Liver Flashcards
liver is intra or retroperitoneal
intra
liver is the ____ organ in the body
largest
the bulk of the liver is beneath the _____
right costal margin
posterior inferior surface of liver is indented by the
right kidney
IVC is _____ to liver
posterior
right lobe of liver is ____ larger than left and extends more ____
2-3x
inferiorly
liver length along midclavicular line
</= 15.5cm
Liver AP measurement
8.1cm
caudate/RT lobe ratio
<0.65
what is the caudate/Rt lobe measurement used for
liver cirrhosis
liver is enlarged if right lobe extends below the
lower pole of right kindey
exception: Rediel’s lobe
Reidel’s lobe
a tongue like extension of the inferior tip of the right lobe of the liver, frequently found in slim females
two methods of dividing the liver
anatomical
functional
in anatomical divisions of the liver, the ____ and a ______ are the borders
falciform ligament
H configuration
4 lobes of the anatomical divisions of the liver
right left caudate and quadrate
falciform ligament divides the ___ and ___ lobes ____ (anatomical divisions of the liver)
right
left
anteriorly
H configuration made up of
lig venosum, IVC
falciform lig, gallbladder
lobes of functional method of liver divisions
right left caduate
right and left portal veins course ____ the segments (____)
R/L/middle hepatic veins course ____ the lobes and segments (_____ or _____)
within
intrasegmental
between
intersegmental
interlobar
main lobar fissure contains
MHV
RIF contains
RHV, RPV
LIF contains
LHV, ascending LPV
medial left lobe is what in the anatomical method
quadrate
caudate lobe is located on the ____ aspect of the liver
posterior
posterior landmark of caudate
anterior?
inferior?
IVC
lig venosum
MPV
caudate processes
extension of CL between the IVC and left portal vein
papillary process
a caudual projection of the caudate lobe
lies along lig venosum and above porta hepatis
couinauds has how many segments
8
each Couinaud’s segment has what
a branch of portal vein at its center bounded by a hepatic vein
couinaud’s divisions
1: caudate
2: left lateral segment sup
3: left lateral segment ing
4: left medial lobe
5: right ant segment inf
6: right post segment inf
7: right post segment sup
8: right ant segment sup
in L lobe, the ____ and ___ are superior landmarks
LHV
LPV
in the left lobe, the LHV and LPV are _____ landmarks
superior
in left lobe, ____ is an inferior landmark
lig teres
in left lobe, lig teres is an _____ landmark
inferior
in r lobe, the ____ and ____ are inferior landmarks
RPV
right kidney
RPV is more _____ than LPV
inferior
HV are always _____ landmarks
superior
MLF divides what
functional R/L
MLF uses what as landmarks
GB and IVC
a short portion of the MLF is seen between the ___ and ____
RPV
GB neck
what courses through the MLF
MHV
RIF divides/contains
r lobe into ant and post
RHV
RPV
LIF divides/contains
l lobe into medial and lateral
LHV
LPV
lig teres
Fissure for the ligamentum venosum (divides/contains)
divides left lateral segment of liver from the caudate
contains lig venosum and hepatogastric lig
lig venosum is a remnant of what
ductus venosum
Fossae is a
depression or indentation
GB fossa contains/location
contains GB
posterior inferior surface of Rt liver
IVC fossa contains/location
contains portion of IVC
posterior liver, between caudate and bare area
porta hepatis
vessels and biliary ducts exit and enter liver here
at prota hepatis, CBD and HA are ____ to PV
anterior
what is the Glisson’s capsule/where is it thickest
connective tissue surrounding the liver
thickest at IVC and porta hepatis
Hepatoduodenal ligament (what, boundary, contains)
fold of lesser omentum
ant boundary of epiploic foramen
contains: MPV, HA, CBD
what is the epiploic foramen
opening between greater and lesser sac
Hepatogastric lig + hepatoduodenal lig =
lesser omentum
hepadtoduodenal lig encloses
portal triad
hepatogastric lig goes from ______ to ____
lesser curvature
fissure for lig venosum
falciform lig extends from
umbilicus to liver
falciform lig conducts ______ in fetus
umbilical vein
lig teres AKA
round lig
lig teres is the ____ margin of the ___
inferior
left lobe
lig teres is the atrophied _____
umbilical vein
lig teres connects to _____ from the caudate lobe sag
LPV
lig venosum is remnant of
fetal ductus venosum
lig venosum is the ____ border of _____
ant
caudate lobe
coronary ligs define the __
bare area
coronary ligs connect _______ surface of liver to _____
post/sup
diaphragm
upper portion of coronary ligs continuous with ____
falciform lig
coronary ligs form
right and left triangular ligs
portal veins carries
partially oxygenated blood
portal vein travels ____segmentally
intra
why are portal vein walls echogenic
connective sheath
portal vein vessel caliber is _____ near the porta hepatis
greater
MPV is conjuction of
SV
SMV
IMV
MPV travels ____, ____ and ____
right
cephalic
oblique
MPV divides into r/l at the ____
porta hepatis
RPV travels ____ and ____
post
caudal
RPV can appear as what
as an elongation of the MPV
LPV moves ____ along the anterior surface of the _____ and then turns ____
cranially
caudate lobe
anterior
HV carry ______ blood ____ from the liver ______ IVC
deoxygenated
away
toward
HV travel ____segmentally
inter
HV caliber ____ as they approach the diaphragm
increases
liver is _____ or _____ to right renal cortex
slightly hyperechoic
isoechoic
patient prep for liver scan
overnight fast or NPO for at least 6 hours
scanning positions for liver
supine
LLD
scanning views (think apical but liver version)
subcostal and intercostal
breathing techniques for liver
breath in and hold
belly out
probe used for liver
2-6 MHz
LFT
liver function test
what is the functional unit of the liver and what is its size/shape
lobule
1-2mm diameter
hexagon
what six things are in a liver lobule
hepatocytes
central hepatic vein
sinusoids
Kupffer cells
bile canaliculi
portal triad
hepatocytes are organized in
2 layer columns
hepatocytes converge towards a _____ and are in contact with ____
central vein
sinusoid blood
what do hepatocytes do
liberate substances in the blood
what are sinusoids
highly permeable blood capillaries (free flow of blood to cells/transfer of products into blood)
blood enters the lobule’s peripheray and moves to a central vein via ___
sinusoid
where are sinusoids located
between the hepatocyte columns
what blood is in hepatocytes
80% portal venous
20% hepatic arterial
where are kuppfer cells, what are they, function
scattered along sinusoids
reticuloendothelial (RE) cells
exhibit phagocytosis (destroy bacteria, old RBC/WBC)
small bile ducts between the 2 layers of the hepatocyte columns
bile canuliculi
what is the smallest division of the biliary tract
bile canuliculi
what is the function of bile canuliculi
collect bile produced by hepatocytes
does bile mix with sinusoid blood
no
what do bile canuliculi converge to form
the right and left hepatic ducts
portal triad contains
bile duct, portal vein, and hepatic artery
where are the portal triads located on a lobule
outer edge of lobule
how many portal triads per lobule
several
the blood in the central vein is cleansed of ____ and rich in _____
toxins
liver secretions
the central hepatic veins converge to form the ___
hepatic veins
where do the central hepatic veins drain to
IVC
blood from ___ and ____ enters liver
PV
HA
what three things are processed by the liver
nutrients, bacteria, and foreign bodies
cleansed blood leaves the liver through _____
hepatic veins
livers primary function
metabolism
liver preforms over ____ separate activities
500
most of the livers functions are carried out by what three cells
hepatocytes
Kuppfer cells
biliary cells
bile contains what three things
bile salts
cholesterol
bilirubin
bilirubin is what
a bile pigment that is a product of RBC breakdown
bile salts are form from ___
cholestrol
bile functions (2)
emulsifies fats and aids in absorption of fatty acids
how much bile is produced per day
700-1200 ml
where is bile stored
GB
unconjugated bilirubin
vs
conjugated bilirubin
fat soluble; toxic to tissues
vs
water soluble, non toxic, secreted by liver
what is the function of RE cells in an embryo
blood production (hemopoiesis)
RE cells three functions
produces plasma proteins and antibodies
removes foreign materials and worn out RBC (via Kuppfer cells)
recovers bile pigment
what is the function of albumin
prevents plasma loss from capillaries
the liver metabolizes what 3 things
carbs
fat
protein
what is the purpose of metabolizing carbohydrates
to maintain a normal blood glucose level
what does the liver store
vitamins
glycogen, fats and amino acids
ferritin
minerals
how much blood does the liver hold
200-400ml
does the liver produce heat? how?
yes from chemical reactions
the liver produces ___ of the body’s lymph fluid
1/3
enzymes are what
proteins that catalyze chemical reactions
are enzymes destroyed after catalyzing reactions
no
ALT/SGPT
produced in hepatocytes
specific to hepatocellular damage
AST/SGOT
in tissue using a lot of energy (liver/muscle)
released with injury to cells
why is the ratio of AST:ALT important
if both = liver
if only AST= could be something else like heart
ALP/ALK PHOS
liver, bone, placenta, intestines
increased in biliary obstructions
LDH
found in multiple organs
not specific
increased liver damage
what enzyme is usually used to detect myocardial or pulmonary infarcts but also detects increased liver damage
LDH
GGT
non specific indicator
sensitive indicator to alcoholism (ginger gin tonic)
AFP
protein
produced in fetal tissue
increased in hepatocellular carcinoma (HCC) and testicular carcinoma
bilirubin is a breakdown product of what
hemoglobin
conjugated bilirubin increased =
extrahepatic biliary obstruction
unconjugated bilirubin increased =
liver disease, hemolytic disease
Prothrombin time (PT)
ability of blood to clot
INR stands for
international normalized ratio
how is INR determined and what is a normal value
dividing PT by controlled standard
value of 1 is normal
if INR is over _____ do not do ____. Why?
1.2
liver biopsy
clotting factors aren’t good = patient could bleed out
PTT
measure clotting time of blood
albumin maintains _____ and ____ in liver dysfunction
osmotic pressure
decreases
