Chapter 2 - Liver Flashcards
Largest parenchymal organ in the body and is a intraperitoneal organ
Liver
Liver is covered by ______ - a thin fibrous casting
Glissons capsule
Rt lobe of liver ( largest bulk of liver) will ____ be situated in the
RUQ
Lt lobe of liver will be situated ___
in the epigastrium and MAY traverse towards the midline of the hypochondrium
The liver will have a small portion left uncovered which will include the ____
- the bare area
- area of falciform ligament
-area of GB fossa
-area adjacent to the IVC
The liver can be divided into 3 different hepatic lobes
-Rt Lobe
-Lt Lobe
-Caudate Lobe
Each lobe can be divided into Lobules, lobules contain
-Kupferr cells
-hepatocytes
-Billiary epethlial cells
Each lobule is surrounded by ____
portal triads
Portal triads is composed of branches of the ___
-Portal vein
-Hepatic artery
-Bile Ducts
Specialized macrophages within the liver that engulf pathogens and damaged cells
Kupferr cells
Livers Vital functions
Carbohydrate metabolism
Fat lipid
Amino acid
removal of waste
vitamin and mineral storage
drug inactivation
synthesis & secretion of bile
blood reservoir
lymph production
detoxification
This system is used to separate the liver into 8 surgical segments
The couinad system
An additional anatomical lobe is ___
Quadrate lobe
The quadrate lobe is located between ____
The GB Fossa and the round ligament
Songraphically the Quadrate lobe is referred to as the _________ and is NOT A MAIN HEPATIC LOBE
Medial segment of the LT lobe
Rt lobe can be divided into what segments
Right Anterior and Right posterior segments
Lt lobe can be divided into what segments
Left Medial and Left lateral segments
The right and left lobes of the liver are divided by ____
The hepatic veins
The vein that supplies the Rt lobe ___
Right hepatic vein
The vein that supplies the Lt Lobe
Left hepatic vein
The vein that supplies the caudate lobe
Both hepatic veins (LT & RT)
The hepatic veins course through the
Between the lobes and segments (interlobar and intersegmental)
The middle hepatic vein separates
The right and left lobes and is located in the main lobar fissure
____ has its own separate blood supply and venous drainage and is the smallest lobe
Caudate Lobe
Caudate lobe is located in ____
the epigastrium and is bounded anteriorly by the ligamentum venosum and posteriorly by the IVC
(lateral to lesser sac)
The caudate lobe can be seperated from the LT lobe by the _____
Ligamentum venosum
Main portal vein enters the liver at ___
Porta hepatis
is the area of the liver where the portal vein and hepatic artery enter and then exit hepatic duct.
Porta hepatis (liver hilum)
Main portal vein is created by the union of the
Superior mesenteric vein and splenic vein
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.
Portal confluence or portal splenic confluence
____ vein provides the liver with 75% of blood supply, which is partially oxygenated because it is derivd from the intestines
Portal vein
The portal veins branch into corresponding branches and match the segments of the liver like
Rt portal - anterior and posterior
Lt portal - medial and lateral
The upper limit of the portal vein
13 mm
Enlargement of the portal vein can indicate
Portal hypertension
When considered normal portal veins they will ________ in size as they approach the diaphgramn
Decrease
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
Hepatopetal
Monophonic
Vascular flow yielding a single phase
Monophonic
Blood flow toward the liver
Hepatopetal
3 hepatic veins
Right
Middle
Left
hepatic veins are considered to be ___ because they are located between the segments and the lobes
intersegmental and interlobar
Unlike the portal veins hepatic veins will _____ when approach the diaphragm
Increase
Hepatic veins have a _____ flow secondary to there association with the right atrium and atrial contraction
Triphasic flow hepatofugal flow
flow away from liver
hepatofugal
Vascular flow yielding three phase
Triphasic
Enlargement of the hepatic veins and IVC is seen with
Right sided heart failure
and occlusion or narrowing of the hepatic veins seen with Budd-Chairi
Separates the anterior segment of the right lobe from the posterior segment of the right Lobe
Right hepatic vein/ right intersgemental fissure
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
Main lobar fissure
Middle hepatic vein
Gallbladder fossa
Separate the left lateral segment of the left lobe from the left medial segment of the left lobe
Left intersegmental fissure
left hepatic vein
ligamentum terese
falciform ligament
Porta hepatis may be referred to as the
Liver hilum
Porta hepatis contains the
Common bile duct
Main portal vein
Hepatic artery
carries oxygenated blood to the liver from the the abdominal aorta , which is a branch of the celiac trunk
common Hepatic artery
Common hepatic artery will have what flow
Low resistance flow
What does the mickey sign describe
transverse image taken at the porta hepatis
Two identifiable ligaments can be noted within normal liver during sonography they are ___
Ligamentum venosum
Falciform ligament
In utero the umbilical vein supplies the fetus with ____
oxygenated blood
Umbilical vein travels to the liver and bifurcates into a ______ branch
Rt and lt branch
Right branch also noted as (ductus venosus)
shunts blood directly into the IVC
After birht the ductus venous collapses and becomes the
Ligamenteum venosum
Left umbilical vein connects directly to the ____ vein
left portal vein
After birth this fibrous cord become _____
Round ligament or ligament teres
Ligamentum teres ascends along the ____
Falciform ligament
recanalization of the paraumbilican vein in the ligamentum teres can occur in the presence of ___
portal hypertension
Ligaments will appear ____ cause of the fat located within and around them
Hyperechoic
Can be noted anterior to the caudate lobe between the caudate lobe and the left hepatic lobe
Ligamentum venosum
Can appear as a triangular shaped structure between left and right hepatic lobes, and. can be near the left portal vein in most people
Faciform ligament
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
DIAPHRAMATIC SLIP
can be described as a tonguelike extension of the right hepatic lobe. and can often be seen in women
Riedel lobe
may extend inferiorly as far as the iliac crest
Riedel lobe
To differentiate riedel lobe from hepatomegaly one could examine the ____ love for coexisting enlargement
Lt lobe
Patient should fast for a period of ____
6-8 hours
The normal liver should be _____
Homogenous
Liver should measure approximately
13-15 mm
Hepatomegaly is considered to be more than ___
15mm
Indirect signs of hepatomegaly
- 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
also known as hepatic steatosis is a disorder characterized by fatty deposites (triglycerides) with in the hepatocytes
Fatty liver disease
Fatty liver disease can be _____
Nonalcoholic and alcoholic liver disease
most common liver disease in the western world is the most common cause of chronic liver disease
Nonalcoholic fatty liver disease
Nonalcoholic liver disease can either be ___
Acquired
Reversible
The causes of fatty liver disease include
-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)
it is also a metabolic syndrome that can lead to steatohepatitis
Fatty liver disease
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
steateoheptatis
Clinical findings of fatty liver disease
aynsomptamtic
alcohol abuse
chemotherapy
diabetes mellitus
eleveted liver function tests (AST AND ALT)
hyperlidimia
obesity
pregnancy
Sono findings of diffuse fatty liver disease
-diffusely echogenic liver
-increased attenuation of sound beam
-wall of hepatic vasculature and dipahgram will not be easily imaged
Sonographic findings of focal fatty infiltration
hyperechoic area adjacent to the GB, near the porta hepatis and part of the lobe may appear echogenic
Sonographic finding of fatty sparring
-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
inflammation of the liver that can lead to cirrhosis, portal hypertension and hepatocellular carcinoma (HCC)
Hepatitis
Hepatitis can be ______
Acute or Chronic
Acute hepatitis is said to be resolved in
4 months
Chronic hepatitis is said to persist beyond
6 months
Hepatitis can come in many forms such as A B C D E and G, but the two most common are
A and B
is spread by fecal - oral route in contaminated water or food
Hepatitis A
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
Hepatitis B
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
Hepatitis C
_____ can be triggered by systemic viruses such as herpes simplex virus, Epstein barr.
Hepatitis
can be caused by Wilson disease hemochromatosis, autoimmune disorders or drug induced
Chronic hepatitis
inherited disorder the causes the body to accumulate excess copper
Wilsons disease
inherited disorder is characterized by disproportionated absorption of iron
hemochromatosis
If a patient has either Wilsons or hemochromatosis a Sonographer should evaluate further for signs of ____
chronic hepatitis
Clinical findings of hepatitis include
- chills
- dark urine
- elevated liver function tests such as , ALP,ALT,AST,LDH, bilirubin and prothrombin (PT)
- fatigue
5.fever - hepatosplenomegaly
- jaundice
8.nausea
9.vomitting
Sonographic findings
- Normal Liver
- Enlarged hypoechoic liver
- periportal cuffing with “starry sky”
- GB wall thickening
impaired liver function, as a result of hepatitis and other hepatic diseases may lead to
hepatic encephalopathy
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
hepatic encephalopathy
In new borns brain damage can occur with severe ___ as a result of bilirubin exposure a condition referred to as kernicterus
Jaundice
brain damage from bilirubin exposure in a newborn with jaundice
kernicterus
describes as the increase echogenicity of the walls of the portal triads. this sonographic manifestation is known as the starry skin sign
periportal cuffing
Possible pathway of disease
Alcoholism —> Hepatic steatosis –> fatty liver –> steatohepatitis –> cirrhosis –> portal hypertension –> portal vein thrombosis –> hepatocellular carcinoma
devastating liver disorder that is defined as hepatocyte death, fibrosis and necrosis of the liver and the subsequent development of regenerating nodules
Cirrhosis
most common cause of cirrhosis is
alcoholism
Cirrhosis can also be caused by
Wilson disease
primary billiary cirrhosis
hepatitis
cholangitis
hemochromatosis
Patients may have normal lab findings until cirrhosis advances into
end-stage liver disease
Laboratory abnormalities include an elevation in
AST
LDH
ALT
Bilirubin
Cirrhosis c caused by alcoholism will lead to development of nodules that typically measure
less than 1 cm (micro nodular)
Cirrhosis caused by hepatitis will lead to development of large nodules that measure between
1 and 5 cm (macronodular)
Clinical findings of Cirrhosis include
- Ascites
- Diarrhea
- Abnormal liver function tests (ALP,ALT, AST, bilirubin, PT, PTT , total protein and decreased albumin
- fatigue
- hepatomegaly (initial)
- jaundice
7.splenomegaly - weight loss
Sonographic findings of cirrhosis include
- hepatosplenomegaly
- shrunken echogenic right lobe of the liver
- enlarged caudate and left lobe
- nodular surface irregularity
- coarse echo texture
- splenomegaly
- ascites
- monophasic flow within the hepatic veins
- hepatofugal flow within the portal veins
When cirrhosis is suspected always look for signs of
portal hypertension
portal vein thrombosis
hepatocellular carcinoma
is the elevation of blood pressure within the portal venous system
portal hypertension
The most common cause of portal hypertension is ___
Cirrhosis
Portal hypertension can also result from ___
portal vein thrombosis
hepatic vein thrombosis
ivc thrombosis
compression of portal vein by a tumor in adjacent organ
Pressure with in portal vein ______ and results in portal hypertension
Increases
Because the liver becomes scarred with cirrhosis the blood flowing to the liver meets greater vasculature resistance resulting in
portal hypertension or high blood pressure with in the veins
The blood traveling into the liver via the main portal vein will have what type of vascularity
Increased vascularity.
The pressure within the portal veins increase , resulting in ____
portal hypertension
The veins will increase resulting in portal hypertension, along with the hepatic artery which will also increase as well and may become
enlarged
