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Abdomen > Liver > Flashcards

Liver Flashcards

1
Q

What capsule is the liver in?

A

Glissons capsule

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2
Q

What is the bare area?

A
  • 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
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3
Q

The gallbladder fossa forms what boundary?

A

Forms right boundary for caudate lobe

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4
Q

What is the “normal” liver length

A

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

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5
Q

Where is the superior - inferior measurement taken? (Length)

A

At the midclavicular plane

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6
Q

If the right lobe of the liver extends past the inferior pole of the right kidney, what should be considered?

A

Hepatomegaly

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7
Q

In pediatric patients, the normal liver should not extend more than ___ below the costal margin

A

1 cm

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8
Q

The right lobe of the liver is __x the size 1 of the left lobe?

A

6x

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9
Q

The right lobe of the liver lies between the __th and __th ribs

A

6th and 10th ribs

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10
Q

What separates the right and left lobe of the liver?

A

Main lobar fissure

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11
Q

The right hepatic vein courses through the right segmental fissure which divides into what segments?

A

Anterior and posterior segments

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12
Q

The lateral left lobe occupies what region?

A

Epigastric

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13
Q

The left hepatic courses through the left segmental fissure which divides the lobe into what segments?

A

Medial and lateral segments

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14
Q

The lateral left lobe is located between what?

A

Ligamentum teres and the spleen

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15
Q

The medial left lobe is formerly called what?

A

Quadrate lobe

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16
Q

What segments make up the medial left lobe?

A

Superior and inferior segments

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17
Q

Where is the medial left lobe located?

A
  • 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
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18
Q

Where is the caudate lobe?

A
  • Located between IVC and the medial left lobe
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19
Q

When can the caudate lobe be enlarged?

A
  • Can be enlarged with cirrhosis and Budd-Chiari syndrome which can cause IVC compression
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20
Q

What are the hepatic ligaments?

A
  1. Triangular ligament
  2. Coronary ligament
    (Connects to falciform ligament anteriorly )
  3. Falciform ligament
    Attaches anterior surface to abdominal wall from diaphragm to umbilicus
  4. Ligamentum teres
    (Inferior portion of falciform ligament )
    -Remnant of umbilical vein
  5. Ligamentum Venosum
    Remnant of ductus venosus
  6. Hepatoduodenal ligament
    Peritoneal folds at the porta hepatis that surrounds the portal vein, bile duct, and hepatic artery
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21
Q

Where can the common hepatic artery originate from instead of celiac axis?

A

SMA (2.5% of patients)

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22
Q

What % of blood does the hepatic artery supply the liver?

A

20% hepatic artery
80% from the main portal vein

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23
Q

When does the common hepatic artery become the proper hepatic artery?

A

After the organ of the gastroduodenal artery

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24
Q

What does the GDA supply?

A

Pancreas and stomach

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25
Q

What’s the normal pressure in the portal vein?

A

5-10 mmHg

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26
Q

When portal pressure exceeds the pressure in the IVC by more than ___ mmHg , portal hypertension is diagnosed

A

10mmHg

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27
Q

What is the normal diameter of the main portal vein

A

<13 mm
-Deep inspiration should cause up to 50% increase in the portal vein diameter in normal patients

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28
Q

What is the velocity of the MPV?

A

15 - 20 cm/s
Increased flow seen after eating

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29
Q

What is the confluence?

A

IMV> Splenic> SMV

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30
Q

Hepatic veins course how?

A

Intersegmental and interlober

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31
Q

How does the hepatic veins show on Doppler?

A

Considered triphasic / pulsatile

32
Q

Relative echogenicities in abdomen from hyperechoic to hypoechoic

A

Renal sinus> pancreas> spleen > liver> renal parenchyma

RSPSLRP

33
Q

In early embryonic life, the liver is responsible for what?

A

Hemopoiesis (development of rbc’s )

34
Q

Vital functions of the liver (10)

A
  • 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
35
Q

What is the smallest hepatic lobe?

A

The caudate lobe (has its own blood supply )

36
Q

Recanalization of the paraumbilical vein can be caused by what?

A

Portal hypertension

37
Q

Where is the Ligamentum venosum?

A

Which appears as a hyperechoic linear structure anterior to the caudate lobe, between the caudate and the left hepatic lobe

38
Q

What is Reidel lobe?
Who does it affect most?

A

A tongue like extension of the right hepatic lobe

  • more often seen in women
39
Q

What is unconjugated bilirubin?

A

Non water solvable form that travels to the liver via the bloodstream

40
Q

What is conjugated bilirubin?

A

Water solvable form that is excreted into the intestines
Excess may be found in urine

41
Q

What is:
1. Prehepatic jaundice
2. Hepatic jaundice
3. Post hepatic jaundice

A
  1. Prehepatic jaundice=
    Liver cannot process that amount of hemolysis of the RBC, resulting in buildup of unconjugated bilirubin
  2. Hepatic jaundice =
    Results from the livers inability to conjugate bilirubin and thus may be caused by viral hepatitis, toxins,
    Drugs, cirrhosis, and liver cancer
  3. Posthepatic jaundice=
    Increase in conjugated bilirubin and caused by an obstruction of bile typically by gallstone or panc mass
42
Q

What is the aka for fatty liver disease?

A

Hepatic steatosis

43
Q

What are some causes of nonalcoholic fatty liver disease?

A
  • 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
44
Q

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

A

Fatty liver disease/ hepatic statuses

45
Q

Fatty liver clinical symptoms

A

’ Often asymptomatic ‘
Patients may have elevated liver function tests.

46
Q

The cystic artery originates at the _____ and the cystic vein empties into the _____

A

Right hepatic artery ; right portal vein

47
Q

A small rounded prominence on the anteroinferior aspect of the normal caudate lobe is called…?

A

Distal papillary process
- it can also be separate from the caudate lobe and be confused w/ a lymph node

48
Q

The bare area of the liver is in direct contact W….?

A

The diaphragm

49
Q

The livers exocrine function includes producing…?

A

Bile

50
Q

Which liver segment is located immediately lateral to the Ligamentum teres?

A

Lateral left lobe

51
Q

All of the following are intrasegmental vessels of the liver except?

Portal veins
Hepatic arteries
Bile ducts
Hepatic veins

A

Hepatic veins (intersegmental)

52
Q

The caudate lobe occupies much of the _____ surface of the liver?

A

Posterior, superior

53
Q

The hepatoduodenal ligament contains what structures?

A

MPV, proper hepatic artery, and common bile duct

54
Q

What is the normal Doppler findings from hepatic veins

A

Triphasic

55
Q

In the normal liver, what happens to the hepatic artery post-prandially? (After eating)

A

An increased RI due to increased portal venous inflow to the liver with digestion

Increased ri= increased PSV and decreased EDV

56
Q

What can be used to differentiate reidels lobe from hepatomegaly?

A

The left lobe is normal with reidels but enlarged with hepatomegaly

57
Q

The abdominal organ that produces the majority of alkaline phosphate is?

A

Liver

The liver and bones produce the majority of alp.it is also produced by the placenta during pregnancy

58
Q

What is the best way to view the dome of the liver?

A
  • Subcostal approach
  • deep inspiration
  • ## the confluence of the hepatic veins can be used to locate the dome
59
Q

What veins drain the caudate lobe?

A

Emissary veins

60
Q

The intrahepatic duct measures less than or equal to

A

4mm

61
Q

What is the flow of portal vein?

A

Continuous

62
Q

What structure prevents free fluid in Morison pouch from moving into the subphrenic space

A

Right coronary ligament
(The coronary ligaments form the anterior and posterior margins of the bare area of the liver.)

63
Q

What does tips stand for?

A

Transjugular intrahepatic portosystemic shunt

64
Q

What is the most common reason for portal vein obstruction?

A

Most commonly caused by tumors from adjacent organs or lymphadenopathy

65
Q

What is the prognosis for ischemic bowel disease ?

A

Ischemic bowel disease ( gas within the portal veins or mesenteric veins) is typically fatal

66
Q

What is budd-chiari syndrome?

A

The occlusion of hepatic veins with possible coexisting occlusion of the IVC

67
Q

What is budd-chiari syndrome associated with?

A

-Congenital webbing disorder (inferior vena cava web)
- coagulation abnormalities
- tumor invasion from HCC
- thrombosis
- oral contraceptive use**
- pregnancy
-Trauma

68
Q

What are the clinical symptoms of budd-chiari?

A
  • Oral contraception (females)
  • ascites
  • RUQ pain
  • hepatomegaly
  • splenomegaly
  • elevated liver tests
69
Q

What is hepatorenal syndrome?

A

Development of renal impairment and possible renal failure due to chronic liver disease and liver failure

70
Q

What # of patients admitted to the hospital with complications of cirrhosis may be suffering from acute kidney injury because of coexisting hepatorenal syndrome?

A

About half

71
Q

When are hepatic cysts usually found?

A

Until middle age

72
Q

What is Von Hippel-Lindau disease?

A

An inherited disease that includes the development of cysts within the liver, pancreas, and other organs

73
Q

What is hydrated liver cysts AKA?

A

Echinococcal cyst

74
Q

How do you get a hydrated liver cyst/ echinococcal cyst?

A

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

75
Q

How does the echinococcal parasite move to the liver and what are the clinical symptoms?

A

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
76
Q

What sonographic sign is associated with hydatid liver cyst/ echinococcal cyst.

A

The water lily sign. - occurs when the daughter cyst is seen floating w/in the mother cyst.

77
Q

What abscess comes from contaminated water?

A

Amebic hepatic abscess

Abdomen (5 decks)

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