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
Separates left lobe from caudate lobe; shown as echogenic line on the transverse and sagittal images
ligamentum venosum
Area superior to the liver that is not covered by peritoneum so that inferior vena cava may enter the chest
bare area
Lies in the epigastrium and left hypochondrium
left lobe of the liver
Largest lobe of the liver
right lobe of the liver
Boundary between the right and left lobest 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 left lobe of the 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 the liver; branches into anterior and posterior segments
right portal vein
Left upper quadrant of the abdomen that contains the left lobe of the liver, spleen, and stomach
left hypochondrium
Area between the right and left hypochondrium
epigastrium
Yellow pigment in bile formed by the breakdown of red blood cells; excreted by liver and stored in the gallbladder
bilirubin
Alanine aminotransferase–enzyme of the liver
ALT
Specific laboratory tests that look at liver function (aspartate or alanine aminotransferase, lactic acid dehydrogenase, alkaline phosphatase, and bilirubin)
liver function tests
Aspartate aminotransferase–enzyme of the liver
AST
Flow away from the liver
hepatofugal
Parenchymal 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
extrahepatic
Hypoechoic mass with an echogenic central core (abscess, metastases)
bull’s-eye (target) lesion
Any new growth (benign or malignant)
neoplasm
Within the liver
intrahepatic
Most common form of neoplasm of the liver; primary sites are colon, breast, and lung
metastatic disease
Affects hepatocytes and interferes with liver function
diffuse hepatocellular disease
Pus-forming collection of fluid
pyogenic abscess
Develops when normal venous channels become obstructed
collateral circulation
A congenital variant, _______________, can sometimes be seen as an anterior projection of the liver and may exten inferiorly as far as the iliac crest.
Riedel’s lobe
The liver is covered by a thin connective tissue layer called _______________ capsule.
Glisson’s
The _______________ fissure is the boundary between the right and left lobes of the liver.
main lobar
The _______________ ligament extends from the umbilicus to the diaphragm in a parasagittal plan and contains the ligamentum teres.
falciform
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 _______________.
left, right, and middle
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
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 bile excretion is blocked.
hepatocellular, obstruction
Raw materials in the form of _______________, _______________, and _______________ are absorbed from the intestine and transported to the liver via the circulatory system.
fats, carbohydrates, 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 oncontic pressure in the vascular system allows fluid to migrate into the interstital 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 presence of mass lesions in the liver.
alkaline phosphatase
Hemoglobin released from the red cells is converted to _______________ within the reticuloendothelial 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 the landmarks of the liver.
It occupies almost all of the right hypochondrium, greater part of the epigastrium, and left hypochondrium. Contour and shape vary. Lies inferior to the diaphragm. Ribs cover most of the left lobe. Extends several centimeters below the xiphoid process. Ribs cover greater part of the right lobe.
Identify at least three characteristics of the right lobe of the liver.
The right lobe is the largest lobe. It occupies the right hypochondrium and is bordered by the falciform ligament (upper), left sagittal fossa (posterior) and umbilical notch (front). Posterior surface is marked by 3 fossa: porta hepatis, gallbladder fossa, and inferior vena cava fossa.
Identify at least three characteristics of the left lobe of the liver.
It lies in the epigastric and left hypochondriac regions. Upper region is convex and molded onto the diaphragm. Its undersurface includes the gastric impression and omental tuberosity.
Name the ligaments and fissures found within the hepatic parenchyma.
Glisson’s capsule, main lobar fissure, falciform ligament, ligamentum teres, ligamentum venosum
Explain how to distinguish hepatic veins from portal veins.
Trace points of entry to the liver. Hepatic vessels flow into IVC. Splenic and mesenteric veins join to form portal system. Hepatic veins course between hepatic lobes and segments. Hepatic veins are larger. Portal veins are larger at the origin. Portal veins have more echogenic borders.
List the seven liver function tests established to analyze how the liver is performing under normal and diseased conditions.
AST, ALT, alkaline phosphatase, bilirubin (indirect, direct, total), prothrombin time, albumin and globulins
Explain why the evaluation of the hepatic structures is one of the most important procedures in sonography.
The parenchyma allows for imaging of surrounding structures. 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 _______________, and the _______________ duct.
hepatic veins, portal veins, hepatic arteries, hepatic duct
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 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
How should time gain compensation be adjusted to balance the far-gain and the near-gain echo signals?
Hold the transducer over a deep segment of the right lobe of the liver. The far time gain should be gradually increased until the posterior is seen. The near-field time gain should be adjusted to see the anterior wall and masculature, anterior hepatic capsule, and the near-field of the hepatic parenchyma.
Generally a wider pie sectore 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/annular
List the four criteria assessed when evaluating the liver parenchyma.
size, configuration, homogeneity, 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 the sonographic findings for fatty infiltration of the liver.
It shows increased echogenicity. Enlargement of lobe is evident. Portal vein structure may be hard to visualize. A decrease in penetration of the sound beam also occurs. Areas of focal sparing occur.
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
List the sonographic findings for cirrhosis of the liver.
coarsening of parenchyma, secondary to fibrosis and nodularity; increased attenuation may be present with vascular markings; hepatospenomegaly with ascites; caudate and left lateral lobe may be hypertrophied; atrophy of right and left medial lobes; hepatic fissures may be accentuated; isoechoic regenerating nodules; portal hypertension; increased occurance of hepatoma tumors
Glycogen storage disease is associated with _______________, focal nodular _______________, and hepatomegaly.
hepatic adenomas, hyperplasia
List the five differential considerations for focal diseases of the liver.
cysts, abcess, hematoma, primary tumor, metastases
List the criteria that the sonographer should use to determine whether the mass is extrahepatic or intrahepatic.
Intrahepatic: displacement of hepatic vascular radicles, extermal bulging of liver capsule, posterior shift of IVC; Extrahepatic: internal invagination, or discontinuity of liver capsule, triangular fat wedge, anteromedial shift of IVC, anterior displacement of right kidney
List the signs and symptoms of a patient who has inflammatory disease of the liver.
fever, white cell elevation, 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 pathologic patterns seen in carcinoma of the liver.
Solitary massive tumor, multiple nodules throughout the liver, diffuse infiltrative masses in the liver
The liver is the third most common organ injured in the abdomen after the _______________ and the _______________.
spleen, kidney
Describe the complications of liver transplantation as seen on an ultrasound.
rejection is most common, confirmed by medical diagnosis; vascular thrombosis may affect hepatic artery, portal vein or IVC and aorta; biliary complications stricture and leakage; infection and neoplasia; hepatic arterial occlusion
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, angle to flow, velocity
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
A patient with a history of cirrhosis shows evidence of hepatomegaly. What are the possible sonographic findings?
A large heterogeneous mass in the right lobe extends from the dome, nearly filling the right lobe. This most likely represents a hepatocellular carcinoma.
