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Abdomen > Liver Anatomy > Flashcards

Liver Anatomy Flashcards

0
Q

What is a liver lobule composed of?

A
  1. Portal triad
  2. Sinusoid
  3. Central vein
  4. Hepatocytes- produce bile
  5. Kupffer cells- phagocytosis and detoxification
  6. Bile canaliculi- drain bile
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1
Q

What is the functional unit of the Liver?

A

Liver lobule

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2
Q

What is the functional cell of liver?

A

Hepatocyte

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3
Q

Portal triad

A

Portal vein, hepatic artery, bile duct.

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4
Q

Extrahepatic portal triad

A

Proper hepatic artery, main portal vein, cbd/chd

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5
Q

What is ampulla of vater?

A

An opening of the second part is of the duodenum, near the pancreatic head

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6
Q

Explain the pathway of bile

A

Hepatocytes&raquo_space; canaliculi&raquo_space; interlobar duct&raquo_space; R & L hepatic duct&raquo_space; Common hepatic duct&raquo_space; joins cystic duct to become&raquo_space; CBD

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7
Q

What is bile made of?

A

Bile salts, bilirubin, amino acids, cholesterol and water

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8
Q

What is cholecystokinin (CCK)

A

Hormone produced by the upper intestine and released when eating fatty food. It makes the GB contract and release bile.

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9
Q

Liver/ Blood reservoir

A

1500 ml of body’s vol flow rate/min through liver
1000-1100 ml/min of blood flows through the portal veins
350-400 ml/min through hepatic artery
The liver has a capacity to enlarge and store 200-400 ml of blood

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10
Q

Detoxification function of Liver

A

The liver converts foreign molecules and hormones to safer compounds that are not as toxic.
Ex: when a.a. Are burned for energy they leave behind the nitrogenous waste that is converted to urea by the liver.
ATP & ADP (forms of energy) is converted to ammonia in the urine.

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11
Q

Lymph formation by the liver

A

The liver produces 1/3-1/2 of the body’s lymph fluid

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12
Q

Acute and chronic hepatitis

A

May be mild or severe.
A, B, C, D, E
These account for 95% of all hepatitis cases

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13
Q

What are the pathological features of viral hepatitis?

A
  1. Liver cell damage
  2. Hepatomegaly
  3. Cellular degeneration and necrosis
  4. Regeneration
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14
Q

Clinical features of hepatitis

A 
Headache
Nausea and vomiting 
Fatigue
Jaundice, dark urine
RUQ Tenderness
Symptoms usually resolve completely in less than 6 weeks with bed rest
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15
Q

What is interferon

A

An into-viral drug used to treat HBV (hepatitis B virus)

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16
Q

What are the lab values for hepatitis?

A 
⬆️ ALT (SGPT)
⬆️ AST (SGOT)
⬆️ bilirubin
⬆️ WBC
⬆️ PTT
Dark urine
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17
Q

What is the sonographic appearance of acute hepatitis?

A

Hepatomegaly
Parenchyma becomes hypoechoic
Vessel walls become more echogenic
Looks like starry sky liver

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18
Q

Chronic hepatitis

A

HBV, HCV, Alcohol

3-6 months of inflammation

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19
Q

What is the sonographic appearance of chronic hepatitis?

A

Small echogenic liver
Leads to cirrhosis- permanent damage

Thickened GB wall seen in both acute and chronic hep.

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20
Q

What is cirrhosis?

A

A progressive, irreversible disease of liver.
Liver cells degenerate faster than they can generate.
Grows over scar tissue
Normal architecture is destroyed

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21
Q

What is cirrhosis etiology?

A
  1. Alcoholism
  2. HCV
  3. Biliary malfunction
  4. Drugs, toxins and infection
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22
Q

What are the clinical signs and symptoms of cirrhosis?

A 
>Early stage may be asymptomatic.
>Later stage: scar tissue (fibrosis), causing:
Exhaustion
Loss of appetite
Nausea
Weakness 
Weight loss
Abdominal pain
Fatigue
>Final stage: ascites and portal hypertension
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23
Q

Lab values of cirrhosis

A

⬇️ albumin
⬆️ liver enzymes (SGPT, SGOT)
⬆️ indirect bilirubin
⬆️ PTT

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24
Q

What are the 3 stages of cirrhosis?

A
  1. Tissue necrosis
  2. Tissue regeneration
  3. Fibrosis

*When fibrosis overwhelms regeneration, the liver will become atrophic and eventually fails.

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25
Q

What is the sonographic appearance of early cirrhosis (stage 1)

A

Hypoechoic

Hepatomegaly

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26
Q

What is the sonographic appearance graphic appearance of stage 2 cirrhosis?

A

Increased liver echogenicity
Atrophy
Ascites
Irregular shape of liver, surface nodularity

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27
Q

With alcoholic cirrhosis, what kind of bilirubin is increased?

A

Indirect bilirubin, Unconjugated, fat soluble.

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28
Q

With biliary cirrhosis what kind of bilirubin is increased?

A

Direct bilirubin, conjugated, water soluble

29
Q

What is the most common cause of intrahepatic portal hypertension?

A

Cirrhosis. Occurring in 90-95% of cases

30
Q

What causes portal hypertension?

A 
Cirrhosis 
Portal and splenic vein thrombosis
Budd chiari syndrome
Sepsis- blood infection
Pancreatitis
31
Q

Intrahepatic portal hypertension causes

A

Cirrhosis
Portal-splenic vein thrombosis
Budd chiari syndrome

32
Q

Extrahepatic portal hypertension causes

A

Sepsis

Pancreatitis

33
Q

What will portal hypertension cause?

A
  1. Gastroesophageal varices: resulting in GI bleed
  2. Caput Medusae: varicose veins radiating from the umbilicus
  3. Splenomegaly, SMV, IMV, hemorrhoidal veins will dilate
  4. Ascites
  5. Hepatic failure
34
Q

What is T.I.P.S.?

A

Trans-Jugular Intrahepatic Porto-Systemic Shunt

*Used to treat portal hypertension

35
Q

What is the sonographic appearance of portal hypertension?

A

Depending on degree of venous obstruction:

  1. Abnormal portal flow
  2. Non-visualization of hepatic veins
  3. Splenomegaly >12 cm
  4. Recanalized ligamentum teres
  5. PV diameter > 13mm
  6. Portal venous pressure is > 30mmhg
  7. Caudate lobe enlargement
36
Q

What is hepatic encephalopathy?

A

Altered mental states as a result of high toxins in the blood

37
Q

What is non-alcoholic steatohepatitis?

A

Serious form of fatty liver found in some people with non-alcoholic fatty liver disease causing inflammation and scarring in liver. At its most severe state it can progress to liver failure.

38
Q

What is fulminant hepatic failure?

A

Acute liver failure, causing excessive bleeding and increased pressure in the brain.

39
Q

Signs and symptoms of Acute Liver Failure

A 
Jaundice
RUQ pain
Nausea/vomiting
Difficulty concentrating 
Disorientation or confusion
Sleepiness
40
Q

What are the causes of acute liver failure?

A

When liver cells are damaged and no longer able to function.
Acetaminophen overdose *most common cause in U.S.
Antibiotics, anti-inflammatory drugs, anticonvulsants
Herbal supplements, such as kava, ephedra, skullcap, pennyroyal.
Hepatitis and other viruses
Toxins such as poisonous wild mushroom
Autoimmune disease
Budd chiari syndrome
Metabolic disease such as Wilson’s disease, acute fatty liver of pregnancy
Cancer
Some have no apparent causes

41
Q

What is should the gallbladder wall measure under ultrasound?

A

Less than 3 mm in thickness

42
Q

What is secretin?

A

Hormone that stimulates the production of bile

43
Q

What are the anatomical components of the gallbladder?

A

Neck aka infundibulum or hartman’s pouch
Body
Fundus

44
Q

What is the size of the gallbladder?

A

Length: 10 cm or less
AP: no more than 4 cm
Wall should be less than 3 mm in thickness

45
Q

When is the gallbladder considered contracted?

A

When measuring less than 2 cm in diameter after appropriate fasting

46
Q

What is hydropic gallbladder?

A

When the GB is larger than normal
> 4 cm AP diameter
Over distended

47
Q

What are the gallbladder variants?

A

Junctional folds- fold between neck and body

Phrygian cap- fold between body and fundus

48
Q

What are Heister Valves?

A

Valves located in the cystic duct that regulate flow in and out of GB.
Keep cystic duct from collapsing or folding.
May shadow and should not be confused for stone

49
Q

What is the size of the intrahepatic bile ducts?

A

< 2 mm

50
Q

Bile duct measurements

A

CHD 5mm or less

CBD 5 mm or less and 1 mm for each decade of life after the 5th decade

51
Q

What is the proper form of measuring CBD?

A

Distally from inner wall to inner wall

52
Q

What are the clinical signs and symptoms of acute cholecystitis?

A 
Positive murphy's sign
Fever
Increased WBC 
Increased bilirubin 
Increased ALP
53
Q

What are the clinical signs and symptoms of chronic cholecystitis?

A

Possible increase in WBC
Possible normal lab values
Not as painful as acute

54
Q

What are the song graphic features of acute cholecystitis?

A

Diffusedly thickened GB wall > 3 mm (striated wall appearance)
Pericholecystic fluid/subserosal edema around GB (halo sign)
Hydropic/cholecystomegaly
Stones
Hypervascularity of the wall
Possible choledocholithiasis

55
Q

Sonographic features of chronic cholecystitis?

A 
Diffuse wall thickening 
Contracted GB after NPO
Non-visualization due to contraction
Stone shadowing
WES sign (in long)
Double Arc sign (in trv)
Post wall will be shadowed out
56
Q

What is cholangitis?

A

Inflamed bile duct or entire biliary tree

57
Q

Etiology of cholangitis

A

Cholelithiasis

Cholecystitis

58
Q

Sonographic appearance of cholangitis

A

Dilated intrahepatic and extrahepatic ducts

59
Q

What complication can arise from acute cholecystitis?

A

Stone obstructs cystic duct, in result obstructing venous drainage and inflammation of GB wall with variable degree of necrosis and infection

60
Q

What causes sludge in GB?

A

Fasting

Obstruction may lead to acute cholecystitis

61
Q

What is hepatization of GB?

A

Sludge that totally fills the gallbladder so that its contents become isle choir with liver

62
Q

What is timer active sludge?

A

Sludge is not mobile, rounded, non-shadowing, medium level echogenic masses in the dependent portion of the gallbladder

63
Q

What is hemobilia?

A

Bleeding into the biliary tree associated with hepatic biopsy, rupture of hepatic artery and blunt abdominal trauma

64
Q

What is hydrops of the gallbladder?

A

Distended, non-inflamed gallbladder due to total obstruction of the cystic duct
Trapped bile is re absorbed and GB is filled with a clear mucinous secretion derived from the mucosa

65
Q

Signs and symptoms of hydrops of the GB

A

Asymptomatic
May present as a palpable RUQ mass

The diagnosis should be suspected on ultrasound when an obstructing stone is noted in an enlarged but non-tender GB

66
Q

What kind of gallstones are there?

A

80% of cholesterol
Black pigment stones
Brown pigment stones

67
Q

When do cholesterol stone form?

A

When bile contains too much cholesterol
Too much bilirubin or not enough bile salts or lecithine
When the GB does not empty often

68
Q

What causes black pigment stones?

A

Too much bilirubin in bile
Associated with hemolytic anemia such as thalacemia, sickle cell anemia and malaria
Cirrhosis of liver
They are black and hard

69
Q

What causes brown stones?

A

Infection ascending from duodenum into bile duct or GB
Bacteria alters bilirubin pigment and combines w fat in bile to form gallstone
They are softer than black pugment gallstones

70
Q

Who is at risk for gallstones?

A 
Those who prolong fasting, dieting, fat free diets or fluid diets. 
More common in women than men 4:1
Increased prevalence with age (3,4th decade)
Overweight Individuals
Pregnancy due to rise in cholesterol
Hormone therapy/birth control
Crohn's disease
Cystic fibrosis of liver
71
Q

What are the symptoms of gallstones?

A 
Biliary colic
Pain under Rt shoulder- may radiate to the back between shoulder blades
Nausea vomiting 
Abdominal bloating
Intolerance of fatty food
Belching
Flatulence 
Indigestion

Abdomen (10 decks)

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