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Abdomen Ultrasound > Liver > Flashcards

Liver Flashcards

(98 cards)

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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
Where are the portal veins largest?
At the porta hepatis
26
Porta hepatis
Door of the liver, where portal triad enters
27
The portal veins run which direction
Horizontally & intrasegmentally
28
The hepatic veins run which direction
Vertically/longitudinally & intersegmentally
29
Where do hepatic veins increase in size?
As they run toward the IVC
30
Appearance of porta hepatis
Hyperechogenic, b/c it is surrounded by a fibro fatty channel
31
Falciform ligament
Divides liver into right/left
32
Main lobar fissure
Inferior to hepatic vein & superior to right portal vein & gallbladder neck
33
Right intersegmental fissure
Divides right lobe into anterior & posterior segments; identified by right heptatic vein
34
Left intersegmental fissure
Divides left lobe into medial & lateral segments; identified by left hepatic vein
35
Ligamentum teres originates from
the obliterated umbilical vein of fetus
36
Ligamentum teres originates from
ductus venosus of fetus
37
Average size of portal vein
13 mm
38
Average size of spleen
13 cm
39
Ligaments that anchor liver to abdomen
Coronary, right/left triangular ligaments
40
Main liver function tests
``` AST (SGOT) - aspartate aminotransferase ALT (SGPT) - alanine aminotransferase Albumin Bilirubin AFP - alpha fetoprotein CEA - carcinoembryonic antigen ```
41
Normal Anatomic Variants
1. Reidel's lobe 2. Caudate lobe size 3. Hepatic Veins 4. Situs inversus
42
Reidel's lobe
Extension of the right lobe
43
Situs inversus
Organ reversal to left side of body
44
Echogenicity of liver compared to spleen
Isoechoic
45
Echogenicity of liver compared to kidney
Isoechoic, or slightly greater than renal cortex
46
Echogenicity of liver compared to pancreas
Slightly hypoechoic
47
Fatty Infiltration is also known
Steatosis
48
2 most common cause of steatosis
Obesity & alchohol abuse
49
Steatosis ultrasound appearance
Increased echogenicity, obscure vessels, difficulty in penetration
50
Focal Fatty Infiltration
Areas of increased echogenicity, can appear as a hyperechoic mass/tumor
51
Focal Sparing
Area spared from fatty infiltration
52
Focal Sparing Ultrasound Appearance
Irregular shaped hypoechoic area
53
Hepatitis
Inflammation of the liver caused by the hepatitis A-F virus
54
Clinical Signs & Symptoms of Hepatitis
Anorexia, jaundice, nausea, fatigue, joint pain
55
Ultrasound Appearance of Acute Hepatitis
Normal, decreased echogenicity, larger portal veins, thickened gallbladder wall, enlarged and tender
56
What is the reasoning behind the appearance of a liver with acute hepatitis?
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
Ultrasound Appearance of Chronic Hepatitis
Coarse echo pattern, increased echogenicity, decreased echogenicity in PV walls
58
What is the reasoning behind the appearance of a liver with chronic hepatitis?
Because the organ is dying, blood has left the vessel to tend to other organs. There is also less vasculature
59
Cirrhosis
Liver parenchyma is replaced by fibrosis and abnormal modules.
60
Fibrosis
Dead tissue/cells
61
Ultrasound Appearance of Early Cirrhosis
Hepatomegaly, fatty infiltration
62
Ultrasound Appearance of Chronic Cirrhosis
Coarse texture, ascites, dialated PV, portosystemic varices, hepatofugal portal flow, splenomegaly, recanalized ligamentum teres, enlarged caudate lobe
63
What is the reasoning behind the appearance of a liver with chronic cirrhosis?
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
Portal Hypertension
PV larger than 13 mm
65
Dilated splenic vein/SMV measurement
> 10mm
66
Hepatofugal
Away from liver
67
Hepatopetal
Towards liver
68
Budd-Chiari Syndrome
Blockage of hepatic veins; very urgent b/c hepatic veins → IVC → heart
69
Ultrasound Appearance of Budd-Chiari Syndrome
Compressed IVC, ascites, enlarged caudate lobe, splenomegaly
70
Cyst Requirements
1. Anechoic 2. Well defined walls 3. Posterior enhancement
71
Cysts are most common in
Right lobe (bigger) & females
72
Hyatid Disease
Echinococcal Cyst, caused by parasitic worm | Mostly found in liver, can also be found in lung, brains, and bone
73
Ultrasound Appearance of Hyatid Disease
Simple cyst with or w/o wall calcification, mother cyst w/ daughter cyst, honeycomb/water lilly design
74
Pyogenic Abscess
Abscess caused by bacterial invasion of liver
75
Bacteria that cause pyogenic abscess
E. coli Clostridium Bacteriodes
76
Infection routes for pyogenic abscess
Biliary tree, portal vein, hepatic artery
77
Symptoms of Pyogenic Abscess
Fever, pain, nausea, vomiting, diarrhea
78
Lab Values for Pyogenic Abscess
Leukocytosis, increased LFTs, anemia
79
Ultrasound Appearance of Pyogenic Abscess
Irregular shape and walls, may have shadowing or comet tail artifact
80
Amoebic Abscess
Caused by amebas that liquefy hepatic tissue; can lead to death without treatment
81
Ultrasound Appearance of Amoebic Abscess
Subcapsular, low amplitude cyst fill in, thickened irregular walls, posterior enhancement
82
Signs/Symptoms of Amoebic Abscess
Abdominal pain, diarrhea, melena
83
Name the benign neoplasms
Cavernous hemangioma, focal nodular hyperplasia, adenoma, hematoma
84
Cavernous Hemangioma
Vascular structures filled w/ blood cells, most common benign liver tumor!
85
Ultrasound Appearance of Cavernous Hemangioma
Round, highly echogenic, well defined solid mass
86
Focal Nodular Hyperplasia
Very rare, benign tumor
87
2 masses caused by oral contraceptives
FNH, adenoma
88
Focal Nodular Hyperplasias are composed of
1. Hepatocytes 2. Kupffer cells 3. Fibrous connective tissue & bile duct elements
89
Liver Cell Adenoma
Benign tumor
90
Increased incidence for adenoma with
1. Oral contraceptives in women 2. Steroid use in men 3. Type 1 glycogen storage disease
91
Hematoma
Mass filled w blood, often caused by trauma
92
Ultrasound Appearance of Hematoma
If hematoma has old blood → hyperechoic | If hematoma has new blood → hypoechoic
93
Name the malignant neoplasms
Hepatocellular carcinoma (aka hepatoma, HCC), metastases
94
Increased risk for hepatoma can be due to
Hepatitis & cirrhosis
95
Ultrasound Appearance of HCC
Hepatomegaly, ascites, invasion of portal & hepatic veins, distorted parenchyma
96
Metastases
Cancer that has originated from another organ and spread to the liver, most common liver malignancy!
97
Signs/Symptoms of Metastases
Jaundice, pain, hepatomegaly
98
Ultrasound Appearance of Metastases
Lung: Bull's eye/target Colon: Hyperechoic Liver/kidney: Moth eaten Can also be calcified

Abdomen Ultrasound (4 decks)

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