Liver Flashcards
What is hemopoiesis?
In early embryonic life the liver is responsible for the formation and development of blood cells
What is the name of the thin layer that covers the liver?
Glisson Capsule
Although the liver is considered an intraperitoneal organ, what 5 areas are left uncovered?
- Bare area
- Galbladder area
- Falciform ligament
- Porta hepatis
- Area adjacent to the IVC
What are the 3 main lobes of the liver?
- Right lobe
- Left lobe
- Caudate lobe
What is a portal triad composed of?
- Portal vein
- hepatic artery
- Bile duct
What is the name of the system used to separate the liver into eight surgical segments?
Couinaud system
What ligament separates the liver into the left medial lobe and the right lateral lobe?
Falciform ligament
also know as Umbilical fissure
Where is the quadrate lobe located?
Between the gallbladder fossa and the round ligament
What divides the right lobe of the liver into anterior and posterior segments?
Right hepatic vein
What separates the right lobe from the left lobe?
Middle hepatic vein and also by the gallbladder fossa
What separates the left lobe into medial and lateral parts?
Left hepatic vein
The main portal vein is created by the union of the ____________ and ____________.
- SMV- superior mesenteric vein
2. Splenic vein
What does the image illustrate?
The Portal Confluence
- SMV
- IMV
- Splenic vein
Enlargement of the portal vein is called what? and what is the measurement?
Portal hypertension
More than 13mm abnormal
Do portal veins increase or decrease as they approach the diaphragm?
Decrease
What should normal flow be within the portal veins?(hepatopetal/fugal & monophasic/triphasic)
Monophasic and hepatopetal
How many hepatic veins do we have and what do they drain into?
3 (right,middle, left) and they drain into the IVC
Hepatic veins(increase/decrease?) as they approach the diaphragm? and what blood flow pattern do they have?
Increase
Triphasic—>because of their association with the right atrium and atrial contraction
what is Budd-Chiari syndrome?
The occlusion of the hepatic veins with possible coexisting occlusion of the inferior vena cava
What are the three structures located within the porta hepatis?
Main portal vein
Common bile duct
Hepatic artery–>carries oxygenated blood to the liver from aorta
Are hepatic arteries low or high resistance??
Low resistance flow pattern
In early embryonic life the umbilical vein bifurcates into what?
Left and right branch
What is the right branch referred as? and what does it turn into?
The right branch is referred as the DUCTUS VENOSUS and after it collpases becomes the ligamentum venosum
What does the left umbilical vein turn into?
It is referred to as the LIGAMENTUM TERES/ROUND LIGAMENT
Where can the ligamentum venosum be noted? What does it look like in the transverse plane?
Anterior to the caudate lobe
In transverse it appears as a hyperechoic triangular shape b/w right and left hepatic lobe
Where is the main lobar fissure?
It houses the middle hepatic vein and and appears to connect the neck of the GB to the right portal vein
What is a diaphragmatic slip?
A pseudomass of the liver seen on sonography resulting from hypertrophied diaphragmatic muscle bundles
What is a reidel lobe?
it is a tonguelike extension of the right hepatic lobe, moslty seen in women and may extend all the way down to iliac crest
What is situs inversus?
Condition in which the organs of the body are on the opposite side
What is the normal measurement of the liver?
13 to 15 cm
At what measurement is hepatomegaly suspected?
larger than 15.5 cm
What is fatty liver disease?
It is referred to as hapatic steatosis and is charecterized by fatty deposits (triglycerides) within the hepatocytes
What are the two types of fatty liver disease?
Nonalcoholic fatty liver disease
Alcoholic fatty liver disease
Which is more common? (Alcoholic or Nonalcoholic liver disease)
Nonalcoholic fatty liver disease is the most common in the western world and most common cause of chronic liver disease
Which is more common? (Alcoholic or Nonalcoholic liver disease)
Nonalcoholic fatty liver disease is the most common in the western world and most common cause of chronic liver disease
What causes Nonalcoholic fatty liver disease?
- starvation
- obesity
- chemotherapy
- diabetes mellitus
- hyperlipidemia
- pregnancy
- glycogen storage disease
- Von Gierke disease
- severe hepatitis
- cystic fibrosis
What is steatohepatitis?
It is an inflammation of the liver and a precursor for chronic liver disease.
What is the appearance of diffuse fatty infiltration?
It will cause the liver to appear diffusely echogenic and will be more difficult to penetrate and the walls of the hepatic vasculature will not be easily imaged
What does focal fatty infiltration appear like?
It will appear as an area of increased echogenicity—>like a solid hyperechoic mass
What is focal fatty sparing and what does it look like?
The area of sparing can appear like a solid hypoechoic mass or even fluid
Where is focal fatty infiltration and sparing likely to be seen?
- seen adjacent to the GB
- near the porta hepatis
- in the left medial segement
What is hepatitis and what can it lead to?
It is an inflammation of the liver and can lead to cirrhosis, portal hypertension and HCC
How long does it take acute hepatitis to resolve?
within 4 months
How long does it take chronic hepatitis to resolve?
More than 6 months
What are the two most common forms of hepatitis?
Hepatitis A and Hepatitis B
How is hepatitis A acquired?
It is spread to by fecal-oral route in contaminated water or food
How is hepatitis B spread?
It is spread by contact with contaminated body fluids, mother to infant transmission , or inadvertent blood contact as seen in case of intravenous drug abuse.
What is Wilson disease?
It is a congenital disorder that causes the body to accumulate excess copper
What are symptoms of hepatitis?
Fever, chills, nausea, vomiting, fatigue, hepatosplenomegaly, dark urine and jaundice
Which common liver function tests are elevated in patients with hepatitis?
- Alkaline phosphate (ALP)
- Aspartate amino’’ “ (AST)
- Alanine amino” “ (ALT)
- Lactate Dehydrogenase (LDH)
- Serum bilirubin
What is hepatic encephalopathy?
It is a condition in which a patient becomes confused or suffers from intermittent loss of consciousness due to the overexposure of the brain to toxic chemicals that the liver would normally remove.
What is kernicterus?
Brain damage from bilirubin exposure in a newborn with jaundice
Sonographic appearance of hepatitis?
Hepatosplenomegaly, enlarged hypoechoic liver and gallbladder wall may be thickened
What is cirrhosis?
A liver disorder, necrosis of the liver and the development of regenerating nodules
Most common cause of cirrhosis?
Alcoholism
What is the sonographic appearance of cirrhosis?
Echogenic small right lobe, an enlarged caudate and left lobe, nodular surface irregularity, coarse echotecture, ascites and splenomegaly
Cirrhosis caused by alcoholism will lead to the development of nodules that measure less than ____ cm
1 cm—>termed micronodular
Cirrhosis caused by hepatitis will cause nodules that measure between ____ and ____ cm
1 to 5 cm—->Macronodular
What are the doppler findings in patients with cirrhosis?
- monophasic flow within the hepatic veins
2. hepatofugal flow within the portal veins
What is portal hypertension?
It is the elevation of blood pressure within the portal venous system
What is the most common cause of portal hypertension?
Cirrhosis
What is the most common sonographically identifiable collateral of portal hypertension?
The recanalization of the paraumbilical vein—-> patent paraumbilical vain
What is hematemesis?
Vomiting blood
What is caput medusa?
Dilation of the superficial veins of the abdomen
What is portal vein thrombosis?
The development of a clot within the portal vein
What is leukocytosis?
An elevated white blood cell count
T/F: Gas within the portal veins or mesenteric veins typically fatal.
true
T/F: Gas within the portal veins or mesenteric veins typically fatal.
true
What is Budd Chiari syndrome?
Its described as the occlusion of the hepatic veins , with possible coexisting occlusion of the IVC
What are the clinical findings of budd chiari?
- Ascites
- elevated liver function tests
- hepatomegaly
- splenomegaly
- upper abdominal pain
What are the sonographic findings of budd chiari syndrome?
- Nonvisualization or reduced visualization of the hepatic veins
- thrombus within the hepatic veins
- enlarged caudate lobe
- lack of flow within the hepatic veins with color
- narrowing of the ivc
What are hepatic cysts usually associated with and when are they encountered?
- middle age
2. are associated with autosomal polycystic kidney disease
What is the sonographic appearance of hepatic cysts?
Simple cyst appearance, shape may be irregular, , they might be in clusters, anachoic
What is the appearance of complex hepatic cysts?
usually associated with hemorrhage , will have internal echoes, thick walls, calcifications, or solid componenets
What are the clinical findings of hepatic cysts?
- asymptomatic
- possible normal liver function tests
- ADPKD
- hemorrhagic or large cysts may cause right RUQ pain
What is a hydatid liver cyst aka echinococcal cyst?
These are cysts that develop from the parasite Echinococcus granulosus, which is a tape worm that lives in dog feces. It is insted by eating contaminated foods and is common in sheep/cattle raising countries—>middle east, australia, mediterranean
What are the clinical findings of hydatid cysts?
- leukocytosis
- low grade fever
- nausae
- obstructive jaundice
- RUQ tenderness
- possible recent travel abroad
What are the sonographic appearance of hydatid cysts?
- anechoic containing some debris
- “water lily” sign
- mother cyst containing daughter cysts
- may contain dense calcifications
What is an amebic hepatic cyst and what causes it?
it comes from the parasite Entamoeba histolytica that grows in the colon and invades the liver via the portal vein. It is typically transmitted through contaminated water
What are the clinical findings of an amebic abscess?
- hepatomegaly
- RUQ or abd pain
- General malaise
- Diarrhea
- fever
- Leukocytosis
- Elevated liver function tests
- mild anemia
- possible recent travel abroad
What is the sonographic apperance of amebic abscess?
- round hypoechoic or anechoic mass
- may contain debris
- acoustic enhancement
What is a pyogenic hepatic abscess?
It can result from the spread of infection from inflammatory conditions such as appendicitis, cholecystitis, cholangitis, endocarditis because bacteria enter the liver through the portal vein, hepatic artery, biliary tree or from op procedure
What are the clinical findings of a pyogenic hepatic abscess?
- fever
- hepatomegaly
- leukocytosis
- abnormal liver function tests
- RUQ pain
What is the sonographic appearance of pyogenic hepatic abscess?
- complex cyst with thick walls
- mass m ay contain debris, septations, or gas
- if it contains gas—> dirty shadowing
What is hepatic candidiasis?
It results from the spread of fungus, candida albicans in the blood to the liver
In which group of people is hepatic candidiasis prone?
the immunocompromised—> cancer pts, transplant pts, hiv pts
What are the clinical findings of hepatic candidiasis?
- immunocompromised
- RUQ pain
- fever
- hepatomegaly
What is the sonographic appearance of hepatic candidiasis?
- multiple massesw/ hyperechoic central portions and hypoechoic borders—>”target” “halo” “bulls eye” sign
- usually 1 cm or smaller
- older lesions may calcify
What is a cavernous hemangioma?
The most common benign liver tumor, more common in women, and are typically found in the right lobe of the liver
What are the clinical findings of the cavernous hemangioma?
asymptomatic
What is the sonographic appearance of the cavernous hemagioma?
- small hyperechoic mass
2. usually in the right lobe
What is focal nodular hyperplasia?
It is the second most common benign liver tumor, typically discovered in women, and is composed of hepatocytes an d fibrous tissue
What are the clinical findings of focal nodular hyperplasia?
- asymptomatic
What is the sonographic appearance of focal nodular hyperplasia?
- can vary, isoechoic, hyperechoic, hypoechoic mass
2. central scar may appear as hyperechoic or hypoechoic, will have hypervascularity with doppler
What is hepatocellular adenoma?
Aka hepatic adenoma or liver cell adenoma is a RARE benign liver tumor and associated with the use of oral contraceptives. It may be prone to hemorrhage and has a propensity to become malignant, they are often removed
What is malignant degradation?
The deterioration of a benign mass into malignancy
What is the sonographic appearance of hepatocellular adenoma?
- variable—>solid and hypoechoic appearance, hyperechoic, isoechoic, mixed echogenicities
What is a hepatic hematoma?
Can be caused by injury or trauma, pts will have pain and decreased hematocrit
What is a intrahepatic hematoma?
hematoma within the liver
What is subcapsular hematoma?
hematoma outside of the liver, around the liver–> glisson capsule
What is an arteriovenous fistula?
An abnormal passageway b/w an artery and a vein
What are the clinical findings of hepatic hematomas?
- trauma/injury
- recent surgery
- pain
- decreased hematocrit
What is the sonographic appearance of hepatic hematoma?
- fresh clot may appear hyperechoic
2. older hemorrhage may appear anechoic or complex
What is hepatocellular carcinoma?
HCC is the most common primary form of liver cancer, most often seen in men and accompanied by cirrhosis and chronic hepatitis
The malignant mass associated with HCC is referred to as a _________.
Hepatoma
What is the tumor marker for HCC?
AFP—-> alpha-fetoprotein
What are the clinical findings of HCC?
- elevated AFP
- abnormal liver function tests
- Cirrhosis
- chronic hepatitis
- unexplained weight loss
- hepatomegaly
- fever
- palpable mass
- abdominal swelling w/ ascites
