1. The liver develops from ___________ at week 4 gestational age.
  2. Endodermal cells (kupffer cells) grow into ___________ (hemapoietic cells, glissons capsule, pv's).
  3. What happens at week 6 gestational age?
    right lobe enlarges and left lobe develops
  4. Hemapoietc functions begin at ___ and end at birth.
    begins at 6 weeks, peaks at 12-24 weeks
  5. Lymphocyte formation starts at week ___________ gestational age.
  6. ___________ starts at week 13-16 gestational age and does not end at birth.
    bile production
  7. The umbilical vein becomes what after birth?
    ligamentum teres
  8. What does the ductus venosus becomes what after birth?
    ligamentum venosum
  9. The liver occupies which regions of the abdomen?
    most of right hypochondrium and epigastrium and part of left hypochondrium
  10. The liver is covered by what?
    glissons capsule
  11. The normal superior/inferior size of liver is ___________ .
    15-17 cm
  12. The normal weight of the liver is ___________ .
    1200-1600 grams
  13. The fundus of the stomach is ___________ to the left lobe of liver.
  14. The body and antrum of stomach are ___________ to liver.
  15. The ___________ is medial to the right lobe of liver.
  16. The ___________ is inferior to left lobe and right anterior lobe and medial to right posterior lobe.
  17. The right kidney is ___________ to liver.
  18. The GB is ___________ to liver.
  19. The IVC and AO are ___________ to liver.
  20. The right lobe is bordered anterosuperiorly by the ___________.
    falciform ligament
  21. Right lobe is bordered ___________ by caudate lobe.
  22. Right lobe is bordered posteroinferiorly by ___________ .
    viscera (stomach, RK, GB)
  23. Right lobe is bordered anteriorly by ___________ .
    umbilical notch
  24. Right lobe is marked ___________ by porta hepatus, GB fossa, and IVC fossa.
  25. Right lobe functionally includes everything to the right of the ___________ .
    main lobar fissur
  26. The right lobe can be divided by:
  27. The left lobe can be divided by:
    LHV, Lig teres
  28. The ___________ lobe is anatomically part of right lobe but functions in left lobe.
  29. The caudate is bordered by ligamentum venosum anterior and left, and by the ___________ posterior and to the right.
    porta hepatus
  30. The ___________ borders the caudate posterior and to the right.
  31. Coinaud Segment I is __________.
  32. Coinaud Segment II is ___________ .
    left posterolateral
  33. Coinaud Segment III is ___________ .
    left anterolateral
  34. Coinaud Segment IVa is ___________ .
    left superomedial
  35. Coinaud Segment IVb is ___________ .
    left inferomedial
  36. Coinaud Segment V is ___________ .
    right anteroinferior
  37. Coinaud Segment VI is ___________ .
    right posteroinferior
  38. Coinaud Segment VII is ___________ .
    right posterosuperior
  39. Coinaud Segment VIII is ___________ .
    right anterosuperior
  40. The ___________ ligament attaches the liver to diaphragm (bare area).
  41. What 2 aspects are part of the coronary ligament?
    right triangular and left triangular
  42. Which ligament surrounds portal triad, bounds the foramen of winslow, and is the right edge of gastrohepatic ligament?
    hepatoduodenal ligament
  43. Name 3 functions of the liver.
    metabolism of food products, detoxification of waste products, storage of physiologic compounds
  44. Describe a hepatocyte.
    performs metabolic functions and is capable of regeneration
  45. What lines the biliary system?
    epithelial cells
  46. Describe Kupffer cells.
    phagocytic, part of RE, and breakdown hemoglobin (HGB) during bile production
  47. hyperglycemia
    increased blood sugar levels
  48. hypoglycemia
    decreased blood sugar levels
  49. In which food product is sugar converted to glucose and used for energy or converted to glycogen and stored in liver cells?
  50. ___________ are absorbed from the intestines as mono and diglycerides.
  51. Which food product is converted within hepatocytes to lipoproteins and stored until later converted to glucose?
  52. Fats cannot travel thru blood and may accumulate in ___________.
    liver cells
  53. Name the 3 proteins that are metabolized in kupffer cells and contribute to correct blood viscosity.
    albumin, fibrinogen, and prothrombin
  54. Which type of bilirubin is conjugated by hepatocytes, formed in spleen by breakdown of HGb, is water soluble, and increases during post hepatic and hepatic jaundice?
  55. Which type of bilirubin is not yet conjugated, water insoluble, and increases during hepatic and pre hepatic jaundice?
  56. What can the liver store?
    glycogen, fats, vitamins, iron, and copper
  57. How much blood is supplied to the liver via the hepatic artery?
  58. Which normal variant is an inferior extension of posterior right lobe, past the lower pole of RK?
    Riedel’s lobe
  59. Which normal variant is a medial extension of the caudate lobe?
    caudate process
  60. Which disease process affects hepatocytes and is treated medically?
  61. Which disease process is treated surgically and the flow of bile is prevented?
  62. What is bile?
    an excretory product of the liver
  63. Where is bile formed?
    in hepatocytes
  64. Bile is collected in ducts, stored in ___________ and released to___________ where its emulsified and removes liver by products.
    GB; duodenum
  65. Bile salts absorb fats and may cause:
    steatorrhea (fatty stools) or prevent absorption of fat soluble vitamins (A, D, E, K)
  66. Name 5 things that can be stored in the liver.
    glycogen, fats, vitamins, iron, copper
  67. What percentage of blood is supplied by the hepatic arteries?
    20 %
  68. What percentage of blood is supplied by the portal veins?
  69. Blood is drained by the ____________.
    hepatic veins
  70. PVs are ____________.
  71. PV's have brightly echogenic walls and get _____ as the move away from the porta hepatus.
  72. The MPV is formed by the union of the ____________and ____________.
    SV; SMV
  73. The MPV enters the liver where?
    at the porta hepatus
  74. The ____________ has a mostly transverse course and enters the liver at the porta hepatus.
  75. The MPV is surrounded by what ligament?
  76. The MPV immediately divides into what?
    right and left branches
  77. The ____________ is the larger branch of the MPV and has anterior and posterior branches.
  78. The ____________ lies more superoanterior and can be seen to course superiorly to enter the left lobe.
  79. A right, middle, and left vein converge to drain directly into what?
  80. Are HV's intra or intersegmental?
  81. HV's have hyperechoic walls and get ____________ as you move towards the IVC.
  82. What is small left lobe is also called?
    Riedel’s lobe
  83. An inferior extension of posterior right lobe, Riedel’s lobe, is past which pole of the kidney?
  84. What is a medial extension of the caudate lobe?
    caudate process
  85. Which disease process affects hepatocytes and is treated medically?
  86. Which disease process prevents the flow of bile and is treated surgically?
  87. Hepatic enzymes present in ____________ and leak into blood during cellular damage.
  88. SGOT
    serum glutamic exaloacetic transaminase.
  89. What is SGOT now called?
    AST (aspartate aminotransferase)
  90. SGPT
    serum glutamic pyruvate
  91. What is SGPT now called?
    ALT (alanine aminotransferase)
  92. ALP
    alkaline phosphatase
  93. What does LDH increases with?
    heart disease
  94. What does GGTP increases with?
    alcoholic liver disease
  95. What does PT(prothrombin) increase with?
    vitamin K deficiency
  96. Which enzyme decreases during chronic liver disease, GI tract inflammatory processes and increases during dehydration?
  97. Which enzyme increases due to hepatoblastoma?
  98. Biliary obstruction is a mild increase of SGOT, SGPT and a major increase of what?
    ALP, direct bilirubin
  99. Which disease causes a major increase of SGOT, SGPT, and a minor increase of ALP and indirect bilirubin?
    cellular disease
  100. Both SGOT and SGPT may increase due to what?
    heart disease
  101. Which enzyme may increase due to pregnancy or bone disease?
  102. Where is bile, an excretory product of the liver, formed?
  103. Bile is collected in ducts, stored in GB and released to the what?
  104. Bile is composed of what?
    water, bile salts, bile pigment, cholesterol, lecithin, and proteins.
  105. Bile salts absorb ____________.
  106. The absence of bile salts may cause what?
    steatorrhea, prevent absorption of fat soluble vitamins
  107. In general, for liver pathology you should set your machine how?
    set field of view to enable you to see all liver parenchyma and set gains to avoid drop out or bending. (Follow orderly protocol)
  108. Describe a simple cyst.
    smooth walls, no internal echoes (anterior cystic noise) and posterior enhancement
  109. Describe an abscess.
    irregular walls, varying internal echogenicity, some posterior enhancement
  110. What would the patients symptoms be for an abscess?
    fever, elevated WBC
  111. What are intrahepatic abscess' caused by?
    infection or trauma
  112. Where are subhepatic abscess' located?
    in morrison's pouch
  113. What causes subphrenic liver abscess'?
    surgical infection, trauma or ulcers
  114. What results from infection within the protozoan parasite?
    amebic liver abscess
  115. What does a pt with amebic liver abscess' present with?
    fever, anorexia, and abdominal pain
  116. What is a hyatid cyst?
    parasitic tapeworm (cyst within a cyst)
  117. Patients with what kind of cyst present with increasing abdominal girth and/or abdominal pain?
    hyatid cyst
  118. What arises in the liver or in the extrahepatic bile ducts?
  119. ________ are most commonly seen in middle aged women.
  120. Describe a cystadenoma.
    well encapsulated, multiloculated, have septations with varying degrees of mural and septal thickening and nodularity.
  121. Which pathology is intrahepatic or subcapsular and its appearance depends on age?
  122. How does a new hematoma appear?
  123. How does a hematoma appear as it ages?
    clot forms and it becomes echogenic
  124. How does a chronic hematoma appear?
    begins to liquefy (hygroma formation) as it resolves
  125. Patients with hematomas have decreased what?
  126. What is a neoplasm?
    Any new growth of abnormal tissue (may be benign or malignant)
  127. True or False. Calcifications are often symptomatic.
    False, they are asymptomatic.
  128. What is the most common causes of a calcification?
    calcified granuloma (eg, tuberculosis and histoplasmosis) and hydatid disease
  129. An adenoma is typically ____________.
  130. A ____________ and ____________ both have increased incidence in women taking birth control pills and both tend to be small, focal lesions with increased echogenicity.
    adenoma, hamartoma
  131. Where in the liver are adenoma and hamartoma often seen?
  132. Can an adenoma or hamartoma hemorrhage?
  133. What is a hemangioma?
    Tend to be small, focal lesions with increased echogenicity
  134. Larger hemangioma's may cause what?
    nausea and vomiting
  135. Name 3 things about hemangioma's.
    they are vascular, more common in women, and most common benign liver mass
  136. What is a lipoma?
    a benign fatty tumor of the liver.
  137. Describe a hepatoma.
    arises from hepatocytes, poorly defined, often occur after long term cirrhosis or hepatitis
  138. Which liver enzymes increase when you have a hepatoma?
    ALP, AST, prothrombin, and AFP (fetal cells gone crazy)
  139. Are hepatomas more common in women or men?
  140. What else is a hepatoma called?
    hepatocellular carcinoma (HCC)
  141. What pathology presents in the first 3 yrs of life?
  142. A hepatoblastoma is the most common symptomatic liver tumor occurring under the age of what?
    5 yrs
  143. What does a hepatoblastoma present with?
    a large palpable mass
  144. What is the most common liver neoplasm?
  145. The primary of mets (metastatic disease) may be:
    colon, breast, lung, pancreas, stomach, lymphoma or melanoma
  146. What does the bowel tend to look like in mets?
    hyperechoic with a bullseye appearance.
  147. What are the 3 appearances of mets?
    well defined hypoechoic mass, well defined hyperechoic mass, diffuse parenchymal changes
  148. Mets is hypoechoic in nature unless they come from the ____________, then they tend to be hyperechoic.
    GI tract
  149. Tendencies: poorly defined means its mainly ____________, and well defined means it mainly ____________.
    malignant; benign
  150. More tendencies: post. enhancement means ______, and post. shadow means its ______.
    benign; malignant
  151. True or false. In liver mets, shadows tend to be bad if post. to a calcification.
  152. What is a lymphoma?
    a well defined hypoechoic malignancy of lymphatic tissue within an organ
  153. Which malignant tumor has hepatomegaly with paranchymal changes and generally no target sign?
  154. Where does a lymphoma typically occur?
    anywhere in your body
  155. When a lymph node gets big its called a ____________.
    lymphadenopathy (enlargement of a node)
  156. Lymphatic tissue is almost always ____________.
  157. Normal to decreased echogenicity with hepatomegaly is common is which form of hepatitis?
  158. Increased echogenicity and decreased size due to scarring and fibrosis is common in ____________ hepatitis.
  159. Hepatitis has 3 increased liver enzymes, what are they?
    ALT, AST, and bilirubin
  160. Symptoms of hepatitis include:
    Nausea, vomiting and fatigue
  161. True or false. Acute hepatitis can look totally normal.
  162. Which infiltrating liver disease is often secondary to heart failure, obesity, and alcohol abuse and has hepatocytes that are damaged w/ fat accumulates?
    fatty infiltration
  163. Fatty infiltration has ____________ sound penetration due to increased attenuation.
  164. Liver echogenicity is slightly increased, with normal visualization of the diaphragm and the intrahepatic vessel borders. Which fatty infiltration is this?
    grade 1 (mild)
  165. Echogenicity is moderately increased, with slightly impaired visualization of the diaphragm or intrahepatic vessels.
    Grade 2 (moderate)
  166. Echogenicity is markedly increased, with poor or no visualization of the diaphragm, the intrahepatic vessels, and posterior portion of the right lobe. Which fatty infiltration is this?
    Grade 3 (severe) fatty infiltration
  167. How does focal fat infiltration appear?
    appears as a hyperechoic area within normal or relatively normal liver parenchyma
  168. Areas of focal fatty infiltration may also be seen within a liver, with what else?
    scattered areas of patchy fatty infiltration and patchy focal sparing
  169. In fat sparing the etiology is unclear but is may be related to what?
    decreased regional portal flow
  170. is the area of focal sparing usually solitary or multiple?
    usually solitary, may be multiple
  171. How does focal sparing appear?
    hypoechoic area with relatively distinct margins within hyperechoic fatty liver
  172. Focal sparing is most commonly seen in which 3 areas?
    in the medial segment of the left lobe adjacent to the main lobar fissure, anterior to the portal vein bifurcation, medial and anterior to the neck and proximal body of the gallbladder
  173. Fibrotic Liver DX:
    small, echogenic liver
  174. Focal Nodular Hyperplasia:
    diffuse or localized fat sparring or scarring
  175. Cirrhosis symptoms include:
    anorexia, dyspepsia, nausea, vomiting, increasing jaundice and abdominal girth
  176. Liver becomes nodular due to cell death, fibrosis and regeneration in what disease?
  177. What is cirrhosis caused by?
    alcohol (ETOH) abuse and hepatitis
  178. How doe cirrhosis appear?
    Increased liver echogenicity and distorted parenchyma with decreased penetration
  179. what are the Sonographic Signs of Cirrhosis?
    Coarse echo pattern, diffusely inhomogeneous echo pattern, increased echogenicity, surface nodularity-Volume redistribution, enlarged caudate and left lobe/small right lobe, caudate: right lobe ratio > 0.65, right lobe: left lobe ratio < 1.3, left portal vein diameter right portal vein diameter, signs of portal hypertension
  180. Liver flow is ____________ or towards the liver.
  181. Liver flow away from the liver is?
  182. paraumbilical vein varices
    ligamentum teres becomes a collaterol pathway for blood and its pretty stable
  183. coronary vein varices
    collaterols that develop to get rid of blood in liver. high risk of rupture.
  184. What is a varice?
    enlarged vessel, usually a vein
  185. Collaterol flow vessels include:
    splenorenal and gastrorenal-splenorenal collaterol veins
  186. Portal vein thrombosis is due to:
    tumor invasion (HCC), inflammatory disease, blood clotting, and chronic hepatitis or cirrhosis
  187. What does PV thrombosis look like sonographically?
    enlarged PV and filled with echogenic clot
  188. Acute PV thrombosis appears:
    PV is big and filled with newly clotted blood. hypoechoic
  189. Chronic PV thrombosis appears:
    small PV filled with clotted blood and is hyperechoic
  190. In PV thrombosis, the liver only get what % of blood: then what happens?
    20%; liver will atrophy and collapse in on itself. Will look heterogeneous and nodular
  191. What is cavernous transformation of the PV?
    adjacent collaterol veins enlarge to span the obstruction and permit continued hepatopetal flow of blood. (PV may reopen and the thrombosis begins to resolve.)
  192. What is budd-chiari syndrome?
    is obstruction to HV outflow due to tumor invasion or thrombus
  193. What may be congenital or secondary to portal hypertension?
    intrahepatic portosystemic venous shunts
  194. what is TIPS?
    transjugular intrahepatic portosystemic shunts. the placement of an expandable metallic stent inserted thru the IJV into the liver between the intrahepatic PV & HV
  195. In TIPS, blood is shunted from the portal circulation to where?
    to the systemic circulation thru the stent, thereby diverting blood away from the varices.
  196. In TIPS, where is the risk for getting a thrombus at?
    at ends of shunt (From MPV to HV)
  197. DIPS
    direct intrahepati portocaval shunt. goes from IVC to PV and excludes HV's. in research only
  198. What is the most common procedure for liver transplants?
    to use cadaveric orthotopic transplantation of entire liver to recipient.
  199. What are the variations of liver transplants?
    segmental transplant from living related donor (usually left lobe). or segmental transplant of cadaveric liver
  200. What are the 5 anastomoses performed in liver tranplantation?
    donor IVC to recipient IVC 2 cm from right atrium; caudal end of IVC to recipient IVC; donor PV to recipient PV; HA to HA; CBD to CBD
  201. What is prehepatic jaundice?
    prevents hepatocytes from taking up bilirubin and conjugating it
  202. What is hepatic jaundice?
    cellular liver damage prevents bilirubin from either being conjugated or being further processed
  203. What is posthepatic jaundice?
    biliary obstruction prevents the outflow of bile
  204. What is cholangiocarcinoma and what are the symptoms?
    is a malignancy of the ducts. symptoms include: intermittent jaundice, weight loss, nausea, and vomiting
  205. Which enzymes increase with cholangiocarcinomas?
    increased direct bilirubin, ALP, and AST
  206. A primary adenocarcinoma of the bile duct epithelium which may distort the porta hepatus is:
Card Set