Hepatobiliary Flashcards
Milan criteria
Single lesion <5cm or up to 3, 3cm or less
No vascular or extra hepatic dz
AFP <1000ng/mL
Most sensitive modality for detecting small liver mets
Intraop US
Pyogenic liver abscess, tx
Broad spectrum abxs, and perc drainage
Required future liver remnant
> 20% healthy, >40% for cirrhotics
Gold standard to hypertrophy future liver remnant
Portal vein embolization
Contraindications to liver txp
Unstable CAD, pulm htn, O2 dependence, uncontrolled malignancy/infx, noncompliance
How to prevent tumor growth between PVE and liver resection
TACE
Suspected distal cholangiocarcinoma; next step
ERCP to visualize and bx, possibly stent
Common organism in SBP
Gram neg enteric bacteria, E coli, Klebsiella, PsA
Isolated gastric varices with hx of chronic pancreatitis; dx and tx
Splenci vein thrombosis, splenectomy
Blood supply CBD
Cystic, hepatic, GDA branches 3 and 9 o’clock
Significant morbidity and mortality in fulminant liver failure; dx and tx
Intracranial HTN and cerebral edema, invasive ICP monitoring
Hydatid disease treatment
Based on WHO classification: Surgery, puncture-aspiration-injection-reaspiration(PAIR), albendazole or observation
Most common cause of esophageal varices; tx
Portal HTN from cirrhosis/hepatitis, Endoscopic/beta-blockade -> TIPS
Unstable with multiple endoscopic attempts at managing esophageal varix bleed
Sengstaken-Blakemore or Minnesota tube
Liver lesion, central scar with intense arterial enhancement
FNH
Liver lesion, Hyperechoic with peripheral nodular enhancement and centripetal fill on delay
Hemangioma
Liver lesion, cirrhotic with arterial enhancement with wash out
HCC
Liver lesion, on OCPs with arterial enhancement and isointense delay
Adenoma
Budd-Chiari syndrome; diagnostic test
Duplex US
Important to improve outcomes for hernia repair in cirrhotics
Control ascitic fluid (diuretics, paracentesis, TIPS)
Major cause of pyogenic liver abscesses
Cholangitis (obstruction due to malignancies/stones)
Hemangioma treatment
Observed, if symptomatic resect
Hepatic amoebic abscess; tx
Metronidazole
Liver abscess, hx of diverticulitis, appendicitis, diarrhea; dx and tx
Pyogenic, IV broad spectrum abxs +/- drain
Liver abscess, hx of travel to tropical under-developed areas; dx and tx
Amoebic (Entamoeba histolytica), Metronidazole
Liver abscess, hx of distant exposure to sheep grazing area (Mediterranean, Central Asia) may have daughter cysts; dx and tx
Hydatid (Echinococcus), Albendazole +/- PAIR
Bleeding esophageal varices; medical tx
Infusion of vasopressin with nitroglycerin, octreotide and PPI
Focal nodular hyperplasia; tx
Conservatively, only resect if persistent symptoms, enlarging size, and dx uncertainty
TIPS indication
> 2-3 large volume paracenteses/month in spite of optimal sodium restriction and and diuretics
Initiating event in the formation of ascites
Sinusoidal hypertension
Area of exchange between hepatocyte and blood
Space of Disse
Where are most conjugated bile acids absorbed and how
Terminal ileum, active transport
