abdomen registry review - liver

the liver is a(n) ___ organ.

intraperitoneal

the covering of the liver is known as ____.

Glisson Capsule

what makes up the portal triad?

portal vein, hepatic artery, CBD

the caudate lobe is separated from the left lobe by the ____.

ligamentum venosum

the caudate lobe is bordered posteriorly by the ___.

IVC

in utero, the ____ becomes the ligamentum venosum.

ductus venosus

ligamentum teres is also known as the ___.

round ligament

in utero, the ligamentum teres is the ____.

umbilical vein

what percent of blood supply to the liver is from the MPV?

70%

what supplies the liver with oxygenated blood?

MPV and proper hepatic artery

the proper hepatic artery and the MPV enter the liver at the ____.

porta hepatis

MPV and the proper hepatic artery should have what type of flow?

hepatopetal

the hepatic artery has ___ resistance.

low

drainage of deoxygenated blood from the liver is by the ____.

hepatic veins

the hepatic veins show what type of flow?

hepatofugal

the portal vein shows what type of waveform?

steady, minimally phasic

the hepatic veins drain into the ____.

IVC and then into the right atrium

extension of the right lobe of the liver over the right kidney

Reidel’s lobe

to distinguish Riedel’s lobe from hepatomegaly, what should be looked at?

the left lobe for enlargement

inferior extension of the caudate lobe

papillary process

the liver is considered normal up to ____.

15 cm

the liver appears slightly ___ when compared to the right kidney.

echogenic

the MPV diameter should be ___.

1.3 cm

liver enzymes that are checked are ____, ____, and ___.

ALT, ALP, AST

ALT =

alanine transaminase

ALP =

alkaline phosphatase

AST =

aspartate transaminase

term used when bilirubin is elevated

hyperbilirubinemia

hyperbilirubinemia (elevated bilirubin) =

jaundice

another term for fatty liver disease is ___.

hepatic steatosis

fatty liver disease may lead chronic steatohepatitis which may lead to chronic disease such as ___.

cirrhosis

what is the most common diffuse liver disease and is most likely the reason for elevated LFTs?

fatty liver infiltration (hepatic steatosis)

clinical signs of fatty liver infiltration

elevated LFTs, no symptoms

sonographic appearance of fatty liver infiltration

echogenic/dense, poor through transmission (high attenuation), poor visualization of vascular

focal hypoechoic area, patch of normal liver, no mass effect

focal fatty sparing

what is the most common location of focal fatty sparing?

next to GB/porta hepatis

what is the most common cause of cirrhosis?

alcoholism

cirrhosis is the result of ____.

liver cell death and fibrosis/liver failure

clinical signs of cirrhosis

elevated LFTs, jaundice, fatigue, weight loss, diarrhea

sonographic appearance of cirrhosis

heterogeneous/coarse texture, small right lobe and enlarged caudate lobe, nodular surface, ascites

the nodular surface of a cirrhotic liver is best evaluated with ____.

higher frequency linear array

smaller nodules seen in cirrhosis patients when caused by alcoholism

micronodular

macronodular surface seen in cirrhosis are nodules measuring ____ when caused by ____.

>1 cm; hepatitis

patients with cirrhosis have an increased risk of ____.

portal hypertension and HCC

what is the most common cause of portal hypertension?

cirrhosis

increased pressure on the portal system, redirecting blood flow AWAY from the liver

portal hypertension

what occurs when pressure of liver disease increases too much?

resists flow coming into the liver and flow is drawn to other lower pressure channels; blood backs up into veins that normally drain into the PV causing dilation or venous collaterals

veins that normally drain into the portal vein =

splenic vein and coronary vein (left gastric)

sonographic appearance of portal HTN

hepatofugal flow, MPV measuring greater than 1.3 cm, dilated venous collaterals,

treatment for portal hypertension

TIPPS (transjugular intrahepatic portosystemic shunt)

communication or bridge between PV and HV to decompress the portal vein and normalize flow direction

TIPSS

if a TIPSS is successful, what will flow demonstrate?

hepatopetal at proximal RPV and hepatofugal at distal RHV

what is obstruction of the PV most commonly caused by?

tumors or lymphadenopathy

thrombosis of the PV may be caused by…

increased liver resistance (HCC, mets, portal HTN) or increased clotting factors

clinical signs of portal vein compression/thrombosis

elevated LFTs, hypovolemia, nausea, vomiting

sonographic appearance of portal vein compression/thrombosis

thrombosis of PV, cavernous transformation

portal vein compression/thrombosis could lead to cavernous transformation which = ____.

periportal collaterals

small vessels surrounding the portal vein to reroute the blood around the clot towards the liver

periportal collaterals

cavernous transformation is different that portosytstemic collaterals. portal HTN collaterals reroute the blood ____.

away from the liver

cavernous transformation is different that portosytstemic collaterals. cavernous transformation is rerouting the blood _____.

back into the liver

occlusion of the hepatic veins and possibly the IVC that leads to liver congestion and eventual liver necrosis

Budd-Chiari syndrome

in cases of Budd-Chiari syndrome, the ____ enlarges to compensate.

caudate

sonographic appearance of Budd-Chiari syndrome

hepatomegaly, enlarged caudate lobe, absent flow hepatic veins

hepatitis is a ____ infection.

diffuse

because hepatitis is a diffuse infection, LFT’s will always be ____.

abnormal

because abscesses are focal, LFT’s might be ___.

normal

fever + a focal finding likely = ____.

abscess

diffuse labs + fever = ___

whole organ infection

the most common form of hepatitis are ___ and ___.

A and B

hepatitis C is most likely the cause of needing ____.

liver transplantation

most common acute hepatitis

hepatitis A

hepatitis A has ____ route.

fecal-oral

clinical signs of acute hepatitis

fever, non-obstructive jaundice (elevated direct bilirubin), elevated LFTs

when acute hepatitis has progressed enough, what is the sonographic appearance?

starry sky, hepatomegaly, hypoechoic

most common chronic hepatitis

hepatitis C

hepatitis C is transmitted by ___.

bodily fluids

chronic hepatitis may have signs of ____ on ultrasound.

fibrosis or cirrhosis

clinical signs of liver abscesses

infection symptoms, fever, pain, leukocytosis

water-lily sign that is associated with daughter cysts

echinococcal cyst

an amebic liver cyst is from a parasite from ___.

water

amebic parasite affects ___ first.

GI

a pyogenic abscess is the result of…

another infection

cysts of the liver are mostly benign and asymptomatic and are associated with…

polycystic kidney disease

most common benign liver tumor

hemangioma

tumor of the liver that has a varied appearance, may be echogenic; associated with orgal contraceptives

adenoma

tumor of the liver made of fat that appears hyperechoic

lipoma

2nd most common benign liver tumor; may be isoechoic to the liver, central scar with vascularity

focal nodular hyperplasia (FNH)

a “bleed” from trauma or surgery

hematoma

hematoma occur within the organ/liver; more focal appearing

intraparenchymal hematoma

hematoma around the liver, just under the Glisson capsule; like free fluid

subcapsular

clinical signs of hematoma

trauma or biopsy history; decreased hematocrit, pain

sonographic appearance of hematoma

anechoic to echogenic depending on the age

hepatocellular carcinoma is also called ____.

hepatoma

increased risk for HCC is seen in patients with…

chronic liver disease, cirrhosis, hepatitis

most common primary liver cancer

HCC

tumor marker for HCC =

elevated AFP

usual sonographic appearance of HCC

usually solitary, hypoechoic mass, ascites

what are the most common sources of cancer found in the liver?

lung, colon, and breast

the liver is the most common location for ___.

mets