1. Hepatomegaly would be seen in conjunction with :
a. Down syndrome
b. Edward syndrome
c. Beckwith–Wiedeman nsyndrome
d. Hirschsprung disease
Liver Questions and Answers
2. Pentalogy of Cantrell includes all of the following findings except :
a. Cardiovascular malformations
b. Diaphragmatic malformations
c. Omphalocele
d. Gastroschisis
3. All of the following are associated with omphalocele except :
a. Trisomy18
b. Pentalogy of Cantrell
c. Intrauterine growth restriction
d. Hirschsprung disease
4. All of the following are associated with esophageal atresia except :
a. Down syndrome
b. VACTERL syndrome
c. Edwards syndrome
d. Oligohydramnios
5. VACTERAL syndrome includes…
6. The commonest abnormality of fetal liver is :
a. Gallstones
b. Hepatocellular lymphadenopathy
c. Cirrhosis
d. Hepatomegaly
7. All of the following are associated with omphalocele except:
a. Trisomy18
b. Pentalogy of Cantrell
c. Intrauterine growth restriction
d. Hirschsprung disease
8. All of the following are associated with esophageal atresia except:
a. Down syndrome
b.VACTERL syndrome
c.Edwards syndrome
d.Oligohydramnios
9. Can u identify the lesion :
10. Gastroschisis occurs more often in what location ?
a. Left lateral of the cord insertion
b. Right lateral of the cord insertion
c. Just superior to the fetal bladder
d. In the base of the umbilical cord
11. Which of the following best describes a choledochal cyst?
a. It is the cystic dilatation of the common bile duct.
b. It is the herniation of the abdominal contents into the umbilical cord.
c. It is the congenital absence of th ecystic duct.
d. It is the inflammation of the biliary tree due to extrinsic obstruction
12. Mention 3 complication of Choledocal cysts
13. Which of the following would be least likely to be associated with anelevated maternal serum alpha-fetoprotein?
a. Pentalogy of Cantrell
b. Anorectal atresia
c. Gastroschisis
d. Omphalocele
14. Fetal gut starts developing by end of which menstrual wks
15. Kidneys reach their adult location in which wk
16. which statement is true about fetal liver
1. fetal liver shows equal sized rt & lt lobe.
2. rt lobe is larger
3. lt lobe is larger
4. fetal rt lobe gets more oxygen from heart
5. fetal lt lobe gets more oxygen from heart
17. Omphalocoel can be associated with :
1. t18
2. t13
3. Pentalogy of Cantrell
4. beckwith–Wiedemann syndrome
5. turner’s syndrome
18. Name 3 causes of pseudo double bubble sign?
1. Bisect normal stomach
2. Choledochal cyst
3. Bowel/Duodenal duplication cyst
4. many other types of abdominal cysts
(renal, hepatic, omental etc).
5. Insura angularis
19. What are Features of Beckwith-Weidemann syndrome in newborn?
1. Omphalocele
2. Macroglossia
3. Gigantism
4. Hepatomegaly
20. Name 4 causes of Echogenic Bowel
21. Cut off mean dia for labelling bowel dilatation is
22. Echogenic bowel
1. Most common echogenic mass of women
2. Seen in lower abdomen and pelvis
3. As echogenic as near by bone
4. Found in 1% of 2nd trimester scans
5. Should be seen with lower frequency transducer
6. All of the above
23. Echogenic bowel 1
1. Most common echogenic mass of women
2. Seen in lower abdomen and pelvis
3. As echogenic as near by bone
4. Found in 1% of 2nd trimester scans
5. Should be seen with lower frequency transducer
6. All of the above
Answers of Question No 1 To 22
Ans Q1 – C. Beckwith–Wiedemann syndrome – Beckwith–Wiedemann syndrome a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver.
Ans Q2 – D. Gastroschisis – pentalogy of Cantrell includes an omphalocele, along with ectopic cordis, cleft sternum, anterior diaphragmatic defect , and pericardial defects.
Ans Q3 – D. Hirschsprung disease
Ans Q4 – D. Oligohydramnios
Ans Q5 – Vertebral defeacts, anal atresia, Cardiac abnormalities, TO fistula, renal and radial dysplasia, Limb Defects
Ans Q6 – Hepatomegaly may occur as a result of intrauterine infections, or be seen with Beckwith–Wiedemann syndrome
Ans Q7 – D. Hirschsprung disease
Ans Q8 – D. Oligohydramnios
Ans Q9 – Meconium peritonitis with multiple calcifications on the peritoneal surface of the liver in a fetus with a meconium pseudocyst (arrowhead) , with an irregularly calcified wall.
Ans Q10 – B. Right lateral of the cord insertion
Ans Q2 – D. Gastroschisis – pentalogy of Cantrell includes an omphalocele, along with ectopic cordis, cleft sternum, anterior diaphragmatic defect , and pericardial defects.
Ans Q3 – D. Hirschsprung disease
Ans Q4 – D. Oligohydramnios
Ans Q5 – Vertebral defeacts, anal atresia, Cardiac abnormalities, TO fistula, renal and radial dysplasia, Limb Defects
Ans Q6 – Hepatomegaly may occur as a result of intrauterine infections, or be seen with Beckwith–Wiedemann syndrome
Ans Q7 – D. Hirschsprung disease
Ans Q8 – D. Oligohydramnios
Ans Q9 – Meconium peritonitis with multiple calcifications on the peritoneal surface of the liver in a fetus with a meconium pseudocyst (arrowhead) , with an irregularly calcified wall.
Ans Q10 – B. Right lateral of the cord insertion
Ans 11 – A. It is the cystic dilatation of the common bile duct
Ans Q12 – Choledochal cysts can lead to cholangitis, portal hypertension, pancreatitis, and liver failure.
Ans Q13 – B. Anorectal atresia
Ans Q14 – by end of 5th menstrual wk
Ans Q15 – 9th wk
Ans Q16 – 3. lt lobe is larger (gets more oxygen from heart
Ans Q17 – All
Ans Q18 – Updating soon.
Ans Q19 – Updating soon
Ans 20 – Cystic Fibrosis, IUGR, IUD, Downs syndrome
Ans Q21 – 7mm
Ans Q22 – 6. All of the above
Ans Q12 – Choledochal cysts can lead to cholangitis, portal hypertension, pancreatitis, and liver failure.
Ans Q13 – B. Anorectal atresia
Ans Q14 – by end of 5th menstrual wk
Ans Q15 – 9th wk
Ans Q16 – 3. lt lobe is larger (gets more oxygen from heart
Ans Q17 – All
Ans Q18 – Updating soon.
Ans Q19 – Updating soon
Ans 20 – Cystic Fibrosis, IUGR, IUD, Downs syndrome
Ans Q21 – 7mm
Ans Q22 – 6. All of the above
Short Note On Liver
Sonographic Technique
►Patient Supine / lateral decubitus
Standard Abdominal transducer
►Viewed in Right anterior oblique view , transverse view, sagittal, coronal views.
Intercostal approach .
►Deep inspiration helps to push Liver down
Normal Anatomy
►Liver is divided in three lobes and these are further divided in eight segments.
►Right and Left Lobes separated by main lobar fissure- it passes through Gall Bladder fossa , to Inferior Vena Cava.
►Caudate Lobe is situated on posterior aspect of Liver between IVC and fissure for ligamentum Venosum.
Couinaud’s Anatomy
►Universally accepted for division of Liver Segments- based on Portal Vein segments. These are of functional as well as pathological importance.
►Each segment has its own blood supply with Arterial , portal venous and Hepatic venous supply, lymphatics and biliary drainage.
Hepatic veins are intersegmental and Portal vein are intrasegmental.
►Right , middle and left hepatic veins divide the Liver longitudinally into four sections .
These are further divided transversely by an imaginary plane through Right and Left main Portal Pedicles.
Segment 1 . Caudate Lobe
Segment 2. Lateral segment of Left Lobe ( superior)
Segment 3. Lateral segment of Left Lobe ( inferior)
Segment 4. Medial segment of Left Lobe
Segment 5. Anterior segment of Right Lobe ( inferior)
Segment 6. Posterior segment of Right Lobe ( inferior)
Segment 7. Posterior segment of Right Lobe ( superior)
Segment 8. Anterior segment of Right Lobe ( superior)
►Ligaments around Liver
Liver is covered by connective tissue layer called – Glisson’s Capsule.
Peritoneal fold at Porta Hepatis is called – hepatoduodenal Ligament.
Umbilical vein atrophies after birth and forms – Ligamentum teres.
Umb vein conducted to Liver in Falciform Ligament.
Falciform Ligament separated in Right coronary Ligament and Left triangular ligament.
Posterio superior Portion of liver uncovered by peritoneal layer is called Bare area.
Obliterated Ductus Venosus is called ligamentum Venosum.
5. VACTERAL syndrome includes…
6. The commonest abnormality of fetal liver is :
a. Gallstones
b. Hepatocellular lymphadenopathy
c. Cirrhosis
d. Hepatomegaly
7. All of the following are associated with omphalocele except:
a. Trisomy18
b. Pentalogy of Cantrell
c. Intrauterine growth restriction
d. Hirschsprung disease
8. All of the following are associated with esophageal atresia except:
a. Down syndrome
b.VACTERL syndrome
c.Edwards syndrome
d.Oligohydramnios
9. Can u identify the lesion :
10. Gastroschisis occurs more often in what location ?
a. Left lateral of the cord insertion
b. Right lateral of the cord insertion
c. Just superior to the fetal bladder
d. In the base of the umbilical cord
11. Which of the following best describes a choledochal cyst?
a. It is the cystic dilatation of the common bile duct.
b. It is the herniation of the abdominal contents into the umbilical cord.
c. It is the congenital absence of th ecystic duct.
d. It is the inflammation of the biliary tree due to extrinsic obstruction
12. Mention 3 complication of Choledocal cysts
13. Which of the following would be least likely to be associated with anelevated maternal serum alpha-fetoprotein?
a. Pentalogy of Cantrell
b. Anorectal atresia
c. Gastroschisis
d. Omphalocele
14. Fetal gut starts developing by end of which menstrual wks
15. Kidneys reach their adult location in which wk
16. which statement is true about fetal liver
1. fetal liver shows equal sized rt & lt lobe.
2. rt lobe is larger
3. lt lobe is larger
4. fetal rt lobe gets more oxygen from heart
5. fetal lt lobe gets more oxygen from heart
17. Omphalocoel can be associated with :
1. t18
2. t13
3. Pentalogy of Cantrell
4. beckwith–Wiedemann syndrome
5. turner’s syndrome
18. Name 3 causes of pseudo double bubble sign?
1. Bisect normal stomach
2. Choledochal cyst
3. Bowel/Duodenal duplication cyst
4. many other types of abdominal cysts
(renal, hepatic, omental etc).
5. Insura angularis
19. What are Features of Beckwith-Weidemann syndrome in newborn?
1. Omphalocele
2. Macroglossia
3. Gigantism
4. Hepatomegaly
20. Name 4 causes of Echogenic Bowel
21. Cut off mean dia for labelling bowel dilatation is
22. Echogenic bowel
1. Most common echogenic mass of women
2. Seen in lower abdomen and pelvis
3. As echogenic as near by bone
4. Found in 1% of 2nd trimester scans
5. Should be seen with lower frequency transducer
6. All of the above
23. Echogenic bowel 1
1. Most common echogenic mass of women
2. Seen in lower abdomen and pelvis
3. As echogenic as near by bone
4. Found in 1% of 2nd trimester scans
5. Should be seen with lower frequency transducer
6. All of the above
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