Liver Flashcards
Codate lobe
- small lobe located on the posterior and superior surface of the left lobe
- located anterior to the IVC
- superior to the porta hepatis
Albumin _________ with chronic liver disease
Decreases
Cirrhosis
- long term/multiple attacts on the liver destroying normal architecture
- looks shrunken may see nodules
- Leading cause is alcohol abuse
- Shrinks liver and causes abnormal buildup of fluid in the abd known as ascites
Right Portal Vein
Larger of the two branches
Runs lateral into the right lobe
Anterior and posterior branches
falciform ligament
- Liver is suspended from the diaphragm and the anterior abdominal wall by this ligament.
- Fold of peritoneum extends from liver to abdominal wall
- Divides the medial and lateral segments of the left lobe
Main lobar fisher
- Best seen in sag
- Splits left and right lobe anatomically
- Connects Right portal vein and gallbladder
Hepatic arteries
Carry blood to the liver from the aorta - oxygen
Amebic (parasitic) abscess
- Caused by parisite
- Patients usualy have a hx of traveling out side the country
Echogenic Metastases
- GI tract
- colon
Couinaud’s 9 segments of the liver
I - Caudate Lobe
II - Left lobe lateral superior
III - Left lobe lateral inferior
IVa - Left lobe medial superior
IVb - Left lobe medial inferior
V - Right lobe anterior inferior
VI - Right lobe posterior inferior
VII - Right lobe posterior superior
VIII - Right lobe anterior superior
Hypoechic Matastases
- Breast cancer
- lung cancer
- lymphoma
Bare area
a large area of liver without peritoneum where the diaphragm makes contact
Hepatitis
Inflamation of the liver
As a sonographer we look at liver size/ any change in liver it self (i.e. tecture)
Diferant types;
A - fecal/oral
B - Blood/bodily fluids
C - Blood
Glisson’s Capsule
dense, fibroelastic, connective tissue layer surrounding liver- pain is felt here when liver swells.
Cavernous hemangioma
- Most common Benign hepatic tumor
- Homogeneous, hyperechoic with sharp margins
- comes in 1 maybe 2
Diseases affecting the liver may be classified as…..
- Hepatocellular-when the liver cells or hepatocytes are affected:
- Hepatitis, cirrhosis, fatty liver, hepatocellular carcinoma
- Treated medically via drugs and other supportive methods
- Obstructive-when bile excretion is blocked
- Gallstones and/or tumor.
- Treated by surgical intervention
Hepatocellular carcinoma
- Also known as Hepatoma
- Primary liver cancer
- Persons with cirrhosis at high risk
- Usualy:
- before 40
- Most common in 6th decade
- not as common as metastatic disease
The 3 structures termed the
Portal Triad
- Portal Vein
- Proper hepatic Artery - anterior and to the left of the portal vein
- Common hepatic bile duct - anterior and to the right og the portal vein
Ligamentum teres (round ligament)
- a remnant of the umbilical vein of fetal circulation, attaches to the left portal vein.
- Runs with the falciform ligament.
- Divides medial and lateral segments of the left lobe.
- Best seenin transverse, inferior to left portal vein
Glycogen storage disease
Autosomal recessive disorder that causes excessive glycogen to be stored in the liver
Multiple hypoecoic masses in bright/fatty liver - will need to know pt hx
*Disorders of metabolism*
Benign
Porta Hepatis
Where triad enters liver
LOCATION
Echinococcus cyst (hydatid disease)
- Parasitic tapeworm
- sonographic appearance
- Water lily sign
- Mother daughter
- honey-comb
Fatty Liver & Sonographic appearance
- Fatty infiltration or steatosis
- accumulation of fatty deposits within the liver cells.
- Benign
- Reversible disorder of **metabolism**
See at Liver kidney interface
Increased echogenicity – bright when compared to the kidney.
Renal cortex will appear hypoechoic.
Fatty Sparring
Part of the liver is spared of fat. Normal liver tissue is spared of the echogenic fatty infiltration.
seen near gallbladder/portal vein
Bull’s Eye or Target pattern
- Lung Cancer (bronchogenic)
- Colorectal Cancer
Main portal vein
- Approaches the porta hepatis toward the right and anterior to IVC
- Enters the liver, divides into two branches
- Formed from junction of SMV and splenic vein
- NOT A BRANCH OF IVC
Left Portal Vein
Anterior and superior than the RPV
Medial and lateral branches
Metastatic Disease
- Secondary tumors
- More common than hepatoma
- “Silent Killer”
- symtoms
- Jaundice
- pain
- Nutritional & muscle wasting
- symtoms
- Several types
- Most common
- GI tract (COLON)
- breast
- lung
- Most common
Focal nodular hyperplasia
FNH
- Rare Benign tumor
- Nodule of extra normal liver tissue
- Females - before 40 on long-term oral contraceptive
- sonographic appearance;
- Hypoecoic, isoechoic or hyperecoic compared to normal surrounding tissue
- <8cm
Hepatic adenoma
- True Neoplasms
- Uncommon
- Females of childbearing are-long time oral contraceptive use.
Anatomicly, THIS seperates the liver into the right and left lobe
Main lobar fisher
Schistosomiasis
- Parasitic
- Parasites in the portal vein walls
- sonogrphic appearance;
- Thinkend/ecogenic portal vein walls
- dilation of MPV - portal HTN
Ligamentum Venosum
- Best seen in Sag
- Seperates left and codate lobe
Fungal (candidiasis) abscess
- Usualy in patinets with compromised ammune systems (i.e. HIV, chemo tratments)
liver and trauma
Trauma can cause Hematoma
new - anicoic
more ecogenic as it ages
Name the 3 lobes of the liver
Right
Left
Codate
Hepatic Veins
- Right (RHV) - largest, and enters the right lateral aspect of the IVC.
- Mid (MHV) - enters the anterior or right anterior aspect of the IVC.
- Left (LHV) - smallest, enters the left anterior surface of the IVC.
** less echogenic due to less collagen**
**Drain Blood from liver into IVC-Detox**
The main portal vein enters the liver and divides into what two branches
The _______ _______ ______ enters the liver and divides into the right and left portal vein.
Right - Larger of the two, runs lateral into the right lobe. Anterior and posterior branches
Left - anterior and superior to RPV. Medial and lateral branches
- portal veins -carry blood from the bowel to the liver - nutrients*
- More ecogenic walls*
Pyogenic (Bacterial) Abscess
- Bacteral infection - may be from recent ABD sx
- Fever and/or high WBC
Bile Ducts
Transport bile, manufactured in the liver, to the duodenum - digestion
8 fuctions of the liver
- Metabolism
- Digestion
- Storage
- Iron, Copper, Vitamins
- Detoxification
- Wast disposal and excretion
- Through bile
- Hemopoiesis before birth
- Production of RBC’s
- Reservoir for Blood
- Heat production
Budd-Chiari Syndrom
Thrombosis in the hepatic veins and/or IVC
