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Liver Anatomy Flashcards

(72 cards)

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0
Q

What is a liver lobule composed of?

A
  1. Portal triad
  2. Sinusoid
  3. Central vein
  4. Hepatocytes- produce bile
  5. Kupffer cells- phagocytosis and detoxification
  6. Bile canaliculi- drain bile
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1
Q

What is the functional unit of the Liver?

A

Liver lobule

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2
Q

What is the functional cell of liver?

A

Hepatocyte

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3
Q

Portal triad

A

Portal vein, hepatic artery, bile duct.

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4
Q

Extrahepatic portal triad

A

Proper hepatic artery, main portal vein, cbd/chd

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5
Q

What is ampulla of vater?

A

An opening of the second part is of the duodenum, near the pancreatic head

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6
Q

Explain the pathway of bile

A

Hepatocytes&raquo_space; canaliculi&raquo_space; interlobar duct&raquo_space; R & L hepatic duct&raquo_space; Common hepatic duct&raquo_space; joins cystic duct to become&raquo_space; CBD

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7
Q

What is bile made of?

A

Bile salts, bilirubin, amino acids, cholesterol and water

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8
Q

What is cholecystokinin (CCK)

A

Hormone produced by the upper intestine and released when eating fatty food. It makes the GB contract and release bile.

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9
Q

Liver/ Blood reservoir

A

1500 ml of body’s vol flow rate/min through liver
1000-1100 ml/min of blood flows through the portal veins
350-400 ml/min through hepatic artery
The liver has a capacity to enlarge and store 200-400 ml of blood

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10
Q

Detoxification function of Liver

A

The liver converts foreign molecules and hormones to safer compounds that are not as toxic.
Ex: when a.a. Are burned for energy they leave behind the nitrogenous waste that is converted to urea by the liver.
ATP & ADP (forms of energy) is converted to ammonia in the urine.

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11
Q

Lymph formation by the liver

A

The liver produces 1/3-1/2 of the body’s lymph fluid

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12
Q

Acute and chronic hepatitis

A

May be mild or severe.
A, B, C, D, E
These account for 95% of all hepatitis cases

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13
Q

What are the pathological features of viral hepatitis?

A
  1. Liver cell damage
  2. Hepatomegaly
  3. Cellular degeneration and necrosis
  4. Regeneration
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14
Q

Clinical features of hepatitis

A 
Headache
Nausea and vomiting 
Fatigue
Jaundice, dark urine
RUQ Tenderness
Symptoms usually resolve completely in less than 6 weeks with bed rest
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15
Q

What is interferon

A

An into-viral drug used to treat HBV (hepatitis B virus)

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16
Q

What are the lab values for hepatitis?

A 
⬆️ ALT (SGPT)
⬆️ AST (SGOT)
⬆️ bilirubin
⬆️ WBC
⬆️ PTT
Dark urine
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17
Q

What is the sonographic appearance of acute hepatitis?

A

Hepatomegaly
Parenchyma becomes hypoechoic
Vessel walls become more echogenic
Looks like starry sky liver

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18
Q

Chronic hepatitis

A

HBV, HCV, Alcohol

3-6 months of inflammation

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19
Q

What is the sonographic appearance of chronic hepatitis?

A

Small echogenic liver
Leads to cirrhosis- permanent damage

Thickened GB wall seen in both acute and chronic hep.

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20
Q

What is cirrhosis?

A

A progressive, irreversible disease of liver.
Liver cells degenerate faster than they can generate.
Grows over scar tissue
Normal architecture is destroyed

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21
Q

What is cirrhosis etiology?

A
  1. Alcoholism
  2. HCV
  3. Biliary malfunction
  4. Drugs, toxins and infection
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22
Q

What are the clinical signs and symptoms of cirrhosis?

A 
>Early stage may be asymptomatic.
>Later stage: scar tissue (fibrosis), causing:
Exhaustion
Loss of appetite
Nausea
Weakness 
Weight loss
Abdominal pain
Fatigue
>Final stage: ascites and portal hypertension
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23
Q

Lab values of cirrhosis

A

⬇️ albumin
⬆️ liver enzymes (SGPT, SGOT)
⬆️ indirect bilirubin
⬆️ PTT

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24
What are the 3 stages of cirrhosis?
1. Tissue necrosis 2. Tissue regeneration 3. Fibrosis *When fibrosis overwhelms regeneration, the liver will become atrophic and eventually fails.
25
What is the sonographic appearance of early cirrhosis (stage 1)
Hypoechoic | Hepatomegaly
26
What is the sonographic appearance graphic appearance of stage 2 cirrhosis?
Increased liver echogenicity Atrophy Ascites Irregular shape of liver, surface nodularity
27
With alcoholic cirrhosis, what kind of bilirubin is increased?
Indirect bilirubin, Unconjugated, fat soluble.
28
With biliary cirrhosis what kind of bilirubin is increased?
Direct bilirubin, conjugated, water soluble
29
What is the most common cause of intrahepatic portal hypertension?
Cirrhosis. Occurring in 90-95% of cases
30
What causes portal hypertension?
``` Cirrhosis Portal and splenic vein thrombosis Budd chiari syndrome Sepsis- blood infection Pancreatitis ```
31
Intrahepatic portal hypertension causes
Cirrhosis Portal-splenic vein thrombosis Budd chiari syndrome
32
Extrahepatic portal hypertension causes
Sepsis | Pancreatitis
33
What will portal hypertension cause?
1. Gastroesophageal varices: resulting in GI bleed 2. Caput Medusae: varicose veins radiating from the umbilicus 3. Splenomegaly, SMV, IMV, hemorrhoidal veins will dilate 4. Ascites 5. Hepatic failure
34
What is T.I.P.S.?
Trans-Jugular Intrahepatic Porto-Systemic Shunt *Used to treat portal hypertension
35
What is the sonographic appearance of portal hypertension?
Depending on degree of venous obstruction: 1. Abnormal portal flow 2. Non-visualization of hepatic veins 3. Splenomegaly >12 cm 4. Recanalized ligamentum teres 5. PV diameter > 13mm 6. Portal venous pressure is > 30mmhg 7. Caudate lobe enlargement
36
What is hepatic encephalopathy?
Altered mental states as a result of high toxins in the blood
37
What is non-alcoholic steatohepatitis?
Serious form of fatty liver found in some people with non-alcoholic fatty liver disease causing inflammation and scarring in liver. At its most severe state it can progress to liver failure.
38
What is fulminant hepatic failure?
Acute liver failure, causing excessive bleeding and increased pressure in the brain.
39
Signs and symptoms of Acute Liver Failure
``` Jaundice RUQ pain Nausea/vomiting Difficulty concentrating Disorientation or confusion Sleepiness ```
40
What are the causes of acute liver failure?
When liver cells are damaged and no longer able to function. Acetaminophen overdose *most common cause in U.S. Antibiotics, anti-inflammatory drugs, anticonvulsants Herbal supplements, such as kava, ephedra, skullcap, pennyroyal. Hepatitis and other viruses Toxins such as poisonous wild mushroom Autoimmune disease Budd chiari syndrome Metabolic disease such as Wilson's disease, acute fatty liver of pregnancy Cancer Some have no apparent causes
41
What is should the gallbladder wall measure under ultrasound?
Less than 3 mm in thickness
42
What is secretin?
Hormone that stimulates the production of bile
43
What are the anatomical components of the gallbladder?
Neck aka infundibulum or hartman's pouch Body Fundus
44
What is the size of the gallbladder?
Length: 10 cm or less AP: no more than 4 cm Wall should be less than 3 mm in thickness
45
When is the gallbladder considered contracted?
When measuring less than 2 cm in diameter after appropriate fasting
46
What is hydropic gallbladder?
When the GB is larger than normal > 4 cm AP diameter Over distended
47
What are the gallbladder variants?
Junctional folds- fold between neck and body | Phrygian cap- fold between body and fundus
48
What are Heister Valves?
Valves located in the cystic duct that regulate flow in and out of GB. Keep cystic duct from collapsing or folding. May shadow and should not be confused for stone
49
What is the size of the intrahepatic bile ducts?
< 2 mm
50
Bile duct measurements
CHD 5mm or less | CBD 5 mm or less and 1 mm for each decade of life after the 5th decade
51
What is the proper form of measuring CBD?
Distally from inner wall to inner wall
52
What are the clinical signs and symptoms of acute cholecystitis?
``` Positive murphy's sign Fever Increased WBC Increased bilirubin Increased ALP ```
53
What are the clinical signs and symptoms of chronic cholecystitis?
Possible increase in WBC Possible normal lab values Not as painful as acute
54
What are the song graphic features of acute cholecystitis?
Diffusedly thickened GB wall > 3 mm (striated wall appearance) Pericholecystic fluid/subserosal edema around GB (halo sign) Hydropic/cholecystomegaly Stones Hypervascularity of the wall Possible choledocholithiasis
55
Sonographic features of chronic cholecystitis?
``` Diffuse wall thickening Contracted GB after NPO Non-visualization due to contraction Stone shadowing WES sign (in long) Double Arc sign (in trv) Post wall will be shadowed out ```
56
What is cholangitis?
Inflamed bile duct or entire biliary tree
57
Etiology of cholangitis
Cholelithiasis | Cholecystitis
58
Sonographic appearance of cholangitis
Dilated intrahepatic and extrahepatic ducts
59
What complication can arise from acute cholecystitis?
Stone obstructs cystic duct, in result obstructing venous drainage and inflammation of GB wall with variable degree of necrosis and infection
60
What causes sludge in GB?
Fasting | Obstruction may lead to acute cholecystitis
61
What is hepatization of GB?
Sludge that totally fills the gallbladder so that its contents become isle choir with liver
62
What is timer active sludge?
Sludge is not mobile, rounded, non-shadowing, medium level echogenic masses in the dependent portion of the gallbladder
63
What is hemobilia?
Bleeding into the biliary tree associated with hepatic biopsy, rupture of hepatic artery and blunt abdominal trauma
64
What is hydrops of the gallbladder?
Distended, non-inflamed gallbladder due to total obstruction of the cystic duct Trapped bile is re absorbed and GB is filled with a clear mucinous secretion derived from the mucosa
65
Signs and symptoms of hydrops of the GB
Asymptomatic May present as a palpable RUQ mass The diagnosis should be suspected on ultrasound when an obstructing stone is noted in an enlarged but non-tender GB
66
What kind of gallstones are there?
80% of cholesterol Black pigment stones Brown pigment stones
67
When do cholesterol stone form?
When bile contains too much cholesterol Too much bilirubin or not enough bile salts or lecithine When the GB does not empty often
68
What causes black pigment stones?
Too much bilirubin in bile Associated with hemolytic anemia such as thalacemia, sickle cell anemia and malaria Cirrhosis of liver They are black and hard
69
What causes brown stones?
Infection ascending from duodenum into bile duct or GB Bacteria alters bilirubin pigment and combines w fat in bile to form gallstone They are softer than black pugment gallstones
70
Who is at risk for gallstones?
``` Those who prolong fasting, dieting, fat free diets or fluid diets. More common in women than men 4:1 Increased prevalence with age (3,4th decade) Overweight Individuals Pregnancy due to rise in cholesterol Hormone therapy/birth control Crohn's disease Cystic fibrosis of liver ```
71
What are the symptoms of gallstones?
``` Biliary colic Pain under Rt shoulder- may radiate to the back between shoulder blades Nausea vomiting Abdominal bloating Intolerance of fatty food Belching Flatulence Indigestion ```

Abdomen (10 decks)

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