Test review Flashcards by William Kerns

ligaments

Falciform Ligament

ligamentum teres

ligamentum venosum

coronary ligament

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Falciform ligament

extends from umbilicus to the diaphragm in parasagittal plane

contains the ligamentum teres

anteriorposterior axis extendes from right rectus muscle to bare area

echogencis reflections contintribute to hepatic ligament and attach to undersurface of diaphragm

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ligamentum teres

appears as a bright echogenic focus as the termination of the falciform ligament

separates the medial and lateral segments of the left lobe

Usually appears triangularly on images

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ligamentum venosum

separates the left and caudate lobes of the liver

seen just inferior to the dome as a linear horizontal line

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Coronary ligament

The wide coronary ligament connects the central superior portion of the liver to the diaphragm.

Located on the lateral borders of the left and right lobes, respectively, the left and right triangular ligaments connect the superior ends of the liver to the diaphragm

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Fissures of the liver

Main lobar

Right intersegmental fissure

Left intersegmental fissure

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Main Lobar Fissure

divides the left and right lobes

hyperechoic line extending from portal vein to neck of GB

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Right intersegmental fissure

Divides right lobe into anterior and posterior segments.
Identified by right hepatic vein

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Left intersegmental fissure

Divides left lobe into medial and lateral segments.
Identified bt left hepatic vein

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Liver function tests

Alkaline Phosphatase

Alanine Aminotransferas

Aspartate Aminotransferase

Lactic Acid dehydrogenase

Bilirubin (direct, indirect and total)

Prothrombin Time

Albumin

Globulins

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Alkaline Phosphatase

Enzyme produced primarily by liver, bone and placenta.

elevation related to

hepatic matastasis

hepatitis

lymphoma

cholestasis secondary to drugs

cirrhosis

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Alanine Aminotransferase

ALT

More specific than AST

slightly elevated in acute cirrhosis, hepatic metastasis, pancreeatitis

mild to moderate increase in obstructive jaundice,

moderate to high increase in hepatocelluar disease and infectious or toxic hepatitis

AST is higher in alcoholic hepatitis

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Aspartate Aminotransferase

An enzyme present in many tissues that have high metabolic rate

released when cells are injured or damaged

released in abnormally high levels

Elevation associated with cirrhosis, acute hepatitis, hepatic necrosis and mononucleosis

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Lactic Acid dehydrogenase

LDH

found in tissues of several systems

cellular injury and death cause enzyme to be released

moderate increase for mononucleosis

mildly elevated in hepatitis, cirrhosis and obstructive jaundice

primary use in detecting myocardial or pulmonary infarction

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bilirubin

product of breakdown of hemoglobin in old RBC’s

liver converts to bile pigments secreted by liver cells into bile ducts

rise in serum leaks and gives skin a jaundices or yellow coloration

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indirect bilirubin

rise in this test is seen with increased RBC destruction

(anemias, trauma from hematoma or hemorrhagic pulmonary infarct)

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direct bilirubin test

product circulates in the bolld and is excreted into the bile after reaching the liver

conjugated with glucuronide

elevatoin usually related to obstructive jaundice (stones or neoplasm)

increase is more in hepatatic metastasis, hepatitis, lymphoma, cholestasis, secondary to drugs and cirrhosis

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prothrombin time

liver enzyme part of blood clotting mechaniam

productoin depends on adequate intake and use of vitamin K

increases in presence of liver disease with cellular damage

cirrhosis and metatasitc disease casue prolonged time

Albumin

sensitive test for metabolic derangement of liver

low results suggest decreased protein synthesis in hepatocellular damaged patients

globulins

common elevation in chronic liver disease

Glycongen Storage disease

inherited characterized by abnormal storage and accumulation of glycongen in tissues (liver, kidneys)

six categories divided based on clinical symptoms and specific enzyme defects

most common type I or von Gierke’s disease

type I or von Gierke’s disease

glycongen storage disease in chich abnormally large amounts of glycogne are deposited in the liver and kidneys

sonographic appearance of glycogen storage dsease

present with hepatomegaly,

increased echogenicity

slightly increased attenuatoin (similar to fatty infiltrate)

associated with hepatic adenomas, focal nodular hyperplasia and hepatomegaly

adenoma presents as well demarcated round homogeneous echogenic tumors

if tumor is large in may be slightly inhomogeneous

benign liver tumors

Cavernouse hemagioma

LIver cell adenoma

focal nodule hyperplasia

hepatic cystadenoma

Cavernous Hemagioma

binign congenital tumor consisting of large blood filled cystic spaces most common benign tumor of liver more frequently in females usually asymptomatic, may bleed causing RUQ pain. enlarge slowly and undergo degeneration, fibrosis and calcification found in hepatic parenchyma or in posterior RL more than LL

Liver Cell Adenoma

tumor of the glandular epithelium in which cells are arranged in recognizable glandular structure normal or slightly atypical hepatocytes, frequently containing areas of bile stasis, focal hemorrhage or necrosis lesion found more in women and related to oral contraceptive use presents iwth RUQ pain secondary to rupture with bleeding increased in type I glycogen storage disease

focal nodule hyperplasia

second most common benign liver mass thought to arise from developmental hyperplastic lesions related to an area of congenital vascular formatoin typically one well circumscribed lesion but may be more than one mass, many located alond subcapsular area of liver, may be pedunculated and have central scar consists of normal hepatocytes, kupffer cells, bile duct elements, fibrous connective tissue bands of fibrous tissue separate the nodules

focal nodular hyperplasia

found in women under 40 asymptomatic more in RL

hepatic cystadenoma

contains cystic structures within the lesoin rare neoplasm occuring in middle aged women most have palpable abdominal mass

Normal variants of the Gallbladder

Bilobed gallbladder Septated gallbladder Phrygian cap Hartmann pouch Junctional fold

Bilobed gallbladder

Hourglass appearance

Septated gallbladder

Appear as thin separations within the gallbladder

Phrygian cap

Gallbladder fundus is folded onto itself

Hartmann pouch

Outpouching of gallbladder neck

Junctional fold

Prominent fold located at the junction of the gallbladder neck

Gallbladder size

Size is variable, but approx 7-10cm in length and 2.5-4cm in width

Heister’s valves function

in the neck keeps the cystic duct from kinking

Anatomy of the Bile Ducts

Consists of the right and left hepatic duct, common hepatic duct, common bile duct, pear shaped gallbladder, and cystic duct

Right and left hepatic ducts

come from the right lobe of the liver in the Porta hepatis and unite to form the CHD

Common Hepatic Duct

approx 4mm in diameter, joins the cystic duct(draining the gallbladder) and is now called the CBD

CBD ends

by piercing into the wall of the duodenum where is joins the main pancreatic duct and together, they open into the duodenum through a small opening called the ampulla of Vater

CBD (prox portion) location

lies lateral to the hepatic artery and anterior to the portal vein (left ear of Mickey Mouse)

CBD measurement

Normal measurement is

Cystic Duct-

approx 4 cm long, connects the neck of the gallbladder to the CHD to form the CBD normally not seen by ultrasound