Abdm Ultra: 100726: Budd-Chiari, Hematomas, Neoplasms, Metastasis, Liver Transplants

Front 1

What is a thrombosis?

Back 1

A local coagulation or clotting of the blood in a part of the circulatory system

Front 2

What is Budd-Chiari Syndrome?

Back 2

Thrombosis of the hepatic veins or the IVC.
(Debra said to know this)

Front 3

What is another name for Budd-Chiari Syndrome?

Back 3

Hepatic vein thrombosis
(Debra said to know this)

Front 4

What are 6 sonographically visible symptoms of Budd-Chiari syndrome?

Back 4

1. Massive ascites
2. Enlarged caudate lobe
3. Atrophied right lobe
4. Enlarged hepatic veins
5. Esophageal varices (extra small vessels) around the GEJ (occurs because enlarged cuadate puts pressure on IVC)
6. Hepatomegaly
(See P 232, 233)
(Debra said to know this)

Front 5

What can occur as a result of Budd-Chiari syndrome?

Back 5

Life-threatening acute liver failure

Front 6

What is a liver "mass"?

Back 6

Anything in the liver that doesn't belong there.

Front 7

What do contrast agents accomplish?

Back 7

They create microbubbles which enhance the Doppler signal from the blood.

Front 8

What is a 1st generation contrast agent? Is it low or high MI?

Back 8

Lenovist
High MI

Front 9

What are two 2nd generation contrast agents? Are they low or high MI?

Back 9

Definity
Optison
Low MI

Front 10

From where do most liver tumors derive their blood supply?

Back 10

The hepatic artery
(Debra said to know this)

Front 11

What is a hematoma?

Back 11

A collection of blood outside the blood vessels, generally the result of hemorrhage, or more specifically, internal bleeding. It is commonly called a bruise.

Front 12

What is a neoplasm?

Back 12

A new and abnormal growth of tissue in some part of the body, esp. as a characteristic of cancer.

Front 13

A (benign / malignant) neoplasm is most common in neonates and infants.

Back 13

benign

Front 14

A (benign / malignant) neoplasm is most common in adults

Back 14

malignant

Front 15

What are the 3 most common types of benign neoplasms?

Back 15

1. Cavernous hemangioma
2. Adenoma
3. Focal nodular hyperplasia

Front 16

What is a hemangioma?

Back 16

A benign tumor of blood vessels, usually asymptomatic

Front 17

Hemangiomas are believed to be linked to ______.

Back 17

estrogen

Front 18

Hemangiomas occur most frequently in (men / women), and (decrease / increase) with age.

Back 18

women
increase

Front 19

Hemangiomas are usually (homogeneous / heterogeneous) and (hyperechoic / hypoechoic), with (poorly defined / well defined) margins and (dirty shadowing / posterior enhancement)

Back 19

homogeneous
hyperechoic
well defined
posterior enhancement
(See Pp 252-255)

Front 20

What is a focal nodular hyperplasia?

Back 20

A benign tumor of the liver, which is the second most prevalent tumor of the liver (the first is hepatic hemangioma). It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential.

Front 21

FNHs are most common in (men / women) (under / over) 40, and is associated with use of ___ ___ ____.

Back 21

women
under
birth control pills
(Debra said to know this)

Front 22

FNHs occur as (poorly defined / well defnined) masses, and are ____ echoic with normal liver tissue.

Back 22

well defined
hyperechoic, hypoechoic, or isoechoic

Front 23

What would be a common differential for a FNH?

Back 23

A cavernous hemangioma, since both can be hyperechoic, occur most commonly in younger women, and are linked to estrogen / birth control pills.

Front 24

Cavernous hemangiomas (do / do not) cause a decrease in liver cell function.

Back 24

do not

Front 25

FNH's (do / do not) cause a decrease in liver cell function.

Back 25

do

Front 26

What is a hepatic adenoma?

Back 26

An uncommon benign liver tumor which is associated with the use of hormonal contraception with a high estrogen content.

Front 27

Hepatic adenomas are usually (solitary / multiple) with (poorly defined / well defined) margins

Back 27

solitary
well defined

Front 28

Hepatic adenomas are (less / more) common in women of childbearing age, and (are / are not) associated with birth control pills.

Back 28

more
are

Front 29

Hepatic adenomas are usually (hyperechoic / hypoechoic / isoechoic).

Back 29

hyperechoic
(See Pp 260, 261)

Front 30

What is a malignant neoplasm?

Back 30

Cancer; a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood).

Front 31

What are 3/4 types of malignant neoplasms?

Back 31

1. Primary hepatic tumors (hepatocellular carcinomas in adult) (I think is same as hepatoma)
2. Metastases (from other areas)
3. Hepatomas (hepatocellular carcinomas)
4. Hepatoblasoma (liver tumor in children)
(Debra said to know this)

Front 32

What are some symptoms of malignant neoplasms?

Back 32

- jaundice
– weight loss
– hepatomegaly
– palpable mass
– ascites
– portal hypertension
– splenomegaly
– RUQ pain
- deterioration of liver function
- fever

Front 33

A hepatoma is usually (focal / dispersed), but can also be (focal / dispersed)

Back 33

focal
dispersed

Front 34

Hepatomas are (large / small / diffuse / circumscribed / all of the above)

Back 34

All of the above

Front 35

Hepatomas are (hyperechoic / hypoechoic / isoechoic / all of the above)

Back 35

All of the above

Front 36

Color (inside the mass / in the periphery) is indicative of malignancy

Back 36

inside the mass

Front 37

(Regular / Irregular) borders are indicative of malignancy

Back 37

Irregular
(See Pp 266-270)

Front 38

What is metastasis?

Back 38

The spread of a disease from one organ or part to another non-adjacent organ or part.

Front 39

From what 3 main sources do hepatic metastatic lesions usually originate?

Back 39

1. Breast
2. GI tract
3. Lungs

Front 40

FNHs, cavernous hemangiomas, hepatic adenomas, and ,primary liver cancers are usually (singular / multiple) - so when you see multiple masses, you normally think of _____.

Back 40

single
metastasis
(See Pp 272-274)

Front 41

What is a hepatoblastoma?

Back 41

An uncommon malignant liver neoplasm occurring in infants and children and composed of tissue resembling fetal or mature liver cells or bile ducts.

Front 42

Hepatoblastomas are most common in (boys / girls), and usually occur before age _.

Back 42

boys
4

Front 43

Hepatoblastomas are usually seen in the ____ lobe, but they can affect both lobes.

Back 43

right

Front 44

The caudate lobe is usually (affected by / spared from) a hepatoblastomas

Back 44

spared from (due to having its own blood supply)

Front 45

What are some clinical symptoms of hepatoblastoma?

Back 45

Hepatomegaly or a palpable abdominal mass
Fever, weight loss, nausea, vomiting, jaundice, anemia, leukocytosis, adenopathy, or bone fractures from metastasis

Front 46

A hepatoblastoma will usually be (solitary / in a group).

Back 46

Solitary

Front 47

A hepatoblastoma will usually contain _____ foci, with dense or coarse _____.

Back 47

anechoic
calcifications (which cause shadowing)

Front 48

Dense or coarse ______ which cause shadowing are common indicators for a hepatoblastoma

Back 48

calcifications

Front 49

When reviewing a liver transplant patient, we should ensure that there is proper ___ ____ in all hepatic _____, specifically checking for ______ or _____.

Back 49

blood flow
vessels
stenosis
thrombus

Front 50

When reviewing a liver transplant patient, we should ensure that the liver _____ has the proper _____.

Back 50

parenchyma
texture

Front 51

After a liver transplant, the main complication is ____ of the organ, usually due to lack of proper ___ flow.

Back 51

rejection
blood

Front 52

After a liver transplant, the vessel most likely to suffer a thrombus or a stenosis is the ____ _____.

Back 52

hepatic artery

Front 53

After a transplant, ____ flow, as well as blood flow, should be checked.

Back 53

biliary

Front 54

Unlike kidneys and the pancreas, the liver is placed ______________ following a transplant

Back 54

back in the same location

Front 55

What are 4 sonographically significant elements we should check after a liver transplant?

Back 55

1. Vascular patency, especially at anastamosis (reconnection) points
2. Biliary duct patency
3. Liver texture (should be same as typical liver
4. Peritoneal fluid (expect a little bit for up to 2 weeks after surgery)

Front 56

The hepatic artery should exhibit a (high / low) resistance wave form.

Back 56

low

Front 57

The chief characteristic of a low resistance wave form is _____ _____ _____.

Back 57

continuous diastolic flow

Front 58

The portal vein should demonstrate (continuous / intermittent) flow in the (hepatopedal / hepatofugal) direction, with mild velocity variations due to respiration.

Back 58

continuous
hepatopedal

Front 59

The hepatic veins should demonstrate a (phasic / pulsatile) wave form, but still reflecting the strong influence of the _____ cycle, which makes it look arterial.

Back 59

phasic
cardiac

Front 60

Veins should sound like they're in a ___ ____.

Back 60

Wind tunnel

Front 61

If hepatic artery thrombosis is present, we will see a damped HA waveform known as a ____ _____ waveform.

Back 61

tardus parvus
(See liver transplants slideset, page 13)

Front 62

A tardus parvus wavform lacks the high _____ peak typical for an artery.

Back 62

systolic

Front 63

Other than hepatic artery complications, what two other types of vascular complications can occur following a liver transplant?

Back 63

1. Portal vein thrombosis
2. IVC thrombosis

Front 64

What are the clinical symptoms of a hepatoma?

Back 64

1. RUQ pain
2. Sudden deterioration of liver function
3. A palpable mass
4. Rapid liver enlargement
5. Fever
(Debra said to know this)