Liver WB EX except 5,7 Flashcards
MLF fissure divedes
L and R lobe
L, R, M hepatics dived what way
longitudinally
R and L portal veins divide what way
transversly
Glissons capsule is
the liver covering
What two ligmaents &/or fissures divide the L lobe into medial and lateral portions
Falciform ligament and Ligamentum teres
Main portal vein as well as MLF divides into
L and R lobes
Whats more ecogenic portal veins or hepatic veins?
Portal
What carries blood from the bowels into the liver?
Portal V
What drains blood from the liver into the IVC?
Hepatic V
What carries oxygenated blood from the aorta to the liver?
Hepatic A
What two vessels carry blood to liver?
Portal v and Hparic A
Brief overview of metabolism
phy and chem process
Brief overview of digestion
bile
Brief overview of storage
Iron and vitamins
Brief overview of detox
drugs and poisons
Define Bilirubin
break down of red blood cells
Hepatobillary systym includs
liver, bile ducts, and gall bladder. Metabolic and excretory fuctions
Hepatic disease is, and treated how
hepatocytes imediate problem ex. viral hepititis destroys cells TX: medically with drugs to decrease Albumin
Obstructive disease is, and is treated how
Bile excretion is blocked, liver malfunctions as secondary result. TX: surgically Severe increase in bilitubin and Alkaine Phos
Raw materials such as carbs(sugars), amino acids (protien), are absorbed from intestines and transported to…
the circulatory system
Carbs
Glucose - energy liver maintains steady state of glucose
Glucose is converted to what for storage
glycogen (starch)
Hypoglycemis
low glucose affects brain and organs
Hperglycemis
Increased glucose levels
Fats
Monoglyceride and diglycerides
Live is the primary site for metabolism of fats and is absorbed in intestenises in the form of
Monglycerides and diglycerides
Dietary fats are converted in to the hepatocytes to
lipoprotiends the transported and stored
Fatty liver
Fat croweds hepatocytes, pregnacy obesity liver disease and diabeties.
Protiens: Indirect- Direct-
Indirect: amino acids absorbed from gut Direct: raw materials stored in body
primary site for Albumin…
liver
Albumin
Helps maintain oncotic presure within vascular supply
Chronic liver disease has increased or decreased Albumin
decreased, hypoalbuminemia Edima, swelling may occur
Sever liver disease = advanced cirrhosis leading to the development of
ascites
Ascites #1 cause
Portal hypertension
Live is the primary source of blood coagulation name two..
fibrogen (1) and prothrobim (2)
Liver disease does what to blood coagulation
decreases coagulation, uncontrollable hemorage, can lead to death
In bile duct obstruction -
there is limited fat absorbtion
in hepatocellular disease
K improves but doesnt restore
Clotting Tests Pro-time Partial thromboplastin
test result in percent of time to clott long period = low percent patient time/ normal time to clot = %
Hepatic Enzymes
Protie catalysts that leak into blood stream when hepatocytes or injurded or dead.
increased hepatic enzymes in blood = what patho
Hepaticellular dissorder
HIgh serum levels in hepatocellular and biliary obstruction
Hepat = 300 untils Biliary = 1000 units
Abnormal Alkaline is the only symptom in
Metastic disease
Hepatic Detox
break down Ammonium, notrogen metabloism converted into nontoxic urea
BUN
Measures urea in blood
Sever liver disease has high or low BUN results
low due to no urea production
Fector hpaticus
fruity or pudgent breath due to ammonium
Low BUM equals high
NH4 ammonium accumulation resulting in brain dysfunction
Bilirubin detox break down of _____ excretes _____ to gut via _______
break down of RBC important detox excreted bilirubin to the gut via biliary tree (RBC on live 120 days)
Retociloendothelial cells in spleen trap what and break them down?
RBC
Bilirubin attaches to what?
Albumin
Metabolic steps take pace in hepatocyte when RBC is released
- uptake - seperate bilirubin and albumin 2.Conjugation - Bilirubin + glucronide = bilirubin diglycuronide 3. Excretion - bilitubin transported to cell memb
Once bilirubin is releaced from hepatocyte it is released into ______ delievered to ______ the exserted into _______
bile ducts Bowel Fesces
Hepatocellular Tests Direct and indirect fraction what one is chemically conjucated and unconjugated
Direct - chem conjugated bilirubin Indirect - unconjugated bilirubin
Total bilirubin =
direct + indirect = 1mg/100 ml or less
Transplant will increase the congugated bilirubin or uncongucated
uncongugated
Biliary obstruction vs. Hepatocelular bilirubin
less than 35/100 greater than 35/100
Examples of Indirect and direct bilirubin
indirect - hemolysis direct - hepato, and biliary obstruction
AST - asparate
Released due to death pr injury to producing cells cirrohsis and acute hep
ALT - alanin
live specific Hepatocellular disease, toxic hep = increased Alchoholic ALT is higher in Hep
LDH - Lactic acid
cell death injury = increase primary detection of myocardial or pulmonary infraction
Alk phos
HIgh alk phos = cirrohsis and hepatitis
3 causes of increased bilirubin
RBC destruction Malfunction of liver cells Blocked ducts leading from cells
Diseases that are both indirect and direct =
Hepatitis, hepaticmetastises, lymphoma, cirohsis
Prothrombin time
Clot time Increased clot time due to liver disease Cirrohsis and metastatix
Albumin and Clobulin tests
Depressed synthesis of protiens
MLF
Sperated L and R lobe
Left intestinal fissure and L portal V
L lobe into medial and lateral
The liver is more hyperechoic that the
kindey
the liver is less hyperechoic than the
spleen and pancreas
In focal sparing whats effected
the anterior callbladder and posterior L lobe are effeced
Fatty infilration =
increase lipid accumulation
Fatty infiltration sono findings
increased echo, lobe enlargemnt, focal sparing
Sono findings for Cirrhosis
Coarse, increased atttenuation, decreased vasulature
Inflamatory disease symptomes
fever, RUQ P, increased WBC count
Hemangioma
benign congenital tumor consisting of blood filled cystic spaces
The four criteria assessed when evaluating the liver parenchyma
Size, configuration, homogeneity, and contour
hepatocellular disease affects the ___ and interferes with liver function ezymes
hepatocytes
the hepatic enzyme levels are elevated with ___ necrosis
cell
fatty infiltration implies increased ___ accumulation in the hepatocytes and results from significant injury to the liver or a systemic disorder leading to impaired or excessive metabolism of fat.
lipid
describe the sonographic findings for fatty infiltration of the liver
Moderate to severe fatty infiltration shows increased echogenicity on ultrasound. Enlargement of the lobe affected by fatty infiltration is evident. The portal vein structures may be difficult to visualize because of increased attenuation of the ultrasound. Increased attenuation also causes a decrease in penetration of the sound beam, which may be a clue for the sonographer to think of fatty liver disease. Fatty infiltration is not always uniform and may demonstrate areas of focal sparing. The most common areas of focal sparing are located anterior to the gallbladder and portal vein and the posterior portion of the left lobe.
in focal sparing, the most common affected areas are anterior to the ___ or the portal vein and the posterior portion of the ___ ___ of the liver
Gallbladder, left lobe
On ultrasound examination, the liver parenchyma in chronic hepatitis is ___ with ___ brightness of the portal triads, but the degree of attenuation is not as great as seen in fatty infiltration
coarse, decreased
Cirrhosis is a chronic degeneration of the liver in which the lobes are covered with fibrous tissue, teh parenchyma ___, and the lobules are infiltrated with ___
degenerates, fat
Glycogen storage disease is associated with ___ ___, focal nodular ____, and hepatomegaly
Hepatic adenomas, hyperplasia
List the criteria that the sonographer should use to determine whether the mass is extrahepatic or intrahepatic
Intrahepatic masses may cause: displacement of the hepatic vascular radicles, external bulging of the liver capsule, or posterior shift of the IVC. Extrahepatic masses may show internal invagination or discontinuity of the liver capsule, formation of a triangular fat wedge, anteromedial shift of the IVC, or anterior displacement of the right kidney
List the signs and symptoms of a patient who has inflammatory disease of the liver
Fever, white cell elevation, and right upper quadrant pain
A(n) ____ is any new growth of new tissue, either benign or malignant.
neoplasm
A(n) ____ is a benign congenital tumor consisting of large, blood-filled cystic spaces.
hemangioma
The pathogenesis of hepatocellular carcinoma is related to ___, chronic ___ virus infection, and hepatocarcinogens in food
cirrhosis, hepatitisB
Describe the pathologic patterns seen in carcinoma of the liver
Solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltrative masses in the liver
The liver is the third most common organ injured in the abdomen after the ___ and the __
spleen, kidney
An increase in portal venous pressure or hepatic venous gradient is defined as ___ ___
portal hypertension
Portal hypertension may also develop when hepatopetal flow is impeded by ___ or __ invasion
thrombus, tumor
The umbilical vein may become __ secondary to portal hypertension.
recanalized
The pulse repetition frequency allows one to record lower velocities at the PRF is ___
decreased
The Doppler sample volume should be ___ than the diameter of the lumen
smaller
Explain what color doppler velocity is dependent on
direction of flow, velocity, and angle to flow
Acute abdominal pain, massive ascites, and hepatomegaly secondary to thrombosis of the hepatic veins or inferior vena cava characterize __-__ syndrome, which has a poor prognosis.
budd-chiari
describe the abnotmality
acute hepatitis w/ portal vein borders slightly more echogenic than normal
describe the lesion in the RUQ and list the most likely differentials in this asymptomatic pt
carernnous hemangioma. well defined irregular lesion is seen in dome of right lpobe of the live. differential considerations include METS, hepatoma (HCC), adenoma, and focular hyperplasia
a pt w/ an incidental finding on US during the evaluation of the liver. what is your differential?
incidental finding of a large solid mass in right lobe- most likely represents hepatocellular carcinoma
pt also has small amout of pleural effusion noted in sagital image
DD- metastatic disease
wht liver abnormality is demonsttated?
polysystic liver disease w. multiple cysts throughout the liver and kidney
