Abdomen & Small Parts Exam 1

Functions of the liver

Detoxification, manufacture of bile, storage of glycogen, phagocytosis, and tissue regeneration.

Detoxification (liver)

Removes toxins from the blood.

Manufacture of bile

Produces bile to aid fat digestion.

Storage of glycogen

The liver stores glucose in the form of glycogen.

Phagocytosis

Ingestion and elimination of particles by Kupffer cells.

Macroscopic relationship of the liver

Duodenum, right kidney, gallbladder, transverse colon, pancreas.

Location of the liver

Right upper quadrant (RUQ).

What lies inferior to the diaphragm?

Peritoneal cavity.

Fluid inferior to the diaphragm is called

Ascites.

Fluid superior to the diaphragm is called

Pleural effusion.

Pleural effusion

Fluid within the pleural space surrounding the lungs.

Ascites

Fluid within the peritoneal cavity.

Hepatomegaly definition

Cranial-caudal liver measurement greater than 13–15 cm (130–150 mm).

13 cm in mm

130 mm.

15 cm in mm

150 mm.

Patient maneuver to move bowel gas

Deep inspiration and hold breath.

Morrison's pouch

Space between the liver and right kidney.

Another name for Morrison's pouch

Hepatorenal recess.

Portal triad

Common bile duct, hepatic artery, main portal vein.

Components of the portal triad

Common bile duct, hepatic artery, main portal vein.

Portal veins on ultrasound

Have echogenic walls.

Why are portal vein walls echogenic?

They are surrounded by fibrous tissue.

Riedel's lobe

Normal tongue-like extension of the right lobe.

Riedel's lobe is most common in

Females.

Riedel's lobe is a

Normal anatomic variant.

Caudate lobe location

Posterosuperior surface of the liver.

Caudate lobe relationship to IVC

Anterior to the IVC.

Structure anterior to the caudate lobe

Ligamentum venosum.

Main lobar fissure

Echogenic line between the gallbladder neck and right portal vein.

Main lobar fissure divides

Right and left lobes.

Middle hepatic vein divides

Right and left lobes.

Left hepatic vein divides

Medial and lateral segments.

Right hepatic vein divides

Anterior and posterior segments of the right lobe.

Ligamentum teres

Remnant of fetal umbilical vein.

Another name for ligamentum teres

Round ligament.

Ligamentum teres ultrasound appearance

Circular echogenic dot at the porta hepatis.

Ligamentum teres artifact

Strong attenuator causing posterior shadowing.

Normal liver echogenicity

Slightly hyperechoic to the renal cortex.

Portal veins are largest at the

Porta hepatis.

Portal veins course

Horizontally.

Portal veins run

Intrasegmentally.

Right portal vein branches

Anterior and posterior branches.

Main liver function tests

ALT and AST.

ALT

Alanine aminotransferase.

AST

Aspartate aminotransferase.

Increased AST indicates

Liver cell necrosis.

Increased ALT indicates

Liver cell necrosis.

Probe position for sagittal left lobe

Epigastric region.

Fibrous capsule of the liver

Glisson's capsule.

Normal liver capsule

Glisson's capsule.

Portal vein formation

Union of the splenic vein and superior mesenteric vein.

Portal vein enters liver at

Porta hepatis.

Portal vein oxygen supply

Provides approximately 50–60% of the liver's oxygen requirement.

Portal vein walls

Thick and echogenic.

Normal liver appearance

Homogeneous and slightly brighter than the kidney.

Acute hepatitis ultrasound

May appear normal.

Acute hepatitis echogenicity

May be decreased.

Acute hepatitis findings

Enlarged liver, accentuated portal vein walls, thickened gallbladder wall.

Chronic hepatitis ultrasound

Coarse echotexture with increased echogenicity.

Cause of hepatitis

Hepatitis viruses.

Types of hepatitis

A, B, C, D, E, F (rare).

Most serious hepatitis types

B and C.

Complications of hepatitis

Cirrhosis, liver failure, hepatocellular carcinoma.

Fatty infiltration definition

Accumulation of lipids within liver cells.

Fatty infiltration is

Acquired and reversible.

Diffuse fatty infiltration

Entire liver is hyperechoic and enlarged.

Diffuse fatty liver findings

Hyperechoic liver, paucity of vessels, hepatomegaly.

Focal fatty infiltration

Localized areas of increased echogenicity.

Focal fatty infiltration can mimic

A liver mass.

Early cirrhosis findings

Hepatomegaly and fatty infiltration.

Cirrhosis definition

Progressive irreversible replacement of liver tissue by fibrosis and nodules.

Cirrhosis complications

Portal hypertension, ascites, splenomegaly, hepatocellular carcinoma.

Portal hypertension definition

Increased portal venous pressure due to impaired liver flow.

Portal hypertension ultrasound findings

Dilated portal vein, splenomegaly, hepatofugal flow, recanalized umbilical vein, ascites.

Portal vein diameter in portal hypertension

Greater than 13 mm.

Splenic vein diameter in portal hypertension

Greater than 10 mm.

SMV diameter in portal hypertension

Greater than 10 mm.

Normal portal flow

Hepatopetal.

Flow away from liver

Hepatofugal.

Portal hypertension collateral veins

Epigastric collateral veins may develop.

Recanalized ligamentum teres

Seen with portal hypertension.

Caput medusae

Collateral abdominal veins caused by portal hypertension.

Most common malignant liver tumor

Metastases.

Bull's-eye sign is associated with

Liver metastases.

Target sign is another name for

Bull's-eye sign.

Metastatic liver lesions may appear

Hypoechoic, hyperechoic, complex, cystic, calcified, patchy, or moth-eaten.

Condition with highest risk of HCC

Cirrhosis.

Hepatocellular carcinoma risk factor

Cirrhosis.

Focal nodular hyperplasia

Benign liver tumor.

Patients at risk for FNH

Females under 40 using oral contraceptives.

FNH ultrasound appearance

Variable; hypoechoic, hyperechoic, or isoechoic.

Oral contraceptives are associated with

Focal nodular hyperplasia.

Liver abscess types

Pyogenic and amoebic.

Pyogenic abscess cause

Bacterial infection.

Amoebic abscess cause

Amebas entering through the portal vein.

Pyogenic abscess symptoms

Fever, pain, nausea, vomiting, diarrhea.

Pyogenic abscess ultrasound

Irregular walls, variable echogenicity, posterior enhancement possible.

Amoebic abscess ultrasound

Subcapsular, irregular walls, good through transmission.

Country travel risk for

Amoebic liver abscess.

Echinococcal cyst

Cystic liver lesion caused by hydatid disease.