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hbs Flashcards

1
Q

cholangio dx

A

can be clinical; no tissuee needed

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2
Q

replace RHA

A

SMA > celiac or aorta.

posterior and lateral to the CBD and pancreas
palpation of a distinct pulse at this location should raise suspicion for this anatomical variant.

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3
Q

Milan criteria for HCC

A

1 tumor < 5 cm or 3 tumors < 3 cm each

txp = survival benefit has been demonstrated for these patients

also eligible:
hilar cholangiocarcinomas a
epithelioid hemangioendothelioma
large hepatic adenomas

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4
Q

UCSF criteria for liver txp in HCC

A

1 lesion < 6.5 cm or up to 3 lesions < 4.5 cm each and total < 8 cm

less restrictive

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5
Q

contraindication to liver txp

A

INTRAhepatic cholangiocarcinoma

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6
Q

arterial enhancement and delayed washouthepatic

A

HCC

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7
Q

strong arterial enhancement with central scar persistent in delayed phase

A

FNHrim

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8
Q

peripheral enhancing lesion in arterial phase

A

intrahpeatic cholangio

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9
Q

peripehral nodular enhancement in arterial phase with central fillin centripetal in delayed

A

heamngioma

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10
Q

adenoma resection lsize?

A

5cm

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11
Q

early washout on portal phase; no stellate scar; peripheral enhancement centripetla

A

adenoma

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12
Q

hyper T1

A

adenoma, FNH

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13
Q

hypo T1

A

hemangioma

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14
Q

dx bile leak after hepatectomy?

A

3x serum bili after POD 3
manage with drainage first

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15
Q

normal liver functional remnant?

A

20-25%c

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16
Q

childs a cirrhotic functional remnant?

A

40%

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17
Q

for HCC presumed off CT scan, what additional imaging recommended?

A

MRI with contrast if 1-2 cm (smal)… to determine FLR
otherwise, <5cm (milan), wack it out.

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18
Q

RCC met to liver tx

A

resection or perc radiofrequency or microwave ablation

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19
Q

FNH mgmt

A

NTD

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20
Q

left trisectionectomy = extended left

A

2, 3, 4, 5, 8

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21
Q

rigth trisectionectomy = extended right

A

4, 5, 6, 7, 8

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22
Q

falci

A

umbo vein remnant (extends to ligamentum teres) separates med/lat LEFT LOBE

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23
Q

Cantlies

A

middle of fossa to IVC separates R and L lobes

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24
Q

portal triad oritentation

A

CBD lateral
portal posterior
hepatic medial

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25
Q

composition of perfusion to liver

A

66% portal
33% hepatic aa

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26
Q

middle hepatic aa origin

A

from LHA
LHV and MHV also join before cava

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27
Q

veins draining into IVC near top of liver

A

M/L, R, inferior phrenic, poss accessory RHV (medial R lobe), caudate vein (received R/L portal and arterial flow)

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28
Q

vits stored in liver

A

ADEK B12

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29
Q

bile salts

A

cholic and chenodeoxycholic
deoxycholic and lithocholic

conjugated to turine and glycine for water solubility

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30
Q

bilirubin clinically evident

A

> 2.5 (under tongue first)

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31
Q

Gilbert disease

A

abnormal conjugation
glucuronyl transferasel

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32
Q

Crigler Najjar disease

A

can’t conjugte. severe gluruonyl transferase def; life tthreatning

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33
Q

newborn. jaundice normal

A

immautre glucuronyl transferase (high iBili)

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34
Q

Rotors syndrome

A

def in storange abililty; high Dbil

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35
Q

Dubin Johnson

A

def in secretion abiliyt; high DBil

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36
Q

fulminant hepatic failure 2/2 to what hepatitis viruses

A

B D E

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37
Q

chronic hepatitis/hepatoma 2/2 to what hepatitis viruses

A

B C D.

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38
Q

MC hepatitis worldwide

A

HBV

39
Q

MC hepatitis causing cirrhosis in Western world

A

HCV

40
Q

best marker of synthetic function in cirrhosis

A

prothrombin TIME

41
Q

Kings College Criteria for poor prognosis ACUTE LIVER FAILURE

A

pH < 7.3 or
INR 6.5, Cr 3.4, grade III+ encephalopathy
with tylenol toxicity

or if not tylenol, then INR 6.5 or
<10 YO, > 40 YO, 7 days jaundice, INR .3.5, bili 17

42
Q

SBP dx

A

PMN > 250 in fluid

43
Q

portal hypertension dx

A

portal vein pressure > 10-12 mm Hg
portal - wedge >6

44
Q

indication for splenorenal shunt

A

Chids A with bleeding (can worsen asictes)

45
Q

chids C mortaility after shunt

A

50%

46
Q

budd chiari tx

A

porta caval shunt

47
Q

splenic VT presentation an dmgmt

A

gastric varices bleed
splenectomy

48
Q

amebic liver abscess location

A

RIGHT mostly usually single (from colon)

49
Q

risk factor amebic (entamoeba histolytica)

A

Mexico

50
Q

dx amebic

A

E. histlytica serology; aspiration is negative (protozoa on rim)

51
Q

mgmt amebic

A

flagyl only

surgery if free rupture only

52
Q

echinococcal cyst dx

A

positive serology ELISA, Casoni skin test, indirect hemagglutinin, latex agglutination, indirect immunofluorescence ab teset

E. granulosus, multilocularis, vulgari

don’t aspirate (anaphylaxis)
DOG (definitive) > sheep hx
CT double walled cyst

53
Q

echinococcal cyst location

A

RIGHT, multiple

54
Q

mgmt echinococcal

A

preop albendazole 2 wks
intraop injection of alcohol PAI
resect ALL of the cyst wall

55
Q

schistosomiasis suspicion

A

presinusoidal portal hypertension (variceal bleeding without LFT issues) + maculopapular rash + Eosinophils
hx water contact

56
Q

schisto mgmt

A

praziquantel and UGIB tx

57
Q

pyogenic abscess

A

MC
MC from E.coli

58
Q

pyogenic abscess location

A

RIGHT

59
Q

hepatic adenoma risk of…

A

80% pain, 50% RUPTURE, 5% malignancy

60
Q

hepatic adenoma location

A

RIGHT

61
Q

hepatic adenoma Kupffer/sulfur colloid scan…

A

won’t show up (no Kupffer cells in adenoma)

62
Q

hepatic adenoma CTA findings

A

CTA arterial enhancement with washout portal z

63
Q

mgmt hepatic adenoma

A

< 4cm: stop OCP
> 4cm or sx: resect

64
Q

focal nodular hyperplasia imaging findings

A

CTA hyperintense arterial, washout with stellate scar
will light up on sulfur colloid

65
Q

mgmt FNH

A

no resection

66
Q

hemangioma MC what

A

MC benign tumor in liver

67
Q

dx heamngioma

A

CT peripheral to central enhancement**; hypervascular; nodular enhancement peripherally

68
Q

complication of hemangioma (not rupture)

A

consumptive coagulopathy = Kasabach - Merritt syndrome and CHF

69
Q

MC cause HCC worldwide

A

HBV

70
Q

best and worse prognosis HCC

A

best: fibrolamellar (young peopel)

worst: diffuse nodular

71
Q

fibrolamellar variant HCC

A

best px but recurs often…. NEUROTENSIN biomarker

72
Q

AFP correlates with what

A

HCC SIZE

73
Q

5 yr survival with resectoin HCC

A

30%

74
Q

margin required for HCC

A

1 cm

75
Q

intrahepatic cholangio dx

A

CT scan: peripheral arterial and venous enhancement involving DUCTS

don’t need to Bx

76
Q

dx lap role in intrahepatic cholangio

A

for staging

77
Q

mgmt of cholangio

A

resectable if no LN past porta hepatis and no multifocal disease

just resect for negative margin

78
Q

mgmt of hilar cholangiocarcinom

A

contralateral hemi liver must have intact arterial/portal flow and biliary drainage uninvolved
then, RNY HJ

79
Q

varices

A

distal esophagus = esophageal submucosa - proximal gastric
rectum = IMV - pudendal
umbilicus = vestigial umbilical V - L portal V
RP = mesenteric - ovarian

80
Q

portal HTN bleeding Rx acute vs ppx

A

acute = octreotide/vasopressin, EGD, TIPS

ppx = B blockers

81
Q

what may TIPS WORSEN*

A

encephalopathy

82
Q

mgmt of esophgeal variceal bleeding

A
  1. resuscitate
  2. transfuse
  3. Abx
  4. intubate for airway and EGD
  5. EGD
  6. octreotide
    7.* TIPS if EGD fails
  7. Senstaken Blakemore if EGD fails
83
Q

surgical options for portal HTN decompression

A

(not TIPS)
1. gastroesophageal devascularization
2. esopahgeal transection and re-anastomosis
3. portosystemic shunts

84
Q

types of portosystemic shunts done surgically

A

selective (I.e.: distal splenorenal WARREN shunt) - will not help ascites

partial nonselective: side to side via interposition graft between portal vein and cava

nonselective portocaval side to side without interposition … high rate encepholaphty and complicated liver txp in the future

85
Q

PET scan for HCC?

A

NO. NEED>

86
Q

cholangio risk factors

A

PSC, choledocholithiasis, choledochal cysts, liver fluke infections, HBV, HCV

87
Q

duodenal adenoma

A

soap bubble sign

88
Q

hepatorenal syndrome types

A
  1. acute/severe = sharp decline
  2. chronic slow progression
89
Q

HRS pathophys

A

portal HTN > splanchnic vasodilation > arterial decrease to kidney> RAAS activated> decreased GFR

90
Q

HRS dx

A

is of exclusion

Lab findings can be: increased Cr and BUN
UNa < 10.
URBC < 50
Uprot < 500

91
Q

HRS tx

A
  1. octreotide - splanch vasoconstrictor
  2. systemic vasoconstriction - midodrine, terlipressin, etc.
  3. albumin
  4. abx if infxn
  5. HD
  6. liver txp or TIPS
92
Q

HBV vaccination efficacy

A

90% in immuncompetent; so don’t wait

93
Q

Wilsons disease

A

copper accumulation;
ATP7B AR

94
Q
A

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