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.
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
3
Q
epigastrium
A
Area between the right and left hypochondrium
4
Q
falcaiform ligament
A
Extends from the umbilicus to the diaphragm in a sagittal plane and contains the ligamentum
5
Q
left hypochondrium
A
Left upper quadrant of the abdomen that contains the left lobe of the liver, spleen, and stomach
6
Q
left lobe of the liver
A
Lies in the epigastrium and left hypochondrium
7
Q
left portal vein
A
Supplies the left lobe of the liver
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
9
Q
ligamentum venosum
A
Separates left lobe from caudate lobe; shown as echogenic line on the transverse and sagittal images
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
11
Q
main portal fissure
A
enter the liver at the porta hepatis
12
Q
right hypochondrium
A
Right upper quadrant of the abdomen that contains the left lobe of the liver and gallbladder
13
Q
right lobe of the liver
A
Largest lobe of the liver
14
Q
right portal vein
A
Supplies the right lobe of the liver; branches into anterior and posterior segments
15
Q
alkaline phosphatase
A
Enzyme of the liver
16
Q
ALT
A
Alanine aminotransferase- enzyme of the liver
17
Q
AST
A
Aspartate aminotransferase- enzyme of the liver
18
Q
bilirubin
A
Yellow pigment in bile formed by the breakdown of red blood cells; excreted by liver and stored on the gallbladder
19
Q
BUN
A
Blood Urea Nitrogen; laboratory measurement of the amount of nitrogenous waste and creatinine in the blood
20
Q
hepatocellular disease
A
Classification of liver disease where hepatocytes are the primary problem
21
Q
hepatocyte
A
Parenchymal liver cell that performs all functions ascribed to the liver
22
Q
hepatofugal
A
Flow away from the liver
23
Q
hepatopetal
A
Flow toward the liver
24
Q
hyperglycemia
A
Uncontrolled increase in blood glucose levels
25
hypoglycemia
Deficiency in blood glucose levels
26
liver function tests
Specific laboratory tests that look at liver function (aspartate or alanine aminotransferase, lactic acid dehydrogenase, alkaline phosphatase, and bilirubin)
27
obstructive disease
Classification of liver disease where the main problem is blocked bile excretion within the liver
28
bull's-eye (target) lesion
Hypoechoic mass with as echogenic central core (abscess, metastases)
29
collateral circulation
Develops when normal venous channels become obstructed
30
diffuse hepatocellular disease
Affect hepatocytes and interferes with liver fuction
31
extrahepatic
Outside the liver
32
intrahepatic
Within the liver
33
metastatic disease
Most common form of neoplasm of the liver; primary sites are colon, breast, and lung
34
neoplasm
Any new growth (benign or malignant)
35
pyogenic abscess
Pus-forming collection of fluid
36
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
37
The liver is covered by a thin connective tissue layer called ____ capsule.
Glisson's capsule
38
The ____ fissure is the boundary between the right and left lobes of the liver.
main lobar fissure
39
The ____ ligament extends from the umbilicus to the diaphragm in a parasagtital plane and contains the ligamentum teres.
falciform ligament
40
The ____ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament.
ligamentum teres
41
The fissure for the ____ separates the left lobe from the caudate lobe.
ligamentum venosum
42
The hepatic veins are divided into three components ___, ___, and ___.
right, middle, left
43
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
44
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
45
A pigment released when the red blood cells are broken down is ___.
bilirubin
46
The liver is a(n)____ site for several compounds used in a variety of physiologic activities throughout the body.
storage site
47
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
48
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
49
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
50
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
51
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
52
The accompanying loss of oncotic pressure in the vascular system allows fluid to migrate into the interstitial space, resulting in ____ in dependent areas.
edema
53
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
54
in severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of ___ and ___ may be seen.
AST ALT
55
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
56
In severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of _____ and ____ may be seen.
AST, ALT
57
Marked elevation of ____ is typically associated with biliary obstruction or the presence of mass lesions in the liver.
alkaline phosphatase
58
Hemoglobin released from the red cells is converted to _____ within the reticuloendotheial system and is then released into the bloodstream.
bilirubin
59
Elevation of serum bilirubin results in _____, which is a yellow coloration of the skin, sclerae, and body secretions.
Jaundice
60
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.
61
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 .
62
Identify at least 3 characteristics of the left lobe
Left lobe lies in the epigastric and left hypochondriac regions
63
Name the ligaments and fissures found within the hepatic parenchyma
Glisson's capsule, main lobar fissure, falciform ligament, ligamentum teres, and ligamentum venosum
64
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
65
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
66
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
67
Within the homogeneous parenchyma lie the thin-walled ____, the brightly reflective ____, the _____ arteries, and the _____ duct.
hepatic veins, portal veins, hepatic, hepatic
68
The portal flow is shown to be _____ (toward the liver) whereas the hepatic venous flow is ____ (away from the liver).
hepatopetal, hepatofugal
69
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
70
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
71
Generally a wider pie sector or curved linear array transducer is the most appropriate to optimally image the ____ of the abdomen
near field
72
To image the far field better, a(n) _____ array transducer with a longer focal zone is used
sector or annular
73
List 4 criteria assessed when evaluation the liver parenchyma
size, configuration, homogeneity, and contour
74
Hepatocellular disease affects the ____ and interferes with liver function enzymes
hepatocytes
75
The hepatic enzyme levels are elevated with _____ necrosis.
cell
76
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
77
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
78
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
79
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
80
Glycogen storage disease is associated with _____, focal nodular ___, and hepatomegaly.
hepatic adenomas, hyperplasia
81
List 5 differential consideration for focal diseases of the liver
cysts, abscess, hematoma, primary tumor, and metastases
82
List the signs and symptoms of a patient who has inflammatory disease of the liver
fever, white cell elevation, and right upper quadrant pain
83
A(n) ____ is any new growth of new tissue, either benign or malignant
neoplasm
84
A (n) ___ is a benign, congenital tumor consisting of large, blood-filled cystic spaces.
hemangioma
85
The pathogenesis of hepatocellular carcinoma is related to ____, chronic ____ virus infection, and hepatocarcinogens in food.
cirrhosis, hepatitis B
86
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
87
The liver is the 3rd most common organ injured in the abdomen after the _____ and the ____.
spleen, kidney
88
Describe the complication of liver transplantation as seen on an ultrasound
include rejection, thrombosis or leak, biliary stricture or leak, infection and neoplasia
89
An increase in portal venous pressure or hepatic venous gradient is defined as ____.
portal hypertension
90
Portal hypertension may also develop when hepatopetal flow is impeded by ___ or ____ invasion
thrombus, tumor
91
The umbilical vein may become ___ secondary to portal hypertension.
recanalized
92
The pulse repetition frequency allows one to record lower velocities as the PRF is _____.
lowered
93
The Doppler sample volume should be ____ than the diameter of the lumen.
smaller
94
Explain what color Doppler velocity is dependent on
direction of flow, velocity, and angle to flow
95
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
