Liver ch.9, ch.12 Flashcards
(128 cards)
1
Q
How long is the liver
A
15cm LONG (13-17cm) is largest abdominal organ
2
Q
a parenchymal liver cell that preforms all the functions ascribed to the liver
A
Hepatocyte
3
Q
Kupffer cells
A
specialized phagocytes in the liver; act as the liver’s defense against bacteria/viruses
4
Q
Foregut
A
Where liver developes from
5
Q
Vitelline duct
A
yoke duct
6
Q
4th week of primitive ducts and 4 parts
A
foregut
midgut
handgun
tailgut
7
Q
Tailgut
A
gets reabsorbed
8
Q
kidneys genicity
A
hypoechoic/isoechoic
9
Q
spleen genicity
A
isoechoic
10
Q
pancreas genicity
A
echogenic
11
Q
liver genicity
A
hypoechoic in general
12
Q
Where does the liver lie in quadrant
A
right Hypochondrium (RUQ)
Epigastrium and left hypochondria (LUQ)
13
Q
Where does stomach lie
A
Lateral to the left lobe- best seen on TRV
14
Q
Portal triad
A
Bileduct
hepatic artery
portal vein
15
Q
What separates the Lateral section from the medial section
A
Ligamentum venosum
16
Q
How many and what are the lobes of the liver?
A
4 Lobes. Left, quadrate, caudate, right
17
Q
Couinauds system of hepatic nomenclature
A
Divides the liver based on the vasculature and has more value from a surgical perspective (punctually divided)
18
Q
has medial and lateral. sections
A
the left lobe
19
Q
Ligamentum venosum
A
After birth, The ductus venous (Umbilical vein) BECOMES Ligamentum venous
20
Q
is functionally the medial segment of the LT lobe that lies between the MHV and the LHV
A
Quadrate lobe
21
Q
Small lobe on posterior surface of LT lobe, Lig, venos. is anterior border of the __ Lobe
IVC is commonly on the posterior border
A
Caudate Lobe
22
Q
Has anterior and posterior sections
A
Right lobe
23
Q
Can be seen as a tongue like projection off the RT Liver. Extending inferiorly to the iliac crest
A
Reidels lobe
24
Q
Thin connective tissue covering the liver
A
Glissons capsule
25
Separates the LT and RT lobes of the liver. seen sonographically as an echogenic, linear structure between the GB and MPV
Main lobar fissure
26
extends from the diaphragm to the umbilicus and contains the ligamentum teres; attaches the liver to the anterior abdominal wall; best seen in pt with ascites
Falciform Ligament
27
AKA lig T/round ligament; remnant of the umbilical vein; the round, echogenic structure seen within the LT lobe of the liver; intrahepatic portion of the falciform ligament; “rounded termination” of the falciform
ligament
Ligamentum teres
28
remnant of the ductus venosus (umbilical vein) in fetal; separates LT lobe from the caudate lobe; linear, echogenic line anterior to caudate
Ligamentum venosum
29
How many segments are there to the liver
8 segments
30
what vein joins the splenic vein
IMV
31
what two veins join to make the MPV
Splenic vein
32
What does MPV branch into
RPV ans LPV
33
What does RPV branch into
Anterior and posterior branches (splits liver)
34
What does LPV branch into
Medial and lateral
35
What is the normal diameter of MPV
0.7-1.3cm
36
What kind of echogenicity are HVs surrounded by?
No echogenic walls
37
What kind of echogenicity are PVs surrounded by?
Echogenic walls
38
What are the primary functions of the liver
Detoxification
digestion/excretory
metabolic
storage
39
What are detox functions
Detoxification of waste products. Nitrogen>Ammonium>Urea (goes to kidney)
40
An increase in ____ Can cause brain dysfunction
Ammonium
41
____ a product that breaks down hemoglobin, results in Jaundice, and a concentration in this can test in a lab for hepatocelluar disease
Bilirubin
42
What two affect the amount of bile salts available for fat absorption
Hepatocellular disease.(doesn't work or failing)
and Biliary obstruction
43
____ are protein catalysts used throughout the body in all metabolic processes
Enzymes
44
What are the hepatobiliary Disease enzymes
Asparate aminotransferase (AST)(SGOT)
Alanine Aminotransferase (ALT) (SGPT)
45
when the liver cells or hepatocytes are the immediate problem; (ex: virus attacks liver resulting in alteration of liver function); treated medically
Hepatocellular disease
46
Sugars
Carbohydrates
47
Fats
lipids
48
Amino acids are basic components of ____
Proteins
49
Raw materials that for carbs, fats, and proteins are absorbed from the intestine and transported to the liver via PVs, Converted chemically to other compounds or processed for storage or energy production
Hepatic metabolic functions
50
Excess sugar can be stored in the liver in the form of ____
Glycogen
51
_1__ Can be absorbed from the blood in several forms, but only __2__ can be used by the body for energy.
1. sugars
2. glucose
52
n the liver, dietary fats are converted to __1___ which help move __2__ throughout your body
1. Lipoproteins
2. Cholesterol
53
to __1__ a substance means to produce it by means of chemical or biological reactions.
synthesize
54
if the liver isn’t functioning properly, it cannot convert fats to lipoproteins or produce cholesterol, thus cholesterol levels _____
decrease
55
is a protein produced in great quantities in the liver; albumin functions as a transport medium for certain molecules in the blood stream..helps to maintain oncotic pressure within the vascular system; it draws fluid INTO the vascular system from the surrounding spaces (acites)
Albumin
56
the pressure exerted by plasma proteins on the capillary wall
oncotic pressure
57
When the liver has advanced disease hypoalbuminemia occurs and this causes a _____ in pressure in the vascular system.
DECREASE
58
a product from the breakdown of hemoglobin in tiredRBCs- the liver secretes them as bile; severe increase in biliaryobstruction
Bilirubin
59
unconjugated bilirubin; elevation ofthis test result is seen with increased RBC destruction(ex: anemia, trauma from a hematoma)
indirect bilirubin
60
conjugated bilirubin; elevation of thistest is usually related to obstructive jaundice
direct bilirubin
61
if ___ direct and indirect bili are elevated= hepaticMETs, hepatitis, lymphoma, cholestasis secondary to drugs, and cirrhosis.
Both
62
a low serum albumin suggests hepatocellular damage
albumin
63
liver enzyme that is part of blood clotting mechanism; prothrombin time is increased in the presence of liver disease with cellular damage
Prothrombin time
64
LTS
How the liver is preforming
65
What normal liver anatomy and texture is?
Typically the liver is 13-17cm SAG/LONG axis
The liver is isoechoic/hyperechoic to the kidneys*
The liver is isoechoic to the spleen.
The liver is hypoechoic to the pancreas.
66
anatomic variant; this is a tongue-like extensionof the RT lobe of the liver and it may extend down to the iliaccrest; do not confuse this with hepatomegaly! (Is the liverotherwise diseased? Bloodwork?)
Reidels lobe
67
____ of the liver is incompatible with life
agenesis
68
CHA may have variations as it arises from the celiac axis; malformations of vasculature within the liver
vascular abnormalities
69
situs in versus, congenital diaphragmatic hernia, or omphalocele
variations in anatomical position
70
uncommon, caused by unfolding of peritoneum
Accessory fissures
71
just as it states: ____ hepato cellular disease affects the liver as a whole and interferes with liver function
diffuse disease
72
What is more hypoechoic in a fatty liver?
Kidney
73
A portion of live is fatty is called ___
Focal fatty infiltration
74
The liver is almost completely fatty but some areas are spared of being fatty (ex.caudate)
Focal fatty sparing
75
General name for inflammatory infectious disease of liver. Usually caused by virus.
Hepatitis
76
Without complications recovery in 4 months
Increased AST, ALT, increased bilirubin, leukopenia,flu-like symptoms,
GB wall thickened, “starry sky”
Acute hepatitis
77
Exists when inflammation extends beyond 6 mos,
Pts may present with anorexia, tumors, jaundice and dark, urine fatigue, and varicosities
A benign process but will eventually progress
Liver is course with some echogenicity (makes portal veins harder to see
Chronic hepatitis
78
Infection caused by a group of viruses that specifically target liver
Pts present clinically with flu like symptoms and gi issues AKA loss of appetite N&V and fatigue
Viral hepatits
79
Primarily spread by fecal contamination
Hepatitis A
80
Exists in bloodstream more common outside the US due to lack of vaccines. Can be transmitted through bloodstream bottle of fluids, infected blood or plasma and use of infected needles
Hepatitis B
81
“Silent killer” doesnt show symptoms until to late and makes irreversible damage. Spread through blood contact
Hepatitis C
82
Calls from chronic liver disease that progresses to the point of liver failure
Cirrhosis
83
An auto immune disease that causes progressive destruction of the bile ducts
Biliary cirrhosis
84
An inherited disease that causes copper to build up in the organs
Wilsons disease
85
Inflammation and then hardening of bile ducts
Primary sclerosing cholangitis
86
When you have cirrhosis, but aren’t symptomatic
Compensated cirrhosis
87
You have cirrhosis and are showing symptoms
Decompensated cirrhosis
88
Associated with chronic alcohol abuse
Micronodular
89
Associated with chronic viral hepatitis or other infection
Macronodular
90
Type of cirrhosis. First sonographic finding
Liver volume decreases in the right level. It increases in the left and caudate lobes.
Liver will eventually atrophy and spleen become inlarged
Liver parenchyma
91
Portal HTN will likely present itself with or without normal blood flow
Spec wave is flattened in HV
The hepatic artery also shows in normal flow pattern with increased diastolic flow and a blunted peak systolic
Hemodymanics
92
Abnormal accumulation in storage of glycogen in the tissues, especially the liver and kidneys
6 types and mist common is von gierkes disease
Hepatomegaly, increased echogenicity, some increased attenuation
Glycogen storage disease
93
Rare disease of iron metabolism characterized by excess aron deposits througjout the body
Cirrotic like changes
Increased echogenicity
Hemochromatosis
94
Developes secondary to congestive heart failure with signs of hepatomegaly
Labs might be sligtly elevated or normal.
Causes dialation of tbe HBs and IVC and potentially even the PV
Passive hepatic congestion
95
Associated with cirrhosis, HVT, PVT, and thrombosis of the IVC
Caused by increased resistance to venous flow through the liver
Cannot process the blood , it backs up, and increases the pressure within the portal veins
Increase in pressure within liver
To relieve pressure pv create collateral channels to deal (varicose veins)
Portal HTN (hypertension
96
What are the most frequent sites of pregnancy?
Esophagus, stomach, rectum
97
What is another name for the left gastric vein
Coronary vein
98
To release some pressure off the PVs the ligamentum teres can reopen to take some pressure off the liver
Liver typically looks abnormal-varies in severity
Ascites may be present
Recanalized umbilical vein
99
MVP becomes thrombosed and it does not recanalize/open back up, small collateral channels can open up to drain the PV system into the liver
The vessels are small and serpiginous and drain deeped into the liver to bipass an old blockage (RPV/LPV)
Cavernous transformation of the portal vein
100
What type of shunt drains portal-splenic confluence to IVC
Portacaval shunt
101
What shunt attaches to tbe SMV to the IVC
mesocaval shunt
102
What shunt Attaches the splenic vein to the renal vein
Splenorenal shunt
103
What shunts are extrahepatic
Portacaval shunt
Mesocaval shunt
Splenorenal shunt
104
What shunts are intrahepatic
Tranjugular inrahepatic portosystimic shunt
105
TIPS. Drains the RPV into the RHV… and sometimes the RPV into the IVC
Transjugular Intrahepatic Portosystemic Shunt
106
Clinically characterized by ascites.
Extensive untreated occlusion can be deadly within weeks
Budd-chiari syndrome
107
Caused by congenital obstruction and presence of membranous webs in IVC (can be removed)
Primary budd-chiari
108
Results from thrombosis and typically occurs in pts with predisposing conditions such as pregnancy, tumors, prolonged oral contraceptive use, infection or trauma
Secondary budd-chiari
109
Usually refers to a solitary non parasitic cyst of the liver pts are often asymptomatic and require no treatment
Well defined
Thin walled
Anechoic
Posterior enhancement
May have internal septation- not as common
May contain calcification
Hepatic cyst
110
Inherited in an autosomal dominant pattern
50-74% of polycystic renal disease will have one to several hepatic cysts
Cysts within the porta hep may enlarge and cause biliary obstruction
Liver function tests are usually normal
Multiple cysts of varying sizes throughout liver and parechyma
Polycystic liver disease
111
Puss formed abscess (cluster)
Pt presents with fever, pain, pleurtus, N&V, and diarrhea
These abscesses are multiple in 67% of pts
Typically in central RT lobe
Pyogenic abscess
112
Yeast/fungus
Occurs in immunocompromised pts
Nonspecific findings such as fever and leukocytosis
Bullseye target lesions
“Wheel within wheel”
Hepatic candidiasis
113
A recessive genetic disorder in which phagocytes (unable to kill certain bacteria and fungi)
In children mainly boys
Reoccurring respiratory infections
Chronic granulomatous disease
114
Collection of puss formed by disintegrated tissue… protozoan parasite,
The amoeba is contracted by ingesting contaminated food and water
Pts may be asymptomatic or may show GI symptoms of abdominal pain, diarrhea, and low grade fever
Variable and non specific
Round or oval
Lack notable defined walls
Internal echos/debris
Distal enhancement
Amoebic abscess
115
Aka liver hydatid cyst
Tapeworm that infects humans
Has two layers inflammatory/ reactive layer and mother daughter (cyst develops from inner layer
“Waterlilly”
Honeycomb
Mother/daughter cyst (cyst within cyst)
Echinococcal cyst
116
The most common organism causing an opportunistic infection in patients with AIDS
Affects undergoing bone marrow and organ transplantation. Or undergoing chemotherapy
Pneumocystis carinii
117
infections that occur more
often or are more severe in people with weakened
immune systems than in people with healthy immune
systems
Opportunistic infection
118
A neoplasm is any new growth of new tissue, either
benign or malignant.
A benign growth usually occurs but does not spread or
invade surrounding structures. It may push tissue aside
or adhere to them.
A malignant mass is uncontrolled and is prone to
metastasize to nearby or distant structures via the
blood stream or lymph nodes.
Primary malignant tumors are relatively rare in the liver.
Hepatic Tumors
119
Blood vessel tumor
The most common benign neoplasm of the liver.
Pts are usually asymptomatic; a small percentage my
bleed causing RUQ pain.
Hemangiomas enlarge slowly and undergo
degeneration, fibrosis, and calcification.
They are usually found in the subcapsular liver (right
along the diaphragm) and are more common in the RT
lobe than the LT lobe.
round
posterior enhancement
detected with P doppler
Cavernous Hemangioma
120
The second most common benign mass of the liver.
Hormonal influence; more common in women.
Clinically the pt is asymptomatic and the neoplasm is
incidentally found.
Difficult to distinguish from hepatic adenoma
Difficult to differentiate from liver tissue
is very isochoic to the liver
Focal Nodular Hyperplasia (FNH)
121
benign tumor that consists of normal or
slightly abnormal hepatocytes- frequently
containing areas of bilestasis, focal hemorrhage,
or necrosis.
Found more commonly in women and has been
related to oral contraceptive use.
Also been found in men taking anabolic steroids.
Difficult to distinguish from FNH
Varied findings
varying echogenicity
central stat
Hepatic adenoma
122
AKA hepatoma
The most common primary malignant neoplasm.
Strongly associated with chronic liver disease (cirrhosis,
hep B and hep C). Occurs more frequently in men.
Clinically pts present has having a hx of hep B/C or
cirrhosis, a palpable mass, hepatomegaly, appetite
disorder and fever.
Associated Lab Values:
Elevated AFP
Elevated LFTs
HCC may present in one of three patterns:
*massive solitary tumor
* multiple masses throughout liver
* diffuse infiltrative masses throughout liver
Variable apperance
hepato cellular Carcinoma
123
a protein found
in developing fetuses; this protein rises with
the presence of HCC and hepatoblastoma
AFP: AKA alpha-fetoprotein
124
The most common form of neoplasm
involvement.
The most common primary CA sites are: colon,
breast, and lung.
The most common location for METs to travel to
are the lung and liver.
Common to have involvement in both RT and LT lobes of liver
variable apperance (multiple lesions)
solitary hypo echoic mass
solitary echogenic mass
Bulls eye target lesion
Metastatic Disease (METS)
125
* Pt may present clinically with enlarged, nontender,
lymph nodes, fever, fatigue, night sweats, weight loss,
bone pain, and abdominal mass.
Sonographic Appearance
hepatomegaly (all da title holes)
Hodgkin’s lymphoma- diffuse liver parenchymal
changes
non-Hodgkin’s lymphoma- hypoechoic target lesions
lymphoma
126
the most common primary malignant
disease in the peds pt
* usually discovered by age 5
* causes an increase in AFP
* asymptomatic OR palpable mass,
jaundice, anorexia, abdominal pain
Sonographic Appearance
o solid
o hyperechoic
o heterogeneous
o may have calcifications
hepatoblastoma
127
diffuse liver parenchymal
changes
Hodgkin’s lymphoma
128
non-Hodgkin’s lymphoma- hypoechoic target lesions
non-Hodgkin’s lymphoma
