1
Q
liver is largely covered by the…
A
peritoneum
2
Q
what portion of the liver is not covered?
A
posterior
3
Q
- Is in direct contact with the diaphragm
- Bordered by the coronary, triangular and falciform ligaments
A
Bare area
4
Q
Bare area
- is in direct contact with what?
- Bordered by?
A
The diaphragm
Bordered by the coronary, triangular and falciform ligaments
5
Q
The liver occupies:
what abdomen section?
greater part of…
and _______ as far as the mammillary line
A
the right hypochondrium
the greater part of the epigastrium,
and the left hypochondrium as far as the mammillary line
6
Q
contour and shape of the liver
lies inferior to what?
_______ covers the greater part of the right lobe?
A
- Contour and shape vary
- Lies inferior to the diaphragm
- Ribs cover the greater part of the right lobe
7
Q
In the epigastric region, the liver extends several centimetres below…
A
In the epigastric region, the liver extends
several centimeters below the xiphoid process
8
Q
A
9
Q
A
10
Q
A
11
Q
A
12
Q
What does the liver border posteriorly?
A
Posteriorly it borders the lumbar region of the posterior abdominal wall
13
Q
Majority of the liver lies beneath…
A
Majority lies beneath the right costal margin
14
Q
Anterosuperior surface of the liver fits snugly in the __________ separated from overlying __________ and ___________
A
dome of the diaphragm
pleural cavities and pericardium
15
Q
Left lobe lies anterior to
A
the porta hepatis and MHV
16
Q
The left lobe of liver is located inferior to
A
the diaphragm
17
Q
The left lobe of the liver may extend
A
to the left mid clavicular line
18
Q
The right lobe of liver lies anterior to
A
the RK
19
Q
The right lobe of the liver is located posteriorly to the
A
MHV
20
Q
The caudate lobe lies anterior and medial to the
A
IVC
21
Q
The caudate lobe is located posterior to the
A
ligamentum of venosum and porta hepatis
22
Q
The caudate lobe is located lateral to the
A
lesser sac
23
Q
“Couinaud’s” Segments of the
Liver
Segment I:
A
Caudate lobe
24
Q
“Couinaud’s” Segments of the
Liver
Segment II and III
A
Left superior and inferior
lateral segments
25
“Couinaud’s” Segments of the
Liver
Segment IVa and IVb
Medial segments of
the left lobe
26
“Couinaud’s” Segments of the
Liver
Segment V and VI
Caudal to the
transverse plane
27
“Couinaud’s” Segments of the
Liver
Segments VII and VIII
Cephalad to the
transverse plane
28
Ligaments and tissues appear .... because of ...
echogenic or hyperechoic
because of the presence of collagen
and fat within and around the
structures
29
Main lobar fissure (MLF) extends between the long axis of the ________ and the ________ in a longitudinal image
Gallbladder and MPV
30
The caudate lobe is anterior to the _______ and is separated from the left lobe of the liver by the _______
IVC
ligamentum venosum
31
Liver functions
1) Removes toxin + medication byproducts
2) Metabolizes nutrients for energy when needed
3) Fights infection by removing bacteria from blood
4) Produces blood clotting substance
5) Stores vitamins + minerals and sugar
6) Produces protein
7) Produces bile
32
Liver is the major site for converting....
dietary sugars (carbs) into glucose
33
liver converts ______ to _______ and stores it, when it is needed it breaks down the ______ and releases _______ into the blood
glucose
glycogen
glycogen
glucose
34
The liver is the major site for metabolizing ______
fats
35
Dietary fats are converted
in the ___________ to
__________, the form in
which fats are transported
throughout the body for
storage or use
hepatocytes
lipoproteins
36
the liver also manufactures __________
converts excess amino acids to _______ and _______
plasma proteins
fatty acids and urea
37
the liver also removes _________ from the blood
nutrients
38
the liver also Phagocytizes ________ and _________
Phagocytizes bacteria and worn-out red
blood cells
39
Livers role in digestion
secretes what?
what is broken down and excreted?
1) Secretes bile, which is important in the digestion of fats
2) Bilirubin, a pigment released when red blood cells are broken down, is excreted in the bile.
40
livers role in storage function
Stores iron and certain vitamins
41
Livers role in detoxification function
Detoxifies many drugs and poisons that enter the body, as well as waste products of the body’s metabolic processes.
42
____________ the breakdown product of hemoglobin, is also an important substance detoxified in the
liver.
Bilirubin
43
Liver excretes bilirubin into the gut via the
biliary tree.
44
Red blood cells survive an average of _______ in the circulatory system; they are then trapped and broken down by __________, primarily in the ________.
120 days
reticuloendothelial cells
spleen
45
Bilirubin molecules become attached to
_________ in the blood and are transported to the liver.
albumin
46
Hemoglobin released from the red cells is
converted to ________ within the
_____________ system and is then
released into the bloodstream.
bilirubin
reticuloendothelial
47
Metabolism of bilirubin in the hepatocytes: UPTAKE
Bilirubin is separated from albumin,
at the __________, and is taken inside the
_________.
cell membrane
hepatocytes
48
Metabolism of bilirubin in the hepatocytes: CONJUGATION
Bilirubin molecule is combined with
two __________ molecules, forming _____________
glucuronide
bilirubin diglucuronide
49
Metabolism of bilirubin in the hepatocytes: EXCRETION
Bilirubin molecule is actively transported
across the cell membrane into the bile canaliculi, which are the microscopic “headwaters” of the biliary
system. Bilirubin released from the hepatocytes passes through
the bile ducts with other components of bile and is delivered to the bowel.
50
With biliary obstruction, the hepatocytes pick up bilirubin and conjugate it with ________
what can they not do with it?
glucuronide molecules
they cannot dispose it.
51
What type of bilirubin is regurgitated back into the bloodstream
what happens because of this?
Conjugated form is then regurgitated into the bloodstream,
with resultant elevation of the direct-acting bilirubin fraction.
52
what may also rise slightly in biliary
obstruction, but what predominates?
Indirect-acting bilirubin may also rise slightly in biliary
obstruction, but the direct bilirubin predominates.
53
The direct or conjugated form of bilirubin also predominates in
hepatocellular disease
54
what is the step most readily
affected when the hepatocytes are damaged?
what happens because of this?
Excretion of bilirubin is the step most readily affected when the hepatocytes are damaged;
therefore the diseased hepatocytes continue to take in and conjugate bilirubin but are unable to excrete it.
55
As in biliary obstruction, the accumulated
conjugated bilirubin is...
regurgitated into the
blood.
56
Excretory product of the liver
Bile
57
Formed continuously by the hepatocytes, collects in the bile canaliculi adjacent to these cells, and is transported to the gut via the bile ducts
Bile
58
Principal components: water, bile salts, and bile
pigments (primarily bilirubin diglucuronide)
Other components: cholesterol, lecithin, and protein
Bile
59
Primary functions of _______
Emulsification of intestinal fat
Removal of waste products excreted by the liver
bile
60
bile is formed continuously by...
then what happens?
the hepatocytes, collects
in the bile canaliculi adjacent to these cells, and is transported to the gut via the bile ducts.
61
what are the principle components of bile?
water, bile salts, and bile
pigments (primarily bilirubin diglucuronide)
Other components: cholesterol, lecithin, and protein
62
what are the primary functions of bile?
Primary functions of bile
Emulsification of intestinal fat
Removal of waste products excreted by the liver
63
what is the normal size of the Right Lobe Midclavicular (MCL)?
13-17cm
64
What is the normal size of the left lobe of liver?
Highly variable
65
Which lobe of liver is larger?
Right
66
What is the weight of the liver in males vs females
males: 1400-1800G
females: 1200 - 1400g
67
Measured in the sagittal plane, what is the size of the mid-hepatic?
15.5cm
68
An increase in albumin suggests what?
Hemolyticanemia
69
An decrease in albumin suggests what?
Liver damage
70
An increase in Bilirubin suggests what?
* Jaundice
* Liver damage
* Obstruction
71
An increase in alkaline phosphatase suggests what?
* Metastases
* Obstruction
* Lesions
* Jaundice
72
An increase in AST suggests what?
- Hepatitis
* Liver injury
* Jaundice
* Fatty liver
* Cirrhosis
* Cholestasis
* Lymphoma
* Myocardial infarction
73
An increase in ALT suggests what?
Jaundice
* Hepatitis
74
An increase in beta globulin suggests what?
fatty liver
75
A decreased in beta globulin suggests what?
Liver disease
* Carcinoma
76
An increase in cholesterol suggests what?
* Gamma globulin
77
An increase in LDH suggests what?
* Liver disease
* Carcinoma
78
What are the 2 different kinds of surfaces in the liver?
1. Anterior or Parietal
2. Posterior or Visceral
79
Right posterosuperior surface
Relations?
Inferiorly with...
Diaphragm, upper posterior abdominal wall, right kidney, right adrenal gland
Inferiorly with right paracolic gutter and
visceral surface of the inferior margin
80
Inferior (Visceral) Surface
Rests on?
Organs associated with each side
Rests on upper abdominal organs
Right side:
- Gallbladder, pylorus, duodenum, right colon
(hepatic flexure and part of transverse
colon), right adrenal gland and right kidney
Left side:
- Stomach and IVC
81
Diaphragm, upper posterior abdominal wall,
right kidney, right adrenal gland
Inferiorly with right paracolic gutter and
visceral surface of the inferior margin
Right posterosuperior surface
82
Rests on upper abdominal organs
Right side
Gallbladder, pylorus, duodenum, right colon
(hepatic flexure and part of transverse
colon), right adrenal gland and right kidney
Left side
Stomach and IVC
Inferior (Visceral) Surface
83
Main Lobar Fissure
Divides what?
Contains what?
Echogenic linear line from _______ to ______
● Roughly divides the right and left hepatic lobes
● Contains MHV
● Echogenic linear line from RPV to GB neck
Abdominal Sonography
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