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Spring 2014 - ABD TEST 2 - LIVER ✔️ > Anatomy And Physiology > Flashcards

Anatomy And Physiology Flashcards

0
Q

What is parenchymal?

A

Texture of tissue in an organ

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1
Q

The liver is the _________ _________ organ in the body.

A

Largest parenchymal

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2
Q

What cavity of the body is the liver in?

A

Intraperitoneal/peritoneal

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3
Q

The liver is what kind of “factory”?

A

Chemical factory

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4
Q

How is the liver used during scanning?

A

Used to evaluate other organs

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5
Q

Renal cortex is more or less echogenic than the liver?

A

Less echogenic

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6
Q

Renal cortex is what compared to the liver?

A

Hypoechoic

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7
Q

Renal sinus is what compared to the liver and the renal cortex?

A

Echogenic

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8
Q

What organ has similar echogenicity to the liver?

A

The spleen

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9
Q

Describe the pancreas compared to the liver.

A

More echogenic

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10
Q

What is the normal size of the liver?

A

15-18 cm

Varies in size and shape

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11
Q

What abdominal regions does the liver occupy?

A

Right hypochondrium
Epigastrium
Left hypochondrium

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12
Q

What covers the liver?

A

The ribs

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13
Q

How does the stomach lie in relation to the left lobe of the liver?

A

Posterior and lateral

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14
Q

The duodenum lies how compared to the liver?

A

Lies adjacent

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15
Q

How is the pancreas seen compared to the left lobe of the liver?

A

Slightly inferior

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16
Q

What is posterior to the liver?

A

Right kidney
IVC
AO

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17
Q

What runs along the superior border of the liver?

A

The diaphragm

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18
Q

What is the liver suspended by?

A

The falciform ligament

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19
Q

The liver is mostly covered by what?

A

The peritoneum

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20
Q

The peritoneum cover most of the liver, however what is the small area called the is not covered and what is it not covering?

A

Bare area

Diaphragm

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21
Q

What can occur in the subphrenic space?

A

Fluid accumulation

Abscess formation

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22
Q

What is another name for the right subphrenic space?

A

Morison’s pouch

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23
Q

Name the 3 lobes of the liver.

A

Right
Left
Caudate

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24
The right lobe is the _________ compared to the other lobes.
Largest
25
What abdominal region does the right lobe occupy?
Right hypochondrium
26
What is a fossa?
Impression of where something lives
27
What fossa's are found posterior to the right lobe?
Porta hepatis Gallbladder IVC
28
What extra part can be found in the right lobe?
Reidel's lobe
29
Describe Reidel's lobe.
Congenital variant Anterior projection More common in women Normal texture
30
How does Reidel's lobe located in the right lobe clinically present?
Hepatomegaly | RUQ mass
31
What segment is Reidel's lobe an elongation of?
Segment VI
32
What abdominal regions does the left lobe occupy?
Epigastric | Left hypochondrium
33
What is the size of the left lobe?
Varies
34
What impression is found on the undersurface of the left lobe?
Gastric impression
35
What lobe is located in the medial, posterioinferior left lobe?
Quadrate lobe
36
What is the Quadrate lobe bounded by?
Gallbladder fossa, porta hepatis, umbilical vein fossa
37
Describe the caudate lobe.
Small Posterior portion Bounded by porta hepatis, IVC fossa,ductus venosus fossa
38
What separates the caudate and left lobe?
Ligamentum venosum
39
Who divided the liver into surgical resections?
Couinaud's
40
How many segments are there in Couinaud's surgical resections?
8
41
What is Segment I?
Caudate lobe
42
What is Segment II?
Superior lateral left lobe
43
What is Segment III?
Inferior lateral left lobe
44
What is Segment IV?
Medial segment of the left - Quadrate
45
What is Segment V?
Anterior inferior segment of the right lobe
46
What is Segment VI?
Posterior inferior segment of the right lobe
47
What is Segment VII?
Posterior superior segment of the right lobe
48
What is Segment VIII?
Anterior superior segment of the right lobe
49
What are the 8 segments based on?
The portal and hepatics
50
What divides the liver longitudinally?
Right, middle, left hepatic veins
51
What divides the liver transversely through an invisible plane?
Right and left portal veins
52
How do ligaments and fissures appear ultrasonically and why?
Echogenic or hyperechoic because of the presence of collagen and fat within and around the structures
53
Name 5 ligaments or fissures found in the liver.
``` Glisson capsule Main lobar fissure Falciform ligament Ligamentum teres (round ligament) Ligamentum venosum ```
54
Describe Glisson's capsule.
Thin connective tissue Surrounds liver - protects it Thickest around IVC and porta hepatis
55
Describe the porta hepatis.
Liver hilum Inferior surface of liver Contains PV, HA, CBD, nerves, lymph vessels
56
Describe the main lobar fissure.
Boundary between right and left lobes | Hyperechoic line from portal vein to gallbladder
57
Describe the falciform ligament.
Formed from mid portion of coronary ligament Umbilicus to the diaphragm Inferior margin contains ligamentum teres
58
Describe ligamentum teres.
Echogenic focus Dividing the medial and lateral left lobe Circular echogenic structure
59
What is the ligamentum teres remnant of?
The umbilical vein
60
Why would the ligamentum teres will recanalize?
Cirrhosis | Portal hypertension
61
Describe the ligamentum venosum.
Remnant ductus venosus Thin echogenic line anterior to the caudate lobe Separates caudate from left lobe
62
What is a fissure?
Indent where the vein lays
63
What fissure contains the right hepatic vein?
Right intersegmental fissure
64
How does the right intersegmental fissure divide the liver?
Anterior and posterior
65
What fissure contains the left hepatic vein?
Left intersegmental fissure
66
How does the left intersegmental fissure divide the liver?
Medial and Lateral
67
What ligaments suspend the liver from the diaphragm?
Coronary and triangular ligaments
68
What does the hepatic artery do?
Carries oxygenated blood from the aorta to the liver
69
Describe the hepatic artery vascularly.
High in oxygen 20-30% of blood supply Branch of celiac axis Bifurcates into left and right
70
What kind of resistance is present in the hepatic artery?
Low resistance
71
Main portal vein in the ______ _______ - _______ _______
Porta hepatis - liver hilum
72
Right portal vein is the _______ branch.
Larger
73
Left portal vein is _________ _________.
More anterior
74
Describe main portal vein.
``` Junction of SV and SMV Anterior to IVC Enters porta hepatis Bifurcates in liver Less than 13 mm AP ```
75
Describe the right portal vein.
Courses laterally and posteriorly | Splits into anterior and posterior branches
76
Describe left portal vein.
Courses superiorly | Splits into medial and lateral branches
77
Portal vein enlargement is an indication of what?
Portal hypertension
78
Describe the portal vein vascularly.
Supplies greater than 60% of total blood supply to liver Lower in oxygen Branches into right and left Enters the center of the liver lobes supplied Two systems mix blood in the sinusoids
79
Right hepatic vein is the _________ and left hepatic vein is the ________.
Largest | Smallest
80
What do the hepatic veins do?
Enter IVC below diaphragm Drains blood from liver and returns it to the heart Courses between hepatic lobes and fissures (intersegmental & interlobar)
81
Describe the right hepatic vein.
``` Largest Drains right lobe Divides right lobe into anterior & posterior segments In right segmental fissure Longitudinal plane ```
82
Describe middle hepatic vein.
Separates right and left lobes In main lobar fissure Transverse plane
83
Describe left hepatic vein.
``` Smallest Drains left lobe Divides left lobe into medial & lateral segments In left segmental fissure Transverse plane ```
84
What does the portal vein do?
Carries blood from the bowel to the liver
85
Portal veins versus hepatic veins
PV - SV joins SMV to from PV, larger at their origin, branches point to the porta hepatis, ECHOGENIC wall, TRAVERSES the lobes, INTRAsegmental, continuous Doppler HV - flow into IVC, course between lobes, larger as they drain into IVC, branches point to the diaphragm, INTERsegmental, multi phasic Doppler
86
Describe layout of the portal triad.
PV, HA, CBD HA anterior and medial to PV CBD anterior and lateral to PV "Mickey Mouse" sign
87
What are the parts to the hepatobiliary system?
Liver, bile ducts, gallbladder
88
What 2 things does the hepatobiliary system do?
Metabolic and excretory
89
Describe metabolic.
Chemical reactions to sustain life
90
Describe excretory.
Elimination of waste products of metabolism
91
What equals the CBD?
Bile canaliculi >> interlobular ducts >> right and left hepatic ducts >> common hepatic duct + cystic duct = CBD
92
Where does the CBD enter?
Enters the duodenum through the Ampulla of Vater
93
What are the 6 liver functions?
Metabolism, waste removal, digestion, storage, detoxification, synthesis and secretion of bile
94
Lobules are a _______ unit
Functional
95
Hepatocytes radiate to the...
Periphery around a vein
96
What is found in the outer margin of the lobules?
Portal triad tracts
97
What are sinusoids lined with?
Endothelials and Kupffer cells
98
Portal triad =
CHA, CBD, MPV
99
What do hepatocytes do?
Synthesize, metabolize, and excrete compounds
100
What do Kupffer cells do?
Phagocytize bacteria and foreign material
101
Define metabolism...
Synthesizing complex substances into simple ones for energy Carbohydrates - hypoglycemia and hyperglycemia
102
Describe protein...
``` Amino acids to fatty acids Albumin synthesis (hypoalbuminemia) Protein synthesis (blood clotting & vitamin k) ```
103
Liver enzymes are...
AST, ALT, Alk Phos
104
Describe biliary obstruction enzyme levels...
AST and ALT mild elev Alk aphis marked elev Abn in metastatic
105
Describe hepatocellular obstruction enzyme levels...
AST and ALT striking elev | ALT more specific
106
Define hepatocellular disease...
Liver cells are the immediate problem | Usually treated medically with supportive measures and drugs
107
Define obstructive disorders...
Bile excretion is blocked | Usually treated surgically
108
AST and ALT elev will be release for what other diseases?
Heart and skeletal damage
109
ALT elevated above AST means what?
Hepatic causes
110
Alk Phos elev will be released for what other diseases?
Bone disease and normal pregnancy
111
What is produced by the liver and yolk sac of a fetus and decreases after birth?
Alpha fetoprotein
112
Digestion expels...
Waste products through bile
113
Bile is formed...
Continuously and transported by ducts
114
What are the digestion components?
Water, bile salts, bile pigment, cholesterol, lecithin, and protein
115
During digestion, what is released and when?
Bilirubin is released when RBCs are broken down
116
What does the liver store?
Vitamins, iron/copper, glycogen, fat, amino acids
117
What happens during detoxification?
``` Chemical waste products are removed Ammonium is converted to urea Urea is eliminated by the kidneys Level is measured in BUN BUN may be low in severe liver diseases Ammonium accumulation -breath odor will be noticed ```
118
What is removed during detoxification?
Poisonous substances Bacteria Alcohol
119
What is bilirubin a product of?
Hemoglobin
120
During the uptake, what happens?
Bilirubin is separated from albumin
121
What happens during conjugation?
Combining
122
What happens during excretion?
Transporting
123
2 types of measurement?
Direct and indirect
124
Describe direct measurements...
Conjugated Elevated hepatocellular disease Elevated biliary obstruction - stone, mass, neoplasm
125
Describe indirect measurements...
Up conjugated | Elevated hematologist diseases
126
Elevated bilirubin can cause what?
Jaundice
127
What is caused if estrogen is not metabolized?
Liver disease - gynecomastia (breast enlargement) or testicular atrophy
128
Bile is a product of the what?
Liver
129
Describe bile...
Formed continuously in the hepatocytes Collects and is transported in the ducts Water, bile salts, and pigment Emulsification of fat and removal of wastes
130
Describe AST...
Enzyme present in tissue with high metabolism Any disease that injures the cells Significant elevations is acute hepatitis and cirrhosis Elevated with hepatic necrosis and infectious mononucleosis
131
Describe ALT...
MORE SPECIFIC THAN AST FOR LIVER Slightly elevated in acute cirrhosis, mets, and pancreatitis Mild to moderate elevation in obstructive jaundice Highly elevated in infectious diseases and toxic hepatitis
132
Describe LDH...
Moderate elevation in infectious mononucleosis Mildly elevated in hepatitis, cirrhosis, and obstructive jaundice Detects myocardial and pulmonary infarction
133
Describe Alk Phos...
Produced by liver, bone, and placenta Good indicator of intrahepatic and extrahepatic obstruction - CA, abscess, cirrhosis Moderately elevated in hepatitis and cirrhosis
134
What is prothrombin time?
Blood clotting Vitamin K Liver diesels causes an increase in PT
135
Describe albumin and globulin...
Metabolic disorders | Decreased levels may be seen in liver disease
136
Indications for a liver US?
``` RUQ pain Palpable mass Hepatomegaly Jaundice Hx of alcohol abuse Abnormal LFTs ?Mets Pancreatitis ```
137
Prep for a liver US?
NPO for 8 hrs if gallbladder is being evaluated
138
List relative echogenicities in the ABD from hyperechoic to hypoechoic...
Renal sinus, pancreas, liver, spleen, renal parenchyma

Spring 2014 - ABD TEST 2 - LIVER ✔️ (3 decks)

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