Anatomy Power Point Flashcards by William Kerns

Liver

Largest organ in body

located in right hypochondrium, epigastrium and left hypochondrium

inferior to the diaphragm

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Liver location

posterior border in contact with right kidney and inferior vena cava

aorta lies posterior to the left lobe

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Subphrenic space

between liver and diaphragm

common site for abscess formation

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right subhepatic space

includes morrison’s pouch, a common space for periotoneal fluid or blood to collect

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pancreas location

inferior to the left lobe of the liver

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Gall Bladder

lies on the visceral surface of the liver

Main lobar fissure is the sonographic landmark leading to the fossa

seen as an echogenic line that runs from the right portal vein to the gallbladder

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Lobes of the liver

Right

left

Caudate

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Right liver lobe

RLL

largest of 3 lobes

contains 3 fossae

Congenital variant, Riedels lobe

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RLL fossae

porta hepatis

gallbladder

inferior vena cava

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RLL Reidels Lobe

sometimes seen as an anterior projectoin of the liver

sometimes extending down the iliac crest

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Left Liver Love

LLL

Size varies from patient to patient

men seem to have smaller lobe

found just under the xiphoid process

if larger makes great acoustic window for pancreas and aorta

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Caudate Lobe

small lobe

situated inferior to the ligamentum venosum

superior to the inferior vena cava

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Liver Ligaments and fissures

Main Lobar fissure

LIgamentum Teres

Ligamentum venosum

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Main lobar fissure

boundry between right and left lobes of liver

on longitudinal scan may be seen as a hyperechoic line extending from portal vein to neck of gallbladder

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ligamentum teres

appears as bright echogenic triangle on transverse scan

separates the medial and lateral segments of the left lobe of the liver

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ligamentum venosum

appears as hyperechoic line separating the left lobe from the caudate lobe

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Liver Vascular supply

Portal venous system

Main portal vein

portal venous system

supplies 80% of blood flow to the liver from the digestive system

flow should be toward the liver-hepatopetal (toward the liver)

Main Portal Vein

MPV

enters the liver at the portahepatis

divides into the right and left portal veins

RPV and LPV

Right Portal vein

RPV

largest portal vein

further divides into anterior and posterior branches

Hepatic Veins

drain blood from the liver back inot the IVC

3 components: Right RHV, Middle MHV and Left LHV

can be distinguished from the portal veins by lackj of bright walls

Hepatic Arteries

Supplies blood to liver (20%)

branch of the celiac artery from the aorta

Liver functions

metabolism-carbs and protein

Digestion

storage

detoxification

Liver Function Tests

LFT

AST

ALT

LDH

Alk phos

Bilibrubin

Albumin

Globulins

Liver scanning

TGC adjusted to balance near and far echos overall gain-adjusted to adequatley penetrate the entire right lobe and a smooth homogeneous pattern depth posterior right lobe positioned at the lower border of screen focuses near the posterior border transducer freq. Avg adult 2.5-5MHz, pediatric 5-7MHz

Liver Scanning evaluation

size in the longitudinal plane attentuation of the parechyma texture presence of hepatic vascular structures, ligaments and fissures

Gallbladder

should be anechoic with wall thickness less than 3mm no fluid between wall and liver

Gall Bladder pathology

polyps gallstones tumors thick walls with fluid around sludge all of above

Pancreas

Head, body, tail, uncinate process seen in transverse scan GDA and CBD lelineate the lateral border of the head splenic vein delineates the posterior border sometimes see pancreatic duct normal is 2mm or less

Kidney

Cortex Hilum pyramids calyx

Cortex

outer parenchyma of kidney

Hilum

midportion of the kidney renal vessels and ureter enter and exit

Pyramids

convey urine to the minor calyces

Calyx

part of the collecting system that collects urine may become obstructed

Kidney Function

excretes waste regulates composition of the blood by filtration of harmful wastes, conserving water and metabolites in the body

Nephron

functional unit of the kidney

Kidney normal texture and pattern

smooth outer contours surrounded by perirenal fat echogenicity is equal (isoechoic) to or hypoechoic to the liver/spleen important to include these organs to compare echogenicity should not be any fluid present

Kidney lab tests

BUN Blood urea nitrogen Creatinine measure the amount of nitrogenous wastes waste products accumulate in blood when kidneys are not functioning properly

Kidney imaging

always bilateral exam nephrectomy-long and trvs image of the renal fossa looking for fluid collection patiens should be hydrated liver and spleen used and window deep inspiration will allow approx 2 cm downward shift of kidneys for better visualization start with RT longitudinal lateral-median then transverse sup-inferior making sure to scan beyond outer contours

Spleen

part of the reticuloendothelial system synthesis of blood proteins largest mass of lymphoid tissue in body active in blood formation during initial part of fetal life blood formation function decreases gradually by 5-6th month when spleen assumes its adult characterisitics plays important role in defense of the body affected by systemic disease, rarely the cause

Spleen physical description

variable in size and shape smooth borders with a convex superior and concave inferior surface mormal measurements are 8-13 cm