ARDMS Abdomen Ultrasound Registry Review Exam
Questions And Answers (Verified And Updated)
How many segments does the Couinaud system divide the liver into?
Eight surgical segments
What divides the right lobe of the liver into an anterior and posterior segment?
Right hepatic vein
What vessel separates the right and left lobe? Where does it lie (fissure)?
Middle hepatic vein, which lies in the main lobar fissure
LLL is divided into medial and lateral segments by:
Left hepatic vein
The caudate lobe is separated from the LLL by which ligament?
ligamentum venosum
Main portal vein is created by the merging of which two vessels? What is this area referred to as?
Superior mesenteric vein and splenic vein. Known as the splenic portal confluence
What is the name of the capsule surrounding the liver?
Glisson capsule
Normal AP measurement of the MPV?
13mm or less
What is an enlarged (>13mm) portal vein signify?
Portal hypertension
Normal MPV flow?
Hepatopetal and monophasic w/ some respiratory variation
Where do the hepatic veins drain?
IVC
These veins are considered both interlobar and intersegmental
hepatic veins. They are located between the segments and the lobes
normal hepatic vein flow
-Hepatofugal - away from liver
-pulsatile, triphasic due to right atrial pressure changes
-respiratory variation
,Narrowing or occlusion of the hepatic veins is indicative of:
Budd-Chiari syndrome
The liver hilum is also know as
The porta hepatis
flow pattern of the hepatic artery should be
low resistance since it is feeding the liver
After birth the umbilical vein becomes
ligamentum teres aka round ligament
-runs along with the falciform ligament
-will usually be seen near left portal vein in left liver
Where can the main lobar fissure be seen?
-in sag plane
-will appear to connect the neck of the GB with the RPV
-also separates right and left hepatic veins
hepatic steatosis
fatty liver
Causes of fatty liver disease
Fatty deposits within the hepatocytes.
Once it becomes cirrhosis, it is non-reversible.
1. Alcoholic fatty liver disease
2. Non-alcoholic fatty liver disease:
-obesity
-starvation
-chemotherapy
-diabetes mellitus
-hyperlipidemia
-pregnancy
-von Gierke disease (glycogen storage dx)
-total parental nutrition
-cystic fibrosis
steatohepatitis
inflammation of the liver associated with fat
precursor for chronic liver dx leading to fibrosis, cirrhosis, and HCC
hepatomegaly size
>15cm
,need to correlate with clinical hx
don't confused Riedel's lobe as hepatomegaly
Fatty liver symptoms and labs
Symptoms:
-usually asymptomatic
Labs:
-Increased LFTs (especially AST and ALT)
Sono appearance of fatty liver dx and focal fatty infiltration
-Diffusely echogenic liver
-Increased attenuation of sound beam
-Walls of hepatic vasculature and diaphragm will not be easily imaged due to increased attenuation
-Fatty changes will be diffuse or focal
Focal fatty infiltration sono app:
-hyperechoic area next to the GB, near the porta hep, or part of lobe may appear echogenic
Focal fatty sparing sonographic appearance
-entire liver is involved with diffuse fatty infiltration with certain areas spared
-Area of sparing can look like a solid hypoechoic mass
-Hypoechoic area will be near GB, porta hep, or entire lobe may be spared
-Can appear to look like pericholecystic fluid
Two most common types of hepatitis:
A and B
A: Fecal-oral route: contaminated water or food
B: Contact with body fluids, mother-to-infant transmission, blood contact (IV drugs)
Most common type of hepatitis in healthcare workers
Hep C
-Spread by blood and body fluid contact
Which type of hepatitis is the leading indication for liver transplantation in US?
Hepatitis C
Wilson disease
Hemochromatosis
Autoimmune disorders
Drugs
All of the above can be causes for chronic ________ of the liver
Hepatitis
What is Wilson disease?
, -An inherited disorder that causes too much copper to accumulate in the liver, brain and other vital
organs.
-Also called hepatolenticular degeneration.
-Causes fatty changes & fibrosis in the liver. Leads to chronic hepatitis
Trademark feature: Copper ring around iris
What is hemochromatosis?
Iron overload disease resulting in abnormal deposition of iron
Can lead to fatty changes and chronic hepatitis
Clinical signs and symptoms of hepatitis
-Nonobstructive Jaundice (related to hep on a cellular level NOT biliary obstruction)
-Hepatosplenomegaly
-Dark urine
-F/N/V
-Elevated LFTs
-Fatigue
-Chills
Hepatic encephalopathy
-central nervous system dysfunction resulting from overexposure of brain to toxins
-causes confusion and intermittent loss of consciousness
What is refractory hypertension?
Hypertension that is unresponsive to medication
- is related to renal artery stenosis
Clinical signs and symptoms of renovascular hypertension and renal artery stenosis (RAS)?
-Refractory HTN (doesn't respond to meds
-Very high systemic blood pressure (malignant HTN)
-Abd bruit
-Elevated creatinine and cholesterol
-Unexplained CHF or pulmonary edema
Most common cause of RAS and location?
Most common: Atherosclerosis
-loc: Proximal segment
2nd most common: FMD
-loc: distal 2/3 of artery
What is the kidneys response when they receive less blood flow (due to RAS)
-Perceive the body as having reduced systemic BP
-will activate renin-angiotensin aldosterone system
>this will raise BP to try to increase flow to the kidneys, ultimately causing systemic HTN
Questions And Answers (Verified And Updated)
How many segments does the Couinaud system divide the liver into?
Eight surgical segments
What divides the right lobe of the liver into an anterior and posterior segment?
Right hepatic vein
What vessel separates the right and left lobe? Where does it lie (fissure)?
Middle hepatic vein, which lies in the main lobar fissure
LLL is divided into medial and lateral segments by:
Left hepatic vein
The caudate lobe is separated from the LLL by which ligament?
ligamentum venosum
Main portal vein is created by the merging of which two vessels? What is this area referred to as?
Superior mesenteric vein and splenic vein. Known as the splenic portal confluence
What is the name of the capsule surrounding the liver?
Glisson capsule
Normal AP measurement of the MPV?
13mm or less
What is an enlarged (>13mm) portal vein signify?
Portal hypertension
Normal MPV flow?
Hepatopetal and monophasic w/ some respiratory variation
Where do the hepatic veins drain?
IVC
These veins are considered both interlobar and intersegmental
hepatic veins. They are located between the segments and the lobes
normal hepatic vein flow
-Hepatofugal - away from liver
-pulsatile, triphasic due to right atrial pressure changes
-respiratory variation
,Narrowing or occlusion of the hepatic veins is indicative of:
Budd-Chiari syndrome
The liver hilum is also know as
The porta hepatis
flow pattern of the hepatic artery should be
low resistance since it is feeding the liver
After birth the umbilical vein becomes
ligamentum teres aka round ligament
-runs along with the falciform ligament
-will usually be seen near left portal vein in left liver
Where can the main lobar fissure be seen?
-in sag plane
-will appear to connect the neck of the GB with the RPV
-also separates right and left hepatic veins
hepatic steatosis
fatty liver
Causes of fatty liver disease
Fatty deposits within the hepatocytes.
Once it becomes cirrhosis, it is non-reversible.
1. Alcoholic fatty liver disease
2. Non-alcoholic fatty liver disease:
-obesity
-starvation
-chemotherapy
-diabetes mellitus
-hyperlipidemia
-pregnancy
-von Gierke disease (glycogen storage dx)
-total parental nutrition
-cystic fibrosis
steatohepatitis
inflammation of the liver associated with fat
precursor for chronic liver dx leading to fibrosis, cirrhosis, and HCC
hepatomegaly size
>15cm
,need to correlate with clinical hx
don't confused Riedel's lobe as hepatomegaly
Fatty liver symptoms and labs
Symptoms:
-usually asymptomatic
Labs:
-Increased LFTs (especially AST and ALT)
Sono appearance of fatty liver dx and focal fatty infiltration
-Diffusely echogenic liver
-Increased attenuation of sound beam
-Walls of hepatic vasculature and diaphragm will not be easily imaged due to increased attenuation
-Fatty changes will be diffuse or focal
Focal fatty infiltration sono app:
-hyperechoic area next to the GB, near the porta hep, or part of lobe may appear echogenic
Focal fatty sparing sonographic appearance
-entire liver is involved with diffuse fatty infiltration with certain areas spared
-Area of sparing can look like a solid hypoechoic mass
-Hypoechoic area will be near GB, porta hep, or entire lobe may be spared
-Can appear to look like pericholecystic fluid
Two most common types of hepatitis:
A and B
A: Fecal-oral route: contaminated water or food
B: Contact with body fluids, mother-to-infant transmission, blood contact (IV drugs)
Most common type of hepatitis in healthcare workers
Hep C
-Spread by blood and body fluid contact
Which type of hepatitis is the leading indication for liver transplantation in US?
Hepatitis C
Wilson disease
Hemochromatosis
Autoimmune disorders
Drugs
All of the above can be causes for chronic ________ of the liver
Hepatitis
What is Wilson disease?
, -An inherited disorder that causes too much copper to accumulate in the liver, brain and other vital
organs.
-Also called hepatolenticular degeneration.
-Causes fatty changes & fibrosis in the liver. Leads to chronic hepatitis
Trademark feature: Copper ring around iris
What is hemochromatosis?
Iron overload disease resulting in abnormal deposition of iron
Can lead to fatty changes and chronic hepatitis
Clinical signs and symptoms of hepatitis
-Nonobstructive Jaundice (related to hep on a cellular level NOT biliary obstruction)
-Hepatosplenomegaly
-Dark urine
-F/N/V
-Elevated LFTs
-Fatigue
-Chills
Hepatic encephalopathy
-central nervous system dysfunction resulting from overexposure of brain to toxins
-causes confusion and intermittent loss of consciousness
What is refractory hypertension?
Hypertension that is unresponsive to medication
- is related to renal artery stenosis
Clinical signs and symptoms of renovascular hypertension and renal artery stenosis (RAS)?
-Refractory HTN (doesn't respond to meds
-Very high systemic blood pressure (malignant HTN)
-Abd bruit
-Elevated creatinine and cholesterol
-Unexplained CHF or pulmonary edema
Most common cause of RAS and location?
Most common: Atherosclerosis
-loc: Proximal segment
2nd most common: FMD
-loc: distal 2/3 of artery
What is the kidneys response when they receive less blood flow (due to RAS)
-Perceive the body as having reduced systemic BP
-will activate renin-angiotensin aldosterone system
>this will raise BP to try to increase flow to the kidneys, ultimately causing systemic HTN
