Liver Flashcards
Location of liver?
-Right hypochondrium, epigastric + part of left hypochondrium
-Periotoneal
Measurement of liver?
13-15.5 cm in length (SAG)
What is the echogenicity/texture of the liver?
-Homogeneous
-Isoechoic or slightly brighter than kidney or slightly less bright than pancreas and spleen
Is the liver the largest internal organ?
Yes
What are the 2 layers of the liver?
-Visceral peritoneum
-Glisson capsule (is highly echogenic and ensheaths the portal triad)
What is the bare area?
-Connection of liver and diaphragm posteriorly that is not covered by visceral layer
-Place of infection spread from abdominal cavity to thoracic cavity
What is morrisons pouch?
-Space between liver and right kidney
-In supine it is very gravity dependent causing a potential space for fluid to develop there
Where + what is the coronary lig?
-Top of liver
-Connects liver to diaphragm
Where + what is the falciform lig?
-Is midportion of coronary lig and extends down
-Separates R/L lobes liver
Where + what is the lig of teres/round lig?
-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
Where + what is the lig venosum?
-Usually attached to LPV
-Separates the caudate lobe from LLL
Where + what is the triangular lig?
-R/L triangular on top of liver in the corners beside coronary lig
-Formed by the upper/lower ends of coronary lig
Where + what is the gastrohepatic lig?
-Connects liver to stomach
-Originates on under surface of liver
Where + what is the hepatoduodenal lig?
-Surrounds portal triad before entering porta hepatis
-Extends between porta hepatis and superior part of duodenum
What are the anatomic/external divisions of liver lobes?
-Right
-Left
-Caudate
-Quadrate
What are the segmental/internal divisions of liver lobes?
-RLL (ant/post)
-LLL (med/lat)
-Caudate
What is couinaud’s classification?
8 segments that specifically divide liver
What is the main lobar fissure (MLF)?
-Separates L/R lobes
-Contains MHV, GB + IVC
-Landmark is seen between GB neck + RPV
What is the right intersegmental fissure?
-Divides RLL into ant/post segments
-Landmark is RHV
(can’t see on u/s)
What is the left intersegmental fissure?
-Divides LLL into med/lat segments
-Landmark is LHV
(can’t see on u/s)
What is a fissure?
An empty space that things may live in
What does -inter and -intra mean?
-inter means between
-intra means within/inside
Where do HV’s run in liver?
-Intersegmentally
-Vertical lines down fist
Where do PV’s run?
-Intrasegmentally
-Horizontal line on fist
Are bile ducts and HA’s intra or intersegmental?
Intrasegmental
What supplies the caudate lobe?
-Has it’s own blood supply from RPV, LPV + HA branches
-Short venous channels drain directly into IVC
-Has its own bile ducts
What are anatomic variations in liver?
-Shape
-Size
-Thinning LLL
-Congenital absence of LLL
-Pseudofissures (diaphragm indents/slips)
-Situs inversus
What is riedel lobe?
-Common enlargement of RLL
-M/C in women
What composes the dual supply of the vascular system?
-HA’s (20-30%)
-PV’s (70-80%)
(is drained by HV’s)
SF of diaphragmatic slips?
Echogenic bumpy/pointy things that look like teeth on the side of the liver
Functions of the liver?
-Bile formation
-Metabolism
What pathology occurs when increased direct/conjugated bilirubin?
-Hepatitis
-Cirrhosis
Measurement of hepatomegaly?
Greater than 15.5cm
Lightbulb for fatty infiltration/steatosis?
-Reversible
-M/c due to alcohol abuse + obesity
-Leads to cirrhosis if not treated
-Associated with HCC
-Caput medusae is indicator
SF of fatty infiltration?
-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
What is cirrhosis?
Diffuse destruction of liver lobules
Cause of cirrhosis?
Alcohol abuse
What are the 4 forms of cirrhosis?
Alcoholic
Biliary
Post-necrotic
Metabolic
SF of acute cirrhosis?
-Heterogeneous
-Hepatomegaly
-Echogenic
-Decreased penetration
SF of chronic cirrhosis?
-Heterogeneous
-Atrophied
-Enlarged caudate
-Bumpy nodularity
What type of glycogen storage disease is m/c?
Type 1 - von Gierke disease
SF of type 1 glycogen storage disease?
-Diffusely echogenic
-Solid masses
-Hepatomegaly
Cause of hepatitis?
Reactions to viruses/toxins (drugs,alcohol)
SF/lightbulb of acute hepatitis?
Starry sky!
SF of chronic hepatitis?
Fibrosis with coarse + hyperechoic tissue
What is hemochromatosis?
Too much iron in liver :(
SF of hemochromatosis?
-Ascites around liver
-Very bumpy walls
-Echogenic
-Cirrhosis
-Hepatomegaly
(image looks like liver is a floating cloud)
What is passive liver congestion?
-Liver swelling
-Vascular congestion
(complication of heart failure)
SF of passive liver congestion?
-Dilated HV’s + IVC
-No change with respiration
What causes congenital cysts?
Abnormal formation of intrahepatic bile ducts
What does congenital cysts have to do with age?
Increased change when person is older
SF of congenital cysts?
-M/c RLL
-M/c solitary
(Well defined, anechoic, post enhancement, calcification - typical SF of cyst)
What are the 2 kinds of polycystic liver disease?
PLD - only liver
ADPKD - liver + kidneys
What is polycystic liver disease?
Multiple cysts
(m/c women aged 30/40)
What are peribiliary cysts?
Cysts around porta hepatis (think biliary)
(M/c in people with severe liver disease)
SF of peribiliary cysts?
0.2-2.5cm
Clustered cysts parallel to bile ducts + PV’s
What is a granuloma?
WBC’s that form during injury/inflammation
(looks like echogenic foci in tissue)
What is the m/c hepatic abscess?
Pyogenic abscess!
Lightbulb/cause of pyogenic abscess?
IV drug abuse + diverticulitis
SF of pyogenic abscess?
-Avascular
-Gas (echogenic lines)
-Vascularity around mass
Lightbulb for abscess?
-Fever
-Leukocytosis
-Avascular
What is amebic abscess caused by?
Ingesting contaminated food/water
SF of amebic abscess?
Acute: echogenic
Chronic: hypoechoic with post enhancement
(m/c RLL)
What causes schistosomiasis + what is its lightbulb/SF?
-Worms digested
-Clay pipe stem pattern! (echogenic lines)
Lightbulb for hydatid disease/echinococcal cyst?
Water lily sign! (mother cyst with daughter cysts)
What causes hydatid disease?
Tapeworm
Lightbulb for HIV/AIDS?
Starry sky
Lightbulb for fungal infection?
Wheel within a wheel sign!
(hypoechoic outer rim, echogenic inner layer, hypoechoic center)
What people are m/c to getting infections?
People with decreased immune system
What is the m/c benign liver tumour?
Hemangioma
(5x m/c women)
SF of hemangioma?
-M/c solitary
-Less than 3cm
-M/c RLL
What is the 2nd m/c benign liver mass?
FNH (focal nodular hyperplasia)
(m/c younger women on OCP)
SF of FNH?
-Subtle/isoechoic to liver
-Less than 5cm
-M/c solitary
-Central stellate scar!
Who is m/c to get hepatic adenoma’s?
Younger women on OCP
(although lesions can disappear is stop taking OCP)
SF of adenoma?
-M/c solitary
-Hyperechoic with hypooechoic halo
-Vascular
SF of lipoma?
Echogenic lesion with possible speed error artifact
Another name for HCC?
Hepatoma
What is the m/c primary malignancy of liver?
HCC
RF’s of HCC?
-Cirrhosis
-Hepatitis
-Heavy alcohol
-NAFLD (non-alchohlic fatty liver disease)
-NASH (non-alcoholic steatohepatitis)
Lightbulb for HCC?
-Increased AFP!
-M/c african american men
-Pre existing cirrhosis
Where does HCC metastasize to?
Lung, PV, lymph nodes, bone, mesentery
Where does HCC invade?
PV (60%)
HV (15%)
Is liver a common site for metastases?
yes, 2nd m/c site
18-20x m/c mass came from another organ than the liver
What are the m/c primary metastases?
Colorectal*
Panc
Breast
