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abdomen > Liver test 2 > Flashcards

Liver test 2 Flashcards

0
Q

What is the largest parenchymal organ in the body?

A

the liver

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1
Q

What do you have to show when you sweep through the liver?

A

left, right and caudate lobe

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2
Q

Where is the liver found?

A

in the peritoneum

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3
Q

The liver is a chemical factory? true or false

A

true

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4
Q

What is the parenchyma?

A

the texture of the liver tissue

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5
Q

Renal cortex is ____ echogenic than the liver

A

Less

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6
Q

Renal sinus is ______compared to the liver and to the renal cortex

A

echogenic

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7
Q

Renal cortex is _______ compared to the liver

A

hypoechoic

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8
Q

What organ is similar to the liver in echotexture?

A

the spleen

make sure you label!!

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9
Q

what is more echogenic than the liver or the spleen?

A

the Pancreas (gets brighter as you age)

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10
Q

What is anterior to the portal confluence and splenic vein?

A

the pancreas

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11
Q

What is the normal size of the liver?

A

varies

typically 18 cm (anything between 15-18cm)

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12
Q

What part of the body does the liver occupy?

A

right hypochondrium

epigastrium

left hypochondrium

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13
Q

What covers the liver?

A

ribs

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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

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15
Q

What lies adjacent to the liver?

A

duodenum

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16
Q

What is posterior to the liver?

A

rt kidney

ivc

Ao

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17
Q

What is the superior border of the liver?

A

the diaphragm

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18
Q

What is the liver suspended by?

A

the falciform ligament

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19
Q

What mostly covers the liver?

A

peritoneum

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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

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21
Q

What is the space between liver and kidney?

A

subphrenic space or morison’s pouch

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22
Q

Where does fluid accumulation or abscess accumlate around the liver?

A

subphrenic space (aka morison’s pouch)

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23
Q

If you see fluid in Morison’s pouch what do you do?

A

a four quadrant sweep

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24
Q

What is the largest lobe of the liver?

A

right lobe

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25
Q

What is a fossa?

A

an impression of where something lives

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26
Q

What are the fossa’s of the liver?

A

porta hepatis

gallbladder

IVC

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27
Q

What is reidel’s lobe?

A

a congenital variant

an anterior projection on the right lobe

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28
Q

How does Reidel clinically present?

A

hepatomegaly

RUQ mass

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29
Q

Where is the left lobe of the liver found?

A

epigastric and left hypochondriac

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30
Q

What impression is under the left lobe?

A

the gastric impression

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31
Q

What is the medial segment of the left lobe??

A

quadrate lobe

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32
Q

Where is the quadrate lobe found?

A

posterioinferior Lt. lobe

bounded by GB fossa, porta hepatis and umbilical vein fossa

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33
Q

What is the caudate lobe?

A

posterior portion of the liver

small

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34
Q

What separates the caudate lobe from the left lobe?

A

ligamentum venosum

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35
Q

Of Couinaud’s 8 segments of the liver, what is segment two?

A

lateral left lobe (superior)

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36
Q

What is segment I of couinaud’s surgical resection of the liver?

A

caudate lobe

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37
Q

Who is Couinaud?

A

Created the surgical resection of the liver with 8 segments

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38
Q

What are the segments based on?

A

what we see of the portal and hepatic veins

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39
Q

how do ligaments and fissures appear on US?

A

appear echogenic or hyperechoic because of the presence of collagen and fat within and around the structures

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40
Q

What are the ligament and fissures?

A

Glisson capsule

main lobar fissure

falciform ligament

ligamentum teres (round ligament)

ligamentum venosum

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41
Q

What is glisson’s capsule

A

thin connective tissue

thickest around the IVC and porta hepatis

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42
Q

what is the main lobar fissure?

A

boundary between right and left lobes

hyper echoic line from portal vein to GB

picture slide 32

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43
Q

What is the falciform ligament?

A

helps attach liver to diaphragm

formed from mid-portion of coronary ligament

inferior margin contains ligamentum teres

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44
Q

What is the ligamentum teres?

A

echogenic focus

dividing the medial and lateral left lobe

circular echogenic structure

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45
Q

Why is the ligamentum teres special?

A

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)

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46
Q

What is the ligamentum venosum a remnant of?

A

ductus venosus

thin echogenic line anterior to the caudate lobe

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47
Q

Where is the right intersegmental fissure?

A

the RHV lays in this fissure

dividing anterior and posterior

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48
Q

Where is the left intersegmental fissure?

A

the LHV lays in this fissure

divides left lobe into medial and lateral

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49
Q

What are the coronary and triangular ligaments?

A

suspends the liver from the diaphragm

Has NOTHING to with the heart

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50
Q

What size does the portal vein need to be to be normal?

A

< 13mm in AP

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51
Q

How does the RPV course through the liver?

A

courses laterally and posteriorly

splits into anterior and posterior branches

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52
Q

What does an enlarged portal vein indicate?

A

portal hypertension

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53
Q

do the IVC and the MPV ever connect?

A

no

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54
Q

what are the two kinds of liver cells?

A

hepatocytes

kupffer cells

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55
Q

What do hepatocytes do?

A

synthesize

metabolize

excrete compounds

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56
Q

What do the kupffer cells do?

A

finish

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57
Q

What is one thing we use the liver for in US?

A

to evaluate other organs

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58
Q

where would we find the pancreas in relation to the liver?

A

seen just inferior to the left lobe

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59
Q

what area of the body does the right lobe of the liver occupy?

A

the right hypochondrium

60
Q

Is Reidel’s lobe more common in men or women?

A

women

61
Q

What is the texture of Reidel’s lobe?

A

normal texture

62
Q

Reidel’s lobe is an elongation of which segment?

A

segment VI

63
Q

What is the caudate lobe bounded by?

A

porta hepatis

IVC fossa

ductus venosus fossa

64
Q

What is segment III of Couinaud’s liver resection?

A

lateral left lobe - inferior

65
Q

What is segment IV of Couinaud’s liver resection?

A

medial segment of the left quadrate

66
Q

What is segment V of Couinaud’s liver resection?

A

anterior inferior segment of the right lobe

67
Q

What is segment VI of Couinaud’s surgical liver resection?

A

posterior segment of the right lobe - inferior

68
Q

What is segment VII of couinaud’s liver resection?

A

posterior superior segment of the right lobe

69
Q

What is segment VIII of Couinaud’s liver resection?

A

superior anterior segment of the right lobe

70
Q

What separates the caudate lobe from the left lobe?

A

ligamentum venosum

71
Q

What does the hepatic artery do?

A

carries oxygenated blood from the aorta to the liver

72
Q

how much oxygen does the hepatic artery supply to the liver?

A

20-30%

73
Q

Is the hepatic artery high or low resistance?

A

Low resistance

74
Q

how does the main portal vein enter the liver?

A

at the hilum

through the porta hepatis

75
Q

Between the LT and RT portal vein, which is the larger branch?

A

The Right portal vein

76
Q

Between the Rt and LT portal vein, which one is more anterior?

A

The LT portal vein

77
Q

How does the LPV course through the liver?

A

superiorly

splits into medial and lateral branches

78
Q

What supplies >60% of the blood supply to the liver?

A

the portal vein

79
Q

Is the portal vein higher or lower in oxygen?

A

lower

80
Q

What does the main portal vein branch into?

A

the LT and RT portal veins

81
Q

What is it called as the PV enters the center of the liver and the lobes that are supplied?

A

intrasegmental

82
Q

Of the hepatic veins, which is the largest?

A

RT hepatic vein

83
Q

of the hepatic veins, which is the smallest?

A

Left hepatic vein

84
Q

Where do the hepatic veins enter the IVC?

A

below the diaphragm

85
Q

What do the hepatic veins do?

A

drain blood from the liver and return it to the heart

86
Q

What is the job of the RHV?

A

drains the right lobe

divides RT lobe into anterior and posterior segments

lies in RT segmental fissure in longitudinal plane

87
Q

What is the job of the MHV?

A

separates right and left lobes

lies in main lobar fissure in trv plane

88
Q

What is the job of the LHV?

A

drains left lobe

divides left lobe into medial and lateral segments

lies in left segmental fissure in trv plane

89
Q

The portal vein carries blood from the ______ to the _____

A

Bowel

Liver

90
Q

The hepatic veins drain blood from the ______ into the _____.

A

Liver

IVC

91
Q

What are the main aspects of the portal veins?

A

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
Q

What are the main aspects of the hepatic veins?

A

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
Q

What is the job of the hepatobiliary system?

A

metabolic - chemical reactions to sustain life

excretory - elimination of waste products of metabolism

94
Q

What makes up the hepatobiliary system?

A

liver

bile ducts

GB

95
Q

Where do the bile ducts enter the duodenum?

A

through the ampulla of vater

96
Q

what structures create the common bile duct?

A

bile canaliculi > interlobular ducts > RT and LT hepatic ducts > common hepatic duct + cystic duct = common bile duct

97
Q

What are the liver functions?

A

metabolism

waste removal

digestion

storage

detoxification

synthesis and secretion of bile

98
Q

what part of the liver are the functional units?

A

the lobules

99
Q

what do the outer margin of the lobules contain?

A

portal triad tracts

100
Q

What do hepatocytes do?

A

synthesize

metabolize

excrete compounds

101
Q

What do Kupffer cells do?

A

aka: reticuloendothelial cells

phagocytize bacteria and foreign material

102
Q

What is the job of the metabolizing physiology of the liver?

A

synthesizing complex substances into simple ones for energy

103
Q

What are the metabolism enzymes that we need to know for liver lab values?

A

AST (aspartase aminotransferase)

ALT (alanine aminotransferase)

Alk Phos (alkaline phosphatase)

104
Q

What in the lab values will tell you if you have a biliary obstruction?

A

AST and ALT mildly elevated

Alk Phos - marked elevation

Abn in metastatic

105
Q

What will happen with the liver lab values if you have hepatocellular obstruction?

A

AST and ALT - striking elevation

ALT is more specific

106
Q

What is hepatocellular disease?

A

liver cells (hepatocytes) are the immediate problem

usually treated medically with supportive measures and drugs

107
Q

What is an obstructive disorder in liver disease?

A

bile excretion is blocked

usually treated surgically

108
Q

If AST and ALT are elevated, what disease are you looking for?

A

heart and skeletal damage

109
Q

If ALT is elevated above AST, what is the cause?

A

Hepatic cause

110
Q

If Alk phos is elevated what are you looking for?

A

bone disease

normal pregnancy

111
Q

What is Alpha fetoprotein?

A

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
Q

How does the GB aid in digestion?

A

Expels waste products

Bile is continuously formed and transported by ducts

release bilirubin when RBC are broken down

113
Q

What does the liver store?

A

vitamins

iron/copper

glycogen

fat

amino acids

114
Q

What organ eliminates Urea?

A

the kidneys

115
Q

How is urea measured?

A

in the BUN (blood urea nitrogen lab value)

116
Q

what might you have if the BUN is low?

A

severe liver disease

117
Q

What is converted to urea?

A

ammonium

118
Q

What condition do you get when there is ammonium accumulation?

A

breath odor - fector hepaticus

119
Q

What does the liver detox?

A

poisonous substances

bacteria

alcohol

120
Q

Bilirubin is the product of ______.

A

hemoglobin

121
Q

what is uptake?

A

when bilirubin separated from albumin

122
Q

What is conjugation?

A

When bilirubin is combined with glucuronic acid…making it soluble in water

123
Q

What is bile?

A

excretory product of the liver

124
Q

What is formed continuously in the hepatocytes?

A

bile

125
Q

Bile _______ and is _________ in the ducts

A

collects

transported

126
Q

What makes up bile?

A

water

bile salts

pigments

127
Q

What is the job of bile?

A

emulsification of fat

removal of wastes

128
Q

What is a liver function test?

A

AST (formerly SGOT) aspartate aminotransferase

129
Q

What is AST?

A

Enzyme present in tissue with high metabolism

130
Q

When will you find elevated AST?

A

With any disease that injures liver cells

131
Q

If you have significant elevations of AST, what conditions do you potentially have?

A

acute hepatitis

cirrhosis

132
Q

What does elevated bilirubin give you?

A

jaundice

133
Q

What is direct bilirubin?

A

conjugated

elevated hepatocellular disease

elevated biliary obstruction

134
Q

What is indirect bilirubin?

A

unconjugated

elevated hematologic disease

135
Q

What happens if estrogen failures to metabolize due to liver disease?

A

gynecomastia (breast enlargement)

testicular atrophy

136
Q

slide 87?

A

make cards?

137
Q

What is LDH?

A

lactic acid dehydrogenase

138
Q

When does LDH elevate?

A

moderate elevation with infectious

FINISH 88

139
Q

When Does alk phos elevate?

A

good indicator of intrahepatic and extrahepatic OBSTRUCTION of the liver

140
Q

What disturbs bilirubin?

A

SLIDE 90

141
Q

What is related to the elevation of DIRECT bilirubin?

A

obstructive jaundice

stone, mass, neoplasm

US “sees” the cause

142
Q

What is prothrombin time (PT)?

A

show blood clotting

vitamin K (adds to blood clotting)

liver disease causes an increase in PT

143
Q

What do albumin and globulin indicate in a liver function test?

A

metabolic disorders

FINISH SLIDE 93

144
Q

What is hepatocellular diseases?

A

Directly effects the actual liver cells (hepatocytes)

145
Q

What are obstructive diseases?

A

a ‘something” is blocking part of the biliary tree

a mass, stone…something blocking

146
Q

What are the indications for US of the liver?

A

RUQ pain

palpable mass

hepatomegaly

jaundice

hx of alcohol abuse

abnormal LFTs

?mets

pancreatitis

147
Q

What is the prep for liver US?

A

NPO for 8 hours if GB is evaluated

148
Q

What are the relative echogenicities in the abdomen (hyperechoic to hypoechoic)?

A

renal sinus»pancreas»liver»spleen»renal parenchyma

abdomen (11 decks)

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