Liver Notes Flashcards
(111 cards)
1
Q
What is the bare area of the liver?
A
A large triangular area devoid of peritoneal covering located between the two layers of the coronary ligament.
2
Q
What is Budd-Chiari syndrome?
A
Thrombosis of the main hepatic veins.
3
Q
What is a cavernous hemangioma?
A
The most common benign neoplasm of the liver consisting of large blood-filled cystic spaces.
4
Q
What is cirrhosis?
A
Irreversible and often progressive parenchymal fibrosis, scarring, and parenchymal necrosis with nodular regeneration.
5
Q
What is collateral in vascular anatomy?
A
An accessory blood pathway developed through enlargement of secondary vessels.
6
Q
What does Couinaud anatomy refer to?
A
Divides the liver into eight segments in an imaginary H pattern.
7
Q
What is an echinococcal cyst?
A
An infectious cystic disease associated with underdeveloped sheep-herding areas of the world.
8
Q
What is fatty infiltration of the liver?
A
An acquired and reversible condition resulting in accumulation of triglycerides in the hepatocytes.
9
Q
What is functional lobar-segmental anatomy?
A
Divides the liver into the right, left, and caudate lobes.
10
Q
What is Glisson’s capsule?
A
A thin connective tissue layer covering the liver and portal veins.
11
Q
What does hepatofugal mean?
A
Blood flowing away from the liver.
12
Q
What does hepatopetal mean?
A
Blood flowing into the liver.
13
Q
What are liver function tests (LFTs)?
A
A generic term used for the laboratory values determining liver function (e.g., ALT, alkaline phosphatase).
14
Q
What is the porta hepatis?
A
The region in the hepatic hilum containing the proper hepatic artery, common duct, and main portal vein.
15
Q
What is portal hypertension?
A
Increased venous pressure in the portal circulation associated with compression or occlusion of the portal or hepatic veins.
16
Q
What is a shunt?
A
A passageway between two natural channels.
17
Q
What is a stent?
A
A tube designed to be inserted in a passageway or vessel to keep it patent.
18
Q
What is traditional lobar anatomy?
A
Divides the liver into the right, left, caudate, and quadrate lobes.
19
Q
What is a true hepatic cyst? What is it associated with?
A
Congenital cyst formation associated with weakening of the bile duct wall.
20
Q
What is a varix?
A
An enlarged or tortuous vein, artery, or lymph vessel.
21
Q
What are the functions of the liver? 9
A
- Breaks down red blood cells, producing bile pigments.
- Secretes bile into the duodenum through the bile ducts.
- Converts excess amino acids into urea and glucose.
- Manufactures glycogen from glucose and stores it for future use.
- Releases glycogen as glucose.
- Manufactures heparin.
- Regulates blood volume.
- Detoxifies harmful substances absorbed by the intestines.
- Major source of body heat as a result of many hepatocellular chemical reactions.
22
Q
What is the size of the liver?
A
The largest solid organ in the body, weighing up to 1800 grams in males and 1400 grams in females.
23
Q
The left lobe of the liver is dived by what? How?
A
Divided into medial and lateral segments by the left hepatic vein and ligamentum teres.
24
Q
What is the caudate lobe?
A
The smallest lobe of the liver, separated from the left lobe by the proximal portion of the left hepatic vein and the ligamentum venosum.
25
What does the coronary ligament form?
Forms the anterior and posterior borders of the bare area and consists of two layers.
26
What is the falciform ligament? What does it attach to?
Two folds of parietal peritoneum that attach the liver to the anterior abdominal wall.
27
What does the gastrohepatic ligament connect?
Connects the lesser curvature of the stomach to the liver.
28
What does the hepatoduodenal ligament connect?
Connects the liver to the proximal duodenum and surrounds the portal triad.
29
What is the teres ligament formally? What is it also known as?
Also known as the round ligament, it is the previous fetal umbilical vein.
30
What is the triangular ligament? What did it connect?
The most lateral portion of the coronary ligament connecting the liver to the body wall.
31
What is the venosum ligament?
Separates the left lobe from the caudate lobe of the liver.
32
What is the left intersegmental fissure?
Divides the left lobe of the liver into medial and lateral segments.
33
What is Morison pouch?
Located lateral to the right lobe of the liver and anterior to the right kidney.
34
What is the subhepatic space?
Space located between the inferior edge of the right lobe and anterior to the right kidney.
35
What is the subphrenic space?
Space located between the diaphragm and the superior border of the liver.
36
What is the proper hepatic artery?
Enters the liver at the porta hepatis and divides into the right and left hepatic arteries.
37
What are the hepatic veins?
Right, middle, and left hepatic veins converge to empty into the inferior vena cava.
38
What is the main portal vein?
Begins at the portal-splenic confluence and enters the porta hepatis.
39
What is the location of the liver?
An intraperitoneal organ occupying the major portion of the right hypochondrium.
40
What is a diaphragmatic slip?
Diaphragmatic muscular bundles that connect the central tendon of the diaphragm to the inner aspect of the lower thoracic cage.
41
What is Riedel lobe?
Extension of the right lobe inferior and anterior to the lower pole of the kidney.
42
What is the normal size of the adult liver?
Midclavicular level 7–17 cm in length, 10–21 cm in height, 20–36 cm in width.
43
What is the normal sonographic appearance of the liver?
Medium shade of gray homogeneous liver parenchyma with moderately hyperechoic portal vein walls.
44
What is the appearance of bile ducts on ultrasound?
Anechoic tubular structures coursing through the liver parenchyma with smooth hyperechoic wall margins.
45
What is the appearance of hepatic veins on ultrasound?
Anechoic tubular structures coursing toward the inferior vena cava with a multiphasic hepatofugal blood flow pattern.
46
What is the appearance of portal veins on ultrasound?
Anechoic tubular structures coursing from the hepatic hilum through the liver parenchyma.
47
What is the preparation for a liver ultrasound?
No preparation is required before a liver ultrasound.
48
What is the recommended transducer selection for liver ultrasound?
Use the highest frequency possible for optimal resolution: 3.0 to 5.0 MHz for adults.
49
What is the patient positioning for a liver ultrasound?
Examination usually begins with the patient in a supine position.
50
What is included in the examination protocol for liver ultrasound?
A systematic approach in the sagittal, coronal, and transverse planes examining all portions of the liver.
51
What is image optimization for liver ultrasound?
Place gain settings to display normal liver parenchyma as a medium shade of gray.
52
What is measured in the main portal vein?
The anterior-posterior diameter and duplex imaging documenting flow type and direction.
53
When/ how should abnormalities in the main portal vein be documented? 2
Abnormalities should be documented and, when applicable
1. Measured in two imaging planes.
2. Color and/or spectral Doppler evaluation should be included.
54
What is the optimal gain setting for liver imaging?
Gain settings should display normal liver parenchyma as a medium shade of gray and reduce artifactually produced echoes.
55
Where should focal zones be placed during imaging?
Focal zone(s) should be placed at or below the area of interest.
56
What is the effect of using multiple focal zones?
It increases detail resolution and decreases temporal resolution.
57
What imaging depth is required?
Sufficient imaging depth is needed to visualize structures immediately posterior to the area of interest.
58
When should harmonic imaging be used?
Harmonic imaging should be used when documenting the biliary tree.
59
How can artifactual echoes be reduced?
Decreasing system compression (dynamic range) can reduce artifactual echoes within normal anechoic structures.
60
What is spatial compounding used for?
Spatial compounding can improve visualization of structures posterior to highly attenuating structures.
61
What should Doppler settings be adjusted for?
Doppler settings should be adjusted for the different flow states of the hepatic vasculature.
62
What is the recommended Doppler angle?
The Doppler angle should be 60 degrees or less, with a sample volume smaller than the vessel.
63
How can liver visualization be improved?
The use of deep inspiration may improve visualization of the liver.
64
What can multiple patient positions help with?
They may redistribute overlying bowel gas.
65
What are some examination limitations? 3
1. Obesity
2. Dense liver parenchyma
3. Superior liver location (high under ribcage).
66
In which plane is the main lobar fissure best visualized?
The sagittal oblique plane.
67
In which plane are hepatic veins best visualized?
The transverse plane with a slight cephalic angulation.
68
Where is the right portal vein best visualized?
In the transverse plane.
69
Where is the common hepatic artery best visualized?
In the transverse plane at the celiac trunk.
70
What are indications for ultrasound examination? 8
1. Abnormal liver function tests (LFTs)
2. Hepatocellular disease
3. Biliary disease
4. Abdominal pain
5. Postprandial pain
6. Palpable liver or spleen
7. Pancreatitis
8. Evaluation of mass documented on another imaging modality.
71
What is the normal adult range for alkaline phosphatase (ALP)?
45 to 115 U/L.
72
What does alkaline phosphatase indicate?
It is the most specific indicator of biliary obstruction and may signal bone and liver abnormalities.
73
What is alpha-fetoprotein? What is it a marker for?
A protein normally synthesized by the liver, yolk sac, and GI tract of the fetus; a nonspecific marker for malignancy.
74
What is the normal adult range for alanine aminotransferase (ALT)?
7 to 35 U/L.
75
What does an elevation in ALT indicate?
It is a very specific indicator of liver cell destruction and is associated with hepatocellular disease, biliary tract obstruction, pancreatitis, and fatty infiltration.
76
What is the normal adult range for aspartate aminotransferase (AST)?
8 to 48 U/L.
77
What does an elevation in AST indicate?
It is used to diagnose liver disease before jaundice occurs and is associated with cirrhosis, hepatitis, mononucleosis, fatty infiltration, myocardial infarction, muscle disease, and cholestasis.
78
What are the normal adult values for bilirubin?
Total bilirubin ≤1.1 mg/dL; direct bilirubin ≤0.5 mg/dL.
79
What does elevated bilirubin indicate?
It reflects the balance between production and excretion of bile and can indicate various liver conditions.
80
What is the normal clotting time for prothrombin time?
10 to 15 seconds.
81
What does an elevation in prothrombin time associated with? 4
It is associated with
1. Cirrhosis
2. Malignancy
3. Malabsorption of vitamin K
4. Clotting failure.
82
What is the normal adult range for serum albumin?
3.5 to 5.0 g/dL.
83
What does a decrease in serum albumin suggest? What is it associated with?
It suggests a decrease in protein synthesis and is associated with hepatocellular disease.
84
What is a cyst? What kind of indiction is it and what is it secondary to? 3
An acquired condition secondary to:
1. Parasitic infection
2. Inflammation
3. Trauma.
85
What are the sonographic findings of a true cyst? 5
1. Anechoic
2. Round- or oval-shaped mass
3. Well-defined
4. Smooth wall margins
5. Posterior acoustic enhancement.
86
What is a cystadenoma? Typically found in which demographic?
A benign neoplasm containing cystic structures within the lesion, typically found in middle-aged women.
87
What are the clinical findings of a cystadenoma? 2 (s/s)
Palpable RUQ mass and hepatomegaly.
88
What are the sonographic findings of a cystadenoma?
Multiloculated cystic mass with well-defined margins and thin septations.
89
What is the most common benign liver mass?
Cavernous hemangioma.
90
What are the clinical findings of cavernous hemangioma?
Typically asymptomatic but may present with RUQ pain.
91
What are the sonographic findings of cavernous hemangioma?
Homogeneous hyperechoic mass with well-defined wall margins.
92
What is the most common cause of cirrhosis in the United States?
Alcoholism and chronic hepatitis C.
93
What are the clinical findings of cirrhosis? 5 (S/S)
1. Weakness
2. Fatigue
3. Weight loss
4. Abdominal pain
5. Ascites.
94
What are the sonographic findings of cirrhosis?
Diffuse increase in parenchymal echogenicity and irregular nodular contour.
95
What is the most common symptomatic vascular tumor in infancy?
Infantile hemangioma.
96
What are the complications of infantile hemangioma? 4
1. Thrombocytopenia
2. Angiopathic anemia
3. Gastrointestinal bleeding
4. Intraabdominal rupture.
97
What is hemangiosarcoma? What exposure is it associated with? What demographic is it seen in?
1. A malignant tumor
2. Associated with exposure to arsenic, polyvinyl thorotrast
3. Typically found in adults aged 60 to 70.
98
What are s/s of a malignant hepatic neoplasm? (2) What doe they look like? sonographically? (3) If cysts are tiny how may they appear?
1. Diffuse abdominal distension
2. Palpable abdominal mass
3. Well-defined large complex mass
4. Predominantly anechoic
5. lacelike configuration.
## Footnote
If cysts are tiny, may appear as a solid mass.
99
What is the most common malignant tumor in children aged 3 years or less? What is it associated with?
Hepatoblastoma
## Footnote
Associated with Beckwith-Wiedemann syndrome, sporadic aniridia, hemi-hypertrophy, and precocious puberty.
100
What are the clinical findings of hepatoblastoma? 5 (s/s)
1. Abdominal distension
2. Nausea/vomiting
3. Weight loss
4. Precocious puberty
5. Marked elevation of alpha-fetoprotein.
101
What are the sonographic findings of hepatoblastoma? 4 (don’t forget about the arterial blood flow findings)
1. Heterogeneous
2. Hyperechoic mass
3. Cystic mass with internal septations
4. High velocity low resistance internal arterial blood flow.
102
What are the clinical findings of hepatocellular carcinoma? 5 (s/s)
1. Palpable mass
2. Abdominal pain
3. Weight loss
4. Unexplained fever
5. Jaundice.
103
What are the sonographic findings of hepatocellular carcinoma? 3
1. Solid mass with variable echogenicity
2. May demonstrate a hypoechoic halo
3. Multiple nodules or diffuse infiltrative masses may also be demonstrated.
104
What are the common etiologies of Budd-Chiari syndrome? 3
1. Tumor extension (renal or liver)
2. Hematologic disorder
3. Congenital webbing of IVC or right atrium.
105
What are the clinical findings of Budd-Chiari syndrome? 4 (s/s)
1. Abdominal pain
2. Abdominal distension
3. Hepatomegaly
4. Lower-extremity edema.
106
What are the sonographic findings of Budd-Chiari syndrome? 4
1. Hypoechoic intraluminal echoes in the hepatic veins (thrombus)
2. Dilated hepatic veins
3. Vein wall thickening
4. Absence of or altered hepatic venous flow.
107
What are the clinical findings of portal vein thrombosis? (S/S) 4
1. Severe abdominal pain
2. Loss of appetite
3. Hematemesis
4. Encephalopathy.
108
What are the sonographic findings of portal vein thrombosis? 3
1. Hypoechoic intraluminal echoes in the portal vein(s)
2. Increase in portal vein diameter
3. Absence or altered portal venous blood flow.
109
What are the postoperative complications of hepatic transplant? 5
1. Hepatic artery thrombosis
2. Hepatic artery stenosis
3. Infection or fluid collections
4. Portal vein stenosis
5. Portal vein thrombosis.
110
What are the normal sonographic findings after a hepatic transplant? 3
1. Homogeneous to slightly heterogeneous liver parenchyma
2. Low resistance waveform in the hepatic artery
3. Resistive index of the proper hepatic artery should range between 0.5 and 0.7.
111
What are the abnormal sonographic findings after a hepatic transplant? 4 (Don’t forget to think about flow characteristics)
1. Heterogeneous or hypoechoic liver parenchyma
2. Intrahepatic biliary dilatation
3. Prolonged systolic acceleration time of the hepatic artery
4. Resistive index of the proper hepatic artery should range less than 0.5.
