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ARDMS- Abdomen (Penny) > Chapter 2 - Liver > Flashcards

Chapter 2 - Liver Flashcards

1
Q

Largest parenchymal organ in the body and is a intraperitoneal organ

A

Liver

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2
Q

Liver is covered by ______ - a thin fibrous casting

A

Glissons capsule

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3
Q

Rt lobe of liver ( largest bulk of liver) will ____ be situated in the

A

RUQ

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4
Q

Lt lobe of liver will be situated ___

A

in the epigastrium and MAY traverse towards the midline of the hypochondrium

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5
Q

The liver will have a small portion left uncovered which will include the ____

A
  • the bare area
  • area of falciform ligament
    -area of GB fossa
    -area adjacent to the IVC
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6
Q

The liver can be divided into 3 different hepatic lobes

A

-Rt Lobe
-Lt Lobe
-Caudate Lobe

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7
Q

Each lobe can be divided into Lobules, lobules contain

A

-Kupferr cells
-hepatocytes
-Billiary epethlial cells

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8
Q

Each lobule is surrounded by ____

A

portal triads

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9
Q

Portal triads is composed of branches of the ___

A

-Portal vein
-Hepatic artery
-Bile Ducts

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10
Q

Specialized macrophages within the liver that engulf pathogens and damaged cells

A

Kupferr cells

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11
Q

Livers Vital functions

A

Carbohydrate metabolism
Fat lipid
Amino acid
removal of waste
vitamin and mineral storage
drug inactivation
synthesis & secretion of bile
blood reservoir
lymph production
detoxification

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12
Q

This system is used to separate the liver into 8 surgical segments

A

The couinad system

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13
Q

An additional anatomical lobe is ___

A

Quadrate lobe

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14
Q

The quadrate lobe is located between ____

A

The GB Fossa and the round ligament

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15
Q

Songraphically the Quadrate lobe is referred to as the _________ and is NOT A MAIN HEPATIC LOBE

A

Medial segment of the LT lobe

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16
Q

Rt lobe can be divided into what segments

A

Right Anterior and Right posterior segments

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17
Q

Lt lobe can be divided into what segments

A

Left Medial and Left lateral segments

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18
Q

The right and left lobes of the liver are divided by ____

A

The hepatic veins

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19
Q

The vein that supplies the Rt lobe ___

A

Right hepatic vein

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20
Q

The vein that supplies the Lt Lobe

A

Left hepatic vein

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21
Q

The vein that supplies the caudate lobe

A

Both hepatic veins (LT & RT)

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22
Q

The hepatic veins course through the

A

Between the lobes and segments (interlobar and intersegmental)

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23
Q

The middle hepatic vein separates

A

The right and left lobes and is located in the main lobar fissure

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24
Q

____ has its own separate blood supply and venous drainage and is the smallest lobe

A

Caudate Lobe

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25
Q

Caudate lobe is located in ____

A

the epigastrium and is bounded anteriorly by the ligamentum venosum and posteriorly by the IVC
(lateral to lesser sac)

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26
Q

The caudate lobe can be seperated from the LT lobe by the _____

A

Ligamentum venosum

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27
Q

Main portal vein enters the liver at ___

A

Porta hepatis

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28
Q

is the area of the liver where the portal vein and hepatic artery enter and then exit hepatic duct.

A

Porta hepatis (liver hilum)

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29
Q

Main portal vein is created by the union of the

A

Superior mesenteric vein and splenic vein

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30
Q

is seen behind the neck of the pancreas from the descending duodenum. Inferior mesenteric vein is also seen joining the junction of splenic vein with superior mesenteric vein.

A

Portal confluence or portal splenic confluence

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31
Q

____ vein provides the liver with 75% of blood supply, which is partially oxygenated because it is derivd from the intestines

A

Portal vein

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32
Q

The portal veins branch into corresponding branches and match the segments of the liver like

A

Rt portal - anterior and posterior
Lt portal - medial and lateral

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33
Q

The upper limit of the portal vein

A

13 mm

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34
Q

Enlargement of the portal vein can indicate

A

Portal hypertension

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35
Q

When considered normal portal veins they will ________ in size as they approach the diaphgramn

A

Decrease

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36
Q

Normal flow in portal veins should be _______with. variation noted with respiratory changes. After a meal they’re will be an increase in portal vein flow

A

Hepatopetal
Monophonic

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37
Q

Vascular flow yielding a single phase

A

Monophonic

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38
Q

Blood flow toward the liver

A

Hepatopetal

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39
Q

3 hepatic veins

A

Right
Middle
Left

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40
Q

hepatic veins are considered to be ___ because they are located between the segments and the lobes

A

intersegmental and interlobar

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41
Q

Unlike the portal veins hepatic veins will _____ when approach the diaphragm

A

Increase

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42
Q

Hepatic veins have a _____ flow secondary to there association with the right atrium and atrial contraction

A

Triphasic flow hepatofugal flow

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43
Q

flow away from liver

A

hepatofugal

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44
Q

Vascular flow yielding three phase

A

Triphasic

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45
Q

Enlargement of the hepatic veins and IVC is seen with

A

Right sided heart failure
and occlusion or narrowing of the hepatic veins seen with Budd-Chairi

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46
Q

Separates the anterior segment of the right lobe from the posterior segment of the right Lobe

A

Right hepatic vein/ right intersgemental fissure

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47
Q

Separates the right lobe from the lt lobe (these are located between the anterior segment of the right lobe and medial segment of the left lobe

A

Main lobar fissure
Middle hepatic vein
Gallbladder fossa

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48
Q

Separate the left lateral segment of the left lobe from the left medial segment of the left lobe

A

Left intersegmental fissure
left hepatic vein
ligamentum terese
falciform ligament

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49
Q

Porta hepatis may be referred to as the

A

Liver hilum

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50
Q

Porta hepatis contains the

A

Common bile duct
Main portal vein
Hepatic artery

51
Q

carries oxygenated blood to the liver from the the abdominal aorta , which is a branch of the celiac trunk

A

common Hepatic artery

52
Q

Common hepatic artery will have what flow

A

Low resistance flow

53
Q

What does the mickey sign describe

A

transverse image taken at the porta hepatis

54
Q

Two identifiable ligaments can be noted within normal liver during sonography they are ___

A

Ligamentum venosum
Falciform ligament

55
Q

In utero the umbilical vein supplies the fetus with ____

A

oxygenated blood

56
Q

Umbilical vein travels to the liver and bifurcates into a ______ branch

A

Rt and lt branch

57
Q

Right branch also noted as (ductus venosus)

A

shunts blood directly into the IVC

58
Q

After birht the ductus venous collapses and becomes the

A

Ligamenteum venosum

59
Q

Left umbilical vein connects directly to the ____ vein

A

left portal vein

60
Q

After birth this fibrous cord become _____

A

Round ligament or ligament teres

61
Q

Ligamentum teres ascends along the ____

A

Falciform ligament

62
Q

recanalization of the paraumbilican vein in the ligamentum teres can occur in the presence of ___

A

portal hypertension

63
Q

Ligaments will appear ____ cause of the fat located within and around them

A

Hyperechoic

64
Q

Can be noted anterior to the caudate lobe between the caudate lobe and the left hepatic lobe

A

Ligamentum venosum

65
Q

Can appear as a triangular shaped structure between left and right hepatic lobes, and. can be near the left portal vein in most people

A

Faciform ligament

66
Q

not a true fissure can present as a pusedomass, and can occur in older patients, it is caused by hypertrophied diaphragmatic muscle bundles, and appears as hyperechoic strands extending from the diaphragm in the sagittal plane , may be confused for a HYPERECHOIC MASS IN TRANSVERSE PLANE

A

DIAPHRAMATIC SLIP

67
Q

can be described as a tonguelike extension of the right hepatic lobe. and can often be seen in women

A

Riedel lobe

68
Q

may extend inferiorly as far as the iliac crest

A

Riedel lobe

69
Q

To differentiate riedel lobe from hepatomegaly one could examine the ____ love for coexisting enlargement

A

Lt lobe

70
Q

Patient should fast for a period of ____

A

6-8 hours

71
Q

The normal liver should be _____

A

Homogenous

72
Q

Liver should measure approximately

A

13-15 mm

73
Q

Hepatomegaly is considered to be more than ___

A

15mm

74
Q

Indirect signs of hepatomegaly

A
  • extension of right lobe beyond the lower pole of right kidney
    -rounding of the inferior tip of the right lobe
    extension of the left lobe well into the left upper quadrant
75
Q

also known as hepatic steatosis is a disorder characterized by fatty deposites (triglycerides) with in the hepatocytes

A

Fatty liver disease

76
Q

Fatty liver disease can be _____

A

Nonalcoholic and alcoholic liver disease

77
Q

most common liver disease in the western world is the most common cause of chronic liver disease

A

Nonalcoholic fatty liver disease

78
Q

Nonalcoholic liver disease can either be ___

A

Acquired
Reversible

79
Q

The causes of fatty liver disease include

A

-starvation
-obesity
chemotherapy
diabetes mellitus
hyperlipidimia
pregnancy
glycogen storage disease or von gierke disease
total parental hyper alimentation
severe hepatitis
cystic fibrosis
intestinal bypass surgery for obesity
use of drugs like (corticosteroids)

80
Q

it is also a metabolic syndrome that can lead to steatohepatitis

A

Fatty liver disease

81
Q

whether caused by alcoholic or nonalcoholic conditions termed nonalcoholic steatoheptits is inflammation of the liver that has been shown tp procures for chronic liver disease leading to fibrosis , cirrhosis, hepatocellular carcinoma

A

steateoheptatis

82
Q

Clinical findings of fatty liver disease

A

aynsomptamtic
alcohol abuse
chemotherapy
diabetes mellitus
eleveted liver function tests (AST AND ALT)
hyperlidimia
obesity
pregnancy

83
Q

Sono findings of diffuse fatty liver disease

A

-diffusely echogenic liver
-increased attenuation of sound beam
-wall of hepatic vasculature and dipahgram will not be easily imaged

84
Q

Sonographic findings of focal fatty infiltration

A

hyperechoic area adjacent to the GB, near the porta hepatis and part of the lobe may appear echogenic

85
Q

Sonographic finding of fatty sparring

A

-hypoechoic area adjacent to the GB near the porta hepatis and part of lobe or entire lobe may be sparred
-can appear much like pericholecystic fluid when identified adjacent to the GB

86
Q

inflammation of the liver that can lead to cirrhosis, portal hypertension and hepatocellular carcinoma (HCC)

A

Hepatitis

87
Q

Hepatitis can be ______

A

Acute or Chronic

88
Q

Acute hepatitis is said to be resolved in

A

4 months

89
Q

Chronic hepatitis is said to persist beyond

A

6 months

90
Q

Hepatitis can come in many forms such as A B C D E and G, but the two most common are

A

A and B

91
Q

is spread by fecal - oral route in contaminated water or food

A

Hepatitis A

92
Q

is spread by contact with contaminated body fluids, mother to infant transmission or inadvertent blood contact as seen in the case of intravenous drug abuse or occupational exposure

A

Hepatitis B

93
Q

this form is an additional concern for health workers and is also spread by means of contact with blood and body fluids and is the current leading indication for liver translate in the US

A

Hepatitis C

94
Q

_____ can be triggered by systemic viruses such as herpes simplex virus, Epstein barr.

A

Hepatitis

95
Q

can be caused by Wilson disease hemochromatosis, autoimmune disorders or drug induced

A

Chronic hepatitis

96
Q

inherited disorder the causes the body to accumulate excess copper

A

Wilsons disease

97
Q

inherited disorder is characterized by disproportionated absorption of iron

A

hemochromatosis

98
Q

If a patient has either Wilsons or hemochromatosis a Sonographer should evaluate further for signs of ____

A

chronic hepatitis

99
Q

Clinical findings of hepatitis include

A
  1. chills
  2. dark urine
  3. elevated liver function tests such as , ALP,ALT,AST,LDH, bilirubin and prothrombin (PT)
  4. fatigue
    5.fever
  5. hepatosplenomegaly
  6. jaundice
    8.nausea
    9.vomitting
100
Q

Sonographic findings

A
  1. Normal Liver
  2. Enlarged hypoechoic liver
  3. periportal cuffing with “starry sky”
  4. GB wall thickening
101
Q

impaired liver function, as a result of hepatitis and other hepatic diseases may lead to

A

hepatic encephalopathy

102
Q

a condition in which a patient becomes confused or suffers from intermittent loss of conciseness secondary to overexposure of the brain to toxic chemicals that the liver would normally from the body

A

hepatic encephalopathy

103
Q

In new borns brain damage can occur with severe ___ as a result of bilirubin exposure a condition referred to as kernicterus

A

Jaundice

104
Q

brain damage from bilirubin exposure in a newborn with jaundice

A

kernicterus

105
Q

describes as the increase echogenicity of the walls of the portal triads. this sonographic manifestation is known as the starry skin sign

A

periportal cuffing

106
Q

Possible pathway of disease

A

Alcoholism —> Hepatic steatosis –> fatty liver –> steatohepatitis –> cirrhosis –> portal hypertension –> portal vein thrombosis –> hepatocellular carcinoma

107
Q

devastating liver disorder that is defined as hepatocyte death, fibrosis and necrosis of the liver and the subsequent development of regenerating nodules

A

Cirrhosis

108
Q

most common cause of cirrhosis is

A

alcoholism

109
Q

Cirrhosis can also be caused by

A

Wilson disease
primary billiary cirrhosis
hepatitis
cholangitis
hemochromatosis

110
Q

Patients may have normal lab findings until cirrhosis advances into

A

end-stage liver disease

111
Q

Laboratory abnormalities include an elevation in

A

AST
LDH
ALT
Bilirubin

112
Q

Cirrhosis c caused by alcoholism will lead to development of nodules that typically measure

A

less than 1 cm (micro nodular)

113
Q

Cirrhosis caused by hepatitis will lead to development of large nodules that measure between

A

1 and 5 cm (macronodular)

114
Q

Clinical findings of Cirrhosis include

A
  1. Ascites
  2. Diarrhea
  3. Abnormal liver function tests (ALP,ALT, AST, bilirubin, PT, PTT , total protein and decreased albumin
  4. fatigue
  5. hepatomegaly (initial)
  6. jaundice
    7.splenomegaly
  7. weight loss
115
Q

Sonographic findings of cirrhosis include

A
  1. hepatosplenomegaly
  2. shrunken echogenic right lobe of the liver
  3. enlarged caudate and left lobe
  4. nodular surface irregularity
  5. coarse echo texture
  6. splenomegaly
  7. ascites
  8. monophasic flow within the hepatic veins
  9. hepatofugal flow within the portal veins
116
Q

When cirrhosis is suspected always look for signs of

A

portal hypertension
portal vein thrombosis
hepatocellular carcinoma

117
Q

is the elevation of blood pressure within the portal venous system

A

portal hypertension

118
Q

The most common cause of portal hypertension is ___

A

Cirrhosis

119
Q

Portal hypertension can also result from ___

A

portal vein thrombosis
hepatic vein thrombosis
ivc thrombosis
compression of portal vein by a tumor in adjacent organ

120
Q

Pressure with in portal vein ______ and results in portal hypertension

A

Increases

121
Q

Because the liver becomes scarred with cirrhosis the blood flowing to the liver meets greater vasculature resistance resulting in

A

portal hypertension or high blood pressure with in the veins

122
Q

The blood traveling into the liver via the main portal vein will have what type of vascularity

A

Increased vascularity.

123
Q

The pressure within the portal veins increase , resulting in ____

A

portal hypertension

124
Q

The veins will increase resulting in portal hypertension, along with the hepatic artery which will also increase as well and may become

A

enlarged

ARDMS- Abdomen (Penny) (3 decks)

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