Liver test 2 Flashcards
0
Q
What is the largest parenchymal organ in the body?
A
the liver
1
Q
What do you have to show when you sweep through the liver?
A
left, right and caudate lobe
2
Q
Where is the liver found?
A
in the peritoneum
3
Q
The liver is a chemical factory? true or false
A
true
4
Q
What is the parenchyma?
A
the texture of the liver tissue
5
Q
Renal cortex is ____ echogenic than the liver
A
Less
6
Q
Renal sinus is ______compared to the liver and to the renal cortex
A
echogenic
7
Q
Renal cortex is _______ compared to the liver
A
hypoechoic
8
Q
What organ is similar to the liver in echotexture?
A
the spleen
make sure you label!!
9
Q
what is more echogenic than the liver or the spleen?
A
the Pancreas (gets brighter as you age)
10
Q
What is anterior to the portal confluence and splenic vein?
A
the pancreas
11
Q
What is the normal size of the liver?
A
varies
typically 18 cm (anything between 15-18cm)
12
Q
What part of the body does the liver occupy?
A
right hypochondrium
epigastrium
left hypochondrium
13
Q
What covers the liver?
A
ribs
14
Q
Where does the stomach lie in comparison to the liver?
A
stomach lies posterior and lateral to the left lobe
if confusion about a mass or stomach…will have parastalisis if its stomach
15
Q
What lies adjacent to the liver?
A
duodenum
16
Q
What is posterior to the liver?
A
rt kidney
ivc
Ao
17
Q
What is the superior border of the liver?
A
the diaphragm
18
Q
What is the liver suspended by?
A
the falciform ligament
19
Q
What mostly covers the liver?
A
peritoneum
20
Q
What is the bare area of the liver?
A
the area on the posterosuperior (diaphragmatic) surface of the liver
bordered by the coronary ligament but itself devoid of peritoneum
the diaphragm and liver lie in direct contact and adhere
21
Q
What is the space between liver and kidney?
A
subphrenic space or morison’s pouch
22
Q
Where does fluid accumulation or abscess accumlate around the liver?
A
subphrenic space (aka morison’s pouch)
23
Q
If you see fluid in Morison’s pouch what do you do?
A
a four quadrant sweep
24
What is the largest lobe of the liver?
right lobe
25
What is a fossa?
an impression of where something lives
26
What are the fossa's of the liver?
porta hepatis
gallbladder
IVC
27
What is reidel's lobe?
a congenital variant
an anterior projection on the right lobe
28
How does Reidel clinically present?
hepatomegaly
RUQ mass
29
Where is the left lobe of the liver found?
epigastric and left hypochondriac
30
What impression is under the left lobe?
the gastric impression
31
What is the medial segment of the left lobe??
quadrate lobe
32
Where is the quadrate lobe found?
posterioinferior Lt. lobe
bounded by GB fossa, porta hepatis and umbilical vein fossa
33
What is the caudate lobe?
posterior portion of the liver
small
34
What separates the caudate lobe from the left lobe?
ligamentum venosum
35
Of Couinaud's 8 segments of the liver, what is segment two?
lateral left lobe (superior)
36
What is segment I of couinaud's surgical resection of the liver?
caudate lobe
37
Who is Couinaud?
Created the surgical resection of the liver with 8 segments
38
What are the segments based on?
what we see of the portal and hepatic veins
39
how do ligaments and fissures appear on US?
appear echogenic or hyperechoic because of the presence of collagen and fat within and around the structures
40
What are the ligament and fissures?
Glisson capsule
main lobar fissure
falciform ligament
ligamentum teres (round ligament)
ligamentum venosum
41
What is glisson's capsule
thin connective tissue
thickest around the IVC and porta hepatis
42
what is the main lobar fissure?
boundary between right and left lobes
hyper echoic line from portal vein to GB
picture slide 32
43
What is the falciform ligament?
helps attach liver to diaphragm
formed from mid-portion of coronary ligament
inferior margin contains ligamentum teres
44
What is the ligamentum teres?
echogenic focus
dividing the medial and lateral left lobe
circular echogenic structure
45
Why is the ligamentum teres special?
remnant of umbilical vein (belly button to placenta)
potential to recanalize - (when there is portal HTN it can pop open and make it a vein again. cirrhosis can cause this too)
46
What is the ligamentum venosum a remnant of?
ductus venosus
thin echogenic line anterior to the caudate lobe
47
Where is the right intersegmental fissure?
the RHV lays in this fissure
dividing anterior and posterior
48
Where is the left intersegmental fissure?
the LHV lays in this fissure
divides left lobe into medial and lateral
49
What are the coronary and triangular ligaments?
suspends the liver from the diaphragm
Has NOTHING to with the heart
50
What size does the portal vein need to be to be normal?
< 13mm in AP
51
How does the RPV course through the liver?
courses laterally and posteriorly
splits into anterior and posterior branches
52
What does an enlarged portal vein indicate?
portal hypertension
53
do the IVC and the MPV ever connect?
no
54
what are the two kinds of liver cells?
hepatocytes
kupffer cells
55
What do hepatocytes do?
synthesize
metabolize
excrete compounds
56
What do the kupffer cells do?
finish
57
What is one thing we use the liver for in US?
to evaluate other organs
58
where would we find the pancreas in relation to the liver?
seen just inferior to the left lobe
59
what area of the body does the right lobe of the liver occupy?
the right hypochondrium
60
Is Reidel's lobe more common in men or women?
women
61
What is the texture of Reidel's lobe?
normal texture
62
Reidel's lobe is an elongation of which segment?
segment VI
63
What is the caudate lobe bounded by?
porta hepatis
IVC fossa
ductus venosus fossa
64
What is segment III of Couinaud's liver resection?
lateral left lobe - inferior
65
What is segment IV of Couinaud's liver resection?
medial segment of the left quadrate
66
What is segment V of Couinaud's liver resection?
anterior inferior segment of the right lobe
67
What is segment VI of Couinaud's surgical liver resection?
posterior segment of the right lobe - inferior
68
What is segment VII of couinaud's liver resection?
posterior superior segment of the right lobe
69
What is segment VIII of Couinaud's liver resection?
superior anterior segment of the right lobe
70
What separates the caudate lobe from the left lobe?
ligamentum venosum
71
What does the hepatic artery do?
carries oxygenated blood from the aorta to the liver
72
how much oxygen does the hepatic artery supply to the liver?
20-30%
73
Is the hepatic artery high or low resistance?
Low resistance
74
how does the main portal vein enter the liver?
at the hilum
through the porta hepatis
75
Between the LT and RT portal vein, which is the larger branch?
The Right portal vein
76
Between the Rt and LT portal vein, which one is more anterior?
The LT portal vein
77
How does the LPV course through the liver?
superiorly
splits into medial and lateral branches
78
What supplies >60% of the blood supply to the liver?
the portal vein
79
Is the portal vein higher or lower in oxygen?
lower
80
What does the main portal vein branch into?
the LT and RT portal veins
81
What is it called as the PV enters the center of the liver and the lobes that are supplied?
intrasegmental
82
Of the hepatic veins, which is the largest?
RT hepatic vein
83
of the hepatic veins, which is the smallest?
Left hepatic vein
84
Where do the hepatic veins enter the IVC?
below the diaphragm
85
What do the hepatic veins do?
drain blood from the liver and return it to the heart
86
What is the job of the RHV?
drains the right lobe
divides RT lobe into anterior and posterior segments
lies in RT segmental fissure in longitudinal plane
87
What is the job of the MHV?
separates right and left lobes
lies in main lobar fissure in trv plane
88
What is the job of the LHV?
drains left lobe
divides left lobe into medial and lateral segments
lies in left segmental fissure in trv plane
89
The portal vein carries blood from the ______ to the _____
Bowel
Liver
90
The hepatic veins drain blood from the ______ into the _____.
Liver
IVC
91
What are the main aspects of the portal veins?
SV joins SMV to form PV
Larger at their orgin
branches point to the porta hepatis
echogenic wall
traverse the lobes
intrasegmental
continuous doppler
92
What are the main aspects of the hepatic veins?
flow into the IVC
course between the lobes
larger as they drain into the IVC
branches point to the diaphragm
intersegmental
multi phasic doppler
93
What is the job of the hepatobiliary system?
metabolic - chemical reactions to sustain life
excretory - elimination of waste products of metabolism
94
What makes up the hepatobiliary system?
liver
bile ducts
GB
95
Where do the bile ducts enter the duodenum?
through the ampulla of vater
96
what structures create the common bile duct?
bile canaliculi > interlobular ducts > RT and LT hepatic ducts > common hepatic duct + cystic duct = common bile duct
97
What are the liver functions?
metabolism
waste removal
digestion
storage
detoxification
synthesis and secretion of bile
98
what part of the liver are the functional units?
the lobules
99
what do the outer margin of the lobules contain?
portal triad tracts
100
What do hepatocytes do?
synthesize
metabolize
excrete compounds
101
What do Kupffer cells do?
aka: reticuloendothelial cells
phagocytize bacteria and foreign material
102
What is the job of the metabolizing physiology of the liver?
synthesizing complex substances into simple ones for energy
103
What are the metabolism enzymes that we need to know for liver lab values?
AST (aspartase aminotransferase)
ALT (alanine aminotransferase)
Alk Phos (alkaline phosphatase)
104
What in the lab values will tell you if you have a biliary obstruction?
AST and ALT mildly elevated
Alk Phos - marked elevation
Abn in metastatic
105
What will happen with the liver lab values if you have hepatocellular obstruction?
AST and ALT - striking elevation
ALT is more specific
106
What is hepatocellular disease?
liver cells (hepatocytes) are the immediate problem
usually treated medically with supportive measures and drugs
107
What is an obstructive disorder in liver disease?
bile excretion is blocked
usually treated surgically
108
If AST and ALT are elevated, what disease are you looking for?
heart and skeletal damage
109
If ALT is elevated above AST, what is the cause?
Hepatic cause
110
If Alk phos is elevated what are you looking for?
bone disease
normal pregnancy
111
What is Alpha fetoprotein?
normally produced by the liver and yolk sac of a fetus
AFP levels decrease soon after birth
AFP probably has no normal function in adults
112
How does the GB aid in digestion?
Expels waste products
Bile is continuously formed and transported by ducts
release bilirubin when RBC are broken down
113
What does the liver store?
vitamins
iron/copper
glycogen
fat
amino acids
114
What organ eliminates Urea?
the kidneys
115
How is urea measured?
in the BUN (blood urea nitrogen lab value)
116
what might you have if the BUN is low?
severe liver disease
117
What is converted to urea?
ammonium
118
What condition do you get when there is ammonium accumulation?
breath odor - fector hepaticus
119
What does the liver detox?
poisonous substances
bacteria
alcohol
120
Bilirubin is the product of ______.
hemoglobin
121
what is uptake?
when bilirubin separated from albumin
122
What is conjugation?
When bilirubin is combined with glucuronic acid...making it soluble in water
123
What is bile?
excretory product of the liver
124
What is formed continuously in the hepatocytes?
bile
125
Bile _______ and is _________ in the ducts
collects
transported
126
What makes up bile?
water
bile salts
pigments
127
What is the job of bile?
emulsification of fat
removal of wastes
128
What is a liver function test?
AST (formerly SGOT) aspartate aminotransferase
129
What is AST?
Enzyme present in tissue with high metabolism
130
When will you find elevated AST?
With any disease that injures liver cells
131
If you have significant elevations of AST, what conditions do you potentially have?
acute hepatitis
cirrhosis
132
What does elevated bilirubin give you?
jaundice
133
What is direct bilirubin?
conjugated
elevated hepatocellular disease
elevated biliary obstruction
134
What is indirect bilirubin?
unconjugated
elevated hematologic disease
135
What happens if estrogen failures to metabolize due to liver disease?
gynecomastia (breast enlargement)
testicular atrophy
136
slide 87?
make cards?
137
What is LDH?
lactic acid dehydrogenase
138
When does LDH elevate?
moderate elevation with infectious
FINISH 88
139
When Does alk phos elevate?
good indicator of intrahepatic and extrahepatic OBSTRUCTION of the liver
140
What disturbs bilirubin?
SLIDE 90
141
What is related to the elevation of DIRECT bilirubin?
obstructive jaundice
stone, mass, neoplasm
US "sees" the cause
142
What is prothrombin time (PT)?
show blood clotting
vitamin K (adds to blood clotting)
liver disease causes an increase in PT
143
What do albumin and globulin indicate in a liver function test?
metabolic disorders
FINISH SLIDE 93
144
What is hepatocellular diseases?
Directly effects the actual liver cells (hepatocytes)
145
What are obstructive diseases?
a 'something" is blocking part of the biliary tree
a mass, stone...something blocking
146
What are the indications for US of the liver?
RUQ pain
palpable mass
hepatomegaly
jaundice
hx of alcohol abuse
abnormal LFTs
?mets
pancreatitis
147
What is the prep for liver US?
NPO for 8 hours if GB is evaluated
148
What are the relative echogenicities in the abdomen (hyperechoic to hypoechoic)?
renal sinus>>pancreas>>liver>>spleen>>renal parenchyma
