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DMST 254 ABD 1 > Liver > Flashcards

Liver Flashcards

1
Q

What cavitiy of the body does the liver reside in?

A

Intraperitoneal

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2
Q

What is the largest organ in the body?

A

Liver

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3
Q

Which quadrant is the liver reside in?

A

RUQ

Or

Right hypochondrium, Epigastrum, LT Hypochondrum

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4
Q

What does the Liver bounded superiorly by what?

A

Diaphragm

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5
Q

What surfaces of the liver are bounded to the diaphragm?

A

Superior, anterior, and posterior surfaces

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6
Q

What is the inferior surface of the liver in contact with?

A

Abdominal organs
posterior surface indented by the right kidney

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7
Q

Which vessel is posterior to the liver?

A

IVC

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8
Q

Pathology can do what to livers?

A

Alter position, size, and shape

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9
Q

What is the largest section of the liver?

A

Right lobe, its 2-3x larger than the left

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10
Q

What is the caudate/RT lobe ratio?

A

<0.65

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11
Q

What is the caudate/RT lobe ratio used for?

A

Liver cirrhosis

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12
Q

Liver enlarged if the right lobe goes where?

A

RT lobe extends below the lower pole of Right kidney

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13
Q

What are the two methods of dividing the liver?

A
  1. Anatomical
  2. Functional
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14
Q

What is the anatomical method based on? 2

A
  1. Based on external markings
  2. Falciparum ligament and an “H” configuration are the boarders
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15
Q

How many lobes does the liver have in the anatomical method?

A

Four lobes
1. RT
2. LT
3. Caudate
4. Quadrate

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16
Q

What does the falciform ligament do in the anatomical method?

A

Divides the right and left lobes anteriorly

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17
Q

What is the functional method based on?

A

Blood supply and biliary drainage

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18
Q

What are significant landmarks for the functional method? 3

A
  1. Ligaments
  2. Fissures
  3. Gall bladder
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19
Q

How many lobes and segments are available in the functional method?

A

3 lobes and 4 segments

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20
Q

What are the three lobes o the functional method?

A
  1. Left
  2. Right
  3. Caudate
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21
Q

The right and left portal veins course within what?

A

The segments (intersegmental fissures)

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22
Q

The right, left and middle hepatic veins course between what/

A

The lobes and segments (intersegmental or interlobar)

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23
Q

The right lobe is separated from the left lobe by what?

A

Main lobar fissure

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24
Q

Superiorly what courses through the main lobar fissure?

A

Middle hepatic vein

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25
Q

The Right lobe is divided into what segments?

A

Anterior and posterior segments by the right intersegmental fissure

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26
Q

What flows through the right intersegmental fissure? 2

A
  1. Right hepatic vein
  2. Right portal vein
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27
Q

The anterior Right portal vein course within what area of the right lobe?

A

Anterior Right lobe

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28
Q

The posterior Right portal vein courses within what area of the right lobe?

A

The posterior right lobe

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29
Q

What does the left lobe divided into?

A

Medial and lateral segments by the Left intersegmental fissure

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30
Q

What courses through the left intersegmental fissure?

A
  1. Left hepatic vein
  2. Ascending left portal vein
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31
Q

What is the medial left lobe equal?

A

Quadrate lobe

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32
Q

The caudate lobe receives PV and HA blood from where?

A

Right and left

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33
Q

Where is the caudate lobe located? (Aspect of the liver)

A

Posterior aspect of the liver

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34
Q

What is the posterior landmark of the caudate lobe?

A

IVC

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35
Q

What is the anterior landmark of the caudate lobe?

A

Ligamentum venosum

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36
Q

What is the inferior landmark of the inferior caudate lobe?

A

Main portal vein

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37
Q

What is the caudate process? What does it lie between?

A

Extension of CL between IVC and portal vein

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38
Q

What is the papillary process?

A

A Caudal projection of the caudate lobe

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39
Q

Where is the papillary process located?

A

It lies along the ligamentum venosum and above the porta hepatis

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40
Q

What may the papillary process mimic sometimes?

A

A lymph node or pancreatic mass

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41
Q

Couindaud’s liver is divided into how many segments?

A

8 segments

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42
Q

Who uses Couinaud’s?

A

Surgeons

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43
Q

Couinaud’s lobe has a what at it’s center? What is it bound by?

A

Portal vein at its center bounded by a hepatic vein

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44
Q

Instead of memorizing the couinauds division what pneumonic can we use?

A

The fist method.
1. Make a fist
2. Your thumb is the caudate
3. Each space between your fingers is a hepatic (left, main, right)
4. Your first Knuckle is the main portal vein

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45
Q

What four questions should we ask to find which section couinaud’s are we in?

A
  1. Is it the caudate?
  2. Is it the right or left lobe?
  3. IF left lobe is it medial or lateral? IF right if posterior or anterior?
  4. Is it superior of inferior?
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46
Q

Right portal veins are considered what kind of landmarks?

A

Anterior/ superior

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47
Q

In the left lobe the ligamentum tere’s is considered what kind of landmark?

A

Superior

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48
Q

If you can see the right portal vein or the kidney which anatomical position are you in?

A

Inferior

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49
Q

The right hepatic vein is what kind of landmark?

A

Superior

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50
Q

Label the Couinaud’s Division

A
  1. Caudate lobe
  2. Left Lateral segment- superior
  3. Left Lateral segment- inferior
  4. Left medial lobe
  5. Right anterior segment- inferior
  6. Right posterior segment - inferior
  7. Right posterior segment- superior
  8. Right anterior segment - superior
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51
Q

What does the main lobar fissure do?

A

Divides functional left and right

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52
Q

What landmarks are used for the main lobar fissure?

A

GB and IVC used as landmarks

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53
Q

A short portion of the MLF is seen between what landmarks?

A

The right portal vein and gallbladder neck

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54
Q

What vein courses through the main lobar fissure?

A

Main hepatic vein

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55
Q

The right intersegmental fissure divides what?

A

The right lobe into anterior and posterior

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56
Q

What courses through the Right intersegmental fissure?

A

Right hepatic vein and a portion of the right portal vein courses through it

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57
Q

What does the left segmental fissure divide?

A

The left lobe into the medial and lateral

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58
Q

What are the three sections the left intersegmental fissures are divided into?

A
  1. Left hepatic vein
  2. Left portal vein
  3. Teres- caudal
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59
Q

What does the ligamentum venosum divide?

A

The left lateral segment of liver from the caudate

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60
Q

What does the fissure for the ligamentum venosum contain? 2

A
  1. ligamentum venosum
  2. Hepatogastric ligament
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61
Q

What is a fossae?

A

Depression or indentation

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62
Q

What does the GB fossa contain?

A

The GB

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63
Q

Where is the GB located in relation to the liver?

A

Posterior inferior surface of the liver

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64
Q

What does the IVC fossa contain?

A

A portion of the IVC

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65
Q

Where is the IVC fossa located?

A

Posterior liver, between caudate and bare area

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66
Q

What enters the porta hepatis?

A

Vessels and biliary ducts exit and enter liver at this point

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67
Q

The CBD and HA are anterior to what?

A

The PV

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68
Q

What is the Glisson’s capsule?2

A
  1. connective tissue surrounding liver
  2. Thickest at IVC and porta hepatis
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69
Q

What is the hepatoduodenal ligament? What is it the anterior boundary of? What does it contain?

A
  1. Fold of lesser omentum
  2. anterior boundary of epiploic foramen
  3. Contains the MPV, hepatic artery, CBD
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70
Q

What does the falciform ligament conduct? What does it extend from?

A
  1. conducts umbilical vein in fetus
  2. Extends from umbilicus to liver
71
Q

What is the ligamentum teres shaped like? Where is it located? What is its origin?

A
  1. Round ligament
  2. Inferior margin of left lobe
  3. Atrophied umbilical vein
72
Q

What is the ligamentum venosum? Where is it located?

A
  1. Remnant of the fetal ductus venosum
  2. Anterior boarder of the caudate lobe
73
Q

What surface of the liver does the coronary ligaments connect to the diaphragm?

A

Posterior superior surface of liver to diaphragm

74
Q

What ligament is the upper portion of the coronary ligaments continuous with?

A

Falciform ligament

75
Q

What ligaments does the coronary ligaments form?

A

Left and right triangular ligaments

76
Q

The Coronary ligaments define what part of the liver?

A

Bare area of liver

77
Q

What does the portal vein carry?

A

Oxygenated blood

78
Q

How does the portal vein travel?

A

Intrasegmentally

79
Q

What kind of walls does the portal vein have?

A

Echogenic reflective walls due to connective sheath

80
Q

The vessel caliber of the portal vein is greater near what?

A

Porta hepatis

81
Q

What is the main portal vein a conjunction of? (what forms it?)

A

SV, SMV, and IMV

82
Q

How does the main portal vein travel?

A

Right, cephalic, and oblique

83
Q

What does the main portal vein divide into?

A

Into right and left at the porta hepatis

84
Q

What does the right portal vein divide into?

A

Divide the anterior and posterior branches

85
Q

How does the right posterior portal vein travel?

A

Posterior and caudal

86
Q

How can the right portal vein appear? An elongation of what?

A

A elongation of the Main portal vein

87
Q

How does the left portal vein move?

A

Cranially along the anterior surface of the caudate lobe and then turns anterior

88
Q

What does the left portal vein divide?

A

Into medial and lateral branches

89
Q

What landmark is associated with the left portal vein?

A

Steers head

90
Q

What does the hepatic veins do?

A

Carry deoxygenated blood away from the liver to the IVC

91
Q

How does the hepatic vein travel?

A

Intersegmentally

92
Q

What does the caliber of the hepatic veins do as they approach the diaphragm?

93
Q

What are the walls of the hepatic veins like compared to the portals?

A

They are less echogenic than the portals

94
Q

Which hepatic vein is the largest?

A

Right hepatic vein

95
Q

Which hepatic vein is the smallest?

A

Left hepatic vein

96
Q

What is the sonographic appearance of parenchyma of the liver? What is the level of echoes like? What is it in comparison to the right kidney? What of the fissures, ligaments , and PVs?

A
  1. Parenchyma homogenous
  2. Fine to medium level echoes
  3. Slightly hyperechoic to, to isoechoic to, the right renal cortex
  4. Fissures, ligaments, and PV walls highly echogenic
97
Q

What is the patient prep for liver scans?

A
  1. Overnight fast
  2. NPO for at least six hours
98
Q

What positions do we use for the liver scan?

A

Supine and LLD

99
Q

Where do we place the probe for the liver scan?

A

Subcostal and intercostal approach

100
Q

Generally what will help get better images?

A

Getting the patient to breathe in and hold

101
Q

What kind of probe will we use for the liver scan?

A

2-6 Mhz probe

102
Q

What kinds of plane assessments can we do for liver scans?

A

Sag and trans views

103
Q

What things do we need to pay attention to for liver scans? 4

A
  1. Size
  2. Texture
  3. Vasculature
  4. Biliary structures
104
Q

What are some indications for ultrasound for livers?

A
  1. RUQ pain
  2. Suspected liver enlargement
  3. Masses, abscesses
  4. Metastases
  5. Abnormal LFT’s
  6. Portal hypertension
  7. Portal/ HV thrombosis
  8. Pre/post op hepatic surgery
105
Q

Label the structure from left to right

A
  1. Right portal vein
  2. Main lobar fissure
106
Q

From left to right label the structures

A
  1. Left Hepatic vein
  2. Ligamentum venosum
  3. Main portal vein (inferior boundary of the caudate lobe)
107
Q

From top down what are the structures

A
  1. Left lobe
  2. GE junction
  3. Aorta
108
Q

From left to right label the structures

A
  1. GE junction
  2. IVC
109
Q

What is the structure?

A

Left portal vein

110
Q

What structure is this?

A

Right portal vein

111
Q

What is the functional unit of the liver?

112
Q

What is the structure of the Lobule, and how big is it?

A

1-2 mm diameter hexagon shape

113
Q

What does the lobule consist of? 6

A
  1. Hepatocytes
  2. Central hepatic vein
  3. Sinusoids
  4. Kupffer cells
  5. Bile canaliculi
  6. Portal triad
114
Q

What makes up most of the liver parenchyma?

A

Hepatocytes

115
Q

Hepatocytes are organized into how many layers?

A

two layered columns

116
Q

Hepatocytes converge toward what?

A

Central vein

117
Q

What kind of blood are hepatocytes in contact with?

A

Sinusoid blood

118
Q

What does Hepatocytes do?

A

Liberate substances in the blood

119
Q

What are sinusoids?

A

Highly permeable blood capillaries
with free flow of blood to cells

120
Q

What does sinusoids do?

A

Transfer of products into blood

121
Q

Blood enters the lobule’s periphery and moves how?

A

Moves to central vein via sinusoid

122
Q

Where are sinusoids located?

A

between the hepatocyte columns

123
Q

What is the mixture in the sinusoids?

A

80% portal venous
20% hepatic arterial

124
Q

Where are Kupffer cells located?

A

Scattered along the sinusoids

125
Q

What are Kupffer cells also called?

A

Reticuloendothelial (RE) cells

126
Q

What does Kupffer cells do?

A

Exhibit phagocytosis (ingest and destroy bacteria, old RBCs and WBCs to cleanse blood)

127
Q

What are bile canuliculi?

A

Small bile ducts between the two layers of the hepatocyte columns

128
Q

What is the smallest division of the biliary duct?

A

Bile Canuliculi

129
Q

What does the bile canuliculi do?

A

Collect bile produced by hepatocytes

130
Q

Does bile mix with sinusoid blood?

131
Q

The bile canculiculi converge to form what?

A

Larger ducts that unit to form the right and left hepatic ducts

132
Q

What are the portal triad formed of?

A
  1. Bile duct
  2. Portal vein
  3. Hepatic artery
133
Q

Where is the portal triad found?

A

Outer edge of each lobule

134
Q

Several portal triads serve what?

A

A single lobule

135
Q

Blood enters periphery of lobule and travels where?

A

To central hepatic vein via sinusoids

136
Q

The blood in the central hepatic vein is cleansed of what?

A

Toxins and rich in liver secretions

137
Q

The central hepatic veins converge to form what?

A

hepatic veins

138
Q

Where does the central hepatic veins drain into?

139
Q

What is the function of the liver?

A
  1. Primary center of metabolism
  2. Performs more than 500 separate activities
140
Q

Most of the 500 separate functions are carried out by what structures in the liver?

A
  1. Hepatocytes
  2. Kupffer cells
  3. Biliary cells
141
Q

What does bile contain? 6

A
  1. Bile salts
  2. Cholesterol
  3. Conjugates of steroid hormones
  4. Amines
  5. Water
  6. Bilirubin
142
Q

What is bilirubin?

A

Bile pigment which is a product of RBC breakdown

143
Q

Bile salts are formed from what?

A

Cholesterol

144
Q

Bile emulsifies fats and acids in what process?

A

The absorption of fatty acids

145
Q

How much bile is formed each day?

A

700 - 1200 ml produced/ day

146
Q

Where is bile stored?

A

Gall bladder

147
Q

Unconjugated bilirubin is also known as

A

Indirect bilirubin

148
Q

Conjugated bilirubin is also known as what?

A

Direct bilirubin

149
Q

What is unconjugated bilirubin? 2

A
  1. Fat soluble, not excreted in urine
  2. Toxic to tissues
150
Q

What is conjugated bilirubin? 2

A
  1. Non-toxic, water soluble
  2. Secreted by liver
151
Q

What are reticuloendothelial functions?

A
  1. Blood production in embryo (hemopoiesis)
  2. Produces plasma proteins and antibodies (Albumin)
  3. Removes foreign material and worn out RBCs
  4. Recovers bile pigment
152
Q

What is hemopoiesis?

A

Blood production in embryo

153
Q

What Albumin prevent loss of?

A

Prevents plasma loss from capillaries

154
Q

Liver plays a important point in the metabolism of what?

A

Macronutrients

155
Q

What is the liver a storage depot for? 4

A
  1. Vitamins
  2. Glycogen, fats and amino acids
  3. Ferritin
  4. Minerals
156
Q

What are some other functions for the liver? 4

A
  1. Blood reservoir
  2. Heat production
  3. Detoxifies
  4. Lymph formation
157
Q

How much blood does the liver hold?

A

200- 400 ml

158
Q

How much lymph does the liver form?

A

1/3 to 1/2 of the body’s lymph

159
Q

Why is the liver important for lab tests?

A

Useful to understand the major lab tests performed to evaluate liver function

160
Q

What is lab test used for correlating? 3

A
  1. Clinical history
  2. Presenting symptoms
  3. Sonographic findings
161
Q

What is important to know in terms of enzymes in the liver?

A

Different cells produce different enzymes

162
Q

If there is cell damage what happens to enzymes?

A

They are released

163
Q

What are enzymes?

A

Proteins that catalyze chemical reactions

164
Q

Increased enzyme levels can indicate what?

A

Damage or disease

165
Q

What fluid can we find enzymes in for tests?

A

Blood (serum) and urine

166
Q

What are some liver function tests?

A
  1. ALT/SGPT
  2. AST/SGOT
  3. ALP or ALK PHOS
  4. LDH
  5. GGT
  6. AFP
  7. Bilirubin
  8. PT (Prothrombin time)
  9. INR
  10. PTT
  11. Protein
  12. Hepatitis testing
167
Q

What is important to know for ALT/SGPT?

A

Specific to hepatocellular damage

168
Q

What is important to know about ALP or ALK PHOS?

A

Values in biliary obstruction

169
Q

What is important to know about GGT?

A

Sensitive indicator of alcoholism

170
Q

What is important to know about AFP?

A

Increase in hepatocellular carcinoma (HCC) and testicular carcinoma

171
Q

What is important to know in terms of the Bilirubin liver function test?

A

Conjugated (direct) = extrahepatic biliary obstruction

172
Q

What is important to know about INR?

A

> 1.2 - do not do liver biopsy

173
Q

What is important to know about the protein liver function test?

A

Decreases in liver dysfunction

DMST 254 ABD 1 (26 decks)

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