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The Liver

The Liver. SONO 131 Lecture #5. Anatomy. Sonographic Presentation. Anterior & Posterior Views. Superior & Inferior Views. Couinaud’s Hepatic Segments. Hepatic Vascular System. Hepatic Vascular System. Portal Vein Doppler. Portal Flow in Tricuspid Regurg. Normal Portal Flow.

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The Liver

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  1. The Liver SONO 131 Lecture #5

  2. Anatomy

  3. Sonographic Presentation

  4. Anterior & Posterior Views

  5. Superior & Inferior Views

  6. Couinaud’s Hepatic Segments

  7. Hepatic Vascular System

  8. Hepatic Vascular System

  9. Portal Vein Doppler Portal Flow in Tricuspid Regurg Normal Portal Flow

  10. Hepatic Vein Doppler Hepatic Vein – Abnormal Hepatic Vein - Normal

  11. Hepatic Artery Doppler

  12. Liver Function(s)

  13. Liver Cells

  14. Liver Cells

  15. Metabolism Carbohydrate Protein Digestion Bile Storage Iron Vitamins Detoxification Drugs and poisons Primary Functions of the Liver

  16. Hepatic Metabolic Functions

  17. Hepatic Detoxification • Waste products of energy production • Waste produce of metabolic activities • Hormone & drug break down

  18. Commercial Product Liver DETOX's Unique Formula: • Milk Thistle - a natural herb, traditionally used to support detoxification functions of the liver. • L-Methionine - an amino acid that the liver uses to create glutathione. • N-Acetyl-Cystine - the liver also uses NAC to create glutathione. • Alpha Lipoic Acid - is an antioxidant that helps revitalize glutathione and supports the antitoxin activities of the liver. • Selenium - helps zinc and vitamins (both antioxidants) to function better in their detoxification properties. • Ayurvedic Herbs - these herbs have long been used to promote the detoxification capabilities of the liver.

  19. Liver Function Tests • AST • ALT • LDH • Alkaline Phosphatase • Bilirubin • Prothrombin Time • Albumin and globulins

  20. Liver Function Tests • Bilirubin – a bile pigment resulting from the breakdown of old blood cells • Formed by Kupffer cells and excreted by hepatocyes • Increases with any chronic inflammatory disease • Reported types • Total = mixture of conjugated + unconjugated • Increases in in chronic liver cell disease (Cirrhosis) • Unconjugated or indirect • Increases in isolated acute hepatocellular disease • Conjugated or direct bilirubin • Increases in biliary duct obstruction

  21. Liver Function Tests • Serum Albumin – protein that is a component of blood • Synthesized by liver • Responsible for maintenance of osmotic pressure in blood • Decreased levels • Liver dysfunction • Malnutrition • Renal disease

  22. Liver Function Tests • AST – Aspartate aminotransferase, formerly know as SGOT • Enzyme found in liver, muscles and tissues with high metabolic rates • Liver causes for abnormal AST • Acute hepatitis • Cirrhosis • Hepatic necrosis • Injury to the liver • Metastases to the liver • Fatty changes • Non-Liver causes for abnormal AST • Mononucleosis • Myocardial Infarction

  23. Liver Function Tests • ALT – Alanine aminotransferase (formerly SGPT) • Enzyme produced in the hepatocytes • Elevated ALT • Hepatitis • Obstructive jaundice • Hepatocellular disease • Shock & drug toxicity causing liver cell death

  24. Liver Function Tests • Alkaline Phosphatase – enzyme produced in liver, kidneys, bones, intestines and placenta • Increase with normal ALT & AST • Bile duct obstruction • Primary biliary cirrhosis • Sclerosing cholangitis • Nonbiliary causes for increase • Abscesses • Liver carcinoma • Cirrhosis

  25. Liver Function Tests

  26. Sonographic Evaluation • Patient Preparation • NPO for at least 6 hours • Transducer • 2.5 to 5 MHz curvilinear or sector • Patient Position • Supine and decubitus as necessary • Patient Breathing • Full inspiration

  27. Sonographic Evaluation • Liver attenuation • Liver texture • Vascular structures • Ligaments, fissures

  28. Liver Images – Transverse & Longitudinal

  29. Liver Images - Transverse

  30. Measurements • Anteroposterior 10 – 12.5cm • Transverse 20 – 22.5 cm

  31. Normal or Not? Transverse Liver

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