Liver Anatomy, Vascular Supply, and Diagnostic Markers

What are the areas of the liver that are not covered by the peritoneum?

Gallbladder fossa, porta hepatitis, and the bare area around the IVC.

What is Glisson's capsule?

A connective tissue covering of the liver.

What is the size and weight of the liver?

The liver measures 21-22 cm transverse, 13-17.5 cm vertical, and 10-12.5 cm A/P depth, weighing 1400-1600 grams.

What separates the right and left lobes of the liver?

The main lobar fissure and the mid hepatic vein (functionally).

What is the function of the ligamentum teres?

It divides the inferior liver into right and left lobes and is a remnant of the left umbilical vein.

What is the function of the ligamentum venosum?

It separates the left lobe from the caudate lobe and is a remnant of the ductus venosus.

What is the main vascular supply to the liver?

The liver receives blood from the hepatic artery, which carries oxygen-rich blood, and the portal vein, which carries nutrient-rich blood from the intestines.

What is the role of bile produced by the liver?

Bile aids in the emulsification of fats and removal of waste products.

What is the significance of sludge in the bile?

Sludge results from bile stasis.

What does an increase in aspartate aminotransferase (AST) indicate?

tissue injury or death, commonly seen in acute hepatitis, cirrhosis, and hepatic necrosis.

What does alanine aminotransferase (ALT) elevation indicate?

Slight elevation in acute cirrhosis, hepatic metastasis, and pancreatitis; moderate to high increases in hepatocellular disease.

What does alkaline phosphatase indicate?

It is an indicator for intra or extra hepatic obstruction, carcinoma, abscess, or elevated in cirrhosis or hepatitis.

What is the significance of bilirubin levels in the blood?

Increased bilirubin indicates RBC destruction, liver malfunction, or ductal blockage, leading to jaundice.

What is the difference between indirect and direct bilirubin?

Indirect bilirubin (unconjugated) is elevated with increased RBC destruction; direct bilirubin (conjugated) is elevated due to obstruction.

What does a prolonged prothrombin time indicate?

It indicates liver disease with cellular damage, commonly seen in cirrhosis and metastatic disease.

What does low serum albumin suggest in liver disease?

It suggests decreased protein synthesis due to hepatocellular damage.

What is alpha-fetoprotein (AFP) and its significance?

AFP is a protein made in the liver of a developing baby; high levels in adults can indicate liver cancer or other diseases.

What is the role of the right, mid, and left hepatic veins?

They drain blood from the liver to the IVC, with the right hepatic vein being the largest.

What is the function of the falciform ligament?

It attaches the liver to the front body wall and separates the anterior liver into left and right lobes.

What is the main portal vein's significance?

It becomes larger at the portal hepatis and divides into the right and left portal veins.

What is the role of hepatic veins in liver function?

They drain blood from the liver to the IVC and become larger as they approach the diaphragm.

What is the clinical relevance of elevated lactic acid dehydrogenase?

It indicates tissue injury or death, with moderate increases seen in mono and mild increases in hepatitis.

What does the presence of gamma globulins indicate in chronic liver diseases?

elevated levels are commonly seen in chronic liver diseases.

What is the relationship between AFP levels and cancer diagnosis?

AFP levels can help diagnose liver cancer when used with other tests, but high levels do not always indicate cancer.

what is the largest organ in the abdominal cavity?

liver

what is the transverse measurement of the liver?

21-22 cm

what is the vertical measurement of the liver?

13-17.5cm

what is the depth of the liver?

10-12.5 cm

which lobe of the liver is the largest?

right lobe

why are ligaments and fissures more hyperechoic/echogenic?

collagen and fat surrounding structures

the right lobe is separated from the left lobe by the?

main lobar fissure

the left lobe is separated from the caudate lobe by the?

ligamentum vernosum

the caudate lobe drains into the

IVC

what is different about the caudate lobe

it has its own blood supply

what term means "reflects sound well"

echogenic

what connects the GB to the portal vein?

main lobar fissure

the mid hepatic vein sits within the?

main lobar fissure

what is the ligament that attaches the liver to the front body wall, and separates the liver into left and right lobes?

falciform ligament

what ligament contains ligamentum teres?

falciform ligament

the ligamentum teres is also called the?

round ligament

the left umbilical vein turns into?

ligamentum teres

what ligament is a remanent of the ductus venosus?

ligamentum venosum

what ligament divides the left and caudate lobes?

ligamentum venosum

what artery and vein supplies the liver?

hepatic artery and portal vein

what drains from the intestines?

the portal vein

what carries blood from the aorta to the liver?

hepatic artery

the hepatic drains take blood from the ____ to the ____.

hepatic vein, IVC

which vessel looks like it has no wall?

hepatic veins

the right hepatic vein is the largest or smallest?

largest

the mid hepatic vein enters the IVC posteriorly or anteriorly?

anteriorly

True or False: the mid hepatic and left hepatic veins can join together?

true

the function of the liver is?

to form bile

bile is formed by?

hepatocytes

bile is held in the?

gallbladder

bile is made of?

water, bile pigments, and bile salts

what results from bile stasis?

sludge

what is alkaline phosphate produced by?

liver, bone, intestines, and placenta

prothrombin time is caused by?

the intake of vitamin k

a low serum albumin suggests?

decreased protein synthesis

what is the protein made in the liver of a developing baby?

AFP

healthy adults should have low or high levels of AFP?

low

a high AFP in an adult can be a sign of?

cancer in the liver, ovaries, or testicles

is it guaranteed that high AFP levels mean cancer as an adult?

no

A congenital variant that can sometimes be seen as an anterior projection of the liver and may extend inferiorly as far as the iliac crest?

Riedel's lobe

the liver is a major center of_______ which may be defined as the physical and chemical process whereby food stuffs are synthesized into complex elements.

metabolism

The accompanying loss of oncotic pressure in the vascular system allows fluid to migrate into the interstitial space, resulting in ____ in dependent areas

edema

Elevation of serum bilirubin results in __________ which is a yellow coloration of the skin, sclerae, and body secretions

jaundice

The landmarks of the liver include all except:

a. Right hypochondrium

b. Greater part of the epigastrium

c. Left hypochondrium

d. Right hypogastrium

right hypogastrium

hepatopetal means

towards the liver

heptaofugal means

away from the liver

hepatic venous flow is

hepatofugal (away from the liver)

generally, a wider pie sector or curved linear array transducer is the most appropriate to optimally image the ______ ______ of the abdomen.

near field

portal veins are _________ so they show up as the color ___ when CF is turned on

hepatopedal, red

portal vein walls are ________ compared to hepatic vein walls

hyperechoic

inspiration can move the liver _____

down

the liver is mostly found in the _____ ________

right hypochondrium

segment 1 is the

caudate lobe

how can you prove the patient has no gallbladder

including an image showing the main lobar fissure and the portal vein

why is it important to image the portal veins

they commonly clot

which are more superior hepatic or portal veins

hepatic

the liver converts sugars into _______ and then converts that into ______

glucose, glycogen

dietary fats are converted into ______ in the hepatocytes

lipoproteins

hepatocellular diseases are treated with

drugs

obstructive diseases are treated with

surgery

__________ bilirubin becomes __________ bilirubin

unconjugated, conjugated

why do we want the patient to be NPO for 6 hours

to see bile in the gallbladder

what is anterior to the caudate lobe?

ligamentum venosum

what is posterior to the caudate lobe

IVC

the liver is more _______ than the kidneys

hyperechoic

the liver is _________ compared to the spleen

hypoechoic

we use a ______ _____ array transducer to image the near field of the abdomen

curved linear

the liver is _________ compared to the spleen

hypoechoic

if a liver is small is the pathology more likely acute or chronic?

chronic

Sagittal protocol

Sagittal
1. Midline left lobe
2. Left lobe include caudate lobe and ligamentum venosum
3. Left Lobe /IVC/ Right Lobe
4. Right lobe include Main Lobar Fissure and Gallbladder
5. Right lobe to include diaphragm
6. Right lobe to include Right Kidney

transverse protocol

Transverse
7. Midline Left Lobe (possible caudate lobe and ligamentum venosum)
8. Right lobe include hepatic veins
9. Right lobe include hepatic veins with color
10. Right lobe include portal veins
11. Right lobe include portal veins with color
12. Right lobe to include portal vein and CBD (measure CBD)
13. Right lobe include right kidney and GB
14. Right lobe lateral edge with diaphragm

liver cells that play a role in the body’s defense

Kupffer cells

the vessel that serves as an intersegmental boundary between the medial and later left lobe

falsiform ligament

the boundaries of the bare area of the liver include

falsiform, coronary, and triangular ligament

Each of the following is a blood plasma protein or clotting factor except: Fibrinogen,
prothrombin, albumin, or arginine

arginine

The left portal vein serves as ________ between the medial and lateral left lobe

intersegmental boundary