Chapter 10: The Liver

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1

bare area

area superior to the liver that is not covered by peritoneum so that the inferior vena cava may enter the chest

2

bilirubin

yellow pigment in bile formed by the breakdown of red blood cells; excreted by the liver and stored in the gallbladder

3

blood urea nitrogen (BUN)

laboratory measurement of the amount of nitrogenous waste and creatinine in the blood; waste products accumulate in the blood when kidneys malfunction

4

bull’s eye (target) lesion

hypoechoic mass with an echogenic central core (abscess, metastases)

5

caudate lobe

smallest lobe of the liver situated on the posterosuperior surface of the left lobe; the ligamentum venosum is the anterior border

6

collateral circulation

circulation that develops when normal venous channels become obstructed

7

diffuse hepatocellular disease

affects hepatocytes and interferes with liver function

8

epigastrium

area between the right and left hypochondrium that contains part of the liver, duodenum, and pancreas

9

extrahepatic

outside the liver

10

falciform ligament

extends from the umbilicus to the diaphragm in a sagittal plane and contains the ligamentum teres

11

hepatocellular disease

classification of liver disease where hepatocytes (liver cells) are the primary problem, as opposed to obstruction of bile secretion

12

hepatocyte

a parenchymal liver cell that performs all functions ascribed to the liver

13

hepatofugal

flow away from the liver

14

hepatopetal

flow toward the liver

15

hyperglycemia

uncontrolled increase in blood glucose levels

16

hypoglycemia

deficiency in blood glucose levels

17

intrahepatic

within the liver

18

left hypochondrium

left upper quadrant of the abdomen that contains the left lobe of the liver, spleen, and stomach

19

left lobe of the liver

lies in the epigastrium and left hypochondrium

20

left portal vein

supplies the left lobe of the liver

21

ligamentum teres

appears as bright echogenic foci on transverse image; along with falciform ligament, it divides medial and lateral segments of the left lobe of the liver

22

ligamentum venosum

separates the left lobe from the caudate lobe; shown as an echogenic line on the transverse and sagittal images

23

liver function tests

specific laboratory tests that look at liver function (aspartate or alanine aminotransferase, lactic acid dehydrogenase, alkaline phosphatase, and bilirubin)

24

main lobar fissure

boundary between the right and left lobes of the liver; seen as a hyperechoic line on the sagittal image extending from the portal vein to the neck of the gallbladder

25

main portal vein

vein formed by union of the splenic vein and superior mesenteric vein; serves as the posterior border of the pancreas; enters the liver at the porta hepatis

26

metastatic disease

tumor that develops away from the site of the organ; most common form of neoplasm of the liver; primary sites are the colon, breast, and lung

27

neoplasm

any new growth (benign or malignant)

28

obstructive disease

classification of liver disease where main problem is blocked bile excretion within the liver or biliary system

29

pyogenic abscess

pus-forming collection of fluid

30

right hypochondrium

right upper quadrant of the abdomen that contains the liver and gallbladder

31

right lobe of the liver

largest lobe of the liver

32

right portal vein

supplies the right lobe of the liver; branches into anterior and posterior segments

33

area superior to the liver that is not covered by peritoneum so that inferior vena cava may enter the chest

Bare area

34

smallest lobe of the liver situated on the posteriosuperior surface of the left lobe; the ligamentum venosum is the anterior border

caudate lobe

35

area between the right and left hypochondrium

epigastrium

36

extends from the umbilicus to the diaphragm in a sagittal plane and contains the ligamentum teres

falciform ligament

37

left hypochondrium

left upper quadrant of the abdomen that contains the left lobe of the liver, spleen, and stomach

38

liver lobe that lies in the epigastium and left hypochondium

left lobe of the liver

39

supplies the left lobe of the liver

left portal vein

40

appears as bright echogenic foci on transverse image; along with falciform ligament, it divides medial and lateral segments of left lobe of the liver

ligamentum teres

41

separates left lobe from caudate lobe; shown as echogenic line on the transverse and sagittal

ligamentum venosum

42

boundary between the right and left lobes of the liver; seen as hyperechoic line on the sagittal image extending from the portal vein to the neck of the gallbladder

main lobar fissure

43

enters the liver at the porta hepatis

main portal vein

44

right upper quadrant of the abdomen that contains the liver and gallbladder

right hypochondrium

45

largest lobe of the liver

right lobe of the liver

46

supplies the right lobe of the liver; branches into anterior and posterior segments

right portal vein

47

alkaline phosphate

enzyme of the liver

48

ALT

alanine aminotransferase – enzyme of the liver

49

AST

aspartate aminotransferase – enzyme of the liver

50

Yellow pigment in bile formed by the breakdown of red blood cells; excreted by liver and stored in the gallbladder

bilirubin

51

BUN

blood urea nitrogen; laboratory measurement of the amount of nitrogenous waste and creatinine in the blood

52

classification of liver disease where hepatocytes are the primary problem

hepatocellular disease

53

parenchymal liver cell that performs all functions ascribed to the liver

hepatocyte

54

hepatofugal

flow away from the liver

55

hepatopetal

flow toward the liver

56

uncontrolled increase in blood glucose levels

hyperglycemia

57

hypoglycemia

deficiency in blood glucose levels

58

specific laboratory tests that look at liver function (aspartate or alanine aminotransferase, lactic acid dehydrogenase, alkaline phosphatase, and bilirubin

liver function tests

59

classification of liver disease where the main problem is blocked bile excretion within the liver of biliary

obstructive disease

60

hypoechoic mass with an echogenic central core (abscess, metastases)

bull’s-eye (target lesion)

61

develops when normal venous channels become obstructed

collateral circulation

62

affects hepatocytes and interferes with liver function

diffuse hepatocellular disease

63

extrahepatic

outside the liver

64

intrahepatic

within the liver

65

most common form of neoplasm of the liver; primary sites are colon, breast, and lung

metastatic

66

any new growth (benign or malignant)

neoplasm

67

pus-forming collection of fluid

pyogenic abscess

68
card image

diaphragm

69
card image

falciform ligament

70
card image

gallbladder

71
card image

inferior border

72
card image

left lobe

73
card image

right lobe

74
card image

right triangular ligament

75
card image

round ligament

76

A congenital variant, ___________________, can sometimes be seen as an anterior projection of the liver and may extend inferiorly as far as the iliac crest.

Reidel's lobe

77

The liver is covered by a thin connective tissue layer called _____________ capsule.

glisson's

78

The ________ fissure is the boundary between the right and left lobes of the liver.

main lobar

79

The ____________ ligament extends from the umbilcus to the diaphragm in a parasagittal plane and contains the ligamentum teres

falciform

80

The ___________ appears as a bright echogenic focus on the sonogram and is seen as the rounded termination of the falciform ligament.

ligamentum teres

81

The fissure for the ____________ separates the left lobe from the caudate lobe.

ligamentum venosum

82

The hepatic veins are divided into three components: _____________, _____________, and ______________

left, middle, right

83

The liver is a major center of _______________, which may be defined as the physical and chemical process whereby foodstuffs are synthesized into complex elements.

metabolism

84

Through the process of __________, the liver expels these waste products from the body via its excretory product, bile, which plays an important role in fat absorption.

digestion

85

A pigment released when the red blood cells are broken down is __________.

bilirubin

86

The liver is a _________ site for several compounds used in a variety of physiologic activities throughout the body.

storage

87

The liver is also a center for __________ of the waste products of metabolism accumulated from other sources in the body and foreign chemicals that enter the body.

detoxification

88

Diseases affecting the liver may be classified as ______________ when the liver cells or hepatocytes are the immediate problem; or _____________ when bile excretion is blocked.

hepatocellular, obstruction

89

Raw materials in the form of ____________, _____________, and _______ are absorbed from the intestine and transported to the liver via the circulatory system.

carbohydrates, fats, amino acids

90

Sugars may be absorbed from the blood in several forms, but only _________ can be used by cells throughout the body as a source of energy.

glucose

91

Dietary fats are converted in the hepatocytes to ____________, in which form fats are transproted throughout the body to sites where they are used by other organs or stored,

lipoprotien

92

The accompanying loss of oncotic pressure in vascular system allows fluid to migrate into the interstitial space, resulting in ___________ dependent areas.

edema

93

Because the liver is a major center of metabolism, large quantities of _______ are present in hepatocytes, and these leak into the bloodstream when the liver cells are damages of destroyed by disease.

enzymes

94

In severe hepatocellular destruction, such as acute viral or toxic hepatitis, striking elevation of ____________ and ____________ may be seen.

AST, ALT

95

Marked elevation of ____________ is typically associated with biliary obstruction or the presence of mass lesions in the liver.

alkaline phosphate

96

Hemoglobin released from the red cells is converted to _____________ within the reticuloendothelial system and is then released into the bloodstream.

bilirubin

97

Elevation of serum of serum bilirubin results in ________________, which is a yellow coloration of the skin, sclerae, and body secretions.

jaundice

98

Embryology

What is the liver derived from?

epithelium of the foregut of the gastrointestinal tract.

99

Embryology

When does hepatopoiesis begin and end?

six weeks - birth

100

Explain the microanatomy of the hepatic parenchyma

hepatocytes

reticuloendothelial cells (kupffer cells)

organized into lobules

101

What is a Kupffer cell?

are specialized macrophages located in the liver lining the walls of the sinusoids that form part of the reticuloendothelial system (RES)

102

What is another name for ligament teres?

round

(fetal umbilical vein)

103

What is the ligamentum venosum originate from?

ductus venosum

104

How is the right lobe subdivided?

anterior and posterior segments

105

How is the left lobe subdivided?

medial and lateral segments

106

What does the portal venous system drain?

spleen

digestive

pancreas

GB

107

What is the relationship between the stomach and the liver

inferior and lateral to the left lobe

108

What is the reticuloendothelial activity of the liver?

fetal blood production

production of plasma proteins and antibodies

destruction of red blood cells

phagocytosis

109

What are the 7 functions of the liver?

reticuloendothelial

metabolism

storage

blood reservoir

Heat production

detoxification

110

What is stored in the liver?

fats

glycogen

amino acids

A, D, B complex

iron / copper

111

What does the liver detoxify?

medications

hormones

bilirubin

112

What is AST?

aspartate aminotransferase

113

What is the significance of AST?

increases with hepatocellular disease

and muscular and skeletal disease

114

What is ALT

Alanine aminotransferase

115

What is the significance of ALT?

increases with hepatocellular disease and biliary obstruction

116

Which is more specific to liver disease, AST ot ALT?

ALT

117

Diffuse liver disease

hepatocellular disease that affects the entire liver

Fatty

GSD

hepatitis

cirrhosis

118

What is GDS?

gylcogen storage disease is a autosomal recessive genetic disorder of carbohydrate metabolism

119

What is the most common type of GDS to affect the liver?

Type I Von Gierke's

120

What is Pompe DIsease?

GSD Type II affects heart and muscles

121

What are the common lab values for hepatitis?

marked increase in AST and ALT (falls rapidly)

bilirubin increases

122

A caudate lobe/ right lobe (C/RL) ratio meaurement increases to greater than .65 What does this imply?

cirrhosis

123

What is presinusoidal portal hypertension?

Prehepatic

thrombosis in the mesenteric, splenic of portal vein

124

What is intrahepatic portal hypertension?

offending process occurs at the hepatic level

125

What is the most common cause of intrahepatic portal hypertension?

cirrhosis

126

What is posthepatic portal hypertension?

Budd-Chiari

offending process after the hepatic level

thrombosis of the IVC or hepatic veins

127

True liver cysts are

congenital

epithelial lining

128

What is the significance of a liver cyst without an epithelial lining?

non-congenital

trauma

parasitic

inflamatory

129

What is a pyogenic cyst?

pus collection caused by bacteria

most commonly E. coli

130

What is the sonographic appearance of pyogenic cysts?

thick walls w/ poor definition

air may cause comet-trail

mostly right lobed

131

What is Amebic abscess

parasitic

generally disease of colon

well defined thin walls

132

Liver candidiasis

yeast infection

bull's eye or wheel within a wheel

needle aspiration can differentiate from lymphoma

133

What is the sonographic appearance of echinococcal cysts?

mother/daughter cysts or honeycomb appearance

134

What are benign neoplasms of the liver?

adenoma

hemangioma

focal nodular hyperplasia

hemangioendothelioma

mesenchymal hamartoma

135

adenoma

slightly atypical hepatocytes

variable appearance

More common in women taking oral contraceptives

136

What benign lesion is associated with oral contraceptives?

adenoma

137

Hemangioma

network of vascular endothelium

usually hyperechoic

138

hemangioendothelioma

overgrowth of capillary vessels in infants

more common in females

139

Mesenchymal hamartoma

rare

encapsulated cystic tumor

less than 2 years old

140

What are malignant tumors of the liver?

hepatoblastoma

hepatocellular carcinoma (HCC) hepatoma

hepatic angiosarcoma

metastasis

141

hepatoblastoma

malignant germ cell tumor

142

Most common malignant tumor occurring in 3 years and younger

hepatoblastoma

143

What is hepatoblastoma associated with?

beckwith- Wiedemann

144

hepatocellular carcinoma (HCC) hepatoma

most common primary liver tumor

145

What is the most common predisposing factor for hepatocellular carcinoma (HCC) hepatoma?

cirrhosis

146

What is the most common site to metastasize?

liver

147

hepatic angiosarcoma

rare

60 - 80 years

148

Hematoma

collection of blood

caused by trauma

149

What is the term for a malignant lesion of the liver?

A) hepatoma

B) focal nodular hyperplasia

C) cavernous hemangioma

D) fibroma

A) hepatoma

150

Caudate lobe enlargement may be due to:

A) fatty infiltration

B) hepatitis

C) cirrhosis

D) hypertension

...

151

Which is the most predisposing factor of hepatocellular carcinoma in Western civilization?

A) biliary disease

B) echinococcal cyst

C) cirrhosis

D) portal hypertension

...

152

Hepatofugal blood flow may be seen in the main portal vein in patients with:

A) cavernous hemangioma

B) biliary disease

C) fatty infiltration

D) portal hypertension

...

153

The portal triad consists of the:

A) main portal vein, common bile duct, hepatic artery

B) main portal vein, hepatic duct, common bile duct

C) main portal vein, hepatic artery, hepatic vein

D) main portal vein, hepatic artery, hepatic duct

...

154

A patient presents with weight loss, increased alpha fetal protein (AFP), and abdominal distention. This is most characterisitic of:

A) focal nodular hyperplasia

B) liver adenoma

C) hepatoma

D) lymphoma

...

155

Which vessels increase in size as they course superiorly toward the diaphragm?

A) hepatic arteries

B) hepatic veins

C) portal veins

D) patent umbilical veins

...

156

A small hyperechoic nodular liver best describes:

A) acute viral hepatitis

B) chronic viral hepatitis

C) cirrhosis

D) normal pediatric liver

...

157

Which of the following is a characteristic of Budd-Chiari syndrome?

A) thrombus in the hepatic and portal vein

B) thrombus in the hepatic artery and vein

C) thrombus in the hepatic vein and inferior vena cava

D) thrombus in the hepatic artery and aorta

...

158

Which of the following are pathological states of the liver does not demonstrate mass- effect on surrounding hepatic vascularity?

A) fatty infiltration

B) diffuse metastasis

C) focal nodular hyperplasia

D) cavernous hemangioma

...

159

A 30 year old patient presents with abdominal pain and abnormal liver function tests. The abdominal ultrasound reveals a dilated portal and superior mesenteric vein with hepatofugal blood flow. This is most characteristic of:

A) portal aneurysm

B) portal atresia

C) portal fistula

D) portal hypertension

...

160

Normal dimension for the common hepatic duct is considered to be:

A) less than 2 mm

B) less than 3 mm

C) less than 5 mm

D) less than 7 mm

...

161

The lesser omentum ligament is also referred to as the :

A) left triangular

B) gastrohepatic

C) falciform

D) ligamentum teres

...

162

Sonographic findings with acute hepatitis can include all of the following except:

A) periportal cuffing

B) normal liver parenchymal echogenicity

C) decreased liver parenchymal echogenicity

D) decreased echogenicity of portal vein walls

...

163

The liver function laboratory test which is most specific to hepatocellular disease is:

A) ALP

B) AST

C) ALT

D) bilirubin

...

164

A cyst within a cyst (daughter cyst) is a characteristic of:

A) polycystic liver disease

B) echinococcal cyst

C) hepatoma

D) pseudocyst

...

165

When using Brisbane’s liver segmentation, how many segments is the liver divided into?

A) 4

B) 8

C) 9

D) 10

...

166

The following carries the majority of the oxygen and nutrients to the liver?

A) hepatic artery

B) portal vein

C) common duct

D) celiac axis

...

167

The patient preparation necessary to examine the liver is:

A) drink 16 ounces of water

B) NPO for 6 hours

C) clear liquids

D) no specific preparation

...

168

What is the reticuloendothelial function of the liver?

A) phagocytosis of Kupffer cells

B) formation of bile

C) blood reservoir

D) synthesis of amino acids

...

169

What is the most common predisposing condition for a bacterial abscess of the liver?

A) portal vein thrombosis

B) biliary obstruction

C) hepatic artery aneurysm

D) surgical procedure

...

170

The fissure of the ligamentum venosum divides the liver into:

A) right and left lobes

B) left lobe and caudate lobe

C) left medial and lateral segments

D) right lobe and caudate lobe

...

171

A 50 year old diabetic patient presents with abdominal pain and slightly elevated liver function tests. Hepatomegaly and diffuse increase in the liver parenchymal echogenicity are present. This is characteristic of:

A) cirrhosis

B) hepatocellular carcinoma

C) pyogenic infection

D) fatty infiltration

...

172

A 20 year old asymptomatic woman presents for an abdominal ultrasound. A round hyperechoic, subcapsular mass is identified in the right lobe of the liver. This is most characteristic of:

A) hepatoblastoma

B) cavernous hemangioma

C) echinococcal cyst

D) solitary metastatic lesion

...

173

Normal Doppler waveform of the hepatic veins demonstrate a “w” appearance. This appearance is attributes to changes in:

A) respiration

B) right ventricular pressure

C) right atrial pressure

D) left ventricular pressure

...

174

What is the waveform of the portal vein?

card image

low resistance with some phasity

175

What is the waveform of the hepatic vein?

card image

W shape from influence from cardiac cysle

176

What is the waveform of the hepatic artery?

card image

low resistance

177

What is the most common Glycogen storage disease?

Type 1 Von Gierke's

178

What is type 2 Glycogen storage disease?

...