Liver Flashcards
Where does the right lobe of liver get its blood supply?
right portal vein
pg. E 4
Where does the left lobe of liver get its blood supply?
left portal vein
pg. E 4
Where does the caudate lobe of the liver get its blood supply?
right and left portal veins
pg. E 4
Where is the caudate lobe located in reference to the ligamentum venosum?
posterior
pg. E 4
Where is the caudate lobe located in reference to the porta hepatis?
posterior
pg. E 4
Where is the caudate lobe located in reference to the IVC?
anterior and medial
pg. E 4
What is the caudate lobe located in reference to the lesser sac?
lateral
pg. E 4
Where is the caudate lobe located within the liver?
posterior superior surface
pg. E 4
What is the first order division of the liver?
lobar/hemilobar anatomy
pg. E 3
How is the liver divided in the first order division of the liver?
right and left lobes are divided by a plane between the GB and IVC
pg. E 3
What is the second order division of the liver?
sector/segment anatomy
pg. E 4
How is the liver divided in the second order division of the liver?
Left lateral Left medial Right anterior Right posterior pg. E 4
What is the third order division of the liver?
segment/subsegment anatomy
pg. E 5
How is the liver divided in the third order division of the liver?
Segment I - caudate lobe Segment II - left lateral superior Segment III - left lateral inferior Segment IVa - left medial superior Segment IVb - left medial inferior Segment V - right anterior inferior Segment VI - right posterior inferior Segment VII - right posterior superior Segment VIII - right anterior superior pg. E 5
What is another name for hepatic veins?
intersegmental vessels
pg. E 7
What is another name for the portal triad?
intrasegmental vessels
pg. E 7
Why do the portal veins have hyperechoic walls?
encased by Glisson’s capsule
pg. E 7
What are the vessels of the portal triad?
main portal vein
proper hepatic artery
common hepatic duct
pg. E 7
Where is the main lobar fissure located?
between the GB neck and junction of RPV and LPV
pg. E 8
What does the main lobar fissure divide?
right and left lobes between IVC and GB
pg. E 8
What is the ligamentum venosum?
remnant of the ductus venosus
separates the LT from the caudate lobe
pg. E 8
What is the ligamentum teres?
remnant of the umbilical vein to the LPV
pg. E 9
What can happen to the ligamentum teres in portal hypertension and cirrhosis?
it can recanalize to form a collateral
pg. E 9
What is the direction of circulation in a fetus?
umbilical vein LPV ductus venosus IVC pg. E 9
What is hepatopetal flow?
flow towards the liver
pg. E 10
What is hepatofugal flow?
flow away from the liver
pg. E 10
Which direction of flow should the portal vein be?
hepatopetal
pg. E 10
What does a normal portal vein waveform look like?
low velocity continuous flow toward the liver
above the baseline
pg. E 10
What is the upper limits of normal diameter of a portal vein?
13 mm
pg. E 10
What does a > 13 mm diameter of the portal vein suggest?
portal hypertension
pg. E 10
What does a normal hepatic vein waveform look like?
triphasic
below the baseline
pg. E 10
What does a normal hepatic artery waveform look like?
low resistive
above the baseline
pg. E 11
If a patient just had a liver transplant and the hepatic artery waveform is high resistive, what does it indicate?
possible organ rejection
pg. E 11
If a patient just had a liver transplant and the hepatic artery waveform is seen as a parvus tardus waveform, what does it indicate?
proximal anastomotic stenosis
pg. E 11
What does the RHV separate?
divides anterior and posterior segments of the RT lobe
pg. E 13
What does the MHV separate?
separates the LT and RT lobes
pg. E 13
What does the LHV separate?
divides medial and lateral segments of the LT lobe
pg. E 13
What is considered hepatomegaly?
- 5 cm or greater
pg. E 14
What is Riedel’s lobe?
inferior projection of the RT lobe
pg. E 14
What is normal liver echotexture?
homogeneous and slightly hyperechoic compared to renal cortex
pg. E 14
What are hepatic granulomas?
calcifications in the liver
pg. E 14
What can hepatic granulomas be caused by?
histoplasmosis
tuberculosis
pg. E 15
What is hepatitis?
inflammation of the liver
pg. E 15
What can cause hepatitis?
viral, bacterial, fungal, parasitic organisms
medications, toxins, and autoimmune disorders
pg. E 15
In hepatitis, what liver enzymes are elevated?
ALT
AST
bilirubin
pg. E 15
What are the sonographic findings of acute hepatitis?
"starry night" periportal cuffing hypOechoic liver parenchyma enlarged liver hyperechoic portal vein walls pg. E 15
What are the sonographic findings of chronic hepatitis?
hypERechoic liver parenchyma
small liver
decreased echogenicity of portal vein walls
pg. E 15
What is the most common cause for hepatic abscesses?
biliary tract disease
pg. E 16
What is the most common type of abscess?
pyogenic abscess (pus-forming) pg. E 16
What are the symptoms for a pyogenic abscess?
RUQ pain Fever elevated LFT's elevated WBC's pg. E 16
What are the sonographic findings of a pyogenic abscess?
Complex mass
Gas
Reverberation artifact
pg. E 16
What does a pyogenic abscess appear similar to?
amebic abscess
pg. E 17
How can you differentiate a pyogenic abscess from an amebic abscess?
sonographically you cannot tell
it is seen in patients who are immigrants or travelers
pg. E 17
What is the sonographic appearance of candidiasis?
changes over the course of the disease "wheel within a wheel" "bulls eye" "uniformly hypoechoic" "echogenic focus" pg. E 17
How can you get an echinococcal cyst?
found in sheep herding countries from ingesting tapeworms eggs from an infected sheep
pg. E 18
What is the sonographic appearance of echinococcal cysts?
“cyst within a cyst”
“water lily” sign
pg. E 18 H 256
What is schistosomiasis and what can it cause?
parasite that can cause portal hypertension
pg. E 19
What are the sonographic findings of schistosomiasis?
thickened portal vein walls
occluded portal veins
pg. E 19
What is the most common organism that causes AIDS?
pneumocystic carinii
pg. E 20 H 256
What are the sonographic characteristics of pneumocystic carinii?
diffuse nonshadowing echogenic foci within the liver
pg. E 20 H 256
What are the sonographic findings of a patient with AIDS?
hepatomegaly splenomegaly lymphadenopathy pneumocystis carinii fatty liver non-hodgkin's lymphoma candidiasis cholangitis (inflammed bile ducts) cholecystitis pg. E 20
What are some of the most common causes of fatty liver?
obesity
excessive alcohol intake
diabetes
pg. E 21 H 235
What is another name for fatty infiltration?
Fatty steatosis
pg. E 21
What is focal fatty infiltration?
focal areas of increased echogenicity within a normal liver parenchyma
pg. E 21
Where is focal fatty infiltration most common?
at the porta hepatis
pg. E 21
What is focal fatty sparing?
focal areas of decreased echogenicity in a fatty liver
pg. E 21
What are some common causes for cirrhosis?
Hepatitis
Alcoholism
Fatty Liver
pg. E 22
What liver function tests are elevated with cirrhosis?
AST ALT bilirubin LDH GGT pg. E 22
What are the sonographic findings of cirrhosis?
Acute - hepatomegaly Chronic - atrophic liver caudate lobe enlargement nodular surface fatty infiltration pg. E 22
What is the most common cause of cirrhosis today?
Hepatitis C
pg. E 22
What is the diameter of the portal vein when it is considered portal hypertension?
13 mm or greater
pg. E 23
What is the most common cause of portal hypertension?
cirrhosis
pg. E 23
What are the sonographic signs of portal hypertension?
increase in diameter of vessel collateral vessels form ascites splenomegaly pg. E 23
What are some techniques to lower portal hypertension?
portacaval shunt
splenorenal shunt
TIPS
pg. E 23
What are some of the physical signs of collaterals?
dilated veins on anterior abdominal wall
hemorrhoids
acites
pg. E 24
What is the role of a TIPS procedure?
lowers portal hypertension
pg. E 25
Where is a TIPS shunt placed?
inserted at the jugular and placed between a hepatic v and a portal v (right is most common)
E 25
Which direction should the flow of the RPV and LPV be with a patent shunt?
hepatofugal
E 25
What is the most common indication for a liver transplant in an adult?
cirrhosis
E 26
What is the most common indication for a liver transplant in children?
biliary atresia
E 26
What is the scoring system for staging liver disease?
MELD -The Model for End-Stage Liver Disease
E 26
What are the sonographic findings of portal vein thrombosis?
hypoechoic thrombus within the portal vein increased portal vein caliber cavernous transformation portal systemic collaterals E 27
What are the causes of portal vein thrombosis?
Hepatocellular carcinoma Metastatic liver disease pancreatic carcinoma cirrhosis E 27
What is Budd-Chiari Syndrome?
Disorder characterized by hepatic vein obstruction
E 28
What are the causes of Budd-Chiari Syndrome?
idopathic (50% of cases) congenital infection pregnancy tumors E 28
What kind of cyst within the liver would cause RUQ pain and a decreasing hematocrit?
hemorrhagic cyst
E 29
What is the most common benign tumor of the liver?
cavernous hemangioma
E 30
What are the sonographic characteristics of a hemangioma?
hyperechoic
posterior acoustic enhancement
generally no flow
E 30
What are the sonographic characteristics of focal nodular hyperplasia?
solid mass with varying echogenicity solitary central fibrous scar stellate vascularity E 31
What is a cause for hepatic adenomas?
oral contraceptive use
E 31
What is a hepatic lipoma?
rare fatty tumor of the liver
E 32
What are the hyperechoic hepatic masses?
Hemangioma
Hepatic lipoma
Focal fatty infiltration
E 32
What is the most common malignancy of the liver?
Hepatocellular carcinoma
E 33
Hepatocellular carcinoma is seen in patients with ___.
cirrhosis
E 33
What malignant liver neoplasm is seen in infants and children?
hepatoblastoma
E 35
AST and ALT are increased in what diseases?
Fatty liver
excessive alcohol intake
Hepatitis
E 36
Alpha Fetoprotein (AFP) is increased in what diseases?
Hepatocellular Carcinoma Germ Cell Tumors Hepatoblastoma Metastatic liver cancer E 37