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Abdomen Ultrasound > Liver > Flashcards

Liver Flashcards

1
Q

Methods for Liver Anatomy

A

Traditional: based on external appearance (lobes & contour)

Couinaud’s: based on functionality (hepatic & portal veins)

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2
Q

Layers of Liver

A
  1. Outer layer from visceral peritoneum

2. Glisson’s capsule

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3
Q

Glisson’s Capsule

A

Echogenic layer that surrounds liver, hepatic artery, portal vein, and bile ducts

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4
Q

Morrison’s Pouch

A

Space between liver & right kidney

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5
Q

Ascites

A

Fluid that accumulates the left & right sub-diaphragmatic spaces

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6
Q

Pleural effusion

A

Liquid around lungs (left & right sub-phrenic space)

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7
Q

Normal size of liver

A

13-15 cm

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8
Q

Average size of liver

A

15-17 cm

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9
Q

Atrophic

A

Smaller than normal

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10
Q

Hepatomegaly

A

Enlarged liver

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11
Q

Lobes of Liver

A
  1. Right
  2. Left
  3. Caudate
  4. Quadrate
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12
Q

What structure is posterior to the left lobe?

A

Aorta

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13
Q

What structure is anterior/posterior/inferior to the caudate lobe?

A

Anterior: Ligamentum venosum
Posterior: IVC
Inferior: Main portal vein

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14
Q

The main lobar fissure connects what 2 structures

A

Portal vein & neck of the gallbladder

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15
Q

Where is the quadrate lobe located?

A

Between the gallbladder fossa & falciform ligament

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16
Q

From which structures does the liver receive blood?

A

Hepatic artery & portal vein

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17
Q

What structures form the portal vein?

A

Superior mesenteric vein & splenic vein

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18
Q

What is the main source of blood to the liver?

A

Portal vein

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19
Q

From where does the hepatic artery orginiate?

A

Aorta > Celiac Trunk > Hepatic Artery

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20
Q

Portal Triad consists of

A

Hepatic artery, portal vein, common bile duct

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21
Q

Function of hepatic veins

A

Drain blood from liver into IVC

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22
Q

How does the left HV divide the liver?

A

Medial/lateral

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23
Q

How does the middle HV divide the liver?

A

Right/left

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24
Q

How does the right HV divide the liver?

A

Anterior/posterior

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25
Q

Where are the portal veins largest?

A

At the porta hepatis

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26
Q

Porta hepatis

A

Door of the liver, where portal triad enters

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27
Q

The portal veins run which direction

A

Horizontally & intrasegmentally

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28
Q

The hepatic veins run which direction

A

Vertically/longitudinally & intersegmentally

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29
Q

Where do hepatic veins increase in size?

A

As they run toward the IVC

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30
Q

Appearance of porta hepatis

A

Hyperechogenic, b/c it is surrounded by a fibro fatty channel

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31
Q

Falciform ligament

A

Divides liver into right/left

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32
Q

Main lobar fissure

A

Inferior to hepatic vein & superior to right portal vein & gallbladder neck

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33
Q

Right intersegmental fissure

A

Divides right lobe into anterior & posterior segments; identified by right heptatic vein

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34
Q

Left intersegmental fissure

A

Divides left lobe into medial & lateral segments; identified by left hepatic vein

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35
Q

Ligamentum teres originates from

A

the obliterated umbilical vein of fetus

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36
Q

Ligamentum teres originates from

A

ductus venosus of fetus

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37
Q

Average size of portal vein

A

13 mm

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38
Q

Average size of spleen

A

13 cm

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39
Q

Ligaments that anchor liver to abdomen

A

Coronary, right/left triangular ligaments

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40
Q

Main liver function tests

A 
AST (SGOT) - aspartate aminotransferase
ALT (SGPT) - alanine aminotransferase
Albumin
Bilirubin
AFP - alpha fetoprotein
CEA - carcinoembryonic antigen
41
Q

Normal Anatomic Variants

A
  1. Reidel’s lobe
  2. Caudate lobe size
  3. Hepatic Veins
  4. Situs inversus
42
Q

Reidel’s lobe

A

Extension of the right lobe

43
Q

Situs inversus

A

Organ reversal to left side of body

44
Q

Echogenicity of liver compared to spleen

A

Isoechoic

45
Q

Echogenicity of liver compared to kidney

A

Isoechoic, or slightly greater than renal cortex

46
Q

Echogenicity of liver compared to pancreas

A

Slightly hypoechoic

47
Q

Fatty Infiltration is also known

A

Steatosis

48
Q

2 most common cause of steatosis

A

Obesity & alchohol abuse

49
Q

Steatosis ultrasound appearance

A

Increased echogenicity, obscure vessels, difficulty in penetration

50
Q

Focal Fatty Infiltration

A

Areas of increased echogenicity, can appear as a hyperechoic mass/tumor

51
Q

Focal Sparing

A

Area spared from fatty infiltration

52
Q

Focal Sparing Ultrasound Appearance

A

Irregular shaped hypoechoic area

53
Q

Hepatitis

A

Inflammation of the liver caused by the hepatitis A-F virus

54
Q

Clinical Signs & Symptoms of Hepatitis

A

Anorexia, jaundice, nausea, fatigue, joint pain

55
Q

Ultrasound Appearance of Acute Hepatitis

A

Normal, decreased echogenicity, larger portal veins, thickened gallbladder wall, enlarged and tender

56
Q

What is the reasoning behind the appearance of a liver with acute hepatitis?

A

Because the liver is under attack from the virus, all the blood is rushing to the liver to fight off the attack. This causes to liver to be enlarged and tender. More blood = less echogenicity

57
Q

Ultrasound Appearance of Chronic Hepatitis

A

Coarse echo pattern, increased echogenicity, decreased echogenicity in PV walls

58
Q

What is the reasoning behind the appearance of a liver with chronic hepatitis?

A

Because the organ is dying, blood has left the vessel to tend to other organs. There is also less vasculature

59
Q

Cirrhosis

A

Liver parenchyma is replaced by fibrosis and abnormal modules.

60
Q

Fibrosis

A

Dead tissue/cells

61
Q

Ultrasound Appearance of Early Cirrhosis

A

Hepatomegaly, fatty infiltration

62
Q

Ultrasound Appearance of Chronic Cirrhosis

A

Coarse texture, ascites, dialated PV, portosystemic varices, hepatofugal portal flow, splenomegaly, recanalized ligamentum teres, enlarged caudate lobe

63
Q

What is the reasoning behind the appearance of a liver with chronic cirrhosis?

A

Because the liver is starting to atrophy, the liver cannot process all the blood coming to the organ. Backed up blood leads to increased pressure around the liver which results in:

  • Dilation of portal vein (Brings blood to heart)
  • Increased blood flow to the spleen (PV leads to splenic vein)
  • Ligamentum teres has restored blood flow
  • Varices form (small blood channels)
64
Q

Portal Hypertension

A

PV larger than 13 mm

65
Q

Dilated splenic vein/SMV measurement

A

> 10mm

66
Q

Hepatofugal

A

Away from liver

67
Q

Hepatopetal

A

Towards liver

68
Q

Budd-Chiari Syndrome

A

Blockage of hepatic veins; very urgent b/c hepatic veins → IVC → heart

69
Q

Ultrasound Appearance of Budd-Chiari Syndrome

A

Compressed IVC, ascites, enlarged caudate lobe, splenomegaly

70
Q

Cyst Requirements

A
  1. Anechoic
  2. Well defined walls
  3. Posterior enhancement
71
Q

Cysts are most common in

A

Right lobe (bigger) & females

72
Q

Hyatid Disease

A

Echinococcal Cyst, caused by parasitic worm

Mostly found in liver, can also be found in lung, brains, and bone

73
Q

Ultrasound Appearance of Hyatid Disease

A

Simple cyst with or w/o wall calcification, mother cyst w/ daughter cyst, honeycomb/water lilly design

74
Q

Pyogenic Abscess

A

Abscess caused by bacterial invasion of liver

75
Q

Bacteria that cause pyogenic abscess

A

E. coli
Clostridium
Bacteriodes

76
Q

Infection routes for pyogenic abscess

A

Biliary tree, portal vein, hepatic artery

77
Q

Symptoms of Pyogenic Abscess

A

Fever, pain, nausea, vomiting, diarrhea

78
Q

Lab Values for Pyogenic Abscess

A

Leukocytosis, increased LFTs, anemia

79
Q

Ultrasound Appearance of Pyogenic Abscess

A

Irregular shape and walls, may have shadowing or comet tail artifact

80
Q

Amoebic Abscess

A

Caused by amebas that liquefy hepatic tissue; can lead to death without treatment

81
Q

Ultrasound Appearance of Amoebic Abscess

A

Subcapsular, low amplitude cyst fill in, thickened irregular walls, posterior enhancement

82
Q

Signs/Symptoms of Amoebic Abscess

A

Abdominal pain, diarrhea, melena

83
Q

Name the benign neoplasms

A

Cavernous hemangioma, focal nodular hyperplasia, adenoma, hematoma

84
Q

Cavernous Hemangioma

A

Vascular structures filled w/ blood cells, most common benign liver tumor!

85
Q

Ultrasound Appearance of Cavernous Hemangioma

A

Round, highly echogenic, well defined solid mass

86
Q

Focal Nodular Hyperplasia

A

Very rare, benign tumor

87
Q

2 masses caused by oral contraceptives

A

FNH, adenoma

88
Q

Focal Nodular Hyperplasias are composed of

A
  1. Hepatocytes
  2. Kupffer cells
  3. Fibrous connective tissue & bile duct elements
89
Q

Liver Cell Adenoma

A

Benign tumor

90
Q

Increased incidence for adenoma with

A
  1. Oral contraceptives in women
  2. Steroid use in men
  3. Type 1 glycogen storage disease
91
Q

Hematoma

A

Mass filled w blood, often caused by trauma

92
Q

Ultrasound Appearance of Hematoma

A

If hematoma has old blood → hyperechoic

If hematoma has new blood → hypoechoic

93
Q

Name the malignant neoplasms

A

Hepatocellular carcinoma (aka hepatoma, HCC), metastases

94
Q

Increased risk for hepatoma can be due to

A

Hepatitis & cirrhosis

95
Q

Ultrasound Appearance of HCC

A

Hepatomegaly, ascites, invasion of portal & hepatic veins, distorted parenchyma

96
Q

Metastases

A

Cancer that has originated from another organ and spread to the liver, most common liver malignancy!

97
Q

Signs/Symptoms of Metastases

A

Jaundice, pain, hepatomegaly

98
Q

Ultrasound Appearance of Metastases

A

Lung: Bull’s eye/target
Colon: Hyperechoic
Liver/kidney: Moth eaten
Can also be calcified

Abdomen Ultrasound (4 decks)

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