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Questions and Answers
What is the maximum normal measurement of the liver?
What is the maximum normal measurement of the liver?
The pancreas is less echogenic than the liver.
The pancreas is less echogenic than the liver.
False
What condition causes the liver to appear echogenic compared to the kidneys?
What condition causes the liver to appear echogenic compared to the kidneys?
Fatty liver or hepatic steatosis
The liver is suspended from the diaphragm and the anterior abdominal wall by the ______ ligament.
The liver is suspended from the diaphragm and the anterior abdominal wall by the ______ ligament.
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Match the following liver structures with their descriptions:
Match the following liver structures with their descriptions:
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What percentage of the total volume of incoming blood to the liver is provided by the portal vein?
What percentage of the total volume of incoming blood to the liver is provided by the portal vein?
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The right hepatic vein (RHV) is the smallest hepatic vein.
The right hepatic vein (RHV) is the smallest hepatic vein.
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What structure provides for 50-60% of the oxygen requirements of hepatocytes?
What structure provides for 50-60% of the oxygen requirements of hepatocytes?
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The __________ artery branches off the celiac axis and enters the right margin of the gastrohepatic ligament.
The __________ artery branches off the celiac axis and enters the right margin of the gastrohepatic ligament.
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Match the hepatic veins with their characteristics:
Match the hepatic veins with their characteristics:
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Which artery is NOT a branch of the hepatic artery?
Which artery is NOT a branch of the hepatic artery?
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The hepatic artery is characterized by a non-pulsatile flow.
The hepatic artery is characterized by a non-pulsatile flow.
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The _____ is where the portal vein and hepatic artery enter the liver and the bile duct exits.
The _____ is where the portal vein and hepatic artery enter the liver and the bile duct exits.
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What is the average normal diameter of the main portal vein?
What is the average normal diameter of the main portal vein?
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The left portal vein is typically more posterior than the right portal vein.
The left portal vein is typically more posterior than the right portal vein.
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What is the main responsibility of the portal venous system?
What is the main responsibility of the portal venous system?
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The main portal vein divides into the right and left __________ veins.
The main portal vein divides into the right and left __________ veins.
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Match the following portal vein branches with their description:
Match the following portal vein branches with their description:
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Which vein is seen posteriorly to the main portal vein in transverse images?
Which vein is seen posteriorly to the main portal vein in transverse images?
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The liver receives nutrients exclusively from the portal vein.
The liver receives nutrients exclusively from the portal vein.
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What type of flow does a normal hepatopetal portal vein indicate?
What type of flow does a normal hepatopetal portal vein indicate?
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What is the primary function of the falciform ligament?
What is the primary function of the falciform ligament?
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The ligamentum teres is formed by the obliterated right umbilical vein.
The ligamentum teres is formed by the obliterated right umbilical vein.
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What two components does the ligamentum venosum connect?
What two components does the ligamentum venosum connect?
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The __________ ligaments extend from the liver to the diaphragm and are formed by the coronary ligament.
The __________ ligaments extend from the liver to the diaphragm and are formed by the coronary ligament.
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Match the ligaments with their descriptions:
Match the ligaments with their descriptions:
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Which ligament surrounds the portal triad?
Which ligament surrounds the portal triad?
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Where does the ligamentum venosum typically attach?
Where does the ligamentum venosum typically attach?
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The color Doppler is used to identify the presence of flow in both bile duct and hepatic artery.
The color Doppler is used to identify the presence of flow in both bile duct and hepatic artery.
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The right triangular ligament is smaller than the left triangular ligament.
The right triangular ligament is smaller than the left triangular ligament.
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What is the internal diameter range of the bile duct in normal values?
What is the internal diameter range of the bile duct in normal values?
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What structure arises from the midportion of the coronary ligament?
What structure arises from the midportion of the coronary ligament?
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The portal vein carries blood from the liver and bowel to the ________.
The portal vein carries blood from the liver and bowel to the ________.
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Which cell type is most abundant in the liver parenchyma and carries out most metabolic functions?
Which cell type is most abundant in the liver parenchyma and carries out most metabolic functions?
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Match the following structures to their functions:
Match the following structures to their functions:
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The ligamentum venosum is located anterior to the inferior vena cava (IVC).
The ligamentum venosum is located anterior to the inferior vena cava (IVC).
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What structure can be identified coursing between the anterior abdominal wall and the left lobe of the liver in patients with ascites?
What structure can be identified coursing between the anterior abdominal wall and the left lobe of the liver in patients with ascites?
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Hepatic artery can have a maximum internal diameter up to 6 mm.
Hepatic artery can have a maximum internal diameter up to 6 mm.
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The ligamentum teres is a remnant of the old ______ vein.
The ligamentum teres is a remnant of the old ______ vein.
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Name the three types of cells that perform functions in the liver.
Name the three types of cells that perform functions in the liver.
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Match the following ligaments with their descriptions:
Match the following ligaments with their descriptions:
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Which landmark divides the right and left lobes of the liver?
Which landmark divides the right and left lobes of the liver?
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The main lobar fissure is a hypoechoic line seen on the longitudinal scan.
The main lobar fissure is a hypoechoic line seen on the longitudinal scan.
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Where is the caudate lobe located relative to the porta hepatis?
Where is the caudate lobe located relative to the porta hepatis?
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Study Notes
Liver Anatomy
- The liver is the largest organ in the body and is quite accessible to sonographic evaluation.
- The parenchyma of a normal liver is used to evaluate other organs in the body.
- The kidneys are equally or less echogenic than the liver.
- Fatty liver, echogenic liver, hepatic/liver steatosis is when the liver appears brighter than the kidney parenchyma.
- A normal liver usually measures less than 16cm.
- The pancreas is equally or slightly more echogenic than the liver.
- Sagittal image of the right liver lobe shows a homogeneous echo pattern of hepatic parenchyma that is isoechoic or mildly hyperechoic compared to renal parenchyma.
- Transverse image demonstrates a homogeneous echo pattern with hepatic veins and inferior vena cava located within normal hepatic parenchyma.
- The liver occupies most of the right hypochondrium, the greater portion of the epigastrium, and the left hypochondrium as far as the mammillary line.
- The liver is inferior to the diaphragm.
- The stomach is located posterior and lateral to the left lobe.
- The duodenum is adjacent to the right lobe.
Liver Measurements
- A normal liver is generally less than 16 cm in measurement.
Liver Segments
- Couinaud's segments, a system providing an anatomical basis for hepatic surgical resections, divides the liver into eight segments.
Liver Vessels
- The liver receives a dual blood supply from the portal vein and the hepatic artery.
- The portal vein carries poorly oxygenated blood from the intestines and spleen, but it is rich in nutrients.
- The portal vein supplies half of the oxygen requirements of the hepatocytes due to the greater flow.
- Hepatic arterial blood is oxygen-rich.
- Portal venous blood carries nutrients after traversing the gastrointestinal tract walls.
- Blood from portal and hepatic arteries mixes in the liver sinusoids.
- Hepatic veins drain blood into the inferior vena cava (IVC).
- The normal diameter of the portal vein ranges between 1.0 and 1.6 cm, with an average of 1.3 cm.
Liver Ligaments and Fissures
- Glisson's capsule surrounds the liver, a thin connective tissue layer.
- The main lobar fissure is the boundary between the right and left lobes, visible as a hyperechoic line extending from the portal vein to the neck of the gallbladder.
- The falciform ligament extends from the umbilicus to the diaphragm, with the ligamentum teres as a remnant of the old umbilical vein.
- The ligamentum teres appears as a bright, triangular, echogenic fossa.
- The ligamentum venosum separates the left lobe from the caudate lobe and is located posterior to the porta hepatis.
- Parasagittal imaging displays a small vein draining directly from the caudate lobe (CL) into the IVC.
- Right and left triangular ligaments are formed by the coronary ligament and are attached to the diaphragm.
- The right triangular ligament is smaller and is attached to the right side of the liver.
- The gastrohepatic ligament/lesser omentum is composed of two folds of visceral peritoneum, originating from the liver and attaching to the lesser curvature of the stomach and first part of the duodenum.
- The hepatoduodenal ligament surrounds portal triads.
Additional Notes
- Riedel's lobe is a congenital variant, appearing as an anterior projection of the liver that may extend to the iliac crest.
- A tongue-like process can extend downward from the right lobe of the liver and laterally to the gallbladder.
- The hepatic parenchyma consists of hepatocytes and Kupffer cells. Hepatocytes are the most numerous cells for metabolic functions. Biliary epithelial cells form the biliary system (bile ducts, canaliculi, and gallbladder). Kupffer cells are phagocytic and part of the reticuloendothelial system and line the sinusoids.
Liver Ultrasound
- Transverse views are best for visualizing hepatic veins and the main portal veins (MPV) are seen entering the liver.
- Oblique color Doppler scans can show blood flow in and out of the hepatic veins and the portal vein.
- Gray-scale and color Doppler images can distinguish the common bile duct (CBD) from the hepatic artery (HA), presenting color in the vessels (portal veins).
- The normal (healthy) diameter of the CBD ranges from 4mm to 8mm.
- The maximum diameter of the hepatic artery is measured to be between 2mm to 6mm.
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Description
Test your knowledge on the anatomy and functions of the liver with this comprehensive quiz. Covering topics like liver measurement, blood supply, and liver structures, this quiz is essential for students of anatomy and medical sciences. See how well you understand the key concepts related to liver function and structure.
