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MIDS 127 > Liver > Flashcards

Liver Flashcards

1
Q

Location of liver?

A

-Right hypochondrium, epigastric + part of left hypochondrium
-Periotoneal

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2
Q

Measurement of liver?

A

13-15.5 cm in length (SAG)

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3
Q

What is the echogenicity/texture of the liver?

A

-Homogeneous
-Isoechoic or slightly brighter than kidney or slightly less bright than pancreas and spleen

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4
Q

Is the liver the largest internal organ?

A

Yes

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5
Q

What are the 2 layers of the liver?

A

-Visceral peritoneum
-Glisson capsule (is highly echogenic and ensheaths the portal triad)

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6
Q

What is the bare area?

A

-Connection of liver and diaphragm posteriorly that is not covered by visceral layer
-Place of infection spread from abdominal cavity to thoracic cavity

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7
Q

What is morrisons pouch?

A

-Space between liver and right kidney
-In supine it is very gravity dependent causing a potential space for fluid to develop there

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8
Q

Where + what is the coronary lig?

A

-Top of liver
-Connects liver to diaphragm

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9
Q

Where + what is the falciform lig?

A

-Is midportion of coronary lig and extends down
-Separates R/L lobes liver

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10
Q

Where + what is the lig of teres/round lig?

A

-Extends from falciform lig and hangs at bottom of liver
-Remnant of umbilical cord, if normal there is no function
-Divides LLL into medial/lateral sections

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11
Q

Where + what is the lig venosum?

A

-Usually attached to LPV
-Separates the caudate lobe from LLL

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12
Q

Where + what is the triangular lig?

A

-R/L triangular on top of liver in the corners beside coronary lig
-Formed by the upper/lower ends of coronary lig

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13
Q

Where + what is the gastrohepatic lig?

A

-Connects liver to stomach
-Originates on under surface of liver

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14
Q

Where + what is the hepatoduodenal lig?

A

-Surrounds portal triad before entering porta hepatis
-Extends between porta hepatis and superior part of duodenum

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15
Q

What are the anatomic/external divisions of liver lobes?

A

-Right
-Left
-Caudate
-Quadrate

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16
Q

What are the segmental/internal divisions of liver lobes?

A

-RLL (ant/post)
-LLL (med/lat)
-Caudate

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17
Q

What is couinaud’s classification?

A

8 segments that specifically divide liver

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18
Q

What is the main lobar fissure (MLF)?

A

-Separates L/R lobes
-Contains MHV, GB + IVC
-Landmark is seen between GB neck + RPV

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19
Q

What is the right intersegmental fissure?

A

-Divides RLL into ant/post segments
-Landmark is RHV

(can’t see on u/s)

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20
Q

What is the left intersegmental fissure?

A

-Divides LLL into med/lat segments
-Landmark is LHV

(can’t see on u/s)

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21
Q

What is a fissure?

A

An empty space that things may live in

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22
Q

What does -inter and -intra mean?

A

-inter means between
-intra means within/inside

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23
Q

Where do HV’s run in liver?

A

-Intersegmentally
-Vertical lines down fist

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24
Q

Where do PV’s run?

A

-Intrasegmentally
-Horizontal line on fist

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25
Q

Are bile ducts and HA’s intra or intersegmental?

A

Intrasegmental

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26
Q

What supplies the caudate lobe?

A

-Has it’s own blood supply from RPV, LPV + HA branches
-Short venous channels drain directly into IVC
-Has its own bile ducts

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27
Q

What are anatomic variations in liver?

A

-Shape
-Size
-Thinning LLL
-Congenital absence of LLL
-Pseudofissures (diaphragm indents/slips)
-Situs inversus

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28
Q

What is riedel lobe?

A

-Common enlargement of RLL
-M/C in women

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29
Q

What composes the dual supply of the vascular system?

A

-HA’s (20-30%)
-PV’s (70-80%)

(is drained by HV’s)

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30
Q

SF of diaphragmatic slips?

A

Echogenic bumpy/pointy things that look like teeth on the side of the liver

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31
Q

Functions of the liver?

A

-Bile formation
-Metabolism

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32
Q

What pathology occurs when increased direct/conjugated bilirubin?

A

-Hepatitis
-Cirrhosis

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33
Q

Measurement of hepatomegaly?

A

Greater than 15.5cm

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34
Q

Lightbulb for fatty infiltration/steatosis?

A

-Reversible
-M/c due to alcohol abuse + obesity
-Leads to cirrhosis if not treated
-Associated with HCC
-Caput medusae is indicator

35
Q

SF of fatty infiltration?

A

-M/c diffuse
-Echogenic liver due to fat accumulation

FFI: hyperechoic mass with angular margins + no mass effect
FFS: hypoechoic area surrounded by fatty liver

36
Q

What is cirrhosis?

A

Diffuse destruction of liver lobules

37
Q

Cause of cirrhosis?

A

Alcohol abuse

38
Q

What are the 4 forms of cirrhosis?

A

Alcoholic
Biliary
Post-necrotic
Metabolic

39
Q

SF of acute cirrhosis?

A

-Heterogeneous
-Hepatomegaly
-Echogenic
-Decreased penetration

40
Q

SF of chronic cirrhosis?

A

-Heterogeneous
-Atrophied
-Enlarged caudate
-Bumpy nodularity

41
Q

What type of glycogen storage disease is m/c?

A

Type 1 - von Gierke disease

42
Q

SF of type 1 glycogen storage disease?

A

-Diffusely echogenic
-Solid masses
-Hepatomegaly

43
Q

Cause of hepatitis?

A

Reactions to viruses/toxins (drugs,alcohol)

44
Q

SF/lightbulb of acute hepatitis?

A

Starry sky!

45
Q

SF of chronic hepatitis?

A

Fibrosis with coarse + hyperechoic tissue

46
Q

What is hemochromatosis?

A

Too much iron in liver :(

47
Q

SF of hemochromatosis?

A

-Ascites around liver
-Very bumpy walls
-Echogenic
-Cirrhosis
-Hepatomegaly

(image looks like liver is a floating cloud)

48
Q

What is passive liver congestion?

A

-Liver swelling
-Vascular congestion

(complication of heart failure)

49
Q

SF of passive liver congestion?

A

-Dilated HV’s + IVC
-No change with respiration

50
Q

What causes congenital cysts?

A

Abnormal formation of intrahepatic bile ducts

51
Q

What does congenital cysts have to do with age?

A

Increased change when person is older

52
Q

SF of congenital cysts?

A

-M/c RLL
-M/c solitary

(Well defined, anechoic, post enhancement, calcification - typical SF of cyst)

53
Q

What are the 2 kinds of polycystic liver disease?

A

PLD - only liver
ADPKD - liver + kidneys

54
Q

What is polycystic liver disease?

A

Multiple cysts
(m/c women aged 30/40)

55
Q

What are peribiliary cysts?

A

Cysts around porta hepatis (think biliary)

(M/c in people with severe liver disease)

56
Q

SF of peribiliary cysts?

A

0.2-2.5cm
Clustered cysts parallel to bile ducts + PV’s

57
Q

What is a granuloma?

A

WBC’s that form during injury/inflammation

(looks like echogenic foci in tissue)

58
Q

What is the m/c hepatic abscess?

A

Pyogenic abscess!

59
Q

Lightbulb/cause of pyogenic abscess?

A

IV drug abuse + diverticulitis

60
Q

SF of pyogenic abscess?

A

-Avascular
-Gas (echogenic lines)
-Vascularity around mass

61
Q

Lightbulb for abscess?

A

-Fever
-Leukocytosis
-Avascular

62
Q

What is amebic abscess caused by?

A

Ingesting contaminated food/water

63
Q

SF of amebic abscess?

A

Acute: echogenic
Chronic: hypoechoic with post enhancement

(m/c RLL)

64
Q

What causes schistosomiasis + what is its lightbulb/SF?

A

-Worms digested
-Clay pipe stem pattern! (echogenic lines)

65
Q

Lightbulb for hydatid disease/echinococcal cyst?

A

Water lily sign! (mother cyst with daughter cysts)

66
Q

What causes hydatid disease?

A

Tapeworm

67
Q

Lightbulb for HIV/AIDS?

A

Starry sky

68
Q

Lightbulb for fungal infection?

A

Wheel within a wheel sign!

(hypoechoic outer rim, echogenic inner layer, hypoechoic center)

69
Q

What people are m/c to getting infections?

A

People with decreased immune system

70
Q

What is the m/c benign liver tumour?

A

Hemangioma

(5x m/c women)

71
Q

SF of hemangioma?

A

-M/c solitary
-Less than 3cm
-M/c RLL

72
Q

What is the 2nd m/c benign liver mass?

A

FNH (focal nodular hyperplasia)

(m/c younger women on OCP)

73
Q

SF of FNH?

A

-Subtle/isoechoic to liver
-Less than 5cm
-M/c solitary
-Central stellate scar!

74
Q

Who is m/c to get hepatic adenoma’s?

A

Younger women on OCP
(although lesions can disappear is stop taking OCP)

75
Q

SF of adenoma?

A

-M/c solitary
-Hyperechoic with hypooechoic halo
-Vascular

76
Q

SF of lipoma?

A

Echogenic lesion with possible speed error artifact

77
Q

Another name for HCC?

A

Hepatoma

78
Q

What is the m/c primary malignancy of liver?

A

HCC

79
Q

RF’s of HCC?

A

-Cirrhosis
-Hepatitis
-Heavy alcohol
-NAFLD (non-alchohlic fatty liver disease)
-NASH (non-alcoholic steatohepatitis)

80
Q

Lightbulb for HCC?

A

-Increased AFP!
-M/c african american men
-Pre existing cirrhosis

81
Q

Where does HCC metastasize to?

A

Lung, PV, lymph nodes, bone, mesentery

82
Q

Where does HCC invade?

A

PV (60%)
HV (15%)

83
Q

Is liver a common site for metastases?

A

yes, 2nd m/c site
18-20x m/c mass came from another organ than the liver

84
Q

What are the m/c primary metastases?

A

Colorectal*
Panc
Breast

MIDS 127 (14 decks)

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