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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 SONO 131 Lecture #5
Portal Vein Doppler Portal Flow in Tricuspid Regurg Normal Portal Flow
Hepatic Vein Doppler Hepatic Vein – Abnormal Hepatic Vein - Normal
Metabolism Carbohydrate Protein Digestion Bile Storage Iron Vitamins Detoxification Drugs and poisons Primary Functions of the Liver
Hepatic Detoxification • Waste products of energy production • Waste produce of metabolic activities • Hormone & drug break down
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.
Liver Function Tests • AST • ALT • LDH • Alkaline Phosphatase • Bilirubin • Prothrombin Time • Albumin and globulins
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
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
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
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
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
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
Sonographic Evaluation • Liver attenuation • Liver texture • Vascular structures • Ligaments, fissures
Measurements • Anteroposterior 10 – 12.5cm • Transverse 20 – 22.5 cm
Normal or Not? Transverse Liver