Term
| What are the 3 orders of liver division and how are they divided? |
|
Definition
First Order-Portal Vein Branching
(Right and Left Portal Branches)
Second Order-Portal Vein Branching
(4 parts divides by 3 Hepatic Veins)Third Oder-Portal Vein Branching
(8 Segments) |
|
|
Term
| Where does the caudate lobe lie? |
|
Definition
| The caudate lobe lies on the posterior-superior surface of the liver between the inferior vena cava and the medial left lobe of the liver. |
|
|
Term
| How is the caudate lobe supplied blood and how is it drained? |
|
Definition
| It is supplied by the branches of the left and right portal venous and hepatic arterial systems. It is drained by small veins (emissary veins) which enter directly into the IVC. |
|
|
Term
| How many segments are there for the liver and what part of the liver is contained in each segment. |
|
Definition
8 segments
I-Caudate Lobe
II-Left Lateral Superior
III-Lef Lateral Inferior
IVa-Left Medial Superior
IVb-Left Medial Inferior
V-Right Anterior Inferior
VI-Right Posterior Inferior
VII-Right Posterior Superior
VIII-Right Anterior Superior |
|
|
Term
| What are the Portal Triad vessels? |
|
Definition
Main Portal Vein
Proper Hepatic Artery
Common Hepatic Duct |
|
|
Term
| Most common parasitic infections in humans, it is the major cause of portal hypertension worldwide |
|
Definition
|
|
Term
| What are the sonographic findings for schistosomiasis |
|
Definition
Occluded intrahepatic portal veins
thickening and increased echogenicity of the portal veins |
|
|
Term
| What are secondary signs of portal hypertension |
|
Definition
Splenomegaly
Ascites
Esophageal variceal bleeding
Portosystemic collaterals |
|
|
Term
| Granulomas present as what in the liver and caused by. |
|
Definition
| They present as small calcifications and caused by Histoplasmosis or Tuberculosis. |
|
|
Term
| The accumulation of triglycerides within the haptocytes is known as? |
|
Definition
Fatty liver disease-steatosis
(fatty infiltration) |
|
|
Term
| Sonographically, infiltration of fat within the liver appears as |
|
Definition
| Increased echogenicity and decreased acoustic penetration. |
|
|
Term
| Focal regions of increased echogenicity within normal liver parenchyma that commonly occurs at the porta hepatis is known as |
|
Definition
|
|
Term
| Focal regions of normal liver parenchyma within a fatty infiltrated liver that commonly occurs adjacent to the GB,in the porta hepatis, in the caudate lobe, and in the liver margins is known as? |
|
Definition
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|
Term
| A genetically acquired disorder that results in excess deposition of glycogen in the liver that's associated with fatty infiltration and hepatic adenomas is known as |
|
Definition
|
|
Term
| Differential diagnosis of hyperechoic masses within the liver include: |
|
Definition
Focal fatty infiltration
Cavernous hemangiomas
Echegenic metastasis
Hepatic lipoma |
|
|
Term
| A diffuse process of fibrosis and distortion of normal liver architecture is? |
|
Definition
|
|
Term
| What is the leading cause of cirrhosis in the nation? |
|
Definition
|
|
Term
| What are some other causes of cirrhosis? |
|
Definition
Alcoholic liver disease
Hep C
Wilson tumor
Right sided heart failure/Tricuspid reurgitation
Hep b |
|
|
Term
| What liver functions increase with cirrhosis? |
|
Definition
AST(SGOT)
ALT(SGPT)
GGT
LDH(LACTATE DYGROGENASE)
Conjugated bilirubin |
|
|
Term
| With cirrhosis sonographic findings include? |
|
Definition
Hepatomegaly(acute)
Liver atrophy(chronic)
Caudate lobe enlargement
Surface nodularity(regenerative nodules)
Fatty infiltration(increased echogenicity)
Changes related to portal hypertension
***Increased incidence of hepatocellular CA |
|
|
Term
| What is normal portal pressure? |
|
Definition
|
|
Term
When the diameter of the portal is >13mm this suggest?
Normal PV diamter is? |
|
Definition
a)Portal hypertension
b)9-10mm |
|
|
Term
| What are 4 types of portal hypertension |
|
Definition
1. Extrahepatic presinusoidal (pv thrmbus)
2.Intrahepatic presinusoidal (schistosomiasis)
3.Intrahepatic(most common)cirrhosis
4.Intrahepatic postsinusoidal (hepatic vein thrombosis) |
|
|
Term
| Sonographic findings of portal hypertension include secondary signs of: |
|
Definition
Splenomegaly
Ascites
Portal systemic venous collaterals |
|
|
Term
| What is the exocrine function of the pancreas? |
|
Definition
| Sectrete trypsin, lipase, and amylase through the ductal system |
|
|
Term
| What is the endocrine function of the pancreas? |
|
Definition
| (non ductal) is to secrete insulin via the islets of Langerhans |
|
|
Term
| The normal pancreas measures __ when measuring in the _______-________ dimension. |
|
Definition
|
|
Term
| The head of the pancreas is ________to the IVC, and ________ to the duodenum. |
|
Definition
|
|
Term
| The common bile duct is _______/______ to the pancreatic head. |
|
Definition
|
|
Term
| The gastroduodenal artery is _______/_______ to the pancreatic head. |
|
Definition
|
|
Term
| The _______ are posterior to the neck of the pancreas. |
|
Definition
| Superior mesenteric artery and vein |
|
|
Term
| The superior mesenteric artery and vein are ______ to the uncinate process. |
|
Definition
|
|
Term
| The pancreatic tail is located ______ and _______ to the splenic hilum. |
|
Definition
|
|
Term
| ________ is posterior to the body of the pancreas. |
|
Definition
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|
Term
| The _________ arises from the aorta at the superior border of the pancreas. |
|
Definition
|
|
Term
| The ___________ arises from the aorta at the inferior border of the pancreas. |
|
Definition
| Superior mesenteric artery |
|
|
Term
| The celiac axis gives off the _________ and then divides into the common hepatic artery and the __________. |
|
Definition
left gastric artery
splenic artery |
|
|
Term
| The common hepatic artery divides into the ___________ and the __________. |
|
Definition
| proper hepatic and the gastroduodenal arteries |
|
|
Term
| The proper hepatic artery travels superiorly toward the liver ________ to the portal vein and left of the _________. |
|
Definition
|
|
Term
| The right gastric artery is a branch of the ___________. |
|
Definition
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|
Term
| The gastroduodenal artery travels posterior to the first portion of the ________ then _________ to the head of the pancreas. |
|
Definition
|
|
Term
| The GDA then divides into: |
|
Definition
right gastroepiploic artery
superior pancreaticoduodenal artery |
|
|
Term
The superior mesenteric artery is located:
inferior to the __________
anterior to the ___________
anterior to the ___________ |
|
Definition
pancreas
uncinate process
3rd portion of the duodenum |
|
|
Term
| The splenic vein is located on the ________ aspect of the pancreas. |
|
Definition
|
|
Term
| The splenic vein joins the superior mesenteric vein to create the _______. |
|
Definition
|
|
Term
The superior mesenteric vein is located :
to the right of the ____________
anterior to the _____________
anterior to the _________ |
|
Definition
Superior mesenteric artery
3rd portion of the duodenum
uncinate process |
|
|
Term
| The common bile duct travels _________ to the 1st portion of the duodenum and the __________ and lies to the right of the main _________. |
|
Definition
posterior
head of the pancreas main pancreatic duct |
|
|
Term
| The common bile duct and the __________ join to become the hepaticopancreatic anpulla (ampulla of Vater) which opens into the 2nd portion of the duodenum at the ________. |
|
Definition
Duct of Wirsung (main pancreatic duct)
major papilla |
|
|
Term
| The accessory pancreatic duct(duct of ________) opens into the 2nd portion of the duodenum at the ___________ approximately __cm proximal to the __________. |
|
Definition
Duct of Santorini
minor papilla
2cm
ampulla of Vater |
|
|
Term
| The duodenum is divided into 4 portions: |
|
Definition
1st and 3rd are transverse
2nd and 4th are longitudinal |
|
|
Term
| The pancreatic duct is considered abnormal if it is ? |
|
Definition
|
|
Term
| What structures are in contact with the pancreatic head? |
|
Definition
IVC
Common bile duct
Gastroduodenal artery
Duodenal C loop (2nd portion) |
|
|
Term
| Inflammatory disease that produces temporary pancreatic change. |
|
Definition
|
|
Term
| The most common causes of acute pancreatitis are? |
|
Definition
Biliary tract disease (approx 40%)
Chronic Alcohol abuse (approx 35%) |
|
|
Term
| Sonographic findings for acute pancreatitis: |
|
Definition
|
|
Term
| An inflammatory mass formed by edema and leakage of pancreatic enzymes is known as? |
|
Definition
| Pancreatic phlegmon (Focal Pancreatitits) |
|
|
Term
| A spreading inflammatory raection to an infection which forms a suppurative lesion is known as a? |
|
Definition
|
|
Term
| Irreversible destruction due to repeated bouts of pancreatic inflammation is: |
|
Definition
|
|
Term
| What are some causes of chronic pancreatitis? |
|
Definition
Alcoholism(most common)
Hereditary
Cystic fibrosis
Blunt abdominal trauma
Congenital abnormalities (panc divisum)
Idiopathic chronic pancreatitis |
|
|
Term
| Sonographic findings for chronic pancreatitis include: |
|
Definition
Small and echogenic gland
Calcifications
Pancreatic duct dilatation
pseudocyst
bile duct dilatation
PV Thrombosis |
|
|
Term
|
Definition
| An accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum. They contain high amounts of amylase,lipase and tryspin. |
|
|
Term
| The pancreas is located within the ____________ of the retroperitoneum. |
|
Definition
|
|
Term
| What is the most common reason for a pseudocyst in children. |
|
Definition
|
|
Term
| Uncommon congenital anomaly where a ring of normal pancreatic tissue encircles the duodenum secondary to abnormal migration of the ventral pancreas. |
|
Definition
|
|
Term
| The _______ also known as pancreaticoduodenectomy is performed with CA at the head of the pancreas. |
|
Definition
|
|
Term
| With the whipple procedure the ______, ________, the ______ and ____ are removed. The remaining _______ and ______ are sutured back to the intestines to direct secretions back to the gut. |
|
Definition
pancreas, a portion of the bile duct, the gb, and the duodenum
remaining pancreas and bile duct are sutured back |
|
|
Term
| Serous cystadenomas are ______. They are associated with _____-______ disease. |
|
Definition
|
|
Term
The _______ is a normal variant extending superior to the isthmus. |
|
Definition
|
|
Term
| The ______ muscles of the neck(_____ & ______) of the neck are seen as thin sonolucent bands along the anterior surface to the thyroid gland. |
|
Definition
Strap
sternohyoid and sternothyroid |
|
|
Term
| The larger sternnocleidomastoid muscles are located? |
|
Definition
|
|
Term
| The muscle located posterior to the thyroid is the __________, which appears as a wedge shaped sonolucent structureadjacent to the cervical vertebrae. |
|
Definition
|
|
Term
| The minor neurovascular bundle is composed of the? |
|
Definition
| Recurrent laryngeal nerve and inferior thyroid vessels |
|
|
Term
| The normal parathyroid glands are located _____ to the thyroid. |
|
Definition
| posterior aspect of the thyroid |
|
|
Term
Anatomical Spatial Relationships to the thyroid
Strap muscles
Sternocleidomastoid
Common carotid Art/Internal jugular V
Minor neurovascular bundle
Longus Colli Muscle
Parathyroid Gland |
|
Definition
a)anterior
b)anterolateral
c)lateral
d)posterior
e)posterior
f)posterior |
|
|
Term
| The thyroid arterial supply comes from the: |
|
Definition
Superior thyroid arteries that branch off the ECA
Inferior thyroid arteries that branch off the thyrocervical trunk |
|
|
Term
| The venous blood from the thyroid is drained into the? |
|
Definition
| Internal jugular vein via the superior and middle thyroid veins and into the innominate veins via the inferior thyroid veins |
|
|
Term
| What glands regulate thyroid hormones? |
|
Definition
Thyroid (T3/T4)
Pituitary(Thyroid stimulating hormone TSH)
Hypothalamus(Thyrotropin-releasing hormone TRH) |
|
|
Term
| ________ is produced by the pituitary gland to produce thyroid hormones. |
|
Definition
| Thyroid Stimulating Hormones (TSH) |
|
|
Term
An increase in TSH is usually the first indication of ______?
Normal levels of TSH = ______ |
|
Definition
|
|
Term
| Serum thyroid hormones are: |
|
Definition
T4-Thyroxine
T3-Triiodothyronine |
|
|
Term
The pituitary gland is regulated by the
________. |
|
Definition
|
|
Term
Lab Values
Hypothyroidism=
Hyperthyroidism= |
|
Definition
Increase TSH
Decreased T3/T4 } Hypothyroidism
Decreased TSH
Increased T3/T4 } Hyperthyroidism |
|
|
Term
| The most commonly encountered benign thyroid nodule is ______? |
|
Definition
|
|
Term
| Risk factors for thyroid cancer are: |
|
Definition
age: <20 and >60 yrs of age
head and neck irradiation
family history of thyroid cancer |
|
|
Term
| Physical findings for Thyroid cancer include: |
|
Definition
recent palpable mass
mass is firm and nontender
mass moves with swallowing
enlarged cervical lymph nodes
hoarseness, voice changes or cough
trouble swallowing or breathing |
|
|
Term
| ______ is the most common primary thyroid cancer accounting for __-__% of all cases. |
|
Definition
|
|
Term
| The major route of spread for papillary carcinoma is through the _______ to nearby ________. |
|
Definition
| lymphatics to cervical lymph nodes |
|
|
Term
| Follicular cancers of the thyroid tend to spread via the ______. |
|
Definition
|
|
Term
| __________ is associated with multiple endocrine neoplasia syndrome. |
|
Definition
|
|
Term
| A very aggressive thyroid cancer that is resistant to treatments and rapidly invades surrounding tissues, causing airway obstruction is __________. |
|
Definition
|
|
Term
| Most effective method for diagnosing malignancy in a thyroid nodule. |
|
Definition
| FNA with cytologic evaluation |
|
|
Term
| FNA should be considered if a: |
|
Definition
Noudle is >1cm with microcalcifications
nodule is >1.5cm that is predominantly solid
nodule is >2cm that has mixed components
nodule demonstrating growth
nodule with ipsilateral abnormal lymph nodes
node is >7 mm in short axis |
|
|
Term
| Composition of thyroid nodules are: |
|
Definition
solid,predominantly solid, mixed solid and cystic, predominantly cystic and cystic
The greater the solid component the higher the risk of malignancy |
|
|
Term
| The recommended minimal size of a solid nodule for FNA is |
|
Definition
|
|
Term
| Echogenicity for thyroid cancers are usually |
|
Definition
hypoechoic
hyperechoic is usually benign |
|
|
Term
| Benign thyroid nodules have _________ margins whereas malignant lesions have __________ margins. |
|
Definition
Benign- sharp well defined
Malignant-irregular poorly defined |
|
|
Term
| Calcifications that are eggshell or peripheral usually indicate a ____ nodule whereas calcifiations that are ______ and ______ are more suggestive for malignancy. |
|
Definition
|
|
Term
| What are the faetures associated with thyroid cancer? |
|
Definition
Micrcalcifications
Solid hypoechogenicity
Irregular margins
Abscence of halo
Intranodule central vascularity
More tall than wide |
|
|
Term
| This results in generalized enlargement of the thyroid gland (goiter). |
|
Definition
|
|
Term
| Specific conditions that commonly produce diffuse enlargement of the thyroid gland include: |
|
Definition
Chronic autoimmune thyroiditis
Adenomatous goiter
Grave's disease |
|
|
Term
| This typically occurs as a painless, diffuse enlargement of the thyroid gland in young or middle aged women and is the common cause for hypothyroidism. |
|
Definition
Chronic Lymphocytic Thyroiditis
(Hashimoto's) |
|
|
Term
| Worlwide, the most common cause of a goiter is? |
|
Definition
|
|
Term
| Symptoms of graves disease include: |
|
Definition
Diffusely enlarged thyroid
Ophthalmopathy-Prominent eyes (hallmark sign)
Tachycardia
Tremors,muscle weakness
Palpitations, dyspnea on exertion
Weight loss |
|
|
Term
| There are __ parathyroid glands located _______ to the thyroid gland. |
|
Definition
|
|
Term
| __________ is the most common type of ______ which is due to the develpoment of an _______ associated with one of the __________. |
|
Definition
Primary Hyperparathyroidism
hyperparathyroidism
adenoma
parathyroid gland |
|
|
Term
| Primary hyperparathyroidism is suspected with an increase in _________ level on routine screening. |
|
Definition
|
|
Term
| A _________ level that is increased with a serum calcium level confirms the diagnosis of _______. |
|
Definition
Serum parathyroid hormone (PTH)
primary hyperparathyroidism |
|
|
Term
| Secondary hyperparathyroidism occurs in patients with _______. |
|
Definition
|
|
Term
| The inability to synthesize vitamin D depresses serum calcium level which stimulates ______. |
|
Definition
| parathyroid gland hyperplasia |
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|
