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MIDS 127 - abdo > The Liver (hardly knew her!) > Flashcards

The Liver (hardly knew her!) Flashcards

1
Q

What is the average liver size?

A

13-16cm length wise

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2
Q

In the liver, which vessel does the right branch bifurcate into an anterior and posterior branch?

A

Right portal vein

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3
Q

In the liver, if a malignant neoplasm appears as an anechoic mass, what is a likely explanation for this echo characteristic?

A

The central liquefaction of necrosis

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4
Q

What are the two capsule layers?

A

The visceral peritoneum and the Glisson capsule (highly echogenic, encases hepatic artery/portal vein/bile ducts within the liver)

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5
Q

Where is Morrison’s Pouch?

A

It is a potential space between the liver and right kidney

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6
Q

Describe the main lobar fissure (MLF) of the liver.

A

Separates left and right lobes, contains main hepatic vein, gallbladder, and IVC fossa. Seen between GB neck and RPV.

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7
Q

Describe the right intersegmental fissure (liver).

A

Divides right lobe into anterior and posterior segments. Landmark: Right hepatic vein

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8
Q

Describe left intersegmental fissure (liver).

A

Divides left lobe into medial and lateral segments.

Landmarks: Left hepatic vein, ascending branch of LPV, ligamentum teres (inferior)

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9
Q

The hepatic veins run between segments (________) and lobes (_______).

A

Intersegmental

Interlobar

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10
Q

The portal vein runs within segments (__________).

A

Intrasegmental

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11
Q

What is a Riedel’s lobe?

A

Downward projection of the anterior edge of RLL to the right of the gallbladder.
Can be mistaken for hepatomegaly.

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12
Q

What vessels does the liver get its blood supply from?

A

Hepatic arteries & portal veins.

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13
Q

What do the portal veins do?

A

Drain blood from GIT, spleen, pancreas, and GB.
RPV divides into the anterior and posterior segmental branches.
LPV divides into the medial and lateral segmental branches.

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14
Q

Where do the hepatic veins drain into?

A

The IVC

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15
Q

What is the porta hepatis?

A

Fissure where portal vein and hepatic artery enter the liver and bile duct exists the liver.

Bile duct is ventral and lateral, hepatic artery is ventral and medial, portal vein is dorsal.

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16
Q

How large must the intrahepatic ducts be to be considered dilated?

A

Greater than 2mm.

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17
Q

What are some of the hepatic functions?

A

Bile formation and secretion, carbohydrate metabolism, fat metabolism, protein metabolism, reticuloendothelial tissue activity, storage depot, blood reservoir, heat production, detoxification, lymph formation

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18
Q

How is bilirubin created?

A

Formed from destroyed RBC’s

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19
Q

Describe conjugated (direct) bilirubin.

A

Conjugated by liver enzymes, becomes water soluble, pooped and peed out

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20
Q

Describe unconjugated (indirect) bilirubin.

A

Remains in the blood.

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21
Q

Describe indirect bilirubin increase.

A

Caused by increased RBC breakdown or diseases that affect liver’s ability to conjugate

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22
Q

Describe direct bilirubin increase.

A

Hepatitis, cirrhosis, obstructive liver disease; directly affects the liver

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23
Q

What is Alanine aminotransferase (ALT)?

A

Responsible for majority of tissue energy production; levels elevate when liver cell damage occurs

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24
Q

What is Aspartate aminotransferase (AST)?

A

Found in all tissues that use energy but large amount in liver

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25
What is Alkaline Phosphatase (ALP)?
Found in many tissues and is normally excreted in bile; INCREASED when biliary obstruction occurs
26
What is lactic dehydrogenase (LDH)?
Found in all tissues, not typically used for liver evaluation
27
What is y-Glutamyl Transpeptidase (GGT)?
Transport of amino acids and peptide across cell membranes; most sensitive indicator of alcoholism; INCREASED in liver disease and posthepatic obstruction
28
What is Prothrombin Time (PT)?
Pathological deficiency of clotting factors due to liver dysfunction or absence of Vitamin K
29
What is Albumin? What organ synthesizes it?
Role in total water distrubtion/osmotic pressure - mostly synthesized by the liver.
30
What does increased Albumin indicate?
Dehydration
31
What does decreased albumin indicate?
Chronic liver disease, ascites, right sided heart failure, cancer, peritonitis
32
How large does the liver have to be for hepatomegaly?
Larger than 16cm
33
What causes hepatomegaly?
Infection, hepatic tumour
34
What is Steatosis?
Fatty infiltration; fat accumulation in the hepatocytes
35
What is more common in Steatosis, focal or diffuse?
Diffuse, affects whole organ
36
What is the main cause of Steatosis?
Alcohol abuse and obesity
37
What is NAFL or NASH?
Non alcoholic fatty liver.
38
What is cirrhosis?
Diffuse destruction of the normal architecture of the liver lobules
39
What's the most common cause of cirrhosis?
Alcohol abuse
40
What are the lab values for Cirrhosis? What is increased/decreased?
Bilirubin elevated ALP may be elevated Albumin decreased a-globulin proteins increased
41
What are the SS of Cirrhosis?
fatigue, weight loss, diarrhea, hepatomegaly, jaundice, ascites, RUQ or epigastric aching pain, fullness
42
What kind of capsule surface does Cirrhosis have?
Lumpy, abnormal
43
What is the SA of chronic cirrhosis?
``` Liver is small (especially RLL) Caudate lobe extremely obvious Surface nodularity Fine to coarse echotexture Potential portal hypertension findings ```
44
What is Hepatitis?
Inflammation of the liver
45
What are the five types of Hepatitis?
A - Parental, fecal-oral, ingesting infected food or water B - Sexual contact (STD), mother/infant contaminated needles, blood, body fluids C - Sexual contact, contaminated needles, blood, body fluids D - Infected blood, unprotected sex, infected needles but must have Hep B already E - Drinking contaminated water
46
What is acute hepatitis' SA?
Normal to hypoechoic parenchyma, but PV will be echogenic (starry sky sign) and GB will can be thickened
47
What is the SA of chronic hepatitis?
Fibrosis with coarse and hyperechoic parenchyma
48
What is Glycogen Storage Disease? What is the most common type?
Defective enzyme that allows excessive deposits of glycogen to be stored in liver, intestinal tract, and kidneys Type 1: von Gierke disease is most common type
49
What is the SA of von Gierke disease?
Increased echogenicity across organ, decreased penetration, hepatomegaly, potential solid liver masses (adenomas)
50
What is passive liver congestion?
Edematous liver secondary to vascular congestion is a complication related to heart failure.
51
What is the SA of passive liver congestion?
Dilated hepatic veins, dilated IVC with little or no change with respiration.
52
Where are congenital cysts most common in the liver?
RLL
53
Describe Polycystic Liver Disease (PLD) and its 2 forms.
A congenital cyst Isolated PLD - only in the liver ADPKD (autosomal dominant polycystic kidney disease) - more common, cysts in liver and kidneys Most common in women in 30's/40's Asymptomatic unless large
54
Describe hematoma.
Acquired cyst that is a collection of blood. Associated with pregnancy-induced hypertension, but can be caused by trauma SS: RUQ pain
55
What is a peribiliary cyst?
Acquired cyst Small (.2-2.5cm) cysts around the porta hepatis More commonly found in patients with severe liver disease SA: Clustered tubular appearing cysts that parallel the bile ducts and PV's in the center of the liver
56
What is the most common source for a pyogenic abscess?
Most common source is from the biliary tract
57
What is the most common hepatic abscess?
Pyogenic abscess
58
What is the SS for a pyogenic abscess?
Pain, fever, leukocytosis, elevated LFT's, hepatomegaly, nausea and vomiting.
59
What causes pyogenic abscesses?
Appendicitis, acute diverticulitis, IBD...
60
What is the SA of a pyogenic abscess?
Single or multiple masses Most commonly affects RLL Irregular walls, poorly defined Heterogenous
61
What causes an Amebic Abscess?
Ingesting contaminated food/water
62
What is the SS of Amebic Abscesses?
RUQ pain, hepatomegaly, diarrhea, fever, chills, jaundice, black tarry stools, elevated LFTs
63
What is the SA of an Amebic Abscess?
Most commonly in the RLL, along the liver capsule, internally avascular
64
What is Schistosomiasis?
Parasitic infection, worms in contaminated water penetrate the skin. Can cause portal hypertension, cirrhosis
65
What causes a "clay-pipe stem" appearance?
Schistomiasis. Hyperechoic thickened portal venous walls.
66
What is another name for Hydatid diease?
Echinococcal Cyst
67
What is Hydatid Disease?
A parasitic tapeworm, larvae ingested and hatch in the intestines and migrate often to liver
68
What are the SS of an Echinococcal Cyst?
Pain, anaphylactic shock, elevated ALP, jaundice if obstruction
69
What causes a honeycomb appearance? Or looks like a congealed water-lily sign?
Hydatid Disease/Echinococcal Cyst
70
What is the SA of HIV-AIDS?
Starry sky pattern, multi-organ calcifications. Also can have fatty infiltration.
71
What is Candida Albicans?
A fungal infection. Occurs in immunocompromised hosts.
72
What is the SS of Candida Albicans?
RUQ pain, fever, hepatomegaly
73
What is the SA of Candida Albicans?
A wheel within a wheel sign, hypoechoic rim. Can become uniformly hyperechoic and calcify as it heals.
74
What is the most common BENIGN liver tumour?
Cavernous Hemangioma
75
Are cavernous hemangiomas (liver) most common in women or men?
Women (5x)
76
What is the SA of a cavernous hemangioma?
Homogenous hyperchoic mass, well defined margins and possible posterior enhancement. Avascular (flow too slow). Can be solitary or multiple. Usually smaller than 3cm Most commonly posterior RLL and subcapsular
77
What is FNH?
Focal Nodular Hyperplasia
78
Who is the most common population for FNH?
Women in childbearing years, linked to OCP.
79
Who is the most common population for liver cell adenoma?
Women in childbearing age, associated with long-term OCP use.
80
What describes: subtle isoechoic well-circumscribed lesion with a central stellate scar, usually less than 5cm. Most commonly RLL and solitary?
Focal Nodular Hyperplasia
81
What describes: Solitary, hyperechoic with hypoechoic halo, has vascularity, is encapsulated and well-circumscribed?
Liver Cell Adenoma
82
What kind of speed error artifact can be seen with lipoma?
Speed error artifact
83
What is the most common MALIGNANT tumour?
Hepatocellular Carcinoma (aka Hepatoma)
84
What causes HCC?
Chronic liver disease (especially cirrhosis), viral infections, parasitic liver infections
85
What has an increased risk with hemochromatosis, some metabolic and glycogen storage diseases?
Hepatoma (HCC)
86
What is the most common population for HCC?
Men (x3)
87
What are the SS of HCC?
Jaundice, ascites, metabolic disturbances, weight loss, n/v, RUW pain, pruritus, splenomegaly, palpable mass, hepatomegaly. INCREASED LAB VALUES: ALP, AST, ALT, AFP
88
What complications can arise from hepatocellular carcinoma?
Biliary obstruction, portal hypertension, potral vein thrombosis
89
What does HCC look like?
Focal multiple or diffuse. Cirrhotic livers - hypoechoic masses. Typically large mass with smaller satellite lesions. Vascularity. Invades PV (60% of cases)
90
What is a Liver Hemangiosarcoma or Angiosarcoma?
Rare but aggressive, occurs in older population, large solid or mixed lesion.
91
What is the 2nd most common site for mets?
Liver
92
What types of neoplasms are hyperechoic?
Colon, RCC, hemangioma, lipoma, neuroendocrine, adenoma (borderline)
93
What neoplasms are isoechoic + hyperechoic?
HCC (hypo) FNH (iso) Lymphoma (hypo) Adenoma (hypo)
94
What is the male's most common neoplasm?
HCC
95
What is the female's most common neoplasms?
FNH, hemangioma, adenoma. ALL tied to OCP.

MIDS 127 - abdo (14 decks)

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