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ABD > Liver A & P > Flashcards

Liver A & P Flashcards

1
Q

What are the three lobes of the liver?

A

right, left, and caudate

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2
Q

T/F - In the event of caudate lobe enlargement, the IVC may be compressed.

A

true

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3
Q

The caudate lobe is located:

_______ to the ligamentum venosum; _______to the porta hepatis; _______ and _______ to the IVC; _____ to the lesser sac.

A

posterior, posterior, anterior and medial, lateral

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4
Q

Caudate lobe receives branches from the ____ and _____ portal veins and its venous drainage is directly into the IVC via the small _______ veins.

A

right and left, emissary veins

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5
Q

List the 8 segments of the liver.

A 
I caudate
II left lateral superior
III left lateral inferior
IVa left medial superior
IVb left medial inferior
V right anterior inferior
VI right posterio inferior
VII right posterior superior
VIII right anterior superior
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6
Q

The hepatic veins are ________, while the vessels of the portal triad are _______ and encased by a fibrofatty sheath known as _______ _______.

A

intersegmental, intrasegmental, Glisson’s capsule

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7
Q

What divides the right and left hepatic lobes?

A

main lobar fissure

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8
Q

What divides the anterior segment of the right lobe from the medial segment of the left lobe?

A

main lobar fissure

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9
Q

The _____ is identified between the GB neck and the junction of the right and left ______ veins.

A

MLF, portal

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10
Q

The RHV divides the right lobe into ______ and _______ segments, aka right intersegmental fissure.

A

anterior, posterior

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11
Q

The _____ is identified between the GB neck and the junction of the right and left ______ veins.

A

MLF, portal

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12
Q

What are the 4 landmarks for the left intersegmental fissure?

A

LHV, ascending LPV, falciform ligament, ligamentum teres

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13
Q

Ligamentum venosum is a remnant of the _____ ______.

A

ductus venosus

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14
Q

What separates the left lobe from the caudate lobe?

A

ligamentum venosum

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15
Q

What are the 3 landmarks for the MLF?

A

GB (inferior end of MLF), IVC, MHV

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16
Q

________ _______ runs from the LPV to the IVC seperating the left lobe from the caudate lobe.

A

ligamentum venosum

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17
Q

What is the name of the remnant of the umbilical vein that runs from the umbilicus to the LPV? Shortly after birth, the umbilical vein contracts down to form this.

A

ligamentum teres

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18
Q

With portal HTN, the _______ ______ recanlizes to form a portosystemic venous collateral.

A

ligamentum teres recanalizes in cirrhosis to function as a venous collateral

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19
Q

Describe direction of fetal circulation, starting at the liver.

A

umbilical vein (lig teres) - LPV - ductus venosus (lig venosum) - IVC

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20
Q

Why doesn’t the liver really infarct?

A

Because it has two sources of blood and would have to thrombose both to infarct.

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21
Q

Hepatopetal

A

flow toward the liver, “seeking”, “pedaling in”

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22
Q

Hepatfugal

A

flow away from the liver, “fleeing”

23
Q

Upper limits measurement for the portal vein diameter.

A

13mm, anything larger suggests portal HTN

24
Q

What are the two sources of blood flow to the liver, what percentage of flow do they each bring, and how much in total per minute?

A

portal vein (75%), proper hepatic artery (25%), 1500 mL/min

25
Q

What is the hepatic oxygenation breakdown between the two inflow vessels?

A

50% PHA and 50% PV, PV bigger but equally give oxygen

26
Q

Describe normal portal vein flow and what can happen with breathing after eating.

A

Usually low-velocity continuous flow with mild undulations in a healthy subject, monophasic. Increases and decreases with breathing. Flow velocity can increase after eating.

27
Q

The ______ _______ is the functional separation of the RT and LT lobes of the liver.

A

portal system

28
Q

Caudate lobe is located on the _____-______ surface of the liver, between the IVC and medial left lobe of the liver.

A

posterior-superior

29
Q

Imaging the liver, when angling superior and transversely, what segments are visualized?

A

7, 8, 4a and 2

30
Q

Imaging the liver, when angling inferior and transversely, what segments are visualized?

A

6,5,4b and 3

31
Q

List the respective segments for left lateral, left medial, right anterior, and right posterior sectors.

A

Left lateral - II and III
Left medial - IVa and IV b
Right anterior - V and VIII
Right posterior - VI and VII

32
Q

Describe normal hepatic vein waveforms.

A

triphasic (reflecting right atrial filling, contraction, and relaxation), phases above and below baseline, pulsatile

33
Q

The proper hepatic artery runs parallel to the MPV and is located ______ and to the ____ of the MPV.

A

anterior, left

34
Q

T/F - The RHA and LHA typically arise from the proper hepatic artery in approx 55% of patients.

A

True

35
Q

Replaced RHA may originate from the SMA in approx ______ % of patients. It would be seen posterior to the head of the pancreas and MPV.

A

11%

36
Q

Replaced LHA may originate from the left _____ artery in approx 10% of patients.

A

gastric

37
Q

Describe normal hepatic artery waveforms.

A

Low-resistance (flow through diastole), parabolic, turbulent with spectral broadening

38
Q

Describe hepatic artery waveform that suggests transplant rejection.

A

high-resistance suggests more commonly venous congestion or possible organ rejection

39
Q

What is the significance of a post-operative hepatic liver transplant with parvus tardus hepatic artery waveform?

A

suggests proximal anastomotic stenosis (>50%)

40
Q

Hepatic ligaments (5)

A

lig. teres, falciform lig., coronary lig, right and left triangular ligs

41
Q

_______ ________ is a peritoneal reflection or fold created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of the portal vein.

A

Falciform lig, may see suspended with ascites surrouding

42
Q

What peritoneal reflections suspend the liver from the diaphragm and surroud the bare area of liver?

A

Coronary lig

43
Q

Liver area that is in direct contact with the diaphragm, is not part of the peritoneal space, and does not accumulate ascites.

A

Bare area

44
Q

What are the peritoneal reflections to the far right and left of the bare area?

A

RT and LT triangular lig

45
Q

Liver size will vary with height, weight, and body surface area. Hepatomegaly is indicated in 75% of patients with a > than _____cm superior-inferior dimension.

A

15.5cm

46
Q

What is Riedel’s lobe?

A

inferior projection of the RT lobe commonly seen in women and may be mistaken for hepatomegaly (Tip: if LT lobe is small and RT lobe is big, likely Riedel’s lobe)

47
Q

Describe liver echogenicity.

A

homogeneous and slightly hyperechoic compared to the normal renal cortex

48
Q

Hyperechoic

A

echoes greater than

49
Q

Hypoechoic

A

echoes less than

50
Q

Isoechoic

A

echoes equal

51
Q

Anechoic

A

without echoes

52
Q

Sonolucent

A

without echoes

53
Q

Put in order of decreasing echogenicity (Spleen/Liver, Pancreas, Renal Sinus, Renal Cortex)

A

renal sinus>pancreas>spleen/liver>renal cortex

ABD (20 decks)

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