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Chapter 9 Vascular > Ch10 Liver > Flashcards

Ch10 Liver Flashcards

1
Q

bare area

A

Area superior to the liver that is not covered by peritoneum so that inferior vena cava may enter the chest.

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2
Q

caudate lobe

A

Smallest lobe of the liver situated on the posterosuperior surface of the left lobe; the ligamentum venosum is the anterior border

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3
Q

epigastrium

A

Area between the right and left hypochondrium

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4
Q

falcaiform ligament

A

Extends from the umbilicus to the diaphragm in a sagittal plane and contains the ligamentum

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5
Q

left hypochondrium

A

Left upper quadrant of the abdomen that contains the left lobe of the liver, spleen, and stomach

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6
Q

left lobe of the liver

A

Lies in the epigastrium and left hypochondrium

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7
Q

left portal vein

A

Supplies the left lobe of the liver

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8
Q

ligamentum teres

A

Appears as bright echogenic foci on transverse image; along with faciform ligament, it divides medial and lateral segments of left lobe of the liver

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9
Q

ligamentum venosum

A

Separates left lobe from caudate lobe; shown as echogenic line on the transverse and sagittal images

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10
Q

main lobar fissure

A

Boundary between the tright and left lobes of the liver; seen as hyperechoic line on the sagittal image extending from the portal vein to the neck of the gallbladder

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11
Q

main portal fissure

A

enter the liver at the porta hepatis

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12
Q

right hypochondrium

A

Right upper quadrant of the abdomen that contains the left lobe of the liver and gallbladder

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13
Q

right lobe of the liver

A

Largest lobe of the liver

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14
Q

right portal vein

A

Supplies the right lobe of the liver; branches into anterior and posterior segments

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15
Q

alkaline phosphatase

A

Enzyme of the liver

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16
Q

ALT

A

Alanine aminotransferase- enzyme of the liver

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17
Q

AST

A

Aspartate aminotransferase- enzyme of the liver

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18
Q

bilirubin

A

Yellow pigment in bile formed by the breakdown of red blood cells; excreted by liver and stored on the gallbladder

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19
Q

BUN

A

Blood Urea Nitrogen; laboratory measurement of the amount of nitrogenous waste and creatinine in the blood

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20
Q

hepatocellular disease

A

Classification of liver disease where hepatocytes are the primary problem

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21
Q

hepatocyte

A

Parenchymal liver cell that performs all functions ascribed to the liver

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22
Q

hepatofugal

A

Flow away from the liver

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23
Q

hepatopetal

A

Flow toward the liver

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24
Q

hyperglycemia

A

Uncontrolled increase in blood glucose levels

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25
Q

hypoglycemia

A

Deficiency in blood glucose levels

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26
Q

liver function tests

A

Specific laboratory tests that look at liver function (aspartate or alanine aminotransferase, lactic acid dehydrogenase, alkaline phosphatase, and bilirubin)

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27
Q

obstructive disease

A

Classification of liver disease where the main problem is blocked bile excretion within the liver

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28
Q

bull’s-eye (target) lesion

A

Hypoechoic mass with as echogenic central core (abscess, metastases)

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29
Q

collateral circulation

A

Develops when normal venous channels become obstructed

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30
Q

diffuse hepatocellular disease

A

Affect hepatocytes and interferes with liver fuction

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31
Q

extrahepatic

A

Outside the liver

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32
Q

intrahepatic

A

Within the liver

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33
Q

metastatic disease

A

Most common form of neoplasm of the liver; primary sites are colon, breast, and lung

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34
Q

neoplasm

A

Any new growth (benign or malignant)

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35
Q

pyogenic abscess

A

Pus-forming collection of fluid

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36
Q

A congenital variant, ____, can sometimes be seen as an anterior projection of the liver and may extend inferiorly as far as the iliac crest

A

Riedel’s lobe

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37
Q

The liver is covered by a thin connective tissue layer called ____ capsule.

A

Glisson’s capsule

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38
Q

The ____ fissure is the boundary between the right and left lobes of the liver.

A

main lobar fissure

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39
Q

The ____ ligament extends from the umbilicus to the diaphragm in a parasagtital plane and contains the ligamentum teres.

A

falciform ligament

40
Q

The ____ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament.

A

ligamentum teres

41
Q

The fissure for the ____ separates the left lobe from the caudate lobe.

A

ligamentum venosum

42
Q

The hepatic veins are divided into three components ___, ___, and ___.

A

right, middle, left

43
Q

The liver is a major center of ___, which may be defined as the physical and chemical process whereby foodstuffs are synthesized into complex elements.

A

metabolism

44
Q

Through the process of ____, the liver expels these waste products from the body via its excretory product, bile, which also plays an important role in fat absorption

A

digestion

45
Q

A pigment released when the red blood cells are broken down is ___.

A

bilirubin

46
Q

The liver is a(n)____ site for several compounds used in a variety of physiologic activities throughout the body.

A

storage site

47
Q

The liver is also a center for ____ of the waste products of metabolism accumulated from other sources in the body and foreign chemicals that enter the body.

A

detoxification

48
Q

Diseases affection the liver may be classified as ____ when the liver cells or hepatocytes are the immediate problem; or ____ when bile excretion is blocked.

A

hepatocellular, obstructive

49
Q

Raw materials in the form of ___, ___, and ___ are absorbed from the intestine and transported to the liver via the circulatory system

A

carbohydrates, fats, amino acids

50
Q

Sugars may be absorbed from the blood on several forms, but only ___ can be used by cells throughout the body as a source of energy.

A

glucose

51
Q

Dietary fats are converted in the hepatocytes to ____, in which form fats are transported throughout the body to sites where they are used by other organs or stored.

A

Lipoproteins

52
Q

The accompanying loss of oncotic pressure in the vascular system allows fluid to migrate into the interstitial space, resulting in ____ in dependent areas.

A

edema

53
Q

Because the liver is a major center of metabolism, large quantities of ____ are present in hepatocytes, and these leak into the bloodstream when the liver cells are damaged or destroyed by disease.

A

enzymes

54
Q

in severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of ___ and ___ may be seen.

A

AST ALT

55
Q

Marked elevation of ____ is typically associated with biliary obstruction or the present in hepatocytes, and these leak into the bloodstream when the liver cells are damaged or destroyed by disease.

A

alkaline phosphatase

56
Q

In severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of _____ and ____ may be seen.

A

AST, ALT

57
Q

Marked elevation of ____ is typically associated with biliary obstruction or the presence of mass lesions in the liver.

A

alkaline phosphatase

58
Q

Hemoglobin released from the red cells is converted to _____ within the reticuloendotheial system and is then released into the bloodstream.

A

bilirubin

59
Q

Elevation of serum bilirubin results in _____, which is a yellow coloration of the skin, sclerae, and body secretions.

A

Jaundice

60
Q

Name landmarks of the liver

A

Occupies the right hypochondriac, epigastrium, and the left hypochondriac. most of the left lobe is covered by the the rib cage. in the epigastric the liver extends centimeters below the xiphoid process. on the right the rib cover most of the liver.

61
Q

Identify at least 3 characteristics of the right lobe

A

Right lobe is the largest lobe exceeds the left lobe by 6:1 Occupies the right hypochondriac .

62
Q

Identify at least 3 characteristics of the left lobe

A

Left lobe lies in the epigastric and left hypochondriac regions

63
Q

Name the ligaments and fissures found within the hepatic parenchyma

A

Glisson’s capsule, main lobar fissure, falciform ligament, ligamentum teres, and ligamentum venosum

64
Q

Explain how to distinguish the hepatic veins from the portal vein

A

Is to trace their points of entry into the liver. Hepatic veins course between the hepatic lobes and segments and are larger as they drain into the inferior vena cava before entering the right atrium: the portal veins are larger a the their origin as they emanate from the porta hepatitis. Portal vein have more echogenic border than hepatic veins because they have a thicker collagenous sheath

65
Q

List the seven liver function tests to analyze how the liver is performing under normal and diseased conditions

A

Aspartate aminotransferaes AST, alanine aminotransferase ALT, lactic acid dehydrogenase LDH, alkaline phosphatase (alk phos), bilirubin (direct, indirect, and total) prothrombin time, albumin and globulins

66
Q

explain why the evaluation of the hepatic structure is one of the most important procedures in sonography

A

Normal, basically homogeneous parenchyma of the liver allow imaging of the neighboring anatomic structures in the upper abdomen. Echo amplitude, attenuation and transmission and parenchymal textures may be physically assessed with proper evaluation of the hepatic structures

67
Q

Within the homogeneous parenchyma lie the thin-walled ____, the brightly reflective ____, the _____ arteries, and the _____ duct.

A

hepatic veins, portal veins, hepatic, hepatic

68
Q

The portal flow is shown to be _____ (toward the liver) whereas the hepatic venous flow is ____ (away from the liver).

A

hepatopetal, hepatofugal

69
Q

Near the porta hepatic, the hepatic duct can be seen along the lateral ____ border of the portal vein, whereas the hepatic artery can be seen along the anterior ____ border.

A

anterior, medial

70
Q

How should time gain compensation be adjusted to balance the far-gain and the near-gain echo signals?

A

Easiest way to do this is to hold the transducer over a deep segment of the right lobe of the liver. Fart time-gain control pods should be increased gradually with a smooth motion of the index finger until the posterior aspect of the liver is well seen. Near-field time-gain controls should be adjusted (usually decreased to image the anterior wall and field of the hepatic parenchyma

71
Q

Generally a wider pie sector or curved linear array transducer is the most appropriate to optimally image the ____ of the abdomen

A

near field

72
Q

To image the far field better, a(n) _____ array transducer with a longer focal zone is used

A

sector or annular

73
Q

List 4 criteria assessed when evaluation the liver parenchyma

A

size, configuration, homogeneity, and contour

74
Q

Hepatocellular disease affects the ____ and interferes with liver function enzymes

A

hepatocytes

75
Q

The hepatic enzyme levels are elevated with _____ necrosis.

A

cell

76
Q

Fatty infiltration implies increased ____ in the hepatocytes and results from significant injury to the liver or a systemic disorder leading to impaired or excessive metabolism fat.

A

lipid accumulation

77
Q

In focal sparing, the most common affected areas are anterior to the ____ or the portal vein and the posterior portion of the ____ of the liver

A

gallbladder, left lobe

78
Q

On ultrasound examination, the liver parenchyma in chronic hepatitis is ____ with ____ brightness of the portal triads, but the degree of attenuation is not as great as seen in fatty infiltration

A

coarse, decreased

79
Q

Cirrhosis is a chronic degeneration of the liver in which the lobes are covered with fibrous tissue, the parenchyma ___, and the lobules are infiltrated with ____.

A

degenerates, fat

80
Q

Glycogen storage disease is associated with _____, focal nodular ___, and hepatomegaly.

A

hepatic adenomas, hyperplasia

81
Q

List 5 differential consideration for focal diseases of the liver

A

cysts, abscess, hematoma, primary tumor, and metastases

82
Q

List the signs and symptoms of a patient who has inflammatory disease of the liver

A

fever, white cell elevation, and right upper quadrant pain

83
Q

A(n) ____ is any new growth of new tissue, either benign or malignant

A

neoplasm

84
Q

A (n) ___ is a benign, congenital tumor consisting of large, blood-filled cystic spaces.

A

hemangioma

85
Q

The pathogenesis of hepatocellular carcinoma is related to ____, chronic ____ virus infection, and hepatocarcinogens in food.

A

cirrhosis, hepatitis B

86
Q

Describe the pathological patterns seen on carcinoma of the liver

A

solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltration masses in the the liver

87
Q

The liver is the 3rd most common organ injured in the abdomen after the _____ and the ____.

A

spleen, kidney

88
Q

Describe the complication of liver transplantation as seen on an ultrasound

A

include rejection, thrombosis or leak, biliary stricture or leak, infection and neoplasia

89
Q

An increase in portal venous pressure or hepatic venous gradient is defined as ____.

A

portal hypertension

90
Q

Portal hypertension may also develop when hepatopetal flow is impeded by ___ or ____ invasion

A

thrombus, tumor

91
Q

The umbilical vein may become ___ secondary to portal hypertension.

A

recanalized

92
Q

The pulse repetition frequency allows one to record lower velocities as the PRF is _____.

A

lowered

93
Q

The Doppler sample volume should be ____ than the diameter of the lumen.

A

smaller

94
Q

Explain what color Doppler velocity is dependent on

A

direction of flow, velocity, and angle to flow

95
Q

Acute abdominal pain, massive ascites, and hepatomegaly secondary to thrombosis of the hepatic veins or inferior vena cava characterize ____ syndrome, which has a poor prognosis

A

Budd- Chiari

Chapter 9 Vascular (16 decks)

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