Liver Flashcards Preview

Abdominal > Liver > Flashcards

Flashcards in Liver Deck (152):
1

What are the 4 functions of the liver?

1. Metabolism
2. Digestion
3. Storage
4. Detoxification

2

In patients with known liver disease, what type of test can help in the diagnosis?

Liver Function Test

3

What refers to a group of laboratory tests established to analyze how the liver is performing under normal and diseased conditions

Liver Function Tests

4

Name of the enzyme present in tissues with a high rate of metabolic activity?

Aspartate Aminotransferase (AST)

5

What causes AST to be released into the bloodstream in abnormally high levels?

Death or injury to producing cells

6

Any disease that injures the cells causes an elevation in _____ levels

AST

7

In what 6 cases pertaining to the liver is AST elevated?

1. Hepatitis
2. Fatty liver
3. Hepatic necrosis
4. Mononucleosis
5. Cirrhosis
6. Metastatic liver disease

8

Alanine Aminotransferase is mildly elevated in what?

1. Acute cirrhosis
2. Hepatic metastasis
3. Pancreatitis

9

Alanine Aminotransferase is mild to moderately elevated in cases of?

Obstructive Jaundice

10

Alanine Aminotransferase is moderate to highly elevated in what 3 cases?

1. Hepatocellular disease
2. infections hepatitis
3. Toxic hepatitis

11

__________ is produced by the liver, bone, intestines and placenta

Alkaline Phosphatase

12

Alkaline Phosphatase is a good indicator of what 5 diseases?

1. Obstruction
2. Hepatic carcinoma
3. Abscess
4. Cirrhosis
5. Hepatitis

13

__________is secreted as bile by the liver cells into the bile ducts

Bilirubin

14

What is bilirubin?

Product of the breakdown of hemoglobin in tired red blood cells

15

The Bilirubin process can be disturbed in what 3 ways

1. Excessive amount of red blood cell destruction
2. Malfunction of liver cells
3. Blockage of ducts leading from cells

16

Conjugated bilirubin name?

Direct bilirubin

17

Unconjugated bilirubin name?

Indirect bilirubin

18

Indirect bilirubin is elevated in what 3 cases?

1. Anemias
2. Trauma from hematoma
3. Hemorrhagic pulmonary infarct

19

Elevation of direct bilirubin is usually related to obstructive jaundice from ________ or _________.

stones; neoplasm

20

Hepatic metastisis, hepatitis, lymphoma, cholestasis secondary to drug use, and cirrhosis will elevate both ________ and _________ ___________.

direct; indirect; bilirubin

21

____________ is increased in the presence of liver disease?

Prothrombin time

22

__________ is part of the blood clotting mechanism?

Prothrombin time

23

Prothrombin time is increased in the presence of liver disease with cellular damage in what two cases?

1. Cirrhosis
2. Metastatic disease

24

_________ affects the hepatocytes and interferes with liver function

Diffuse disease

25

________are parenchymal liver cells that performs all the functions?

Hepatocytes

26

7 common causes of diffuse disease?

1. Alcoholic liver disease
2. Diabetes
3. Obesity
4. Pregnancy
5 Severe hepatitis
6. Chronic illness
7. Steroids

27

Diffuse disease patients are usually asymptomatic, however some may present with these 4 symptoms

1. Jaundice
2. Nausea
3. Vomiting
4. Abdominal pain

28

________increases lipid accumulation in the hepatocytes

Fatty infiltration

29

Sonographic findings of fatty infiltration?

-increased echogenicity
-Enlargement of affected lobe
-difficulty penetrating the entire liver
-portal veins may be difficult to visualize due to attenuation

30

General term for inflammatory and infectious disease of the liver?

Hepatitis

31

What are the three causes of hepatitis?

1. local infection (viral hepatitis)
2. infection elsewhere in the body (mono)
3. Chemical or dug toxicity

32

Mild inflammation impairs hepatocyte fuction, whereas more severe inflammation may lead to obstruction of ________ and _______ flow in the liver and impaired liver cell function.

blood; bile

33

what are the 5 types of hepatitis?

1. hav
2. hbv
3. hcv
4. hdv
5. hev

34

HBV is ___ % in the US

60

35

HAV is _____% in the US

20

36

Other types of hepatitis is _____% in the US

20

37

What type of hepatitis is found in saliva, semen, and can spread through sexual contact or through blood?

HBV

38

What type of hepatitis is at greatest risk for healthcare workers?

HBV

39

HBV symptoms? (4)

1. flu-like
2. loss of appetite
3. vomiting
4. fatigue

40

What disease can range from mild damage to massive necrosis and liver failure?

Acute hepatitis

41

Acute Hepatitis sonographic findings (4)

1. liver texture may be normal
2. attenuation may be present
3. hepatosplenomegaly
4. gallbladder wall thickening

42

_________ exists when there is evidence of hepatic inflammation for at least 3-6 months

chronic hepatitis

43

what are symptoms of chronic hepatitis? (7)

1. nausea
2. anorexia
3. weightloss
4. tremors
5. jaundice
6. dark urine
7. fatigue

44

Diagnosis these symptoms: nausea, anorexia, weight loss, tremors, jaundice, dark urine, fatigue

chronic hepatitis

45

Chronic hepatitis sonographic findings (3)

1. Liver texture is coarse
2. Decreased brightness of portal triad
3. No increase in size

46

Diagnose these sonographic findings:
1. liver texture may be normal
2. attenuation may be present
3. hepatosplenomegaly
4. gallbladder wall thickening

Acute hepatitis

47

________ is a chronic degenerative disease of the liver

cirrhosis

48

Diagnose these sonographic findings:
1. lobes are covered with a fibrous tissue
2. the parenchyma degenerates
3. the lobes are infiltrated with fat

cirrhosis

49

What disease is most commonly the result of chronic alcohol abuse but can also be the result of nutritional deprivation, hepatitis, or infection

cirrhosis

50

Name 3 types of cirrhosis

1. biliary
2. fatty
3. posthepatic

51

Name the acute cirrhosis symptoms? (9)

1. possibly asymptomatic
2. nausea
3. flatulence
4. ascities
5. light colored stool
6. weakness
7. abdominal pain
8. varicosities
9. spider angiomas

52

diagnosis these symptoms:
1. possibly asymptomatic
2. nausea
3. flatulence
4.ascities
5. light colored stool
6. weakness
7. abdominal pain
8. varicosities
9. spider angiomas

Acute Cirrhosis

53

what type of cirrhosis has a symptom of dark urine?

chronic cirrhosis

54

_______ may lead to liver failure and portal hypertension?

Chronic cirrhosis

55

diagnosis these sonographic finding:
1. diagnosis with ultrasound may be difficult
2. coarsening of the liver parenchyma
3. nodularity
4. increased attenuation
5. decreased vascular markings
6. hepatosplenomegaly
7. Ascites surrounding the liver
8. portal hypertension with or without abnormal doppler
9. increased incidence of hepatic tumors
10. late stage may show atrophy of liver

Cirrhosis

56

Cirrhosis sonographic findings

1. diagnosis with ultrasound may be difficult
2. coarsening of the liver parenchyma
3. nodularity
4. increased attenuation
5. decreased vascular markings
6. hepatosplenomegaly
7. Ascites surrounding the liver
8. portal hypertension with or without abnormal doppler
9. increased incidence of hepatic tumors
10. late stage may show atrophy of liver

57

________ can occur anywhere in the liver

cysts

58

Are cyst more common in men or women with increasing age?

women

59

Enlarging simple cyst may cause ______?

pain

60

Walls of simple cyst are _____ and ______?

thin; well defined

61

T or F
Simple Cyst are asymptomatic?

T

62

T or F
Cyst are large (4-5 cm)

False
cyst are small (less than 2-3 cm)

63

_____% have associated polyycystic renal disease

60

64

T or F
1 in 500 with polycystic renal disease

T

65

Sonographic findings of cysts

Anechoic
well defined borders
posterior enhancement
ultrasound may be used for guided aspiration
multiple cyst throughout the liver
cysts are small (2-3 cm)

66

_______ is parasitic or infectious collections in the liver

Abscesses

67

_______ contains seous fluid, pus, degris or blood clots

abscesses

68

Tiny gas forming organisms may develop within ________

Abscesses

69

T or F
Abscesses have regular or irregular edges

True

70

Symptoms of Abscesses (7)

1. Patients are usually very ill
2. RUQ pain
3. Tender hepatomegaly
4. Fever
5. Nausea
6. Vomitting
7. Weightloss

71

Diagnosis these symptoms
1. Patients are usually very ill
2. RUQ pain
3. Tender hepatomegaly
4. Fever
5. Nausea
6. Vomitting
7. Weightloss

Abscesses

72

_______ are pus forming abscess, usually caused by bacteria.

pyogenic abscess

73

Pyogenic abscess gains abscess to the liver, from the ______,_______ or _______

biliary tree, portal vein, hepatic artery

74

Diagnosis this symptom:
1. fever
2. pain
3. pleuritis
4. nausea
5. vomiting
6. diarrhea
7. leukocytosis

phyogenic abscess

75

phyogenic abscess symptoms

1. fever
2. pain
3. pleuritis
4. nausea
5. vomiting
6. diarrhea
7. leukocytosis

76

what treatment is used for pyogenic abscess

antibiotic and/or drainage

77

pyogenic abscesses size vary from__cm to _____

1cm to very large

78

diagnosis these sonographic findings
variable
size varies 1cm to very large
rt. central lobe is the most common site
may be hypoechoic or complex
may have fluid level
may be hyperechoic with dirty shadow due to gas

pyogenic abscess

79

pyogenic abscess sonographic findings

variable
size varies 1cm to very large
rt. central lobe is the most common site
may be hypoechoic or complex
may have fluid level
may be hyperechoic with dirty shadow due

80

Bowel is most commonly infected in?

Amebic abscess

81

Amebic abscess infection may spread to the ____, ____ or _____ by the bloodstream

liver, brain or lungs

82

Amebic Abscess symptoms

Low fever
leukocytosis
GI symptoms
-abd. pain
-diarrhea

83

__________ is an infectious cystic disease common in sheep hearding areas of the world

Echinococcal cyst

84

________ is a tapeworm that resides in the small intestines of dogs

echinococcus

85

What type of cyst has larvae enter the small intestine and burrow through the mucosa then enters the portal circulation and travels to the liver

Echinococcal cyst

86

a ______ cyst has two layers, may enlarge and rupture, may impinge onthe blood vessels and lead to vasculaqr thrombosis and infarctions

Echinococcal cyst

87

Sonographic Findings
-may be simple or complex
-oval or spherical
- may contain calcifications
-septations are frequent- honeycomb appearance

Echinococcal Cyst

88

A benign congenital tumor consisting of a large blood filled cystic spaces

Cavernous Hemangioma

89

What is the most commone benign tumor in the liver, most common in females, and most common in the right lobe

Cavernous Hemangioma

90

Name symptoms of Cavernous Hemangioma

-Asymptomatic
-small percentage mayb bleed causing RUQ pain

91

Sonographic Findings
-Hyperechoic
-Posterior Enhancement
-Round or oval
-May be lobulated
-Well defined borders
-May have mixed echo patterns due to necrosis

Cavernous hemangioma

92

Benign mass of epithelial cells, more commonly in women and are related to long term oral contraceptives

Adenoma

93

Name symptoms of Adenoma

-usually asymptomatic
-have RUQ pain to hemorage

94

Name turmor that is asymptomatic, with RUQ pain to hemorage

Adenoma

95

Name tumor for these sonographic findings:
-usually well circumscribed
-variable in size and shape
-similar appearance to hemangiomas or metastatic massses

Adenoma

96

What is the second most common benign liver mass after hemangioma

Focal nodular hyperplasia

97

What tumor is asymptomatic, hemorrrhage is rare, and no malignant potential?

Focal nodular hyperplasia

98

Name the tumor most commonly seen in females under the age of 40

Focal nodular hyperplasia

99

Name tumor with these sonographic findings:
-well defined
-hyperechoic or isoechoic to surrounding liver tissue
-ulually less than 5 cm
- Can be mistake for an adenoma or hemangioma

Focal nodular hyperplasia

100

Name the three Benign Hepatic Tumors

Cavernous hemangioma
adenoma
Focal nodular hyperplasia

101

Name the two malignant hepatic tumors

hepatocellular carcinoma
Metastatic disease

102

clinical sign of a malignant hepatic tumor (7)

-nausea
-vomiting
-fatigue
-weight loss
-hepatomegally
-portal hypertension
splenomegaly

103

Which tumor is related to cirrhosis

Hepatocellular carcinoma

104

80% of patients with preexisting cirrhosis develop _________. Occurs more frequently in men.

Hepatocellular carcinoma

105

Symptoms of ____________.
-hx of cirrhosis
-palpable mass
-appetite disorder
-hepatomegally
-fever

Hepatocellular carcinoma

106

Which tumor is present in three patterns?
-solitary massive tumor
-Multiple nodules throughout the liver
-Diffuse infiltrative masses in the liver

Hepatocellular carcinoma

107

________tumor may invade the hepatic veins to produce __________. Portal venous system may also be invaded.

Hepatocellular carcinoma, Budd-Chiari syndrome

108

Sonographic appearence:
-Solid discrete masses
-diffuse parenchyma involvement
-combination

Hepatocellular carcinoma

109

_________ is more common than primary liver tumors

Metastatic disease

110

Metastatic disease is most common _____ of the liver

neoplasm

111

Metastatic disease most common primaries _______,_________,_________.

Colon
Breast
Lung

112

Metastatic spread occurs as the tumor ______ the wall and travels through the ______ ________ or through the bloodstream to the portal vein or hepatic artery to the liver.

erodes, lymphatic system

113

Sonographic appearence:
-varies
-typically there are multiple lesions throughout both lobes

Metastatic disease

114

What are the four patterns of Metastatic disease

-well defined hypoechoic mass
-well defined echogenic mass
-diffuse distortion of the normal liver parenchyma
-Targey or Bull's Eye lesion

115

Which disease has the target or Bull's eye lesion?

metastatic disease

116

Metastatic disease is a result due to _____ around the tumor or _______or _________ within the tumor

edema, necrosis, or hemorrhage

117

Metastatic disease as the tumor grows rapidly in size they outgrow their _____ _____ and _________ or hemorrhage can occur within the tumor.

blood supply,necrosis

118

_______ and _________ _________ present a complex waveform, which flows above and below the baseline, relecting the reflux of blood from the right atrium during systome and variations with the respiratory cycle

IVC & Hepatic Veins

119

Thrombosis of the ___________ is called Budd-Chiari Syndrome

hepatic vein

120

Sonograpically with hepatic vascular flow abnormalities the hepatic veins appear?

reduced in size and may contain echogenic thrombotic material

121

The presence of _______blood flow in the hepatic veins permits the exclusion of _____________

typical, Budd-Chiari syndrome

122

Budd Chiari syndrome is associated with?

-hematologic disorder
-oral contraceptives
-Collagen disease
-Echinococcus
-Before and after pregnancy

123

What syndrom is associated with oral contraceptives?

Budd Chiari syndrome

124

In portal veins the flow is ___________.

Hepatopetal(towards the liver)

125

Flow is hepatopetal, relatively continuous, and varies slightly with respirations with what vein?

portal vein

126

Sonographic findings:
-lack of doppler signal indicates absence of blood flow
-in cirrhotic patiens, thrombosis is often supsected when ascitese suddenly worsens

Portal vein thrombosis

127

What are the indirect signs of a portal vein thrombosis?

-loss of normal portal venous landmarks
-dilation of the SMV and splenic veins
venous collaterals in the porta hepatis

128

Portal veins may be ________to visualize in patients with cirrhosis.

difficult

129

The portal vein should be examined in what kind of patients?

cirrhotic patients

130

An increase in portal venous pressure or hepatic venous gradient

Portal venous hypertension

131

Majority of the time an increase in portal venous pressure or hepatic venous gradient is a result of ?

intrinsic liver disease

132

Portal venous pressure can also be obstructed by _______,______ and _________or prolonged congestive heart failure

protal vein, hepatic vein, IVC

133

_______or ________ hepatocellular disease can block the flow of blood throughout the liver, causing it to back up into the ___________.

Acute or Chronic, hepatic portal circulation

134

In portal venous hypertension doppler techniques are used to determine ?

wheter blood flow in the portal vein is hepatopeta (towards) or hepatofugal(away)

135

What are the doppler findings of Portal Venous Hypertension?

-portal vein shows low velocity
-patent paraumblical vein
-respiratory variations of the vessel is uaually lost vecause the veins do not collapse with breathing

136

Sonographic Findings:
-Dilated PV, SV, and SMV
-patent umbilical vein
-varicies
-splenomegaly with dilated splenci radicles
-dimished response to respiration
-dilated SA and HA
-Ascities-f
-small liver with irregularities

Portal Venous Hypertension

137

In patients with portal venous hypertension the blood flow may take one of seveal paths through? (5)

-coronary-esophagealvarices
-Splenic varices
-Splenorenal shunts
-Recanalized umbilical vein
-Surgical Shunts

138

Splenic varices the flow in main, right and left portal vein is _________? Flow in splenic vein is __________? Flow in the SMV is ________?

reversed/ hepatofugal, reversed, normal

139

In Splenorenal Shunts flow in main, right and left portal vein is _______? Flow in splenic vein is __________? Flow in SMV is __________?

reversed/hepatofugal, reversed, normal

140

In recanalized umbilical vein flow in the main and left portal vein is ________. flow in the right portal vein is __________? flow in the SMV and splenic vein is ________?

normal/hepatopetal, reversed/hepatofugel, normal

141

What are the four spontaneious shunting sites?

1.coronary-gastroesphageal
2.paraumbilical vein
3.hemorrhoidal anastomoses
4. retroperitoneal anastomoses

142

which spontaneous shunting spot is most common?

coronary gastroesophageal

143

the spontaneous shunting of the coronary gastroesophageal occurs where the esophageal branches of the ________ form anastomeses with branches of the _______ and _______veins in the lower esophagus.

left gastric vein, azygos, hemiazygos vein

144

appears as a continuation of the left portal vein and extends to the anterior abdominal wall near the umbilicus?

paraumbilical vein

145

__________ sponatneous shunting occurs between the superior and middle hemorrhoidal veins?

Hemorrhoidal anastomoses

146

Vascular structures withing the lesser omentum may cause thickening of the omentum. Small vessels may be seen around the pancreas.

Retroperitoneal anastomoses

147

TIPS

Transjugular intrhpetic portosystemic shunt

148

Mesocaval

SMV and IVC

149

Splenorenal

Splenic vein and renal vein

150

Portacaval

Portal vein and IVC

151

Four liver function tests?

1. Alanine Aminotransferase
2.alkaline Phosphatase
3. Bilirubin
4.Prothrombin time

152

Alkaline phosphatase is moderately elevated in what 2 cases?

1. Cirrhosis
2. Hepatitis