Liver Flashcards
1
Q
What is the largest parenchymal organ in the body?
A
Liver
2
Q
What does parenchymal mean?
A
has tissue
3
Q
The primitive gut is formed during the _____ week of embryonic life and is composed of these 3 parts:
A
4th
Foregut
Midgut
Hindgut
4
Q
The _____ veins bring oxygenated blood from the embryonic portion of the placenta to the embryonic heart.
A
umbilical veins
5
Q
The _____ veins return blood from the yolk sac to the heart.
A
vitelline veins
6
Q
Vitelline veins eventually become what vessels?
A
portal veins
7
Q
The liver comes from what part of the primitive gut?
A
the foregut
8
Q
In prenatal live, oxygenated blood from the placenta is carried by the _____ _____ vein and _____ _____ to the IVC and _____ atrium.
A
left umbilical vein
ductus venosus
right atrium
9
Q
List the various liver structures (6)
A
1) portal veins
2) hepatic veins
3) arteries
4) ducts
5) hepatic ligaments
6) hepatic fissures
10
Q
The liver tissue sequentially moves into the _____ veins and then the _____ veins.
A
vitelline veins
umbilical veins
11
Q
As the liver tissue moves into the vitelline veins, their midsection becomes _____, whereas their _____ ends become the _____ _____ veins and their _____ ends become the _____ _____ veins.
A
capillarized
caudal ends become the primitive portal veins
cranial ends become the early hepatic veins
12
Q
After the right umbilical vein and part of the left umbilical vein degenerate during fetal development, the remaining left umbilical vein carries all the blood from the _____ to the _____.
A
placenta
fetus
13
Q
An umbilical cord should contain _____ arter(ies) and _____ vein(s).
A
2 arteries
1 vein
14
Q
The ductus venosus develops as a large shunt within the liver and allows blood to connect from the _____ _____ to the baby’s _____, by bypassing the _____.
A
umbilical cord
heart (right side)
liver
15
Q
Direction of fetal circulation:
Umbilical Vein (ligamentum teres)
l
l
\/
?
l
l
\/
? (AKA ?)
l
l
\/
?
A
Umbilical Vein (ligamentum teres)
l
l
\/
Left Portal Vein
l
l
\/
Ductus Venosus (AKA Ligamentum Venosum)
l
l
\/
IVC
16
Q
The _____ _____ closes shortly after birth, when the umbilical cord is cut and blood flowing between the mother and fetus stops.
A
ductus venosus
17
Q
The _____ _____ is a remnant of the ductus venosus. It runs from the _____ to the _____, separating the left LLL from the caudate lobe of the liver.
A
ligamentum venosum
LPV
IVC
18
Q
The liver is covered by a thin connective tissue called
A
Glisson’s capsule
19
Q
Glisson’s capsule covers the entire liver except the “_____ _____” near the dome of the liver, on the posterior surface of the RLL.
A
“bare area”
20
Q
Glisson’s capsule is at its thickest around the _____ and the _____.
A
IVC
porta hepatis
21
Q
These macrophages remove bacteria, foreign matter and weakened blood cells from the liver sinusoids (blood in the sinusoids).
A
Kupffer cells
22
Q
T or F? Kupffer cells are around at all times, they just “hang out” if no infection.
A
True
23
Q
The hepatic parenchyma is composed of _____ (type of cell) dispersed with Kupffer cells and organized into lobules approximately 1 x 2 mm in size.
A
hepatocytes
24
Q
Typically about _____ million of these are found in the liver, and they are the functional units of the liver.
A
1 million
lobules
25
The liver occupies a major portion of the _____ _____ (region of abdomen).
right hypochondrium
26
Inferiorly, the liver extends into the
epigastrium
27
Laterally, the liver extends into the
left hypochondrium
28
Superiorly, the liver extends into the
dome of the diaphragm
29
Posteriorly, the liver borders the
bony lumbar region of the muscular posterior abdominal wall
30
The 5 main liver functions are
1) Bile drainage
2) Blood glucose regulation
3) Synthesis/Storage of amino acids, proteins, vitamins, and fats
4) Detoxification
5) Blood circulation/filtration
31
Bile from the liver travels down the _____ and joins with the bile from the _____ and ends in the _____ head.
CBD
GB
pancreatic head
32
The liver is a(n) _____ (location in body) structure situated in the _____ upper quadrant of the abdomen.
intraperitoneal
| right
33
What portions of the liver are in contact with the diaphragm?
superior
anterior
part of the posterior
34
The caudate lobe, which is the smallest lobe, is marked on the _____ border by the _____ surface of the LPV and the _____ border is the _____.
anterior border
posterior surface
posterior border
IVC
35
The posterior surface of the right lobe of the liver is indented by the _____.
right kidney
36
The IVC lies _____ to the liver and has a short _____ course just before entering the right atrium of the heart.
posterior
| intrahepatic
37
The LLL lies adjacent to the body of the pancreas, _____, and _____, and lies close to the body and _____ of the stomach.
SV
SA
antrum
38
The blood received by the liver from the PV delivers nutrients just absorbed from the _____.
intestines
39
Oxygenated (and some deoxygenated) blood is brought to the liver by the _____ and ______.
PVs
| HAs
40
Hepatic sinusoids are similar to what other vascular structure we have learned about?
capillaries
41
Central veins connect to _____ veins, which then connect to the _____.
hepatic
| IVC
42
What allows blood from the HAs and PV to mix in the liver?
HAs and PV deliver blood to the tiny hepatic sinusoids and is eventually delivered to the HVs, which conduct blood toward the heart.
43
Blood from the liver sinusoids is eventually deliver to the _____ veins, which conduct blood toward the _____.
hepatic veins
| heart
44
The average adult liver is _____ grams.
1500
45
Liver size depends on the _____ segment of the _____ (lobe) and the length of the _____.
lateral
LLL
RLL
46
Hepatomegaly is indicated with a superior-inferior dimension of >____cm or when the RLL extends inferior to the _____ _____ of the _____ kidney.
15
lower pole
right
47
Liver echogenicity is usually _____ (heterogeneous/homogeneous) and is slightly _____ (echogenicity) compared to the normal renal cortex.
homogeneous
| hyperechoic
48
T or F? The LLL is always smaller than the RLL.
True
49
If the LLL is congenitally small or atrophic, it may be a result of interference with the _____ supply when the _____ _____ closes at birth.
LPV
| ductus venosus
50
The longer the RLL, the _____ (less/more) likely the interference of bowel gas by the hepatic flexure.
less
51
The length of the _____ (lobe) determines the clarity of the right kidney in the supine position.
RLL
52
A tongue-like projection of the RLL that may extend to the iliac crest.
Reidel's Lobe
53
Reidel's lobe is usually positioned _____ (direction) and more common in _____ (men/women).
anteriorly
| women
54
In 1957, the _____ classification system was created that divides the liver into _____ (number) functional segments.
Couinaud
| 8
55
Each Couinaud segment of the liver has its own _____, _____, and _____.
PV
HA
Bile Duct
56
T or F? The Couinaud division system makes it possible to identify and remove tumors in specific segments while leaving others untouched.
True
57
The liver's 3 lobes are
Right
Left
Caudate
58
The RLL and LLL are based on the the _____'s right and left branches.
MPV
59
The RLL is divided into _____ and _____ segments.
anterior
| posterior
60
The LLL is divided into _____ and _____ segments.
medial
| lateral
61
The medial segment of the LLL was formerly called the _____ lobe.
Quadrate
62
This lobe of the liver lies on the posterior-superior surface of the liver between the IVC and the medial LLL.
Caudate
63
The caudate lobe is supplied by branches of the _____ and _____ _____ veins and the _____ (vessel).
right and left PVs
| HA
64
The Caudate lobe is drained by _____ veins, which enter directly into the IVC.
emissary
65
Study the 8 segments of the liver
okay
66
Segmental anatomy of the liver is based on the distribution of the _____ (vessels).
PVs
67
The vessels of the _____ _____ course to the center of each segment of the liver.
portal triad
68
_____ (vessels) divide the liver longitudinally into 4 sections.
HVs
69
Each of the 4 sections of the liver (divided by the HVs) is divided further transversely by a(n) _____ plane through the right and left PVs.
imaginary
70
The HVs are both _____ and _____ veins (type/classification).
interlobar
| intersegmental
71
HVs course between the _____ and _____ of the liver and have _____ (echogenicity) walls.
lobes
segments
non-echogenic
72
The _____ vein separates and drains the anterior and posterior segments of the _____.
RHV
| RLL
73
The _____ vein separates and drains the medial and lateral segments of the _____ (lobe).
LHV
| LLL
74
The _____ vein separates and drains the right and medial _____ (lobe).
MHV
| LLL
75
This is the term for HVs that course BETWEEN the segments and lobes of the liver.
intersegmental
76
This is the term for vessels of the portal triad that course WITHIN each segment of the liver.
intrasegmental
77
What fissure divides the RLL and LLL by an oblique plane between the IVC and GB fossa?
main lobar fissure (MLF)
78
The _____ vein travels within the MLF.
MHV
79
Landmarks for the MLF are (3)
GB
IVC
MHV
80
This is the fissure identified between the GB neck and the junction of the RPV and LPV.
MLF
81
It is also correct to say the _____ fissure divides the _____ segment of the RLL from the _____ segment of the LLL.
MLF
anterior
medial
82
This fissure divides the RLL into anterior and posterior segments.
Right Intersegmental Fissure
83
The landmark for the Right Intersegmental Fissure is the (1)
RHV
84
This fissure divides the LLL into medial and lateral segments.
Left Intersegmental Fissure
85
The landmarks for the Left Intersegmental Fissure are (4)
LHV
ascending LPV
falciform ligament
ligamentum teres
86
Name the 7 ligaments of the liver.
```
coronary
falciform
round
right triangular
left triangular
gastrohepatic
hepatoduodenal
```
87
This ligament suspends the liver from the diaphragm and surround the "bare area".
coronary ligament
88
This ligament appears as a bright echogenic focus demarcating the lateral border of the medial portion of the LLL.
falciform ligament
89
The falciform ligament separates segment # _____ from segment # _____ and is the structure above the ligamentum teres.
3
| 4
90
What is a double fold of the peritoneum created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of the PV?
falciform ligament
91
What is a sickle-shaped fold that connects the liver to the anterior abdominal wall and to the diaphragm?
falciform ligament
92
The ligamentum teres is also known as the
round ligament
93
This ligament is a remnant of the umbilical vein which runs from the umbilicus to the LPV. Shortly after birth, the umbilical vein contracts down forming this ligament.
ligamentum teres (AKA round ligament)
94
With portal HTN, this ligament recannalizes to form a portosystemic venous collateral.
ligamentum teres (AKA round ligament)
95
These ligaments aren't normally seen on an U/S and are peritoneal reflections to the far right and far left of the bare area.
triangular ligaments
96
This ligament is a portion of the lesser omentum that extends across the ligamentum venosum at the porta hepatis.
gastrohepatic ligament
97
The porta hepatis is contained in peritoneal folds called the _____ ligament.
hepatoduodenal ligament
98
This ligament is a portion lesser omentum that extends as the right border of the gastrohepatic ligament.
hepatoduodenal ligament
99
Are HVs interlobar or intralobar?
interlobar
100
Are PVs interlobar or intralobar?
intralobar
101
The liver receives its nutrients from the _____ and the _____ (vessels).
HA
| PV
102
The HVs are interlobar and follow a _____ course.
horizontal
103
The caliber of the HVs _____ (increases/decreases) as they course toward the diaphragm and IVC.
increases
104
The caliber of the PVs _____ (increases/decreases) toward the porta hepatis.
increases
105
T or F? One of the functions of the liver is the destruction of bad RBCs.
True
106
This lab value increases with liver disease (as well as heart, skeletal muscle, kidney, and brain).
SGOT or AST
107
This lab value increases with liver disease (specifically) and biliary tract obstruction.
SGPT or ALT
108
An increase in AST without an increase in ALT is seen with
a myocardial infarction
109
_____ (direct/indirect) bilirubin increases with liver disease and biliary tract obstruction.
direct
110
_____ (direct/indirect) bilirubin increases with liver dx. and disorders that cause increased RBC hemolysis.
indirect
111
Elevated levels of bilirubin can cause
obstructive or non-obstructive jaundice
112
Serum protein _____ (increases/decreases) with liver disease, especially albumin (a specific serum protein).
decreases
113
If a person isn't pregnant (because this increases naturally with pregnancy), this lab value increases with bone or liver abnormalities.
ALP
| alkaline phosphatase
114
This lab value may increase with liver damage but is also a tumor marker for scrotal cancer.
LDH
| lactic dehydrogenase
115
This lab value is present in over 50% of patients with hepatomas or hepatoblastomas (synthesized by the fetal liver).
AFT
| alpha-fetal protein
116
If AFP (alpha-fetal protein) is elevated in an adult, they will ALWAYS have _____ (disease).
hepatocellular carcinoma (HCC)
117
This lab value (clotting factor) increases with liver disease; it is a time (in seconds) that it takes for blood to coagulate.
PT
| prothrombin time
118
At least _____ clotting factors are needed to clot blood.
12
119
Vitamin _____ is needed to produce prothrombin.
K
120
Abnormal PT (prothrombin time) is often due to (2)
```
liver disease
Coumadin treatment (blood thinner)
```
121
When doing invasive procedures, these 3 blood tests are drawn to measure blood clotting factors.
PT (prothrombin time)
PPT (partial prothrombin time)
INR (international normalized ratio)
122
This test "standardizes" the PT test so that values may be compared between different labs.
INR
| international normalized ratio
123
The liver should be _____ (homogeneous/heterogeneous) and moderately _____ (echogenicity) throughout.
homogeneous
| echogenic
124
Ultrasound for the liver is indicated for
Suspected liver enlargement
Hepatic or perihepatic masses, abscesses and obstructive or metastatic lesions
Cystic, solid or complex masses
Pleural effusions may be visualized in the subphrenic or subdiaphragmatic region
Ascites
Vascular structures for the presence, direction and velocity of blood flow
Portal vein, hepatic arteries & veins, and splenic artery and vein examinations
125
Long-dot-long is an image of what?
porta hepatis oblique
126
What are visual elements on an U/S for early (acute) stages of cirrhosis? (3)
hepatomegaly
decreased vasculature
scalloped edges
127
Chronic stages of cirrhosis show a _____, _____ liver on U/S.
shriveled
| small
128
This ligament recannalizes in cirrhosis to function as a venous collateral.
ligamentum teres
129
The length of the RLL determines the clarity of
The right kidney in the supine position
130
The caudate lobe lies on the _____ - ______ surface of the liver, between the IVC and _____ _____ _____ of the liver. It is supplied by the branches of the _____ and _____ _____ _____ (vessels) and the _____ _____ (vessel).
```
Posterior-superior
IVC
medial LLL
LPV/RPV
HA
```
