hepatobiliary GB <3 Flashcards

1
Q

Liver blood supply

A

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

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2
Q

Liver venous drainage

A

R, M, L hepatic veins -> IVC

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3
Q

Falciform ligament

A

Connects ab wall to liver, contains ligamentum teres (obliterated umbilical vein)

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4
Q

Coronary ligament

A

Peritoneal reflection on cranial aspect of liver that attaches it to diaphragm

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5
Q

Glisson’s capsule

A

peritoneal membrane covering the liver

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6
Q

Hepatodudoenal ligament

A

Contains portal triad (CBD, portal vein, hepatic artery). Forms anterior boundary of epiploic foramen of Winslow, connects the greater and lesser peritoneal cavities.

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7
Q

What are the components of bile?

A

Cholesterol, lecithin, bile acids, bilirubin

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8
Q

Enterohepatic ciculation

A

Bile acids released from liver into duodenum -> reabsorbed in terminal ileum -> back to liver via portal vein

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9
Q

Dark urine, clay-colored stools indicates what type of jaundice?

A

Obstructive (high levels of unconjugated bilirubin, which can enter urine)

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10
Q

Treatment of liver abscess/cyst

A

Pyogenic: percutaneous drainage + IV abx. Amebic abscess (E. histolytica): IV metronidazole. Parasitic (hydatid cysts): albendazole (never aspirate!) followed by resection.

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11
Q

Most common benign tumor of the liver?

A

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

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12
Q

Hepatic adenoma

A

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.

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13
Q

Focal nodular hyperplasia

A

Benign hepatic tumors with ‘central scar’ on pathology. Resect only if symptomatic

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14
Q

Hepatocellular carcinoma (aka hepatoma) risk factors

A

Cirrhosis, Hep B and C, hemochromatosis, A1AT deficiency, liver flukes, anabolic steroid use

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15
Q

What markers are elevated in HCC?

A

ALP, AST, ALT, GGT, AFP, DCP

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16
Q

Treatment of HCC

A

Resection (or transplant) only cure

17
Q

Most common hepatic malignancy?

A

Metastasis; from colon, breast, lung most often

18
Q

What is Child-Pugh score based on?

A

Bilirubin, albumin, ascites, neuro disorder, PT

19
Q

Most common causes of portal HTN

A

US: alcoholic cirrhosis. World: schistosomiasis

20
Q

Esophageal varices

A

Left gastric vein -> esophageal veins

21
Q

Caput medusa

A

Umbilical vein (via falciform ligament) to epigastric veins

22
Q

Hemorrhoids

A

Superior rectal vein -> middle and inferior rectal veins

23
Q

Drawbacks of shunting for portal HTN

A

Increased incidence of hepatic encephalopathy (more toxins diverted to systemic circulation) and decreased blood to liver = increased death from hepatic failure

24
Q

What is the EEG like in hepatic encephalopathy?

A

Normal

25
Q

Esophageal varices

A

Use beta-blockers to prevent rupture, but not once actively bleeding / hemodynamically unstable

26
Q

Emphysematous cholecystitis

A

Rare, severe variant caused by gas-forming bacteria, most often seen in elderly diabetic men. Can result in perforation

27
Q

Acalculous cholecystitis

A

10% of all cases of acute cholecystitis. Acute inflammation in absence of gallstones, thought to be 2/2 stasis. Most often seen in ICU pt with multisystem organ failure, trauma (incl major surgery), burns, sepsis, TPN. Tx: urgent CCY

28
Q

Charcot’s triad

A

Acute cholangitis: fever, jaundice, RUQ pain

29
Q

Reynold’s pentad

A

Acute cholangitis: fever, jaundice, RUQ pain plus CNS symptoms and septic shock

30
Q

Gallstone ileus

A

SBO caused by gallstone in pt with long standing stones, most commonly a large one that erodes through GB directly into duodenum via fistula. Most common place for obstruction is ileocecal valve.

31
Q

Carcinoma of the gallbladder is usually what type

A

Adenocarcinoma. Rare. Peak age 75 yo, F>M

32
Q

Benign tumors of the bile ducts

A

Most common type is adenoma, commonly found at ampulla of Vater. Causes intermittent jaundice, RUQ pain. Tx: resection (surgical or endoscopic)

33
Q

Cholangiocarcinoma location

A

Nearly all are adenocarcinomas. Can arise anywhere along intrahepatic or extrahepatic biliary system, but most common spot is bifurcation into R and L hepatic ducts (Klatskin tumor)

34
Q

Tx of cholangiocarcinoma

A

Proximal: resect with RenY hepaticojejunostomy. Distal: Whipple procedure. Some are not resectable.