Liver Function and Embryology Quiz

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Questions and Answers

Which tumor marker is associated with Medullary Thyroid Cancer?

CA 125

CEA

Calcitonin (correct)

Lactate Dehydrogenase

What is the primary use of monitoring PT, INR, PTT, and Platelets?

To ensure proper clotting factors prior to invasive procedures (correct)

To evaluate renal function

To diagnose cancer types

To assess liver function

Which of the following tumor markers is linked to prostate cancer?

CA 19-9

HCG

CA 72-4

PSA (correct)

Which tumor marker is related to ovarian cancer?

CA 125 Signup and view all the answers

What does a high level of Alkaline Phosphatase indicate primarily?

Bone cancer Signup and view all the answers

What is the main job of the liver?

Filter blood coming from the digestive tract Signup and view all the answers

What is the remnant of the umbilical vein called after birth?

Ligament Teres Signup and view all the answers

What condition is indicated by a liver size greater than 15.5 cm?

Hepatomegaly Signup and view all the answers

Which structure bypasses the liver in fetal circulation?

Ductus Venosus Signup and view all the answers

Where is the liver primarily located?

Right Hypochondrium and Epigastrium Signup and view all the answers

What shape is the liver described as?

Wedge shaped Signup and view all the answers

What can cause hepatomegaly?

Infection, hepatic tumors, or metabolic disorders Signup and view all the answers

How is liver size typically measured?

At the MID-CLAVICULAR sagittal or coronal MID-AXIAL plane Signup and view all the answers

What is the primary function of the coronary ligament?

To suspend the liver from the diaphragm Signup and view all the answers

Which ligament is a remnant of the umbilical vein?

Ligamentum teres Signup and view all the answers

What role does the falciform ligament play in liver anatomy?

It separates the right and left lobes of the liver Signup and view all the answers

Which hepatic ligament can appear round or triangular when visualized?

Ligamentum teres Signup and view all the answers

In the presence of ascites, which ligament is identifiable as it courses between the abdominal wall and the left lobe of the liver?

Falciform ligament Signup and view all the answers

Which ligament is formed by the upper and lower ends of the coronary ligaments?

Right triangular ligament Signup and view all the answers

What echogenicity characteristic is true of a normal liver?

It is hyper-echoic compared to the renal cortex Signup and view all the answers

Which statement best describes the number of functions performed by the liver?

It is essential to life performing over 500 separate activities. Signup and view all the answers

What are the three primary lobes of the liver?

Right, Left, Caudate Signup and view all the answers

How is the liver anatomically divided into lobes?

Based on the distribution of the Portal and Hepatic veins Signup and view all the answers

Which segment corresponds to the caudate lobe?

Segment I Signup and view all the answers

What distinguishes the second order division of the liver?

Division by hepatic veins into four segments Signup and view all the answers

Which part of the liver is supplied by both the right and left portal veins?

Caudate lobe Signup and view all the answers

How many total segments does the liver have following the third order division?

8 Signup and view all the answers

What defines intersegmental vessels in the liver?

Hepatic veins that lie between lobes and segments Signup and view all the answers

Which statement about portal veins is true?

They are intrasegmental vessels Signup and view all the answers

What is the main characteristic of the portal triad?

Encased by Glisson’s capsule Signup and view all the answers

Which segments belong to the left medial part of the liver?

Segments IVa & IVb Signup and view all the answers

Which type of cell is the most abundant in the liver and carries out most metabolic functions?

Hepatocytes Signup and view all the answers

Which liver function test is more specific for liver disease than AST?

Alanine Aminotransferase Signup and view all the answers

What does an increased level of Gamma Glutamyl Transpeptidase (GGT) indicate?

Hepatocellular disease Signup and view all the answers

Which condition is associated with elevated Alpha Fetoprotein (AFP) levels?

Hepatocellular carcinoma Signup and view all the answers

What does a low platelet concentration indicate?

Thrombocytopenia Signup and view all the answers

What is the primary function of Kupffer cells in the liver?

Phagocytose pathogens Signup and view all the answers

What is the significance of an elevated AST without an increase in ALT?

Indicates myocardial infarction Signup and view all the answers

Which test is used primarily to monitor patients on anticoagulant therapy?

Prothrombin Time (PT) Signup and view all the answers

Which enzyme is primarily associated with tissue damage in various body organs, including the liver?

Lactic Dehydrogenase Signup and view all the answers

Which of the following tests characterizes blood coagulation and detects abnormalities in clotting factors?

Partial Thromboplastin Time (PTT) Signup and view all the answers

Study Notes

Liver Function

Primary role: filtering blood from the digestive tract
Detoxifies chemicals
Processes drugs
Secretes bile which returns to the intestines
Produces proteins essential for blood clotting and other bodily functions

Embryology and Fetal Circulation

Umbilical vein carries oxygenated blood from the placenta to the fetus
After birth, the umbilical vein closes and becomes the Ligamentum teres
Ligamentum teres originates from the umbilicus and extends to the left portal vein
The ductus venosus bypasses the liver during fetal development and closes after birth to form the Ligamentum venosum

Liver Location

Located in the right hypochondrium
May extend into the left hypochondrium, depending on size and shape
Variable shape that can be categorized as irregular, hemispherical, or wedge-shaped

Liver Size

Difficult to accurately assess due to limitations of ultrasound
Measured superior-inferiorly at the mid-clavicular sagittal or coronal mid-axial plane
Hepatomegaly, exceeding 15.5 cm in superior-inferior dimension, may indicate infections, tumors, or congenital/metabolic disorders.
Reidel’s lobe, an inferior projection of the right lobe, may resemble hepatomegaly

Liver Anatomy

Divided into three lobes: right, left, and caudate
Quadrate lobe is considered the medial aspect of the left lobe
Divisions are based on portal and hepatic vein distribution
First order division encompasses the right and left lobes
Second order division further subdivides into four segments: left lateral, left medial, right anterior, and right posterior
Third order division creates eight segments:
- Segment I: Caudate lobe
- Segment II: Left lateral superior
- Segment III: Left lateral inferior
- Segment IVa: Left medial superior
- Segment IVb: Left medial inferior
- Segment V: Right anterior inferior
- Segment VI: Right posterior inferior
- Segment VII: Right posterior superior
- Segment VIII: Right anterior superior

Hepatic and Portal Veins

Hepatic veins (intersegmental) course between lobes and segments
Portal veins (intrasegmental) course to the center of each segment
Portal triad: main portal vein, proper hepatic artery, common hepatic duct

Liver Blood Supply

Liver receives a dual blood supply
Hepatic ligaments:
- Coronary ligament: Connects the posterior-superior surface of the liver to the diaphragm; highly reflective on ultrasound, surrounds the bare area
- Right and left triangular ligaments: Formed by the upper and lower ends of the coronary ligaments; highly reflective on ultrasound
- Ligamentum teres: Remnant of the umbilical vein; highly reflective, appears round or triangular
- Falciform ligament: Broad, thin, anterior-posterior fold of the parietal peritoneum; separates the right and left lobes on the anterior surface

Liver Echogenicity

Normal liver is homogeneous and slightly hyperechoic compared to the renal cortex
Echogenicity comparisons should be made between structures

Liver Physiology

Essential for life, performing over 500 distinct activities
Single liver cell functions are diverse, capable of carrying out:
- Production of chemical compounds
- Short- and long- term storage
- Heat production
- Waste excretion
- Tissue regeneration
Composed of three cell types:
- Hepatocytes (most abundant; carry out most metabolic functions)
- Biliary epithelial cells (line the biliary system, including ducts, canaliculi, and the gallbladder)
- Kupffer cells (phagocytic cells that line the sinusoids and belong to the reticuloendothelial system)

Liver Function Tests (LFTs)

Aspartate aminotransferase (AST) / SGOT: Present in the liver, heart, skeletal muscle, kidney, and brain. An elevated AST alone is non-specific for liver disease.
Alanine aminotransferase (ALT) / SGPT: More specific for liver disease than AST; present in high levels within liver tissue. Elevated AST and LDH with a normal ALT rules out hepatic disease.
Gamma glutamyl transpeptidase (GGT): Present in hepatocytes and bile duct epithelium. Elevated GGT indicates hepatocellular disease and biliary obstruction.
Lactic dehydrogenase (LDH): Enzyme found in many body tissues. Elevated LDH indicates cellular damage; LDH4 and LDH5 are found in the liver and may be elevated in cirrhosis and chronic viral hepatitis.
Alpha fetoprotein (AFP): Protein produced by the fetal liver; elevated levels can indicate hepatocellular carcinoma (HCC), germ cell tumors, metastatic liver disease, or hepatoblastoma in children.
Platelets: Contribute to hemostasis; thrombocytopenia (low platelet count) and thrombocytosis (elevated platelet count)
Prothrombin time (PT): Clotting factor; used to diagnose unexplained bleeding or blood clots; monitored in patients taking blood thinners (Warfarin or Coumadin).
International normalized ratio (INR): Standardized measurement of PT used to monitor patients on blood thinners.
Partial thromboplastin time (PTT): Used to monitor patients on Heparin

Tumor Markers

Important for diagnosing and monitoring various types of cancers.
Alpha fetoprotein (AFP): HCC and germ cell tumors
Human chorionic gonadotropin (HCG): Germ cell tumors and testicular cancer
Prostate-specific antigen (PSA): Prostate cancer
CA 15-3 and CA 27-29: Breast cancer
CA 125: Ovarian and uterine cancer
CA 72-4 & CA 19-9: Pancreatic, lung, gastric, colorectal, and biliary cancers
Carcinoembryonic antigen (CEA): Bile duct, bladder, uterine, breast, GI, esophageal, and colorectal cancers
Calcitonin: Medullary thyroid cancer
Lactate dehydrogenase (LDH): Gastrointestinal and germ cell tumors
Alkaline phosphatase: Bone and liver disorders
CEA: Bile duct, bladder, uterine, breast, GI, esophageal, and colorectal cancers

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Description

This quiz covers key aspects of liver function, its physiological role in processing blood and detoxifying chemicals, as well as embryological features like fetal circulation and the development of ligaments. It provides insights into the anatomical location and variability of liver size, essential for medical students and healthcare professionals alike.