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AB&SS 1 > C3: Liver > Flashcards

C3: Liver Flashcards

1
Q

which aspect of the liver is in contact w/ the diaphragm

A

superior, anterior, posterior

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2
Q

the liver occupies which regions of the body

A

R hypochondrium
epigastric
L hypochondrium (sometimes)

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3
Q

which surface of the liver is indented by the R kidney

A

posterior IVC runs through posterior aspect too)

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4
Q

what can cause displacement of the liver caudally

A

tumors
cirrhosis
subphrenic abscesses

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5
Q

what can cause displacement of the liver cranially

A

abdo tumor
ascites
excessive dilation of the colon

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6
Q

how much larger is the R lobe than the L

A

2-3 X larger

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7
Q

whats the norm length measurement of the liver? where would you measure it

A

= 15.5 cm

-@ midclavicuar line: from diaphragm to inferior edge (where you get kidney coming in)

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8
Q

whats the norm AP measurement of the liver? where would you measure it

A
  1. 1 cm

- @ midpoint of longitudinal measurement

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9
Q

what is a norm caudate/RT lobe ratio

where would you take the ratio

A

<0.65

-subcostal in true trans plane

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10
Q

how can you tell if the liver is enlarged

A

-if the R lobe extends below the lower pole of the R kid (Reidels lobe is the exception)

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11
Q

how can you tell if the liver is enlarged or if its a reidels lobe

A

if a liver appears to have no pathology then its a reidels…. if there is pathology then the liver is likely enlarged

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12
Q

what is a reidels lobe

A

tongue like extension of the R lobe (inferior tip).

common in slim females

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13
Q

how does the anatomical method divide the liver

what landmarks does it use to divide

A

-into 4 lobes based on external markings (see page 3 for image)
lobes are: quadrate, caudate, R and L

  • falciform lig divides the R and L lobes anteriorly
  • caudate lies b/w the IVC, portal vein and Lig venosum
  • quadrate divided by the porta hepatis, GB fossa and Lig teres
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14
Q

how does the functional method divide the liver

what landmarks does it use to divide

A
  • into 3 lobes and 4 segments based on blood supply and billiard drainage…. uses lig, fissures and GB to divide

lobes: R, L and caudate
segments: R-anteior and posterior, L- medial (quadrate) and lateral

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15
Q

how do the portal and hepatic veins course in the liver

A

portals: intrasegmental
hepatics: intersegmental

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16
Q

what landmarks separate the L and R lobes of liver

A

Main lobar fissue

Middle hepatic vein

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17
Q

what landmarks separate the segments of the R lobe of liver

A

R intersegmental tissue
RHV
RPV

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18
Q

what landmarks separate the segments of the L lobe of liver

A

L intersegmental tissue
LHV
LPV
Lig Teres

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19
Q

which segment of liver used to be the quadrate lobe

A

medial L

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20
Q

the caudate lobe gets portal venous and hepatic arterial blood from which lobe

A

both

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21
Q

where is caudate lobe located

A

posterior of liver

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22
Q

what are the posterior, anterior and inferior landmarks for the caudate

A

P: IVC
A: Lig venosum
I: MPV

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23
Q

what is the caudate process

A

the part of the caudate that extends obliquely to the R and passes b/w the IVC and LPV

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24
Q

what is the papillary process

A

the caudal projection of the caudate lobe which lies along the Lig venosum and above the portal hepatis

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25
Q

what structure can the papillary process mimic

A

lymph node or panc. mass

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26
Q

each segment of couinauds contains which structure and is bound bounded by which structure

A
  • each contains a portal vein @ its centre

- bounded by a hepatic vein

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27
Q

what structures are used to divide the liver in couinauds?

A
  • RHV, MHV, LHV divide the liver longitudinally into 4 sections
  • divided trans. by a line drawn through the R main and L main portal branches
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28
Q

which 2 structures are used as landmarks for the MLF

A

GB and IVC in TRANS

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29
Q

the L intersegmental fissure is divided into cranial, middle and caudal sections…. which structures run in which section

A

cranial: LHV
mid: LPV
caudal: Lig teres

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30
Q

the fissure for the Lig venosum divides which segment of the liver from the caudate?

what does this fissure contain?

A

L lateral

  • contains ligamentum venosum (remnant of the ductus venosum)
  • contains hepatogastric ligament (which makes up part of the lesser omentum w/ the hepatoduodenal Lig)
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31
Q

where is the GB fossa located?

A

posterior and inferior part of the R lobe of liver

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32
Q

where is the IVC fossa located

A

on the posterior surface of the liver b/w the caudate and bare area

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33
Q

whats the relationship of the CBD and HA to the PV

A

anterior

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34
Q

what is the glissons capsule

where is it the thickest

A
  • capsule of c-tissue that surrounds the liver

- @ IVC and porta hepatis

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35
Q

which structure accompanies the portal vessel into the liver for a short distance

A

glissons capsule

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36
Q

what is the hepatoduodenal Lig? is it thinner than the hepatogastric Lig

A

a folder of lesser omentum

-yes

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37
Q

what structure forms the anterior boundary of the epiploic foramen

A

hepatoduodenal Lig

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38
Q

what 3 structures run through the hepatoduodenal Lig

A

MPV
HA
CBD
(portal triade)

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39
Q

where does the falciform Lig extend from and where does it attach (2 places)?

what structure of the fetus runs in this ligament

A

umbilicus to liver…. attaches to diaphragm and superior surface of liver

-fetal umbilical vein

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40
Q

where does the Lig teres extend from

what structure forms this ligament

A

LPV to inferior aspect of the liver

-fetal umbilical vein atrophies to become this ligament

41
Q

another name for Lig teres

A

round ligament

42
Q

describe the coronary ligaments, where are they located.

they connect the liver to which structure?

A

define the bare area of the liver

  • connect to the posterosuperior surface of the liver to the diaphragm
  • form the R &L triangular ligaments
43
Q

the falciform Lig splits into which ligaments

A

coronary

44
Q

which part of the coronary Lig is continuous w/ the falciform

A

upper portion

45
Q

portal veins carry O2 low blood from which areas of the body to the liver

A

intestines, spleen, panc, GB and bowel

46
Q

how can you tell youre in the porta hepatis region

A

the elongation of the MPV over the IVC

47
Q

how does the RPV travel in the liver

A

posterior and inferior

48
Q

which PV is more posterior, RPV or LPV

A

RPV

49
Q

how does the LPV travel in the liver

A

cranially along the anterior surface of the caudate lobe, then turns anteriorly

50
Q

why do the PV walls appear bright?

A

they have a c-tissue sheath that surrounds them (and the portal triade) to keep the triade togehter

51
Q

which HV is the largest

A

RHV

52
Q

which HV is the smallest

A

LHV

53
Q

describe the US appearance of the liver

A
  • homogenous w/ medium level echos

- minimally hyperechoic or isoechoic to the cortex of the R kidney

54
Q

when comparing echogenicity of the liver the kidney cortex, at what level do you compare them

A

hortizontally at the same level

55
Q

what is the functional unit of the liver?

how large is it

A

lobule

1-2 mm diameter w/ hexagon shape

56
Q

how are hepatocytes organized in the liver

what is there function

A
  • organized into 2 layers columns that converge towards a central hepatic vein
  • 2 columns divided by the sinusoids so hepatocytes are in contact w/ sinusoid blood

-liberate substances into the blood and into the bile canaliculi

57
Q

what are sinusoids

where are they located

A

highly permeable blood capillaries

-b/w the hepatocytes columns

58
Q

how does blood flow in the sinusoids

A

-blood from a portal vein and hepatic vein enters at the periphery of the lobule and travels to the central hepatic vein through the sinusoids

59
Q

sinusoids contain what % portal blood and what % hepatic

A

P: 80%
H: 20%

60
Q

describe kupffer cells

where are they located

A
  • part of the RE system
  • function is to cleanse blood by carrying out phagocytosis

-scattered along sinusoids

61
Q

what is the smallest division of the biliary tree

A

bile canaliculi

62
Q

describe the bile canaliculi, where are they located?

A
  • smallest division of the biliary tree
  • b/w the 2 layers of the liver cell columns so bile in the canaliculi are always separated from sinusoid blood by a row of hepatocytes
63
Q

how does bile enter the bile canaliculi

A

-bile is liberated by the hepatocytes into the canaliculi and it flows towards a larger bile duct at the outer edge of the liver lobule….

….those ducts converge to form larger ducts and then the R&L hepatic ducts… then the common hepatic duct which joing w/ the cystic duct to form the CBD

64
Q

where is the portal triade located in reference to the liver lobules?
does the lobule have 1 or multiple portal triades?

A

at the periphery of the lobule

multiple

65
Q

when do the central hepatic veins of each liver lobule eventually combine to form?

A

the HVs

66
Q

what is the primary centre of metabolism

A

liver

67
Q

what components of the liver carry out the majority of its functions

A

hepatocytes, kupffer cells and biliary cells

68
Q

what is bilirubin

A

-bile pigment that is a product of RBC breakdown by kupffer cells and other RE cells

69
Q

what is bile salt composed of and where is it formed

A
  • cholesterol

- formed in hepatic cells

70
Q

how much bile is produced daily

A

700-1200 ml

71
Q

where is unconjugated/indirect bilirubin conjugated?

A

in the liver

72
Q

how is most conjugated bilirubin secreted

A

feces

73
Q

describe unconjugated/indirect bilirubin

A
  • fat soluble (Eg stored in fat)
  • not excreted in urine
  • toxic to tissues
74
Q

describe conjugated/direct bilirubin

A
  • non toxic
  • water soluble
  • secreted by the liver into the bile canaliculi
75
Q

what are the livers RE function

A
  • produces RBCs in the fetus
  • produce plasma proteins and antibodies
  • removes antigens and old RBCs (via kupffer cells)
  • recovers bile pigment
76
Q

what plasma proteins and antibodies does the liver produce

A
  • fibrinogen: helps w/ blood clotting
  • albumin: prevents plasma loss from capillaries (helps control osmotic press)
  • globulins: for natural and acquire immunity
77
Q

what are the metabolic functions of the liver

A

metabolizes fat, protein and carbs

78
Q

carbohydrates are referred to as what type of buffer

A

glucose buffer

79
Q

what substance does the liver store

A 
posions (copper, iron)
ferritin
a.a.s
fats
glycogen
80
Q

how much blood can the liver store

A

200-400 mls

81
Q

the liver forms how much of the bodies lymph fluid

A

1/3 to 1/2

82
Q

what is an enzyme

A

-protein that catalyzes a chemical rxn… it accelerates and controls the rate of the rxn and remains unchanged after the catalyzation.

83
Q

when might enzymes be released into the blood stream

A

when theres damage to tissue…. b/c of this enzyme levels reflect body function

84
Q

what is ALT or SGPT

A
  • enzyme produced by the hepatocytes
  • specific indicator of hepatocelluar damage
  • used w/ AST to distinguish b/w cardiac or hepatic damage
  • elevated ALT means you need A Liver Transplant… SGPT has a P and T and so does hePaTocyte so its specific to the liver*
85
Q

what is AST or SGOT

A

-enzyme found in liver, muscle and tissue w/ high metabolic rates

86
Q

what is ALP or Alk phos

what do increased values indicate

A

enzyme in the liver, bone, intestines and placenta

-biliary obstruction

87
Q

what does it mean if ALP is increased w/ a norm AST and ALT?

A

disease of the bile duct

88
Q

what is LDH

A

-“likely dead heart”

  • enzyme found in multiple organ systems
  • used to detect MI or pulmonary infarcts
  • NON specific indicator of liver damage
89
Q

what is GGT

A
  • “ginger gin and tonic”
  • sensitive to the effects of alcohol in the liver
  • NON specific indicator of liver damage
90
Q

what is AFP

what do increased values indicate

A
  • PROTEIN produced in fetal tissue and by the liver

- hepatocellular carcinoma and testicular carcinoma

91
Q

what does a bilirubin blood test measure and what does it include

A

concentration of bilirubin

includes:
total bilirubin
unconjugated/indirect
conjugated/direct

92
Q

what is total bilirubin

what do increased values indicate

A
  • combines unconjugated and conjugated

- hepatocellular disease

93
Q

what do increased values of unconjugated/indirect bilirubin indicate

A

-hepatocellular disease

94
Q

what do increased values of conjugated/direct bilirubin indicate

A

-extrahepatic bile duct obstruction or bile duct disease

95
Q

what is a prothrombin time lab test

A
  • prothrombin is a clotting factor produced in the liver & effected by levels of Vit K
  • test measures the ability to clot
96
Q

what is INR

what value is norm
w/ what value should you not do a biopsy

A

-international normalized ratio

  • ratio used in place of PT
  • value of 1 is norm
  • > 1.2 - liver biopsy shouldnt be done
97
Q

what is PTT

when will it be prolonger

A

measures clotting time of blood

-in hepatic disease and anticoagulant therapy

98
Q

what is a serum protein lab test

what do increased values indicate

A
  • checks for levels of albumin in blood

- liver dysfunction

99
Q

why is hepatitis testing used

A

used to determine if patient has been exposed to or currently has or is a carries of viral hepatitis

AB&SS 1 (13 decks)

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