Liver WB EX except 5,7 Flashcards
(115 cards)
1
Q
MLF fissure divedes
A
L and R lobe
2
Q
L, R, M hepatics dived what way
A
longitudinally
3
Q
R and L portal veins divide what way
A
transversly
4
Q
Glissons capsule is
A
the liver covering
5
Q
What two ligmaents &/or fissures divide the L lobe into medial and lateral portions
A
Falciform ligament and Ligamentum teres
6
Q
Main portal vein as well as MLF divides into
A
L and R lobes
7
Q
Whats more ecogenic portal veins or hepatic veins?
A
Portal
8
Q
What carries blood from the bowels into the liver?
A
Portal V
9
Q
What drains blood from the liver into the IVC?
A
Hepatic V
10
Q
What carries oxygenated blood from the aorta to the liver?
A
Hepatic A
11
Q
What two vessels carry blood to liver?
A
Portal v and Hparic A
12
Q
Brief overview of metabolism
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phy and chem process
13
Q
Brief overview of digestion
A
bile
14
Q
Brief overview of storage
A
Iron and vitamins
15
Q
Brief overview of detox
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drugs and poisons
16
Q
Define Bilirubin
A
break down of red blood cells
17
Q
Hepatobillary systym includs
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liver, bile ducts, and gall bladder. Metabolic and excretory fuctions
18
Q
Hepatic disease is, and treated how
A
hepatocytes imediate problem ex. viral hepititis destroys cells TX: medically with drugs to decrease Albumin
19
Q
Obstructive disease is, and is treated how
A
Bile excretion is blocked, liver malfunctions as secondary result. TX: surgically Severe increase in bilitubin and Alkaine Phos
20
Q
Raw materials such as carbs(sugars), amino acids (protien), are absorbed from intestines and transported to…
A
the circulatory system
21
Q
Carbs
A
Glucose - energy liver maintains steady state of glucose
22
Q
Glucose is converted to what for storage
A
glycogen (starch)
23
Q
Hypoglycemis
A
low glucose affects brain and organs
24
Q
Hperglycemis
A
Increased glucose levels
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Fats
Monoglyceride and diglycerides
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Live is the primary site for metabolism of fats and is absorbed in intestenises in the form of
Monglycerides and diglycerides
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Dietary fats are converted in to the hepatocytes to
lipoprotiends the transported and stored
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Fatty liver
Fat croweds hepatocytes, pregnacy obesity liver disease and diabeties.
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Protiens: Indirect- Direct-
Indirect: amino acids absorbed from gut Direct: raw materials stored in body
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primary site for Albumin...
liver
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Albumin
Helps maintain oncotic presure within vascular supply
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Chronic liver disease has increased or decreased Albumin
decreased, hypoalbuminemia Edima, swelling may occur
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Sever liver disease = advanced cirrhosis leading to the development of
ascites
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Ascites #1 cause
Portal hypertension
35
Live is the primary source of blood coagulation name two..
fibrogen (1) and prothrobim (2)
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Liver disease does what to blood coagulation
decreases coagulation, uncontrollable hemorage, can lead to death
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In bile duct obstruction -
there is limited fat absorbtion
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in hepatocellular disease
K improves but doesnt restore
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Clotting Tests Pro-time Partial thromboplastin
test result in percent of time to clott long period = low percent patient time/ normal time to clot = %
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Hepatic Enzymes
Protie catalysts that leak into blood stream when hepatocytes or injurded or dead.
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increased hepatic enzymes in blood = what patho
Hepaticellular dissorder
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HIgh serum levels in hepatocellular and biliary obstruction
Hepat = 300 untils Biliary = 1000 units
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Abnormal Alkaline is the only symptom in
Metastic disease
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Hepatic Detox
break down Ammonium, notrogen metabloism converted into nontoxic urea
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BUN
Measures urea in blood
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Sever liver disease has high or low BUN results
low due to no urea production
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Fector hpaticus
fruity or pudgent breath due to ammonium
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Low BUM equals high
NH4 ammonium accumulation resulting in brain dysfunction
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Bilirubin detox break down of _____ excretes _____ to gut via \_\_\_\_\_\_\_
break down of RBC important detox excreted bilirubin to the gut via biliary tree (RBC on live 120 days)
50
Retociloendothelial cells in spleen trap what and break them down?
RBC
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Bilirubin attaches to what?
Albumin
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Metabolic steps take pace in hepatocyte when RBC is released
1. uptake - seperate bilirubin and albumin 2.Conjugation - Bilirubin + glucronide = bilirubin diglycuronide 3. Excretion - bilitubin transported to cell memb
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Once bilirubin is releaced from hepatocyte it is released into ______ delievered to ______ the exserted into \_\_\_\_\_\_\_
bile ducts Bowel Fesces
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Hepatocellular Tests Direct and indirect fraction what one is chemically conjucated and unconjugated
Direct - chem conjugated bilirubin Indirect - unconjugated bilirubin
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Total bilirubin =
direct + indirect = 1mg/100 ml or less
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Transplant will increase the congugated bilirubin or uncongucated
uncongugated
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Biliary obstruction vs. Hepatocelular bilirubin
less than 35/100 greater than 35/100
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Examples of Indirect and direct bilirubin
indirect - hemolysis direct - hepato, and biliary obstruction
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AST - asparate
Released due to death pr injury to producing cells cirrohsis and acute hep
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ALT - alanin
live specific Hepatocellular disease, toxic hep = increased Alchoholic ALT is higher in Hep
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LDH - Lactic acid
cell death injury = increase primary detection of myocardial or pulmonary infraction
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Alk phos
HIgh alk phos = cirrohsis and hepatitis
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3 causes of increased bilirubin
RBC destruction Malfunction of liver cells Blocked ducts leading from cells
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Diseases that are both indirect and direct =
Hepatitis, hepaticmetastises, lymphoma, cirohsis
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Prothrombin time
Clot time Increased clot time due to liver disease Cirrohsis and metastatix
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Albumin and Clobulin tests
Depressed synthesis of protiens
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MLF
Sperated L and R lobe
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Left intestinal fissure and L portal V
L lobe into medial and lateral
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The liver is more hyperechoic that the
kindey
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the liver is less hyperechoic than the
spleen and pancreas
71
In focal sparing whats effected
the anterior callbladder and posterior L lobe are effeced
72
Fatty infilration =
increase lipid accumulation
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Fatty infiltration sono findings
increased echo, lobe enlargemnt, focal sparing
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Sono findings for Cirrhosis
Coarse, increased atttenuation, decreased vasulature
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Inflamatory disease symptomes
fever, RUQ P, increased WBC count
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Hemangioma
benign congenital tumor consisting of blood filled cystic spaces
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The four criteria assessed when evaluating the liver parenchyma
Size, configuration, homogeneity, and contour
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hepatocellular disease affects the ___ and interferes with liver function ezymes
hepatocytes
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the hepatic enzyme levels are elevated with ___ necrosis
cell
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fatty infiltration implies increased ___ accumulation in the hepatocytes and results from significant injury to the liver or a systemic disorder leading to impaired or excessive metabolism of fat.
lipid
81
describe the sonographic findings for fatty infiltration of the liver
Moderate to severe fatty infiltration shows increased echogenicity on ultrasound. Enlargement of the lobe affected by fatty infiltration is evident. The portal vein structures may be difficult to visualize because of increased attenuation of the ultrasound. Increased attenuation also causes a decrease in penetration of the sound beam, which may be a clue for the sonographer to think of fatty liver disease. Fatty infiltration is not always uniform and may demonstrate areas of focal sparing. The most common areas of focal sparing are located anterior to the gallbladder and portal vein and the posterior portion of the left lobe.
82
in focal sparing, the most common affected areas are anterior to the ___ or the portal vein and the posterior portion of the ___ \_\_\_ of the liver
Gallbladder, left lobe
83
On ultrasound examination, the liver parenchyma in chronic hepatitis is ___ with ___ brightness of the portal triads, but the degree of attenuation is not as great as seen in fatty infiltration
coarse, decreased
84
Cirrhosis is a chronic degeneration of the liver in which the lobes are covered with fibrous tissue, teh parenchyma \_\_\_, and the lobules are infiltrated with \_\_\_
degenerates, fat
85
Glycogen storage disease is associated with ___ \_\_\_, focal nodular \_\_\_\_, and hepatomegaly
Hepatic adenomas, hyperplasia
86
List the criteria that the sonographer should use to determine whether the mass is extrahepatic or intrahepatic
Intrahepatic masses may cause: displacement of the hepatic vascular radicles, external bulging of the liver capsule, or posterior shift of the IVC. Extrahepatic masses may show internal invagination or discontinuity of the liver capsule, formation of a triangular fat wedge, anteromedial shift of the IVC, or anterior displacement of the right kidney
87
List the signs and symptoms of a patient who has inflammatory disease of the liver
Fever, white cell elevation, and right upper quadrant pain
88
A(n) ____ is any new growth of new tissue, either benign or malignant.
neoplasm
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A(n) ____ is a benign congenital tumor consisting of large, blood-filled cystic spaces.
hemangioma
90
The pathogenesis of hepatocellular carcinoma is related to \_\_\_, chronic ___ virus infection, and hepatocarcinogens in food
cirrhosis, hepatitisB
91
Describe the pathologic patterns seen in carcinoma of the liver
Solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltrative masses in the liver
92
The liver is the third most common organ injured in the abdomen after the ___ and the \_\_
spleen, kidney
93
An increase in portal venous pressure or hepatic venous gradient is defined as ___ \_\_\_
portal hypertension
94
Portal hypertension may also develop when hepatopetal flow is impeded by ___ or __ invasion
thrombus, tumor
95
The umbilical vein may become __ secondary to portal hypertension.
recanalized
96
The pulse repetition frequency allows one to record lower velocities at the PRF is \_\_\_
decreased
97
The Doppler sample volume should be ___ than the diameter of the lumen
smaller
98
Explain what color doppler velocity is dependent on
direction of flow, velocity, and angle to flow
99
Acute abdominal pain, massive ascites, and hepatomegaly secondary to thrombosis of the hepatic veins or inferior vena cava characterize \_\_-\_\_ syndrome, which has a poor prognosis.
budd-chiari
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108
describe the abnotmality
acute hepatitis w/ portal vein borders slightly more echogenic than normal
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112
describe the lesion in the RUQ and list the most likely differentials in this asymptomatic pt
carernnous hemangioma. well defined irregular lesion is seen in dome of right lpobe of the live. differential considerations include METS, hepatoma (HCC), adenoma, and focular hyperplasia
113
a pt w/ an incidental finding on US during the evaluation of the liver. what is your differential?
incidental finding of a large solid mass in right lobe- most likely represents hepatocellular carcinoma
pt also has small amout of pleural effusion noted in sagital image
DD- metastatic disease
114
wht liver abnormality is demonsttated?
polysystic liver disease w. multiple cysts throughout the liver and kidney
