Liver Flashcards
What capsule is the liver in?
Glissons capsule
What is the bare area?
- Portion of the liver not covered by peritoneum/ capsule
- fluid cannot accumulate there because the liver is in direct contact with the diaphragm
- superior surface to the right of the IVC, in direct contact wl the diaphragm
- portion of the porta Nepalis is bare and a portion is wrapped in glissons capsule
- gallbladder fossa
The gallbladder fossa forms what boundary?
Forms right boundary for caudate lobe
What is the “normal” liver length
13.5 - 15.5cm
However keep in mind that normal liver size is proportional to patient habitus; a 6ft 250lb patient can have a 16cm liver
Where is the superior - inferior measurement taken? (Length)
At the midclavicular plane
If the right lobe of the liver extends past the inferior pole of the right kidney, what should be considered?
Hepatomegaly
In pediatric patients, the normal liver should not extend more than ___ below the costal margin
1 cm
The right lobe of the liver is __x the size 1 of the left lobe?
6x
The right lobe of the liver lies between the __th and __th ribs
6th and 10th ribs
What separates the right and left lobe of the liver?
Main lobar fissure
The right hepatic vein courses through the right segmental fissure which divides into what segments?
Anterior and posterior segments
The lateral left lobe occupies what region?
Epigastric
The left hepatic courses through the left segmental fissure which divides the lobe into what segments?
Medial and lateral segments
The lateral left lobe is located between what?
Ligamentum teres and the spleen
The medial left lobe is formerly called what?
Quadrate lobe
What segments make up the medial left lobe?
Superior and inferior segments
Where is the medial left lobe located?
- Anterior to the transverse colon and porta hepatis
- medial to the GB fossa
- bordered medially by the middle hepatic vein and laterally by the falciform ligament and ligamentum teres
Where is the caudate lobe?
- Located between IVC and the medial left lobe
When can the caudate lobe be enlarged?
- Can be enlarged with cirrhosis and Budd-Chiari syndrome which can cause IVC compression
What are the hepatic ligaments?
- Triangular ligament
- Coronary ligament
(Connects to falciform ligament anteriorly ) - Falciform ligament
Attaches anterior surface to abdominal wall from diaphragm to umbilicus - Ligamentum teres
(Inferior portion of falciform ligament )
-Remnant of umbilical vein - Ligamentum Venosum
Remnant of ductus venosus - Hepatoduodenal ligament
Peritoneal folds at the porta hepatis that surrounds the portal vein, bile duct, and hepatic artery
Where can the common hepatic artery originate from instead of celiac axis?
SMA (2.5% of patients)
What % of blood does the hepatic artery supply the liver?
20% hepatic artery
80% from the main portal vein
When does the common hepatic artery become the proper hepatic artery?
After the organ of the gastroduodenal artery
What does the GDA supply?
Pancreas and stomach
What’s the normal pressure in the portal vein?
5-10 mmHg
When portal pressure exceeds the pressure in the IVC by more than ___ mmHg , portal hypertension is diagnosed
10mmHg
What is the normal diameter of the main portal vein
<13 mm
-Deep inspiration should cause up to 50% increase in the portal vein diameter in normal patients
What is the velocity of the MPV?
15 - 20 cm/s
Increased flow seen after eating
What is the confluence?
IMV> Splenic> SMV
Hepatic veins course how?
Intersegmental and interlober
How does the hepatic veins show on Doppler?
Considered triphasic / pulsatile
Relative echogenicities in abdomen from hyperechoic to hypoechoic
Renal sinus> pancreas> spleen > liver> renal parenchyma
RSPSLRP
In early embryonic life, the liver is responsible for what?
Hemopoiesis (development of rbc’s )
Vital functions of the liver (10)
- Carbs metabolism
- fat (lipid) metabolism
- amino acid metabolism
- removal of waste products
- vitamin and mineral storage
- drug inactivation
- synthesis and secretion of bile
- blood resivoir
- lymph production
- detoxification
What is the smallest hepatic lobe?
The caudate lobe (has its own blood supply )
Recanalization of the paraumbilical vein can be caused by what?
Portal hypertension
Where is the Ligamentum venosum?
Which appears as a hyperechoic linear structure anterior to the caudate lobe, between the caudate and the left hepatic lobe
What is Reidel lobe?
Who does it affect most?
A tongue like extension of the right hepatic lobe
- more often seen in women
What is unconjugated bilirubin?
Non water solvable form that travels to the liver via the bloodstream
What is conjugated bilirubin?
Water solvable form that is excreted into the intestines
Excess may be found in urine
What is:
1. Prehepatic jaundice
2. Hepatic jaundice
3. Post hepatic jaundice
- Prehepatic jaundice=
Liver cannot process that amount of hemolysis of the RBC, resulting in buildup of unconjugated bilirubin - Hepatic jaundice =
Results from the livers inability to conjugate bilirubin and thus may be caused by viral hepatitis, toxins,
Drugs, cirrhosis, and liver cancer - Posthepatic jaundice=
Increase in conjugated bilirubin and caused by an obstruction of bile typically by gallstone or panc mass
What is the aka for fatty liver disease?
Hepatic steatosis
What are some causes of nonalcoholic fatty liver disease?
- Starvation
- obesity
- chemotherapy
- diabetes
-Hyperlipidemia - pregnancy
- glycogen storage disease
- Von gierke Disease (glycogen storage disease type I)
- severe hepatitis
- cystic fibrosis
-Intestinal bypass surgery for obesity - use of some drugs such as corticosteroids
What is the most common liver disorder in the western world and subsequently the most common cause of chronic liver disease, hepatic failure, and liver cancer
Fatty liver disease/ hepatic statuses
Fatty liver clinical symptoms
’ Often asymptomatic ‘
Patients may have elevated liver function tests.
The cystic artery originates at the _____ and the cystic vein empties into the _____
Right hepatic artery ; right portal vein
A small rounded prominence on the anteroinferior aspect of the normal caudate lobe is called…?
Distal papillary process
- it can also be separate from the caudate lobe and be confused w/ a lymph node
The bare area of the liver is in direct contact W….?
The diaphragm
The livers exocrine function includes producing…?
Bile
Which liver segment is located immediately lateral to the Ligamentum teres?
Lateral left lobe
All of the following are intrasegmental vessels of the liver except?
Portal veins
Hepatic arteries
Bile ducts
Hepatic veins
Hepatic veins (intersegmental)
The caudate lobe occupies much of the _____ surface of the liver?
Posterior, superior
The hepatoduodenal ligament contains what structures?
MPV, proper hepatic artery, and common bile duct
What is the normal Doppler findings from hepatic veins
Triphasic
In the normal liver, what happens to the hepatic artery post-prandially? (After eating)
An increased RI due to increased portal venous inflow to the liver with digestion
Increased ri= increased PSV and decreased EDV
What can be used to differentiate reidels lobe from hepatomegaly?
The left lobe is normal with reidels but enlarged with hepatomegaly
The abdominal organ that produces the majority of alkaline phosphate is?
Liver
The liver and bones produce the majority of alp.it is also produced by the placenta during pregnancy
What is the best way to view the dome of the liver?
- Subcostal approach
- deep inspiration
- ## the confluence of the hepatic veins can be used to locate the dome
What veins drain the caudate lobe?
Emissary veins
The intrahepatic duct measures less than or equal to
4mm
What is the flow of portal vein?
Continuous
What structure prevents free fluid in Morison pouch from moving into the subphrenic space
Right coronary ligament
(The coronary ligaments form the anterior and posterior margins of the bare area of the liver.)
What does tips stand for?
Transjugular intrahepatic portosystemic shunt
What is the most common reason for portal vein obstruction?
Most commonly caused by tumors from adjacent organs or lymphadenopathy
What is the prognosis for ischemic bowel disease ?
Ischemic bowel disease ( gas within the portal veins or mesenteric veins) is typically fatal
What is budd-chiari syndrome?
The occlusion of hepatic veins with possible coexisting occlusion of the IVC
What is budd-chiari syndrome associated with?
-Congenital webbing disorder (inferior vena cava web)
- coagulation abnormalities
- tumor invasion from HCC
- thrombosis
- oral contraceptive use**
- pregnancy
-Trauma
What are the clinical symptoms of budd-chiari?
- Oral contraception (females)
- ascites
- RUQ pain
- hepatomegaly
- splenomegaly
- elevated liver tests
What is hepatorenal syndrome?
Development of renal impairment and possible renal failure due to chronic liver disease and liver failure
What # of patients admitted to the hospital with complications of cirrhosis may be suffering from acute kidney injury because of coexisting hepatorenal syndrome?
About half
When are hepatic cysts usually found?
Until middle age
What is Von Hippel-Lindau disease?
An inherited disease that includes the development of cysts within the liver, pancreas, and other organs
What is hydrated liver cysts AKA?
Echinococcal cyst
How do you get a hydrated liver cyst/ echinococcal cyst?
From a tapeworm that lives in dog feces. Food, such as vegetables, contaminated by the faces is consumed indirectly by sheep, cattle, goat, and possibly humans.
Therefor I there is a higher prevalence of hydatif disease in sheep - and-cattle-raising countries such as the Middle East, Australia, and the Mediterranean
How does the echinococcal parasite move to the liver and what are the clinical symptoms?
The parasite moves from the bowel to the portal vein to enter the liver
- low grade fever
- RUQ tenderness
- nausea
-Obstructive jaundice - leukocytosis
- slightly raised alkaline phosphate
What sonographic sign is associated with hydatid liver cyst/ echinococcal cyst.
The water lily sign. - occurs when the daughter cyst is seen floating w/in the mother cyst.
What abscess comes from contaminated water?
Amebic hepatic abscess
