Ch10 Liver Flashcards
bare area
Area superior to the liver that is not covered by peritoneum so that inferior vena cava may enter the chest.
caudate lobe
Smallest lobe of the liver situated on the posterosuperior surface of the left lobe; the ligamentum venosum is the anterior border
epigastrium
Area between the right and left hypochondrium
falcaiform ligament
Extends from the umbilicus to the diaphragm in a sagittal plane and contains the ligamentum
left hypochondrium
Left upper quadrant of the abdomen that contains the left lobe of the liver, spleen, and stomach
left lobe of the liver
Lies in the epigastrium and left hypochondrium
left portal vein
Supplies the left lobe of the liver
ligamentum teres
Appears as bright echogenic foci on transverse image; along with faciform ligament, it divides medial and lateral segments of left lobe of the liver
ligamentum venosum
Separates left lobe from caudate lobe; shown as echogenic line on the transverse and sagittal images
main lobar fissure
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
main portal fissure
enter the liver at the porta hepatis
right hypochondrium
Right upper quadrant of the abdomen that contains the left lobe of the liver and gallbladder
right lobe of the liver
Largest lobe of the liver
right portal vein
Supplies the right lobe of the liver; branches into anterior and posterior segments
alkaline phosphatase
Enzyme of the liver
ALT
Alanine aminotransferase- enzyme of the liver
AST
Aspartate aminotransferase- enzyme of the liver
bilirubin
Yellow pigment in bile formed by the breakdown of red blood cells; excreted by liver and stored on the gallbladder
BUN
Blood Urea Nitrogen; laboratory measurement of the amount of nitrogenous waste and creatinine in the blood
hepatocellular disease
Classification of liver disease where hepatocytes are the primary problem
hepatocyte
Parenchymal liver cell that performs all functions ascribed to the liver
hepatofugal
Flow away from the liver
hepatopetal
Flow toward the liver
hyperglycemia
Uncontrolled increase in blood glucose levels
hypoglycemia
Deficiency in blood glucose levels
liver function tests
Specific laboratory tests that look at liver function (aspartate or alanine aminotransferase, lactic acid dehydrogenase, alkaline phosphatase, and bilirubin)
obstructive disease
Classification of liver disease where the main problem is blocked bile excretion within the liver
bull’s-eye (target) lesion
Hypoechoic mass with as echogenic central core (abscess, metastases)
collateral circulation
Develops when normal venous channels become obstructed
diffuse hepatocellular disease
Affect hepatocytes and interferes with liver fuction
extrahepatic
Outside the liver
intrahepatic
Within the liver
metastatic disease
Most common form of neoplasm of the liver; primary sites are colon, breast, and lung
neoplasm
Any new growth (benign or malignant)
pyogenic abscess
Pus-forming collection of fluid
A congenital variant, ____, can sometimes be seen as an anterior projection of the liver and may extend inferiorly as far as the iliac crest
Riedel’s lobe
The liver is covered by a thin connective tissue layer called ____ capsule.
Glisson’s capsule
The ____ fissure is the boundary between the right and left lobes of the liver.
main lobar fissure
The ____ ligament extends from the umbilicus to the diaphragm in a parasagtital plane and contains the ligamentum teres.
falciform ligament
The ____ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament.
ligamentum teres
The fissure for the ____ separates the left lobe from the caudate lobe.
ligamentum venosum
The hepatic veins are divided into three components ___, ___, and ___.
right, middle, left
The liver is a major center of ___, which may be defined as the physical and chemical process whereby foodstuffs are synthesized into complex elements.
metabolism
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
digestion
A pigment released when the red blood cells are broken down is ___.
bilirubin
The liver is a(n)____ site for several compounds used in a variety of physiologic activities throughout the body.
storage site
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.
detoxification
Diseases affection the liver may be classified as ____ when the liver cells or hepatocytes are the immediate problem; or ____ when bile excretion is blocked.
hepatocellular, obstructive
Raw materials in the form of ___, ___, and ___ are absorbed from the intestine and transported to the liver via the circulatory system
carbohydrates, fats, amino acids
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.
glucose
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.
Lipoproteins
The accompanying loss of oncotic pressure in the vascular system allows fluid to migrate into the interstitial space, resulting in ____ in dependent areas.
edema
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.
enzymes
in severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of ___ and ___ may be seen.
AST ALT
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.
alkaline phosphatase
In severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of _____ and ____ may be seen.
AST, ALT
Marked elevation of ____ is typically associated with biliary obstruction or the presence of mass lesions in the liver.
alkaline phosphatase
Hemoglobin released from the red cells is converted to _____ within the reticuloendotheial system and is then released into the bloodstream.
bilirubin
Elevation of serum bilirubin results in _____, which is a yellow coloration of the skin, sclerae, and body secretions.
Jaundice
Name landmarks of the liver
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.
Identify at least 3 characteristics of the right lobe
Right lobe is the largest lobe exceeds the left lobe by 6:1 Occupies the right hypochondriac .
Identify at least 3 characteristics of the left lobe
Left lobe lies in the epigastric and left hypochondriac regions
Name the ligaments and fissures found within the hepatic parenchyma
Glisson’s capsule, main lobar fissure, falciform ligament, ligamentum teres, and ligamentum venosum
Explain how to distinguish the hepatic veins from the portal vein
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
List the seven liver function tests to analyze how the liver is performing under normal and diseased conditions
Aspartate aminotransferaes AST, alanine aminotransferase ALT, lactic acid dehydrogenase LDH, alkaline phosphatase (alk phos), bilirubin (direct, indirect, and total) prothrombin time, albumin and globulins
explain why the evaluation of the hepatic structure is one of the most important procedures in sonography
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
Within the homogeneous parenchyma lie the thin-walled ____, the brightly reflective ____, the _____ arteries, and the _____ duct.
hepatic veins, portal veins, hepatic, hepatic
The portal flow is shown to be _____ (toward the liver) whereas the hepatic venous flow is ____ (away from the liver).
hepatopetal, hepatofugal
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.
anterior, medial
How should time gain compensation be adjusted to balance the far-gain and the near-gain echo signals?
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
Generally a wider pie sector or curved linear array transducer is the most appropriate to optimally image the ____ of the abdomen
near field
To image the far field better, a(n) _____ array transducer with a longer focal zone is used
sector or annular
List 4 criteria assessed when evaluation the liver parenchyma
size, configuration, homogeneity, and contour
Hepatocellular disease affects the ____ and interferes with liver function enzymes
hepatocytes
The hepatic enzyme levels are elevated with _____ necrosis.
cell
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.
lipid accumulation
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
gallbladder, left lobe
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
coarse, decreased
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 ____.
degenerates, fat
Glycogen storage disease is associated with _____, focal nodular ___, and hepatomegaly.
hepatic adenomas, hyperplasia
List 5 differential consideration for focal diseases of the liver
cysts, abscess, hematoma, primary tumor, and metastases
List the signs and symptoms of a patient who has inflammatory disease of the liver
fever, white cell elevation, and right upper quadrant pain
A(n) ____ is any new growth of new tissue, either benign or malignant
neoplasm
A (n) ___ is a benign, congenital tumor consisting of large, blood-filled cystic spaces.
hemangioma
The pathogenesis of hepatocellular carcinoma is related to ____, chronic ____ virus infection, and hepatocarcinogens in food.
cirrhosis, hepatitis B
Describe the pathological patterns seen on carcinoma of the liver
solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltration masses in the the liver
The liver is the 3rd most common organ injured in the abdomen after the _____ and the ____.
spleen, kidney
Describe the complication of liver transplantation as seen on an ultrasound
include rejection, thrombosis or leak, biliary stricture or leak, infection and neoplasia
An increase in portal venous pressure or hepatic venous gradient is defined as ____.
portal hypertension
Portal hypertension may also develop when hepatopetal flow is impeded by ___ or ____ invasion
thrombus, tumor
The umbilical vein may become ___ secondary to portal hypertension.
recanalized
The pulse repetition frequency allows one to record lower velocities as the PRF is _____.
lowered
The Doppler sample volume should be ____ than the diameter of the lumen.
smaller
Explain what color Doppler velocity is dependent on
direction of flow, velocity, and angle to flow
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
Budd- Chiari
