Liver power point reverse Flashcards
largest organ in the body, next to the skin
weighs approx 1500 grams in the adult
Liver physical description
occupies almost all of the right hypochondrium, great part of epigastrium and left hypochondrium as far as the mammillary line
inferior to the diaphragm
posterior border in contact with the rt kidney and IVC
aorta lies posterior to the left lobe
Liver location
tissue known as Glisson’s capsule
liver covering
divides liver into sectoins based on main lobar fissure and vascular landmarks
divides into 8 surgical sections
Couinad’s anatomy
subphrenic spacebetween the liver and diaphragm is a common site fo abcess formation
Subphrenic space
includes morrisons pouch
a common site for periotoneal fluid or blood to collect
right subhepatic space
enclosed portion of the peritonial space posterior to the liver and stomach is another site for abcess formation
lesser sac
hemopoiesis
embryonic repsonibility
intraperitoneal organ
type of organ
3 helatic lobes
each lobe further divided into thousands of liver lobules
liver basic anatomy
contain kepatocytes
biliary epitheleal cells
kupfer cells
each lobule surrounded by portal triads, small branches of PF, BD and HA
liver lobules
Right
Left
Caudate
Lobes of the liver
Right hepatic vein
right intersegmental ligament
Separates anterior and posterior of right lobe
left hepatic vein
left intersenmental fissure
ligamentum teres
falciform ligament
separates lateral and medial segment of the left lobe of the liver
middle hepatic vein
main lobar fissure
gallbladder fossa
separates the right and left lobe
largest lobe
contains 3 fossae: porta hepatis, gallbladder and IVC
may contain riedels lobe
Right lobe of liver
can sometimes be seen as an anterior projection of the liver sometimes extending down the iliac crest
Riedels lobe
size varies from patient to patient, really effects the quality of scanning the pancreas
found just under the xiphoid process
Left Lobe
attaches the liver to the diaphragm and anterior abd wall
contains the ligamentum teres, triangular or rounded hyperechoic structure which is the termination of the ligament
Falcifomr ligament
smallest lobe
inferior to the ligamentum venosum
superior to the IVC
caudate lobe
Main lobar fissure
Falciform Ligament
ligamentum teres
ligamentum venosum
LIgaments and fissures
boundry between right and left lobes
longitudinal scan may be seen as a hyperechoic line extending from the portal vein to the neck of the gallbladder
main lobar fissure
extends from the umbilicus to the diaphragm,
contains the ligamentum teres
falciform ligament
appears as a bright echogenic triangle on a transverse scan
separates the medial and lateral segments of the left lobe
ligamentum teres
appears as a hyperechoic line separating the left and caudate lobes
ligamentum venosum
Portal venous system
Hepatic veins
hepatic arteries
Vascular supply
supplies 70-75% of blood volume to liver from the digestive system
flow should be hepatopetal
low veloctiy, phasic flow
portal venous system
Main portal vein
Right portal vein
left portal vein
Portal veins
enters at the portahepatis
11-12mm
divides into the right and left portal veins
Main portal vein
largest of the portal veins
divides into anterior and posterior branches
Right portal vein
lies more anterior and cranial than the right portal vein
divides into medial and lateral branch
lies within a thick band of connective tissue coursing throught eh central portion of the lateral segment of the left lobe
Left portal vein
flow into the IVC
hepatofugal flow (below baseline)
Hepatic veins
flow into the liver hepatopetal flow
bright walls sue to the increases connective tissue-Glissons capsule
Portal veins
drain blood from liver back to IVC
divided into 3 components, RIght, Middle and left
Doppler signal is low velocity but more pulsitile than portal veins due to the closer proximity to the heart
Hepatic veins
supplies about 20% of the blood to the liver
common is a branch of the celiac trunk from the aorta
courses towards the right changing names to the proper_____as it curves anterior and cephalad towards the porta hepatis
at porta hepatis it diveds into right, middle and left
Hepatic arteries
right hepatic artery courses between the bile duct and portal vein
anatomical variations of hepatic artery are quite common
referred to as a replaced right hepatic artery
portal veins are contained within a connective sheath and have bright echogenci walls
Portal triad
metabolism
digestion
storage
detoxification
phagocytosis
Liver functions
carbohydrates:
fat
protein
manufactures many of the plasma proteins in the blood
metabolism
converts glucose to glycogen and stores
when needed breaks down glycogen and releases glucose into the blood
Carbohydrate metabolism
absored from the intestine in the form of monoglycerides and diglcerides
converted in tehhepatocytes to lipoproteins
lipoproteins are transported throughout the body to be stored or used by other organs
priciple site for cholesterol synthesis
failure of hepatocytes to manufacture lipoproteins lead to an accumulation of fat within the hepatocytes resulting in fatty liver
Fat metabolism
secretes bile
aids in digestoin of fat
Digestion
stores iron and certain vitamins
storage
drugs and poisons that enter the body
detoxification
bacteria and worn out blood cells are removed
phagocytosis
liver produces a variety of proteins, either indirectly from amino acids or directly from raw materials stored in body
albumin produced in great amounts
albumin is nonionic and functions to draw water into the vascular system from tissue spaces
if diseases the liver allows for fluid to accumulate in the interstitial spaces resulting in edema, may contribute to acites in advanced cirrhosis
Protein mteabolism
}Principal source of proteins necessary for blood coagulation, including fibrinogen (factor 1), prothrombin (factor ll), and factores V, VII, IX, and X
}In liver disease, decreased production of these proteins my lead to inadequate blood coagulation and uncontrollable hemorrhage.
}Deficiencies in clotting factors may also be a result of failed intestinal absorption of vitamin K
Proteins for blood coagulation
Liver contains macrophages called Kupffer cells. These cells engulf and breakdown toxic matter such as microorganisms, dead cells and chemicals. Kupffer cells ingest microorganism by phagocytosis. The engulfed microorganism is called phagosome. Lysosmes in the cytoplasm of kupffer cell, fuse with the phagosome and release digestive enzymes. These enzymes breakdown and kill the microorganism
Kuppfer Cells
}Enzymes are protein catalysts used throughout the body in all metabolic processes. Due to the liver being a major center for metabolism, large quanities of enzymes are present in the hepatocytes.
}The liver enzymes may leak into the bloodstream when the liver cells are damaged or destroyed due to disease.
}The presence of increased quanities of enzymes in the blood is a sensitive indicator of a hepatocellular disorder
Hepatic Enzymes
}Process where what we eat is broken down into substances that provide energy for our cells.
}The waste products of this process is excreted through bile, which leaves the liver via the biliary system.
}In hepatobiliary disease, each of the functions of the liver will be decreased.
}This will lead to abnormal lab findings, sonographic findings and clinical symptoms
Metabolism
AST
ALT
LDH
Alk phos
Bilirubin
PT
Albumin and globulins
Liver Function Tests LFT’s
Alkaline phosphatase (Alk phos)-produced by the liver,bone,intestines and placenta
◦Cirrhosis
◦Extrahepatic biliary obstruction
◦Gallstones
◦Hepatitis
◦Metastatic liver disease
◦Pancreatic carcinoma
Elevated liver function tests
◦Hepatitis
◦Hepatocellular disease
◦Obstructive jaundice
Aspartate aminotransferase-(AST)an enzyme produced in high-metabolic tissues, may indicate
cirrhosis
fatty liver
hepatitis
metastatic liver disease
May indicate other organ diseases other than liver
}Alanine aminotransferase-(ALT)more specific than AST for evaluating liver function
◦Hepatitis
◦Cirrhosis
◦Obstructive jaundice
◦Found in tissues of several systems including kidneys, heart, brain, lungs
◦Main use is in the detection of myocardial or pulmonary infarction
}Lactate dehydogenase (LDH)
Unconjugated (indirect) bilirubin-acute hepatocelluar disease-receives too much at one time- cannot detoxify
- Conjugated (direct) bilirubin-biliary tract obstruction
- Total bilirubin- cirrhosis and other chronic liver cell disease
Serum Bilirubin (bilirubin)
}liver enzyme that is part of the blood clotting system dependant on the adequate intake and use of vitamin K
◦Prolonged- metastases to the liver
◦Shortened- extrahepatic duct obstruction
Prothrombin (PT)-
}is a pigment that is released when red blood cells are broken down
The liver receives bilirubin that is attached to the albumin in the blood. The hepatocytes get busy performing metabolic functions of uptake, conjugation, and excretion
Bilirubin
the hepatocytes pick up the bilirubin and conjugates it, but cannot excrete it. Direct bilirubin is increased
biliary obstruction
}the hepatocytes are damaged , the cells continue to take in and conjugate the bilirubin, but cannot excrete it.
hepatocellular disease
is released by the reticuloendothelial system (spleen/bone marrow) in too large of quanities that the liver can handle. These are hemolytic conditions hemolytic anemia/blood transfusion reactions
Uncongugated, or indirect bilirubin
}TGC-should be adjusted to balance the far-gain and near-gain echo signals
}Overall gain-should be adjusted to adequatley penetrate the entire right lobe of the liver as a smooth, homogenous echo pattern
}Depth-posterior right lobe is positioned at the lower border of the screen
}Focuses-near the posterior border of the liver
}Transducer frequency-depends on patient body habitus. Average adult 2.5-5 MHz, pediatric 5-7MHz
Liver Scanning
}The size of the liver
}The attenuation of the liver parenchyma
}Liver texture
The presence of hepatic vascular structures, ligaments, and fissures
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