Test review Flashcards
ligaments
Falciform Ligament
ligamentum teres
ligamentum venosum
coronary ligament
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
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
ligamentum venosum
separates the left and caudate lobes of the liver
seen just inferior to the dome as a linear horizontal line
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
Fissures of the liver
Main lobar
Right intersegmental fissure
Left intersegmental fissure
Main Lobar Fissure
divides the left and right lobes
hyperechoic line extending from portal vein to neck of GB
Right intersegmental fissure
Divides right lobe into anterior and posterior segments.
Identified by right hepatic vein
Left intersegmental fissure
Divides left lobe into medial and lateral segments.
Identified bt left hepatic vein
Liver function tests
Alkaline Phosphatase
Alanine Aminotransferas
Aspartate Aminotransferase
Lactic Acid dehydrogenase
Bilirubin (direct, indirect and total)
Prothrombin Time
Albumin
Globulins
Alkaline Phosphatase
Enzyme produced primarily by liver, bone and placenta.
elevation related to
hepatic matastasis
hepatitis
lymphoma
cholestasis secondary to drugs
cirrhosis
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
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
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
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
indirect bilirubin
rise in this test is seen with increased RBC destruction
(anemias, trauma from hematoma or hemorrhagic pulmonary infarct)
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
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
