Liver normal and diffuse, metabolic, infections Flashcards
(119 cards)
1
Q
functions of the liver?
A
- produces most proteins
- Metabolizes or breaks down nutrients for food to produce energy when needed
- prevents shortages of nutrients by storing certain vitamins, minerals, sugar
- Produces bile
- produces most substances that regulate blood clotting
- immune function
- removes potentially toxic byproducts of certain medications
2
Q
what is a hepatocyte?
A
- triad of a bile duct, portal vein, and hepatic artery throughout the liver parenchyma
3
Q
where is bile produced within?
A
- produced within the cell
- bile enters the bile duct to be transpoted to the GB
4
Q
hepatic artery supplies?
A
oxygenated blood
5
Q
portal vein supplies?
A
WBC and returns flow to the liver from the intestines for cleansing
6
Q
the central vein function?
A
drains old blood back to the hepatic veins
7
Q
what is the hepatic artery?
A
- branch of the celiac axis
- supplies the liver cells with oxygenated blood
8
Q
what is the main portal vein?
A
- formed by the confluence of the SMV and splenic vein
- supples liver with lympocytes and RBC’s from the spleen and blood from the intesttimes that needs to be purifies by the liver
9
Q
HV function?
A
- drains deoxygenated blood from the liver into the IVC and returns it to the cardiopulmonary system for rejuvenation
10
Q
Which structure separates the medial and lateral left lobe?
A
Left intersegmental fissure
11
Q
Which structures lie within the left intersegmental fissure?
- cranially
- middle
- caudally
A
Cranially-LHV
Middle-Ascending LPV
Caudally-ligamentum teres
12
Q
The hepatic veins are visualized when scanning which portion of the liver?
A
superior
13
Q
What does the MHV separate?
A
Anterior RL and medial LL
14
Q
What borders on each side of the RHV?
A
Anterior and posterior RL
15
Q
What is the name of the capsule surrounding the liver?
A
glisson’s capsule
16
Q
Why is there a bare area on the liver?
A
lacks peritoneum
17
Q
right lobe normal measurement?
A
13-17 cm
- abnormal >14 cm (compare with rt kidney)
18
Q
hapatopetal flow of the liver?
A
portal venous flow
19
Q
hepatofugal flow of the liver?
A
hepatic veins
20
Q
MPV should not exceed what AP diameter?
A
13mm
21
Q
list 4 normal variants?
A
Diaphragmatic Slips
Reidels lobe
Papillary Process Caudate
Long left lobe
22
Q
Normal Variants- Diaphragmatic Slips is a cause of?
A
- cause of pseusomass on liver
23
Q
Diaphragmatic Slips are associated with?
A
diaphragmatic muscle bundles that attach the central tendon tot he thoracic cage
24
Q
A
Diaphragmatic Slip
- apperance changes with respiration
25
papillary process of caudate
26
Situs inversus totalis?
liver is found in the LT hypochondruim
27
Alpha-fetoprotein (AFP)?
- what is it?
- what is it a marker for?
- Not seen under normal circumstances
- A protein normally synthesized by the liver, yolk sac and GI tract of the fetus
- A nonspecific marker for malignancy
28
Alkaline Phosphatase(ALP)?
- what is it?
- where is it excreted
- marked elevation is associated with?
- enzyme produced primarily by liver, bone, and placenta
- excreted through bile ducts
- marked elevation is associated with obstructive jaundice
29
what is Alanine aminotransferase-ALT?
- enzyme found in high concentration in the liver and lower concentrations in the heart, muscle, and kidneys
- remains elevated longer than AST
- used to assess jaundice
30
Alanine aminotransferase-ALT elevation is associated with?
- cirrhosis
- hepatitis
- biliary obstruction
31
Alanine aminotransferase-ALT mild elevation associated with?
liver metastases
32
Aspartate aminotransferase-AST?
- enzyme present in many kinds of tissue that is released then cells are injured or damaged
- levels proportional to amount of damage and the time between cell injury and testing
33
Aspartate aminotransferase-AST us used to diagnose?
- liver disease before jaundice occurs
34
Aspartate aminotransferase-AST elevation is associated with? (3)
- cirrhosis
- hepatitis
- mononucleosis
35
prothrombin time- normal clotting time?
10-15 secs
36
what is prothrombin time?
- enzyme produced by liver
- producation depends on the amount of vitamin k
37
elevation of prothrombin time is associated with?
- cirrhosis
- malignancy
- malabsorption of vitamin K
- clotting failure
38
prothrombin time decreases with?
- subacute or acute cholecystitis
- internal biliary fistula
- carcinoma of GB
- biliary duct injury
- prolonged extrahepatic biliary obstruction
39
what are leukocytosis?
- WBC count above the normal range
- sign of inflammatory or infection response
- includes parasitic infections
- not a disease but a lab finsing
40
what is serum albumin?
- decrease suggests a decrease in protein synthesis
41
what is bilirubin?
- A product from the breakdown of hemoglobin in old red blood cells
- A disruption in the process may cause abnormal levels
- Leakage into tissues gives the skin a yellow appearance
- Reflects the balance between production and excretion of bile
42
elevation of direct or conjugated bilirubin is associated with?
- obstruction
- hepatitis
- cirrhosis
- liver meastases
43
elevation of indirect or unconjugated bilirubin is associated with?
- nonobstructive conditions (steatosis)
44
indication for liver exam? (6)
abnormal LFT’s
hepatocellular disease
biliary disease
abdominal /postprandial pain
palpable liver or spleen
pancreatitis
45
whats included in the medial segment of the liver?
- segment 4a and 4b
- includes quadrate lobe
- left portal vein is the anatomical landmark dividing 4a and 4b
46
what is the round ligament?
- remnant of umbilical vein
= inferior landmark that divides the inferior lateral segment from inferior medial segment
47
where is the gallbladder fossa located?
- inferiorly and is the anatomical landmark separating the segment 4b from segment 5
48
what is hepatocellular disease?
- liver cells (hepatocytes) are the immediate problem
- usually treated medically with supportive measures and drugs
49
what is obstructive disorders?
- bile excretion is blocked
- usually treated surgically
50
what is diffuse disease?
- affects the hepatocytes and interferes with liver function
- measured through a series of liver function tests
51
hepatic enzyme levels are elevated with?
cell necrosis
52
4 disorders of metabolism?
- steatosis (fatty liver)
- glycogen storage disease- neonatal
- cirrhosis- chronic liver disease
- NASH- non-alcoholic steatohepatitis
53
what is Steatosis-Fatty Liver?
- an acquired reversible disorder of metabolism
54
causes of Steatosis-Fatty Liver?
- obesity (M/C)
- excessive alcohol
- severe hepatitis
- hyperlipidemia
55
Steatosis-Fatty Liver correction?
- correction of the primary abnormality will usually reverse the process
56
Steatosis-Fatty Liver is a precursor for?
significant chronic disease
57
Steatosis-Fatty Liver may lead to?
HCC
58
Steatosis-Fatty Liver deposits?
may be focal or diffuse
59
steatosis
60
mild Characterization of Steatosis?
- minimal diffuse increase in hepatic echogenicity
61
moderate Characterization of Steatosis?
- moderate diffuse increase in hepatic echogenicity
- slightly impaired visualization of intrahepatic vessels and diaphragm
62
severe Characterization of Steatosis?
- marked increase in echogenicity
- poot penetration of posterior liver
- poor or no visualization of hepatic vessels and diaphragm
- hepatomegaly
63
steatosis
64
Other Sonographic Appearances of Fatty Liver (3)
1. focal fatty infiltration
2. fatty sparing
3. focal fat
65
what is focal infiltration?
* regions of increased echogenicity are present within a background of normal liver
* can mimic a mass
66
focal fatty infiltration
67
what is focal fat? where is the preferred site for focal fat?
* hyperechoic- no mass effect
* preferred site is anterior to portal vein at porta hepatis
68
what is NASH?
* nonalcoholic steatohepatitis
* “silent” liver disease
69
NASH u/s features?
* resembles alcoholic liver disease
* occurs in people who drink little or no alcohol
major features:
* fat in the liver
* inflammation
* damage
70
NASH can lead to?
cirrhosis
71
NASH is commonly related to?
obesity
72
NASH S/S? (3)
* fatigue
* weight loss
* weakness may begin once disease is advanced or cirrhosis is present
73
NASH lab values?
increased LFT's
74
NASH diagnosed by?
biopsy
75
NASH treatment?
* reduce weight
* eat well
* phusical activity
* avoid alcohol and unnecessary medication
* liver transplant may be necessary if cirrhosis ensues
76
NASH on u/s?
* dense fatty infiltation
* cirrhosis
77
what is glycogen storage disease?
• Inherited disease - occurs in neonatal period
78
Glycogen storage disease characterized by?
* abnormal storage and accumulation of glycogen in the tissues (especially liver and kidneys)
79
Glycogen storage disease may develop?
* benign adenomas
* HCC
80
Glycogen storage disease appearance?
* indistinguishable from diffuse fatty infiltration
* (different age group)
81
Six categories of glycogen storage disease based on clinical symptoms and specific enzymatic defects?
* most common is type 1 or von gierke disease
* abnormally large amounts of glycogen are deposited in the liver and kidneys
82
glycogen storage disease
83
what is viral hepatitis?
* inflammation of liver
* common disease that occurs worldwide
* 6 distinct hepatitis- A through E and G
* may be fatal if not treated
84
viral hepatis may lead to? (3)
* portal hypertension
* cirrhosis
* HCC
85
Hepatitis A?
* HAV
* worldwide
* spreads fecal-oral route
* endemis in developing countries- affects the young
* acute infection
* death from acute liver failure
86
Hepatitis B?
* HBV
* Worldwide
* transmitted parenterally (not oral)
* blood transfusions, needle punctures, sexual contact, and at birth
* predominate in asia, aferica, and Greenland
87
hepatitis D?
* dependent on hep B for infectivity
* geographically the same as hep B
* uncommon in north America
* IV drug use
88
s/s of viral hepatitis? (8)
* fatigue
* headache
* anorexia
* fever
* abdo pain
* nausea
* vomiting
* jaundice
89
acute hepatitis?
* recovery within 4 months
* liver parenchyma more hyopechoic leading to appearance of bring periportal walls
* starry night sign
90
acute hepatitis
91
chronic hepatitis?
* exists when clinical or biochemical evidence of hepatic inflammation extends beyond 6 months
92
chronic hepatitis causes (4)?
* viral
* metabolic
* autoimmune
* drug-induced
93
s/s chronic hepatitis?
* nausea
* anorexia
* weight less
* tremors
* jaundice
* dark urine
* fatigue
* varicosities
94
chronic active hepatitis usually progresses to?
* cirrhosis
* liver failure
95
chronic hepatitis u/s?
* liver parenchyma is coarse with decreased brightness of the portal triads
* does not increase in size
* fibrosis may be seen which may produce “soft shadowing” posteriorly
96
chronic hepatitis
97
what is cirrhosis?
* chronic degenerative disease of the liver
* lobes covered with fibrous tissue
* parenchyma degenerates
* lobules are infiltrated with fat
98
essential feature of cirrhosis?
* simultaneous parenchymal necrosis
* regeneration
* diffuse fibrosis resulting in disorganization of lobular architecture
99
cirrhosis
100
cirrhosis causes?
* most common cause of micronodular form- alcohol consumption
* most frequent cause of macronodular form- chronic viral hepatitis
most common cause/etiology of portal hypertension
101
etiologies of cirrhosis?
* biliary cirrhosis
* wilsons disease
* primary sclerosing cholangitis
* hemochromatosis
102
cirrhosis clinical presentation?
* hepatomegly
* jaundice
* ascites
103
cirrhosis on u/s? (5)
* Volume redistribution
* coarse echotexture
* nodular surface
* nodules: regenerative and dysplastic
* portal hypertension: ascites, spenomegly, varices
104
cirrhosis early stages on u/s?
* enlarged liver
* may be difficult to distinguish from fatty liver
* look for irregular contour
105
advanced stages of cirrhosis?
* liver is often small- shrinking
* ascites
106
nodular surface- cirrhosis?
* irregularity of liver surface
* due to presence of regenerating nodules and fibrosis
* ascites helps outline edges
* linear probe delineates contour well
107
regenerating nodules- cirrhosis?
* hepatocytes surrounded by fibrotic septae
* may be isoechoic or hypoechoic with a thin echogenic border
108
dysplastic nodules- cirrhosis?
* adenomatous hyperplastic nodules
* \>10mm- considered premalignant
* well-differentiated hepatocytes, portal venous blood supply, atypical or malignant cells
109
HCC
110
**Doppler Characteristics of Cirrhosis**?
* The hepatic vein velocity waveform reflects the hemodynamics of the right atrium.
* This triphasic pattern has two large antegrade diastolic and systolic waves and a small retrograde wave that corresponds to the atrial kick (from the heart).
* Hepatic veins easily receive the transfer of flow via the collaterals from the portal veins in a normal liver.
111
doppler characteristics of cirrhosis: hepatic venous flow
112
what is hepatic failure?
* inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology
* 2 forms are recognised- acute and chronic
113
acute liver failure?
* the rapid development of hepatocellular dysfunction, specifically coagulopathy and mental status changes in a patient without known prior liver disease
114
chronic liver failure usually occurs in?
cirrhosis
115
chronic liver failure causes?
* excessive alcohol intake
* hep B or C
* autoimmune, hereditary and metabolic causes- iron or copper overload
* steatohepatitis or non-alcoholic fatty liver disease
* ascites occurs secondary to liver cell failure
* worsening jaundice
* coagulopathy
* hepatic encephalopathy
* drug toxicity
* death occurs if loss of hepatic parenchyma by necrosis is \>40%
116
what is coagulopathy?
* AKA clotting and bleeding disorder
* bloods ability to clot is impaired
* may occur spontaneously or following a medical condition
117
what is hepatic encephalopathy?
* brought on by disorders that affect liver
* AKA portosystemic encephalopathy or hepatic coma
* patient exhibits confusion, altered level of consciousness, coma
* result of liver failure
118
what is drug toxicity?
* drugs account for 20-40% of hepatic failure
* alcoholics are susceptible
* outcome is liver transplant or death
119
what is hemochromatosis?
* rare disease of iron metabolism characterized by iron deposits through the body
* may lead to cirrhosis and portal hypertension
u/s features:
* hepatomegaly
* cirrhotic changes
* increased echogenicity may be seen uniformly throughout hepatic parenchyma
