the liver Flashcards
give some details about the liver
liver is largest organ in the body and its 1.5
surrounded whole by fibrous tissue and partially by the peritoneum
what the function of the liver ?
1- production of the bilirubin
2- metabolism of the body like fat ,CHO,protein , drugs and hormone
3- maintaining the core temperature of the body that are the hormones could act and maintaining the body temperature
4-filteration of the blood from the bacteria and the foreign body
whatre the lobs of the liver ?
Rt and Lt lobe
caudate and cuadrare
what’re the ligaments of the liver ?
These include the coronary, triangular, falciform, round, hepatogastric and hepatoduodenal ligaments, together with ligamentum venosum. and ligmentum teres
what’re the content of the porta hepatis
porta hepatis is a deep fissure in the inferior surface of the liver through which all the neurovascular structures (except hepatic veins) and hepatic ducts enter or leave the liver 1. It runs in the hepatoduodenal ligament and contains: right and left hepatic ducts. right and left branches of hepatic artery.
whats the blood of the liver ?
hepatic artery and the portal vein
the lymphatic drainage of the liver ?
The liver produces a large amount of lymph, which is estimated to be 25 to 50 % of lymph flowing through the thoracic duct. … It is suggested that 80 % or more of hepatic lymph drains into portal lymphatic vessels, while the remainder drains through sublobular and capsular lymphatic vessels.
the venous drainage of the liver ?
hepatic veins are the veins that drain de-oxygenated blood from the liver into the inferior vena cava.
what’re the segment of the liver ?
Lt to the line between the gall bladder --------------------------------------------------------- 3L & M 1- left hepatic artery 2-left hepatic vein 3-left portl vein 4- meddle hepatic vein
3R & M
1- right hepatic artery
2-right hepatic ve
why we divid the liver into segments ?
1- because each segment have it own separate venous drainage
2-we divide it into many section because the lesion or tumer may attack only one segment
what the benefit of the ultrasound in the liver ?
1- detect the liver tumer and liver cyst and a good guide to take liver biopsy
2- duct dictation and gall stones
what’re the benefit of the CT scan ?
the CT need contact but the MRI use the bile as contrast
if the I give him oral contrast to see the stomach and the duodenum in the relation to the hilum
if give him IV contact
early arterial phase —– small liver tumer
venous phase —— inflammatory lesion
late venous phase ———heamangioma
measurement the density of the liver lesion (cystic)
whats the MRCP ?
Magnetic resonance cholangiopancreatography
its non-invasive hight quality imaging of the bile duct but ERCP is better picture
whats the MRA ?
magnetic resonance angiogram
its angiogram for the hepatic vein and portal vein alternative of the hepatic angiography
whats the ERCP?
Endoscopic retrograde cholangio-pancreatography
Diagnostic for the obstructive jaundice and bile tract abnormality
therapeutic for the sone and duct stricture
insert stent and take tumer biopsy for cytology
what the difference between the ERCP and MRCP ?
MRCP is that it is not a therapeutic procedure, while in contrast ERCP is used for both diagnosis and treatment.
ERCP is an invasive procedure where incision is required on the body whereas MRCP is non-invasive
RCP involves the use of a contrast dye to be inserted while images are being taken whereas a dye is not used in MRCP as it is a completely non-invasive procedure
ERCP is more expensive than MRCP
ERCP cannot be done in persons who have undergone previous allergic reaction
MRCP cannot be opted for in persons who have undergone previous stent surgery or have a pacemaker implanted as the magnetic resonance will interfere in the working of the pace maker.
whats the PTC ? and whats the indication ?
Percutaneous transhepatic cholangiography
- when the failure of the ERCP
- or there is tumer in the hilum of the duct that make visualization through the ERSP is impossible to see the intrahepatic duct
what’re the indications of the angiography in the liver disease ?
a-Dignostic
- to visualize the hepatic artery and the portal vein
- give information about liver nodule
b-Therpeutic
- treat any occlusion in the artery and the vein
- treat the emboli in the liver
- chemoembolization
laparoscopy and laparoscopic U/S indication ?
these are used for the staging
- HBP cancer
- peritoneal meatstis
- superficial liver tumer
what’re the material that used in the nuclear medicine scanning ?
- ## technishium 99mif there is any bile leakage or obstruction
its only obtained by the kuppfer cell not the hepatocyte
its differnate the adenoma from the hemangioma which don’t take the sulfur because its hepatocyte from focal nodular hyperplasia which take the sulfur because its the kuppfer cells
T or F
CT is better than MRCP in the detection of the billiard tree pathology
false , CT for liver parenchyma
while the MRCP in the billiard duct
T OR F
MRCP is invasive and therapeutic tech. while ERCP noninainvasive and only diagnostic
false
T OR F
ct can’t diagnosis the liver cyst
false
T OR F
PTC is an IV injection of dye when it fail then ERCP is second choice
false
T OR F
pancritits and cholngitis , bleeeding and perforation are the main complication of MRCP .
false
how to suspect or diagnosis pt with liver trauma ?
1- in penetrating trauma as stabbing in the Lower chest and upper abdomen and pt with low PB and high pulse rate (heamodynic unstable )
2- in blunt trauma and stable hemodynamically and have tenderness and gardening (spasm of muscle on palpation )
what’re the complication of penetrating and blunt trauma of the liver
اما نزيف الدم
او الدم يطلع بالكابسول
او يصير ابسس
او يصير للدكت فستيولا او ستركشر للدكت ------------------------- او يصير للشريان توسع او فستيولا ------------------- او بالاخير liver failure
pyogenic liver abscess ?
aute or chronic
multiple and smal , single and large
whats the manifestation of the liver abcesss?
pain, redness, swelling, fever
and loss of function as lethargy malaise anorexia
whose pt are risk for the liver access ?
1-immuncompromise 2- malnourished 3- elderly 4- DM 5-post trauma and post operation 6-sicker
whats the most common cause of the liver abcesss ?
E.choli and streptococcus milleri
whats the source of the liver access ?
1- common is from the duct
2- from the blood hematogenous hepatic artery
3-potal vein
4 from the liver it self (per hepatic infective focus )
Dx for the liver abccess ?
ct to see ht eparanchymai
and x ray for the air and the fluid LEVEL
