Liver Q&A

where is the liver located?

under diaphragm, RUQ, occupies right hypochondria and part of epigastrium

Is the liver retroperitoneal or intraperitoneal organ?

intraperitoneal

The part of the liver that is not covered by the peritoneum is called:

bare area

bare area is located:

posterosuperior surface of liver

what courses through the bare area

IVC

liver is made up of (3):

hepatocytes, kupffer, fibrous tissue

liver is covered by ____ capsule

glisson’s

normal measurement of the liver:

13-15 cm, up to 17 cm for larger patients

3 lobes of liver:

right (largest), left, caudate (tail)/spiegel’s (smallest)

right lobe is divided into:

anterior and posterior

left lobe is divided into:

lateral and medial (quadrate)

another name for caudate lobe:

spiegel’s lobe

the caudate lobe is located:

posterosuperior aspect of liver

caudate lobe is bordered:

• posteriorly by ___

• anteriorly by ____

• anterioinferiorly by ____

IVC; ligamentum venosum; proximal LT portal vein

3 fissures of the liver:

1. main lobar fissure

2. right intersegmental fissure (not seen)

3. left intersegmental fissure (not seen)

main lobar fissure divides the liver into:

right and left (right anterior and medial left)

main lobar fissure connects the GB and PV (t or f)

true

the U/S appearance of the MLF is:

echogenic

right intersegmental fissure divides the liver lobe into:

right lobe into: anterior and posterior segments (coronal)

(contains right hepatic vein)

left intersegmental fissure divides left lobe into:

medial and lateral (sagittal)

contains left hepatic vein, falciform ligament, ligamentum teres

another name for medial segment of left lobe:

quadrate lobe

2 ligaments that are identified on a routine scan are:

1. ligamentum teres

2. ligamentum venosum

In utero the umbilical vein brings the oxygenated blood from the mother and enters into the fetal abdomen (liver) and it divides into:

right UV branch (Ductus Venosus) and left UV branch

after birth, the left UV branch closes and becomes:

ligamentum teres (round ligament)

after birth, the right UV branch (ductus venosus) becomes:

ligamentum venosum

the round ligament/ligamentum teres separates the left lobe into:

medial and lateral segments

U/S appearance of ligamentum teres:

echogenic

The ligamentum teres could recanalizes(reopens) in case of:

severe cirrhosis

function of the ductus venosus in utero:

shunts blood from umbilical vein to IVC bypassing the liver

ductus venosus divides caudate lobe from:

left lobe

____attaches the liver to anterior abdominal wall

falicform ligament

___attaches liver to diaphragm

coronary and right & left triangular ligaments

The couinaud classification of liver anatomy divides the liver into -------------functionally segments

nine

segmental anatomy of the liver is determined by:

branching of portal veins

liver receives blood supply from ____ and ____

portal vein; hepatic artery

80% of blood supply of liver is from:

portal vein

MPV and PHA enter the liver in area called:

porta hepatis (hilum)

MPV is formed by union of:

SMV + SV + IMV

inferior mesenteric vein (IMV) joined the splenic vein (SV) near the:

body/tail of pancreas

SMV and SV join __ to head of pancreas

posterior

size of MPV and SV / IMV is:

MPV <13mm

SV and IMV <10mm

portal vein enters liver carrying blood drained from the: (4)

spleen, stomach, bowel, pancreas

oxygen content of the PV is:

80-85%

which three things in the liver are intrasegmental:

PV, HA, CBD

hepatic veins are ____ and ____

intersegmental and interlobar

___originates at splenic hilum

splenic vein

____Originates at the mesentery (intestine) and joins splenic vein posterior to the neck of the pancreas to form main portal vein

SMV

___Joins splenic vein posterior to the body of the pancreas, usually not easily seen sonographically

IMV

MPV bifurcates into ____ and ____ once is enters liver

right and left portal veins

RPV bifurcates into:

anterior and posterior branch

LPV bifurcates into:

medial and lateral branch

flow within PVs is called:

hepatopetal (toward liver)

flow away from liver is called:

hepatofugal (abnormal)

flow within hepatic arteries is:

hepatopetal (toward liver)

flow within hepatic veins:

hepatofugal

Portal vessels decrease in size as they course into the liver; Hepatic veins increase in size as they near the diaphragm to exit the liver. T/F

true

Hepatic veins have thicker walls than portal veins. T/F

false

normal pressure in portal vein:

5-10 mmHg

Portal flow rate and diameter increases with inspiration and after eating. T/F

true

Portal veins branch horizontally (transversely) toward porta hepatis. T/F

true

PVs get larger as they move away from the porta hepatis. T/F

false

PVs are smaller as they approach the diaphragm. T/F

true

Commonly how many hepatic veins are seen in a patient

3: right, middle, left

Right hepatic vein (RHV) drains----------- lobe, divides right lobe into----------- and -----segments

right; anterior and posterior

Left hepatic vein (LHV) drains ----lobe, divides left lobe into ----------- and -----------segments

left; medial and lateral

Middle hepatic vein (MHV) drains part of the ------ and ------ lobes, divides liver into---- and --- lobes

right and left; right and left

The vein that drains the caudate lobe directly into the IVC is called

emissary vein

The caudate lobe is supplied by

Both left & right hepatic arteries and left & right portal veins

Hepatic veins are the largest tributaries to the IVC. T/F

true

The best way to demonstrate the 3 hepatic veins by u/s is:

Oblique subcostal approach angled toward patient’s right shoulder entering IVC

HVs are intersegmental & interlobar. T/F

true

HVs get larger as they move towards the IVC or diaphragm. T/F

true

Flow in the hepatic veins is:

Triphasic flow and hepatofugal

The portal triad is consists of:

1. Hepatic artery 2. Portal Vein 3. Bile Duct

HA and bile duct are anterior to PV. T/F

true

The 5 land marks that divide the liver into right and left lobe are:

1. MHV 2. MPV 3. MLF 4. GB 5. IVC

The 3 land marks that divide the right lobe into anterior and posterior segment are:

1. RHV 2. RPV 3. Right intersegmental fissure

The 5 land marks that divide the left lobe into medial and lateral segment are:

1. LHV 2. LPV 3. Left intersegmental fissure 4. Ligamentum teres 5. Falciform ligament

The land mark that separates the caudate from left lobe is:

Ligamentum venosum

The main functions of the liver are: (6)

1. Metabolism of carbohydrate, lipid and protein

2. Storing certain vitamins, minerals, and sugars

3. Filtration/detoxification

4. Digestion: secretion & storage of bile

5. Producing immune (phagocytosis) factors and removing bacteria, helping the body fight infection (Kupffer cells)

6. The liver is responsible for hemopoiesis during the embryonic life

(how I remember: Shadows (storing) Drift (digestion) Midday (metabolism) Past (producing) Forgotten (filtration) Hills (hemopoiesis)

Liver function tests (LFT’s) refers to:

A group of various laboratory (blood) tests established to provide the clinician with an analysis of how the liver is performing under normal and diseased conditions

The lab values that may be increased due to liver cell disease are: (4)

1. ALT 2. AST 3. Indirect (unconjugated bilirubin) 4. LDH

Between ALT & AST which one is more sensitive for liver cell disease?

ALT

The two lab values that will increase due to bile obstruction are:

1. ALP 2. Direct (conjugated bilirubin)

-----------is used to determine the clotting tendency of blood

Prothrombin time (PT)/INR/PTT

----------- elevation may indicate primary or secondary cancerous liver tumors.

Alpha fetoprotein (AFP)

The transducer choice to scan the liver is:

3.0 MHz curve linear. 5.0 MHz for very thin patient

Patient preparation for scanning the liver is:

Nothing by mouth (NPO) for 6-8 hours to eliminate bowel gas and ensure fullness of gallbladder

Patient position for scanning the liver is:

Supine or left posterior oblique position

Sonographic appearance of the liver is:

Homogeneous parenchyma, mid gray echo texture

Interruptions in homogeneous appearance of the liver could be because of:

Vascular structures and Ligaments

The u/s appearance of fissures and ligaments is:

Echogenic

The u/s appearance of blood vessels is

Anechoic lumen & echogenic walls

Compare the echogenicity of the liver with the cortex of the kidney:

The liver echo texture is slightly greater than renal cortex

Compare the echogenicity of the liver with the pancreas:

The liver echo texture is less (the liver is darker, hypoechoic) than pancreas

Compare the echogenicity of the liver with the spleen:

The liver echo texture is isoechoic to echogenic compared to the spleen

---------------is a tongue-like extension of the right lobe.

riedel’s lobe

Riedel’s lobe may increase cranial-caudad liver length. T/F

true

------------is an Inferior extension of the caudate lobe.

Papillary process

--------------------- is the most common variation in hepatic vein anatomy.

An accessory right hepatic vein