Normal week 6 liver

Liver functions (8)

Produce bile-important for digestion of fats

Role in carbohydrate, protein, and fat metabolism

Converts excess amino acids into urea and glucose

Create glycogen from glucose and stores it

Releases glycogen as glucose

Makes heparin

Regulates blood volume

Plays a role in detoxification

Largest abdominal organ

Liver

The liver is a ____ organ

Intraperitoneal

Liver position/location

Fills right hypochondriac space and extends across epi gastric space, often left mammary line

Extends to inferior right costal margin

Lies agains diaphragm

What covers the liver?

Glissons capsule

Falciform ligament

Divides right and left lobes of liver

Suspends the liver from the diaphragm and anterior abdominal wall

Caudate lobe location

Between ligamentum venosum and IVC on posterior surface

Quadrate lobe

Old term for medial segment of left lobe

Left lobe divided into medial and lateral segments by:

Left hepatic vein and ligamentum teres

Left lobe separated from the caudate lobe by:

Ligamentum venosum

Left lobe separated from right lobe by:

The middle hepatic vein superiority and the main lobar fissure inferiorly

Left lobe lies anterior to:

Porta hepatis, middle hepatic vein, body of pancreas, splenic artery and vein

Right lobe divided into the anterior and posterior segments by:

Right hepatic vein

Is the right or left lobe bigger

Right lobe (6x)

What indents the posterior surface of the right lobe

Gallbladder, porta hepatis, and IVC

Right lobe location

Anterior to kidney and posterior to middle hepatic vein

Smallest liver lobe

Caudate lobe

Caudate lobe is separated from the left lobe by!

The proximal portion of the left hepatic vein and the ligamentum venosum

Blood supply to caudate lobe

Portal veins or hepatic arteries

Caudate lobe drains where?

Directly into the IVC

Caudate lobe location

Lies anterior to the IVC and posterior to the ligamentum venosum and porta hepatis

Diaphragmatic slip

Diaphragmatic muscles bundles cause hepatic invaginations

Left lobe variants

Extension into left upper quadrant

Small left lobe

Riedel’s lobe

Right lobe extends inferior to the kidney

How many liver ligaments are there total

7

What is the liver attached to by ligaments

The diaphragm, anterior abdominal wall, stomach, and retroperitoneum

Coronary ligament

Connects the posterior liver to the diaphragm

Gastrohepatic ligament aka

Lesser omentum

Gastrohepatic ligament

Attaches the lesser curvature of the stomach to the liver

Hepatoduodenal ligament

Attaches liver to proximal duodenum

Ligamentum teres aka

Round ligament

Ligamentum teres

*previous fetal umbilical vein

Lies within the falciform ligament

Triangular ligament

Connects liver to body wall

Ligamentum venosum

Separates left lobe from caudate lobe

Previous fetal ductus venosum

Left intersegmental fissure

Separates left lobe into medial and lateral segments

Contains the left hepatic vein, ligamentum teres, falciform ligament, and the ascending segment of the left portal vein

Main lobar fissure

Separates the right and left lobes of the liver

Extends from the right portal vein to the gall bladder fossa

Right intersegmental fissure

Separated the right lobe into anterior and posterior segments

Contains the right hepatic vein

Bare space

Area with no peritoneum

Located in posterior aspect of right lobe

Morison pouch aka

Hepatorenal

Morison pouch

Between the right kidney and the right lobe of liver

Subhepatic pouch

Inferior edge of right lobe

Subphrenic space

Between diaphragm and superior border of liver

Portal vein flow

Hepatopetal- towards the liver

where does main portal vein enter liver?

Through the porta hepatis from hepatoduodenal ligament

What vessel supplies most of the nutrient rich blood to the liver?

Main portal vein

Is the right or left portal vein larger?

Right portal vein

Anterior branch of right portal vein

Feeds anterior segment of right lobe

Posterior branch of right portal vein

Feeds posterior segment of right lobe

Left portal vein location

More anterior and cranial than right

Left portal vein lies:

In canal filled with large amounts of connective tissue

Sonographer sees Echogenic band around left portal vein in central portion of left lobe

Left portal vein splits into:

Horizontal and ascending branches

Portal triad

Made up of a branch of the portal vein, the hepatic artery, and the bile duct

Hepatic artery

Branches of hepatic artery run in portal triad alongside portal vein

Hepatopetal flow- towards the liver

Hepatic veins

Hepatofugal flow- away from liver

Originate in liver and drain into IVC

Largest hepatic vein

Right hepatic vein

right hepatic vein

Drains right lobe

Separates anterior and posterior segments of right lobe

Middle hepatic vein

Drains right and left lobe

Separates right and left lobes

Left hepatic vein

Drains left lobe

Separates medial and lateral segments of left lobe

Caudate lobe veins

Has its own short veins that drain directly into the IVc which helps it to be spared from diffuse liver disease

Distinguish portal veins from hepatic veins

Hepatic veins drain into IVC

Portal veins enter liver at porta hepatis

Portal veins have Echogenic walls due to portal triad connective tissue

Hepatic veins run between lobes and segments

Portal veins forum through lobes and segments

3 major hepatic enzymes

Aspartase aminotransferase (AST) (SGOT)

Alanine aminotransferase (ALT) (SGPT)

Alkaline phosphates (ALP)

Biliary obstruction enzyme effect

Mildly high AST & ALT

Very high ALP

Asparate aminotransferase (AST, SGOT)

Present in metabolically active tissue

Released in bloodstream when cells damaged/destroyed

Produce in locations other than liver, so elevations can occur with problems other than liver disease

Large elevations of AST

Acute Hepatitis, cirrhosis, diffuse metastases

Alanine Aminotransferase (ALT, SGPT)

More specific to liver damage and remains elevated longer than AST

ALT elevation associated with

Hepatocellular disease, biliary tract obstruction, pancreatitis, and fatty infiltration

Alkaline phosphatase (ALP)

Produced by liver, bone, intestines, and placenta

Most sensitive indicator of biliary obstruction

Bilirubin

Product of hemoglobin breakdown in worn out RBCs

Elevation of bilirubin

Excessive RBC destruction

Malfunctioning liver cells (hepatocellular disease)

Biliary obstruction (blockage of bile ducts)

What happens when serum bilirubin elevates?

It leaks into tissues and patients become jaundiced

Which enzymes are highest with liver disease

ALT and AST

Which enzyme is highest with bilirubin obstruction

ALP

Indirect bilirubin- unconjugated

Hasn’t been processed by liver cells

Elevation caused by increased RBC destruction

Direct bilirubin- conjugated

Has been processed by liver cells

Found in bile

Elevation caused by biliary obstruction, liver Mets, hepatitis, cirrhosis, cholestasis

Prothrombin

Liver enzyme that helps blood clot

Albumin

Protein produced by liver

Is a transport vehicle in blood plasma

Low albumin in blood =

Hepatocellular disease

Liver gain

Adjusted so the entire right lobe of the liver is homogenous, medium gray

Liver focus

One focal point: place at posterior part of image, at or below AOI

May use multiple foci but will decrease FR

Normal liver measurement

13-17 cm

Patient prep

NPO (at least 8 hours)

Minimizes bowel gas and gallbladder not contracted