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Drafts of absite from online deck > ABSITE Review - Liver > Flashcards

ABSITE Review - Liver Flashcards

1
Q

What is the #1 and #2 hepatic artery variant?

A 
#1 R hepatic artery off SMA (20%) - courses behind pancreas, POSTEROLATERAL to the CBD
#2 L hepatic artery off L gastric (20%) - found in gastrohepatic ligament
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2
Q

What is the falciform ligament?

A

Separates the medial and lateral segments of the L lobe; attaches liver to anterior abdominal wall; extends to umbilicus and carries umbilical vein.

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3
Q

What is the ligamentum teres?

A

Carries the obliterated umbilical vein to the undersurface of the liver; extends from the falciform ligament

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4
Q

What are the segments of the liver?

A

I - caudate
II - superior left lateral segment
III - inferior left lateral segment
IV - left medial segment (quadrate)
V - inferior right anterolateral segment
VI - inferior right posterolateral segment
VII - superior right posterolateral segment
VIII - superior right anteromedial segment

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5
Q

Where is the bare area of liver?

A

Posterior-superior surface of liver not covered by Glisson’s capsule

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6
Q

Where the portal triad enters the liver?

A

Segments IV and V

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7
Q

What is other name for liver macrophages?

A

Kupffer cells

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8
Q

What is in the portal triad and their location within it?

A

Portal vein posteriorly, CBD laterally, hepatic artery medially

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9
Q

What is the Pringle maneuver?

A

Porta hepatis clamping; will not stop hepatic vein bleeding

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10
Q

What is the positioning of the Foramen of Winslow?

A

Anterior - portal triad
Posterior - IVC
Inferior - Duodenum
Superior - Liver

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11
Q

What two veins form the portal vein?

A

Forms from SMv joining splenic vein (no valves)

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12
Q

How many portal veins are in the liver and what segment they drain?

A

Left - II, III, IV

Right - V, VI, VII, VIII

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13
Q

Where the middle hepatic artery usually comes off?

A

Middle heaptic artery MC a branch off the Left hepatic artery

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14
Q

Which segment each hepatic veins drain?

A

Left - II, III, sup IV
Middle - V, inf IV
Right - VI, VII, VIII

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15
Q

What is the arterial supplay and venous drainage of the caudate lobe?

A

Receives separate right and left portal and arterial blood flow; drains directly into IVC via separate hepatic veins

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16
Q

What is the usual energy source of the liver?

A

Ketones

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17
Q

Where is urea synthesized?

A

Liver

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18
Q

Which factors are not made in the liver?

A

vWF, factor VIII (endothelium)

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19
Q

Which is the only water soluble vitamin stored in the liver?

A

B12

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20
Q

What are the Mc problems after a hepatic resection?

A

Bleeding and bile leak

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21
Q

Which hepatocytes are the most sensitive to ischemia?

A

Central lobular (acinar zone III)

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22
Q

How much liver can be safely resected?

A

75%

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23
Q

What are the two primary bile acids?

A

Cholic and chenodeoxycholic

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24
Q

What are the two secondary bile acids?

A

Deoxycholic and lithocolic

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25
Q

What is the main biliary phospholipid?

A

Lecithin

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26
Q

Where is the first place to look for jaundice?

A

Under the tongue

27
Q

What is Gilbert’s disease?

A

Abnormal uptake; mildly high unconjugated bilirubin

28
Q

What is Crigler-Najjar disease?

A

Inability to conjugate; deficiency of glucoronyl transferase; high unconjugated bilirubin –> life-threatening

29
Q

What is physiologic jaundice of newborn?

A

Immature glucoronyl transferase; high unconjugated bilirubin

30
Q

What is Rotor’s syndrome?

A

Deficiency in storage ability; high conjugated bilirubin

31
Q

What is Dubin-Johnson syndrome?

A

Deficiency in secretion ability; high conjugated bilirubin

32
Q

What types of hepatitis can cause chronic hepatitis and hepatoma?

A

B, C and D

33
Q

What is the tyoe of hepatitis that is DNA?

A

Hepatitis B

34
Q

What is the marker of Hepatitis B vaccination?

A

Increase anti-HBs antibodies

35
Q

What is the MCC of liver failure?

A

Cirrhosis

36
Q

What is the best indicator of synthetic function in a patient with cirrhosis?

A

Prothrombin time

37
Q

What is the treatment for hepatic encephalopathy?

A

Lactulose - cathartic that gets rid of bacteria in the gut and acidifies colon (preventing NH3 uptake by converting it to ammonium)
Limit protein intake
Branched-chain amino acids

38
Q

What is the most likely cause of hepatic failure with ascites postpartum?

A

Hepatic vein thrombosis

Dx - SMA arteriogram with venous phase contrast

39
Q

What is the MC bacteria in SBP?

A

E coli

40
Q

What is the treatment for esophageal varices?

A

Sclerotherapy, Vasopressin (splanchnic artery constriction), Octreotide (decrease portal pressure by decrease blood flow), Propanolol

41
Q

What are the three types of portal HTN? Give some examples of each.

A

Presinusoidal obstruction - schistomiasis, congenital hepatic fibrosis, portal vein thrombosis
Sinusoidal obstruction - cirrhosis
Postsinusoidal obstruction - Budd-Chiari syndrome (hepatic vein occlusive disease), constrictive pericarditis, CHF

42
Q

What is the normal portal vein pressure?

A

<12 mmHg

43
Q

When is a TIPS indicated?

A

Used for protracted bleeding, progression of coagulopathy, visceral hypoperfusion, refractory ascites.

44
Q

What is a splenorenal shunt?

A

Ligate Left adrenal vein, left gonadal vein, inferior mesenteric vein, coronary vein, and pancreatic branches of splenic vein
Used only for Child’s A cirrhotics who present just with bleeding

45
Q

What is Budd-Chiari syndrome?

A

Occlusion of hepatic veins and IVC
Dx - angio, CT scan, liver biopsy sinusoidal dilatation, congestion, centrilobular congestion
Tx - portacaval shunt

46
Q

What is the MCC of splenic vein thrombosis?

A

Pancreatitis

47
Q

How is an amebic infection diagnosed? What is the treatment?

A

Entamoeba histolytica

Tx - Flagyl

48
Q

What are the risk factor for an amebic abscess? Which liver lobe is most commonly involved?

A

Travel to Mexico, ETOH, fecal-oral transmission

Right lobe of liver

49
Q

What is the agent that cause Hydatid cyst? How it can be diagnosed?

A

Echinococcus

Dx - Positive Casoni skin test, positive indirect hemagglutination

50
Q

Which animals are carrier of Echinococcus?

A

Sheeps

51
Q

Can you aspirate a hydatid cyst? What is the treatment?

A

No!!! It can leak and cause an anaphylactic shock.
Tx - Preop ERCP if jaundice, increase LFTs or cholangitis. Preop albendazole
Surgical removal (may want to inject cyst with alcohol at time of removal to kill organisms); need to get all the cyst wall

52
Q

In 80% of the liver abscesses, the MCC is?

A

Pyogenic abscess

53
Q

What are the risk factors for liver adenomas?

A

Women, steroid use, OCPs, type I collagen storage disease

54
Q

How are liver adenomas diagnosed?

A

MRI demonstrates hypervascular tumor, has peripheral blood supply
No Kupffer cells in adenomas, thus no uptake on sulfur colloid scan (cold)

55
Q

What is the treatment for liver adenomas?

A

Asymptomatic - stop OCPs, if no regression –> pt needs resection
Symptomatic - tumor resection for bleeding and malignancy risk; embolization if multiple and unresectable

56
Q

What is usually describe as a central stellate scar?

A

Focal nodular hyperplasia

57
Q

How is FNH diagnosed? What is the treatment?

A

Dx - Abdominal CT; has Kupffer cells, so will take up sulfur colloid on liver scan
MRI/CT scan demonstrates a hypervascular tumor
Tx- conservative mgmt

58
Q

What is the MC benign hepatic tumor?

A

Hemangioma

59
Q

How is FNH diagnosed? What is the treatment?

A

Dx - MRI and CT scan show peripheral to central enhancement, hypervascular lesion
Tx - conservative unless symptomatic, then surgery +/- embolization, XRT and steroids for unresectable disease

60
Q

What are the risk factors of HCC?

A

HBV (#1), HCVm ETOH, hemochromatosis, alpha-1-antitrypsin deficiency, primary sclerosing cholangitis, aflatoxins, hepatic adenoma, steroids, pesticides

61
Q

What marker correlates with HCC tumor size?

A

AFP

62
Q

What are the risk factors for hepatic sarcoma?

A

PVC, Thorotrast, arsenic

63
Q

What are the risk factors asocciated with cholangiosarcoma?

A

Clonorchiasis infection, ulcerative colitis, hemochromatosis, primary sclerosing cholangitis, choledochal cyst

64
Q

What is the difference in vascularity of primary vs metastatic liver tumors?

A

Primary - hypervascular

Metastatic - hypovascular

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