Chapter 10 The Liver HA Flashcards
The Liver
1
Q
Area superior to the liver that is not covered by peritoneum so that the IVC may enter the chest.
A
Bare area
2
Q
Smallest lobe of liver situated on the posterosuperior surface of the left lobe; the ligamentum venosum is the anterior border
A
Caudate lobe
3
Q
Area between the right and left hypochondrium
A
epigastrium
4
Q
Extends from umbilicus to diaphragm in a sagittal plane and includes the ligamentum teres
A
falciform ligament
5
Q
LUQ of the abdomen that contains the left lobe of liver, spleen, and stomach
A
left hypochondrium
6
Q
Lies in the epigastrium and left hypochondrium
A
left lobe of liver
7
Q
Supplies the left lobe of liver
A
left portal vein
8
Q
Appears as bright echogenic foci on transverse image; along with the falciform ligament, it divides medial and lateral segments of the left lobe of liver
A
ligamentum teres
9
Q
Seperates left lobe of liver from caudate lobe; shown as an echogenic line on the transverse and sagittal images
A
ligamentum venosum
10
Q
Boundary between the right and left lobes of liver; seen as a hyperechoic line on the sagittal image extending from the portal vein to the neck of the GB
A
main lobar fissure
11
Q
Enters the liver at the porta hepatis
A
Main portal vein
12
Q
RUQ of the abdomen that contains the liver and GB
A
right hypochondrium
13
Q
Largest lobe of liver
A
right lobe
14
Q
Supplies the right lobe of liver; branches into anterior and posterior segments
A
right portal vein
15
Q
Enzyme of the liver
A
alkaline phosphatase
16
Q
Alanine aminotransferase- enzyme of the liver
A
ALT
17
Q
Aspartate aminotransferase
A
AST
18
Q
Yellow pigment in bile formed by the breakdown of RBC’s; excreted by the liver and stored by the GB
A
bilirubin
19
Q
Blood urea nitrogen; lab measurement of the amount of nitrogenous waste and creatinine in the blood
A
BUN
20
Q
Classification of liver disease in which the hepatocytes are the primary problem.
A
hepatocellular disease
21
Q
Parenchymal liver cell that performs all functions ascribed to the liver
A
hepatocyte
22
Q
Flow away from liver
A
hepatofugal
23
Q
Flow toward the liver
A
hepatpetal
24
Q
Uncontrolled increase in blood glucose levels
A
hyperglycemia
25
Deficiency in blood glucose levels
hypoglycemia
26
Specific lab tests that look at liver function (AST, ALT, lactic acid dehydrogenase, alkaline phosphatase, bilirubin)
liver function tests
27
Classification of liver disease where the main problem is blocked bile excretion within the liver or biliary system.
obstructive disease
28
Hypoechoic mass with an echogenic central core (abscess, metastases)
Bulls eye (target) lesion
29
Develops when normal venous channels become obstructed
collateral circulation
30
Affects hepatocytes and interferes with liver function
diffuse hepatocellular disease
31
Outside the liver
extrahepatic
32
Within the liver
intrahepatic
33
Most common form of neoplasm of the liver; primary sites are colon, breast, lung
metastatic disease
34
Any new growth (benign or malignant)
neoplasm
35
Pus forming collection of fluid
pyogenic abscess
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.
Reidel's lobe
37
The liver is covered by a thin connective layer of tissue called ____capsule.
Glisson's
38
The ___ fissure is the boundary between the right and left lobes of the liver.
main lobar
39
The _____ ligament extends from the umbilicus to the diaphragm in a parasagittal plane and contains the ligamentum ters.
falciform
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 ____ seperates the left lobe and caudate lobe.
ligamentum venosum
42
The hepatic veins are divided into three components.
right, middle, left
43
The liver is a major center for ___, 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 waste products from the body via its excretory product, bile, which also plays a role in fat absorption.
digestion
45
A pigment released when RBC's are broken down is ___.
bilirubin
46
The liver is a ____ site for several compounds used in a variety of physiologic activities throughout the body.
storage
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 affecting the liver may be classified as ___ when the hepatocytes are the immediate problem, and ___ 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 through the blood in several forms, but only ___ can be used as a source of energy throughout the body.
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 i ___ in dependent areas.
edema
53
Because the liver is a major center for metabolism, large quantities of ___ are present in hepatocytes, and these leak into the bloodstream when 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 presence of mass lesions in the liver.
alkaline phosphatase
56
Hemoglobin released from the red cells is converted to ___ within the reticuloendothelial system and is then released into the bloodstream.
bilirubin
57
Elevation of serial bilirubin results in ___, which is yellow coloration of the skin, sclerae, and body secretions.
jaundice
58
Name the liver landmarks.
Takes up almost the entire right hypochondrium, greater part of epigastrium, and left hypochondrium as far as the mamillary line. Inferior to the diaphragm, and extends several cm under the xiphoid.
59
Identify 3 characteristics of the liver right lobe.
Right lobe is largest by 6:1; Bordered on the upper surface by the falciform ligament, posterior border is left sagittal fossa, front by umbilical notch. Inferior and posterior surface are marked by the porta hepatis, GB fossa, and IVC fossa.
60
Identify 3 characteristics of the left lobe.
Lies epigastric and left hypochondrium. Upper surface in convexand molded to diaphragm. In front it is bound by the anterior margin of the liver, behind by the porta hepatis, right side by GB fossa, and left by umbilical vein fossa.
61
Name the ligaments and fissures found within the liver parenchyma.
Glisson's capsule, main lobar fissure, falciform ligament, ligamentum teres and ligamentum venosum.
62
Explain how to differentiate hepatic veins from portal veins.
Trace points of origin. Hepatics flow into IVC, no echogenicity. Portals are created by the junction of splenic and mesenteric veins, echogenic. Hepatics are larger as they drain into IVC (leave). Portals are larger as they emanate from the porta hepatis (arrive).
63
List the 7 liver function tests.
AST, ALT, LDH lactic acid dehydrogenase, alkaline phosphate, bilirubin, prothrombin time, albumin and globulins
64
Explain why liver evaluation is one of the most important procedures in sonography.
The normal homogenous parenchyma of the livers allows the neighboring structures in the abdomen to be imaged. Echo amplitude, attenuation and transmission, and parenchymal textures may be assessed with proper evaluation of the liver.
65
Within the homogenous parenchyma lie the thin walled ___, the brightly reflective ___, the ___ arteries, and the ____ duct.
hepatic veins, portal veins, hepatic, hepatic
66
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
67
How should TGC be adjusted to balance the far gain and near gain echo signals?
Place transducer over a deep segment of right lobe. The far gains should be increased gradually with a smooth motion of the finger until the posterior aspect is well seen. Adjust the near gain (usually decreased) as needed.
68
Generally a wider pie sector or curved linear array is the most appropriate to optimally image the ___ of the abdomen.
near field
69
To image the far field better, a ___ array transducer with a longer focal zone is used.
sector or annular
70
List the 4 criteria assessed when evaluating liver parenchyma.
Size, homogenity, configuration, contour
71
Hepatocellular disease affects the ___ and interferes with liver function enzymes.
hepatocytes
72
The hepatic enzyme levels are elevated with ____ necrosis.
cell
73
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
74
Describe sono findings of fatty infiltration of the liver.
Increased echogenicity, lobe enlargement, portal vein structures hard to identify. Decrease in sound beam penetration. Fatty infiltrate isnt always uniform, there can be areas of focal sparing
75
In focal sparing, the most commonly affected areas are anterior to the ____ or the portal vein and the posterior portion of the ____ of the liver.
GB, left lobe
76
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
77
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
78
List the sono findings of cirrhosis of the liver.
Coarsening of liver parenchyma, increased attenuation with decreased vascular markings, hepatosplenomegaly with ascites, caudate and left lobe hypertrophy, accentuated hepatic fissures, isoechoic nodules, portal hypertension, hepatoma tumors
79
Glycogen storage disease is associated with ___, focal nodular ____, and hepatomegaly.
hepatic adenomas; hyperplasia
80
List the 5 differential considerations for focal diseases of the liver.
Cysts, abscess, hematoma, primary tumor, metasteses
81
List the criteria that the sonographer should use to determine whether the mass is extrahepatic or intrahepatic.
Intrahepatic- displacement of the hepatic vascular radicles, external bulging of the liver capsule, posterior shift of the IVC; Extrahepatic- internal invagination or discontinuity of the liver capsule, formation of triangular fat wedge, anteromedial shift of the IVC, anterior displacement of the right kidney
82
List the signs/symptoms of a patient who has inflammatory disease of the liver.
fever, white cell elevation, RUQ pain
83
A ___ is any new growth of new tissue, either benign or malignant.
neoplasm
84
A ___ is a benign, congenital tumor consisting of a large, blood filled cystic spaces.
hemangioma
85
The pathogenesis of hepatocellular carcinoma is related to ____, chronic _____ virus infection, and hepatocarcinogens in food.
cirrhosis; hep B
86
Describe the pathologic patterns seen in carcinoma of the liver.
Solitary massive tumor, multiple liver nodules, diffuse infiltrative masses in the liver
87
The liver is the third most common organ injured in the abdomen after the ____ and the ___.
Spleen, kidney
88
Describe the complications of liver transplantation as seen on an ultrasound.
Rejection--thrombosis, leaks, biliary stricture, infection, neoplasia. Vascular complications-- thrombosis, stricture, arterial anastomodic pseudoaneurysm
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, angle of flow
95
Acute abdominal pain, massive ascites, and hepatomegaly secondary to thrombosis of the hepatic veins or IVC characterize ___ syndrome, which has a poor prognosis.
Budd-Chiari
