Liver Flashcards
the liver is suspended from the diaphragm and anterior abdominal wall by the _____ ligament and from the diaphragm by the reflections of the peritoneum
falciform
most of the liver is covered by peritoneum but a large area rests directly on the diaphragm, this is called the _____
bare area
the _____ space between the liver (or spleen) and diaphragm is a common site for abscess formation
subphrenic; the right subperenic space is between the right lobe, the right kidney and the right colic flexure
the _____ is an enclosed portion of the peritoneal space posterior to the liver and stomach
lesser sac; communicates near the head of the pancreas
the right _____ space is located inferior to the right lobe of the liver and includes morison’s pouch
subhepatic
the caudate lobe is situated one the ____ surface of the left lobe
posteriosuperior
the right, middle, and left hepatic veins divide the liver _____ into four sections
longitudinally; each of these sections is divided transversely by an invisible plane through right and left portal veins (8 sections all together)
the liver is covered by a thin connective tissue layer called _____
glisson’s capsule
the _____ is the boundary between the right and left lobes of the liver; in long it may be seen as a line from the portal vein to the neck of the gallbladder
main lobar fissure
the _____ extends from the umbilicus to the diaphragm in the parasagittal plane and contains the ligamentum teres
falciform ligament
the _____ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament; they both divide the medial and lateral segments of the left lobe of the liver
ligamentum teres
the fissure for the _____ separates the left lobe from the caudate lobe
ligamentum venosum
______ is a pigment released when the red blood cells are broken down
bilirubin
disease affecting the liver may be classified as _____, when the liver cells or hepatocytes are immediate problem; _____ when bile excretion is blocked
hepatocellular; obstructive
the liver functions as a major site for conversion of dietary sugars into _____, which is released into the bloodstream for general use
glucose; with liver disease the body may become glucose deficient (hypoglycemia)
in severe liver disease, abnormally low blood levels of ______ may be noted because the liver is the principal site for cholesterol synthesis
cholesterol
when the liver is chronically diseased, clinical laboratory results may reveal a significant lowering of the serum albumin (produced by the liver), a condition called _____
hypoalbuminemia
what laboratory test detect clotting deficiencies related to liver disease?
prothrombin time (pro-time) and partial thromboplastin time (PTT); percentage of time required for certain coagulation steps to occur in the patient’s blood compared to normal blood
the presences of increased quantities of enzymes in the blood is a sensitive indicator of a hepatocellular disorder., _____, _____ and _____ are of particular interest
aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; they are also included in biliary obstruction
in severe hepatocellular destruction, such as acute viral or toxic hepatitis, a striking elevation of ___ and ___ may be seen (exceeding 1000) but not elevated in biliary obstruction
AST and ALT
Marked elevation of _____ is typically associated with biliary obstruction or the presence of mass lesions in the liver
alkaline phosphatase
_____ is somewhat more specific for liver disease than AST
ALT; therefore elevation of ALT about AST suggest a hepatic cause
the level of urea in the blood is measured as the _____, and in severe liver disease this may be abnormally low because of falloff of urea production
blood urea nitrogen (BUN); failure of ammonium detoxification is a serious consequence of liver failure
measurement of the concentration of bilirubin in the blood is a standard laboratory test for hepatocellular disease, what are the two fractions of bilirubin that is measured?
direct-acting, consists of conjugated bilirubin, and indirect-acting, which consists of unconjugated bilirubin released from the reticuloendothelial system
biliary obstruction result in elevation of the _____; as wall as hepatocellular disease
direct-acting bilirubin; results in jaundice
indirect bilirubin predominates in _____
hemolysis
vitamin _____ is an essential precursor for the hepatic production of several clotting factors
K
any disease that injures the cells causes an elevation in _____ levels; this enzyme is also produced in other high metabolic tissues
AST; seen in acute hepatitis, cirrhosis, hepatic necrosis and infectious mononucleosis
hepatocellular disease and infectious or toxic hepatitis produces moderate to highly increased levels of _____
ALT
_____ primary use is in detection of myocardial or pulmonary infarction
lactic acid dehydrogenase
a _____ prothrombin time indicates a poor prognosis, chronic liver disease commonly show an elevation of gamma globulins
prolonged
the average adult abdomen usually requires at least a broadband _____ frequency, whereas the more obese adult may require a lower frequency _____ transducer
2.5 MHz to 5 MHz; 2.25MHz
children may need 5 to 7 MHz
neonates may need 7.5 to 12 MHz
the right lobe of the liver is divided into anterior and posterior segments by the _____
right intersegmental fissure
the _____ divides the left lobe into medial and lateral segments
left intersegmental fissure
the hepatic veins course between the lobes and segments this is called _____
interlobar and intersegmental
the major branches of the portal veins run centrally within the segments this is called _____
intrasegmental
generally the liver measures less than _____ in long view
15 cm with 15 to 20 cm representing the upper limits of normal; hepatomegaly is when liver exceeds 20 cm
in a congenital diaphragmatic _____ or omphalocele, where varying amounts of liver tissue may herniate into the thorax or outside the abdominal cavity
hernia
variations in the branching of the hepatic veins are common, with the most common being when the accessory vein drains the _____ segment of the right lobe
superoanterior
_____ is an acquired, reversible disorder of metabolism, resulting in an accumulation of triglycerides within the hepatocytes
fatty liver
_____ implies increased lipid accumulation in the hepatocytes and results from major injury to the liver or a systemic disorder leading to impaired or excessive metabolism of fat
fatty infiltration
what are the three grades of liver texture for classification of fatty infiltration?
mild-minimal diffuse increase in hepatic echgenicity
moderate- increased echogenicity, impaired visualization of the diaphragm and intrahepatic vascular borders
severe- marked increase in echogenicity, decrease penetration, poor visualization of the diaphragm and hepatic vessels
the most common areas for focal sparing are anterior to the _____ or the portal vein and the periportal region of the medial segment of the left lobe of the liver
gallbladder
_____ is the general name for inflammatory and infectious disease of the liver
hepatitis; may result from a local infection (viral hepatitis); or from an infection elsewhere in the body (mononucleosis or amebiasis); or from chemical or drug toxicity
patients with _____ and _____ hepatitis may initially present with flulike and gastrointestinal symptoms, including loss of appetite, nausea, vomiting, and fatigue
acute and chronic
_____ hepatitis may be fatal with secondary acute hepatic necrosis or chronic hepatitis, which may lead to portal hypertension, cirrhosis, and hepatocellular carcinoma
viral
hepatitis _____ spreads primarily by fecal contamination, because the virus lives in the alimentary tract
A
hepatitis _____ can spread by transfusions of infected blood or plasma or through the use of contaminated needles; it is also found in body fluids such as saliva and semen, and may be spread by sexual contact
B
hepatitis _____ is diagnosed by the presence in blood of the antibody to HCV
C
with acute hepatitis texture may appear normal or the portal vein borders are more _____ than usual and the liver is slightly echogenic; hepatosplenomegaly is present, and gallbladder wall is thickened
prominent
with chronic hepatitis the liver is coarse with _____ brightness of the portal triads, but the degree of attenuation is not as great as in fatty liver; no increase in size, fibrosis may be evident
decrease
_____ is a chronic degenerative disease of the liver in which the lobes are covered with fibrous tissue, and the parenchyma degenerates, and the lobules are infiltrated with fat
cirrhosis; micronodular cirrhosis is most commonly teh result of chronic alcohol abuse, where as macronodular cirrhosis is caused by chronic viral hepatitis or other infection
patients with _____ cirrhosis may seem asymptomatic or may have symptoms that include nausea, flatulence, ascites, light-colored stools, weakness, abdominal pain, varicosities, and spider angiomas
acute
_____ cirrhosis patients symptoms include nausea, anorexia, weight loss, jaundice, dark urine, fatigue, or varicosities; may progress to liver failure and portal hypertension
chronic
as cirrhosis becomes more severe, the liver volume ____ in the right lobe, with ______ of the left and caudate lobe
decreases; enlargement; a C/RL value of 0.65 is considered cirrhosis
_____ cirrhosis may show nudularity of the liver edges, especially well demonstrated with ascites; isoechoic regenerating nodules may be seen throughout the liver parenchyma
chronic
_____ nodules or _____ hyperplastic nodules are larger than the regenerating nodules and are considered premalignant; these nodules contain well differentiated hepatocytes, portal venous blood supply, and a typical or frankly malignant cells
dysplastic or adenomatous
_____ is an inherited disease characterized by the abnormal storage and accumulation of glycogen in the tissued, especially the liver and kidneys
glycogen storage disease; there are 6 different types
the most common type of glycogen storage disease is _____, this is a form in which abnormally large amounts of glycogen are deposited in the liver and kidneys
type 1 or von Gierke’s disease
_____ is associated with hepatic adenomas, focal nodular hyperplasia, and hepatomegaly; the adenoma presents as a well-demarcated, round, homogeneous, echogenic tumors
glycogen storage disease
_____ is a rare disease of iron metabolism characterized by excess iron deposits throughout the body; may lead to cirrhosis and portal hypertension
hemochromatosis
_____ exists when the portal venous pressure is above 10 mmHg or the hepatic venous gradient is more than 5mmHg
portal venous hypertension; secondary to liver disease
_____ develops when the normal venous channels become obstructed; this diverted blood flow causes embryologic channels to reopen
collateral circulation; the most common are through the coronary and esophageal veins
normal portal vein waveform is _____ with low velocity; the flow should be smooth and laminar
monophasic; obstruction of the portal venous system is recognized by turbulence within the vessel
what are the 3 types of portal shunts
portacaval shunt- attaches the main portal vein at the SMV-splenic confluence to the anterior IVC
mesocaval shunt- attaches the middistal SMV to the IVC
splenorenal shunt- attaches the splenic vein to the left renal vein
the primary type of Budd-Chiari syndrome is caused by _____ of the hepatic veins or IVC by membranous webs across the upper vena cava at or just about the entrance of the left and middle hepatic vein
congenital obstruction; ascites is the most common characteristic of this disease; others is URQ pain and hepatomegaly
in Budd-Chiari the _____ lobe is enlarge and there is often atrophy of the right hepatic lobes
caudate; has an independent vascular supply; in late stages of this disease the liver appears hyperechoic and inhomogeneous with fibrosis
a _____ mass in the area of the porta hepatis causes the same clinical signs as seen in biliary obstruction
extrahepatic
a _____ is a pus-forming abscess; bacteria gets into the liver through the biliary tree, the portal vein, or the hepatic artery
pyogentic abscess; clinically present with fever, pain pleuritis, nausea, vomiting, and diarrhea
_____ is caused by a species of Candida, usually occurs in immunocompromised hosts; the fungus invades the bloodstream
hepatic candidiasis; may present as multiple small hypoechoic masses with echogenic central core (bulls-eye or target lessions)
_____ is a collection of pus formed by disintegrated tissue in a cavity, usually in the liver, caused by the protozoan parasite Entamoeba histolytica; reaches the liver via the portal vein
amebic abscess; ingested by contaminated water; usually affects the colon and cecum; the lesion is hypoechoic compared with normal liver and may be some enhancement
hepatic _____ is an infectious cystic disease common in sheep-herding areas of the world; its a tapeworm
echinococcal; has 2 layers, the smaller daughter cysts may develop from the inner layer; may rupture and lead to vascular thrombosis and infarction
echinococcal cysts have a _____ appearance with fluid collections and sometimes calcifications
honeycomb; water lily sign shows a detachment and collapse of the germinal layer
_____ is a common life-threatening infection in patients with human immunodeficiency virus
pneumocystis carinii; diffuse, tiny, nonshadowing, echogenic foci to extensive replacement of parenchyma by various echogenic clumps of calcification
a _____ is a benign, congenital tumor consisting of large, blood-filled cystic spaces
hemangioma
_____ hemangioma is the most common benign tumor of the liver
cavernous; frequently in women; large masses may show necrosis, degeneration, calcification; hyperechoic w/ enhancement
a liver cell _____ consists of normal and slightly atypical hepatocytes, frequently containing areas of bile stasis and focal hemorrhage or necrosis
adenoma; more common in women; ruq pain secondary to rupture with bleeding; hyperechoic with central echogenic areas caused by hemorrage; fluid may be present
____ lesion consists of normal hepatocytes, Kupffer cells , bile duct elements, and fibrous connective tissue, which separate into multiple nodules
focal nodular hyperplasia; more frequent in women less than 40; frequently found in right lobe of liver
the most common malignant tumor is _____
hepatocellular carcinoma; clinical symptoms to liver cancer include nausea, vomiting, fatigue, weight loss, and hepatomegaly; portal hypertension and splenomegaly is common
_____ may present in one of 3 patterns; solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltrative masses in the liver
Hepatocelluar carcinoma; indications of cirrhosis, may invade hepatic veins, thrombus
what are the primary sites for metastatic disease of the liver?
colon, breast, and lung; elevated LFT’s; diffuse distortion of the bulls eye pattern; typically multiple nodes throughout the liver
_____ are malignant neoplasms involving lymphocyte proliferation in the lymph nodes; 2 main disorders, hodgkins lymphoma (hypoechoic or diffuse patterns) and non-hodgkins lymphoma ( target or echogenic lesions)
lymphoma; elevated LFT’s; intrahepatic and lucent multiple small, discrete solid lesions without enhancement
with _____ intraperitonial fluid should be assessed along the flanks and into the pelvis; septations and internal echoes develop 1 to 4 weeks after
hepatic laceration
the presents of portal vein _____ is a predictor of a higher risk in liver transplants
thrombosis; the primary function of the sonographic examination is to evaluate the portal vein, hepatic artery, the IVC, and the liver parenchymal pattern
complications of live transplant include rejection, thrombosis or leak, biliary stricture or infarction, and neoplasia; ______ is the most common cause of hepatic dysfunction
rejection; during the postoperative period, hepatic artery thrombosis is the most serious complication of liver transplantation
