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Flashcards in Liver Deck (69):
1

How many lobes is the liver divided into?

3 (Right, Left, Caudate)

2

How many segments is the liver divided into?

8 ( 9 including caudate segment)

3

How many segments does the caudate lobe have?

1

4

How many segments does the left lobe have?

4

5

How many segments does the right lobe have?

4

6

What is the difference between hepatic veins and portal veins in appearance?

hepatic veins do not have echogenic walls

7

What vessels consist in the portal triad?

Main Portal vein, Hepatic Artery, CHD

8

What is the portal triad covered by?

Glissons Capsule

9

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

10

What does the Right hepatic vein divide?

Anterior and posterior segments

11

What does the Left hepatic vein divide?

Medial and Lateral segments

12

What is the Ligament Venosum?

Remnant of ductus venosus

Separates the left lobe from the caudate lobe

13

Explain fetal circulation?

Umbilical Vein (Ligamentum Teres) > Left portal vein > Ductus venosus ( Ligamentum venosum) > IVC

14

What is Hepatopetal flow?

Flow toward the liver

15

What is hepatofugal flow?

Flow away from liver

16

What is upper limits for portal vein diameter?

13 mm
Large diameter suggests portal hypertension

17

What type of flow does hepatic veins have?

Hepatofugal

18

What type of flow do portal veins have?

Hepatopetal

19

What is Parvus Tardus?

proximal anastomotic stenosis

20

What recanalizes in case of liver cirrhosis?

Ligamentum Teres

21

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

22

What is the Coronary ligament?

Suspend liver from the diaphragm.

23

Right and left triangular ligament?

Reflections of right and left bare area

24

What is considered Hepatomegaly?

Greater than 15.5 cm superior- inferior dimension

25

What is a Reidels Lobe?

Inferior projection of the right lobe

26

What are hepatic granulomas?

Small calcifications of macrophages seen in liver and spleen

27

What is hepatitis?

Liver inflammation resulting from infectious or noninfectious agents

28

What labs might be elevated in hepatitis?

ALT
AST
Conjugated and unconjugated Bilirubin

29

What might be seen with acute hepatitis?

"starry night" (periportal cuffing)
hypoechoic liver parenchyma
liver enlargement
hyperechoic portal vein walls

30

What is the most common source for pyogenic (bacterial) abscess?

Biliary Tract Disease

31

What is an amebic abscess?

Parasite from the intestines, reaches liver via portal vein.

32

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"

33

What is echonicoccal cyst (Hydatid disease)?

Tapeworms

34

What is Schistosomiasis?

Most common parasitic infections in humans
Major cause of portal hypertension worldwide

35

What is focal fatty infiltration?

focal regions of increased echogenicity within normal liver parenchyma. Most commonly occurs at the porta hepatis

36

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

37

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

38

What is cirrhosis?

diffuse process of fibrosis and distortion of normal liver architecture

39

What is the main cause of cirrhosis?

Alcohol abuse

40

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

41

What is the major cause of portal hypertension?

Cirrhosis

42

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

43

How does portal hypertension affect the spleen?

Splenomegaly

44

What does TIPS stand for?

Transjugular Intrahepatic Portal- systemic Shunt

45

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

46

Where is this device places?

Between a hepatic vein and a portal vein (usually RHV and RPV)

47

What type of flow should TIPS demonstrate?

Hepatofugal

48

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

49

What is the only exception for TIPS with a recanalized umbilical vein?

The LPV may be in either direction of flow. Hepatopetal or Hepatofugal

50

What is the most common TIPS material used?

GORE Viatorr endoprosthesis

51

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")

52

What is Budd-Chiari Syndrome?

Hepatic vein obstruction

53

What are patients signs for budd chiari?

Ascites, Hepatomegaly, splenomagaly

54

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

55

What is portal vein gas?

Air noted within the intrahepatic portal veins.

56

Explain what a liver cyst is?

Fluid filled space lined by biliary epithelium. Usually referred to as nonparasitic simple cysts

57

What are some characteristics of a simple cyst?

Anechoic, thin walled, Acoustic Enhancement

58

What are some characteristics of a hemorrhagic cyst?

cyst with internal echoes, RUQ pain, decreasing hemotocrit

59

What is a cavernous hemangioma?

- Most common benign liver tumor
- Hyperechoic and posterior enhancement

60

What is Focal Nodular Hyperplasia?

benign solid liver mass that is believed to be a developmental hyperplastic lesion instead of a true neoplasm

61

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

62

What is Focal Nodular Mass known as?

"Stealth lesion"
Displaces intrahepatic blood vessels

63

Know about hepatic adenomas?

- associated with oral contraceptives
- Associated with Glycogen storage disease
- Patient pain due to tumor hemorrhage

64

Know about hepatic lipoma?

- rare
- tuberous sclerosis and congenital familial disease associated with hepatic lipomas and angiomyolipomas

65

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

66

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

67

What is a Hepatoblastoma?

uncommon malignant liver neoplasm occurring in infants and children
- increased AFP levels
- associated lung mets and portal vein invasion

68

Review Labs

Page 36 in ESP

69

Tumor Markers

Page 38 in ESP