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OTC DMS 2020 > The Liver > Flashcards

The Liver Flashcards

1
Q

The liver is located in these 3 abdominal regions

A
  • the right hypochondrium
  • the greater part of the epigastrium
  • the left hypochondrium as far as the mammillary line
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2
Q

Which is true? The contour and shape of the liver may vary or stays the same.

A

-may vary

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3
Q

The liver lies _____ to the diaphragm.

A

-inferior

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4
Q

These cover the greater part of the right lobe of the liver.

A

-ribs

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5
Q

The liver extends several centimeters below the xiphoid process in this region.

A

-epigastric

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6
Q

Fluid build up around the liver is called

A

-ascites

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7
Q

The texture of the liver is

A

-homogeneous with fine-low level echos

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8
Q

This area is inferior to the lungs and superior to the liver

A

-subphrenic recess

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9
Q

This area is inferior to the liver and superior to the right kidney

A

-subhepatic space

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10
Q

The echogenicity of the cortex around the kidney is

A

-hypoechoic

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11
Q

The echogenicity of the center of the kidney is

A

-hyperechoic

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12
Q

The echogenicity of the diaphragm is

A

-hyperechoic

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13
Q

The liver is housed and stays in place by

A

-ligaments

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14
Q

This line is where anterior to posterior measurements are taken

A

-mid-clavicle line

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15
Q

This fold in the parietal peritoneum extends from the umbilicus to the diaphragm and contains the ligamentum teres

A

-falciform ligament

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16
Q

Remnant of the obliterated left umbilical vein seen as a triangular echogenic foci dividing the medial and lateral segments of the left lobe of the liver in the transverse plane

A

-ligamentum teres

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17
Q

This area is not covered by peritoneum

A

-bare area

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18
Q

A fibroelastic, connective tissue layer that surrounds the liver

A

-Glisson Capsule

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19
Q

Transverse measurement of liver

A

20-22.5cm

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20
Q

AP measurement of liver

A

10-12.5cm

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21
Q

Length measurement of liver

A

15-17cm

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22
Q

Enlargement of the liver(anything over 17cm) is called

A

-hepatomegaly

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23
Q

Dual blood supply from these two vessels

A

-portal vein and hepatic artery

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24
Q

This blood supply to the liver is oxygen rich

A

-hepatic artery

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25
Q

This blood supply to the liver is nutrient rich

A

-portal vein

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26
Q

The porta hepatis consists of the

A

-portal vein(largest), common bile duct(L), and the hepatic artery(R)

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27
Q

Signs and symptoms of liver disease are:

A

-anorexia, fatigue, fever, jaundice, hepatomegaly, and Abn LFT

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28
Q

Normal common bile duct measurements

A

4-8mm

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29
Q

Which hepatic artery is larger than the other

A

-Right, since the right lobe is larger

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30
Q

Will a diseased liver effect the caudate lobe? Why or why not?

A

-No, it has its own separate blood supply.

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31
Q

Couinaud system breaks the liver into

A

-8 segments

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32
Q

Segment I

A

Caudate Lobe

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33
Q

Segment II

A

Superior lateral segment

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34
Q

Segment III

A

Inferior lateral segment

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35
Q

Segments IVa and IVb

A

Medial segments

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36
Q

Segment V

A

Inferior anterior segment

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37
Q

Segment VI

A

Inferior posterior segment

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38
Q

Segment VII

A

Superior posterior segment

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39
Q

Segment VIII

A

Superior anterior segment

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40
Q

These two things appear echogenic and hyperechoic because of the presence of collagen and fat within and around the structures.

A

-ligaments and fissures

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41
Q

Name the 5 ligaments or fissures of the liver:

A

-Glisson capsule, main lobar fissure, falciform ligament, ligamentum teres(round lig.), ligamentum venosum

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42
Q

Divides the right and left lobes of the liver; seen in the sagittal plane as an echogenic line between the gallbladder neck and the main portal vein

A

-Main lobar fissure

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43
Q

This ligament appears bright echogenic focus in the left lobe of the liver in the transverse image.

A

-Ligamentum teres

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44
Q

Remnant of the ductus venosus seen as an echogenic line separating the caudate lobe from the left lobe

A

-Ligamentum venosum

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45
Q

The portal venous supply for the liver is made up of

A

-Main portal vein, right portal vein, and left portal vein

46
Q

These veins carry blood from the bowel to the liver

A

-Portal veins

47
Q

These veins drain blood from the liver into the IVC

A

-Hepatic veins

48
Q

This transports bile, which is manufactured in the liver, to the duodenum.

A

-Bile ducts

49
Q

This term refers to when portal veins do not drain blood from the liver.

A

-Hepatic feugal

50
Q

Do portal veins have more or less echogenic borders than the hepatic veins?

A

-more echogenic

51
Q

The hepatic artery may be seen posterior to the portal vein on the oblique transverse view which is known as the

A

-portal triad

52
Q

Hepatic metabolic functions of the liver:

A
  • converts sugars(carbs) into glucose
  • converts glucose into glycogen and stores it
  • metabolizes fats
  • converts dietary fats into hepatocytes to lipoproteins
  • uses stored fats for energy
53
Q

Other functions of the liver include:

A
  • manufactures plasma proteins
  • converts excess amino acids into fatty acids and urea
  • removes nutrients from blood
  • phagocytizes bacteria and worn-out RBCs
54
Q

The liver’s role in digestion:

A
  • secretes bile(digests fats)

- releases bilirubin when RBCs are broken down

55
Q

Storage function of the liver:

A

-iron and certain vitamins(K)

56
Q

Detoxification function of the liver:

A

-filters drugs, poisons, and waste products of metabolic process from the body

57
Q

Hepatocellular disease

A
  • Liver cells(hepatocytes) are the immediate problem
  • Effects liver function
  • Treated medically w/supportive measures and drugs
58
Q

Obstructive disorders

A
  • Bile excretion blocked

- Treated surgically

59
Q

Bilirubin detoxification

A
  • liver excretes bilirubin into the gut vie the biliary tree
  • after 120 days in the circulatory system, RBCs are trapped and broken down by reticuloendothelial cells, primarily in the spleen.
  • hemoglobin from RBCs converted to bilirubin w/i reticuloendothelial system then released into bloodstream
  • bilirubin molecules attach to albumin in blood and are transported to liver
60
Q

Metabolism of Bilirubin in Hepatocytes

A
  1. Uptake: bilirubin separated from albumin and taken to hepatocytes
  2. Conjugation: bilirubin molecule combined with 2 glucuronide molecules, forming bilirubin diglucuronide
  3. Excretion: Bili molecule actively transported into bile canaliculi, then released from hepatocytes and passes through bile ducts and delivered to the bowel
61
Q

Biliary obstruction

A
  • hepatocytes pick up bilirubin and conjugate it w/glucuronide, but cannot dispose it
  • conjugated form regurgitated into bloodstream with elevation of direct-acting bilirubin fraction
  • indirect-acting bilirubin may rise slightly w/obstruction, but direct bilirubin predominates
62
Q

What form of bilirubin predominates in hepatocellular disease?

A

-direct or conjugated

63
Q

What is the excretory product of the liver?

A

-bile

64
Q

Bile is continuously formed by hepatocytes and collects in

A

-bile canaliculi (bile ducts)

65
Q

Bile is made of

A

-water, bile salts, and bile pigments

other components: cholesterol, lecithin, and protein

66
Q

Primary functions of bile:

A
  • emulsify fats

- removes waste products excreted by liver

67
Q

Blood flow toward the liver; normal flow of portal veins

A

-hepatopetal

68
Q

Blood flow away from the liver; normal flow of hepatic veins

A

-hepatofugal

69
Q

Patient preparation for liver evaluation

A

-NPO for 6 hours before scan to eliminate bowel gas and ensure fullness of gallbladder

70
Q

Patient position for liver evaluation

A

-supine or right anterior oblique position; deep inspirations allow the liver to move inferior to the rib cage

71
Q

Completer survey of liver includes

A

-transverse, coronal, subcostal oblique, and sagittal views

72
Q

What lies within the homogeneous parenchyma?

A

-hepatic veins, portal veins, hepatic arteries, and hepatic duct

73
Q

Are the hepatic veins thick or thin walled?

A

-thin walled(hypoechoic)

74
Q

Are the portal veins dim or brightly reflective?

A

-brightly reflective(hyperechoic)

75
Q

With color-flow Doppler imaging, how does the portal veins flow?

A

-hepatopetal(toward the liver)

76
Q

With color-flow Doppler imaging, how does the hepaitc vein flow?

A

-hepatofeugal(away from the liver)

77
Q

Before beginning a liver exam, the parameters should be adjusted:

A
  • TGC
  • overall gain
  • transducer frequency and type
  • depth and focus
78
Q

Liver assessment criteria

A
  • size in SAG plane
  • texture
  • attenuation of liver parenchyma
  • presence of hepatic vascular structures, ligaments, and fissures
79
Q

This separates the right lobe from the left lobe of the liver

A

-main lobar fissure

80
Q

This passes through the gallbladder fossa to the IVC

A

-main lobar fissure

81
Q

This divides the right lobe of the liver into anterior and posterior segments

A

-right intersegmental fissure

82
Q

This divides the left lobe into medial and lateral segments

A

-left intersegmental fissure

83
Q

Are fissure hyperechoic or hypoechoic?

A

-hyperechoic

84
Q

This is found on the posterior aspect of the liver, with the IVC on its posterior border and the ligamentum venosum on the anterior border

A

-Caudate lobe

85
Q

These course bewteen the lobes(interlobal) and between the segments(intersegmental) of the liver

A

-Hepatic veins

86
Q

What major branches of veins run centrally within the segments?

A

-Portal veins

87
Q

This vein runs in the left intersegmental fissure

A

-ascending portion of the left portal vein

88
Q

The liver is _____ to _____ when compared with the renal cortex of the kidney, and ______ when compared to the spleen.

A

-hyperechoic, isochoic, hypoechoic

89
Q

Diffuse disease is measured through a series of

A
  • LFT or liver function tests

- hepatic enzyme levels elevated w/cell necrosis

90
Q

The most common benign disease of the liver; usually in the posterior segment of right lobe

A

-Cavernous hemangioma

91
Q

This is a reversible disorder of metabolism

A

-Fatty liver

92
Q

This disorder implies increased lipid accumulation in hepatocytes and the result of major injury to the liver or a systemic disorder

A

-Fatty infiltration

93
Q

These are not visible with fatty liver

A

-veins

94
Q

Causes of Fatty Liver

A
  • obesity
  • excessive alcohol intake
  • poorly controlled hyperlipidemia(high Choles.)
  • diabetes
  • excess corticosteroids
  • pregnancy
  • total parenteral hyperalimentation
  • severe hepatitis
  • glycogen storage disease
  • cystic fibrosis
  • pharmaceutical
95
Q

What stage of fatty liver:
minimal diffuse increase in hepatic echogenicity with normal visualization of diaphragm and intrahepatic vascular borders

A

-Mild

96
Q

What stage of fatty liver:

increased echogenicity with slightly impaired visualization of the diaphragm and intrahepatic vascular borders

A

-Moderate

97
Q

What stage of fatty liver:
significant increase in echogenicity of the liver parenchyma, decreased penetration of the posterior segment of the right lobe, and decreased to poor visualization of the diaphragm and hepatic vessels

A

-Severe

98
Q

This liver condition is most common cause of intrahepatic-portal hypertention

A

-Portal Venous Hypertension

99
Q

This condition may develop when hepatopetal flow(towards liver) is impeded by a thrombus or tumor invasion

A

-Portal Hypertension

100
Q

With portal hypertention, the liver is _____ in the early stage and ______ in the late stage.

A

-enlarged, small

101
Q

Doppler techniques for Heptaic vascular flow

A
  • Pulse repetition frequency(PRF)
  • Sample volume size and placement
  • Filters
  • Pulse wave (PW) Doppler
  • Color Doppler
  • Measurements: peak, systolic velocity, resistance index
102
Q

Diffuse abnormalities of the liver parenchyma

A
  • biliary obstruction
  • common duct stones and structures
  • extrahepatic mass
  • passive hepatic congestion
103
Q

Simple Hepatic Cysts

A
  • usually found incidental
  • found more often in women than men
  • round with acoustic enhancement, even echotexture, thin wall surrounds it
104
Q

What is Situs Inversus?

A

-internal organs are mirrored from their normal positions(right on left, left on right)

105
Q

What is Reidel’s Lobe?

A

-An anatomic variant in which the right lobe is enlarged and extends inferiorly as a tongue-like projection

106
Q

This connects and reroute the portal vein with the R hepatic vein to relieve some pressure and give relief

A

-Portosystemic Shunt

107
Q

a-fetoprotein; a tumor marker frequently elevated in cases of hepatocellular carcinoma and certain testicular cancers

A

AFP

108
Q

alkaline phosphates; an enzyme found in liver tissue that can be elevated with biliary obstruction

A

ALP

109
Q

alanine aminotransferase; a liver enzyme most specific to hepatocellular damage

A

ALT

110
Q

aspartate aminotransferase; an enzyme found in all tissues, but in largest amounts in the liver, an increase can indicate hepatocellular damage

A

AST

111
Q

Yellowish pigmentation of the skin and whites of the eyes caused by increased levels of bilirubin in the blood

A

-Jaundice

112
Q

Known as the gate to the liver; a fissure when the portal vein and hepatic artery enter the liver and the common hepatic duct exits the liver

A

-Porta hepatis

OTC DMS 2020 (1 decks)

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