Fiser Liver Flashcards
What is the #1 hepatic artery variant?
right hepatic artery off of the SMA (courses behind pancreas, posterolateral to CBD)
what does the falciform ligament contain?
remnant of umbilical vein
what separates the right and left lobe of the liver?
portal fissure or cantlie’s line: line drawn from the middle of the gallbladder fossa to IVC
what are liver macrophages called?
kupffer cells
whats the portal triad?
CBD (lateral), portal vein (posterior), proper hepatic aa (medial)
what are the boundaries of the Foramen of Winslow?
Anterior: portal triad
Posterior: IVC
Inferior: duodenum
Superior: liver
what joins together to make the portal vein?
SMV and splenic vein
most primary and secondary liver tumors are supplied by what artery?
hepatic artery
what segments of the liver do the left, right and middle hepatic arteries supply?
Left: II, III, IVa (superior)
Middle: V, IVb (inferior)
Right: VI, VII, VIII
caudate lobe has separate arteries and veins
what is the usual energy source for the liver?
ketones
which clotting factors are not made in the liver?
von willebrand factor and factor VIII (endothelium)
what is the only water soluble vitamin stored in the liver?
vitamin B12
what percentage of liver can be resected?
75%
what are the steps from hemoglobin to bilirubin?
hemoglobin -> heme -> biliverdin -> bilirubin
what are the primary bile acids? secondary?
primary: cholic, chenodeoxycholic
secondary: deoxycholic and lithocholic
what is the main biliary phospholipid and whats the function?
lecithin: emulsifies fats and solubizes cholesterol
where is jaundice first evident?
under the tongue
what is Gilbert’s disease
abnormal biliary conjugation, mild defect in glucuronyl transferase
what is crigler-najjar syndrome?
inability to conjugate bilirubin, severe deficiency in glucuronyl transferase, high unconjugated bilirubin, life threatening
what is physiologic jaundice of the newborn?
immature glucuronyl transferase, high unconjugated bilirubin
what is rotor’s syndrome?
deficiency in storage ability of conjugated bilirubin, high conjugated bili
what is dubin johnson’s syndrome?
deficiency in secretion ability, high conjugated bilirubin
fulminant hepatic failure can w which strands of viral hepatitis?
B,D, E (RARELY A and C)
most common viral hepatitis strand worldwide
hep B
most common viral hepatitis strand leading to live txp
hep c
what is the drug used to cure hep c
sovaldi: inhibits hep c protein
when do you see hepatitis E?
fulminant hepatic failure in pregnancy, most often in 3rd trimester
what viral hepatitis strand has the highest overall mortality?
hep B + D (D is cofactor and worsens prognosis)
what is the best indicator of synthetic function in pt w cirrhosis?
prothrombin time (PT)
treatment of hepatic encephalopathy?
lactulose, limit protein intake, branched-chain amino acids, neomycin
calculation of albumin amt replacement of paracentesis fluid
1g per 100cc fluid removed
cause of postpartum liver failure with ascites, tx?
hepatic vein thrombosis (from ovarian vein source), has infectious component (pelvic thrombophlebitis)
tx: heparin and antibiotics
4 criteria for diagnosis of SBP
fever, abdominal pain, PMN >250 in fluid, + cultures
1 cause of SBP (#2, #3)
e coli, then pneumococci, streptococci
what effect does vasopressin have in the tx of esophageal varices?
splanchnic artery constriction
what are 3 post sinusoidal causes of portal hypertension?
Budd Chiari, Constrictive pericarditis, CHF
how do you measure portal vein pressure? what value is considered significant?
hepatic venous wedge pressure, > 10-12mmHg considered significant
what does TIPS stand for and what is one of its major complications?
Transjugular Intahepatic Portosystmic Shunt, encephalopathy
contraindication to a splenorenal shunt?
refractory ascites- SRS can worsen ascites
what are the different mortalities associated with Child’s Pugh Scores?
A = 2% w shunt B = 10% w shunt C = 50% w shunt
what are the components of Child’s Pugh Score?
albumin, bilirubin, INR, ascites, encephalopathy
what are the components of MELD?
INR, Cr and total bilirubin
what is Budd-Chiari Syndrome?
occlusion of the hepatic veins or IVC
what is the most common risk factor for budd chiari syndrome?
polycythemia vera
risk factors for liver amebic abscess?
mexico, etoh, fecal-oral tansmission
what organism causes amebic liver abscess?
entamoeba histolytica
tx of amebic liver abscess?
flagyl, aspirate only if refractory, surgery only if free rupture
what is organism behind hydatid liver cyst?
echinococcus
what are risk factors for hydatid liver cyst?
sheep (carriers), dog (transmission)
tx of hydatid cyst?
DO NOT ASPIRATE- can cause anaphylaxis
pe-op albendazole (2wks), then surgical removal without spilling them
symptoms and treatment of schistosomiasis?
symptoms: maculopapular ash, increased eosinophils
tx: praziquantel
MMC of pyogenic liver abscess?
e coli
hepatic adenomas: diagnosis
there’s no kupffer cells so no uptake on sulfur colloid scan (cold)
hepatic adenomas: treatment
asymptomatic and <4cm: stop OCPs, if no regression then resect
symptomatic or >4cm: resection for bleeding and malignancy risk
what liver lesion has a central stellate scar?
focal nodular hyperplasia
focal nodular hyperplasia: diagnosis
has Kupffer cells so will take up sulfer colloid on liver scan
focal nodular hyperplasia: treatment
no resection, no malignancy risk
what is the most common benign liver lesion?
hemangiomas
what is kasabach-merritt syndrome?
rare complication of hemangioma that leads to consumptive coagulopathy
1 cause of hepatocellular cancer worldwide
hepatitis B
which type of HCC has the best prognosis?
fibolamellar type
what is 5 year survival for pts w resection of HCC
30%
what margin do you need for HCC?
1cm
bile is produced by which type of cells?
hepatocytes
the falciform ligament separates what?
the medial and lateral left lobes of the liver
what is most common organism causing emphysematous cholecystitis?
clostridium species: anaerobic, GPR
fuel source for small bowel enterocyte
glutamine (especially during time of stress ie septic shock)
fuel source for colonocytes
short chain fatty acids
