hepatobiliary GB <3 Flashcards
Liver blood supply
75% portal vein, 25% hepatic arteries (although 50-50 for oxygen due to different O2 sats). Celiac trunk -> common hepatic -> proper hepatic -> L and R hepatic arteries
Liver venous drainage
R, M, L hepatic veins -> IVC
Falciform ligament
Connects ab wall to liver, contains ligamentum teres (obliterated umbilical vein)
Coronary ligament
Peritoneal reflection on cranial aspect of liver that attaches it to diaphragm
Glisson’s capsule
peritoneal membrane covering the liver
Hepatodudoenal ligament
Contains portal triad (CBD, portal vein, hepatic artery). Forms anterior boundary of epiploic foramen of Winslow, connects the greater and lesser peritoneal cavities.
What are the components of bile?
Cholesterol, lecithin, bile acids, bilirubin
Enterohepatic ciculation
Bile acids released from liver into duodenum -> reabsorbed in terminal ileum -> back to liver via portal vein
Dark urine, clay-colored stools indicates what type of jaundice?
Obstructive (high levels of unconjugated bilirubin, which can enter urine)
Treatment of liver abscess/cyst
Pyogenic: percutaneous drainage + IV abx. Amebic abscess (E. histolytica): IV metronidazole. Parasitic (hydatid cysts): albendazole (never aspirate!) followed by resection.
Most common benign tumor of the liver?
Cavernous hemangioma (results from abnl differentiation of angioblastic tissue during fetal life). Usu just found incidentally; do NOT biopsy, resect only if symptomatic or going to rupture
Hepatic adenoma
Seen in child-bearing females, risk factors include OCPs,, anabolic steroids, glycogen storage disease. Even if someone had adenoma that resolved after stopping OCPs, risk of rupture/hemorrhage during pregnancy.
Focal nodular hyperplasia
Benign hepatic tumors with ‘central scar’ on pathology. Resect only if symptomatic
Hepatocellular carcinoma (aka hepatoma) risk factors
Cirrhosis, Hep B and C, hemochromatosis, A1AT deficiency, liver flukes, anabolic steroid use
What markers are elevated in HCC?
ALP, AST, ALT, GGT, AFP, DCP