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Flashcards in test review reverse Deck (63):
1

Falciform Ligament

ligamentum teres

ligamentum venosum

coronary ligament

 

ligaments

2

extends from umbilicus to the diaphragm in parasagittal plane

contains the ligamentum teres

anteriorposterior axis extendes from right rectus muscle to bare area

echogencis reflections contintribute to hepatic ligament and attach to undersurface of diaphragm

Falciform ligament

3

appears as a bright echogenic focus as the termination of the falciform ligament

separates the medial and lateral segments of the left lobe

Usually appears triangularly on images

ligamentum teres

4

separates the left and caudate lobes of the liver

seen just inferior to the dome as a linear horizontal line

 

ligamentum venosum

5

The wide coronary ligament connects the central superior portion of the liver to the diaphragm.


Located on the lateral borders of the left and right lobes, respectively, the left and right triangular ligaments connect the superior ends of the liver to the diaphragm

Coronary ligament

6

Main lobar

Right intersegmental fissure

Left intersegmental fissure

Fissures of the liver

7

divides the left and right lobes

hyperechoic line extending from portal vein to neck of GB

 

Main Lobar Fissure

8

Divides right lobe into anterior and posterior segments.
Identified by right hepatic vein

Right intersegmental fissure

9

Divides left lobe into medial and lateral segments.
Identified bt left hepatic vein

Left intersegmental fissure

10

Alkaline Phosphatase

Alanine Aminotransferas

Aspartate Aminotransferase

Lactic Acid dehydrogenase 

Bilirubin (direct, indirect and total)

Prothrombin Time

Albumin

Globulins

Liver function tests

11

Enzyme produced primarily by liver, bone and placenta. 

elevation related to

higher in obstruction 

hepatic matastasis

hepatitis

lymphoma

cholestasis secondary to drugs

cirrhosis

Alkaline Phosphatase

 

12

More specific than AST

slightly elevated in acute cirrhosis, hepatic metastasis, pancreeatitis

mild to moderate increase in obstructive jaundice, 

moderate to high increase in hepatocelluar disease and infectious or toxic hepatitis

AST is higher in alcoholic hepatitis

Alanine Aminotransferase

ALT

13

An enzyme present in many tissues that have high metabolic rate

 released when cells are injured or damaged

released in abnormally high levels

Elevation associated with cirrhosis, acute hepatitis, hepatic necrosis and mononucleosis

Aspartate Aminotransferase

14

found in tissues of several systems 

cellular injury and death cause enzyme to be released

moderate increase for mononucleosis

mildly elevated in hepatitis, cirrhosis and obstructive jaundice

primary use in detecting myocardial or pulmonary infarction

Lactic Acid dehydrogenase 

LDH

15

product of breakdown of hemoglobin in old RBC's

liver converts to bile pigments secreted by liver cells into bile ducts

rise in serum leaks and gives skin a jaundices or yellow coloration

bilirubin

16

rise in this test is seen with increased RBC destruction 

(anemias, trauma from hematoma or hemorrhagic pulmonary infarct)

indirect bilirubin

17

product circulates in the bolld and is excreted into the bile after reaching the liver

conjugated with glucuronide

elevatoin usually related to obstructive jaundice (stones or neoplasm)

increase is more in hepatatic metastasis, hepatitis, lymphoma, cholestasis, secondary to drugs and cirrhosis

direct bilirubin test

18

liver enzyme part of blood clotting mechaniam

productoin depends on adequate intake and use of vitamin K

increases in presence of liver disease with cellular damage

cirrhosis and metatasitc disease casue prolonged time

prothrombin time

19

sensitive test for metabolic derangement of liver

low results suggest decreased protein synthesis in hepatocellular damaged patients

Albumin

20

common elevation in chronic liver disease

globulins

21

inherited characterized by abnormal storage and accumulation of glycongen in tissues (liver, kidneys)

six categories divided based on clinical symptoms and specific enzyme defects

most common type I or von Gierke's disease

Glycongen Storage disease

22

glycongen storage disease in chich abnormally large amounts of glycogne are deposited in the liver and kidneys

type I or von Gierke's disease

23

present with hepatomegaly, 

increased echogenicity

slightly increased attenuatoin (similar to fatty infiltrate)

associated with hepatic adenomas, focal nodular hyperplasia and hepatomegaly

adenoma presents as well demarcated round homogeneous echogenic tumors

if tumor is large in may be slightly inhomogeneous

sonographic appearance of glycogen storage dsease

24

Cavernouse hemagioma

LIver cell adenoma

focal nodule hyperplasia

hepatic cystadenoma

 

benign liver tumors

25

binign congenital tumor consisting of large blood filled cystic spaces

most common benign tumor of liver

more frequently in females

usually asymptomatic, may bleed causing RUQ pain.

enlarge slowly and undergo degeneration, fibrosis and calcification

found in hepatic parenchyma or in posterior RL more than LL

Cavernous Hemagioma

26

tumor of the glandular epithelium in which cells are arranged in recognizable glandular structure

normal or slightly atypical hepatocytes, frequently containing areas of bile stasis, focal hemorrhage or necrosis

lesion found more in women and related to oral contraceptive use

presents iwth RUQ pain secondary to rupture with bleeding

increased in type I glycogen storage disease

Liver Cell Adenoma

27

second most common benign liver mass

thought to arise from developmental hyperplastic lesions related to an area of congenital vascular formatoin

typically one well circumscribed lesion but may be more than one mass, many located alond subcapsular area of liver, may be pedunculated and have central scar

consists of normal hepatocytes, kupffer cells, bile duct elements, fibrous connective tissue bands of fibrous tissue separate the nodules

 

focal nodule hyperplasia

28

found in women under 40

asymptomatic

more in RL

focal nodular hyperplasia

29

contains cystic structures within the lesoin

rare neoplasm occuring in middle aged women

most have palpable abdominal mass

hepatic cystadenoma

30

Bilobed gallbladder

Septated gallbladder

Phrygian cap

Hartmann pouch

Junctional fold

Normal variants of the Gallbladder

31

Hourglass  appearance

Bilobed gallbladder

32

Appear as thin separations within the gallbladder

Septated gallbladder

33

Gallbladder fundus is folded onto itself

Phrygian cap

34

Outpouching of gallbladder neck

Hartmann pouch

35

Prominent fold located at the junction of the gallbladder neck

Junctional fold

36


—Size is variable,

but approx 7-10cm in length and 2.5-4cm in width
 

Gallbladder size

37


—in the neck keeps the cystic duct from kinking
 

Heister’s valves function

38


—Consists of the right and left hepatic duct,

common hepatic duct,

common bile duct,

pear shaped gallbladder,

and cystic duct
 

Anatomy of the Bile Ducts

39


—come from the right lobe of the liver in the Porta hepatis and unite to form the CHD
 

Right and left hepatic ducts 

40

approx 4mm in diameter, joins the cystic duct(draining the gallbladder) and is now called the CBD


Common Hepatic Duct
 

41

by piercing into the wall of the duodenum where is joins the main pancreatic duct and together, they open into the duodenum through a small opening called the ampulla of Vater

CBD ends 

42


—lies lateral to the hepatic artery and anterior to the portal vein  (left ear of Mickey Mouse) 
 

CBD (prox portion) location

43


6mm < 60yrs of age

increase 1mm per 10 yrs of aging
 

CBD measurement

44

approx 4 cm long,

connects the neck of the gallbladder to the CHD to form the CBD 

normally not seen by ultrasound

Cystic Duct- 

45

bililrubin mild to severe increase

hepatocellular disease

46

serum albumin

decreased

hepatocellular disease

47

AST

moderate to severe increase

hepatocellular disease

48

ALT

moderate to severe increase

hepatocellular disease

49

Alkaline Phosphatase

minimal to moderate increase

hepatocellular disease

50

bilirubin

severe increase

obstruction

51

albumin

normal

obstruction

52

AST

mild increase

obstruction

53

ALT

mild increase

obstruction

54

Alkaline phosphatase

severe increase

obstruction

55

normnal measurement

4mm

Common Hepatic Duct

56

tumor at the bifurcatoin of the hepatic ducts

may cause asymmetric obstruction of the biliary tree

Klatskin's tumor

57

uncommon cause for extrahepatic biliary obstruction resulitng from an impacted stone in cystic duct

Mirizzi sundrome

58

normal to increased hepatic enzymes

increased ALK phosphatase

increased birect bilirubin

Fatty infiltrate liver

59

increased  AST

increased ALT

increased bilirubin

leukopenia

Acute hepatitis

60

increased AST

increased ALT

increased bilirubin

leukopenia

Chronic hepatitis

61

increased Alk Phos

increased direct bilirubin

increased AST

increased ALT

leukopenia

Cirrhosis

62

disturbance of acid-base balance

Glycogen storage disease

63

increase iron levels in blood

hemochromatosis