Chapter 10 Liver Flashcards
Smallest lobe of the liver situated on the posterosuperior surface of the left lobe; the ligamentum venosum is the anterior border
caudate lobe
seperates left lobe from caudate lobe; shown as echogenic line on the transverse sagittal images
ligamentum venosum
Area superior to the liver that is not covered by peritoneum so that inferior vena cava may enter chest
bare area
Lies in the epigastrium and left hypochondrium
left lobe of liver
Largest lobe of the liver
right lobe of liver
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
main lobar fissure
Extends from the umbilicus to the diaphragm in a sagittal plane and contains the ligamentum teres
falciform ligament
Supplies the left lobe of the liver
left portal vein
Appears as bright echogenic foci on transverse image; along with falciform ligament, it divides medial and lateral segments of the left lobe of liver
ligamentum teres
Enters the liver at the porta hepatis
main portal vein
Right upper quadrant of the abdomen that contains the liver and gallbladder
right hypochondrium
Supplies the right lobe of liver; branches into anterior and posterior segments
right portal vein
Left upper quadrant of the abdomen that contains the left lobe of liver, spleen, and stomach
left hypochondrium
Area between the right and left hypochomdrium
epigastrium
Yellow pigment in bile formed by the breakdown of red blood cells; excreted by liver and stored in gallbladder
bilirubin
Alanine aminotransferase-enzyme of the liver
ALT
What’s the name for specific laboratory tests that look at liver function
liver function tests
Aspartate aminotransferase-enzyme of the liver
AST
Flow away from the liver
hepatofugal
Parenchyml liver cell that performs all functions ascribed to the liver
hepatocyte
Uncontrolled increase in blood glucose levels
hyperglycemia
Enzyme of the liver
alkaline phosphatase
Classification of liver disease where hepatocytes are the primary problem
hepatocellular disease
Blood urea nitrogen; laboratory measurement of the amount of nitrogenous waste and creatinine in the blood
BUN
Classification of liver disease where the main problem is blocked bile excretion within the liver or biliary system
obstructive disease
Flow toward the liver
hepatopetal
Deficiency in blood glucose levels
hypoglycemia
Outside the liver (pathology term)
extrahepatic
Hypoechoic mass with an echogenic central core (abcess, metastases)
(pathology term)
bull’s-eye (target) lesion
Any new growth (benign or malignant)
pathology term
neoplasm
Within the liver
pathology term
intrahepatic
Most common form of neoplasm of the liver; primary sites are colon, breast, and lung.
(pathology term)
metastatic disease
Affects hepatocytes and interferes with liver function
pathology term
diffuse hepatocellular disease
Pus-forming collection of fluid
pathology term
pyogenic abscess
Develops when normal venous channels become obstructed
pathology term
collateral circulation
A cogenital variant, __________________ can sometimes be seen as an anterior projection of the liver and may extend inferiorly as far as the iliac crest.
Riedels lobe
The liver is covered by a thin connective tissue layer called ________________ capsule.
Glissions
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 parasagittal 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, and 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 wast 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
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 affecting the liver may be classified as __________________ when the liver cells or hepatocytes are the immediate problem; or _________________ when the 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, and amino acids
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.
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, ans these leak into the bloodstream when the liver cells are damaged or destroyed by disease.
enzyemes
In severe hepatocelluar 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 phosphate
Hemoglobin released from the red blood cells is converted to ________________ within the reticuloendothelial system and is then released into the bloodstream.
bilirubin
Elevation of serum bilirubin results in ____________, which is yellow coloration of the skin, sclerae, and body secretions.
juandice
Name landmarks of the liver.
Right hypochondrium region
Inferior to diaphragm
Epigastric region below xiphoid process
Right & left covered by rib
Identify at least three characteristics of the right lobe of the liver.
Largest lobe of the liver
Bordered on its upper surface by falciform ligament
Occupies right hypochondrium
Identify at least three characteristics of the left lobe of the liver.
Epigastric and left hypochondriac regions
Upper surface convex and molded to diaphragm
Under-surface includes gastric impression
Name the ligaments and fissures found within the hepatic parenchyma.
Glissons Capsule, main lobar fissure, falciform ligament, ligamentum teres, ligamentum venosum.
Explain how to distinguish hepatic veins from portal veins.
Trace the points of entry to the liver. Hepatic veins flow into the IVC and portal veins have more echogenic borders.
List the seven liver function tests established to analyze how the liver is performing under normal and diseased.
AST, ALT, Lactic acid dehydrogense (LDH), Alkaline Phosphatase, Bilirubin (indirect, direct and total), Prothrombin time and Albumin & Globulins.
Within the homogeneous parenchyma lie the thin-walled _______________, the brightly reflective _________________, the _______________ arteries, and the __________ duct.
hepatic veins; portal veins; hepatic arteries; hepatic duct.
The portal flow is shown to be _____________
hepatopetal (toward the liver)
The hepatic venous flow is _______________.
hepatofugal (away from the liver)
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.
anterior; medial
Generally a wider pie sector or curved linear array transducer is the most appropraite 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
List the four criteria assessed when evaluating the liver.
Size, attenuation, texture, 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 of fat.
lipid accumulation
Describe sonographic findings for fatty infiltration of the liver.
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.
In focal sparing, the most common affected areas are anterior to the ______________ or the portal vein and the posterior 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
List sonographic findings for cirrhosis of the liver
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.
Glycogen storage disease is associated with ________________, focal nodular _____________, and hepatomegaly.
hepatic adenomas, hyperplasia
List the five differental considerations for focal diseases of the liver.
Cysts, Abcess, hematoma, primary tumor and metasteses.
List the criteria that the sonographer should use to determine whether the mass is extrahepatic or intrahepatic
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.
List the signs and symptoms of a patient who has inflammatory disease of the liver.
Fever, elevated white cell count and right upper quadrent pain.
A ______________ 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.
cirrohsis; hepatitis B
Describe the pathologic patterns seen in carcinoma of the liver.
Solitary massive tumor, multiple nodules throughout the liver or diffuse infiltrative masses in the liver.
The liver is the third most common organ injured in the abdomen after the ___________ and the _______________.
kidney; spleen
Describe the complications of the liver transplantation as seen on an ultrasound.
Biliary leak, direct visualization of the vessel narrowing, vascular thrombosis may affect hepatic artery, portal vein or IVC.
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 the 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 of 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
