Term
| Name the four major functions of the liver |
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Definition
| Excretory, metabolic, storage, synthetic |
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Term
| The phagocytic cells that line the sinusoids |
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Definition
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Term
| Because the portal vein receives blood from the spleen, portal hypertension causes |
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Definition
| chronic passive congestion in the spleen and spleenomegaly |
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Term
| Lack of bile in the intestines adversely affects digestion resulting in |
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Definition
| poor absorption of fats and fat soluble vitamins (A,D,E, K) |
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Term
| Distension of Glisson's capsule is secondary to |
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Definition
| chronic passive congestion (typical of congestive heart failure) |
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Term
| liver diseases result in hypoproteinemia (t/f) |
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Definition
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Term
| What is the most abundant plasma protein produced by the liver |
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Definition
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Term
| lack of albumin reduces (?) resulting in (?) |
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Definition
| oncotic capacity of the plasma, edema |
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Term
| Elevated Alkaline phosphatase is a marker for |
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Definition
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Term
| In the US is the liver more likely to be affected by metastatic or primary cancer |
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Definition
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Term
| An increase in (?) is prehepatic and msot likely caused by excessive bilirubin formation secondary to hemolysis |
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Definition
| unconjugated hyperbilirubinemia |
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Term
| Conjugated hyperbilirubinemia is related to |
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Definition
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Term
| which form of bilirubin is water soluble |
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Definition
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Term
| Examples of nonspecific hepatitis infections are |
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Definition
mononucleosis, herpes virus, cytomegalovirus
(yellow fever in the tropics) |
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Term
| Which form of hepatitis is from DNA |
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Definition
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Term
| Which forms of hepatitis are spread from a fecal oral route |
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Definition
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Term
| Which is more likely to progress to chronic hepatitis, HCV or HBV |
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Definition
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Term
| Synonym for end stage liver disease |
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Definition
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Term
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Definition
Alcohol
hepatitis virus (B, C and D)
Hereditary metabolic diseaese
Autoimmune disease
drugs
biliary obstruction
cryptogenic (unknown) |
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Term
| This is an autoimmune disease affecting the bile ducts |
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Definition
| primary biliary cirrhosis |
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Term
| This develops following prolonged partial or complete obstruciton of bile flow |
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Definition
| secondary biliary cirrhosis |
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Term
| The presence of what two things in liver parenchyma upon histological examination favors a diagnosis of alcoholic liver disease |
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Definition
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Term
| fibrosis and nodularity of the liver (during cirrhosis) may impede blood flow causing |
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Definition
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Term
| Three major anatomic consequences of portal hypertension |
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Definition
| Ascites, Splenomegaly, Anastomoses between the portal and systemic circulation (varices) |
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Term
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Definition
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Term
| The two most important causes of ascites are |
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Definition
| portal hypertension and hypoproteinemia (lack of albumin) |
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Term
| What disease processes would be indicated in a patient who presents with a high elevated Total Bilirubin and a relatively normal Direct Bilirubin |
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Definition
| If a patient had elevated total bilirubin and normal direct bilirubin, thus having elevated indirect bilirubin we would conclude that they had a disease process that results in having elevated red blood cell destruction or hemolysis. This is found in hemolytic anemia |
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Term
| Liver fibrosis is the result of which type of liver injury |
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Definition
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Term
| What is the most serious clinical manifestation or complication of Alcoholic liver disease in regards to the patient outcome |
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Definition
| The most serious complication is GI bleed from varicies. Will lead to death without surgical intervention and surgery is not always successful. |
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Term
| Explain the factors that contribute to the formation of Ascites in patients with liver failure |
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Definition
Portal hypertension and hypoproteinemia lead to ascites in liver failure patients.
• Back pressure in branches of the portal vein results in the transudation of fluid from the serosal surfaces of the intestines, liver, and peritoneal surfaces lining the abdominal cavity.
• Reduced oncotic pressure of the plasma secondary to hypoalbuninemia facilitates the passage of fluids from the circulation into the abdominal cavity.
• This results in hypovolemia (reduction in circulating blood) which triggers the release of aldostreone from the adrenal cortex. Aldosterone acts on the kidneys, causing sodium and water retention, further compounding the problem.
• Eventually the kidneys stop producing urine and the patient develops hepatorenal syndrome. |
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Term
| What is autoimmune hepatitis? |
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Definition
| Autoimmune hepatitis is inflammation of the liver that occurs when immune cells mistake the liver's normal cells for harmful invaders and attack them. It is a form of chronic hepatitis. Autoimmune hepatitis sometimes occurs in relatives of people with autoimmune diseases, which suggests that there is a genetic cause. This disease is most common in young girls and women. |
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Term
| Describe the sonographic appearance of Acute hepatitis. |
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Definition
| Acute Hepatitis causes diffuse interstitial edema and infiltration of inflammatory cells. Acute Hepatitis may present as normal or we may see Hepatomegaly, gallbladder wall edema, and diffuse decrease in parenchymal echogenicity. This appears as a “starry sky” appearance because the bright portal triads stand out against the comparatively hypoechoic parenchyma. |
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Term
| Describe the location and function of the hepatic sinusoid. How does the circulation enter and exit the structure |
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Definition
| The bulk of the liver consists of epithelial hepatocytes arranged into cords which are separated by vascular sinusoids. Blood enters via portal areas (portal triad consists of a large vein, small artery and a duct for bile). These portal areas are located at the corners between adjacent lobules. The sinusoids course between the hepatic cords. The sinusoids are vascular spaces lined by fenestrated endothelium. These fenestrations allow blood plasma to was freely over the exposed surfaces of the hepatocytes in the space of Disse. Blood from both portal vein and hepatic artery mixes together in the sinusoid. The large sinusoidal volume permits sinusoidal blood to percolate providing time for efficient transfer of substances across the hepatocyte membrane. The sinusoids drain into a central vein which leads to hepatic veins and then to the IVC. |
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Term
| Explain why a TIPS is placed, |
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Definition
| • In some patients with cirrhotic liver disease and variceal hemorrhages a TIPS is placed between the hepatic vein and intrahepatic portal vein to prevent bleeding of gastroesophageal varices. This placement is designed to divert blood around the liver, thereby relieving portal hypertension by reducing portal vein pressure. |
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Term
| List four sonographic findings which would suggest Portal Hypertension |
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Definition
• Portal vein diameter greater than 13 mm and Splenic Vein or SMV diameter greater than 10 mm
• Portal vein flow velocity less than 21 cm/sec
o Hepatofugal flow in portal vein
• Splenomegaly and ascites are usually present w/significant portal hypertension
• Identification of porto-systemic collateral vessel enlargement (varices)/patent para-umbilical vein through the fissure of the Ligamentum teres and long the Falciform ligament to the anterior abdominal wall and umbilicis/collateral vessesl seen along the lesser curvature of the stomach, in the hilum of the spleen, and in the retroperitoneal especially near the renal hilum |
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Term
| List a common etiology of passive congestion of the liver |
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Definition
| Any disease that results in right heart failure can cause chronic passive congestion of the liver. |
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Term
| Sonographic findings of chronic passive congestion of the liver include |
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Definition
o The IVC and hepatic veins dilate with increasing central venous pressure, hepatic veins are considered dilated when their diameter exceeds 9-10mm
o The IVC and hepatic veins lose their normal triphasic pulsatility on spectral Doppler and shows an abnormal pattern of continuous blood flow toward the heart
o Portal venous blood flow becomes pulsatile as elevated pressure from the right heart is transmitted to the portal vein
o Other findings include cardiomegaly, pleural effusions, pericardial effusions, ascites and hepatomagaly |
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Term
| What hepatic findings are common with glycogen storage disease |
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Definition
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Term
| what kind of tissue lines the sinusoids |
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Definition
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Term
| The liver is the largest parenchymal organ weighing |
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Definition
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Term
| The connective tissue Glisson's Capsule includes the (?) |
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Definition
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Term
| Stellate cells are also known as |
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Definition
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Term
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Definition
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Term
| What is the major cell type that is involved in liver fibrosis |
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Definition
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Term
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Definition
| formation of scar tissue in response to liver damage |
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Term
| Which enzyme is more specific to the liver, AST or ALT |
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Definition
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Term
| What are the 3 types of liver abscesses |
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Definition
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Term
| liver abscesses commonly arise as complications of (?) and are frequently associated with obstruction of the biliary tract |
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Definition
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Term
What does this describe?
Most comon parasite
Mother cysts and daughter cysts
Discrete cysts with thick or calcified walls |
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Definition
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Term
| True liver cyst is described as |
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Definition
| fluid filled mass with epithelial lining |
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