Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

My Absite > 31 Liver > Flashcards

31 Liver Flashcards

1
Q

Hepatic artery variants

A

Right hepatic artery off superior mesenteric artery (most common 20%) - courses behind pancreas, posterolateral to the CBD
Left hepatic artery off left gastric artery (20%) - found in gastrohepatic ligament medially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Falciform ligament

A

Separates medial and lateral segments of the left lobe
Attaches liver to anterior abdominal wall
Extends to umbilicus and carries remnant of the umbilical vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ligamentum teres

A

Carries the obliterated umbilical vein to the under surface of the liver
Extends from the falciform ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cantlie’s line (portal fissure)

A

Line drawn from the middle of the gallbladder fossa to IVC

Separates the right and left liver lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sections of the liver

A

Right lobe: anterior (8, 5) and posterior (7,6)

Left lobe: left medial section (1, 4) and left lateral section (2,3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Liver segment - I

A

Caudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Liver segment - II

A

Superior left lateral segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Liver segment - III

A

Inferior left lateral segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Liver segment - IV

A

Left medial segment (quadrate lobe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Liver segment - V

A

Inferior right anteromedial segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Liver segment - VI

A

Inferior right posterolateral segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Liver segment - VII

A

Superior right posterolateral segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Liver segment - VIII

A

Superior right anteromedial segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Glisson’s capsule

A

Peritoneum that covers the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bare area

A

Area on the posterior-superior surface of the liver not covered by Glisson’s capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Triangular ligaments

A

Lateral and medial extensions of the coronary ligament on the posterior surface of the liver, made up of peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Portal triad enters via:

A

Segments IV and V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gallbladder lies under:

A

Segments IV and V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Relationship of structures within the hepatoduodenal ligament

A

Lateral - CBD
Portal vein (posterior)
Medial - Proper hepatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Kupffer cells

A

Liver macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contents of the portal triad

A

Common bile duct (lateral)
Portal vein (posterior)
Proper hepatic artery (medial)
Come together in the hepatoduodenal ligament (porta hepatis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pringle maneuver

A

Porta hepatis clamping

Will NOT stop hepatic vein bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Foramen of Winslow

A 
Entrance to the lesser sac
Anterior - portal triad
Posterior - IVC
Inferior - duodenum
Superior - liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Portal vein forms from:

A

Superior mesenteric vein joining the splenic vein (no valves)
Inferior mesenteric vein drains into the splenic vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Portal vein branches

A

2 branches - providing 2/3 of hepatic blood flow
Left - segments II, III, IV
Right - segments V, VI, VII, VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Arterial blood supply to the liver

A

Right left and middle hepatic arteries
Middle hepatic artery is a branch of left hepatic artery
Hepatic artery supplies most primary and secondary tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hepatic venous drainage

A

3 hepatic veins - drain into IVC
Left - II, III, superior IV
Middle - V, inferior IV
Right - VI, VII, VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Variation of the middle hepatic vein

A

80% drain into left hepatic vein

20% drain directly into the IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What do accessory right hepatic veins drain?

A

Medial aspect of the right lobe, directly into IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Blood supply of caudate lobe

A

Receives separate right and left portal and arterial blood flow
Drains directly into the IVC via separate hepatic veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Alkaline phosphatase origin

A

Canalicular membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Where does nutrient uptake occur?

A

Sinusoidal membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Where is urea synthesized?

A

In the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What coagulation factors are NOT synthesized in the liver?

A

vWF, factor VIII (endothelium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What vitamins are stored in the liver?

A

Fat soluble and B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the most common problems with hepatic resection?

A

Bleeding

Bile leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which hepatocytes are most sensitive to ischemia?

A

Central lobular (acinar zone III)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is bilirubin the product of?

A

Breakdown of hemoglobin

Hbg –> heme –> biliverdin –> bilrubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How is the water solubility of bilirubin improved?

A

Conjugated to glucuronic acid (glucoronyl transferase)

Occurs in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What form of bilirubin is actively secreted into bile?

A

Conjugated bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is bilirubin processed after it is secreted in bile?

A

Free bilirubin is created via bacterial breakdown of conjugated bilirubin in the terminal ileum
It is reabsorbed and converted into urobiligen, which is released as urobilin in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What causes cola colored urine?

A

Excess urobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the content of bile?

A 
Bile salts (85%)
Protein
Phospholipids (lecithin)
Cholesterol
Bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What determines the final composition of bile?

A

Active resorption of water via Na/K ATPase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is cholesterol’s role in bile?

A

Used to make bile salts/acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are bile salts conjugated to? Why?

A

Taurine, glycine

Improves water solubility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Primary bile acids (Salts)

A

Cholic and chenodeoxycholic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Secondary bile acids (salts)

A

Deoxycholic and lithocholic

Dehydroxylated primary bile acids via bacteria in gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Role of bile in digestion

A

Bile solubilizes cholesterol and emulsifies fats in the intestine, forming micelles, which enter enterocytes by fusing with the membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Minimum bilirubin level for jaundice? Where do you see it first?

A

Bilirubin >2.5

Under the tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Maximum bilirubin level?

A

30

Unless underlying renal disease, hemolysis or bile duct-hepatic vein fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Causes of elevated unconjugated bilirubin

A

Prehepatic - hemolysis

Hepatic deficiencies of uptake or conjugation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Causes of elevated conjugated bilirubin

A

Secretion defects into bile ducts

Excretion defects into GI tract (stones, strictures, tumors)

54
Q

Gilbert’s disease

A

Abnormal conjugation

Mild defect in glucuronyl transferase

55
Q

Crigler-Najjar disease

A

Inability to conjugate
Severe deficiency in glucuronyl transferase
High unconjugated bilirubin - life-threatening disease

56
Q

Physiologic jaundice of newborn

A

Immature glucuronyl transferase

High unconjugated bilirubin

57
Q

Rotor’s syndome

A

Deficiency in storage ability

High conjugated bilirubin

58
Q

Dubin-Johnson syndrome

A

Deficiency in secretion ability

High conjugated bilirubin

59
Q

Fulminant hepatic failure - which viral hepatitis?

A

B, D and E (rare with A and C)

60
Q

Chronic hepatitis and hepatoma - which viral hepatitis?

A

B, C and D

61
Q

Hepatitis A

A

RNA
Fecal/oral
Serious consequences uncommon

62
Q

Hepatitis B

A

DNA - funny replication with reverse transcriptase

Associated with both acute and chronic hepatitis

63
Q

Anti-HBc antibodies (hep B)

A

Core antibody
IgM elevated first 6mo after exposure
IgG >6mo
NOT in vaccination

64
Q

Hep B vaccination

A

Elevated anti-HBs (surface) antibodies only

65
Q

Elevated anti-HBc antibody
Elevated anti-HBs antibody
Negative HbsAg

A

Patient had infection with recovery

Has immunity

66
Q

Hepatitis C

A

RNA
Long incubation period
Not associated with acute hepatitis - associated with chronic hepatitis
Most common viral hepatitis leading to liver TXP

67
Q

Hepatitis D

A

RNA
Cofactor for hepatitis B
Worse prognosis

68
Q

Hepatitis E

A

RNA

Fulminant hepatic failure in pregnancy (3rd trimester)

69
Q

Most common cause of liver failure?

A

Cirrhosis (palpable liver, jaundice, ascites)

70
Q

Best indicator of synthetic function in patients with cirrhosis?

A

Prothrombin time (PT)

71
Q

Mortality in acute liver failure?

A

Fulminant hepatic failure has 80% mortality

Outcome determined by course of encephalopathy

72
Q

Criteria for urgent liver transplant listing?

A

King’s college criteria

Separated between acetaminophen-induced and other

73
Q

King’s college criteria for acetaminophen-induced ALF?

A 
Arterial pH <7.3 irrespective of coma grade
OR, all of the following:
- INR >6.5
- Creatinine >3.4
- Grade III/IV encephalopathy
74
Q

King’s college criteria for Non-acetaminophen-induced ALF?

A 
INR >6/5
OR, any 3 of the following:
- Age <10 or >40
- Drug toxicity or undetermined etiology
- Jaundice >7 days before encepholopathy
- INR >3.5
- Bilirubin >17
75
Q

Why does liver failure cause hepatic encephalopathy?

A

Inability to metabolize ammonia, mercantanes, and false neurotransmitters

76
Q

Causes, apart from liver failure, for encephalopathy?

A

GI bleed
Infection (SBP)
Electrolyte imbalance
Drugs

77
Q

Treatment of hepatic encephalopathy?

A 
Possible emoblization of previous therapeutic shunts or other major collaterals
Lactulose
Limit protein intake (<70g/day)
Add BCAA to diet
No Abx unless specific infection
Neomycin
78
Q

How does lactulose help with hepatic encephalopathy?

A

Cathartic that gets rid of bacteria in the gut
Acidifies the colon - prevents NH3 uptake by converting it to ammonium
Titrate to 2-3 stools/day

79
Q

How does neomycin help with hepatic encephalopathy?

A

Gets rid of ammonia-producing bacteria from the gut

80
Q

How does chronic cirrhosis cause ascites?

A 
Hepatocyte destruction -->
Fibrosis and scaring of liver -->
Increased hepatic pressure -->
Portal venous congestion -->
Lymphatic overload -->
Leakage of splanchnic and hepatic lymph into peritonium
--> Ascites
81
Q

Albumin dose with paracentesis for ascites

A

1g albumin for every 100cc removed

82
Q

Treatment of ascites

A

Water restrict ion(1-1.5L/day)
Decreased NaCl (1-2g/day)
Diuretics (spironolactone conteracts hyperaldosteronism seen with liver failure)
Paracentesis
TIPS
Prophylactics for SBP (Norfloxacin - if previous SBP or current UGI bleed)

83
Q

Why is aldosterone elevated with liver failure?

A

Impaired hepatic metabolism

Impaired GFR

84
Q

Hepatorenal syndrome

A

Progressive renal failure due to hepatic failure (end-stage)
Same lab findings as prerenal azotemia
Tx: Stop diuretics, give volume; liver TXP

85
Q

Asterixis

A

Neurological changes due to liver failure

Sign that it is getting worse

86
Q

Postpartum liver failure with ascites

A

Due to hepatic vein thrombosis - infectious component
Dx: SMA arteriogram with venous phase contrast
Tx: Heparin + abx

87
Q

Diagnostic criteria for SBP?

A

Fever
Abdominal pain
PMNs >250 in fluid
+/- positive cultures

88
Q

Bacteria causing SBP?

A

E. coli
Pneumococci
Streptococci

89
Q

Differentiating between SBP and bowel perf?

A

SBP is mono-organism

If it is a poly infection - consider perf

90
Q

Risk factors for SBP?

A

Ascites (required)
Prior SBP
Upper GI bleed (variceal hemorrhage)
Low-protein ascites

91
Q

Treatment of SBP?

A

3rd generation cephalosporins

Patients respond in 48 hours

92
Q

Treatment of esophageal varices

A

Banding and sclerotherapy (95% effective)
Vasopressin/octreotide (temporizing)
Sengstaken-Blakemore esophgeal tube
Propranolol (prevent re-bleed, not useful acutely)
TIPS for refractory bleeding

93
Q

Vasopressin - MOA in esophageal varices

A

Splanchnic artery constriction

If patient has hx of CAD - add NTG

94
Q

Octreotide - MOA in esophageal varices

A

Decreases portal pressures by decreasing blood flow

95
Q

Late complication from sclerotherapy? Tx?

A

Strictures

Dilation

96
Q

Causes of portal hypertension?

A

Pre-sinusoidal obstruction - schistosomiasis, congential hepatic fibrosis, portal vein thrombosis
Sinusoidal obstruction - cirrhosis
Post-sinusoidal obstruction - Budd-Chiari syndrome, constrictive pericarditis, CHF

97
Q

Normal portal vein pressure

A

<12 mmHg

98
Q

Which hepatic vein acts as collaterals between the portal vfein adn systemic venous system?

A

Coronary veins - portal vein to veins of lower esophagus (azygous vein)

99
Q

Complications of portal hypertension?

A

Esophageal variceal hemorrhage
Ascites
Splenomegaly
Hepatic encephalopathy

100
Q

Role of shunts in portal hypertension? Complications?

A

Decompress the portal system

Can increase risk of encephalopathy (bypassing the metabolism of liver)

101
Q

Transjugular intrahepatic portosystemic shunt

A

TIPS
Indication: protracted bleeding, progression of coagulopathy, visceral hypoperfusion, refractory ascites

Allows antegrade flow
Complication - encephalopathy

102
Q

Splenorenal shunt

A

Lower rate of encephalopathy
Ligate left adrenal vein, left gonadal vein, IMV, coronary vein and pancreatic branches of splenic vein
Indications - Child’s A cirrhotic presenting with just bleeding
CI: refractory ascites (can make it worse)

103
Q

Child’s B or C with indication for shunt

A

Treat with TIPS

104
Q

Child’s A with just bleeding symptoms

A

Consider splenorenal shunt (more durable)

Otherwise TIPS

105
Q

Child-Pugh Score

A

Assessment of liver failure
Assesses:
- Albumin (>3.5 - 3-3.5 - <3.0)
- Bilirubin (<2.5 - 2.5-4 - >4)
- Encephalopathy (none - minimal - refractory)
- Ascites (none - tx with meds - refractory)
- INR (<1.7 - 1.7-2.3 - >2.3)

Give 1-2-3 points for each category
A - 5-6; B - 7-9; C 10+

106
Q

Association of Child-Pugh Score with Shunt placement

A

Correlates with mortality after open shunt placement
Child’s A - 2%
Child’s B - 10%
Child’s C - 50%

107
Q

Budd-Chiari syndrome

A

Occlusion of hepatic veins of IVC
Sx: RUQ pain, hepatosplenomegaly, ascites, fulminant hepatic failure, muscle wasting, variceal bleeding
Dx: angiogram with venous phase, CT angiogram; liver bx (sinusoidal dilation, congetsion, centrilobular congestion)
Tx: Porta-caval shunt (connecting to IVC above the obstruction)

108
Q

Splenic vein thrombosis

A

Cause: Pancreatitis
Sx: Isolated gastric varices (without elevation of the rest of the portal system pressure), UGI bleed of the varices
Ts: Splenectomy if symptomatic

109
Q

Amebic liver abscess

A 
Single in right lobe of liver
Entamoeba histolytica
Reaches liver via portal vein
Culture of abscess negative
Dx: CT (rim enhancing lesion)
Tx: Flagyl, aspiration (if refractory), surgery (free rupture)
110
Q

Echinococcus liver abscess

A

Hydatid cyst
Positive Casoni skin test, positive serology
Right love of liver
Dx: CT (calcified, double-walled cyst); ERCP (jaundice, increased LFTs, cholangitis to assess for communication with biliary tract)
Tx: pre-op albendazole (2 weeks), surgical removal (inject cyst with alcohol, get entire cyst wall)

DO NOT aspirate - anaphylactic shock

111
Q

Schistosomiasis liver abscess

A

Maculopapular rash, increased eosinophils
Sigmoid colon infection (fine granulation tissue, petechiae, ulcers)
Can cause variceal bleeding
Tx: praziquantel

112
Q

Pyogenic liver abscess

A

Sx: Fever, chills, wt loss, RUQ pain, increased LFTs, WBC, sepsis
Right lobe
E. coli
Contiugous infection from biliary tract or bacteremia
Dx: aspiration
Tx: CT-guided drainage and abx; surgical drainage for unstable condition and continued sepsis

113
Q

Benign liver tumors

A

Hepatic adenomas
Focal nodular hyperplasia
Hemangioma
Solitary cyst

114
Q

Hepatic adenoma

A

Steroids/OCP
Sx: Pain, increased LFT, hypotension (rupture), palpable mass
Dx: Negative sulfur colloid scan (no Kupffer cells), MRI hypervascular tumor
Tx:
Asymptomatic - stop OPCs, if no regression –> resection
Symptomatic - resection for bleeding/malignancy risk; embolization if multiple and unresectable

115
Q

Sulfur colloid scan

A

Used to liver tumors
Kupffer cells uptake sulfur colloid - positive scan
Hepatic adenomas have NO kupffer cells
Focal nodular hyperplasia does have kupffer cells

116
Q

Focal nodular hyperplasia

A

Central stellate scar - looks like cancer
No malignancy risk, unlikely to rupture
Dx: Abdomina CT, positive sulfur colloid scan (has kupffer cells), hypervasular tumor
Tx: conservative (no surgery)

117
Q

Hemangioma

A

Rare rupture
Avoid biopsy - risk of hemorrhage
Dx: MRI/CT - peripheral to central enhancement; hypervascular lesion
Tx: symptomatic - surgery +/- pre-op emobolization; steroids and possible XRT for unresectable

118
Q

Kasabach-Merritt syndrome

A

Consumptive coagulopathy due to hemangioma (rare, children)

119
Q

Rare complications of hemangioma seen in children?

A 
Consumptive coagulopathy (Kasabach-Merritt)
CHF
120
Q

What type of CT do you use to assess the liver?

A

Triple phase

  • Native
  • Portal
  • Arterial
121
Q

Solitary liver cysts

A 
Congenital
Women
Right lobe
Characteristic blue hue
Tx: nothing
122
Q

Hepatoma (HCC)

A

Most common cancer worldwide

AFP level correlates with tumor size

123
Q

Risk factors for HCC

A

Hep B, Hep C, ETOH, hemochromatosis, aslpha-1-antitrypsin deficiency, primary sclerosing cholangitis, alfatoxins, hepatic adenoma, steroids, pesticides

NOT - primary biliary cirrhosis, Wilson’s disease

124
Q

Best prognosis forms of HCC

A

Clear cell
Lymphocyte infiltrative
Fibrolamellar type (adolescent, young adults)

125
Q

Tumor marker for HCC

A

AFP

126
Q

Margins for HCC

A

1cm

127
Q

Risk factors for hepatic sarcoma

A

PVC, thorotrast, arsenic

128
Q

Isolated colon CA metastases to liver - treatment

A

Resection if there is >35% of (good) liver remaining

129
Q

Primary liver tumors CT apperance

A

Hypervascular

130
Q

Metastatic liver tumors CT apperance

A

Hypovascular

My Absite (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions