Lobes of liver

Cu as cupric acetate). Small lobes of liver removed at 5 min.,... 

Splenomegaly is perceptible by touch at the costal arch in the inspiratory phase. This can be accomplished in particular during ventrodorsal palpation when the physician s right hand works from the back towards the (not too deeply) palpating left hand. An enlarged spleen is easily perceptible due to its downward and inward movement (in contrast to the left lobe of liver). Sensitivity to pressure of the enlarged spleen points to an inflammation. (see chapter 11)... 

Once the percussion technique has been mastered, the relative liver dullness can also be more closely defined within the area of superficial dullness as a zone with a resonance on percussion resembling that of the thigh, i. e. the cranial part of the liver covered by the lung. This is the only way of determining the true size of the liver upwards . The size of the left lobe of liver is determined by percussion above Traube s space, which is narrowed in terms of percussion from the right due to an increase in size of the left lobe of liver. 

Fig. 6.6 Liver cirrhosis with ascites (longitudinal section) the left lobe of liver is rounded and pluinp intrahepatic vessels are reduced. Irregular and inhomogeneous structure. Clear undulatory limitation (arrow) on the underside due to nodular transformation. Wide hypoechoic fringe due to ascites...

Position 2 Inspection of the right upper abdomen with the upper body raised in left rotation (= right lobe of liver, gall bladder, round ligament, falciform ligament, duodenum). 

Fig. 7.7 Congested lymphatic vessels in the area of the medial part of the right lobe of liver (insertion of the left falciform ligament can be clearly identified) with partial vessel wall segmentation. Here in chronic toxic hepatitis...

It should be noted that findings in the area of the right lobe of liver can be checked later by percutaneous... 

Focal liver diseases Biopsy material cannot be guaranteed as being representative. A higher degree of diagnostic accuracy can be achieved by a 2 to 3 fold liver biopsy in the course of a laparoscopic-bioptic examination of both lobes of liver. The same is true for peliosis hepatis (236, 305), granulomas and chronic hepatitis C, for example. (120)... 

Scintigraphic proof of cirrhosis is based on (i.) enlarged rectangular liver, (2.) reduced and patchy uptake of radioactivity by the hepatic RES ( mottled liver ), (3.) shift in the maximum activity from the right to the left lobe of liver, and (4.) increased uptake by the spleen and bone RES. The recorded scintigraphic findings permit assessment of the course of liver cirrhosis and provide information on focal complications such as .) occlusion of the branches of the portal vein with locally impaired perfusion and (2.) development of hepatocellular carcinoma. 

In the Budd-Chiari syndrome, the central area of the liver shows a normal or even increased concentration of radioactivity, whereas the peripheral regions of both lobes of liver exhibit reduced or even no uptake ( hot spots and multiple focal storage defects). Only the caudate lobe shows increased activity due to its separate venous flow, it is not functionally affected by hepatic vein thrombosis. (26)... 

Fig. 9.3 Liver metastases Anterior view during scintigraphy using jgppm-S-Qolloid (100 MBq) three foci in the right lobe of liver in colon carcinoma...

Hepatomegaly is present if (I.) palpation locates the lower border of the right lobe of liver to be more than 2 cm (1-2 finger breadths) below the left costal arch (MCL lateral to rectus abdominis) (caution phrenoptosis), (2.) the absolute liver dullness on percussion is more than 14 cm, or (3.) the longitudinal diameter of the liver in the MCL is greater than approximately 15 cm in the sonogram. 

Fig. 22.15 Large sunken scar plate in the area of the left lobe of liver (about 6X4 cm) subsequent to massive dystrophic liver parenchymal necrosis due to viral hepatitis B...

Fig. 24.5 Small nodular hepatic tuberculosis foci, the size of a millet seed up to that of a lentil, in the right lobe of liver...

Fig. 25.1 Ultrasonographic visualization of an amoebic abscess in the right lobe of liver (s. fig. 9.2)...

Fig. 25.19 Laparoscopic view of a large Echinococcus cysticus hydatid in the right lobe of liver irregularly thickened hypervascu-lar capsule. Fibrin deposition at the adjacent peritoneum. Distended elastic consistency...

A case report of blastomycosis of the hepatobiliary i yi -tem describes the following conditions (39) development of chronic cholangitis in the area of the left hepatic duct with encroachment of the mycotic inflammation to the left lobe of liver in cases of predisposing and/or preexisting choledocholithiasis histological evidence of liver granulomas and periportal fibrosis marked increase in alkaline phosphatase and y-GT. (40)... 

The right lobe of liver, especially the dorsal segments, is most frequently involved (60-70%). In 20-30% of cases, both lobes are affected. Solitary abscesses are localized in the right lobe of liver in 80-90% of cases. Multiple abscesses can be observed in approx. 40% of patients. Subhepatic localization of an abscess was observed following the perforation of a gastric ulcer (11) and conventional cholecystectomy. (Ill)... 

Fig. 33.2 So-called lupoid hepatitis. The left lobe of liver shows an irregularly rippled surface (scattered light reflex) with salmon-pink and yellow colouring, patchy red marking due to highly inflammatory parenchymal zones fine vascular multiplication and whitish scarred areas with diffuse fibrosis...

Fig. 34.3 Chronic active hepatitis flat, undulatory liver surface ( scattered light reflection ) with pronounced fibrosis, scarring and a marked rim of connective tissue in the left lobe of liver. Red spots due to highly inflammatory parenchymal areas. Isolated fine blood vessels and distinct lymphatic congestion...

Fig. 34.6 Chronic necrotizing hepatitis B marked postnecrotic cleft formation in the area of the left lobe of liver (10 months after severe, acute necrotic hepatitis). Brownish to brick-red colouring of the liver with a flat, undulatory surface, scarry indentations and proliferation of connective tissue as well as spots of capsular fibrosis. Fine hypervascular arteries, pronounced venous contours and isolated lymph vessel congestion...

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