Term
| What is the powerhouse among abdominal organs? |
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Definition
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Term
| What is the largest parenchymal organ in the body? |
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Definition
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Term
| What does liver structure include? |
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Definition
| Portal vein, hepatic vein, arteries, ducts, hepatic ligaments & fissures |
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Term
| The primitive gut is formed during the 4th week of embryonic life and is composed of which 3 parts? |
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Definition
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Term
| Where does the oxygenated blood come from in the fetal and which vein brings it? Which vein return blood from the yolk sac to the heart? |
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Definition
| The umbilical veins bring oxygenated blood from the embryonic portion of the placenta to the embyonic heart, whereas the vitelline veins return blood from the yolk sac to the heart |
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Term
| Which veins does the liver tissure sequentially move into? |
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Definition
| The liver tissue sequentially moves into the vitelline veins and then the umbilical veins |
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Term
| What happens as the liver tissue moves into the vitelline veins? |
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Definition
| Their midsection becomes capillarized, whereas their caudal ends become the premitive portal veins and their cranial ends become the early hepatic veins |
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Term
| Which vein in a fetal degenerate? |
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Definition
| the right umbilical vein and part of the left umbilical vein |
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Term
| Part of the left umbilical vein degenerate what happens to the remaining left umbilical vein? |
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Definition
| the remaining left umbilical vein carries all the blood from the placenta to the fetus |
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Term
| What develops as a large shunt within the liver to connect the umbilical vein to the IVC? |
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Definition
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Term
| What does the ductus venosus allow? |
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Definition
| Ductus venosus allows some blood to bypass the liver and flow directly from the placenta to the heart |
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Term
| What does the umbilical vein become postnatally? |
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Definition
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Term
| What does the ductus venosum become postnatally? |
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Definition
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Term
| The _________ _________ is a remnant of the ductus venosus. |
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Definition
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Term
| From where does the ligamentum venosum run? |
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Definition
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Term
| Which lobes does the ligamentum venosum seperate? |
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Definition
| left lobe from the caudate lobe |
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Term
| What is the direction of the fetal circulation? |
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Definition
| umbilical vein -> left portal vein -> ductus venosus -> IVC |
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Term
| What is the thin connective tissue layer that covers the liver? |
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Definition
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Term
| The Glisson's capsule covers the entire liver except for a small portion what is this portion called and where is it located? |
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Definition
called the bare area
located near the dome of the liver |
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Term
| The glisson's capsule is at its thickest around the ________ and ________ __________ |
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Definition
| around the IVC and Porta Hepatis |
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Term
| What is the function of Kupffer cells? |
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Definition
| Kupffer cells remove bacteria foreign matter and weakened blood cells from the liver sinusoids |
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Term
| What is the hepatic parenchyma composed of? |
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Definition
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Term
| What is interspersed with hepatocytes? |
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Definition
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Term
| How is the hepatocytes and the Kupffer cells organized? |
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Definition
| They are organized into lobules approximately 1 x 2mm in size |
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Term
| What are the functional units of the liver? |
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Definition
| 1 million lobules that are found in the liver |
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Term
| The liver occupies a major portion of the _________ _____________ |
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Definition
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Term
| Where does the liver extend inferiorly? |
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Definition
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Term
| Where does the liver extend laterally? |
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Definition
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Term
| Where does the liver extend superiorly? |
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Definition
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Term
| Where does the liver extend posteriorly? |
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Definition
| Liver extends posteriorly to the border of the bony lumbar region of the muscular posterior abd wall |
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Term
| What are the functions of the liver? |
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Definition
synthesis and storage of amino acids, proteins, vitamins and fats
detoxification
blood circulation and filtration
bile drainage
blood glucose regulation |
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Term
| The liver is an ___________ structure situated in the right upper quadrant of the abdomen |
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Definition
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Term
| Which area of the liver are in contact with the diaphragm? |
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Definition
| The superior, anterior and a portion of the posterior surface |
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Term
| Which lobe is marked on the anterior border by the posterior surface of the LPV and the posterior border is the IVC? |
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Definition
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Term
| The posterior surface of which lobe of the liver is indented by the right kidney? |
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Definition
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Term
| Which vessel also lies posterior to the liver and has a short intrahepatic course just before entering the right atrium? |
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Definition
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Term
| Where does the left lobe lie in relation to the pancreas and stomach? |
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Definition
| The left lobe lies adjacent to the body of the pancreas, splenic vein and splenic artery and lies close to the body and antrum of the stomach |
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Term
| Which vessels bring oxygenated blood to the liver? |
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Definition
| portal veins and hepatic arteries |
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Term
| What does the portal vein deliver to the liver? |
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Definition
| nutrients just absorbed from the intestine |
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Term
| How does the blood from the hepatic arteries and portal vein mix? |
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Definition
| small branches of the hepatic arteries and portal vein deliver blood to the tiny hepatic sinusoids |
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Term
| What happens to the blood at the liver sinusoids? |
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Definition
| Blood from the liver sinusoids is eventually delivered to the hepatic veins, which conduct blood toward the heart |
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Term
| what does liver size depends on? |
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Definition
| The lateral segment of the LLL and the length of the RLL |
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Term
| What does the liver weight in a male and female? |
|
Definition
1400-1800 grams in males
1200 - 1400 grams in females |
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Term
| When is hepatomegaly indicated? |
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Definition
| hepatomegaly is indicated with a greater than 15 cm superior inferior dimension or when the right lobe extends inferior to the lower pole of the right kidney |
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Term
| What is the approximate diameters of an adult liver? |
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Definition
transverse - 20 cm - 20.5 cm
AP mid clavicular - 10 cm - 12.5cm
Right lobe - 15 cm - 17 cm |
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Term
| What is the liver echogenicity? |
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Definition
| The normal liver is homogeneous and is slightly hyperechoic compared to the normal renal cortex |
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Term
| Which is the smallest lobe? |
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Definition
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Term
| How does the LLL become smaller? |
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Definition
| It can be congenitally small or atrophic which may be a result of interference with the LPV supply when the ductus venosus closes at birth |
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Term
| What happens if the RLL is long? |
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Definition
| The longer the RLL, the less likely the interference of bowel gass by the hepatic flexure |
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Term
| What determines the clarity of the right kidney in the supine position? |
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Definition
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Term
| What is the tongue like projection of the RLL that may extend to the iliac crest called? |
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Definition
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Term
| Where is the Reidels lobe positioned? |
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Definition
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Term
| What is common in each segment of the liver? |
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Definition
| portal vein, hepatic artery and bile duct |
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Term
| What are the 3 lobes that the liver is divided into? |
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Definition
| right, left & caudate lobe |
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Term
| What divides the right and left hepatic lobe? |
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Definition
| The main portal vein into its right and left branches |
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Term
| What does the right lobe divide into? |
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Definition
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|
Term
| What does the left lobe divide into? |
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Definition
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Term
| What was the medial segment of the left lobe of the liver formerly called? |
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Definition
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Term
| Where does the caudate lobe lie? |
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Definition
| caudate lobe lies on the posterior-superior surface of the liver between the IVC and the medial left lobe of the liver |
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Term
| which branches supplies the caudate lobe? |
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Definition
branches from the left and right portal veins and the hepatic artery supply the caudate lobe
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Term
| What is the vein called that drains the caudate lobe directly to the IVC? |
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Definition
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Term
| Segmental anatomy of the liver is based on what? |
|
Definition
| the distribution of the portal vein |
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Term
| Where does the vessels of the portal triad course to ? |
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Definition
| the center of each segment |
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Term
| What divides the liver longitudinally into 4 sections? |
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Definition
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Term
| Where does the hepatic vein course? what kind of walls do they have? |
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Definition
| between the lobes and segments and have non echogenic walls |
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Term
| What is interlobar & intersegmental? |
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Definition
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Term
| What separates and drains the anterior and posterior segments of the RLL? |
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Definition
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Term
| What seperates and drains the medial and lateral segments of the LLL? |
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Definition
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Term
| What separates and drains the right and medial LLL |
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Definition
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Term
| What courses between the segments and the lobes? Hence what is it called? |
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Definition
| Hepatic veins - intersegmental |
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Term
| What vessels course within each segment? Hence what is it called? |
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Definition
| portal triad - intrasegmental |
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Term
| Which fissure divides the right and left lobe of the liver? |
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Definition
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Term
| Where does the main lobar fissure lie? |
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Definition
| between the IVC and the gallbladder fossa |
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Term
| What are the landmarks for the main lobar fissure? |
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Definition
| GB, IVC and middle hepatic vein |
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Term
| What does the main lobar fissure identified between? |
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Definition
| the GB neck and the junction of the right and left portal vein |
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Term
| Which segments does the main lobar fissure divide? |
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Definition
| divides the anterior segment of the right lobe from the medial segment of the left lobe |
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Term
| Which fissure divides the right lobe into anterior and posterior segments? |
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Definition
| right inersegmental fissure |
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Term
| What is the landmark for the right intersegmental fissure? |
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Definition
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Term
| Which fissure divides left lobe into medial and lateral segments? |
|
Definition
| left intersegmental fissure |
|
|
Term
| what are the landmarks for the left intersegmental fissure? |
|
Definition
left hepatic vein
ascending left portal vein
falciform ligament
ligamentum teres |
|
|
Term
| How is the liver attached to other organs? |
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Definition
| the liver is attached to the anterior abdominal wall, the diaphragm, the retroperitoneum and the lesser curvature of the stomach |
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|
Term
which ligaments attach the liver to the anterior abd wall, the diaphragm, the retroperitoneum and the lesser curvature of the stomach? |
|
Definition
1. coronary
2. falciform
3. round
4. right triangular
5. left triangular
6. gastrohepatic
7. hepatoduodenal
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|
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Term
| What is a peritoneal reflection which suspend the liver from the diaphragm? which area doesn't it surround? |
|
Definition
| coronary ligament / the bare area |
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|
Term
| Which ligament is a bright echogenic focus demarcating the lateral border of the medial portion of the LLL? |
|
Definition
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|
Term
| How is the falciform ligament formed? |
|
Definition
| Falciform ligament is a peritoneal reflecion or fold created by the passage of the embryonic umbilical vein from the umbilicus to the left branch of the portal vein |
|
|
Term
| What connects the liver to the anterior abdominal wall and to the diaphragm? |
|
Definition
| Falciform ligament (a sickle shaped fold) |
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|
Term
| ___________ ___________ is the structure above the ligamentum teres |
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Definition
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|
Term
| Ligamentum teres is also known as _________ __________ |
|
Definition
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|
Term
| How is the ligamentum teres formed? |
|
Definition
| the ligamentum teres is a remnant of the umbilical vein which runs from the umbilicus to the LPV. Shortly after birth, the umbilical vein contracts down forming the teres |
|
|
Term
| What happens to the ligamentum teres when there is portal HTN? |
|
Definition
| the ligamentum teres recannalizes to form a portosystemic venous collateral |
|
|
Term
| What is the peritoneal reflection to the far right and far left of the bare area? |
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Definition
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Term
| What is the ligament that is a portion of the lesser omentum that extends across the ligamentum venosum at the porta hepatis |
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Definition
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|
Term
| What is the ligament that is a portion of the lesser omentum that extends as the right border of the gastrohepatic ligament |
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Definition
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|
Term
| The porta hepatis is contained in peritoneal folds that is called? |
|
Definition
|
|
Term
| From where does the liver receives its nutrients from? |
|
Definition
| hepatic artery and the portal vein |
|
|
Term
| The portal veins are ________ and follow a _________ course |
|
Definition
|
|
Term
| Where does the caliber of the hepatic vein and the portal vein increase? |
|
Definition
The hepatic veins increases as they course toward the diaphragm and IVC
The portal vein increases towards the porta hepatis |
|
|
Term
| What are the functions of the liver? |
|
Definition
1. formation of bile
2. blood production (hempoieses) of embryo
3. destruction of RBC's
4. metabolism of carbohydraes, lipids & protiens
5. storage depot for glycogen, amino acids, fats, vitamins A, D & B complex and iron & copper
6. Blood reservoir
7. Heat production
8. Detoxification
|
|
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Term
| What lab value increases with liver, heart, skeletal muscle, kidney & brain disease? |
|
Definition
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|
Term
| What lab value increases with liver disease & biliary tract obstruction? (specific for liver disease) |
|
Definition
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|
Term
| AST lab value is __________ for liver disease by itself |
|
Definition
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|
Term
| An increase in AST "without" an increase in ALT is seen with |
|
Definition
|
|
Term
| What is a direct increase with liver disease & biliary tract obstruction? |
|
Definition
|
|
Term
| What is the indirect increase with liver disease & disorder that cause increased RBC hemolysis? |
|
Definition
|
|
Term
| Elevated levels of bilirubin can cause ________ |
|
Definition
| jaundice either obstructive or non obstructive jaundice |
|
|
Term
| What decreases with liver disease, especially albumin? |
|
Definition
|
|
Term
| What is the marked increase in a non pregnant adult signals bone or liver abnormalities? |
|
Definition
| ALP (alkaline phosphatase) |
|
|
Term
| What may increase with liver damage but is a tumor marker for scrotal cancer? |
|
Definition
| LDH (lactic dehydrogenase) |
|
|
Term
| What is present in over 50% of patients with hepatomas or hepatoblastomas (synthesized by the fetal liver) |
|
Definition
| AFP (alpha- fetal protein) |
|
|
Term
| If AFP is elevated in an adult they will always have _______ |
|
Definition
| HCC (hepatocellular carcinoma) |
|
|
Term
| When does Prothrombin time increase? |
|
Definition
| Prothrombin time increases with liver disease |
|
|
Term
|
Definition
| PT is the time (in seconds) that it takes for blood to coagulate. At lease 12 blood clotting factors are need to clot blood. PT or Factor II is one of those clotting factors produced by the liver |
|
|
Term
| Which vitamin is needed to produce prothrombin? |
|
Definition
|
|
Term
| When is abnormal PT found? |
|
Definition
| it is often due to liver disease or Coumadin treatment |
|
|
Term
| What blood tests are drawn to measure blood clotting factors? |
|
Definition
|
|
Term
|
Definition
PPT - partial prothrombin time
INR - International normalized ratio (this test "standardizes the PT test so that values may be compared between different labs) |
|
|
Term
| How does the liver look sonographically? |
|
Definition
| the liver should be homogenous and moderately echogenic throughout |
|
|
Term
| The _________ lobe is anterior to the inferior vena cava |
|
Definition
|
|
Term
| What is the early stages of cirrhosis? |
|
Definition
| hepatomegaly, decreased vasculature |
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