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52 Cards in this Set
- Front
- Back
what separates left and right lobes superiorily?
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middle hepatic vein
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what divide segments of left and right lobes of the liver at the superior level?
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LEFT: left hepatic vein seperates lateral and medial segments; RIGHT: r hepatic vein separates anterior and posterior segments
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what proportion of bloodflow to liver from hepatic A. and portal V.?
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hepatic artery: 20%; portal vein: 80%
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attentunation of abdominal organs on C- CT
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Liver > Spleen > Pancreas > Kidney
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three types of malignant primary liver tumors
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HCC (hepatocellular), CHOLANGIOCARCINIMA (biliary epithelium), ANGIOSARCOMA (mesenchymal)
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three types of benign primary liver tumors
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focal nodular hyperplasia (hepatocellular), simple hepatic cyst (biliary epithelium), hemangioma (mesenchymal)
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findings in autosomal dominant polycystic dz
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multiple cysts in liver and kidney, with secondary splenomegaly
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charactersitics of simple cyst on CT
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homogenous waterdense lesions with imperceptible wall
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what liver pathology causes diffuse increased echogenicity?
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fatty infiltration, cirrhosis, diffuse HCC, AIDS
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what liver pathology causes diffuse decreased echogenicity?
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hepatitis, amyloid
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what does hemangioma look like on CT, US, and MRI?
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CT: C+ early dense PERIPHERAL ENHANCEMENT with delayed centripetal filling; US: hyperechoic with enhanced through transmission; MRI: T1 hypointense T2 hyperintense
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most common benign tumor of the liver
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hemangioma
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fat and fluid on T1 and T2
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fat: bright, fluid: dark (opposite on T2)
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characteristic feature of focal nodular hyperplasia (FNH)
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central stellate scar; also, has functional kupffer cells / hepatocytes --> can use uptake imaging
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Focal nodular hyperplasia (FNH) on CT/US/MRI
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CT: C- hypodense +/- CENTRAL SCAR (30%), C+ early enhancement; US: hypoechoic with inc flow from central feeding vessel; MRI: Gd-BOPTA test of choice, ISOINTENSE with liver on 2 hr delay due to similar excretion into biliary tract
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what is Gd-BOPTA
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used for liver MRI; taken up by hepatocytes and then excreted into biliary system
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hepatocellular adenoma vs FNH on Gd-BOPTA
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both take up Gd-BOPTA, but adenoma is not connected to biliary system --> low signal on delayed views, unlike FNH which maintains isodensity
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hepatocellular adenoma on CT/US/MRI
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consists of fat and glycogen --> CT: hypodense with hyperdense enhancment on C+; US: HYPERechoic, heterogenous if necrosis/hemorrhage; MRI: fat --> darkens on T1 from in phase to out of phase, low signal on delayed GdBOPTA
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which is more common, liver mets or primary liver tumors?
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liver mets 20x as common, unless cirrhosis or hemochromatosis --> HCC more common than mets
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radiologic test of choice for HCC
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triple-phase CT: C- low attenuation; C+: ARTERIAL phase: hyperdense; PORTAL phase: hypodense; EQUILIBRIUM phase: hypodense with hyperdense pseudocapsule [because HCC receives blood from hepatic artery, while liver only receives 20% from hepatic a.]
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what does leiomyosarcoma look like on CT?
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large, noncalcified, homogenous mass with inhomogenous peripheral enhancement
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what hepatic pathology more common in young women on OCP
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hepatic adenoma and FNH
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causes of psammomatous calcification of hepatic mets
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mucinous cystadenocarcinoma of the GI tract (colon, stomach, pancreas); serous cystadenocarcinoma of the ovaries
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radiologic findings with cirrhosis
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early: hepatomegaly +/- fatty infiltration; late: shrunken, nodular liver with portal HTN, hypertrophied caudate lobe and sometimes left lobe (dual blood supply),
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what do regenerating nodules and fibrosis look like on MRI?
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regen nodules bright on t1, fibrosis dark; opposite for t2
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where do varices of portal HTN tend to cluster?
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splenic hilum
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how to diagnose fatty infiltration by imaging
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MRI: T1 --> fat changes from bright (in phase) to dark (out of phase)
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causes of high attenuation liver (CT)
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infiltration: hemosiderosis, hemochromatosis, amiodarone, gold therapy, wilson's disease, glycogen storage disease, thorotrast
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diff between hemochromatosis and hemosiderosis
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hemochromatosis: Fe in parenchyma (not RES) --> liver and panc with end-organ dystruction, no spleen involvement; HEMOSIDEROSIS: Fe in RES only --> liver and SPLEEN, pancreas spared, no end-organ dysfunction
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how to dx iron deposition in the liver (imaging)
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MRI: T1 --> dark out of phase, even darker in phase (opposite of fat)
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mcc biliary tract air
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iatrogenic or fistula
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only potentially curative tx for HCC
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surgical resection
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blood supply to HCC vs liver parenchyma
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HCC is 100% hepatic artery; parenchyma is 20% hepatic a., 80% portal v
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regenerating nodules vs siderotic nodules on imaging
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regen nodules bright on t1, siderotic nodules dark on t1
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between what two arteries is the pancreas found?
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below the celiac trunk, above the SMA, anterior to the aorta
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in what renal space is the pancreas found?
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anterior pararenal space (along with duodenum and descending colon)
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what risk increased with pancreas divisum? What is it?
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most commong congenital variant -- failure to fuse of dorsal and ventral pancreatic heads --> 2 openings into duodenum --> INCREASED risk of PANCREATITIS, perhaps b/c second opening too small --> backup of enzymes
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Balthazar's grading system for pancreatitis (5)
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A: NORMAL pancreas; B: focal or diffuse pancreatic EDEMA; C: ABNORMAL pancreas + peripancreatic INFLAMMATION; D: small, single FLUID collection; E: >=2 large fluid collections +/- gas
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what characteristic radiologic finding on plain film for pancreatitis
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"splenic cutoff sign:" abrupt tapering in proximal descending colon (due to spasm); also, "sentinal small bowel loop" with air fluid levels
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what is the "renal halo sign"
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seen with pancreatitis: fluid collection develops in anterior pararenal space, makes perirenal fat more promient, looks like a halo around the kidneys
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what does pancreatic necrosis look like on CT?
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no enhancement on C+ CT
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what causes diffuse changes in echotexture of pancreas?
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diffuse hyperechoic: fatty replacement; diffuse hypoechoic: edema
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most common pancreatic neoplasm
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ductal adenocarcinoma (75%), usu located in the head
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CT appearance of pancreatic cancer
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hypodense -- usu poorly vascular
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US apperance of pancreatic cancer
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almost always hypoechoic or with hypoechoic areas
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CT criteria of unresectability of pancreatic mass (4)
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1) INVASION of surrounding organs; 2) enlarged LYMPH NODES; 3) distant METS; 4) VASCULAR encasement/occlusion
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"double duct sign"
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both CBD and pancreatic duct dilated -- often seen with pancreatic cancer (other causes: ampullary carcinoma, cholangiocarcinoma, stones)
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what is meig's syndrome?
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benign ovarian fibroma a/w hydrothorax and ascites
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what is krukenberg tumor?
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primary GI tumor (pancreatic or stomach) with mets to both ovaries
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two big groups of cystic neoplasms
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mucinous macrocystic (MALIGNANT) and serous microcystic (BENIGN); both increased freq in women
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what is whipple's procedure?
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pancreaticoduodenectomy (duodenum/jejunum attached directly to stomach body
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how to assess transplant vasculature
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color doppler
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