Liver Flashcards
1
Q
liver is intra or retroperitoneal
A
intra
2
Q
liver is the ____ organ in the body
A
largest
3
Q
the bulk of the liver is beneath the _____
A
right costal margin
4
Q
posterior inferior surface of liver is indented by the
A
right kidney
5
Q
IVC is _____ to liver
A
posterior
6
Q
right lobe of liver is ____ larger than left and extends more ____
A
2-3x
inferiorly
7
Q
liver length along midclavicular line
A
</= 15.5cm
8
Q
Liver AP measurement
A
8.1cm
9
Q
caudate/RT lobe ratio
A
<0.65
10
Q
what is the caudate/Rt lobe measurement used for
A
liver cirrhosis
11
Q
liver is enlarged if right lobe extends below the
A
lower pole of right kindey
exception: Rediel’s lobe
12
Q
Reidel’s lobe
A
a tongue like extension of the inferior tip of the right lobe of the liver, frequently found in slim females
13
Q
two methods of dividing the liver
A
anatomical
functional
14
Q
in anatomical divisions of the liver, the ____ and a ______ are the borders
A
falciform ligament
H configuration
15
Q
4 lobes of the anatomical divisions of the liver
A
right left caudate and quadrate
16
Q
falciform ligament divides the ___ and ___ lobes ____ (anatomical divisions of the liver)
A
right
left
anteriorly
17
Q
H configuration made up of
A
lig venosum, IVC
falciform lig, gallbladder
18
Q
lobes of functional method of liver divisions
A
right left caduate
19
Q
right and left portal veins course ____ the segments (____)
R/L/middle hepatic veins course ____ the lobes and segments (_____ or _____)
A
within
intrasegmental
between
intersegmental
interlobar
20
Q
main lobar fissure contains
A
MHV
21
Q
RIF contains
A
RHV, RPV
22
Q
LIF contains
A
LHV, ascending LPV
23
Q
medial left lobe is what in the anatomical method
A
quadrate
24
Q
caudate lobe is located on the ____ aspect of the liver
A
posterior
25
posterior landmark of caudate
anterior?
inferior?
IVC
lig venosum
MPV
26
caudate processes
extension of CL between the IVC and left portal vein
27
papillary process
a caudual projection of the caudate lobe
lies along lig venosum and above porta hepatis
28
couinauds has how many segments
8
29
each Couinaud's segment has what
a branch of portal vein at its center bounded by a hepatic vein
30
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
31
in L lobe, the ____ and ___ are superior landmarks
LHV
LPV
32
in the left lobe, the LHV and LPV are _____ landmarks
superior
33
in left lobe, ____ is an inferior landmark
lig teres
34
in left lobe, lig teres is an _____ landmark
inferior
35
in r lobe, the ____ and ____ are inferior landmarks
RPV
right kidney
36
RPV is more _____ than LPV
inferior
37
HV are always _____ landmarks
superior
38
MLF divides what
functional R/L
39
MLF uses what as landmarks
GB and IVC
40
a short portion of the MLF is seen between the ___ and ____
RPV
GB neck
41
what courses through the MLF
MHV
42
RIF divides/contains
r lobe into ant and post
RHV
RPV
43
LIF divides/contains
l lobe into medial and lateral
LHV
LPV
lig teres
44
Fissure for the ligamentum venosum (divides/contains)
divides left lateral segment of liver from the caudate
contains lig venosum and hepatogastric lig
45
lig venosum is a remnant of what
ductus venosum
46
Fossae is a
depression or indentation
47
GB fossa contains/location
contains GB
posterior inferior surface of Rt liver
48
IVC fossa contains/location
contains portion of IVC
posterior liver, between caudate and bare area
49
porta hepatis
vessels and biliary ducts exit and enter liver here
50
at prota hepatis, CBD and HA are ____ to PV
anterior
51
what is the Glisson's capsule/where is it thickest
connective tissue surrounding the liver
thickest at IVC and porta hepatis
52
Hepatoduodenal ligament (what, boundary, contains)
fold of lesser omentum
ant boundary of epiploic foramen
contains: MPV, HA, CBD
53
what is the epiploic foramen
opening between greater and lesser sac
54
Hepatogastric lig + hepatoduodenal lig =
lesser omentum
55
hepadtoduodenal lig encloses
portal triad
56
hepatogastric lig goes from ______ to ____
lesser curvature
fissure for lig venosum
57
falciform lig extends from
umbilicus to liver
58
falciform lig conducts ______ in fetus
umbilical vein
59
lig teres AKA
round lig
60
lig teres is the ____ margin of the ___
inferior
left lobe
61
lig teres is the atrophied _____
umbilical vein
62
lig teres connects to _____ from the caudate lobe sag
LPV
63
lig venosum is remnant of
fetal ductus venosum
64
lig venosum is the ____ border of _____
ant
caudate lobe
65
coronary ligs define the __
bare area
66
coronary ligs connect _______ surface of liver to _____
post/sup
diaphragm
67
upper portion of coronary ligs continuous with ____
falciform lig
68
coronary ligs form
right and left triangular ligs
69
portal veins carries
partially oxygenated blood
70
portal vein travels ____segmentally
intra
71
why are portal vein walls echogenic
connective sheath
72
portal vein vessel caliber is _____ near the porta hepatis
greater
73
MPV is conjuction of
SV
SMV
IMV
74
MPV travels ____, ____ and ____
right
cephalic
oblique
75
MPV divides into r/l at the ____
porta hepatis
76
RPV travels ____ and ____
post
caudal
77
RPV can appear as what
as an elongation of the MPV
78
LPV moves ____ along the anterior surface of the _____ and then turns ____
cranially
caudate lobe
anterior
79
HV carry ______ blood ____ from the liver ______ IVC
deoxygenated
away
toward
80
HV travel ____segmentally
inter
81
HV caliber ____ as they approach the diaphragm
increases
82
liver is _____ or _____ to right renal cortex
slightly hyperechoic
isoechoic
83
patient prep for liver scan
overnight fast or NPO for at least 6 hours
84
scanning positions for liver
supine
LLD
85
scanning views (think apical but liver version)
subcostal and intercostal
86
breathing techniques for liver
breath in and hold
belly out
87
probe used for liver
2-6 MHz
88
LFT
liver function test
89
what is the functional unit of the liver and what is its size/shape
lobule
1-2mm diameter
hexagon
90
what six things are in a liver lobule
hepatocytes
central hepatic vein
sinusoids
Kupffer cells
bile canaliculi
portal triad
91
hepatocytes are organized in
2 layer columns
92
hepatocytes converge towards a _____ and are in contact with ____
central vein
sinusoid blood
93
what do hepatocytes do
liberate substances in the blood
94
what are sinusoids
highly permeable blood capillaries (free flow of blood to cells/transfer of products into blood)
95
blood enters the lobule's peripheray and moves to a central vein via ___
sinusoid
96
where are sinusoids located
between the hepatocyte columns
97
what blood is in hepatocytes
80% portal venous
20% hepatic arterial
98
where are kuppfer cells, what are they, function
scattered along sinusoids
reticuloendothelial (RE) cells
exhibit phagocytosis (destroy bacteria, old RBC/WBC)
99
small bile ducts between the 2 layers of the hepatocyte columns
bile canuliculi
100
what is the smallest division of the biliary tract
bile canuliculi
101
what is the function of bile canuliculi
collect bile produced by hepatocytes
102
does bile mix with sinusoid blood
no
103
what do bile canuliculi converge to form
the right and left hepatic ducts
104
portal triad contains
bile duct, portal vein, and hepatic artery
105
where are the portal triads located on a lobule
outer edge of lobule
106
how many portal triads per lobule
several
107
the blood in the central vein is cleansed of ____ and rich in _____
toxins
liver secretions
108
the central hepatic veins converge to form the ___
hepatic veins
109
where do the central hepatic veins drain to
IVC
110
blood from ___ and ____ enters liver
PV
HA
111
what three things are processed by the liver
nutrients, bacteria, and foreign bodies
112
cleansed blood leaves the liver through _____
hepatic veins
113
livers primary function
metabolism
114
liver preforms over ____ separate activities
500
115
most of the livers functions are carried out by what three cells
hepatocytes
Kuppfer cells
biliary cells
116
bile contains what three things
bile salts
cholesterol
bilirubin
117
bilirubin is what
a bile pigment that is a product of RBC breakdown
118
bile salts are form from ___
cholestrol
119
bile functions (2)
emulsifies fats and aids in absorption of fatty acids
120
how much bile is produced per day
700-1200 ml
121
where is bile stored
GB
122
unconjugated bilirubin
vs
conjugated bilirubin
fat soluble; toxic to tissues
vs
water soluble, non toxic, secreted by liver
123
what is the function of RE cells in an embryo
blood production (hemopoiesis)
124
RE cells three functions
produces plasma proteins and antibodies
removes foreign materials and worn out RBC (via Kuppfer cells)
recovers bile pigment
125
what is the function of albumin
prevents plasma loss from capillaries
126
the liver metabolizes what 3 things
carbs
fat
protein
127
what is the purpose of metabolizing carbohydrates
to maintain a normal blood glucose level
128
what does the liver store
vitamins
glycogen, fats and amino acids
ferritin
minerals
129
how much blood does the liver hold
200-400ml
130
does the liver produce heat? how?
yes from chemical reactions
131
the liver produces ___ of the body's lymph fluid
1/3
132
enzymes are what
proteins that catalyze chemical reactions
133
are enzymes destroyed after catalyzing reactions
no
134
ALT/SGPT
produced in hepatocytes
specific to hepatocellular damage
135
AST/SGOT
in tissue using a lot of energy (liver/muscle)
released with injury to cells
136
why is the ratio of AST:ALT important
if both = liver
if only AST= could be something else like heart
137
ALP/ALK PHOS
liver, bone, placenta, intestines
increased in biliary obstructions
138
LDH
found in multiple organs
not specific
increased liver damage
139
what enzyme is usually used to detect myocardial or pulmonary infarcts but also detects increased liver damage
LDH
140
GGT
non specific indicator
sensitive indicator to alcoholism (ginger gin tonic)
141
AFP
protein
produced in fetal tissue
increased in hepatocellular carcinoma (HCC) and testicular carcinoma
142
bilirubin is a breakdown product of what
hemoglobin
143
conjugated bilirubin increased =
extrahepatic biliary obstruction
144
unconjugated bilirubin increased =
liver disease, hemolytic disease
145
Prothrombin time (PT)
ability of blood to clot
146
INR stands for
international normalized ratio
147
how is INR determined and what is a normal value
dividing PT by controlled standard
value of 1 is normal
148
if INR is over _____ do not do ____. Why?
1.2
liver biopsy
clotting factors aren't good = patient could bleed out
149
PTT
measure clotting time of blood
150
albumin maintains _____ and ____ in liver dysfunction
osmotic pressure
decreases
