Flashcards in Liver Deck (130):
What is the largest parenchymal organ in the body?
What does parenchymal mean?
The primitive gut is formed during the _____ week of embryonic life and is composed of these 3 parts:
The _____ veins bring oxygenated blood from the embryonic portion of the placenta to the embryonic heart.
The _____ veins return blood from the yolk sac to the heart.
Vitelline veins eventually become what vessels?
The liver comes from what part of the primitive gut?
In prenatal live, oxygenated blood from the placenta is carried by the _____ _____ vein and _____ _____ to the IVC and _____ atrium.
left umbilical vein
List the various liver structures (6)
1) portal veins
2) hepatic veins
5) hepatic ligaments
6) hepatic fissures
The liver tissue sequentially moves into the _____ veins and then the _____ veins.
As the liver tissue moves into the vitelline veins, their midsection becomes _____, whereas their _____ ends become the _____ _____ veins and their _____ ends become the _____ _____ veins.
caudal ends become the primitive portal veins
cranial ends become the early hepatic veins
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 _____.
An umbilical cord should contain _____ arter(ies) and _____ vein(s).
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 _____.
heart (right side)
Direction of fetal circulation:
Umbilical Vein (ligamentum teres)
? (AKA ?)
Umbilical Vein (ligamentum teres)
Left Portal Vein
Ductus Venosus (AKA Ligamentum Venosum)
The _____ _____ closes shortly after birth, when the umbilical cord is cut and blood flowing between the mother and fetus stops.
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.
The liver is covered by a thin connective tissue called
Glisson's capsule covers the entire liver except the "_____ _____" near the dome of the liver, on the posterior surface of the RLL.
Glisson's capsule is at its thickest around the _____ and the _____.
These macrophages remove bacteria, foreign matter and weakened blood cells from the liver sinusoids (blood in the sinusoids).
T or F? Kupffer cells are around at all times, they just "hang out" if no infection.
The hepatic parenchyma is composed of _____ (type of cell) dispersed with Kupffer cells and organized into lobules approximately 1 x 2 mm in size.
Typically about _____ million of these are found in the liver, and they are the functional units of the liver.
The liver occupies a major portion of the _____ _____ (region of abdomen).
Inferiorly, the liver extends into the
Laterally, the liver extends into the
Superiorly, the liver extends into the
dome of the diaphragm
Posteriorly, the liver borders the
bony lumbar region of the muscular posterior abdominal wall
The 5 main liver functions are
1) Bile drainage
2) Blood glucose regulation
3) Synthesis/Storage of amino acids, proteins, vitamins, and fats
5) Blood circulation/filtration
Bile from the liver travels down the _____ and joins with the bile from the _____ and ends in the _____ head.
The liver is a(n) _____ (location in body) structure situated in the _____ upper quadrant of the abdomen.
What portions of the liver are in contact with the diaphragm?
part of the posterior
The caudate lobe, which is the smallest lobe, is marked on the _____ border by the _____ surface of the LPV and the _____ border is the _____.
The posterior surface of the right lobe of the liver is indented by the _____.
The IVC lies _____ to the liver and has a short _____ course just before entering the right atrium of the heart.
The LLL lies adjacent to the body of the pancreas, _____, and _____, and lies close to the body and _____ of the stomach.
The blood received by the liver from the PV delivers nutrients just absorbed from the _____.
Oxygenated (and some deoxygenated) blood is brought to the liver by the _____ and ______.
Hepatic sinusoids are similar to what other vascular structure we have learned about?
Central veins connect to _____ veins, which then connect to the _____.
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.
Blood from the liver sinusoids is eventually deliver to the _____ veins, which conduct blood toward the _____.
The average adult liver is _____ grams.
Liver size depends on the _____ segment of the _____ (lobe) and the length of the _____.
Hepatomegaly is indicated with a superior-inferior dimension of >____cm or when the RLL extends inferior to the _____ _____ of the _____ kidney.
Liver echogenicity is usually _____ (heterogeneous/homogeneous) and is slightly _____ (echogenicity) compared to the normal renal cortex.
T or F? The LLL is always smaller than the RLL.
If the LLL is congenitally small or atrophic, it may be a result of interference with the _____ supply when the _____ _____ closes at birth.
The longer the RLL, the _____ (less/more) likely the interference of bowel gas by the hepatic flexure.
The length of the _____ (lobe) determines the clarity of the right kidney in the supine position.
A tongue-like projection of the RLL that may extend to the iliac crest.
Reidel's lobe is usually positioned _____ (direction) and more common in _____ (men/women).
In 1957, the _____ classification system was created that divides the liver into _____ (number) functional segments.
Each Couinaud segment of the liver has its own _____, _____, and _____.
T or F? The Couinaud division system makes it possible to identify and remove tumors in specific segments while leaving others untouched.
The liver's 3 lobes are
The RLL and LLL are based on the the _____'s right and left branches.
The RLL is divided into _____ and _____ segments.
The LLL is divided into _____ and _____ segments.
The medial segment of the LLL was formerly called the _____ lobe.
This lobe of the liver lies on the posterior-superior surface of the liver between the IVC and the medial LLL.
The caudate lobe is supplied by branches of the _____ and _____ _____ veins and the _____ (vessel).
right and left PVs
The Caudate lobe is drained by _____ veins, which enter directly into the IVC.
Study the 8 segments of the liver
Segmental anatomy of the liver is based on the distribution of the _____ (vessels).
The vessels of the _____ _____ course to the center of each segment of the liver.
_____ (vessels) divide the liver longitudinally into 4 sections.
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.
The HVs are both _____ and _____ veins (type/classification).
HVs course between the _____ and _____ of the liver and have _____ (echogenicity) walls.
The _____ vein separates and drains the anterior and posterior segments of the _____.
The _____ vein separates and drains the medial and lateral segments of the _____ (lobe).
The _____ vein separates and drains the right and medial _____ (lobe).
This is the term for HVs that course BETWEEN the segments and lobes of the liver.
This is the term for vessels of the portal triad that course WITHIN each segment of the liver.
What fissure divides the RLL and LLL by an oblique plane between the IVC and GB fossa?
main lobar fissure (MLF)
The _____ vein travels within the MLF.
Landmarks for the MLF are (3)
This is the fissure identified between the GB neck and the junction of the RPV and LPV.
It is also correct to say the _____ fissure divides the _____ segment of the RLL from the _____ segment of the LLL.
This fissure divides the RLL into anterior and posterior segments.
Right Intersegmental Fissure
The landmark for the Right Intersegmental Fissure is the (1)
This fissure divides the LLL into medial and lateral segments.
Left Intersegmental Fissure
The landmarks for the Left Intersegmental Fissure are (4)
Name the 7 ligaments of the liver.
This ligament suspends the liver from the diaphragm and surround the "bare area".
This ligament appears as a bright echogenic focus demarcating the lateral border of the medial portion of the LLL.
The falciform ligament separates segment # _____ from segment # _____ and is the structure above the ligamentum teres.
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?
What is a sickle-shaped fold that connects the liver to the anterior abdominal wall and to the diaphragm?
The ligamentum teres is also known as the
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)
With portal HTN, this ligament recannalizes to form a portosystemic venous collateral.
ligamentum teres (AKA round ligament)
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.
This ligament is a portion of the lesser omentum that extends across the ligamentum venosum at the porta hepatis.
The porta hepatis is contained in peritoneal folds called the _____ ligament.
This ligament is a portion lesser omentum that extends as the right border of the gastrohepatic ligament.
Are HVs interlobar or intralobar?
Are PVs interlobar or intralobar?
The liver receives its nutrients from the _____ and the _____ (vessels).
The HVs are interlobar and follow a _____ course.
The caliber of the HVs _____ (increases/decreases) as they course toward the diaphragm and IVC.
The caliber of the PVs _____ (increases/decreases) toward the porta hepatis.
T or F? One of the functions of the liver is the destruction of bad RBCs.
This lab value increases with liver disease (as well as heart, skeletal muscle, kidney, and brain).
SGOT or AST
This lab value increases with liver disease (specifically) and biliary tract obstruction.
SGPT or ALT
An increase in AST without an increase in ALT is seen with
a myocardial infarction
_____ (direct/indirect) bilirubin increases with liver disease and biliary tract obstruction.
_____ (direct/indirect) bilirubin increases with liver dx. and disorders that cause increased RBC hemolysis.
Elevated levels of bilirubin can cause
obstructive or non-obstructive jaundice
Serum protein _____ (increases/decreases) with liver disease, especially albumin (a specific serum protein).
If a person isn't pregnant (because this increases naturally with pregnancy), this lab value increases with bone or liver abnormalities.
This lab value may increase with liver damage but is also a tumor marker for scrotal cancer.
This lab value is present in over 50% of patients with hepatomas or hepatoblastomas (synthesized by the fetal liver).
If AFP (alpha-fetal protein) is elevated in an adult, they will ALWAYS have _____ (disease).
hepatocellular carcinoma (HCC)
This lab value (clotting factor) increases with liver disease; it is a time (in seconds) that it takes for blood to coagulate.
At least _____ clotting factors are needed to clot blood.
Vitamin _____ is needed to produce prothrombin.
Abnormal PT (prothrombin time) is often due to (2)
Coumadin treatment (blood thinner)
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)
This test "standardizes" the PT test so that values may be compared between different labs.
(international normalized ratio)
The liver should be _____ (homogeneous/heterogeneous) and moderately _____ (echogenicity) throughout.
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
Vascular structures for the presence, direction and velocity of blood flow
Portal vein, hepatic arteries & veins, and splenic artery and vein examinations
Long-dot-long is an image of what?
porta hepatis oblique
What are visual elements on an U/S for early (acute) stages of cirrhosis? (3)
Chronic stages of cirrhosis show a _____, _____ liver on U/S.
This ligament recannalizes in cirrhosis to function as a venous collateral.
The length of the RLL determines the clarity of
The right kidney in the supine position