ARDMS ABDOMEN EXAM Questions With 100% Correct Answers 2024 GRADED A+, Exams of Nursing

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ARDMS ABDOMEN EXAM Questions

With 100% Correct Answers 2024

GRADED A+

The right and left hepatic lobes are divided by a plane between ____ and _____ - Correct Answer-The Gallbladder and inferior vena cava The right lobe of the liver is supplied by the? - Correct Answer- Right Portal Vein The left lobe of the liver is supplied by the? - Correct Answer- Left Portal Vein The_____ lobe receives branches from both the right and left portal veins - Correct Answer-Caudate The caudate lobe is drained by small veins called? - Correct Answer-Emissary veins

Emissary veins enter directly into the ____ - Correct Answer- IVC Segment 1 of liver - Correct Answer-Caudate lobe Segment 2 of liver - Correct Answer-Left lateral superior Segment 3 of liver - Correct Answer-Left lateral inferior Segment 4a of liver - Correct Answer-Left medial superior Segment 4b of liver - Correct Answer-Left medial inferior Segment 5 of liver - Correct Answer-Right anterior inferior Segment 6 of liver - Correct Answer-Right posterior inferior Segment 7 of liver - Correct Answer-Right posterior superior Segment 8 of liver - Correct Answer-Right anterior superior

The hepatic veins have ____ walls - Correct Answer-Non- echogenic Which veins are considered intersegmental? - Correct Answer- Hepatic veins (They course between the lobes and segments) Which veins are considered intrasegmental? - Correct Answer- Portal triad (Course to the center of each segment) The portal triad is encased by a fibrofatty sheath called? - Correct Answer-Glisson's capsule Portal veins have ____ walls - Correct Answer-hyperechoic What vessels make up the portal triad? - Correct Answer-Main portal vein Proper hepatic artery Common hepatic duct

Main lobar fissure - Correct Answer-Divides right and left hepatic lobes by an oblique plane between the IVC and the GB fossa Landmarks for the Main lobar fissure - Correct Answer- Gallbladder Inferior Vena Cava Middle Hepatic Vein The main lobar fissure divides the _____ segment of the right lobe from the _____ segment of the left lobe - Correct Answer-Anterior Medial Right intersegmental fissure divides right lobe into ____and _____ segments - Correct Answer-Anterior Posterior Landmark for right intersegmental fissure - Correct Answer- Right hepatic vein

Left intersegmental fissure divides left lobe into _____ and _____ segments - Correct Answer-Medial Lateral Landmarks for left intersegmental fissure - Correct Answer- Left hepatic vein Ascending left portal vein Falciform ligament Ligamentum teres Ligamentum venosum - Correct Answer-Remnant of the ductus venosus The ligamentum teres runs from the ____ to the ____ - Correct Answer-Umbilicus Left portal vein Ligamentum Teres - Correct Answer-Remnant of the umbilical vein Hepatic Blood Flow - Correct Answer-approx. 1500mL/min 25 - 30% Proper Hepatic Artery

70 - 75% Portal Vein Hepatic Oxygenation - Correct Answer- 45 - 50% Proper Hepatic Artery 50 - 55% Portal Vein ( PV O2 Sat = 85%) The ____ vein supplies greater volume and oxygen needs to the liver - Correct Answer-Portal ___ is the upper limits of portal vein diameter - Correct Answer-13mm Hepatic vein waveforms are typically ____ reflecting ____ filling, contraction, and relaxation - Correct Answer-Triphasic Right Atrial The proper hepatic artery runs____ to the MPV - Correct Answer-Parallel The classic anatomy of the right and left hepatic ateries arising from the proper hepatic artery is seen in approx. ___% of patients - Correct Answer- 55

10% of the time, the left hepatic artery may originate from the? - Correct Answer-Left gastric artery Where is a replaced RHA seen? - Correct Answer-Posterior to the MPV What type of waveform would suggest organ rejection in a post liver transplant pt? - Correct Answer-High resistance ( no flow in diastole) Why does the ligametum teres recanalize in cirrhosis? - Correct Answer-To function as a venous collateral Falciform Ligament - Correct Answer-Peritoneal reflection of fold created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of the portal vein Coronary Ligament - Correct Answer-Peritoneal reflections which suspend the liver from the diaphragm. Right and Left Triangular Ligament - Correct Answer- Peritoneal reflections to the far right and left of the bare area

RHV Location - Correct Answer-Right intersegmental fissure RHV Usefulness - Correct Answer-Divides anterior & posterior segments of right lobe MHV Location - Correct Answer-Main Lobar Fissure MHV Usefulness - Correct Answer-Separates right and left lobes LHV Location - Correct Answer-Left intersegmental fissure LHV Usefulness - Correct Answer-Divides medial and lateral segments of the left lobe RPV (anterior branch) Location - Correct Answer- Intrasegmental in anterior segment of the right lobe RPV (anterior branch) Usefulness - Correct Answer-Courses centrally in anterior segment of right lobe

RPV (posterior branch) Location - Correct Answer- Intrasegmental in posterior segment of the right lobe RPV (posterior branch) Usefulness - Correct Answer-Courses centrally in posterior segment of right lobe LPV (horizontal segment) Location - Correct Answer-Anterior to caudate lobe LPV (horizontal segment) Usefulness - Correct Answer- Separates caudate lobe from medial segment of left lobe LPV (ascending segment) Location - Correct Answer-Left intersegmental fissure LPV (ascending segment) Usefulness - Correct Answer-Divides medial from lateral segment of left lobe Gallbladder fossa Location - Correct Answer-Main lobar fissure Gallbladder fossa usefulness - Correct Answer-Separates right and left lobes

Ligamentum Teres Location - Correct Answer-Left intersegmental fissure Ligamentum Teres Usefulness - Correct Answer-Divides caudal aspect of left lobe into medial and lateral segments Ligamentum Venosum Location - Correct Answer-Left anterior margin of the caudate lobe Ligamentum Venosum Usefulness - Correct Answer-Separates caudate lobe from left lobe Granulomas - Correct Answer-Present as small calcifications in the liver and spleen Caused by Histoplasmonsis or Tuberculosis infection Hepatitis - Correct Answer-May result in elevation of ALT, AST, conjugated and unconjugated bilirubin Viral infections account for most cases of hepatitis

Route of transmission for Hepatitis A - Correct Answer- Fecal/Oral Route of transmission for Hepatitis B - Correct Answer-Blood/ body fluids Route of transmission for Hepatitis C - Correct Answer-Blood/ body fluids Sonographic findings of acute hepatitis - Correct Answer- "Starry Night" Hypoechoic liver parenchyma Liver enlargement Hyperechoic portal vein walls Sonographic findings of chronic hepatitis - Correct Answer- Hyperechoic live parenchyma Small liver Decreased echogenicity of portal vein walls Pyogenic (Bacterial) Abscess - Correct Answer-Occurs commonly in the right lobe of liver

Reaches the liver via the bile ducts, portal veins, hepatic arteries, or lymphatic channels Sonographic appearance of a pyogenic abscess - Correct Answer-complex mass echogenic gas reverberation artifact Differential diagnosis for pyogenic abscess - Correct Answer- amebic abscess echinococcal cyst hemorrhagic cyst hematoma cystic neoplasm Symptoms of pyogenic abscess - Correct Answer-RUQ Pain leukocytosis fever elevated liver function tests

_____ is needed to confirm diagnosis of pyogenic abscess - Correct Answer-aspiration Amebic Abscess - Correct Answer-Occurs when a parasite from the intestiones reaches the liver viat the portal vein What is the most common extraintestinal complication of amoebic dysentery? - Correct Answer-Amebic abscess Symptoms and findings of amebic abscess - Correct Answer- RUQ Pain Diarrhea Fever Leukocytosis Elevated Liver Function Tests Elevated Rigth dome of diaphragm by X-ray Sonographic features of amebic abscess - Correct Answer- Round hypoechoic/ complex mass Typically occurs in right lobe (dome) Contiguous with the liver capsule

Fungal abscess (Candidiasis) - Correct Answer-A mycotic (fungal) infection of the blood that results in small abscesses in the liver The earliest manifestation of a fungal infection and most recognizable is? - Correct Answer-"Wheel within a wheel" Lesion with a peripheral hypoechoic zone, and inner echogenic wheel and a hypoechoic center. "Bull's eye" Fungal abscess - Correct Answer-lesion appears like this when the hypoehoic center calcifies "Uniformly hypoechoic focus" Fungal abscess - Correct Answer-Most common presentation of lesion "Echogenic focus" Fungal abscess - Correct Answer- Calcification representing scar formation seen late in the disease process How are eggs passed into the liver with hydatid disease? - Correct Answer-Via the portal venous system

Sonographic appearance of hydatid disease? - Correct Answer- Simple cyst Cyst with detached endocyst cyst with multiple daughter cyst calcified mass Tests used to diagnose hydatid disease - Correct Answer- Casoni skin test (70% sensitivity) Detection of antibodies (ecchinococcal Arc 5) Echinococcal cysts are associated with? - Correct Answer- Anaphalactic shock Schistosomiasis - Correct Answer-one of the most common parasitic infections in humans Major cause of portal hypertension worldwide With schistosomiasis, eggs reach the liver through the portal vein inciting a granulomatous reaction resulting in? - Correct Answer-Periportal fibrosis

How does schistosomiasis cause portal hypertension? - Correct Answer-The intrahepatic portal veins occlude due to periportal fibrosis causing portal hypertension Sonographic findings of schistosomiasis include? - Correct Answer-Occluded intrahepatic portal veins Thickening and increased echogenicity of the portal vein walls Secondary signs of portal hypertension are? - Correct Answer- Splenomegaly Ascites Esophageal Variceal Bleeding Portosystemic collateral It is estimated that ______ people infected with schistosomiasis have immigrated to this country - Correct Answer-400, Sonographic findings associated with AIDS - Correct Answer- Hepatomegaly (Hepatitis) Splenomegaly Lymphadenopathy

Pnemocystis carinii (hepatic) Fattly liver infiltration Non-Hodgkins Lymphoma Candidiasis Cholangitis Acalculous Cholecystitis Kaposi's Sarcoma Nephropathy (hyperechoic kidneys) What is the most common organism causing infection in AIDS patients? - Correct Answer-Pneumocystic carinii Sonographic findings of pneumocystic carinii involvement of the liver - Correct Answer-diffuse, nonshadowing, hyperechoic foci Sclerosing and AIDS Cholangitis sonographically appear as? - Correct Answer-Thickened biliary ducts Thickening may compromise the lumen causing biliary obstruction

Lymphoma and Kaposi's sarcoma may be seen as? - Correct Answer-An intrahepatic mass or possible diffuse infiltration without visualization of a sonographic abnormality Fatty liver disease is also known as? - Correct Answer- Steatosis Causes of Cirrhosis - Correct Answer-Hepatitis C Alcoholic liver disease Non-alcoholic fatty liver disease Non-alcoholic Steatohepatitis Hepatitis B Abnormal liver function test with cirrhosis - Correct Answer- AST ALT GGT LDH conjugated bilirubin Sonographic findings include - Correct Answer-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 carcinoma Normal portal pressure is? - Correct Answer-5 to 10 mmHg What is the major cause of portal hypertension? - Correct Answer-Cirrhosis What are the four types of portal hypertension? - Correct Answer-Extrahepatic preinusoidal Intrahepatic presinusoidal Intrahepatic Intrahepatic postsinusoidal Example of extrahepatic presinusoidal portal hypertension - Correct Answer-Portal vein thrombosis

Example of intrahepatic presinusoidal portal hypertension - Correct Answer-Schistosomiasis Example of intrahepatic portal hypertension - Correct Answer- Cirrhosis Example of intrahepatic postsinusoidal portal hypertension - Correct Answer-Hepatic Vein Thrombosis Secondary findings of portal hypertension - Correct Answer- Splenomegaly Ascites Portal systemic venous collaterals Surgical techniques to lower portal pressure - Correct Answer- Portacaval shunt Splenorenal shunt/ Linton shunt Distal splenorenal shunt/ Warren shunt TIPS

Gastroesophageal varices - Correct Answer-Collaterals of the distal esophagus and gastric fundus. May lead to life- threatening gastrointestinal hemmorhage Splenorenal varices - Correct Answer-Tortuous collateral veins seen in the splenic and left renal hilum Intestinal varices - Correct Answer-The veins of retroperitoneal structures such as the colon, duodenum and pancreas anastomose with systemic tributaries Rectal varices (hemorrhoids) - Correct Answer-A collateral path in which the inferior mesenteric vein drains into the rectal venis which connect the systemic tributaries Physical signs of portal systemic collaterals - Correct Answer- dilated veins on anterior abd wall caput medusa hemorrhoids ascites Caput Medusa - Correct Answer-Tortuous collaterals around umbilicus

Criteria for TIPS malfunction - Correct Answer-Low shunt velocity (<50 cm/sec) High focal shunt velocity ( >190 cm/sec) Hepatopetal LPV or RPV Hepatofugal MPV Absent shunt flow Most commonly used TIPS material - Correct Answer-GORE Viatorr endoprosthesis Indications for liver transplant in adults - Correct Answer- Cirrhosis Indications for liver transplant in children - Correct Answer- Biliary atresia Sonographic evaluation for liver transplants includes: - Correct Answer-Biliary tree Portal vein patency Hepatic artery patency Hepatic vein patency

IVC patency Presence of venous collaterals Postoperative collections (hematoma, biloma) What is MELD? - Correct Answer-THE MODEL FOR END-STAGE LIVER DISEASE Sonographic findings of Portal Vein Thrombosis - Correct Answer-Hypoechoic thrombus within the portal vein Increased portal vein caliber Cavernous transformation Portal systemic collaterals Tumoral causes of portal vein thrombosis - Correct Answer- Hepatocellular carcinoma Metastatic liver disease Pancreatic carcinoma Non-tumoral causes of portal vein thrombosis - Correct Answer-Pancreatitis Cirrhosis/ hepatitis

IBD

Trauma Splenectomy Hypercoagulation Portal lymphadenopathy Cavernous transformation - Correct Answer-worm-like venous colloateraal that parallel the chronically thrombosed portal vein With Budd-Chiari Syndrome, patient presents with signs associated with what? - Correct Answer-Portal hypertension

• Acites
• Splenomegaly
• Hepatomegaly Number one cause of Budd-Chiari Syndrome - Correct Answer- Frequently idiopathic(50%) Congenital causes of Budd-Chiari Syndrome - Correct Answer- IVC membranous obstruction Hepatic vein stenosis or hypoplasia

Hypercoagulable states that cause Budd-Chiari Syndrome - Correct Answer-Polycythemia vera Paroxysmal nocturnal hemoglobiuria Factor V Leiden deficiency Protein C & S deficiency Antithrombin III deficiency Antiphospholipid anitbody syndrome Sickle Cell disease Oral contraceptives Tumors that cause Budd-Chiari Syndrome - Correct Answer- Hepatocellular carcinoma Renal cell carcinoma Adrenal carcinoma Portal vein gas - Correct Answer-Uncommon condition where air is noted within the intrahepatic portal veins Portal vein gas is asscociated with? - Correct Answer- Ulcerative Colitis