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Flashcards in Liver Deck (130):
1

What is the largest parenchymal organ in the body?

Liver

2

What does parenchymal mean?

has tissue

3

The primitive gut is formed during the _____ week of embryonic life and is composed of these 3 parts:

4th
Foregut
Midgut
Hindgut

4

The _____ veins bring oxygenated blood from the embryonic portion of the placenta to the embryonic heart.

umbilical veins

5

The _____ veins return blood from the yolk sac to the heart.

vitelline veins

6

Vitelline veins eventually become what vessels?

portal veins

7

The liver comes from what part of the primitive gut?

the foregut

8

In prenatal live, oxygenated blood from the placenta is carried by the _____ _____ vein and _____ _____ to the IVC and _____ atrium.

left umbilical vein
ductus venosus
right atrium

9

List the various liver structures (6)

1) portal veins
2) hepatic veins
3) arteries
4) ducts
5) hepatic ligaments
6) hepatic fissures

10

The liver tissue sequentially moves into the _____ veins and then the _____ veins.

vitelline veins
umbilical veins

11

As the liver tissue moves into the vitelline veins, their midsection becomes _____, whereas their _____ ends become the _____ _____ veins and their _____ ends become the _____ _____ veins.

capillarized
caudal ends become the primitive portal veins
cranial ends become the early hepatic veins

12

After the right umbilical vein and part of the left umbilical vein degenerate during fetal development, the remaining left umbilical vein carries all the blood from the _____ to the _____.

placenta
fetus

13

An umbilical cord should contain _____ arter(ies) and _____ vein(s).

2 arteries
1 vein

14

The ductus venosus develops as a large shunt within the liver and allows blood to connect from the _____ _____ to the baby's _____, by bypassing the _____.

umbilical cord
heart (right side)
liver

15

Direction of fetal circulation:

Umbilical Vein (ligamentum teres)
l
l
\/
?
l
l
\/
? (AKA ?)
l
l
\/
?

Umbilical Vein (ligamentum teres)
l
l
\/
Left Portal Vein
l
l
\/
Ductus Venosus (AKA Ligamentum Venosum)
l
l
\/
IVC

16

The _____ _____ closes shortly after birth, when the umbilical cord is cut and blood flowing between the mother and fetus stops.

ductus venosus

17

The _____ _____ is a remnant of the ductus venosus. It runs from the _____ to the _____, separating the left LLL from the caudate lobe of the liver.

ligamentum venosum
LPV
IVC

18

The liver is covered by a thin connective tissue called

Glisson's capsule

19

Glisson's capsule covers the entire liver except the "_____ _____" near the dome of the liver, on the posterior surface of the RLL.

"bare area"

20

Glisson's capsule is at its thickest around the _____ and the _____.

IVC
porta hepatis

21

These macrophages remove bacteria, foreign matter and weakened blood cells from the liver sinusoids (blood in the sinusoids).

Kupffer cells

22

T or F? Kupffer cells are around at all times, they just "hang out" if no infection.

True

23

The hepatic parenchyma is composed of _____ (type of cell) dispersed with Kupffer cells and organized into lobules approximately 1 x 2 mm in size.

hepatocytes

24

Typically about _____ million of these are found in the liver, and they are the functional units of the liver.

1 million
lobules

25

The liver occupies a major portion of the _____ _____ (region of abdomen).

right hypochondrium

26

Inferiorly, the liver extends into the

epigastrium

27

Laterally, the liver extends into the

left hypochondrium

28

Superiorly, the liver extends into the

dome of the diaphragm

29

Posteriorly, the liver borders the

bony lumbar region of the muscular posterior abdominal wall

30

The 5 main liver functions are

1) Bile drainage
2) Blood glucose regulation
3) Synthesis/Storage of amino acids, proteins, vitamins, and fats
4) Detoxification
5) Blood circulation/filtration

31

Bile from the liver travels down the _____ and joins with the bile from the _____ and ends in the _____ head.

CBD
GB
pancreatic head

32

The liver is a(n) _____ (location in body) structure situated in the _____ upper quadrant of the abdomen.

intraperitoneal
right

33

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

superior
anterior
part of the posterior

34

The caudate lobe, which is the smallest lobe, is marked on the _____ border by the _____ surface of the LPV and the _____ border is the _____.

anterior border
posterior surface
posterior border
IVC

35

The posterior surface of the right lobe of the liver is indented by the _____.

right kidney

36

The IVC lies _____ to the liver and has a short _____ course just before entering the right atrium of the heart.

posterior
intrahepatic

37

The LLL lies adjacent to the body of the pancreas, _____, and _____, and lies close to the body and _____ of the stomach.

SV
SA
antrum

38

The blood received by the liver from the PV delivers nutrients just absorbed from the _____.

intestines

39

Oxygenated (and some deoxygenated) blood is brought to the liver by the _____ and ______.

PVs
HAs

40

Hepatic sinusoids are similar to what other vascular structure we have learned about?

capillaries

41

Central veins connect to _____ veins, which then connect to the _____.

hepatic
IVC

42

What allows blood from the HAs and PV to mix in the liver?

HAs and PV deliver blood to the tiny hepatic sinusoids and is eventually delivered to the HVs, which conduct blood toward the heart.

43

Blood from the liver sinusoids is eventually deliver to the _____ veins, which conduct blood toward the _____.

hepatic veins
heart

44

The average adult liver is _____ grams.

1500

45

Liver size depends on the _____ segment of the _____ (lobe) and the length of the _____.

lateral
LLL
RLL

46

Hepatomegaly is indicated with a superior-inferior dimension of >____cm or when the RLL extends inferior to the _____ _____ of the _____ kidney.

15
lower pole
right

47

Liver echogenicity is usually _____ (heterogeneous/homogeneous) and is slightly _____ (echogenicity) compared to the normal renal cortex.

homogeneous
hyperechoic

48

T or F? The LLL is always smaller than the RLL.

True

49

If the LLL is congenitally small or atrophic, it may be a result of interference with the _____ supply when the _____ _____ closes at birth.

LPV
ductus venosus

50

The longer the RLL, the _____ (less/more) likely the interference of bowel gas by the hepatic flexure.

less

51

The length of the _____ (lobe) determines the clarity of the right kidney in the supine position.

RLL

52

A tongue-like projection of the RLL that may extend to the iliac crest.

Reidel's Lobe

53

Reidel's lobe is usually positioned _____ (direction) and more common in _____ (men/women).

anteriorly
women

54

In 1957, the _____ classification system was created that divides the liver into _____ (number) functional segments.

Couinaud
8

55

Each Couinaud segment of the liver has its own _____, _____, and _____.

PV
HA
Bile Duct

56

T or F? The Couinaud division system makes it possible to identify and remove tumors in specific segments while leaving others untouched.

True

57

The liver's 3 lobes are

Right
Left
Caudate

58

The RLL and LLL are based on the the _____'s right and left branches.

MPV

59

The RLL is divided into _____ and _____ segments.

anterior
posterior

60

The LLL is divided into _____ and _____ segments.

medial
lateral

61

The medial segment of the LLL was formerly called the _____ lobe.

Quadrate

62

This lobe of the liver lies on the posterior-superior surface of the liver between the IVC and the medial LLL.

Caudate

63

The caudate lobe is supplied by branches of the _____ and _____ _____ veins and the _____ (vessel).

right and left PVs
HA

64

The Caudate lobe is drained by _____ veins, which enter directly into the IVC.

emissary

65

Study the 8 segments of the liver

okay

66

Segmental anatomy of the liver is based on the distribution of the _____ (vessels).

PVs

67

The vessels of the _____ _____ course to the center of each segment of the liver.

portal triad

68

_____ (vessels) divide the liver longitudinally into 4 sections.

HVs

69

Each of the 4 sections of the liver (divided by the HVs) is divided further transversely by a(n) _____ plane through the right and left PVs.

imaginary

70

The HVs are both _____ and _____ veins (type/classification).

interlobar
intersegmental

71

HVs course between the _____ and _____ of the liver and have _____ (echogenicity) walls.

lobes
segments
non-echogenic

72

The _____ vein separates and drains the anterior and posterior segments of the _____.

RHV
RLL

73

The _____ vein separates and drains the medial and lateral segments of the _____ (lobe).

LHV
LLL

74

The _____ vein separates and drains the right and medial _____ (lobe).

MHV
LLL

75

This is the term for HVs that course BETWEEN the segments and lobes of the liver.

intersegmental

76

This is the term for vessels of the portal triad that course WITHIN each segment of the liver.

intrasegmental

77

What fissure divides the RLL and LLL by an oblique plane between the IVC and GB fossa?

main lobar fissure (MLF)

78

The _____ vein travels within the MLF.

MHV

79

Landmarks for the MLF are (3)

GB
IVC
MHV

80

This is the fissure identified between the GB neck and the junction of the RPV and LPV.

MLF

81

It is also correct to say the _____ fissure divides the _____ segment of the RLL from the _____ segment of the LLL.

MLF
anterior
medial

82

This fissure divides the RLL into anterior and posterior segments.

Right Intersegmental Fissure

83

The landmark for the Right Intersegmental Fissure is the (1)

RHV

84

This fissure divides the LLL into medial and lateral segments.

Left Intersegmental Fissure

85

The landmarks for the Left Intersegmental Fissure are (4)

LHV
ascending LPV
falciform ligament
ligamentum teres

86

Name the 7 ligaments of the liver.

coronary
falciform
round
right triangular
left triangular
gastrohepatic
hepatoduodenal

87

This ligament suspends the liver from the diaphragm and surround the "bare area".

coronary ligament

88

This ligament appears as a bright echogenic focus demarcating the lateral border of the medial portion of the LLL.

falciform ligament

89

The falciform ligament separates segment # _____ from segment # _____ and is the structure above the ligamentum teres.

3
4

90

What is a double fold of the peritoneum created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of the PV?

falciform ligament

91

What is a sickle-shaped fold that connects the liver to the anterior abdominal wall and to the diaphragm?

falciform ligament

92

The ligamentum teres is also known as the

round ligament

93

This ligament is a remnant of the umbilical vein which runs from the umbilicus to the LPV. Shortly after birth, the umbilical vein contracts down forming this ligament.

ligamentum teres (AKA round ligament)

94

With portal HTN, this ligament recannalizes to form a portosystemic venous collateral.

ligamentum teres (AKA round ligament)

95

These ligaments aren't normally seen on an U/S and are peritoneal reflections to the far right and far left of the bare area.

triangular ligaments

96

This ligament is a portion of the lesser omentum that extends across the ligamentum venosum at the porta hepatis.

gastrohepatic ligament

97

The porta hepatis is contained in peritoneal folds called the _____ ligament.

hepatoduodenal ligament

98

This ligament is a portion lesser omentum that extends as the right border of the gastrohepatic ligament.

hepatoduodenal ligament

99

Are HVs interlobar or intralobar?

interlobar

100

Are PVs interlobar or intralobar?

intralobar

101

The liver receives its nutrients from the _____ and the _____ (vessels).

HA
PV

102

The HVs are interlobar and follow a _____ course.

horizontal

103

The caliber of the HVs _____ (increases/decreases) as they course toward the diaphragm and IVC.

increases

104

The caliber of the PVs _____ (increases/decreases) toward the porta hepatis.

increases

105

T or F? One of the functions of the liver is the destruction of bad RBCs.

True

106

This lab value increases with liver disease (as well as heart, skeletal muscle, kidney, and brain).

SGOT or AST

107

This lab value increases with liver disease (specifically) and biliary tract obstruction.

SGPT or ALT

108

An increase in AST without an increase in ALT is seen with

a myocardial infarction

109

_____ (direct/indirect) bilirubin increases with liver disease and biliary tract obstruction.

direct

110

_____ (direct/indirect) bilirubin increases with liver dx. and disorders that cause increased RBC hemolysis.

indirect

111

Elevated levels of bilirubin can cause

obstructive or non-obstructive jaundice

112

Serum protein _____ (increases/decreases) with liver disease, especially albumin (a specific serum protein).

decreases

113

If a person isn't pregnant (because this increases naturally with pregnancy), this lab value increases with bone or liver abnormalities.

ALP
(alkaline phosphatase)

114

This lab value may increase with liver damage but is also a tumor marker for scrotal cancer.

LDH
(lactic dehydrogenase)

115

This lab value is present in over 50% of patients with hepatomas or hepatoblastomas (synthesized by the fetal liver).

AFT
(alpha-fetal protein)

116

If AFP (alpha-fetal protein) is elevated in an adult, they will ALWAYS have _____ (disease).

hepatocellular carcinoma (HCC)

117

This lab value (clotting factor) increases with liver disease; it is a time (in seconds) that it takes for blood to coagulate.

PT
(prothrombin time)

118

At least _____ clotting factors are needed to clot blood.

12

119

Vitamin _____ is needed to produce prothrombin.

K

120

Abnormal PT (prothrombin time) is often due to (2)

liver disease
Coumadin treatment (blood thinner)

121

When doing invasive procedures, these 3 blood tests are drawn to measure blood clotting factors.

PT (prothrombin time)
PPT (partial prothrombin time)
INR (international normalized ratio)

122

This test "standardizes" the PT test so that values may be compared between different labs.

INR
(international normalized ratio)

123

The liver should be _____ (homogeneous/heterogeneous) and moderately _____ (echogenicity) throughout.

homogeneous
echogenic

124

Ultrasound for the liver is indicated for

Suspected liver enlargement

Hepatic or perihepatic masses, abscesses and obstructive or metastatic lesions

Cystic, solid or complex masses

Pleural effusions may be visualized in the subphrenic or subdiaphragmatic region

Ascites

Vascular structures for the presence, direction and velocity of blood flow

Portal vein, hepatic arteries & veins, and splenic artery and vein examinations

125

Long-dot-long is an image of what?

porta hepatis oblique

126

What are visual elements on an U/S for early (acute) stages of cirrhosis? (3)

hepatomegaly
decreased vasculature
scalloped edges

127

Chronic stages of cirrhosis show a _____, _____ liver on U/S.

shriveled
small

128

This ligament recannalizes in cirrhosis to function as a venous collateral.

ligamentum teres

129

The length of the RLL determines the clarity of

The right kidney in the supine position

130

The caudate lobe lies on the _____ - ______ surface of the liver, between the IVC and _____ _____ _____ of the liver. It is supplied by the branches of the _____ and _____ _____ _____ (vessels) and the _____ _____ (vessel).

Posterior-superior
IVC
medial LLL
LPV/RPV
HA