanation

Cirrhosis is a fibrotic process that causes
the liver to shrink. An enlarged liver occurs in the
early stages of alcohol-related liver disease when
there is fatty infiltration or hepatitis. A nodular outline,
increased echogenicity, and hepatofugalflow of
the portal veins are all features of severe cirrhosis.

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24. All of the following are features of portal hypertensionEXCEPT

Explanation

Portal hypertension refers to an increase
in pressure in the portal venous system, usually
caused by liver disease or possibly portal vein
thrombosis. Hepatic artery thrombosis is not a
typical result of portal hypertension; however, the
portal vein often becomes thrombosed in portal
hypertension. Collaterals and splenomegaly result
from the pressure being reversed or forced to create
new paths.

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25. A patient with end-stage cirrhosis exhibits hepatofugal
portal flow, making the presence of collateral
vessels likely. A close look at which of the
following will MOST easily demonstrate collateral
flow?

Explanation

Hepatofugal portal flow occurs in advanced
portal hypertension, a common sequel to
chronic cirrhosis. When sinusoidal resistance to
flow is so great that the direction of flow reverses,
portosystemic collaterals open up; the easiest to
detect is the recanalized paraumbilical vein that
travels in the ligamentum teres. To locate the paraumbilical
vein, find the ascending portion of the
left portal vein and follow the umbilical portion of
it inferiorly between the medial and lateral segments
of the left lobe of the liver. Color flow
Doppler will demonstrate flow and that the vein is
indeed recanalized.

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26. Hepatofugal flow may be indicative of all of the
following EXCEPT?

Explanation

Common bile duct obstruction is not associated
with hepatofugal flow. Hepatofugal flow
occurs when the pressure in the portal system of
the liver is increased and blood cannot flow
through the portal vein. A reversal of the normal
direction of flow is detected with Doppler imaging;
however, a poor Doppler angle may create
false direction of flow.

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27. A 23-year-old college student is referred by the universityhealth clinic because of diffuse abdominaland right upper quadrant pain. There is some freefluid in her abdomen and an encapsulated mass inher liver that is solid but contains complex cysticcomponents. The sonologist, quite correctly, makeshepatic adenoma the first differential diagnosis forall of the following reasons EXCEPT one. Which is it?
**Will not be graded*** Hard question to get you thinking :)

Explanation

If a mass and ascites are discovered, it is
necessary to search carefully for metastases and
enlarged lymph nodes, treating the lesion as a
possible malignancy. However, in their absence,
this woman's history—especially the oral contraceptive
use—is appropriate for hepatic adenoma.
Hepatic adenomas are benign, so metastatic lesions
("bull's eye" or otherwise) would not be
present. The free fluid in her abdomen is from the
bleeding going on in her mass, which has ruptured
through the capsule into the peritoneum, irritating
it and causing her diffuse pain.

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28. A preoperative ultrasound study reveals a solitaryliver mass displacing two structures in the liver.The surgeon is told he can confine his operation tothe medial segment of the left lobe. Which twostructures are being displaced?

Explanation

The middle and left hepatic veins border
the medial segment of the left lobe of the liver. The
ligamentum teres separates the lateral and medial
segments of the left lobe at a more inferior level. A
mass that touches the gallbladder would have to
be in the right anterior lobe. The main portal vein
and hepatic duct are down by the porta hepatis.The left portal vein lies exclusively in the lateral segment of the left lobe, not the medial segment.

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29. A health care worker contracted hepatitis B from an
accidental needle stick. Which of the following is
NOT likely to be seen on her abdominal sonogram?

Explanation

This one is tricky I added it, but you will not be graded on this question. :)

A lobular outline to the liver is a feature
of cirrhosis, not hepatitis. Prominent portal vessels,
a thickened gallbladder wall, splenomegaly, and a
hypoechoic liver are all seen in hepatitis. Prominent
portal vessels, giving rise to the "starry night" appearance,are caused by edema of the liver.

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30. The normal Doppler waveform of the portal veinis

Explanation

The normal portal vein flows continuously
into the liver, which makes it a monophasic
waveform. Triphasic describes a waveform seen
particularly in the leg arteries and hepatic veins.

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31. On which of the following views are all three hepatic
veins BEST seen?

Explanation

A high transverse view close to the diaphragm
best shows the three hepatic veins. The
veins join the inferior vena cava just below the diaphragm.
Longtudinal views only show a single
vein.

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32. Common conditions in which the gallbladder wall
is thickened include all of the following EXCEPT

***Think ***** This is a tough one!!!!
Will not count if you get it wrong

Explanation

Isolated fatty infiltration of the liver is not
associated with gallbladder wall thickening. Acute
cholecystitis, AIDS, ascites, and hypoalbuminemia
all cause gallbladder wall thickening.

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33. Which of the following vessels is associated with
waveforms that do NOT vary with respiration in a
normal patient?

Explanation

The waveforms of the hepatic vein, jugular
vein, femoral vein, and inferior vena cava all vary
with respiration. Only the portal vein waveform
does not vary with respiration.

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34. Which of the following statements concerning
metastatic lesions to the liver is TRUE?
*Hard Question will not count in grading*

Explanation

The first four answers are absolute statements:
melanomas frequently metastasize to the
gallbladder; colon metastases are sometimes "bull's
eye" lesions; color flow Dopplermay show vascular
flow; and lymphomatous lesions in the liver are
usually hypoechoic, but not always. Actually, this
was a trick question to ask after the cautionary tip
about "never" being in the answer. However, in
this case "never" means "not always," so it is stopping
you from making an absolute statement.

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The liver is an intraperitoneal organ surrounded byperitoneum. Which...
Which of the following is a liver function test relatedto a blood...
With hepatopetal flow, the blood in the portal veinand the blood in...
The vessel that typically runs between the portalvein and the common...
A remnant of the fetal ductus venosus that dividesthe caudate lobe of...
All of the following are characteristics of the hepaticveins EXCEPT?
Which of the following is a rare malignant tumor,most commonly found...
The vessel that is responsible for supplying the liverwith the most...
Choppy, triphasic flow patterns are seen in the
A highly vascular, benign tumor in the liver is referredto as a?
A casual reading of an abdominal sonogram in apatient with a Riedel's...
A 30-year-old man is referred to ultrasound forgeneralized right upper...
Serum glutamic pyruvic transaminase (SGPT) isalso referred to as?
A complex cystic area is seen in the liver. Which ofthe following...
All of the following are possible causes of...
Fatty infiltration of the liver is associated with all ofthe following...
Which of the following decreases in Hepatocellulardisease?
The vessel(s) in the liver that is(are) important indenning lobar...
The porta hepatis contains all of the following EXCEPT??
In a patient with a highly echogenic liver, all of thefollowing...
All of the following increase in hepatocellular diseaseEXCEPT??
Cirrhosis of the liver can be caused by all of the followingEXCEPT?
All of the following are typical of long-standing cirrhosisEXCEPT?
All of the following are features of portal hypertensionEXCEPT
A patient with end-stage cirrhosis exhibits hepatofugalportal flow,...
Hepatofugal flow may be indicative of all of thefollowing EXCEPT?
A 23-year-old college student is referred by the universityhealth...
A preoperative ultrasound study reveals a solitaryliver mass...
A health care worker contracted hepatitis B from anaccidental needle...
The normal Doppler waveform of the portal veinis
On which of the following views are all three hepaticveins BEST seen?
Common conditions in which the gallbladder wallis thickened include...
Which of the following vessels is associated withwaveforms that do NOT...
Which of the following statements concerningmetastatic lesions to the...
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