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General Sonography > Liver > Flashcards

Liver Flashcards

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1
Q

What are some conditions that can be evaluated using liver ultrasound?

A 
Cirrhosis
Liver failure
Portal hypertension
Tumors
Abscesses
Traumatic injury
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2
Q

Why is the liver a useful sonographic window?

A

It has high fluid content and natural homogenous parenchyma

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3
Q

What is the connective tissue surrounding the liver called?

A

Glisson’s capsule

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4
Q

What type of structure is the liver?

A

Intraperitoneal

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5
Q

Where is the liver located?

A

Right upper quadrant
Inferior and posterior to the diaphragm and moves with it during respiration
Anatomic right of stomach

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6
Q

What are the three structures that comprise the portal triad?

A

Hepatic artery, common bile duct, portal vein

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7
Q

How is the liver measured?

A

From inferior tip of dome and along the midclavicular line

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8
Q

What is the maximum normal size of the liver?

A

16 cm

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9
Q

What do the walls of the hepatic veins look like?

A

They are thin and dull

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10
Q

What do the walls of the portal vein and hepatic artery look like?

A

They are thick and echogenic

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11
Q

What transducers are preferred for liver scanning?

A

Low frequency 5-2.5 mHZ with curvilinear probe

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12
Q

What may be needed to scan the liver between the ribs?

A

Phased array

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13
Q

How long should a patient be NPO?

A

8 hours

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14
Q

How should a patient be positioned for a liver scan?

A

Supine or left lateral decubitis

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15
Q

How do you optimize liver images?

A

Deep breaths

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16
Q

What surfaces of the liver are in contact with the diaphragm?

A

Superior and anterior

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17
Q

What are useful approaches in liver sonography?

A

TA sagittal and transverse
Intercostal
Subcostal

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18
Q

How do hepatic ligaments appear?

A

Hyperechoic relative to surrounding parenchyma

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19
Q

What classification divides the liver into segments

A

Functional or Couinaud

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20
Q

What does each liver segment possess a branch of?

A

Portal vein
Hepatic artery
Hepatic vein
Bile duct

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21
Q

What are characteristics of doppler mode imaging?

A

Color flow provides information regarding the liver

Pulsed wave is useful in evaluating portal hypertension

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22
Q

How does the HA supply the liver?

A

With oxygenated blood

Hepatopedal

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23
Q

How does the PV supply the liver?

A

Afferent blood flow from intestines

Hepatopedal

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24
Q

What forms the main portal vein?

A

Splenic and superior mesenteric veins

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25
What describes HV flow?
Drain deoxygenated blood into IVC | Hepatofugal
26
What liver characteristics should be studied and documented?
Contour, echogenicity, and vascularity
27
What does the bile duct look like on US?
Hyperechoic walls and lumen w no color flow
28
What does the HV look like on color doppler?
Thin walls w lumen that has flow
29
What does the HA look like on pulsed wave doppler?
Hyperechoic walls w pulsatile flow
30
How do you differentiate portal and hepatic veins?
Tracing path of HV back to IVC
31
Where is the diaphragm in regards to the liver?
Superior w hyperechoic border
32
Where is the potential space for intraperitoneal fluid accumulation?
In front of Morison's pouch | Between liver and RT kidney
33
Where does the HV return blood to?
IVC
34
What does the main lobar fissure connect?
Gallbladder and portal vein
35
How do we improve liver imaging?
Pt fast 8 hours Deep breath and hold Raise RT elbow over head Left lateral decubitus
36
What is the normal sonographic appearance of the liver?
Homogenous parenchyma with mid-grey color Isoechoic to renal cortex Hypoechoic to spleen Vessels and ducts that are anechoic w bright walls
37
What surrounds the liver?
Glisson's pouch
38
What is the largest parenchymal organ in the body?
The liver
39
What are some functions of the liver?
Produces and secretes bile | Synthesizes clotting factors
40
What structures should you capture on liver ultrasound?
IVC, HV, PV & branches w color | Right, left, caudate lobes
41
What axis should the liver be measured in?
Longitudinal
42
What can we use as a comparison when evaluating liver echogenicity?
Right kidney
43
What are the four lobes of the liver?
Right, left, caudate, quadrate
44
What is a remnant of the umbilical vein?
Ligamentum teres
45
What does the main lobar fissure separate?
Right and left hemiliver lobes
46
Where does the main lobar fissure run?
From gallbladder through IVC to caudate lobe
47
What vessel carries the greatest percentage of total blood flow to the liver?
Portal vein | 75%
48
What vessels form the portal vein?
Splenic vein and superior and inferior mesenteric veins
49
What do the splenic and superior and inferior mesenteric veins empty?
Spleen, gallbladder, pancreas, GI tract
50
What are normal flow patterns of HV?
Hepatofugal Pulsatile Multiphasic
51
What are normal flow patterns of HA?
Hepatopedal | Low resistant
52
What are normal flow patterns of PV?
Hepatopedal Continuous flow Moderate pulsatility
53
What is the metabolic function of the liver for carbs?
Conversion of dietary sugars into glucose Excess glucose into glycogen and stored Glycogen back to glucose
54
Why can liver disease lead to hypoglycemia?
It prevents the liver from making enough glucose | Glucose deficiency
55
Why can liver disease lead to hyperglycemia?
Liver may fail to convert excess glucose into glycogen
56
What is the metabolic function of the liver associated with fats?
Metabolism of fats Dietary fats to lipoproteins Converts fats to energy
57
What is fatty liver?
Nonspecific finding | Manifestation of many kinds of hepatocellular disease
58
What may fatty liver disease be associated with?
``` Hepatitis Alcoholic liver disease Obesity Diabetes Pregnancy Chemical exposure ```
59
What is the metabolic function of the liver with proteins?
Produces proteins from amino acids and raw materials Produces albumin Produces fibrinogen and thrombin for coagulation
60
Why can liver disease cause edema?
Loss of vascular osmotic pressure causes fluid build up in interstitial space
61
What is the principal cause of ascites development?
Portal hypertension
62
Why can liver disease cause hemorrhage?
Decreased production of thrombin and fibrinogen needed for clotting
63
What are hepatic enzymes?
Protein catalysts that leak into bloodstream when liver cells are damaged or destroyed
64
What is the detoxification function of the liver?
Detox waste products of energy production | Breaks down foreign chemicals
65
Why would a Pt with severe liver disease have fruity or pungent breath?
Because of an ammonium concentration
66
Why is failure of ammonium detox serious?
If not detoxified by the liver, it can cause coma or death from blood loss
67
Describe uptake of bilirubin
Bilirubin separated from albumin and taken by hepatocytes
68
Describe conjugation of bilirubin
Bilirubin molecule combined with glucuronide
69
Describe excretion of bilirubin
Bilirubin released from hepatocytes, goes through bile ducts to bowel
70
What is bile?
The excretory product of the liver formed by hepatocytes
71
What is the function of bile?
Emulsification of fat | Removal of waste products from bile excretion
72
What causes echogenic bile?
Stasis | Decreased bile from the liver
73
What is aspartate aminotransferase? AST
Enzyme found in tissues w high metabolic rate
74
What are pathologies associated w AST?
Acute hepatitis Cirrhosis Hepatic necrosis Infectious mononucleosis
75
What is alanine aminotransferase? ALT
Enzyme found in tissues w high metabolic rate
76
What are pathologies associated w ALT?
``` Acute cirrhosis Hepatic metastasis Pancreatitis Infectious or toxic hepatitis Hepatocellular disease ```
77
Where is lactic acid dehydrogenase found?
Liver, kidneys, skeletal muscle, brain, lungs
78
What are pathologies associated with lactic acid dehydrogenase?
Hepatitis Cirrhosis Obstructive jaundice
79
What is alkaline phosphatase?
Enzyme produced by liver, bone, intestines, and placenta
80
What are pathologies associated with alkaline phosphatase?
Intra or extrahepatic obstruction Hepatic carcinoma Abscess Carcinoma
81
What is bilirubin a product of?
Hemoglobin breakdown of tired red blood cells
82
What is direct bilirubin?
Conjugated
83
What is indirect bilirubin?
Unconjugated
84
What is prothrombin?
Liver enzyme that plays a part in blood clotting mechanism
85
What is albumin?
Serum used to detect protein synthesis levels | Low albumin, low PS
86
What is globulin?
Used to show chronic liver diseases | Elevated globulin = CLD
87
What are indications for a liver scan?
Elevated LFT Prior dx of hepatitis, cirrhosis, hepatic steatosis Hepatomegaly Mass near or in liver

General Sonography (8 decks)

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