abdominal 1 pathology key pearls FINAL
how does chronic hepatitis appear on ultrasound?
Hyperechoic liver parenchyma, course texture, small liver, decreased echogenicity of portal vein
how does acute hepatitis appear on ultrasound?
May be normal, but usually will be a "starry night" appearance, hepatomegaly, hepatosplenomegaly, thick GB wall
what is the difference between focal and sparing fatty liver?
- focal is one spot int eh whole liver that is affect - sparing is the whole liver is fatty accept one spot
complications of hepatitis?
can range from mild disease, to necrosis, to liver failure
What is a transjugular intrahepatic portosystemic shunt (TIPS)?
connect the portal vein to the hepatic vein
What is a portacaval shunt?
connects the portal vein directly to the IVC
What is ectasia of the aorta?
diffuse dilation of a vessel, the inflammation o the aorta all around
what is hepatoceullar?
disease of the liver cells (hepatocytes)
what causes jaundice?
elevated bilirubin, causing yellow coloration of the skin
What is hemochromatosis?
excess iron deposits throughout the body
What divides the left and right lobes of the liver?
falciform ligament, runs from the umbilium to the ligamentum tres
what is a AAA?
focal enlargement, localized dilation of the aorta
What is renal vein thrombosis?
formation of a clot in the vein that drains blood from the kidneys, can ultimately cause renal cell carcinoma
where does the left renal artery course through to get to the left kidney?
from the aorta directly into the the hilum
what measurement shows AAA?
greater then 3 cm, larger then 5 needs surgery
What is arteriosclerosis?
hardening or thickening of the arterial walls, because of substance build up
what is the result of extrahepatic portal hypertension?
increased pressure int he portal- splenic venous system
What is portal hypertension?
increased resistance to blood flow in the portal venous system
what causes a flow disturbance?
increased velocity or obstruction of flow
what is hepatitis?
inflammation of the liver
where does the right renal artery course through to get to the right kidney?
it courses from the aorta posterior to the IVC and enters the hilum.
what are the hepatic veins?
largest visceral tributaries of the IVC, they originate between the segment of the liver and drains posteriorly into the IVC.
what does the left hepatic artery supply?
left and caudate lobe of the liver
what separated the medial and lateral segments?
ligamentum teres
what separated the caudate and left lobe?
ligamentum venosums
what is the largest organ in the abdominal cavity?
liver
What are hepatocytes?
lover cells that perform all the functions ascribes to the liver
what is the hyperechoic line extending from the portal vein to the neck of the gallbladder?
main lober fissure
what are the functions of the liver?
metabolism, digestion, storage, detoxification
What does the portal triad consist of?
portal vein, hepatic artery, common bile duct
Where is the caudate lobe located?
posterior surface of the left lobe
how is the portal vein formed?
posterior the pancreas by the union of the SMV and splenic vein
what does the common hepatic artery branch into?
proper hepatic artery and gastroduodenal artery
in what three parts in the measurement of the aorta taken at?
prox, mid, dis
What can arteriosclerosis lead to?
restriction of blood flow to the organs and tissue of the body
Which lobe is larger in the liver?
right lobe
what are the lobes of the liver
right, left, caudate, quadrate
what are the 5 sections of the aorta?
root, ascending, descending, abdominal, bifurcation
what is the primary risk for AAA?
rupture of the vessel
what is a hepatic cyst?
solitary nonparasitic cyst in the liver, can be congenital or acquired, it can be one or multiple
what allows you to see the velocity and turbulence of flow?
spectral analysis
what vessels shows the greatest turbulence of all the celiac branches?
splenic artery
what does the celiac trunk consist of?
splenic artery, common hepatic artery, and left gastric artery
How can AAA be repaired?
surgically repaired with a flexible graft material attached to the end of the remaining aorta.
what does the right subphrenic space include?
the Morison pouch
what artery is a high resistive vessel?
the SMA, non resistive when not fasting, resistive when fasting
what is the Flo of the blood leaving the liver?
the blood is perfused with the liver parenchyma, then it goes through the hepatic sinusoids, then it enters the hepatic venues which unite to form the larger hepatic veins
what does the right hepatic artery supply?
the gallbladder via the cystic duct, and the right lobe of the liver
where does the portal vein drain from?
the gastrointestinal tract
how is the IVC formed?
the left and right common iliac veins
what branches arise just inferior to the SMA?
the left and right renal arteries
what is the relationship with the liver and gallbladder?
the liver excretes bilirubin into the gut via the biliary tree in the gallbladder where it is stored.
what artery has a low impedance?
the main renal artery
what happens when the patient has portal venous hypertension?
the portal blood flow becomes hepatofugal (away from the liver)
what do the hepatic veins do?
the right drains the right lobe of the liver, the middle drains the caudate lobe and the left drains the left lobe
where does the liver lay?
the right hypochondrium, epigastric, and left hypochondrium
which renal artery is longer?
the right renal artery is longer then the left
what do the portal veins do as they progress into the liver?
they get smaller
what do the IVC and hepatic veins have in common?
they present a complex waveform which flows above and below the baseline.
how do the portal veins course through the liver?
they run centrally within the segments, accept the left portal vein which runs more left.
What is Budd-Chiari syndrome?
thrombosis of hepatic veins or IVC
what is a hepatic abscess?
- A collection of pus in the liver caused by infection (bacterial, fungi, parasitic) - often occur in complications of the biliary tact disease, surgery, or trauma
what causes fatty infiltration?
- acoholic patients - obese patients
what is the difference between acute and chronic hepatitis?
- acute last only 4 months and can be reversable - chronic is longer then 6 months and can lead to cirrhosis
What causes portal hypertension?
- cirrhosis - hepatic vein thrombosis - portal vein thrombosis - thrombus In the IVC
what are the focal diseases of the liver?
- cyst - abscess - hematoma - primary tumor -metastases
what are the diffuse diseases of the liver?
- fatty infiltration - hepatitis acute or chronic -cirrhosis acute or chronic - glycogen storage disease
what is the difference between fusiform and saccular aneurysm?
- fusiform is a gradual transition between normal to abnormal and is seen as a football like shape because it extend on both sides of the aorta - saccular is a sudden transition between normal and abnormal and is somewhat spherical and is only on one side of the aorta
name all the segments of the liver.
- left superior lateral segment - left inferior lateral segment - caudate lobe - left medial superior segment - left medial inferior segmemt - right anterior superior segment - right anterior inferior segment - right posterior superior segment - right posterior inferior segment
what are the three classifications of an aorta dissection?
- type 1 and 2 involve the ascending aorta and aortic arch - type 3 involves the descending aorta inferior the left subclavian artery
what is the blood supply to the liver?
80 percent from the portal vein, 20 percent from the hepatic artery
What is a mesocaval shunt?
Attaches the mid/distal SMV to the IVC
What is a splenorenal shunt?
Attaches the splenic vein to the left renal vein
what is polycystic liver disease?
It's an autosomal dominant disease which typically begins in the kidney, lifespan is 30-40 years, it is when you have more then 10 cysts in the liver.
what is the most common glycogen storage disease type?
Type 1 calls von Gierke's disease
what is cirrhosis?
a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism or hepatitis.
What is an LFT test?
a liver function test, to analyze how the liver is performing under normal and disease conditions.
What is the liver covered by?
a thin connective tissue layer called Glisson's capsule
what is the difference between a true aneurysm and a false aneurysm (pseudoaneurysm)?
a true aneurysm is lined by all three layers of the aorta, a false aneurysm is only 2 layers and has a to and fro flow through a neck.
Where do the common iliac arteries bifurcate?
abdominal aorta
what is glycogen storage disease?
abnormal storage and accumulation of glycogen in tissues
What is fatty infiltration?
accumulation of triglycerides within the hepatocytes, fat build up in the liver
what is intrahepatic obstruction?
an inflammation or obstruction of the inside vessels of the liver - portal veins, hepatic artery, bile duct, hepatic veins
what is extra hepatic obstruction?
an inflammation or obstruction outside of the liver - portal triad, bile duct
Where is the SMA located?
anterior the abdominal aorta, 1 cm inferior to the celiac trunk
where do the right and left renal veins arise from?
anterior to the renal arteries at the level of L2
by what is blood carried away from the body?
arteries
where does the right posterior subphrenic space lie?
between the right lobe of the liver and the right kidney
how does cirrhosis appear on ultrasound?
hepatomagely, increased echogenicity, and coarsening of the hepatic parenchyma secondary to fibrosis and surface nodularity .
what is the ultrasound appearance of GSD?
hepatomagely, increased echogenicity, slightly increased attenuation
what direction do the SMV and splenic vein travel?
hepatopetal (towards the liver)
how does fatty infiltration look like in ultrasound?
increase echogenicity of the liver
how does hemochromatosis appear on ultrasound?
increased echogenicity uniformly throughout the hepatic parenchyma.
what is the function of the circulatory system?
transports gasses, nutrients,and other substances to the tissues, and transport waste to appropriate sites for excretion.
how does the liver expel waste?
turning it into bile which plays a role in fat absorption
where does the splenic artery travel through?
upper border of the pancreas
by what is blood returned to the heart?
veins
what are resistive vessels?
vessels that supply organs that do not need constant perfusion like the external carotid and the iliac arteries. fasting vessels
what are non resistive vessels?
vessels that supply organs that need constant perfusion, like the carotid artery, hepatic artery, or renal artery. non fasting vessels
what is the result of intrahepatic portal hypertension?
when a patient has cirrhosis
