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Sonography part 1 > Chapter 10 Liver > Flashcards

Chapter 10 Liver Flashcards

1
Q

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

A

caudate lobe

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2
Q

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

A

ligamentum venosum

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3
Q

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

A

bare area

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4
Q

Lies in the epigastrium and left hypochondrium

A

left lobe of liver

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5
Q

Largest lobe of the liver

A

right lobe of liver

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6
Q

Boundrary between the right 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

A

main lobar fissure

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7
Q

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

A

falciform ligament

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8
Q

Supplies the left lobe of the liver

A

left portal vein

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9
Q

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

A

ligamentum teres

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10
Q

Enters the liver at the porta hepatis

A

main portal vein

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11
Q

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

A

right hypochondrium

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12
Q

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

A

right portal vein

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13
Q

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

A

left hypochondrium

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14
Q

Area between the right and left hypochomdrium

A

epigastrium

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15
Q

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

A

bilirubin

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16
Q

Alanine aminotransferase-enzyme of the liver

A

ALT

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17
Q

What’s the name for specific laboratory tests that look at liver function

A

liver function tests

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18
Q

Aspartate aminotransferase-enzyme of the liver

A

AST

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19
Q

Flow away from the liver

A

hepatofugal

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20
Q

Parenchyml liver cell that performs all functions ascribed to the liver

A

hepatocyte

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21
Q

Uncontrolled increase in blood glucose levels

A

hyperglycemia

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22
Q

Enzyme of the liver

A

alkaline phosphatase

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23
Q

Classification of liver disease where hepatocytes are the primary problem

A

hepatocellular disease

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24
Q

Blood urea nitrogen; laboratory measurement of the amount of nitrogenous waste and creatinine in the blood

A

BUN

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25
Q

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

A

obstructive disease

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26
Q

Flow toward the liver

A

hepatopetal

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27
Q

Deficiency in blood glucose levels

A

hypoglycemia

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28
Q

Outside the liver (pathology term)

A

extrahepatic

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29
Q

Hypoechoic mass with an echogenic central core (abcess, metastases)
(pathology term)

A

bull’s-eye (target) lesion

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30
Q

Any new growth (benign or malignant)

pathology term

A

neoplasm

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31
Q

Within the liver

pathology term

A

intrahepatic

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32
Q

Most common form of neoplasm of the liver; primary sites are colon, breast, and lung.
(pathology term)

A

metastatic disease

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33
Q

Affects hepatocytes and interferes with liver function

pathology term

A

diffuse hepatocellular disease

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34
Q

Pus-forming collection of fluid

pathology term

A

pyogenic abscess

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35
Q

Develops when normal venous channels become obstructed

pathology term

A

collateral circulation

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36
Q

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

A

Riedels lobe

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37
Q

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

A

Glissions

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38
Q

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

A

main lobar fissure

39
Q

The ________________ ligament extends from the umbilicus to the diaphragm in a parasagittal 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, and 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 wast 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

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 affecting the liver may be classified as __________________ when the liver cells or hepatocytes are the immediate problem; or _________________ when the 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, and amino acids

50
Q

Sugars may be absorbed from the blood in 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, ans these leak into the bloodstream when the liver cells are damaged or destroyed by disease.

A

enzyemes

54
Q

In severe hepatocelluar 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 presence of mass lesions in the liver.

A

alkaline phosphate

56
Q

Hemoglobin released from the red blood cells is converted to ________________ within the reticuloendothelial system and is then released into the bloodstream.

A

bilirubin

57
Q

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

A

juandice

58
Q

Name landmarks of the liver.

A

Right hypochondrium region
Inferior to diaphragm
Epigastric region below xiphoid process
Right & left covered by rib

59
Q

Identify at least three characteristics of the right lobe of the liver.

A

Largest lobe of the liver
Bordered on its upper surface by falciform ligament
Occupies right hypochondrium

60
Q

Identify at least three characteristics of the left lobe of the liver.

A

Epigastric and left hypochondriac regions
Upper surface convex and molded to diaphragm
Under-surface includes gastric impression

61
Q

Name the ligaments and fissures found within the hepatic parenchyma.

A

Glissons Capsule, main lobar fissure, falciform ligament, ligamentum teres, ligamentum venosum.

62
Q

Explain how to distinguish hepatic veins from portal veins.

A

Trace the points of entry to the liver. Hepatic veins flow into the IVC and portal veins have more echogenic borders.

63
Q

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

A

AST, ALT, Lactic acid dehydrogense (LDH), Alkaline Phosphatase, Bilirubin (indirect, direct and total), Prothrombin time and Albumin & Globulins.

64
Q

Within the homogeneous parenchyma lie the thin-walled _______________, the brightly reflective _________________, the _______________ arteries, and the __________ duct.

A

hepatic veins; portal veins; hepatic arteries; hepatic duct.

65
Q

The portal flow is shown to be _____________

A

hepatopetal (toward the liver)

66
Q

The hepatic venous flow is _______________.

A

hepatofugal (away from the liver)

67
Q

Near the porta hepatis, 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

68
Q

Generally a wider pie sector or curved linear array transducer is the most appropraite to optimally image the ____________ of the abdomen.

A

near field

69
Q

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

A

sector

70
Q

List the four criteria assessed when evaluating the liver.

A

Size, attenuation, texture, and contour

71
Q

Hepatocellular disease affects the _____________ and interferes with liver function enzymes

A

hepatocytes

72
Q

The hepatic enzyme levels are elevated with _____________ necrosis.

A

cell

73
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 of fat.

A

lipid accumulation

74
Q

Describe sonographic findings for fatty infiltration of the liver.

A

Appear in a variety of patterns dependent on the amount and distribution of fat in liver. Enlargement of lobe, portal vein structure would be difficult to visualize. Liver could be so dense that typical gain settings do not allow penetration.

75
Q

In focal sparing, the most common affected areas are anterior to the ______________ or the portal vein and the posterior of the _______________ of the liver.

A

gallbladder; left lobe

76
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

77
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

78
Q

List sonographic findings for cirrhosis of the liver

A

Hepatomegaly, liver volume decreases in right lobe as cirrhosis gets more severe with enlargement of the left and caudate lobes. Increased echnogenicity and coarsening of hepatic parenchyma.

79
Q

Glycogen storage disease is associated with ________________, focal nodular _____________, and hepatomegaly.

A

hepatic adenomas, hyperplasia

80
Q

List the five differental considerations for focal diseases of the liver.

A

Cysts, Abcess, hematoma, primary tumor and metasteses.

81
Q

List the criteria that the sonographer should use to determine whether the mass is extrahepatic or intrahepatic

A

Intrahepatic masses may cause: displacement of the hepatic vascular radicles, external bulging of the liver capsule, or posterior shift of the inferior vena cava.
Extrahepatic mass may show: internal invagination or discontinuity of the liver capsule, formation of a triangular fat wedge, anteromedial shift of the inferior vena cavsa, or anterior displacement of right kidney.

82
Q

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

A

Fever, elevated white cell count and right upper quadrent pain.

83
Q

A ______________ is a benign, congenital tumor consisting of large, blood-filled cystic spaces.

A

hemangioma

84
Q

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

A

cirrohsis; hepatitis B

85
Q

Describe the pathologic patterns seen in carcinoma of the liver.

A

Solitary massive tumor, multiple nodules throughout the liver or diffuse infiltrative masses in the liver.

86
Q

The liver is the third most common organ injured in the abdomen after the ___________ and the _______________.

A

kidney; spleen

87
Q

Describe the complications of the liver transplantation as seen on an ultrasound.

A

Biliary leak, direct visualization of the vessel narrowing, vascular thrombosis may affect hepatic artery, portal vein or IVC.

88
Q

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

A

portal hypertension

89
Q

Portal hypertension may also develop when hepatopetal flow is impeded by ___________ or ____________ invasion.

A

thrombus; tumor

90
Q

The umbilical vein may become _________ secondary to the portal hypertension.

A

recanalized

91
Q

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

A

lowered

92
Q

The doppler sample volume should be __________ than the diameter of the lumen.

A

smaller

93
Q

Explain what color doppler velocity is dependent on.

A

direction of flow, velocity, and angle of flow.

94
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

Sonography part 1 (5 decks)

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