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Abd / SS > Module 3 : Liver > Flashcards

Module 3 : Liver Flashcards

1
Q

Liver - location

A
  • intraperitoneal
  • largest organ in the body
  • RUQ
  • right hypochondrium, epigastric, left hypochondrium
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2
Q

Liver - superior margins

A
  • bordered superiorly by diaphragm

- superior anterior posterior surface of liver are in contact with the diaphragm

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3
Q

Liver - inferior surface

A
  • in contact with viscera, rests on upper abdominal organs
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4
Q

Liver - posterior surface

A
  • indented by right kidney
  • ## IVC is posterior
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5
Q

Liver- displacement

A 
Caudally 
  - tumors 
  - cirrhosis 
  - subphrenic abscesses 
Cranially 
   - abdominal tumor
   - ascites
   - excessive dilatation of colon
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6
Q

Liver - shape and size

A
  • varies in size and shape dependent on body habitus
  • right lobe 2-3 times larger than left lobe in size
  • left lobe varies in size and shape
    + wedge shaped
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7
Q

Liver - measurement

A
  • length (midclavicular line - from diaphragm to inferior edge)
    • = 15.5
  • AP at mid point of longitudinal measurement
    • 8.1 +/- 1.9 S.D
  • Caudate/ RT Lobe ratio (subcostal true transverse)
    • < 0.65
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8
Q

Liver enlarged if…

A
  • Rt lobe extends below lower pole of right kidney

- except with reidels lobe

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9
Q

Reidels lobe

A
  • tongue like extension of inferior tip of Rt lobe of liver, frequently found in slim females
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10
Q

Lobar anatomy - anatomical

A
  • not typically used in medicine
  • based on external markings
  • 4 lobes: quadrate , caudate, right and left
  • falciform ligament divides right and left lobes
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11
Q

Anatomical division - caudate and quadrate

A

Caudate - lies between IVC, LIG venosum, and Portal Vein

Quadrate - porta hepatis, gallbladder fossa, LIG teres

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12
Q

Functional division

A
  • based on blood supply and biliary drainage (important for surgical reasons)
  • ligaments, fissures, and gallbladder as landmarks
  • 3 lobes and 4 segments
    + right lobe : anterior posterior
    + left lobe : lateral medial
    + caudate
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13
Q

Functional - intrasegmental

A
  • right and left portal veins course WITHIN the segments
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14
Q

Functional - Intersegmental

A
  • right left and middle hepatic veins course between the lobes and segments
  • INTERLOBAR
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15
Q

Functional - right lobe

A
  • separated by left lobe by main lobar fissure
    + middle hepatic vein courses through MLF
  • divides into anterior posterior segments by right Intersegmental fissure
    + right hepatic vein and right portal vein course though RIF
    = anterior Right Portal within anterior Right Lobe
    = posterior right portal within posterior right lobe
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16
Q

Functional - left lobe

A
  • divided into medial and lateral segments by left Intersegmental fissure
    + left hepatic vein, left portal and LIG teres run through LIF
  • medial left lobe considered quadrate lobe
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17
Q

Functional - caudate lobe

A
  • receives portal venous and hepatic arterial blood from both right and left systems
  • located on the posterior aspect of the liver
  • posterior landmark = IVC
  • anterior landmark = LIG venosum
  • structure directly inferior = MPV
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18
Q

Functional- caudate process

A
  • portion of the caudate that extends to the right obliquely and passes between the IVC and portal vein
  • everyone has one
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19
Q

Functional - papillary process

A
  • caudal projection of the caudate lobe

- not on everyone

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20
Q

main lobar fissure

A
  • divides liver into functional right and left lobes
  • gallbladder and IVC used as landmarks
  • short portion of the main lobar fissure is identified between the right portal vein and gallbladder neck in sagittal
  • middle hepatic vein courses through it
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21
Q
  • right intersegmental fissure
A
  • divides right lobe into anterior and posterior segments

- right hepatic vein and portion of rpv course through it

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22
Q

left intersegmental fissure

A
  • divides the left lobe into medial and lateral segments
  • fissure divided into cranial middle and caudal
    + left hepatic vein courses within the cranial third
    + ascending branch of left portal vein represents middl third
    + lig teres divides caudal portion
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23
Q

fissure for the ligamentum venous

A
  • divides the left lateral segment from the caudate lobe
  • contains lig venosum (remnant of ductus venous)
  • contains hepatogastric ligament (makes up lesser omentum)
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24
Q

gallbladder fossa

A
  • contains gall bladder
  • located on posterior inferior portion of right lobe of liver
  • closely related to main lobar fissure
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25
Q

inferior vena cava fossa

A
  • contains portion of IVC

- depression on posterior surface of the liver between the caudate and bare area

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26
Q

porta hepatis

A
  • main vessel and biliary ducts leave and enter the liver at this point
  • COMMON BILE DUCT AND HEPATIC ARTERY ARE ANTERIOR TO PORTAL VEIN
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27
Q

glissons capsule

A
  • thin layer of connective tissue surrounding the liver

- thickest at IVC and porta hepatis

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28
Q

hepatoduodenal ligament

A
  • a fold of lesser omentum
    + with hepatogastric is full lesser omentum
  • anterior boundary of epiploic foramen
    + connection between greater and lesser sac
  • 3 structures within HL
    + main portal vein, hepatic artery, CBD
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29
Q

falciform ligament

A
  • extends from umbilicus to liver
  • attaches the diaphragm to the superior surface of the liver
  • conducts fetal umbilical vein
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30
Q

ligamentum teres (round ligamnetum)

A
  • inferior margin of the liver

- atrophied umbilical vein

31
Q

ligamentum venosum

A
  • remnant of the fetal ductus venosum

- anterior border of the caudate lobe

32
Q

coronary ligaments

A
  • defines bare area of liver
  • connects the posterosuperior surface of the liver to the diaphragm upper portion continuous with falciform ligament
  • forms right and left triangular ligament
33
Q

portal veins

A
  • carry partially oxygenated blood from intestines, spleen, pancreas, GB and bowel
  • travel intrasegmentally (within the segments)
  • echogenic reflective walls (connective tissue surrounding portal triad)
  • vessel caliber is greater near porta hepatis
34
Q

main portal vein

A
  • formed by conjunction of splenic vein, SMV, IMV
  • travels to the right in a cephalic oblique
  • divides into the right and left portal vein at porta hepatis
35
Q

right portal vein

A
  • anterior and posterior branches
  • travels posterior and caudally
  • can appear as elongation of MPV
36
Q

left portal vein

A
  • moves cranially along the anterior surface of the caudate lobe and then turns anterior
  • divides into medial and lateral branches
  • steers head
37
Q

hepatic veins

A
  • carry deoxygenated blood from the liver to the IVC
  • drain toward right atrium
  • travel intersegmentally (between lobes)
  • caliber increases as the approach diaphragm and IVC
  • do NOT have echogenic walls
38
Q

right hepatic vein

A
  • Largest

- travels in right intersegmental fissure

39
Q

left hepatic vein

A
  • smallest

- travels in left intersegmental fissure

40
Q

middle hepatic vein

A
  • travels in main lobar fissure
41
Q

sonographic appearance

A
  • homogenous with fine to medium level echoes
  • MINIMALLY HYPERECHOIC OR ISOECHOIC WHEN COMPARED TO RIGHT RENAL CORTEX
  • fissures and ligaments are highly echogenic
  • portal vein walls are echoic
42
Q

patient prep and scanning

A
  • over night fast NPO
  • supine of LLD
  • subcostal and intercostal
  • big breath in and hold
  • curvilinear
  • sag and trans assessment
  • attention to size, texture, vasculature, and biliary structs
43
Q

lobule

A
  • FUNCTIONAL UNIT OF THE LIVER
  • 1 to 2 mm in diameter
  • consists of
    + hepatocytes
    + central hepatic vein
    + sinusoids
    + kupffer cells
    + bile canaliculi
    + portal triads
44
Q

hepatocytes

A
  • organized in two layered columns converging toward a central vein in a radial pattern
  • in contact with sinusoid blood
  • liberate substances into the blood
  • make up most of liver tissue
45
Q

sinusoids

A
  • blood enters periphery of lobule and travels to central vein via sinusoid
  • located between hepatocyte and colomns
  • consists of 80% portal venous blood and 20% hepatic blood
46
Q

kupffer cells

A
  • scattered along sinusoids
  • part of reticuloendothelial system (defensive)
  • ingest and destroy foreign material (phagocytosis)
  • cleanse blood
47
Q

bile canaliculi

A
  • between 2 layers of liver cell columns
  • smalles division of biliary tract
  • bile liberated from hepatocytes into canaliculi flowing toward the later bile duct outer edge of liver lobule
  • bile duct is always separated from the sinusoid blood
  • converge to form larger ducts then unite to form right and left hepatic ducts
48
Q

portal triad

A
  • consist of bile duct, portal vein, and hepatic artery
  • at outer edge of lobule
  • several portal triads in single lobule
49
Q

central hepatic vein

A
  • blood enters periphery of lobule and travels toward the central vein via the sinusoids
  • blood in central vein should be cleansed of toxins and rich in lover secretions
  • converge into larger veins which unite into hepatic veins draining into IVC
50
Q

function of liver

A
  • primary centre of metabolism
  • performs about 500 separate activities
  • functions carried out via hapetocytes, kupffer cells, biliary cells
51
Q

bile formation and secretion

A
  • bilirubin is a product of red blood cell breakdown
  • bile salts are formed froth cholesterol in hepatic cells
  • bile emulsifies fats and aids in absorption of fatty acids
  • 700 to 1200ml / day
52
Q

bilirubin

A 
- unconjugated bilirubin 
     \+ indirect 
     \+ fat soluble 
     \+ not excreted into urine
     \+ toxic to tissues 
- conjugated bilirubin 
    \+ direct
    \+ non toxic
    \+ water soluble
    \+ secreted by liver into bile canaliculi
53
Q

reticuloendothelial function/immune system

A
  • produces blood cells in the embryo (hemopoiesis)
  • produces plasma protein and antibodies
  • remove foreign material and worn out red blood cells via kupffer cells (phagocytosis)
  • recovers bile pigment
54
Q

metabolism

A
  • carbohydrate
    + glucose buffer
  • fat
  • protein
55
Q

storage depot

A
  • vitamin A, D, B12
  • glycogen, fats, amino acids
  • ferritin (derivative of iron)
  • copper and iron
    + poison
56
Q

blood reservoir

A
  • can store 200 - 400 ml
57
Q

heat production

A
  • produces heat result of chemical reactions
58
Q

detoxification

A
  • alcohol
59
Q

lymph formation

A
  • one third to half of body lymph fluid
60
Q

lab tests

A
  • test for enzyme
61
Q

enzyme

A
  • protein that catalyze chemical rxn
  • accelerate and control rxn rates = not destroyed
  • diff cells produce diff enzymes
  • tissue cell damage&raquo_space; enzyme in blood streams
  • reflect function of body
  • blood (serum) & urine
62
Q

ALT / SGPT

A
  • enzyme porduced in hepatocytes
  • SPECIFIC INDICATOR FOR HEPATOCELLULAR DAMAGE
  • used with AST to distinguish between cardiac and hepatic damage
  • increased values seen in hepatitis, cirrhosis, tutors, hepatotoxicity
63
Q

AST / SGOT

A
  • found in liver, muscle and tissue with high metabolic rates
  • released with injury to cells in tissue
  • increased values in hepatitis , cirrhosis, hepatotoxicity, myocardial infarction
64
Q

ALP or Alk Phos

A
  • enzyme in liver bone placenta
  • BILIARY OBSTRUCTION
  • ALP INCREASED WITH NORMAL AST AND ALT INDICATES DISEASE OF BILE DUCT
65
Q

LDH

A
  • multiple organ systems
  • usually used to detect myocardial infarctions or pulmonary infarcts
  • increase in hepatitis cirrhosis instructive jaundice
66
Q

GGT

A
  • nonspecific indicator of hepatic disease

- SENSITIVE TO EFFECTS OF ALCOHOL IN LIVER

67
Q

AFP

A
  • produced in fetal tissue
  • PROTEIN
  • INCREASED VALUES IN HEPATOCELLULAR CARCINOMA AND TESTICULAR CARCINOMA
68
Q

BILIRUBIN

A
  • breakdown product of hemoglobin
  • values consist of
    + total bilirubin
    - combined conjugates and unconjugated bilirubin
    - increase in hepaticelluar damage
    + unconjugated/indirect
    - elevated in hepatocellular disease and hemolytic anemia
    + conjugated/direct
    - ELEVATED IN EXTRAHEPATIC BILE DUCT OBSTRUCTION
69
Q

PROTHROMBIN TIME (PT)

A
  • clotting factor affected by levels of vitamin K
  • ability of blood to clot
  • prolonged in nonfunctioning or scarred liver and lack of vitamin K
  • also prolonged with anticoagulant therapy
70
Q

INR (internation normalized ratio)

A
  • ratio used in place of PT

- greater than 1.2 liver biopsies should not be done

71
Q

PTT

A
  • measures clotting time of blood
72
Q

SERUM PROTEIN

A
  • albumin is a PROTEIN synthesized by the liver and maintains osmotic pressure in blod
  • decreased levels seen in liver dysfunction
73
Q

HEPATITIS TESTING

A
  • used to determine is patient has been exposed to or currently infected with or carrier of viral hepatitis
  • hep A or B
  • hep non A or non B

Abd / SS (14 decks)

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