Flashcards in Liver Deck (69):
How many lobes is the liver divided into?
3 (Right, Left, Caudate)
How many segments is the liver divided into?
8 ( 9 including caudate segment)
How many segments does the caudate lobe have?
How many segments does the left lobe have?
How many segments does the right lobe have?
What is the difference between hepatic veins and portal veins in appearance?
hepatic veins do not have echogenic walls
What vessels consist in the portal triad?
Main Portal vein, Hepatic Artery, CHD
What is the portal triad covered by?
What is the purpose of the main lobar fissure?
Divides right and left hepatic lobes by an oblique plane between the inferior vena cava and gallbladder fossa
Also divides anterior segment of right lobe from medial segment of left lobe
What does the Right hepatic vein divide?
Anterior and posterior segments
What does the Left hepatic vein divide?
Medial and Lateral segments
What is the Ligament Venosum?
Remnant of ductus venosus
Separates the left lobe from the caudate lobe
Explain fetal circulation?
Umbilical Vein (Ligamentum Teres) > Left portal vein > Ductus venosus ( Ligamentum venosum) > IVC
What is Hepatopetal flow?
Flow toward the liver
What is hepatofugal flow?
Flow away from liver
What is upper limits for portal vein diameter?
Large diameter suggests portal hypertension
What type of flow does hepatic veins have?
What type of flow do portal veins have?
What is Parvus Tardus?
proximal anastomotic stenosis
What recanalizes in case of liver cirrhosis?
What is the Falciform Ligament?
peritoneal reflection or fold created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of portal vein
What is the Coronary ligament?
Suspend liver from the diaphragm.
Right and left triangular ligament?
Reflections of right and left bare area
What is considered Hepatomegaly?
Greater than 15.5 cm superior- inferior dimension
What is a Reidels Lobe?
Inferior projection of the right lobe
What are hepatic granulomas?
Small calcifications of macrophages seen in liver and spleen
What is hepatitis?
Liver inflammation resulting from infectious or noninfectious agents
What labs might be elevated in hepatitis?
Conjugated and unconjugated Bilirubin
What might be seen with acute hepatitis?
"starry night" (periportal cuffing)
hypoechoic liver parenchyma
hyperechoic portal vein walls
What is the most common source for pyogenic (bacterial) abscess?
Biliary Tract Disease
What is an amebic abscess?
Parasite from the intestines, reaches liver via portal vein.
What is a fungal abscess (Candidiasis)?
A fungal infection of the blood that results in small abscesses in the liver.
"Wheel within Wheel"
" Bull's eye"
What is echonicoccal cyst (Hydatid disease)?
What is Schistosomiasis?
Most common parasitic infections in humans
Major cause of portal hypertension worldwide
What is focal fatty infiltration?
focal regions of increased echogenicity within normal liver parenchyma. Most commonly occurs at the porta hepatis
What is focal fatty sparring?
focal regions of normal liver parenchyma within a fatty infiltrated liver. Occurs adjacent to GB, in porta hepatis, in caudate lobe and at the liver margins
What is Glycogen Storage Disease? (Von Gierke disease)
Genetically acquired disorder that results in excess deposition of glycogen in the liver.
Absence or deficiency of one of the enzymes responsible for making or breaking down glycogen
What is cirrhosis?
diffuse process of fibrosis and distortion of normal liver architecture
What is the main cause of cirrhosis?
What is portal hypertension?
increased pressure in the portal venous system. Normal pressure is 5 to 10 mmHg. When pressure gradient increases, considered portal hypertension
What is the major cause of portal hypertension?
What are the four types of portal hypertension?
1. Extrahepatic presinusoidal: Portal vein thrombus
2. Intrahepatic presinusoidal: Schistomiasis
3. Intrahepatic: Cirrhosis
4. Intrahepatic postsinusoidal: Hepatic vein thrombus
How does portal hypertension affect the spleen?
What does TIPS stand for?
Transjugular Intrahepatic Portal- systemic Shunt
What is the ,point for TIPS?
shunts created to lower portal pressure avoiding the development or rupture of gastroesophageal varices and reducing the accumulation of ascites
Where is this device places?
Between a hepatic vein and a portal vein (usually RHV and RPV)
What type of flow should TIPS demonstrate?
What is the criteria for TIPS malfunction?
1. low shunt velocity ( <50 cm/sec)
2. High focal shunt velocity ( >190 cm/sec)
3. Hepatopetal LPV or RPV
4. Hepatofugal MPV
5. Absent shunt flow
What is the only exception for TIPS with a recanalized umbilical vein?
The LPV may be in either direction of flow. Hepatopetal or Hepatofugal
What is the most common TIPS material used?
GORE Viatorr endoprosthesis
Explain Portal vein thrombus?
Most commonly associated with portal hypertension.
With portal thrombus, extensive collaterals can form at the liver hilum. (" cavernous transformation of portal vein")
What is Budd-Chiari Syndrome?
Hepatic vein obstruction
What are patients signs for budd chiari?
Ascites, Hepatomegaly, splenomagaly
What might you find with Budd-Chiari syndrome?
Caudate lobe enlarges with atrophy of the Right and Left lobes. IVC can be compressed with the large caudate lobe
What is portal vein gas?
Air noted within the intrahepatic portal veins.
Explain what a liver cyst is?
Fluid filled space lined by biliary epithelium. Usually referred to as nonparasitic simple cysts
What are some characteristics of a simple cyst?
Anechoic, thin walled, Acoustic Enhancement
What are some characteristics of a hemorrhagic cyst?
cyst with internal echoes, RUQ pain, decreasing hemotocrit
What is a cavernous hemangioma?
- Most common benign liver tumor
- Hyperechoic and posterior enhancement
What is Focal Nodular Hyperplasia?
benign solid liver mass that is believed to be a developmental hyperplastic lesion instead of a true neoplasm
What does a Focal Nodular Mass contain?
Hyperplastic hepatocytes in abnormal arrangement with dense fibrous tissue. Contains proliferating bile ducts, Kupffer cells, connective tissue and a central stellate scar
What is Focal Nodular Mass known as?
Displaces intrahepatic blood vessels
Know about hepatic adenomas?
- associated with oral contraceptives
- Associated with Glycogen storage disease
- Patient pain due to tumor hemorrhage
Know about hepatic lipoma?
- tuberous sclerosis and congenital familial disease associated with hepatic lipomas and angiomyolipomas
Know about Hepatic Carcinoma
- most common primary malignancy of liver
- occurs in patients with cirrhosis and chronic liver disease
- Invades venous structures: Portal veins, Hepatic veins, and IVC
- Increased AFP, AST, ALT
Know about the different types of liver mets
1. Hyperechoic metastasis: GI tract
2. Hypoechoic Mets: Lymphoma
3. Bull's eye or Target Mets: Lung
4. Calcified Mets: Mucinous Adenocarcinoma of colon
5. Cystic Mets: Leiomyosarcoma
What is a Hepatoblastoma?
uncommon malignant liver neoplasm occurring in infants and children
- increased AFP levels
- associated lung mets and portal vein invasion
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