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Liver Flashcards

0
Q

Ductus venosus becomes

A

Ligamentum venosum

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1
Q

Umbilical vein becomes

A

Ligamentum teres/ round ligament after birth

Opens back in portal htn. Re canalized umbilical vein.

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2
Q

Largest organ in the body

A

Liver

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3
Q

Liver is an intraperitoneal organ except the

A

Bare area. (Area not covered by peritoneum) adj to GB fossa, porta hepatis, and area surrounding IVC.

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4
Q

Liver

A 
Weighs 1500grams
Trvs 20-22.5 cm
AP 20-12.5
L 15-20 cm
Convex at diaphragm concave at visceral surface
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5
Q

Glisson’s capsule aka visceral peritoneum

A

Fibroelastic connective tissue covering the liver. Has vessels, lymphatics, & nerves.

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6
Q

Ligaments

A

Coronary: where parietal becomes visceral layer. Gives rise to rt & lt triangular ligament

Falciform ligament: divides r & l lobes

Round ligament/Ligamentum Teres

Rt triangular

Lt triangular / lateral ligament

Gastrohepatic

Hepatoduodenal

Ligamentum venosum/hepatogastric lig (post to liver): separates lt lobe & caudate

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7
Q

Anatomical division

A
  1. ) Right lobe (includes caudate and quadrate)
  2. ) Left love

Further divided…4 lobes

  1. ) right
  2. ) left
  3. ) caudate
  4. ) quadrate
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8
Q

Segmental division

A
  1. ) right lobe
  2. ) left lobe (including quadrate)
  3. ) caudate
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9
Q

Couinaud Segments

A

Used for liver resection

  1. ) caudate lobe
  2. ) lateral segment lt lobe sup
  3. ) lateral segment lt lobe inf
  4. ) quadrate/ medial segment lt lobe sup and inf
  5. ) ant segment rt lobe inf
  6. ) posterior segment rt lobe inf
  7. ) post segment rt lobe sup
  8. ) ant segment rt lobe sup
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10
Q

Liver blood supply and drainage

A

Hepatic artery: O2 rich
Portal vein: nutrient rich. Most of liver is supplied by PV

Hepatic veins into ivc drains

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11
Q

Liver function carried out by

A

Hepatocytes, biliary epithelial cells, kupffer cells (phagocytes)

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12
Q

Liver functions

A

Digestion, carb metabolism, storage, protein metabolism, detoxification

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13
Q

LFT’s

A

Alt, AST, bilirubin, alk phos, LDH, alp, ggtp/ggt inc with alcohol abuse, pt, dec albumin, afp inc cancer.

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14
Q

Reidel’s lobe

A

Tongue like projection of rt lobe

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15
Q

Transplant Doppler

A

Normal: RI < 0.8, acceleration time < 0.08, low resistant artery wave.

PRF, 45-60*, depth, sm color box, gain, wall filter, power Doppler on slow flow.

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16
Q

Most common liver transplant complication

A

Ischemic reprofusion injury

Rejection confirmed with biopsy

2nd most common = hepatic artery stenosis

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17
Q

Stenosis

A

Distal tardus parvus wave, vel > 200 cm/s, color aliasing at stenosis

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18
Q

Hepatic veins

A

Right middle left

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19
Q

Ligamentum venosum divides

A

Medial segment Left lobe and caudate lobe.

Remnant of ductus venosus

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20
Q

Ligamentum teres divides

A

Medial and lateral segments of the left lobe.

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21
Q

Lab decreases with chronic liver disease

A

Serum albumin

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22
Q

What liver segment is between the left hepatic vein and the middle hepatic vein?

A

MSLL

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23
Q

Reticuloendothelial tissue activity

A

Digestion of hemoglobin released from ruptured red blood cells.

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24
Phagocytic function of the liver is carried out by
Kupffer cells
25
What are the boundaries of the quadrate lobe?
GB fossa, lig teres
26
Milan criteria for patient with HCC
No lesion > 5cm,
27
Reye's syndrome
Associates with pediatric use of aspirin
28
Von Gierkes Type I
MC Glycogen storage disease
29
Wilson's disease
Copper disease. Must avoid organ foods such as liver kidney heart nuts and dried beans. Brown rings around eyes called Kayser-Fleischer Ring
30
Schistosomiasis
Turtle back liver. From snails in water penetrate skin. Leads to portal htn & pipe stem cirrhosis Portal vein occlusion by the larvae leads to portal htn, splenomegaly, ascites, and varices
31
Amoebiasis
Protozoa amoeba can lead to liver dysfunction and abscess, primarily affects colon.
32
Candidiasis
Fungus balls, immunosuppressed
33
Echinococcus / Hydatid disease
Honey comb appearance/water lily sign/ lily pad, tapeworm, dog poop in sheep heard and humans eat infected sheep. Egg travels through portal to liver. Echinococcal cyst/hydatid cyst/daughter cyst Large cyst with small daughter cysts. Hydatid sand internal echoes seen. Changes & can turn into collapsed calcified mass.
34
Pneumocystitis | Pneumocystis Carinii
Affects lungs mostly, immunosuppressed patients. Numerous echogenic foci MC organism to affect AIDs patients 80%. May manifest as pneumonia.
35
Hepatitis
Acute hepatitis: starry sky liver, hypo liver, enlarged, portal veins inc echoes in the bands known as periportal cuffing. Chronic: hyperechoic small liver, dec echo of PV A-daycare workers, oral/fecal/water, wash hands after changing diapers, Vaccine Hep A available, self limiting B-blood/body fluids/unprotected sex/needles. Vaccine Hep B, healthcare workers at risk C-blood D-from Hep B, hep B vaccine. E-food/water G-? True hepatitis
36
Gaucher's disease
Error of lipid metabolism, Type I MC, glucoscerobrocyde lipid accumulates in organs bc of enzyme deficiency Enzyme replacement therapy Bruising, low platelets, anemic, tired. Hepatosplenomegaly
37
Hemochromatosis
Iron overload, gets in organs Joint pain. Phlebotomy removed excess iron take out a pint 1-2 weeks for months and maintenance therapy blood given every 2-4 months for life.
38
Focal fatty infiltrate / Focal infiltration
Usually in periportal region. Anterior to portal vein and porta hepatis
39
Pneumobilia
Air in biliary tract
40
Portal Hypertension
Most common cause is cirrhosis hepatosplenomegaly, hepatofugal flow in portal vein, PV diam > 13mm Hepatofugal flow, Recanalized umbilical vein (best seen sag subcoastal view of left lobe through lig teres), enlarged left gastric vein aka coronary vein, ascites
41
Fatty liver/ Fatty Infiltration
Is reversible, Fat accumulates in liver. Inc attenuation, dec penetration, inc echogenicity, hetero, focal or diffuse, rapid change in appearance over time Causes: obesity, diabetes, alcohol, hepatitis, chronic illness, steroids, malnutrition, pregnancy, Reye's syndrome, hyperlipidemia, glycogen storage disease, cystic fibrosis,
42
Hepatomegaly
Rounding of inferior border of liver, long meas exceeding 20, extension of right lobe inferior to the lower pole of the right kidney, increased AP measurement.
43
Cavernous hemangioma
Most common liver tumor, Homogeneous, hyperechoic lesion, has a vascular network, more common in females, usually Asymptomatic
44
Hepatic cyst
Thin wall, post acoustic enhancement, anechoic, inc through transmission
45
Cirrhosis
Nodular liver, small liver, may cause HCC, caudate sparing, luminal narrowing of hepatic veins, color and Doppler on hepatics show high velocities through strictures, splenomegaly, azotemia (inc blood nitrogen), collateral vessels, leads to jaundice, portal HTN, & liver failure Caused by ETOH abuse, hepatitis, hep C, Wilton's, hemochromatosis, galactosemia, biliary obstruction, vascular disease, drugs
46
HCC/Hepatoma
Inc AFP Invasion of portal veins may be due to HCC Often with cirrhosis, hep B, carcinogens, usually males RUQ pain, Hepatomegaly, wt loss, palp mass, loss appetite, fever, cirrhosis, Inc color, inc # vessels, high velocity, inc diastolic May mets to heart, lungs, brain, kidney, spleen. Poor prognosis. 3-4 months. If early can do tx
47
Kaposi's Sarcoma
Skin cancer | Skin lesion increased with AIDS patients.
48
Mets to liver
Most common adenocarcinoma of the Colon, then breast and lung. 20 times more common than HCC Target, bulls eye appearance. Any echogenicity, hepatosplenomegaly, ascites Inc afp, alt, AST, lft, bili
49
Focal nodular hyperplasia
Well defined mass, central stellate scar, color Doppler prominent vessels coursing within the scar Rare, assoc with BCP, second MC, benign. Asymptomatic, iso, hypo, hyper. Spoke wheel pattern. Multiple veins come out from center.
50
Budd Chiari
Occlusion of ivc and hepatics, portal vein may be occluded or show hepatofugal flow
51
Liver transplant complication not detected by ultrasound
Rejection
52
Liver transplant complications extrahepatic fluid collection could be
Biloma, hematoma, located ascites, abscess
53
Liver tx complications
Biliary sludge, portal vein stenosis, hep art thrombosis, liver malignancy The gallbladder is removed. Don't search for gb problems.
54
TIPs
Transjugular Intrahepatic Portosystemic Shunt RHV-RPV Connects portal vein and hepatic vein Relieved symptoms of portal HTN Hepatofugal flow in shunt, vel 100-190cm/s 190cm/s = stenosis
55
Liver tx can be anastamoses via
IVC, PV, HA, bile duct
56
Best view of coronary vein
Sag view through splenic hilum
57
Cavernous transformation of the portal vein
Sequelae of portal vein thrombus and is the replacement of the normal single channel portal vein with numerous tortuous venous channels
58
Galactosemia
Can't convert galactose to glucose
59
Rt intersegmental fissure divides
Rt anterior and rt post lobe | Rt hep vein is landmark
60
Left intersegmental fissure divides
Medial and lateral left lobe. Ligamentum teres and left hepatic and left portal are landmarks
61
Parietal peritoneum
Lining of abdominal cavity
62
What are intersegmental ? What are intrasegmental?
Hep veins intersegmental Portal triad intrasegmental
63
Granuloma
Small calcifications Liver or spleen From histoplasmosis or tuberculosis
64
Pyogenic bacterial abscess
E. coli, reaches liver via portal vein, hep artery, bile duct, or lymphatics. Hypo round fluid filled mass, echogenic foci with gas producing organisms.
65
Fungal abscess
Sequence of change. Wheel within a wheel, bullseye, hypo mass, echogenic mass.
66
Amoebic abscess. Parasitic.
Aka amoebiosis Contaminated food and water. Entamoeba histolytica. Resides in colon. Goes to liver via portal vein. Round oval hypo mass. Distal enhancement.
67
Giving a fatty meal does what to the bile ducts?
Inc with obstruction, dec if normal
68
Glycogen storage disease
Error in glycogen metabolism. Type I most common. Von Gierkes Syndrome. Inc fat and glycogen store in liver. Hepatomegaly Hypoglycemic, fatigue, seizure Treated by giving glucose drink.
69
2 most common causes of biliary tract obstruction
Panc cancer and gallstones.
70
Niemann-Picks Disease
Error in lipid metabolism. Types A-C. Type B most common. Die at late childhood. Red spots in eyes. Type A rapidly fatal. Lymphadenopathy, hepatosplenomegaly mental retard
71
Polycystic Disease
Assoc w. Kidneys, panc, spleen
72
Chronic Granulomatous Disease
Congenital defect in leukocyte. Hypo areas wit Ca+ and shadowing.
73
Hemangioma
MC benign liver tumor. Vascular tumor. Asymptomatic. Usually hyperechoic.
74
Liver Cell Adenoma
Rare, assoc w BCP, palp mass, RUQ pain, assoc w. Von Gierkes. Very vascular. Inc risk life threatening hemorrhage.
75
Lipoma
Very rare, asymptomatic, assoc w. Tuberous Sclerosis and renal angiomyolipomas. Hyperechoic, fat, propagation speed artifact. Propagation speed artifact.
76
Hepatic Cystadenoma
Rare, multilocular, fluid filled
77
Hemangiosarcoma | Hepatic Angiosarcoma
Cancer Rare, exposure to carcinogens (thoratrast, arsenic, polyviral chloride) Large mass, hemorrhage, necrosis
78
Morrisons Pouch/ recess of Morrison/ Hepatorenal pouch
Name of potential peritoneal space that is bound by the liver, kidney, colon, and duodenum
79
Hodgkin's disease/ Hodgkin's lymphoma
``` Cancer Enlg lymphoid tissue Younger Hepatosplenomegaly, hypo lesions. Diffuse lesions ```
80
NonHodgkins lymphoma
Cancer Inc in aids pts, inc in pts with cyclosporine (tx rejection drug) Older pt, worse prognosis Focal lesions
81
Leukemia
Blood cancer
82
Liver trauma
3rd mc organ to be damaged next to spleen and kidney.
83
Infantile hemangioendothelioma/cavernous hemangioma/hemangioma
Benign | MC vascular tumor in infancy. Associated with CHF, cutaneous hemangioma
84
Hepatoblastoma
MC primary liver tumor in peds. <5 yrs, male, rt lobe. Assoc with beckwith-wiedemann, hemihypertrophy, familial adenomatous polyposis, precocious puberty
85
Describe the main lobar fissure
Imaginary line between gb fossa and IVC. Separates rt and lt lobe. Middle hepatic vein is a landmark.
86
Rt intersegmental fissure
Divides rt lobe into ant and post | Rt hep vein is a landmark.
87
Lt intersegmental fissure
Divides left lobe into medial and lateral. Left hep vein, Ligamentum teres, and asc segment of left portal vein are landmarks.
88
Coronary Ligament
Parietal peritoneum into liver becoming visceral peritoneum Rt & lt triangular ligament
89
Acute hepatitis
Starry sky | Hypo liver, Hepatomegaly, hyperechoic portal vein walls
90
Chronic hepatitis
Hyperechoic liver, small liver, dec echogenicity of portal vein walls
91
Focal fatty sparing
Island of normal liver in a sea of fatty liver. Seen adj to GB fossa. No mass effect.
92
Name 5 portosystemic shunts
1. Portocaval shunt 2. Proximal splenorenal shunt 3. Distal splenorenal (Warren) shunt (PV hepatopedal) 4. Mesocaval shunt 5. Transjugular Intrahepatic Portosystemic Shunt (hepatopedal in PV) Confirm shunt with US by showing flow within shunt and Hepatofugal portal vein flow.
93
Thin capsule surrounding liver
Glissons capsule
94
What vessel courses within main lobar fissure
Middle hepatic vein
95
Which forms the caudal border of the left portal vein
Ligamentum teres

Abdomen (15 decks)

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