ARRT Exam Prep Liver

Alcoholic liver disease

Liver injury resulting from alcohol abuse

Amebic hepatic abscess

An absecc that develops from a parasite that grows in thecolon and invades the liver via the portal vein

Arteriovenous fistula

An abnormal passageway between an artery and vein

Bare area

The region of the liver not covered by the peritoneum

Biloma

A collectio of bile within the abdomen; it can be intrahepatic or extrahepatic

Kupffer cells

Specialized macrophages within the liver that engulf pathogens and damaged cells

Leukocytosis

An elevated WBC count

Ligamentum teres

A ligament that forms part of the edge of the falciform ligament of the liver, connecting the liver to the umbilicus; a remnant of the left umbilical vein; also refered to as the round ligament of the liver

Ligamentum venosum

A remanant of the fetal ductus venosus; it appears as a hyperechoic linear ligametn between the caudate and left liver lobes

Liver fibrosis

The development of scar tissue within the liver as a result of the liver repeatedly trying to repair itself

Liver hilum

The area of the liver where the common bile duct exits the liver and portal vein and hepatic artery enter the liver; also referred to as porta hepatis

Malignant degeneration

The deterioration of a benign mass into malignancy

Palmar erythema

Reddening of the palms

Periportal cuffing

An increase in echogenicity of the portal triads seen in hepatitis and other conditions

Caput medusae

Recognizable dilation of the superficil veins in the abdomen

Cavernous hemangioma

The most common benign liver tumor

Cholangitis

Inflammation of the bile ducts

Cirrhosis

A condition defined as hepatocye death, fibrosis and necrosis of the liver, and subsequent development of regeneraating nodules

Conjugated bilirubin

The water soluble formof bilirubin that is excreted into the intestines in bile and excreted in the stool; also referred to as direct bilirubin

Couinaud classification

A system used to separate the liver into eight surgical segments; used to describe functional liver anatomy

Cruveilhier-Baumgarten syndrome

A syndrome characterized by cirrhosis, portal hypertension, and dialtion of the umbilical and paraumbilical veins

Cystic fibrosis

A genetic disorder linked with the developmetn of scar tissue accuulation within the lungs, liver, pancreas, kidneys and/or intestines

Diaphragmatic slip

A pseudomass of the liver ssen on sonography resulting from hypertrophied diaphramatic muscle bundles

Dysentery

An infection of the bowel which leads to diarrhea that may contain mucus and/or blood

Echinococcus granulosus

A parasite responsible for the development of hydatid liver cysts

Epstein-Barr virus

The virus responsible for mononcleosis and other potential complications

Facial telangiectasia

Dilated or broken vessels located near the surface of the skin on the face that appears like thread like red lines; commonly refered to as spider veins

Falciform ligament

The ligament that attaches the liver to the anterior abdominal wall

Fatty liver

A reversible disease characterized by deposits of fat within the hepatocytes; also referred as hepatic steatosis

Fector hepaticus

Bad breath secondary to end-stage liver disease and the livers inability to filter toxins; often accomponies cirrhosis, portal hypertension, and hepatic encephalopathy

Focal fatty sparing

Manifestation of fatty liver disease in which an area of the liver is spared from fatty infiltration

Focal nodular hyperplasia

A benign liver mass composed of combination of hepatocytes and fibrous tisue that typically contins a central scar

Glisson capsule

The thin fibrous casing of the liver

Gynecomastia

Enlargement of the male breast

Hematemesis

Vomiting blood

Hemochromatosis

An inherited disease characterized by a disproportionate absorption of iron

Hemopoiesis

The formation and development of blood cells

Hepatic candidiasis

A hepatic mass that resultsfrom the spread of fungus in the blood to the liver

Hepatic encephalopathy

A condition in which a patient becomes confused or suffers from intermittent loss of consciousness secondary to the overexposure of the brain to toxic chemicals that the liver would normally remove from the body

Hepatic jaundice

Jaundice resulting from the liver's inability to cojugate bilirubin; may be caused by conditions such as viral hepatiis, toxins, drugs, cirrhosis, and liver cancer

Hepatocellular adenoma

A benign liver mass often associated with the use of oral contraceptives

Hepatorenal syndrome

The development of renal impairment and possible renal failure because of chronic liver diease

Hepatosplenomegaly

Concurrent enlagemnt of the liver and spleen

Hydatid liver cyst

A liver cyst that develops from a tapeworm that lives in dog feces; also referred to as an echinococcal cyst becuase of the parsite that it originates from

Hypovolemia

Decreased blood volume

Inferior vena cava web

A rare condition characterized by obstruction of the IVC by membranous or fibrous bands; can cause obstruction of the hepatic veins leading to Budd-Chiari syndrome

Ischemic bowel disease

A condition that resulsfrom decreased blood flow to the intestines resulting in damaged bowel tissue owing to inadequate oxygenation; also referred to as intestinal ischemia

Kernicterus

Brain damage from bilirubin exposure in newborns with jaundice

Pneumobilia

Air within the biliary tree

Posthepatic jaundice

Elevation in bilirubin caused by an obstruction of bile flow, typically by a gallstone lodged in the biliary tract or a pancreatic mass

Prehepatic jaundice

When the liver cannot process the amount of hemolysis of the red blood cells, resulting in abuildup of circulating bilirubin in the bloodstream

Pseudocirrhosis

The nodular appearance of the liver caused by multiple metastatic tumors

Purpura

Blod spots under the skin that may appear purple

Pyogenic liver abscess

A liver abscess that can result from the spread of infection from inflammatory conditions such as appendicitis, diverticulitis, cholecystitis, cholengitis, and endocarditis

Quadrate lobe

The medial segment of the left lobe

Sequela

An illness resulting from another disease, trauma, or injury

Serpiginous

Twisted or snake-like pattern

Shear wave elastography

An elastography technique that utilizes a standard ultrasound transducer with elastogrphy technology to obtain information about the stiffness of tissue in case of liver fibrosis or necrosis

Spider nevi

A cluster of vessels oted in the skin that have a web like pattern; singular form in nevus

Splanchnic circulation

Blood flow to the major GI organs including the stomach, liver, spleen, pancreas, small intestine, and large intestine; consists of the celiac artery, superior mesenteric artery and inferior mesenteric artery

Steatohepatitis

A type of fatty liver disease that causes inflammation of the liver

Total parental hyperalimentation

A procedure in which an individual receives viatamin and nutrients through a vein, usually the subclavian vein

Transient elastography

An imaging technique that utilizes a special transducer to assess the liver and other organs for sign of cirrhosis and fibrosis; usedto measure stiffness of tissue

Transjugular intrahepatic portosystemic shunt (TIPS)

The therapy for portal hypertension that involves the placement of a stent between the portal veins and hepatic veins to reduce portal systemic pressure

Unconjugated bilirubin

The non-water soluble form of bilirubin that travels to the liver via the bloodstream; it is eventualy converted to conjugated bilirubin by the liver; it is also referred to as indirect bilirubin

Von Gierke disease

A condition in which the body does not have the ability to break down glycogen; also referred to as glycogen storage disease type 1

Von Hippel-Lindau disease

An inherited disease that includes the development of cysts within the liver, pancreas and other organs

Decreased albumin is indicituve of

Chronic liver disease and cirrhosis

Increased ALP is indictive of

Cirrhosis, extrahepatic biliary obstruction, gallstones, hepatitis, metasatic liver disease, and pancreatic carcinoma

Increased ALT is indicitve of

Biliary tract obstruction, hepatitis, hepatocellular disease, and obstructive jaundice

Increase AST is indictive of

Cirrhosis, fatty liver, hepatitis, and metastatic liver disease

Increased Gamma-glutamyl transferase (GGT) is indicitive of

Diffuse liver disease, and posthepatic obstruction

Increased direct bilirubin is indicitive of

Acute hepatocellular disease

Increased indirect bilirubin is indictive of

Biliary tract obstruction

Increased ttal bilirubin is indictive of

Cirrhosis, hepatitis, and other liver cell diseases

Increased LDH indicitive of

Obstructive jaundice, cirrhosis, and hepatitis

Prolonged PT is indicitive of

Metastasis of the liver and hepatitis

Shortened PT is indicitve of

Extrahepatic duct obstruction

Increase AFP is indicitive of

Hepatocellular carcinoma, and a hepatoblastoma

Doppler characteristics of the portal veins

Hepatopetal and monophasic with some variation with breathing

Doppler characteristics of the hepatic veins

It is hepatofugal and triphasic

Portal veins function

They transport blood to the liver from the intestines and other organs

Hepatic veins functions

They drain blood fromthe liver and deposit it directly into the IVC

The portal veins are located

Intrasegmental with the main portal vein coming in at the porta hepatis

The hepatic vein are located

In the upper aspect of the liver. They are intersegmental and interlobar

Number and pattern of the portal veins

The main portal vein branches into the left and right. They decrease in size as they approach the diaphragm

Number and pattern of the hepatic veins

There are 3 right, left, and middle but some people may have more. They increase in size as they approach the diaphragm

Sonographic appearance of the portal veins

They have hyperechoic walls

Sonographic appearance of the hepatic veins

They are thin walled

Clinical findings of fatty liver disease

Asymptomatic, alcohol abuse, chemo, diabetes, elevated LFT's, hyperlipidemia, obesity, and pregnancy

Sonographic findings of diffuse fatty liver disease

Diffusely echogenic liver, increased attenuation of the sound beam, and an increased difficulty to visualize the hepatic vasculature and hemidiaphragm

Sonographic findings of focal fatty infiltration

A hyperechoic area adjacent to the gallbladder, near the porta hepatis, or part of the liver lobe may appear echogenic

Sonographic findings of focal fatty sparing

Hyperechoic area adjacent to the gallbladder, near the porta hepatis, or part of a lobe or an entire lobe may be spared. Can appear much like pericholecystic fluid when identified adjacent to the gallbladder

Clinical findings of hepatitis

Chills, dark urine, elevated LFT's, fatigue, fever, heptosplenomegaly, jaundice, nausea, and vomiting

Sonographic findings of hepatitis

Normal liver, enlarged hypoechoic liver, periportal cuffing with starry sky appearance, gallbladder wall thickening

Clinical findings of cirrhosis

Ascites, diarrhea, abnormal LFT's, fatigue, heptomegaly, juandice, splenomegaly, weight loss with muscle wasting, caput medusae, spider nevi, palmar erythema, gynecomastia, fector hepaticus, facial telangiectasia, hepatic encephalopathy, testicular atrophy, hemorrhoids

Sonographic findings of cirrhosis

Hepatosplenomegaly, enlarged echogenic rigth lobe, enlarged caudate and left lobes, nodular surfce irregularity, course echotexture, splenomegaly, ascites, monophasic flow within the heptic veins, hepatofugal flow within the portal veins

Portosystemic collaterals that may form in case of portal hypertension

Coronary vein, short gastric vein, gastrorenal pathway, splenorenal pathway, the umbilical vein, anterior abdominal wall vein, superior mesenteric vein

With portal hypertension the portal vein diameter will be

Greater than 13mm

With portal hypertension the superior mesenteric vein diameter will be

Greater than 10mm