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Flashcards in Anatomy Power Point Deck (41):
1

Liver

Largest organ in body

located in right hypochondrium, epigastrium and left hypochondrium 

inferior to the diaphragm

2

Liver location

posterior border in contact with right kidney and inferior vena cava

aorta lies posterior to the left lobe

3

Subphrenic space

between liver and diaphragm 

common site for abscess formation

 

4

right subhepatic space

includes morrison's pouch, a common space for periotoneal fluid or blood to collect

5

pancreas location

inferior to the left lobe of the liver

6

Gall Bladder

lies on the visceral surface of the liver

Main lobar fissure is the sonographic landmark leading to the fossa

seen as an echogenic line that runs from the right portal vein to the gallbladder

7

Lobes of the liver

Right

left

Caudate

8

Right liver lobe

RLL

largest of 3 lobes

contains 3 fossae

Congenital variant, Riedels lobe

 

9

RLL fossae

porta hepatis

gallbladder

inferior vena cava

10

RLL Reidels Lobe

sometimes seen as an anterior projectoin of the liver

sometimes extending down the iliac crest

 

11

Left Liver Love

LLL

Size varies from patient to patient

men seem to have smaller lobe

found just under the xiphoid process

if larger makes great acoustic window for pancreas and aorta

12

Caudate Lobe

CL

small lobe

situated inferior to the ligamentum venosum

superior to the inferior vena cava

13

Liver Ligaments and fissures

Main Lobar fissure

LIgamentum Teres

Ligamentum venosum

14

Main lobar fissure

boundry between right and left lobes of liver

on longitudinal scan may be seen as a hyperechoic line extending from portal vein to neck of gallbladder

15

ligamentum teres

appears as bright echogenic triangle on transverse scan

separates the medial and lateral segments of the left lobe of the liver

16

ligamentum venosum

appears as hyperechoic line separating the left lobe from the caudate lobe

17

Liver Vascular supply

Portal venous system

Main portal vein

 

18

portal venous system

supplies 80% of blood flow to the liver from the digestive system

flow should be toward the liver-hepatopetal (toward the liver)

19

Main Portal Vein

MPV

enters the liver at the portahepatis

divides into the right and left portal veins

RPV and LPV

20

Right Portal vein

RPV

largest portal vein

further divides into anterior and posterior branches

21

Hepatic Veins

drain blood from the liver back inot the IVC

3 components: Right RHV, Middle MHV and Left LHV

can be distinguished from the portal veins by lackj of bright walls

22

Hepatic Arteries

Supplies blood to liver (20%)

branch of the celiac artery from the aorta

23

Liver functions

metabolism-carbs and protein

Digestion

storage

detoxification

24

Liver Function Tests

LFT

AST

ALT

LDH

Alk phos

Bilibrubin

PT

Albumin 

Globulins

25

Liver scanning

TGC adjusted to balance near and far echos

overall gain-adjusted to adequatley penetrate the entire right lobe and a smooth homogeneous pattern

depth posterior right lobe positioned at the lower border of screen

focuses near the posterior border

transducer freq.  Avg adult 2.5-5MHz, pediatric 5-7MHz

26

Liver Scanning evaluation

size in the longitudinal plane

attentuation of the parechyma

texture

presence of hepatic vascular structures, ligaments and fissures

27

Gallbladder

should be anechoic with wall thickness less than 3mm

no fluid between wall and liver

28

Gall Bladder pathology

polyps

gallstones

tumors

thick walls with fluid around

sludge

all of above

29

Pancreas

Head, body, tail, uncinate process

seen in transverse scan

GDA and CBD lelineate the lateral border of the head

splenic vein delineates the posterior border

sometimes see pancreatic duct

normal is 2mm or less

 

30

Kidney

Cortex

Hilum

pyramids

calyx

 

31

Cortex

outer parenchyma of kidney

32

Hilum

midportion of the kidney 

renal vessels and ureter enter and exit

33

Pyramids

convey urine to the minor calyces

34

Calyx

part of the collecting system that collects urine

may become obstructed

35

Kidney Function

excretes waste

regulates composition of the blood by filtration of harmful wastes, conserving water and metabolites in the body

 

36

Nephron

functional unit of the kidney

37

Kidney normal texture and pattern

smooth outer contours surrounded by perirenal fat

echogenicity is equal (isoechoic) to or hypoechoic to the liver/spleen

important to include these organs to compare echogenicity

should not be any fluid present

38

Kidney lab tests

BUN Blood urea nitrogen

Creatinine

measure the amount of nitrogenous wastes

waste products accumulate in blood when kidneys are not functioning properly

39

Kidney imaging

always bilateral exam

nephrectomy-long and trvs image of the renal fossa looking for fluid collection

patiens should be hydrated

liver and spleen used and window

deep inspiration will allow approx 2 cm downward shift of kidneys for better visualization

start with RT longitudinal lateral-median then transverse sup-inferior making sure to scan beyond outer contours

40

Spleen

part of the reticuloendothelial system

synthesis of blood proteins

largest mass of lymphoid tissue in body

active in blood formation during initial part of fetal life

blood formation function decreases gradually by 5-6th month when spleen assumes its adult characterisitics

plays important role in defense of the body

affected by systemic disease, rarely the cause

41

Spleen physical description

variable in size and shape

smooth borders with a convex superior and concave inferior surface

mormal measurements are 8-13 cm