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Flashcards in Liver power point reverse Deck (62):
1

2

largest organ in the body, next to the skin

weighs approx 1500 grams in the adult

 

 

Liver physical description

3

occupies almost all of the right hypochondrium, great part of epigastrium and left hypochondrium as far as the mammillary line

inferior to the diaphragm

posterior border in contact with the rt kidney and IVC

aorta lies posterior to the left lobe

 

Liver location

4

tissue known as Glisson's capsule

liver covering

5

divides liver into sectoins based on main lobar fissure and vascular landmarks

divides into 8 surgical sections

Couinad's anatomy 

6

subphrenic spacebetween the liver and diaphragm is a common site fo abcess formation

Subphrenic space

7

includes morrisons pouch

a common site for periotoneal fluid or blood to collect

 

right subhepatic space

8

enclosed portion of the peritonial space posterior to the liver and stomach is another site for abcess formation

lesser sac

9

hemopoiesis

embryonic repsonibility

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intraperitoneal organ

type of organ

11

3 helatic lobes

each lobe further divided into thousands of liver lobules

 

liver basic anatomy

12

contain kepatocytes

biliary epitheleal cells

kupfer cells

each lobule surrounded by portal triads, small branches of PF, BD and HA

liver lobules

13

Right

Left

Caudate

Lobes of the liver

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Right hepatic vein

right intersegmental ligament

Separates anterior and posterior of right lobe

15

left hepatic vein

left intersenmental fissure

ligamentum teres

falciform ligament

separates lateral and medial segment of the left lobe of the liver

16

middle hepatic vein

main lobar fissure

gallbladder fossa

separates the right and left lobe

17

largest lobe

contains 3 fossae: porta hepatis, gallbladder and IVC

may contain riedels lobe

Right lobe of liver

18

can sometimes be seen as an anterior projection of the liver sometimes extending down the iliac crest

Riedels lobe

19

size varies from patient to patient, really effects the quality of scanning the pancreas

found just under the xiphoid process

 

Left Lobe

20

attaches the liver to the diaphragm and anterior abd wall

contains the ligamentum teres, triangular or rounded hyperechoic structure which is the termination of the ligament

Falcifomr ligament

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smallest lobe

inferior to the ligamentum venosum

superior to the IVC

caudate lobe

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Main lobar fissure

Falciform Ligament

ligamentum teres

ligamentum venosum

LIgaments and fissures

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boundry between right and left lobes

longitudinal scan may be seen as a hyperechoic line extending from the portal vein to the neck of the gallbladder

main lobar fissure

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extends from the umbilicus to the diaphragm,

contains the ligamentum teres

falciform ligament

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appears as a bright echogenic triangle on a transverse scan

separates the medial and lateral segments of the left lobe

ligamentum teres

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appears as a hyperechoic line separating the left and caudate lobes

ligamentum venosum

27

Portal venous system

Hepatic veins

hepatic arteries

Vascular supply

28

supplies 70-75% of blood volume to liver from the digestive system

flow should be hepatopetal

low veloctiy, phasic flow

 

portal venous system

29

Main portal vein

Right portal vein

left portal vein

 

Portal veins

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enters at the portahepatis

11-12mm

divides into the right and left portal veins

Main portal vein

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largest of the portal veins

divides into anterior and posterior branches

Right portal vein

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lies more anterior and cranial than the right portal vein

divides into medial and lateral branch

lies within a thick band of connective tissue coursing throught eh central portion of the lateral segment of the left lobe

Left portal vein

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flow into the IVC

hepatofugal flow (below baseline)

Hepatic veins

34

flow into the liver hepatopetal flow

bright walls sue to the increases connective tissue-Glissons capsule

Portal veins

35

drain blood from liver back to IVC

divided into 3 components, RIght, Middle and left

Doppler signal is low velocity but more pulsitile than portal veins due to the closer proximity to the heart

Hepatic veins

36

supplies about 20% of the blood to the liver

common is a branch of the celiac trunk from the aorta

courses towards the right changing names to the proper_____as it curves anterior and cephalad towards the porta hepatis

at porta hepatis it diveds into right, middle and left

Hepatic arteries

37

right hepatic artery courses between the bile duct and portal vein

anatomical variations of hepatic artery are quite common

referred to as a replaced right hepatic artery

portal veins are contained within a connective sheath and have bright echogenci walls

Portal triad

38

metabolism

digestion

storage

detoxification

phagocytosis

Liver functions

39

carbohydrates:

fat 

protein

manufactures many of the plasma proteins in the blood

metabolism

40

converts glucose to glycogen and stores

when needed breaks down glycogen and releases glucose into the blood

Carbohydrate metabolism

41

absored from the intestine in the form of monoglycerides and diglcerides

converted in tehhepatocytes to lipoproteins

lipoproteins are transported throughout the body to be stored or used by other organs

priciple site for cholesterol synthesis

failure of hepatocytes to manufacture lipoproteins lead to an accumulation of fat within the hepatocytes resulting in fatty liver

Fat metabolism

42

secretes bile

aids in digestoin of fat

Digestion

43

stores iron and certain vitamins

storage

44

drugs and poisons that enter the body

detoxification

45

bacteria and worn out blood cells are removed

phagocytosis

46

liver produces a variety of proteins, either indirectly from amino acids or directly from raw materials stored in body

albumin produced in great amounts

albumin is nonionic and functions to draw water into the vascular system from tissue spaces

if diseases the liver allows for fluid to accumulate in the interstitial spaces resulting in edema, may contribute to acites in advanced cirrhosis

Protein mteabolism

47


}Principal source of proteins necessary for blood coagulation, including fibrinogen (factor 1), prothrombin (factor ll), and factores V, VII, IX, and X
}In liver disease, decreased production of these proteins my lead to inadequate blood coagulation and uncontrollable hemorrhage.
}Deficiencies in clotting factors may also be a result of failed intestinal absorption of vitamin K
 

Proteins for blood coagulation

48

Liver contains macrophages called Kupffer cells. These cells engulf and breakdown toxic matter such as microorganisms, dead cells and chemicals. Kupffer cells ingest microorganism by phagocytosis. The engulfed microorganism is called phagosome. Lysosmes in the cytoplasm of kupffer cell, fuse with the phagosome and release digestive enzymes. These enzymes breakdown and kill the microorganism

Kuppfer Cells

49


}Enzymes are protein catalysts used throughout the body in all metabolic processes.  Due to the liver being a major center for metabolism, large quanities of enzymes are present in the hepatocytes.
}The liver enzymes may leak into the bloodstream when the liver cells are damaged or destroyed due to disease.
}The presence of increased quanities of enzymes in the blood is a sensitive indicator of a hepatocellular disorder
 

Hepatic Enzymes

50


}Process where what we eat is broken down into substances that provide energy for our cells.   
}The waste products of this process is excreted through bile, which leaves the liver via the biliary system.
}In hepatobiliary disease, each of the functions of the liver will be decreased. 
}This will lead to abnormal lab findings, sonographic findings and clinical symptoms 
 

Metabolism

51


AST
ALT
LDH
Alk phos
Bilirubin
PT
Albumin and globulins
 

Liver Function Tests LFT’s

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Alkaline phosphatase (Alk phos)-produced by the liver,bone,intestines and placenta
◦Cirrhosis
◦Extrahepatic biliary obstruction
◦Gallstones
◦Hepatitis
◦Metastatic liver disease
◦Pancreatic carcinoma
 

Elevated liver function tests

53


◦Hepatitis
◦Hepatocellular disease
◦Obstructive jaundice

Aspartate aminotransferase-(AST)an enzyme produced in high-metabolic tissues, may indicate

  cirrhosis

  fatty liver

  hepatitis

  metastatic liver disease

May indicate other organ diseases other than liver


}Alanine aminotransferase-(ALT)more specific than AST for evaluating liver function
 

54


◦Hepatitis
◦Cirrhosis
◦Obstructive jaundice
◦Found in tissues of several systems including kidneys, heart, brain, lungs
◦Main use is in the detection of myocardial or pulmonary infarction
 


}Lactate dehydogenase (LDH)
 

55

Unconjugated (indirect) bilirubin-acute hepatocelluar disease-receives too much at one time- cannot detoxify

  -Conjugated (direct) bilirubin-biliary tract obstruction

  -Total bilirubin- cirrhosis and other chronic liver cell disease

Serum Bilirubin (bilirubin)

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}liver enzyme that is part of the blood clotting system dependant on the adequate intake and use of vitamin K

◦Prolonged- metastases to the liver
◦Shortened- extrahepatic duct obstruction
 

Prothrombin (PT)-

57


}is a pigment that is released when red blood cells are broken down
The liver receives bilirubin that is attached to the albumin in the blood.  The hepatocytes get busy performing metabolic functions of uptake, conjugation, and excretion

Bilirubin

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the hepatocytes pick up the bilirubin and conjugates it, but cannot excrete it.  Direct bilirubin is increased

biliary obstruction

59


}the hepatocytes are damaged , the cells continue to take in and conjugate the bilirubin, but cannot excrete it.
 

hepatocellular disease

60

is released by the reticuloendothelial system (spleen/bone marrow) in too large of quanities that the liver can handle.  These are hemolytic conditions   hemolytic anemia/blood transfusion reactions

Uncongugated, or indirect bilirubin

61


}TGC-should be adjusted to balance the far-gain and near-gain echo signals
}Overall gain-should be adjusted to adequatley penetrate the entire right lobe of the liver as a smooth, homogenous echo pattern
}Depth-posterior right lobe is positioned at the lower border of the screen
}Focuses-near the posterior border of the liver
}Transducer frequency-depends on patient body habitus.  Average adult 2.5-5 MHz, pediatric 5-7MHz 
 

Liver Scanning

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}The size of the liver 
}The attenuation of the liver parenchyma
}Liver texture
The presence of hepatic vascular structures, ligaments, and fissures

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