test review reverse Flashcards
reverse
Falciform Ligament
ligamentum teres
ligamentum venosum
coronary ligament
ligaments
reverse
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
Falciform ligament
reverse
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 teres
reverse
separates the left and caudate lobes of the liver
seen just inferior to the dome as a linear horizontal line
ligamentum venosum
reverse
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
Coronary ligament
reverse
Main lobar
Right intersegmental fissure
Left intersegmental fissure
Fissures of the liver
reverse
divides the left and right lobes
hyperechoic line extending from portal vein to neck of GB
Main Lobar Fissure
reverse
Divides right lobe into anterior and posterior segments.
Identified by right hepatic vein
Right intersegmental fissure
reverse
Divides left lobe into medial and lateral segments.
Identified bt left hepatic vein
Left intersegmental fissure
reverse
Alkaline Phosphatase
Alanine Aminotransferas
Aspartate Aminotransferase
Lactic Acid dehydrogenase
Bilirubin (direct, indirect and total)
Prothrombin Time
Albumin
Globulins
Liver function tests
reverse
Enzyme produced primarily by liver, bone and placenta.
elevation related to
higher in obstruction
hepatic matastasis
hepatitis
lymphoma
cholestasis secondary to drugs
cirrhosis
Alkaline Phosphatase
reverse
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
Alanine Aminotransferase
ALT
reverse
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
Aspartate Aminotransferase
reverse
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
Lactic Acid dehydrogenase
LDH
reverse
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
bilirubin
reverse
rise in this test is seen with increased RBC destruction
(anemias, trauma from hematoma or hemorrhagic pulmonary infarct)
indirect bilirubin
reverse
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
direct bilirubin test
reverse
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
prothrombin time
reverse
sensitive test for metabolic derangement of liver
low results suggest decreased protein synthesis in hepatocellular damaged patients
Albumin
reverse
common elevation in chronic liver disease
globulins
reverse
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
Glycongen Storage disease
reverse
glycongen storage disease in chich abnormally large amounts of glycogne are deposited in the liver and kidneys
type I or von Gierke’s disease
reverse
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
sonographic appearance of glycogen storage dsease
reverse
Cavernouse hemagioma
LIver cell adenoma
focal nodule hyperplasia
hepatic cystadenoma
benign liver tumors
reverse
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
Cavernous Hemagioma
reverse
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
Liver Cell Adenoma
reverse
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 nodule hyperplasia
reverse
found in women under 40
asymptomatic
more in RL
focal nodular hyperplasia
reverse
contains cystic structures within the lesoin
rare neoplasm occuring in middle aged women
most have palpable abdominal mass
hepatic cystadenoma
reverse
Bilobed gallbladder
Septated gallbladder
Phrygian cap
Hartmann pouch
Junctional fold
Normal variants of the Gallbladder
reverse
Hourglass appearance
Bilobed gallbladder
reverse
Appear as thin separations within the gallbladder
Septated gallbladder
reverse
Gallbladder fundus is folded onto itself
Phrygian cap
reverse
Outpouching of gallbladder neck
Hartmann pouch
reverse
Prominent fold located at the junction of the gallbladder neck
Junctional fold
reverse
Size is variable,
but approx 7-10cm in length and 2.5-4cm in width
Gallbladder size
reverse
in the neck keeps the cystic duct from kinking
Heister’s valves function
reverse
Consists of the right and left hepatic duct,
common hepatic duct,
common bile duct,
pear shaped gallbladder,
and cystic duct
Anatomy of the Bile Ducts
reverse
come from the right lobe of the liver in the Porta hepatis and unite to form the CHD
Right and left hepatic ducts
reverse
approx 4mm in diameter, joins the cystic duct(draining the gallbladder) and is now called the CBD
Common Hepatic Duct
reverse
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 ends
reverse
lies lateral to the hepatic artery and anterior to the portal vein (left ear of Mickey Mouse)
CBD (prox portion) location
reverse
6mm < 60yrs of age
increase 1mm per 10 yrs of aging
CBD measurement
reverse
approx 4 cm long,
connects the neck of the gallbladder to the CHD to form the CBD
normally not seen by ultrasound
Cystic Duct-
bililrubin mild to severe increase
hepatocellular disease
serum albumin
decreased
hepatocellular disease
AST
moderate to severe increase
hepatocellular disease
ALT
moderate to severe increase
hepatocellular disease
Alkaline Phosphatase
minimal to moderate increase
hepatocellular disease
bilirubin
severe increase
obstruction
albumin
normal
obstruction
AST
mild increase
obstruction
ALT
mild increase
obstruction
Alkaline phosphatase
severe increase
obstruction
normnal measurement
4mm
Common Hepatic Duct
tumor at the bifurcatoin of the hepatic ducts
may cause asymmetric obstruction of the biliary tree
Klatskin’s tumor
uncommon cause for extrahepatic biliary obstruction resulitng from an impacted stone in cystic duct
Mirizzi sundrome
normal to increased hepatic enzymes
increased ALK phosphatase
increased birect bilirubin
Fatty infiltrate liver
increased AST
increased ALT
increased bilirubin
leukopenia
Acute hepatitis
increased AST
increased ALT
increased bilirubin
leukopenia
Chronic hepatitis
increased Alk Phos
increased direct bilirubin
increased AST
increased ALT
leukopenia
Cirrhosis
disturbance of acid-base balance
Glycogen storage disease
increase iron levels in blood
hemochromatosis
