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Absite Review > Fiser Liver > Flashcards

Fiser Liver Flashcards

1
Q

What is the #1 hepatic artery variant?

A

right hepatic artery off of the SMA (courses behind pancreas, posterolateral to CBD)

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2
Q

what does the falciform ligament contain?

A

remnant of umbilical vein

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3
Q

what separates the right and left lobe of the liver?

A

portal fissure or cantlie’s line: line drawn from the middle of the gallbladder fossa to IVC

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4
Q

what are liver macrophages called?

A

kupffer cells

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5
Q

whats the portal triad?

A

CBD (lateral), portal vein (posterior), proper hepatic aa (medial)

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6
Q

what are the boundaries of the Foramen of Winslow?

A

Anterior: portal triad
Posterior: IVC
Inferior: duodenum
Superior: liver

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7
Q

what joins together to make the portal vein?

A

SMV and splenic vein

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8
Q

most primary and secondary liver tumors are supplied by what artery?

A

hepatic artery

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9
Q

what segments of the liver do the left, right and middle hepatic arteries supply?

A

Left: II, III, IVa (superior)
Middle: V, IVb (inferior)
Right: VI, VII, VIII
caudate lobe has separate arteries and veins

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10
Q

what is the usual energy source for the liver?

A

ketones

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11
Q

which clotting factors are not made in the liver?

A

von willebrand factor and factor VIII (endothelium)

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12
Q

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

A

vitamin B12

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13
Q

what percentage of liver can be resected?

A

75%

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14
Q

what are the steps from hemoglobin to bilirubin?

A

hemoglobin -> heme -> biliverdin -> bilirubin

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15
Q

what are the primary bile acids? secondary?

A

primary: cholic, chenodeoxycholic
secondary: deoxycholic and lithocholic

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16
Q

what is the main biliary phospholipid and whats the function?

A

lecithin: emulsifies fats and solubizes cholesterol

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17
Q

where is jaundice first evident?

A

under the tongue

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18
Q

what is Gilbert’s disease

A

abnormal biliary conjugation, mild defect in glucuronyl transferase

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19
Q

what is crigler-najjar syndrome?

A

inability to conjugate bilirubin, severe deficiency in glucuronyl transferase, high unconjugated bilirubin, life threatening

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20
Q

what is physiologic jaundice of the newborn?

A

immature glucuronyl transferase, high unconjugated bilirubin

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21
Q

what is rotor’s syndrome?

A

deficiency in storage ability of conjugated bilirubin, high conjugated bili

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22
Q

what is dubin johnson’s syndrome?

A

deficiency in secretion ability, high conjugated bilirubin

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23
Q

fulminant hepatic failure can w which strands of viral hepatitis?

A

B,D, E (RARELY A and C)

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24
Q

most common viral hepatitis strand worldwide

A

hep B

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25
Q

most common viral hepatitis strand leading to live txp

A

hep c

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26
Q

what is the drug used to cure hep c

A

sovaldi: inhibits hep c protein

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27
Q

when do you see hepatitis E?

A

fulminant hepatic failure in pregnancy, most often in 3rd trimester

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28
Q

what viral hepatitis strand has the highest overall mortality?

A

hep B + D (D is cofactor and worsens prognosis)

29
Q

what is the best indicator of synthetic function in pt w cirrhosis?

A

prothrombin time (PT)

30
Q

treatment of hepatic encephalopathy?

A

lactulose, limit protein intake, branched-chain amino acids, neomycin

31
Q

calculation of albumin amt replacement of paracentesis fluid

A

1g per 100cc fluid removed

32
Q

cause of postpartum liver failure with ascites, tx?

A

hepatic vein thrombosis (from ovarian vein source), has infectious component (pelvic thrombophlebitis)
tx: heparin and antibiotics

33
Q

4 criteria for diagnosis of SBP

A

fever, abdominal pain, PMN >250 in fluid, + cultures

34
Q

1 cause of SBP (#2, #3)

A

e coli, then pneumococci, streptococci

35
Q

what effect does vasopressin have in the tx of esophageal varices?

A

splanchnic artery constriction

36
Q

what are 3 post sinusoidal causes of portal hypertension?

A

Budd Chiari, Constrictive pericarditis, CHF

37
Q

how do you measure portal vein pressure? what value is considered significant?

A

hepatic venous wedge pressure, > 10-12mmHg considered significant

38
Q

what does TIPS stand for and what is one of its major complications?

A

Transjugular Intahepatic Portosystmic Shunt, encephalopathy

39
Q

contraindication to a splenorenal shunt?

A

refractory ascites- SRS can worsen ascites

40
Q

what are the different mortalities associated with Child’s Pugh Scores?

A 
A = 2% w shunt
B = 10% w shunt
C = 50% w shunt
41
Q

what are the components of Child’s Pugh Score?

A

albumin, bilirubin, INR, ascites, encephalopathy

42
Q

what are the components of MELD?

A

INR, Cr and total bilirubin

43
Q

what is Budd-Chiari Syndrome?

A

occlusion of the hepatic veins or IVC

44
Q

what is the most common risk factor for budd chiari syndrome?

A

polycythemia vera

45
Q

risk factors for liver amebic abscess?

A

mexico, etoh, fecal-oral tansmission

46
Q

what organism causes amebic liver abscess?

A

entamoeba histolytica

47
Q

tx of amebic liver abscess?

A

flagyl, aspirate only if refractory, surgery only if free rupture

48
Q

what is organism behind hydatid liver cyst?

A

echinococcus

49
Q

what are risk factors for hydatid liver cyst?

A

sheep (carriers), dog (transmission)

50
Q

tx of hydatid cyst?

A

DO NOT ASPIRATE- can cause anaphylaxis

pe-op albendazole (2wks), then surgical removal without spilling them

51
Q

symptoms and treatment of schistosomiasis?

A

symptoms: maculopapular ash, increased eosinophils
tx: praziquantel

52
Q

MMC of pyogenic liver abscess?

A

e coli

53
Q

hepatic adenomas: diagnosis

A

there’s no kupffer cells so no uptake on sulfur colloid scan (cold)

54
Q

hepatic adenomas: treatment

A

asymptomatic and <4cm: stop OCPs, if no regression then resect
symptomatic or >4cm: resection for bleeding and malignancy risk

55
Q

what liver lesion has a central stellate scar?

A

focal nodular hyperplasia

56
Q

focal nodular hyperplasia: diagnosis

A

has Kupffer cells so will take up sulfer colloid on liver scan

57
Q

focal nodular hyperplasia: treatment

A

no resection, no malignancy risk

58
Q

what is the most common benign liver lesion?

A

hemangiomas

59
Q

what is kasabach-merritt syndrome?

A

rare complication of hemangioma that leads to consumptive coagulopathy

60
Q

1 cause of hepatocellular cancer worldwide

A

hepatitis B

61
Q

which type of HCC has the best prognosis?

A

fibolamellar type

62
Q

what is 5 year survival for pts w resection of HCC

A

30%

63
Q

what margin do you need for HCC?

A

1cm

64
Q

bile is produced by which type of cells?

A

hepatocytes

65
Q

the falciform ligament separates what?

A

the medial and lateral left lobes of the liver

66
Q

what is most common organism causing emphysematous cholecystitis?

A

clostridium species: anaerobic, GPR

67
Q

fuel source for small bowel enterocyte

A

glutamine (especially during time of stress ie septic shock)

68
Q

fuel source for colonocytes

A

short chain fatty acids

Absite Review (30 decks)

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