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Liver ch.9,ch.12 > Liver ch.9, ch.12 > Flashcards

Liver ch.9, ch.12 Flashcards

1
Q

How long is the liver

A

15cm LONG (13-17cm) is largest abdominal organ

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2
Q

a parenchymal liver cell that preforms all the functions ascribed to the liver

A

Hepatocyte

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3
Q

Kupffer cells

A

specialized phagocytes in the liver; act as the liver’s defense against bacteria/viruses

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4
Q

Foregut

A

Where liver developes from

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5
Q

Vitelline duct

A

yoke duct

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6
Q

4th week of primitive ducts and 4 parts

A

foregut
midgut
handgun
tailgut

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7
Q

Tailgut

A

gets reabsorbed

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8
Q

kidneys genicity

A

hypoechoic/isoechoic

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9
Q

spleen genicity

A

isoechoic

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10
Q

pancreas genicity

A

echogenic

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11
Q

liver genicity

A

hypoechoic in general

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12
Q

Where does the liver lie in quadrant

A

right Hypochondrium (RUQ)
Epigastrium and left hypochondria (LUQ)

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13
Q

Where does stomach lie

A

Lateral to the left lobe- best seen on TRV

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14
Q

Portal triad

A

Bileduct
hepatic artery
portal vein

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15
Q

What separates the Lateral section from the medial section

A

Ligamentum venosum

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16
Q

How many and what are the lobes of the liver?

A

4 Lobes. Left, quadrate, caudate, right

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17
Q

Couinauds system of hepatic nomenclature

A

Divides the liver based on the vasculature and has more value from a surgical perspective (punctually divided)

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18
Q

has medial and lateral. sections

A

the left lobe

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19
Q

Ligamentum venosum

A

After birth, The ductus venous (Umbilical vein) BECOMES Ligamentum venous

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20
Q

is functionally the medial segment of the LT lobe that lies between the MHV and the LHV

A

Quadrate lobe

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21
Q

Small lobe on posterior surface of LT lobe, Lig, venos. is anterior border of the __ Lobe
IVC is commonly on the posterior border

A

Caudate Lobe

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22
Q

Has anterior and posterior sections

A

Right lobe

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23
Q

Can be seen as a tongue like projection off the RT Liver. Extending inferiorly to the iliac crest

A

Reidels lobe

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24
Q

Thin connective tissue covering the liver

A

Glissons capsule

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25
Q

Separates the LT and RT lobes of the liver. seen sonographically as an echogenic, linear structure between the GB and MPV

A

Main lobar fissure

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26
Q

extends from the diaphragm to the umbilicus and contains the ligamentum teres; attaches the liver to the anterior abdominal wall; best seen in pt with ascites

A

Falciform Ligament

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27
Q

AKA lig T/round ligament; remnant of the umbilical vein; the round, echogenic structure seen within the LT lobe of the liver; intrahepatic portion of the falciform ligament; “rounded termination” of the falciform
ligament

A

Ligamentum teres

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28
Q

remnant of the ductus venosus (umbilical vein) in fetal; separates LT lobe from the caudate lobe; linear, echogenic line anterior to caudate

A

Ligamentum venosum

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29
Q

How many segments are there to the liver

A

8 segments

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30
Q

what vein joins the splenic vein

A

IMV

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31
Q

what two veins join to make the MPV

A

Splenic vein

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32
Q

What does MPV branch into

A

RPV ans LPV

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33
Q

What does RPV branch into

A

Anterior and posterior branches (splits liver)

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34
Q

What does LPV branch into

A

Medial and lateral

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35
Q

What is the normal diameter of MPV

A

0.7-1.3cm

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36
Q

What kind of echogenicity are HVs surrounded by?

A

No echogenic walls

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37
Q

What kind of echogenicity are PVs surrounded by?

A

Echogenic walls

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38
Q

What are the primary functions of the liver

A

Detoxification
digestion/excretory
metabolic
storage

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39
Q

What are detox functions

A

Detoxification of waste products. Nitrogen>Ammonium>Urea (goes to kidney)

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40
Q

An increase in ____ Can cause brain dysfunction

A

Ammonium

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41
Q

____ a product that breaks down hemoglobin, results in Jaundice, and a concentration in this can test in a lab for hepatocelluar disease

A

Bilirubin

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42
Q

What two affect the amount of bile salts available for fat absorption

A

Hepatocellular disease.(doesn’t work or failing)
and Biliary obstruction

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43
Q

____ are protein catalysts used throughout the body in all metabolic processes

A

Enzymes

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44
Q

What are the hepatobiliary Disease enzymes

A

Asparate aminotransferase (AST)(SGOT)

Alanine Aminotransferase (ALT) (SGPT)

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45
Q

when the liver cells or hepatocytes are the immediate problem; (ex: virus attacks liver resulting in alteration of liver function); treated medically

A

Hepatocellular disease

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46
Q

Sugars

A

Carbohydrates

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47
Q

Fats

A

lipids

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48
Q

Amino acids are basic components of ____

A

Proteins

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49
Q

Raw materials that for carbs, fats, and proteins are absorbed from the intestine and transported to the liver via PVs, Converted chemically to other compounds or processed for storage or energy production

A

Hepatic metabolic functions

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50
Q

Excess sugar can be stored in the liver in the form of ____

A

Glycogen

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51
Q

_1__ Can be absorbed from the blood in several forms, but only __2__ can be used by the body for energy.

A
  1. sugars
  2. glucose
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52
Q

n the liver, dietary fats are converted to __1___ which help move __2__ throughout your body

A
  1. Lipoproteins
  2. Cholesterol
53
Q

to __1__ a substance means to produce it by means of chemical or biological reactions.

A

synthesize

54
Q

if the liver isn’t functioning properly, it cannot convert fats to lipoproteins or produce cholesterol, thus cholesterol levels _____

A

decrease

55
Q

is a protein produced in great quantities in the liver; albumin functions as a transport medium for certain molecules in the blood stream..helps to maintain oncotic pressure within the vascular system; it draws fluid INTO the vascular system from the surrounding spaces (acites)

A

Albumin

56
Q

the pressure exerted by plasma proteins on the capillary wall

A

oncotic pressure

57
Q

When the liver has advanced disease hypoalbuminemia occurs and this causes a _____ in pressure in the vascular system.

A

DECREASE

58
Q

a product from the breakdown of hemoglobin in tiredRBCs- the liver secretes them as bile; severe increase in biliaryobstruction

A

Bilirubin

59
Q

unconjugated bilirubin; elevation ofthis test result is seen with increased RBC destruction(ex: anemia, trauma from a hematoma)

A

indirect bilirubin

60
Q

conjugated bilirubin; elevation of thistest is usually related to obstructive jaundice

A

direct bilirubin

61
Q

if ___ direct and indirect bili are elevated= hepaticMETs, hepatitis, lymphoma, cholestasis secondary to drugs, and cirrhosis.

A

Both

62
Q

a low serum albumin suggests hepatocellular damage

A

albumin

63
Q

liver enzyme that is part of blood clotting mechanism; prothrombin time is increased in the presence of liver disease with cellular damage

A

Prothrombin time

64
Q

LTS

A

How the liver is preforming

65
Q

What normal liver anatomy and texture is?

A

Typically the liver is 13-17cm SAG/LONG axis

The liver is isoechoic/hyperechoic to the kidneys*

The liver is isoechoic to the spleen.

The liver is hypoechoic to the pancreas.

66
Q

anatomic variant; this is a tongue-like extensionof the RT lobe of the liver and it may extend down to the iliaccrest; do not confuse this with hepatomegaly! (Is the liverotherwise diseased? Bloodwork?)

A

Reidels lobe

67
Q

____ of the liver is incompatible with life

A

agenesis

68
Q

CHA may have variations as it arises from the celiac axis; malformations of vasculature within the liver

A

vascular abnormalities

69
Q

situs in versus, congenital diaphragmatic hernia, or omphalocele

A

variations in anatomical position

70
Q

uncommon, caused by unfolding of peritoneum

A

Accessory fissures

71
Q

just as it states: ____ hepato cellular disease affects the liver as a whole and interferes with liver function

A

diffuse disease

72
Q

What is more hypoechoic in a fatty liver?

A

Kidney

73
Q

A portion of live is fatty is called ___

A

Focal fatty infiltration

74
Q

The liver is almost completely fatty but some areas are spared of being fatty (ex.caudate)

A

Focal fatty sparing

75
Q

General name for inflammatory infectious disease of liver. Usually caused by virus.

A

Hepatitis

76
Q

Without complications recovery in 4 months

Increased AST, ALT, increased bilirubin, leukopenia,flu-like symptoms,

GB wall thickened, “starry sky”

A

Acute hepatitis

77
Q

Exists when inflammation extends beyond 6 mos,
Pts may present with anorexia, tumors, jaundice and dark, urine fatigue, and varicosities

A benign process but will eventually progress

Liver is course with some echogenicity (makes portal veins harder to see

A

Chronic hepatitis

78
Q

Infection caused by a group of viruses that specifically target liver

Pts present clinically with flu like symptoms and gi issues AKA loss of appetite N&V and fatigue

A

Viral hepatits

79
Q

Primarily spread by fecal contamination

A

Hepatitis A

80
Q

Exists in bloodstream more common outside the US due to lack of vaccines. Can be transmitted through bloodstream bottle of fluids, infected blood or plasma and use of infected needles

A

Hepatitis B

81
Q

“Silent killer” doesnt show symptoms until to late and makes irreversible damage. Spread through blood contact

A

Hepatitis C

82
Q

Calls from chronic liver disease that progresses to the point of liver failure

A

Cirrhosis

83
Q

An auto immune disease that causes progressive destruction of the bile ducts

A

Biliary cirrhosis

84
Q

An inherited disease that causes copper to build up in the organs

A

Wilsons disease

85
Q

Inflammation and then hardening of bile ducts

A

Primary sclerosing cholangitis

86
Q

When you have cirrhosis, but aren’t symptomatic

A

Compensated cirrhosis

87
Q

You have cirrhosis and are showing symptoms

A

Decompensated cirrhosis

88
Q

Associated with chronic alcohol abuse

A

Micronodular

89
Q

Associated with chronic viral hepatitis or other infection

A

Macronodular

90
Q

Type of cirrhosis. First sonographic finding
Liver volume decreases in the right level. It increases in the left and caudate lobes.

Liver will eventually atrophy and spleen become inlarged

A

Liver parenchyma

91
Q

Portal HTN will likely present itself with or without normal blood flow
Spec wave is flattened in HV

The hepatic artery also shows in normal flow pattern with increased diastolic flow and a blunted peak systolic

A

Hemodymanics

92
Q

Abnormal accumulation in storage of glycogen in the tissues, especially the liver and kidneys

6 types and mist common is von gierkes disease

Hepatomegaly, increased echogenicity, some increased attenuation

A

Glycogen storage disease

93
Q

Rare disease of iron metabolism characterized by excess aron deposits througjout the body

Cirrotic like changes
Increased echogenicity

A

Hemochromatosis

94
Q

Developes secondary to congestive heart failure with signs of hepatomegaly

Labs might be sligtly elevated or normal.

Causes dialation of tbe HBs and IVC and potentially even the PV

A

Passive hepatic congestion

95
Q

Associated with cirrhosis, HVT, PVT, and thrombosis of the IVC
Caused by increased resistance to venous flow through the liver

Cannot process the blood , it backs up, and increases the pressure within the portal veins
Increase in pressure within liver
To relieve pressure pv create collateral channels to deal (varicose veins)

A

Portal HTN (hypertension

96
Q

What are the most frequent sites of pregnancy?

A

Esophagus, stomach, rectum

97
Q

What is another name for the left gastric vein

A

Coronary vein

98
Q

To release some pressure off the PVs the ligamentum teres can reopen to take some pressure off the liver

Liver typically looks abnormal-varies in severity

Ascites may be present

A

Recanalized umbilical vein

99
Q

MVP becomes thrombosed and it does not recanalize/open back up, small collateral channels can open up to drain the PV system into the liver

The vessels are small and serpiginous and drain deeped into the liver to bipass an old blockage (RPV/LPV)

A

Cavernous transformation of the portal vein

100
Q

What type of shunt drains portal-splenic confluence to IVC

A

Portacaval shunt

101
Q

What shunt attaches to tbe SMV to the IVC

A

mesocaval shunt

102
Q

What shunt Attaches the splenic vein to the renal vein

A

Splenorenal shunt

103
Q

What shunts are extrahepatic

A

Portacaval shunt
Mesocaval shunt
Splenorenal shunt

104
Q

What shunts are intrahepatic

A

Tranjugular inrahepatic portosystimic shunt

105
Q

TIPS. Drains the RPV into the RHV… and sometimes the RPV into the IVC

A

Transjugular Intrahepatic Portosystemic Shunt

106
Q

Clinically characterized by ascites.
Extensive untreated occlusion can be deadly within weeks

A

Budd-chiari syndrome

107
Q

Caused by congenital obstruction and presence of membranous webs in IVC (can be removed)

A

Primary budd-chiari

108
Q

Results from thrombosis and typically occurs in pts with predisposing conditions such as pregnancy, tumors, prolonged oral contraceptive use, infection or trauma

A

Secondary budd-chiari

109
Q

Usually refers to a solitary non parasitic cyst of the liver pts are often asymptomatic and require no treatment

Well defined
Thin walled
Anechoic
Posterior enhancement
May have internal septation- not as common

May contain calcification

A

Hepatic cyst

110
Q

Inherited in an autosomal dominant pattern
50-74% of polycystic renal disease will have one to several hepatic cysts

Cysts within the porta hep may enlarge and cause biliary obstruction

Liver function tests are usually normal

Multiple cysts of varying sizes throughout liver and parechyma

A

Polycystic liver disease

111
Q

Puss formed abscess (cluster)

Pt presents with fever, pain, pleurtus, N&V, and diarrhea

These abscesses are multiple in 67% of pts

Typically in central RT lobe

A

Pyogenic abscess

112
Q

Yeast/fungus

Occurs in immunocompromised pts

Nonspecific findings such as fever and leukocytosis

Bullseye target lesions
“Wheel within wheel”

A

Hepatic candidiasis

113
Q

A recessive genetic disorder in which phagocytes (unable to kill certain bacteria and fungi)
In children mainly boys
Reoccurring respiratory infections

A

Chronic granulomatous disease

114
Q

Collection of puss formed by disintegrated tissue… protozoan parasite,

The amoeba is contracted by ingesting contaminated food and water

Pts may be asymptomatic or may show GI symptoms of abdominal pain, diarrhea, and low grade fever

Variable and non specific
Round or oval
Lack notable defined walls
Internal echos/debris
Distal enhancement

A

Amoebic abscess

115
Q

Aka liver hydatid cyst
Tapeworm that infects humans

Has two layers inflammatory/ reactive layer and mother daughter (cyst develops from inner layer

“Waterlilly”
Honeycomb
Mother/daughter cyst (cyst within cyst)

A

Echinococcal cyst

116
Q

The most common organism causing an opportunistic infection in patients with AIDS

Affects undergoing bone marrow and organ transplantation. Or undergoing chemotherapy

A

Pneumocystis carinii

117
Q

infections that occur more
often or are more severe in people with weakened
immune systems than in people with healthy immune
systems

A

Opportunistic infection

118
Q

A neoplasm is any new growth of new tissue, either
benign or malignant.

A benign growth usually occurs but does not spread or
invade surrounding structures. It may push tissue aside
or adhere to them.

A malignant mass is uncontrolled and is prone to
metastasize to nearby or distant structures via the
blood stream or lymph nodes.

Primary malignant tumors are relatively rare in the liver.

A

Hepatic Tumors

119
Q

Blood vessel tumor

The most common benign neoplasm of the liver.

Pts are usually asymptomatic; a small percentage my
bleed causing RUQ pain.

Hemangiomas enlarge slowly and undergo
degeneration, fibrosis, and calcification.

They are usually found in the subcapsular liver (right
along the diaphragm) and are more common in the RT
lobe than the LT lobe.

round
posterior enhancement
detected with P doppler

A

Cavernous Hemangioma

120
Q

The second most common benign mass of the liver.

Hormonal influence; more common in women.

Clinically the pt is asymptomatic and the neoplasm is
incidentally found.

Difficult to distinguish from hepatic adenoma

Difficult to differentiate from liver tissue
is very isochoic to the liver

A

Focal Nodular Hyperplasia (FNH)

121
Q

benign tumor that consists of normal or

slightly abnormal hepatocytes- frequently
containing areas of bilestasis, focal hemorrhage,
or necrosis.

Found more commonly in women and has been
related to oral contraceptive use.

Also been found in men taking anabolic steroids.

Difficult to distinguish from FNH

Varied findings
varying echogenicity
central stat

A

Hepatic adenoma

122
Q

AKA hepatoma

The most common primary malignant neoplasm.

Strongly associated with chronic liver disease (cirrhosis,
hep B and hep C). Occurs more frequently in men.

Clinically pts present has having a hx of hep B/C or
cirrhosis, a palpable mass, hepatomegaly, appetite
disorder and fever.

Associated Lab Values:

Elevated AFP

Elevated LFTs

HCC may present in one of three patterns:
*massive solitary tumor
* multiple masses throughout liver
* diffuse infiltrative masses throughout liver

Variable apperance

A

hepato cellular Carcinoma

123
Q

a protein found
in developing fetuses; this protein rises with
the presence of HCC and hepatoblastoma

A

AFP: AKA alpha-fetoprotein

124
Q

The most common form of neoplasm
involvement.

The most common primary CA sites are: colon,
breast, and lung.

The most common location for METs to travel to
are the lung and liver.

Common to have involvement in both RT and LT lobes of liver

variable apperance (multiple lesions)
solitary hypo echoic mass
solitary echogenic mass
Bulls eye target lesion

A

Metastatic Disease (METS)

125
Q
  • Pt may present clinically with enlarged, nontender,
    lymph nodes, fever, fatigue, night sweats, weight loss,
    bone pain, and abdominal mass.

Sonographic Appearance

hepatomegaly (all da title holes)

Hodgkin’s lymphoma- diffuse liver parenchymal
changes

non-Hodgkin’s lymphoma- hypoechoic target lesions

A

lymphoma

126
Q

the most common primary malignant
disease in the peds pt
* usually discovered by age 5
* causes an increase in AFP
* asymptomatic OR palpable mass,
jaundice, anorexia, abdominal pain

Sonographic Appearance
o solid
o hyperechoic
o heterogeneous
o may have calcifications

A

hepatoblastoma

127
Q

diffuse liver parenchymal
changes

A

Hodgkin’s lymphoma

128
Q

non-Hodgkin’s lymphoma- hypoechoic target lesions

A

non-Hodgkin’s lymphoma

Liver ch.9,ch.12 (2 decks)

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