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Abdominal > Liver > Flashcards

Liver Flashcards

1
Q

What are the 4 functions of the liver?

A
  1. Metabolism
  2. Digestion
  3. Storage
  4. Detoxification
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2
Q

In patients with known liver disease, what type of test can help in the diagnosis?

A

Liver Function Test

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3
Q

What refers to a group of laboratory tests established to analyze how the liver is performing under normal and diseased conditions

A

Liver Function Tests

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4
Q

Name of the enzyme present in tissues with a high rate of metabolic activity?

A

Aspartate Aminotransferase (AST)

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5
Q

What causes AST to be released into the bloodstream in abnormally high levels?

A

Death or injury to producing cells

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6
Q

Any disease that injures the cells causes an elevation in _____ levels

A

AST

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7
Q

In what 6 cases pertaining to the liver is AST elevated?

A
  1. Hepatitis
  2. Fatty liver
  3. Hepatic necrosis
  4. Mononucleosis
  5. Cirrhosis
  6. Metastatic liver disease
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8
Q

Alanine Aminotransferase is mildly elevated in what?

A
  1. Acute cirrhosis
  2. Hepatic metastasis
  3. Pancreatitis
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9
Q

Alanine Aminotransferase is mild to moderately elevated in cases of?

A

Obstructive Jaundice

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10
Q

Alanine Aminotransferase is moderate to highly elevated in what 3 cases?

A
  1. Hepatocellular disease
  2. infections hepatitis
  3. Toxic hepatitis
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11
Q

__________ is produced by the liver, bone, intestines and placenta

A

Alkaline Phosphatase

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12
Q

Alkaline Phosphatase is a good indicator of what 5 diseases?

A
  1. Obstruction
  2. Hepatic carcinoma
  3. Abscess
  4. Cirrhosis
  5. Hepatitis
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13
Q

__________is secreted as bile by the liver cells into the bile ducts

A

Bilirubin

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14
Q

What is bilirubin?

A

Product of the breakdown of hemoglobin in tired red blood cells

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15
Q

The Bilirubin process can be disturbed in what 3 ways

A
  1. Excessive amount of red blood cell destruction
  2. Malfunction of liver cells
  3. Blockage of ducts leading from cells
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16
Q

Conjugated bilirubin name?

A

Direct bilirubin

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17
Q

Unconjugated bilirubin name?

A

Indirect bilirubin

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18
Q

Indirect bilirubin is elevated in what 3 cases?

A
  1. Anemias
  2. Trauma from hematoma
  3. Hemorrhagic pulmonary infarct
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19
Q

Elevation of direct bilirubin is usually related to obstructive jaundice from ________ or _________.

A

stones; neoplasm

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20
Q

Hepatic metastisis, hepatitis, lymphoma, cholestasis secondary to drug use, and cirrhosis will elevate both ________ and _________ ___________.

A

direct; indirect; bilirubin

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21
Q

____________ is increased in the presence of liver disease?

A

Prothrombin time

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22
Q

__________ is part of the blood clotting mechanism?

A

Prothrombin time

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23
Q

Prothrombin time is increased in the presence of liver disease with cellular damage in what two cases?

A
  1. Cirrhosis

2. Metastatic disease

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24
Q

_________ affects the hepatocytes and interferes with liver function

A

Diffuse disease

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25
Q

________are parenchymal liver cells that performs all the functions?

A

Hepatocytes

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26
Q

7 common causes of diffuse disease?

A
  1. Alcoholic liver disease
  2. Diabetes
  3. Obesity
  4. Pregnancy
    5 Severe hepatitis
  5. Chronic illness
  6. Steroids
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27
Q

Diffuse disease patients are usually asymptomatic, however some may present with these 4 symptoms

A
  1. Jaundice
  2. Nausea
  3. Vomiting
  4. Abdominal pain
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28
Q

________increases lipid accumulation in the hepatocytes

A

Fatty infiltration

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29
Q

Sonographic findings of fatty infiltration?

A
  • increased echogenicity
  • Enlargement of affected lobe
  • difficulty penetrating the entire liver
  • portal veins may be difficult to visualize due to attenuation
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30
Q

General term for inflammatory and infectious disease of the liver?

A

Hepatitis

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31
Q

What are the three causes of hepatitis?

A
  1. local infection (viral hepatitis)
  2. infection elsewhere in the body (mono)
  3. Chemical or dug toxicity
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32
Q

Mild inflammation impairs hepatocyte fuction, whereas more severe inflammation may lead to obstruction of ________ and _______ flow in the liver and impaired liver cell function.

A

blood; bile

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33
Q

what are the 5 types of hepatitis?

A
  1. hav
  2. hbv
  3. hcv
  4. hdv
  5. hev
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34
Q

HBV is ___ % in the US

A

60

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35
Q

HAV is _____% in the US

A

20

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36
Q

Other types of hepatitis is _____% in the US

A

20

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37
Q

What type of hepatitis is found in saliva, semen, and can spread through sexual contact or through blood?

A

HBV

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38
Q

What type of hepatitis is at greatest risk for healthcare workers?

A

HBV

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39
Q

HBV symptoms? (4)

A
  1. flu-like
  2. loss of appetite
  3. vomiting
  4. fatigue
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40
Q

What disease can range from mild damage to massive necrosis and liver failure?

A

Acute hepatitis

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41
Q

Acute Hepatitis sonographic findings (4)

A
  1. liver texture may be normal
  2. attenuation may be present
  3. hepatosplenomegaly
  4. gallbladder wall thickening
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42
Q

_________ exists when there is evidence of hepatic inflammation for at least 3-6 months

A

chronic hepatitis

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43
Q

what are symptoms of chronic hepatitis? (7)

A
  1. nausea
  2. anorexia
  3. weightloss
  4. tremors
  5. jaundice
  6. dark urine
  7. fatigue
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44
Q

Diagnosis these symptoms: nausea, anorexia, weight loss, tremors, jaundice, dark urine, fatigue

A

chronic hepatitis

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45
Q

Chronic hepatitis sonographic findings (3)

A
  1. Liver texture is coarse
  2. Decreased brightness of portal triad
  3. No increase in size
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46
Q

Diagnose these sonographic findings:

  1. liver texture may be normal
  2. attenuation may be present
  3. hepatosplenomegaly
  4. gallbladder wall thickening
A

Acute hepatitis

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47
Q

________ is a chronic degenerative disease of the liver

A

cirrhosis

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48
Q

Diagnose these sonographic findings:

  1. lobes are covered with a fibrous tissue
  2. the parenchyma degenerates
  3. the lobes are infiltrated with fat
A

cirrhosis

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49
Q

What disease is most commonly the result of chronic alcohol abuse but can also be the result of nutritional deprivation, hepatitis, or infection

A

cirrhosis

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50
Q

Name 3 types of cirrhosis

A
  1. biliary
  2. fatty
  3. posthepatic
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51
Q

Name the acute cirrhosis symptoms? (9)

A
  1. possibly asymptomatic
  2. nausea
  3. flatulence
  4. ascities
  5. light colored stool
  6. weakness
  7. abdominal pain
  8. varicosities
  9. spider angiomas
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52
Q

diagnosis these symptoms:

  1. possibly asymptomatic
  2. nausea
  3. flatulence
  4. ascities
  5. light colored stool
  6. weakness
  7. abdominal pain
  8. varicosities
  9. spider angiomas
A

Acute Cirrhosis

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53
Q

what type of cirrhosis has a symptom of dark urine?

A

chronic cirrhosis

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54
Q

_______ may lead to liver failure and portal hypertension?

A

Chronic cirrhosis

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55
Q

diagnosis these sonographic finding:

  1. diagnosis with ultrasound may be difficult
  2. coarsening of the liver parenchyma
  3. nodularity
  4. increased attenuation
  5. decreased vascular markings
  6. hepatosplenomegaly
  7. Ascites surrounding the liver
  8. portal hypertension with or without abnormal doppler
  9. increased incidence of hepatic tumors
  10. late stage may show atrophy of liver
A

Cirrhosis

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56
Q

Cirrhosis sonographic findings

A
  1. diagnosis with ultrasound may be difficult
  2. coarsening of the liver parenchyma
  3. nodularity
  4. increased attenuation
  5. decreased vascular markings
  6. hepatosplenomegaly
  7. Ascites surrounding the liver
  8. portal hypertension with or without abnormal doppler
  9. increased incidence of hepatic tumors
  10. late stage may show atrophy of liver
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57
Q

________ can occur anywhere in the liver

A

cysts

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58
Q

Are cyst more common in men or women with increasing age?

A

women

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59
Q

Enlarging simple cyst may cause ______?

A

pain

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60
Q

Walls of simple cyst are _____ and ______?

A

thin; well defined

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61
Q

T or F

Simple Cyst are asymptomatic?

A

T

62
Q

T or F

Cyst are large (4-5 cm)

A

False

cyst are small (less than 2-3 cm)

63
Q

_____% have associated polyycystic renal disease

A

60

64
Q

T or F

1 in 500 with polycystic renal disease

A

T

65
Q

Sonographic findings of cysts

A 
Anechoic
well defined borders
posterior enhancement
ultrasound may be used for guided aspiration
multiple cyst throughout the liver
cysts are small (2-3 cm)
66
Q

_______ is parasitic or infectious collections in the liver

A

Abscesses

67
Q

_______ contains seous fluid, pus, degris or blood clots

A

abscesses

68
Q

Tiny gas forming organisms may develop within ________

A

Abscesses

69
Q

T or F

Abscesses have regular or irregular edges

A

True

70
Q

Symptoms of Abscesses (7)

A
  1. Patients are usually very ill
  2. RUQ pain
  3. Tender hepatomegaly
  4. Fever
  5. Nausea
  6. Vomitting
  7. Weightloss
71
Q

Diagnosis these symptoms

  1. Patients are usually very ill
  2. RUQ pain
  3. Tender hepatomegaly
  4. Fever
  5. Nausea
  6. Vomitting
  7. Weightloss
A

Abscesses

72
Q

_______ are pus forming abscess, usually caused by bacteria.

A

pyogenic abscess

73
Q

Pyogenic abscess gains abscess to the liver, from the ______,_______ or _______

A

biliary tree, portal vein, hepatic artery

74
Q

Diagnosis this symptom:

  1. fever
  2. pain
  3. pleuritis
  4. nausea
  5. vomiting
  6. diarrhea
  7. leukocytosis
A

phyogenic abscess

75
Q

phyogenic abscess symptoms

A
  1. fever
  2. pain
  3. pleuritis
  4. nausea
  5. vomiting
  6. diarrhea
  7. leukocytosis
76
Q

what treatment is used for pyogenic abscess

A

antibiotic and/or drainage

77
Q

pyogenic abscesses size vary from__cm to _____

A

1cm to very large

78
Q 
diagnosis these sonographic findings
variable
size varies 1cm to very large
rt. central lobe is the most common site
may be hypoechoic or complex
may have fluid level
may be hyperechoic with dirty shadow due to gas
A

pyogenic abscess

79
Q

pyogenic abscess sonographic findings

A 
variable
size varies 1cm to very large
rt. central lobe is the most common site
may be hypoechoic or complex
may have fluid level
may be hyperechoic with dirty shadow due
80
Q

Bowel is most commonly infected in?

A

Amebic abscess

81
Q

Amebic abscess infection may spread to the ____, ____ or _____ by the bloodstream

A

liver, brain or lungs

82
Q

Amebic Abscess symptoms

A 
Low fever
leukocytosis
GI symptoms
   -abd. pain
   -diarrhea
83
Q

__________ is an infectious cystic disease common in sheep hearding areas of the world

A

Echinococcal cyst

84
Q

________ is a tapeworm that resides in the small intestines of dogs

A

echinococcus

85
Q

What type of cyst has larvae enter the small intestine and burrow through the mucosa then enters the portal circulation and travels to the liver

A

Echinococcal cyst

86
Q

a ______ cyst has two layers, may enlarge and rupture, may impinge onthe blood vessels and lead to vasculaqr thrombosis and infarctions

A

Echinococcal cyst

87
Q

Sonographic Findings

  • may be simple or complex
  • oval or spherical
  • may contain calcifications
  • septations are frequent- honeycomb appearance
A

Echinococcal Cyst

88
Q

A benign congenital tumor consisting of a large blood filled cystic spaces

A

Cavernous Hemangioma

89
Q

What is the most commone benign tumor in the liver, most common in females, and most common in the right lobe

A

Cavernous Hemangioma

90
Q

Name symptoms of Cavernous Hemangioma

A
  • Asymptomatic

- small percentage mayb bleed causing RUQ pain

91
Q

Sonographic Findings

  • Hyperechoic
  • Posterior Enhancement
  • Round or oval
  • May be lobulated
  • Well defined borders
  • May have mixed echo patterns due to necrosis
A

Cavernous hemangioma

92
Q

Benign mass of epithelial cells, more commonly in women and are related to long term oral contraceptives

A

Adenoma

93
Q

Name symptoms of Adenoma

A
  • usually asymptomatic

- have RUQ pain to hemorage

94
Q

Name turmor that is asymptomatic, with RUQ pain to hemorage

A

Adenoma

95
Q

Name tumor for these sonographic findings:

  • usually well circumscribed
  • variable in size and shape
  • similar appearance to hemangiomas or metastatic massses
A

Adenoma

96
Q

What is the second most common benign liver mass after hemangioma

A

Focal nodular hyperplasia

97
Q

What tumor is asymptomatic, hemorrrhage is rare, and no malignant potential?

A

Focal nodular hyperplasia

98
Q

Name the tumor most commonly seen in females under the age of 40

A

Focal nodular hyperplasia

99
Q

Name tumor with these sonographic findings:

  • well defined
  • hyperechoic or isoechoic to surrounding liver tissue
  • ulually less than 5 cm
  • Can be mistake for an adenoma or hemangioma
A

Focal nodular hyperplasia

100
Q

Name the three Benign Hepatic Tumors

A

Cavernous hemangioma
adenoma
Focal nodular hyperplasia

101
Q

Name the two malignant hepatic tumors

A

hepatocellular carcinoma

Metastatic disease

102
Q

clinical sign of a malignant hepatic tumor (7)

A

-nausea
-vomiting
-fatigue
-weight loss
-hepatomegally
-portal hypertension
splenomegaly

103
Q

Which tumor is related to cirrhosis

A

Hepatocellular carcinoma

104
Q

80% of patients with preexisting cirrhosis develop _________. Occurs more frequently in men.

A

Hepatocellular carcinoma

105
Q

Symptoms of ____________.

  • hx of cirrhosis
  • palpable mass
  • appetite disorder
  • hepatomegally
  • fever
A

Hepatocellular carcinoma

106
Q

Which tumor is present in three patterns?

  • solitary massive tumor
  • Multiple nodules throughout the liver
  • Diffuse infiltrative masses in the liver
A

Hepatocellular carcinoma

107
Q

________tumor may invade the hepatic veins to produce __________. Portal venous system may also be invaded.

A

Hepatocellular carcinoma, Budd-Chiari syndrome

108
Q

Sonographic appearence:

  • Solid discrete masses
  • diffuse parenchyma involvement
  • combination
A

Hepatocellular carcinoma

109
Q

_________ is more common than primary liver tumors

A

Metastatic disease

110
Q

Metastatic disease is most common _____ of the liver

A

neoplasm

111
Q

Metastatic disease most common primaries _______,_________,_________.

A

Colon
Breast
Lung

112
Q

Metastatic spread occurs as the tumor ______ the wall and travels through the ______ ________ or through the bloodstream to the portal vein or hepatic artery to the liver.

A

erodes, lymphatic system

113
Q

Sonographic appearence:

  • varies
  • typically there are multiple lesions throughout both lobes
A

Metastatic disease

114
Q

What are the four patterns of Metastatic disease

A
  • well defined hypoechoic mass
  • well defined echogenic mass
  • diffuse distortion of the normal liver parenchyma
  • Targey or Bull’s Eye lesion
115
Q

Which disease has the target or Bull’s eye lesion?

A

metastatic disease

116
Q

Metastatic disease is a result due to _____ around the tumor or _______or _________ within the tumor

A

edema, necrosis, or hemorrhage

117
Q

Metastatic disease as the tumor grows rapidly in size they outgrow their _____ _____ and _________ or hemorrhage can occur within the tumor.

A

blood supply,necrosis

118
Q

_______ and _________ _________ present a complex waveform, which flows above and below the baseline, relecting the reflux of blood from the right atrium during systome and variations with the respiratory cycle

A

IVC & Hepatic Veins

119
Q

Thrombosis of the ___________ is called Budd-Chiari Syndrome

A

hepatic vein

120
Q

Sonograpically with hepatic vascular flow abnormalities the hepatic veins appear?

A

reduced in size and may contain echogenic thrombotic material

121
Q

The presence of _______blood flow in the hepatic veins permits the exclusion of _____________

A

typical, Budd-Chiari syndrome

122
Q

Budd Chiari syndrome is associated with?

A
  • hematologic disorder
  • oral contraceptives
  • Collagen disease
  • Echinococcus
  • Before and after pregnancy
123
Q

What syndrom is associated with oral contraceptives?

A

Budd Chiari syndrome

124
Q

In portal veins the flow is ___________.

A

Hepatopetal(towards the liver)

125
Q

Flow is hepatopetal, relatively continuous, and varies slightly with respirations with what vein?

A

portal vein

126
Q

Sonographic findings:

  • lack of doppler signal indicates absence of blood flow
  • in cirrhotic patiens, thrombosis is often supsected when ascitese suddenly worsens
A

Portal vein thrombosis

127
Q

What are the indirect signs of a portal vein thrombosis?

A

-loss of normal portal venous landmarks
-dilation of the SMV and splenic veins
venous collaterals in the porta hepatis

128
Q

Portal veins may be ________to visualize in patients with cirrhosis.

A

difficult

129
Q

The portal vein should be examined in what kind of patients?

A

cirrhotic patients

130
Q

An increase in portal venous pressure or hepatic venous gradient

A

Portal venous hypertension

131
Q

Majority of the time an increase in portal venous pressure or hepatic venous gradient is a result of ?

A

intrinsic liver disease

132
Q

Portal venous pressure can also be obstructed by _______,______ and _________or prolonged congestive heart failure

A

protal vein, hepatic vein, IVC

133
Q

_______or ________ hepatocellular disease can block the flow of blood throughout the liver, causing it to back up into the ___________.

A

Acute or Chronic, hepatic portal circulation

134
Q

In portal venous hypertension doppler techniques are used to determine ?

A

wheter blood flow in the portal vein is hepatopeta (towards) or hepatofugal(away)

135
Q

What are the doppler findings of Portal Venous Hypertension?

A
  • portal vein shows low velocity
  • patent paraumblical vein
  • respiratory variations of the vessel is uaually lost vecause the veins do not collapse with breathing
136
Q

Sonographic Findings:

  • Dilated PV, SV, and SMV
  • patent umbilical vein
  • varicies
  • splenomegaly with dilated splenci radicles
  • dimished response to respiration
  • dilated SA and HA
  • Ascities-f
  • small liver with irregularities
A

Portal Venous Hypertension

137
Q

In patients with portal venous hypertension the blood flow may take one of seveal paths through? (5)

A
  • coronary-esophagealvarices
  • Splenic varices
  • Splenorenal shunts
  • Recanalized umbilical vein
  • Surgical Shunts
138
Q

Splenic varices the flow in main, right and left portal vein is _________? Flow in splenic vein is __________? Flow in the SMV is ________?

A

reversed/ hepatofugal, reversed, normal

139
Q

In Splenorenal Shunts flow in main, right and left portal vein is _______? Flow in splenic vein is __________? Flow in SMV is __________?

A

reversed/hepatofugal, reversed, normal

140
Q

In recanalized umbilical vein flow in the main and left portal vein is ________. flow in the right portal vein is __________? flow in the SMV and splenic vein is ________?

A

normal/hepatopetal, reversed/hepatofugel, normal

141
Q

What are the four spontaneious shunting sites?

A
  1. coronary-gastroesphageal
  2. paraumbilical vein
  3. hemorrhoidal anastomoses
  4. retroperitoneal anastomoses
142
Q

which spontaneous shunting spot is most common?

A

coronary gastroesophageal

143
Q

the spontaneous shunting of the coronary gastroesophageal occurs where the esophageal branches of the ________ form anastomeses with branches of the _______ and _______veins in the lower esophagus.

A

left gastric vein, azygos, hemiazygos vein

144
Q

appears as a continuation of the left portal vein and extends to the anterior abdominal wall near the umbilicus?

A

paraumbilical vein

145
Q

__________ sponatneous shunting occurs between the superior and middle hemorrhoidal veins?

A

Hemorrhoidal anastomoses

146
Q

Vascular structures withing the lesser omentum may cause thickening of the omentum. Small vessels may be seen around the pancreas.

A

Retroperitoneal anastomoses

147
Q

TIPS

A

Transjugular intrhpetic portosystemic shunt

148
Q

Mesocaval

A

SMV and IVC

149
Q

Splenorenal

A

Splenic vein and renal vein

150
Q

Portacaval

A

Portal vein and IVC

151
Q

Four liver function tests?

A
  1. Alanine Aminotransferase
  2. alkaline Phosphatase
  3. Bilirubin
  4. Prothrombin time
152
Q

Alkaline phosphatase is moderately elevated in what 2 cases?

A
  1. Cirrhosis

2. Hepatitis

Abdominal (15 decks)

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