Liver

Question 1

Codate lobe

Answer 1

• small lobe located on the posterior and superior surface of the left lobe
• located anterior to the IVC
• superior to the porta hepatis

Question 2

Albumin _________ with chronic liver disease

Answer 2

Decreases

Question 3

Cirrhosis

Answer 3

• • long term/multiple attacts on the liver destroying normal architecture
• • looks shrunken may see nodules
• • Leading cause is alcohol abuse
• • Shrinks liver and causes abnormal buildup of fluid in the abd known as ascites

Question 4

Right Portal Vein

Answer 4

Larger of the two branches

Runs lateral into the right lobe

Anterior and posterior branches

Question 5

falciform ligament

Answer 5

• Liver is suspended from the diaphragm and the anterior abdominal wall by this ligament.
• Fold of peritoneum extends from liver to abdominal wall
• Divides the medial and lateral segments of the left lobe

Question 6

Main lobar fisher

Answer 6

• Best seen in sag
• Splits left and right lobe anatomically
• Connects Right portal vein and gallbladder

Question 7

Hepatic arteries

Answer 7

Carry blood to the liver from the aorta - oxygen

Question 8

Amebic (parasitic) abscess

Answer 8

• Caused by parisite
• Patients usualy have a hx of traveling out side the country

Question 9

Echogenic Metastases

Answer 9

• GI tract
  
  • colon

Question 10

Couinaud’s 9 segments of the liver

Answer 10

I - Caudate Lobe

II - Left lobe lateral superior

III - Left lobe lateral inferior

IVa - Left lobe medial superior

IVb - Left lobe medial inferior

V - Right lobe anterior inferior

VI - Right lobe posterior inferior

VII - Right lobe posterior superior

VIII - Right lobe anterior superior

Question 11

Hypoechic Matastases

Answer 11

• Breast cancer
• lung cancer
• lymphoma

Question 12

Bare area

Answer 12

a large area of liver without peritoneum where the diaphragm makes contact

Question 13

Hepatitis

Answer 13

Inflamation of the liver

As a sonographer we look at liver size/ any change in liver it self (i.e. tecture)

Diferant types;

A - fecal/oral

B - Blood/bodily fluids

C - Blood

Question 14

Glisson’s Capsule

Answer 14

dense, fibroelastic, connective tissue layer surrounding liver- pain is felt here when liver swells.

Question 15

Cavernous hemangioma

Answer 15

• Most common Benign hepatic tumor
• Homogeneous, hyperechoic with sharp margins
• comes in 1 maybe 2

Question 16

Diseases affecting the liver may be classified as…..

Answer 16

• Hepatocellular-when the liver cells or hepatocytes are affected:
  
  • Hepatitis, cirrhosis, fatty liver, hepatocellular carcinoma
  • Treated medically via drugs and other supportive methods
• Obstructive-when bile excretion is blocked
  
  • Gallstones and/or tumor.
  • Treated by surgical intervention

Question 17

Hepatocellular carcinoma

Answer 17

• Also known as Hepatoma
• Primary liver cancer
• Persons with cirrhosis at high risk
• Usualy:
  
  • before 40
  • Most common in 6th decade
• not as common as metastatic disease

Question 18

The 3 structures termed the

Portal Triad

Answer 18

1. Portal Vein
2. Proper hepatic Artery - anterior and to the left of the portal vein
3. Common hepatic bile duct - anterior and to the right og the portal vein

Question 19

Ligamentum teres (round ligament)

Answer 19

• a remnant of the umbilical vein of fetal circulation, attaches to the left portal vein.
• Runs with the falciform ligament.
• Divides medial and lateral segments of the left lobe.
• Best seenin transverse, inferior to left portal vein

Question 20

Glycogen storage disease

Answer 20

Autosomal recessive disorder that causes excessive glycogen to be stored in the liver

Multiple hypoecoic masses in bright/fatty liver - will need to know pt hx

*Disorders of metabolism*

Benign

Question 21

Porta Hepatis

Answer 21

Where triad enters liver

LOCATION

Question 22

Echinococcus cyst (hydatid disease)

Answer 22

• Parasitic tapeworm
• sonographic appearance
  
  • Water lily sign
  • Mother daughter
  • honey-comb

Question 23

Fatty Liver & Sonographic appearance

Answer 23

• Fatty infiltration or steatosis
• accumulation of fatty deposits within the liver cells.
• Benign
• Reversible disorder of **metabolism**

See at Liver kidney interface

Increased echogenicity – bright when compared to the kidney.

Renal cortex will appear hypoechoic.

Question 24

Fatty Sparring

Answer 24

Part of the liver is spared of fat. Normal liver tissue is spared of the echogenic fatty infiltration.

seen near gallbladder/portal vein

Question 25

Bull's Eye or Target pattern

Answer 25

* Lung Cancer (bronchogenic) * Colorectal Cancer

Question 26

Main portal vein

Answer 26

* Approaches the porta hepatis toward the right and anterior to IVC * Enters the liver, divides into two branches * Formed from junction of SMV and splenic vein * NOT A BRANCH OF IVC

Question 27

Left Portal Vein

Answer 27

Anterior and superior than the RPV Medial and lateral branches

Question 28

Metastatic Disease

Answer 28

* Secondary tumors * More common than hepatoma * "Silent Killer" * symtoms * Jaundice * pain * Nutritional & muscle wasting * Several types * Most common * GI tract (COLON) * breast * lung

Question 29

Focal nodular hyperplasia FNH

Answer 29

* Rare **Benign tumor** * Nodule of extra normal liver tissue * Females - before 40 on long-term oral contraceptive * sonographic appearance; * Hypoecoic, isoechoic or hyperecoic compared to normal surrounding tissue * \<8cm

Question 30

Hepatic adenoma

Answer 30

* **True Neoplasms** * Uncommon * Females of childbearing are-long time oral contraceptive use.

Question 31

Anatomicly, THIS seperates the liver into the right and left lobe

Answer 31

Main lobar fisher

Question 32

Schistosomiasis

Answer 32

* Parasitic * Parasites in the *_portal vein_* walls * sonogrphic appearance; * Thinkend/ecogenic portal vein walls * dilation of MPV - portal HTN

Question 33

Ligamentum Venosum

Answer 33

* Best seen in Sag * Seperates left and codate lobe

Question 34

Fungal *(candidiasis)* abscess

Answer 34

* Usualy in patinets with compromised ammune systems (i.e. HIV, chemo tratments)

Question 35

liver and trauma

Answer 35

Trauma can cause Hematoma new - anicoic more ecogenic as it ages

Question 36

Name the 3 lobes of the liver

Answer 36

Right Left Codate

Question 37

Hepatic Veins

Answer 37

* Right (RHV) - largest, and enters the right lateral aspect of the IVC. * Mid (MHV) - enters the anterior or right anterior aspect of the IVC. * Left (LHV) - smallest, enters the left anterior surface of the IVC. \*\* less echogenic due to less collagen\*\* **\*\*Drain Blood from liver into IVC-Detox\*\***

Question 38

The main portal vein enters the liver and divides into what two branches

Answer 38

The _______ \_\_\_\_\_\_\_ ______ enters the liver and divides into the right and left portal vein. **Right** - Larger of the two, runs lateral into the right lobe. *_Anterior and posterior branches_* **Left** - anterior and superior to RPV. _Medial and lateral branches_ * portal veins -carry blood from the bowel to the liver - nutrients* * More ecogenic walls*

Question 39

Pyogenic (*Bacterial*) Abscess

Answer 39

* Bacteral infection - may be from recent ABD sx * Fever and/or high WBC

Question 40

Bile Ducts

Answer 40

Transport bile, manufactured in the liver, to the duodenum - digestion

Question 41

8 fuctions of the liver

Answer 41

1. Metabolism 2. Digestion 3. Storage * Iron, Copper, Vitamins 4. Detoxification 5. Wast disposal and excretion * Through bile 6. Hemopoiesis *before birth* * Production of RBC's 7. Reservoir for Blood 8. Heat production

Question 42

Budd-Chiari Syndrom

Answer 42

Thrombosis in the hepatic veins and/or IVC