Abd / SS > Module 3 : Liver > Flashcards

Module 3 : Liver Flashcards

(73 cards)

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1
Q

Liver - location

A
  • intraperitoneal
  • largest organ in the body
  • RUQ
  • right hypochondrium, epigastric, left hypochondrium
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2
Q

Liver - superior margins

A
  • bordered superiorly by diaphragm

- superior anterior posterior surface of liver are in contact with the diaphragm

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3
Q

Liver - inferior surface

A
  • in contact with viscera, rests on upper abdominal organs
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4
Q

Liver - posterior surface

A
  • indented by right kidney
  • ## IVC is posterior
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5
Q

Liver- displacement

A 
Caudally 
  - tumors 
  - cirrhosis 
  - subphrenic abscesses 
Cranially 
   - abdominal tumor
   - ascites
   - excessive dilatation of colon
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6
Q

Liver - shape and size

A
  • varies in size and shape dependent on body habitus
  • right lobe 2-3 times larger than left lobe in size
  • left lobe varies in size and shape
    + wedge shaped
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7
Q

Liver - measurement

A
  • length (midclavicular line - from diaphragm to inferior edge)
    • = 15.5
  • AP at mid point of longitudinal measurement
    • 8.1 +/- 1.9 S.D
  • Caudate/ RT Lobe ratio (subcostal true transverse)
    • < 0.65
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8
Q

Liver enlarged if…

A
  • Rt lobe extends below lower pole of right kidney

- except with reidels lobe

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9
Q

Reidels lobe

A
  • tongue like extension of inferior tip of Rt lobe of liver, frequently found in slim females
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10
Q

Lobar anatomy - anatomical

A
  • not typically used in medicine
  • based on external markings
  • 4 lobes: quadrate , caudate, right and left
  • falciform ligament divides right and left lobes
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11
Q

Anatomical division - caudate and quadrate

A

Caudate - lies between IVC, LIG venosum, and Portal Vein

Quadrate - porta hepatis, gallbladder fossa, LIG teres

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12
Q

Functional division

A
  • based on blood supply and biliary drainage (important for surgical reasons)
  • ligaments, fissures, and gallbladder as landmarks
  • 3 lobes and 4 segments
    + right lobe : anterior posterior
    + left lobe : lateral medial
    + caudate
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13
Q

Functional - intrasegmental

A
  • right and left portal veins course WITHIN the segments
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14
Q

Functional - Intersegmental

A
  • right left and middle hepatic veins course between the lobes and segments
  • INTERLOBAR
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15
Q

Functional - right lobe

A
  • separated by left lobe by main lobar fissure
    + middle hepatic vein courses through MLF
  • divides into anterior posterior segments by right Intersegmental fissure
    + right hepatic vein and right portal vein course though RIF
    = anterior Right Portal within anterior Right Lobe
    = posterior right portal within posterior right lobe
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16
Q

Functional - left lobe

A
  • divided into medial and lateral segments by left Intersegmental fissure
    + left hepatic vein, left portal and LIG teres run through LIF
  • medial left lobe considered quadrate lobe
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17
Q

Functional - caudate lobe

A
  • receives portal venous and hepatic arterial blood from both right and left systems
  • located on the posterior aspect of the liver
  • posterior landmark = IVC
  • anterior landmark = LIG venosum
  • structure directly inferior = MPV
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18
Q

Functional- caudate process

A
  • portion of the caudate that extends to the right obliquely and passes between the IVC and portal vein
  • everyone has one
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19
Q

Functional - papillary process

A
  • caudal projection of the caudate lobe

- not on everyone

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20
Q

main lobar fissure

A
  • divides liver into functional right and left lobes
  • gallbladder and IVC used as landmarks
  • short portion of the main lobar fissure is identified between the right portal vein and gallbladder neck in sagittal
  • middle hepatic vein courses through it
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21
Q
  • right intersegmental fissure
A
  • divides right lobe into anterior and posterior segments

- right hepatic vein and portion of rpv course through it

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22
Q

left intersegmental fissure

A
  • divides the left lobe into medial and lateral segments
  • fissure divided into cranial middle and caudal
    + left hepatic vein courses within the cranial third
    + ascending branch of left portal vein represents middl third
    + lig teres divides caudal portion
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23
Q

fissure for the ligamentum venous

A
  • divides the left lateral segment from the caudate lobe
  • contains lig venosum (remnant of ductus venous)
  • contains hepatogastric ligament (makes up lesser omentum)
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24
Q

gallbladder fossa

A
  • contains gall bladder
  • located on posterior inferior portion of right lobe of liver
  • closely related to main lobar fissure
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25
inferior vena cava fossa
- contains portion of IVC | - depression on posterior surface of the liver between the caudate and bare area
26
porta hepatis
- main vessel and biliary ducts leave and enter the liver at this point - COMMON BILE DUCT AND HEPATIC ARTERY ARE ANTERIOR TO PORTAL VEIN
27
glissons capsule
- thin layer of connective tissue surrounding the liver | - thickest at IVC and porta hepatis
28
hepatoduodenal ligament
- a fold of lesser omentum + with hepatogastric is full lesser omentum - anterior boundary of epiploic foramen + connection between greater and lesser sac - 3 structures within HL + main portal vein, hepatic artery, CBD
29
falciform ligament
- extends from umbilicus to liver - attaches the diaphragm to the superior surface of the liver - conducts fetal umbilical vein
30
ligamentum teres (round ligamnetum)
- inferior margin of the liver | - atrophied umbilical vein
31
ligamentum venosum
- remnant of the fetal ductus venosum | - anterior border of the caudate lobe
32
coronary ligaments
- defines bare area of liver - connects the posterosuperior surface of the liver to the diaphragm upper portion continuous with falciform ligament - forms right and left triangular ligament
33
portal veins
- carry partially oxygenated blood from intestines, spleen, pancreas, GB and bowel - travel intrasegmentally (within the segments) - echogenic reflective walls (connective tissue surrounding portal triad) - vessel caliber is greater near porta hepatis
34
main portal vein
- formed by conjunction of splenic vein, SMV, IMV - travels to the right in a cephalic oblique - divides into the right and left portal vein at porta hepatis
35
right portal vein
- anterior and posterior branches - travels posterior and caudally - can appear as elongation of MPV
36
left portal vein
- moves cranially along the anterior surface of the caudate lobe and then turns anterior - divides into medial and lateral branches - steers head
37
hepatic veins
- carry deoxygenated blood from the liver to the IVC - drain toward right atrium - travel intersegmentally (between lobes) - caliber increases as the approach diaphragm and IVC - do NOT have echogenic walls
38
right hepatic vein
- Largest | - travels in right intersegmental fissure
39
left hepatic vein
- smallest | - travels in left intersegmental fissure
40
middle hepatic vein
- travels in main lobar fissure
41
sonographic appearance
- homogenous with fine to medium level echoes - MINIMALLY HYPERECHOIC OR ISOECHOIC WHEN COMPARED TO RIGHT RENAL CORTEX - fissures and ligaments are highly echogenic - portal vein walls are echoic
42
patient prep and scanning
- over night fast NPO - supine of LLD - subcostal and intercostal - big breath in and hold - curvilinear - sag and trans assessment - attention to size, texture, vasculature, and biliary structs
43
lobule
- FUNCTIONAL UNIT OF THE LIVER - 1 to 2 mm in diameter - consists of + hepatocytes + central hepatic vein + sinusoids + kupffer cells + bile canaliculi + portal triads
44
hepatocytes
- organized in two layered columns converging toward a central vein in a radial pattern - in contact with sinusoid blood - liberate substances into the blood - make up most of liver tissue
45
sinusoids
- blood enters periphery of lobule and travels to central vein via sinusoid - located between hepatocyte and colomns - consists of 80% portal venous blood and 20% hepatic blood
46
kupffer cells
- scattered along sinusoids - part of reticuloendothelial system (defensive) - ingest and destroy foreign material (phagocytosis) - cleanse blood
47
bile canaliculi
- between 2 layers of liver cell columns - smalles division of biliary tract - bile liberated from hepatocytes into canaliculi flowing toward the later bile duct outer edge of liver lobule - bile duct is always separated from the sinusoid blood - converge to form larger ducts then unite to form right and left hepatic ducts
48
portal triad
- consist of bile duct, portal vein, and hepatic artery - at outer edge of lobule - several portal triads in single lobule
49
central hepatic vein
- blood enters periphery of lobule and travels toward the central vein via the sinusoids - blood in central vein should be cleansed of toxins and rich in lover secretions - converge into larger veins which unite into hepatic veins draining into IVC
50
function of liver
- primary centre of metabolism - performs about 500 separate activities - functions carried out via hapetocytes, kupffer cells, biliary cells
51
bile formation and secretion
- bilirubin is a product of red blood cell breakdown - bile salts are formed froth cholesterol in hepatic cells - bile emulsifies fats and aids in absorption of fatty acids - 700 to 1200ml / day
52
bilirubin
``` - unconjugated bilirubin + indirect + fat soluble + not excreted into urine + toxic to tissues - conjugated bilirubin + direct + non toxic + water soluble + secreted by liver into bile canaliculi ```
53
reticuloendothelial function/immune system
- produces blood cells in the embryo (hemopoiesis) - produces plasma protein and antibodies - remove foreign material and worn out red blood cells via kupffer cells (phagocytosis) - recovers bile pigment
54
metabolism
- carbohydrate + glucose buffer - fat - protein
55
storage depot
- vitamin A, D, B12 - glycogen, fats, amino acids - ferritin (derivative of iron) - copper and iron + poison
56
blood reservoir
- can store 200 - 400 ml
57
heat production
- produces heat result of chemical reactions
58
detoxification
- alcohol
59
lymph formation
- one third to half of body lymph fluid
60
lab tests
- test for enzyme
61
enzyme
- protein that catalyze chemical rxn - accelerate and control rxn rates = not destroyed - diff cells produce diff enzymes - tissue cell damage >> enzyme in blood streams - reflect function of body - blood (serum) & urine
62
ALT / SGPT
- enzyme porduced in hepatocytes - SPECIFIC INDICATOR FOR HEPATOCELLULAR DAMAGE - used with AST to distinguish between cardiac and hepatic damage - increased values seen in hepatitis, cirrhosis, tutors, hepatotoxicity
63
AST / SGOT
- found in liver, muscle and tissue with high metabolic rates - released with injury to cells in tissue - increased values in hepatitis , cirrhosis, hepatotoxicity, myocardial infarction
64
ALP or Alk Phos
- enzyme in liver bone placenta - BILIARY OBSTRUCTION - ALP INCREASED WITH NORMAL AST AND ALT INDICATES DISEASE OF BILE DUCT
65
LDH
- multiple organ systems - usually used to detect myocardial infarctions or pulmonary infarcts - increase in hepatitis cirrhosis instructive jaundice
66
GGT
- nonspecific indicator of hepatic disease | - SENSITIVE TO EFFECTS OF ALCOHOL IN LIVER
67
AFP
- produced in fetal tissue - PROTEIN - INCREASED VALUES IN HEPATOCELLULAR CARCINOMA AND TESTICULAR CARCINOMA
68
BILIRUBIN
- breakdown product of hemoglobin - values consist of + total bilirubin - combined conjugates and unconjugated bilirubin - increase in hepaticelluar damage + unconjugated/indirect - elevated in hepatocellular disease and hemolytic anemia + conjugated/direct - ELEVATED IN EXTRAHEPATIC BILE DUCT OBSTRUCTION
69
PROTHROMBIN TIME (PT)
- clotting factor affected by levels of vitamin K - ability of blood to clot - prolonged in nonfunctioning or scarred liver and lack of vitamin K - also prolonged with anticoagulant therapy
70
INR (internation normalized ratio)
- ratio used in place of PT | - greater than 1.2 liver biopsies should not be done
71
PTT
- measures clotting time of blood
72
SERUM PROTEIN
- albumin is a PROTEIN synthesized by the liver and maintains osmotic pressure in blod - decreased levels seen in liver dysfunction
73
HEPATITIS TESTING
- used to determine is patient has been exposed to or currently infected with or carrier of viral hepatitis - hep A or B - hep non A or non B
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