Liver A & P

Question 1

What are the three lobes of the liver?

Answer 1

right, left, and caudate

Question 2

T/F - In the event of caudate lobe enlargement, the IVC may be compressed.

Answer 2

true

Question 3

The caudate lobe is located:

_______ to the ligamentum venosum; _______to the porta hepatis; _______ and _______ to the IVC; _____ to the lesser sac.

Answer 3

posterior, posterior, anterior and medial, lateral

Question 4

Caudate lobe receives branches from the ____ and _____ portal veins and its venous drainage is directly into the IVC via the small _______ veins.

Answer 4

right and left, emissary veins

Question 5

List the 8 segments of the liver.

Answer 5

I caudate
II left lateral superior
III left lateral inferior
IVa left medial superior
IVb left medial inferior
V right anterior inferior
VI right posterio inferior
VII right posterior superior
VIII right anterior superior

Question 6

The hepatic veins are ________, while the vessels of the portal triad are _______ and encased by a fibrofatty sheath known as _______ _______.

Answer 6

intersegmental, intrasegmental, Glisson’s capsule

Question 7

What divides the right and left hepatic lobes?

Answer 7

main lobar fissure

Question 8

What divides the anterior segment of the right lobe from the medial segment of the left lobe?

Answer 8

main lobar fissure

Question 9

The _____ is identified between the GB neck and the junction of the right and left ______ veins.

Answer 9

MLF, portal

Question 10

The RHV divides the right lobe into ______ and _______ segments, aka right intersegmental fissure.

Answer 10

anterior, posterior

Question 11

The _____ is identified between the GB neck and the junction of the right and left ______ veins.

Answer 11

MLF, portal

Question 12

What are the 4 landmarks for the left intersegmental fissure?

Answer 12

LHV, ascending LPV, falciform ligament, ligamentum teres

Question 13

Ligamentum venosum is a remnant of the _____ ______.

Answer 13

ductus venosus

Question 14

What separates the left lobe from the caudate lobe?

Answer 14

ligamentum venosum

Question 15

What are the 3 landmarks for the MLF?

Answer 15

GB (inferior end of MLF), IVC, MHV

Question 16

________ _______ runs from the LPV to the IVC seperating the left lobe from the caudate lobe.

Answer 16

ligamentum venosum

Question 17

What is the name of the remnant of the umbilical vein that runs from the umbilicus to the LPV? Shortly after birth, the umbilical vein contracts down to form this.

Answer 17

ligamentum teres

Question 18

With portal HTN, the _______ ______ recanlizes to form a portosystemic venous collateral.

Answer 18

ligamentum teres recanalizes in cirrhosis to function as a venous collateral

Question 19

Describe direction of fetal circulation, starting at the liver.

Answer 19

umbilical vein (lig teres) - LPV - ductus venosus (lig venosum) - IVC

Question 20

Why doesn’t the liver really infarct?

Answer 20

Because it has two sources of blood and would have to thrombose both to infarct.

Question 21

Hepatopetal

Answer 21

flow toward the liver, “seeking”, “pedaling in”

Question 22

Hepatfugal

Answer 22

flow away from the liver, “fleeing”

Question 23

Upper limits measurement for the portal vein diameter.

Answer 23

13mm, anything larger suggests portal HTN

Question 24

What are the two sources of blood flow to the liver, what percentage of flow do they each bring, and how much in total per minute?

Answer 24

portal vein (75%), proper hepatic artery (25%), 1500 mL/min

Question 25

What is the hepatic oxygenation breakdown between the two inflow vessels?

Answer 25

50% PHA and 50% PV, PV bigger but equally give oxygen

Question 26

Describe normal portal vein flow and what can happen with breathing after eating.

Answer 26

Usually low-velocity continuous flow with mild undulations in a healthy subject, monophasic. Increases and decreases with breathing. Flow velocity can increase after eating.

Question 27

The ______ _______ is the functional separation of the RT and LT lobes of the liver.

Answer 27

portal system

Question 28

Caudate lobe is located on the _____-______ surface of the liver, between the IVC and medial left lobe of the liver.

Answer 28

posterior-superior

Question 29

Imaging the liver, when angling superior and transversely, what segments are visualized?

Answer 29

7, 8, 4a and 2

Question 30

Imaging the liver, when angling inferior and transversely, what segments are visualized?

Answer 30

6,5,4b and 3

Question 31

List the respective segments for left lateral, left medial, right anterior, and right posterior sectors.

Answer 31

Left lateral - II and III Left medial - IVa and IV b Right anterior - V and VIII Right posterior - VI and VII

Question 32

Describe normal hepatic vein waveforms.

Answer 32

triphasic (reflecting right atrial filling, contraction, and relaxation), phases above and below baseline, pulsatile

Question 33

The proper hepatic artery runs parallel to the MPV and is located ______ and to the ____ of the MPV.

Answer 33

anterior, left

Question 34

T/F - The RHA and LHA typically arise from the proper hepatic artery in approx 55% of patients.

Answer 34

True

Question 35

Replaced RHA may originate from the SMA in approx ______ % of patients. It would be seen posterior to the head of the pancreas and MPV.

Answer 35

11%

Question 36

Replaced LHA may originate from the left _____ artery in approx 10% of patients.

Answer 36

gastric

Question 37

Describe normal hepatic artery waveforms.

Answer 37

Low-resistance (flow through diastole), parabolic, turbulent with spectral broadening

Question 38

Describe hepatic artery waveform that suggests transplant rejection.

Answer 38

high-resistance suggests more commonly venous congestion or possible organ rejection

Question 39

What is the significance of a post-operative hepatic liver transplant with parvus tardus hepatic artery waveform?

Answer 39

suggests proximal anastomotic stenosis (>50%)

Question 40

Hepatic ligaments (5)

Answer 40

lig. teres, falciform lig., coronary lig, right and left triangular ligs

Question 41

_______ ________ is a peritoneal reflection or fold created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of the portal vein.

Answer 41

Falciform lig, may see suspended with ascites surrouding

Question 42

What peritoneal reflections suspend the liver from the diaphragm and surroud the bare area of liver?

Answer 42

Coronary lig

Question 43

Liver area that is in direct contact with the diaphragm, is not part of the peritoneal space, and does not accumulate ascites.

Answer 43

Bare area

Question 44

What are the peritoneal reflections to the far right and left of the bare area?

Answer 44

RT and LT triangular lig

Question 45

Liver size will vary with height, weight, and body surface area. Hepatomegaly is indicated in 75% of patients with a > than _____cm superior-inferior dimension.

Answer 45

15.5cm

Question 46

What is Riedel's lobe?

Answer 46

inferior projection of the RT lobe commonly seen in women and may be mistaken for hepatomegaly (Tip: if LT lobe is small and RT lobe is big, likely Riedel's lobe)

Question 47

Describe liver echogenicity.

Answer 47

homogeneous and slightly hyperechoic compared to the normal renal cortex

Question 48

Hyperechoic

Answer 48

echoes greater than

Question 49

Hypoechoic

Answer 49

echoes less than

Question 50

Isoechoic

Answer 50

echoes equal

Question 51

Anechoic

Answer 51

without echoes

Question 52

Sonolucent

Answer 52

without echoes

Question 53

Put in order of decreasing echogenicity (Spleen/Liver, Pancreas, Renal Sinus, Renal Cortex)

Answer 53

renal sinus>pancreas>spleen/liver>renal cortex