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ABS > LIVER > Flashcards

LIVER Flashcards

1
Q

Amebic liver abscess - bilirubin?

A

Usually normal

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2
Q

Pyogenic liver abscess - bilirubin?

A

Usually elevated

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3
Q

Pyogenic liver abscess vs amebic liver abscess - which causes left shift?

A

Pyogenic liver abscess

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4
Q

Indications for prophylactic abx against SBP

A
  1. Presence of GIB
  2. Hx SBP
  3. Ascitic protein <1.5 g/dL
  4. Cr >1.2 (impaired renal function)
  5. BUN >25
  6. Serum Na <130
  7. Bilirubin >3
  8. Child Pugh Score > 9
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5
Q

Pathophysiology of SBP

A

Usually disturbance in gut flora –> overgrowth and extraintestinal dissemination of a specific organism (E. coli). Hepatic cirrhosis - predisposes patients to bacterial overgrowth due to altered small intestinal motility or hypochlorhydria (due to PPIs). In addition, pts with hepatic cirrhosis have increased intestinal permeability –> translocation of bacteria into mesenteric lymph nodes.

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6
Q

Liver lesion on CT: well circumscribed, isoattenuated noncontrast. Mural and nodular enhancement with contrast

A

Biliary cystadenoma

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7
Q

Liver lesion on CT: well circumscribed, homogenous. Centripetal enhancement and washout delayed phase

A

Hemangioma

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8
Q

Liver lesion on MRI: well circumscribed, homogenous. T1 hypointense. T2: VERY hyperintense

A

Hemangioma

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9
Q

Liver lesion on CT: hyperattenuated arterial phase (early enhancement), loss of contrast enhancement in delayed phase

A

Adenoma

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10
Q

Liver lesion on MRI: Eovist (gadoxetic acid) NOT retained in delayed hepatobiliary phase

A

Adenoma

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11
Q

MRI lesion (liver): eovist (gadoxetic acid) retention on delayed hepatobiliary phase

A

FNH

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12
Q

Pre-hepatic portal HTN

A

portal vein thrombosis, splenic vein thrombosis, AVF

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13
Q

Intra hepatic portal HTN

A

infiltrative liver diseases, cirrhosis, other fibrosing conditions, polycystic liver disease

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14
Q

Post-hepatic portal HTN

A

Budd-Chiari, IVC webs and thrombosis, right heart failure

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15
Q

Initial mgmt esophageal variceal hemorrhage

A

2 large bore IVs and rapoid transfusion, intubation
Transfusion target Hct 25-30% (over transfusion may worsen portal HTN)
Coagulopathy correction
Infusion with vasopressin in conjunction with nitroglycerin (to prevent ischemia)
Additional infusion with octreotide with PPIs

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16
Q

After resuscitation initiated, next steps for esophageal varices

A

EGD - sclerotherapy, banding
If bleeding not controlled, balloon tamponade with Sengstaken-Blakemore tube or Minneosta tube (traction to compress GEJ). 50% rebleed rate

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17
Q

Risk of esophageal varices bleeding (annual)

A

5-15%

18
Q

Tx for unresectable hepatocellular carcinoma

A

Atezolizumab + bevacizumab (better overall and progression free survival outcomes compared to sorafenib)

19
Q

How to dx amebic liver abscess

A

CT scan. Serum Abs will show it but it takes 7-10 days

20
Q

MELD score components

A

Bilirubin, creatinine, and INR (more recently, sodium)

21
Q

MELD exceptions

A

HCC, hepatopulmonary syndrome, portopulmonary HTN, familial amyloid polyneuropathy, primary hyperoxaluria, CF, hilar cholangioCA, hepatic a thrombosis (w/i 14 days of liver transplant)

22
Q

Stage I HCC

A

One nodule <2 cm; may be listed for liver txp but not receive exception points

23
Q

Stage II HCC

A

One nodule between 2-5 cm OR 2-3 nodules, none > 3 cm. At 6 months after dx/listing, MELD exception score of 28.

24
Q

Stage III HCC

A

One nodule >5 cm or 2-3 nodules with at least one >3 cm. Do NOT receive standard MELD exception.

25
Q

Stage IV HCC

A

4+ nodules, gross involvement of portal vein or hepatic vein, involvement of porta hepatis LN or metastatic disease. Do NOT receive MELD exception.

26
Q

Duration of anticoagulation in Budd Chiari

A

Lifelong

27
Q

What is the hepatic vein pressure gradient?

A

Gradient between wedged hepatic vein pressure and free hepatic vein pressure. If >6 mmHg, portal HTN diagnosed.

28
Q

MC primary malignant liver tumor in children

A

Hepatoblastoma

29
Q

Future liver remnant in cirrhotics

A

FLR > 40%

30
Q

Risk of transformation to malignancy in hepatic adenomas

A

5% (probably less)

31
Q

MCC SBP (bacteria)

A

E coli

32
Q

Order of vessel ligation in R hepatectomy

A

hepatic a –> portal v –> hepatic v

33
Q

5 steps of R hepatectomy

A
  1. mobilization of liver
  2. chole + cannulation of cystic duct
  3. isolating and control of vascular structures with vessel loops
  4. Ligation of hepatic a, portal v then hepatic v
  5. division of hepatic parenchyma
34
Q

Treatment of advanced (unresectable) HCC with improved survival and progression free survival

A

Atezolizumab + bevacizumab

35
Q

Locations for varices

A

GE collaterals (intercostal, diaphragmatic, esophageal)
Hemorrhoids (middle and inf hemorrhoidal)
Caput medusa (umbilical and abdominal wall)
RP collaterals (L renal v)

36
Q

Preferred technique for live donor liver resection in pediatric transplan

A

Left lateral hepatectomy (segments II and III, with or without segment I)

37
Q

MRI findings hepatic hemangioma

A

HYPOintense on T1
HYPERintense on T2

38
Q

Which liver lesion contains Kupffer cells (sulfur colloid WILL show uptake)

A

FNH

39
Q

hepatic adenoma - Kupffer cells? (sulfur colloid WILL show uptake)?

A

No

40
Q

Which liver lesion is Eovist NOT retained in delayed HPB phase

A

ADENOMA

41
Q

Which liver lesion is Eovist RETAINED in delayed HPB phase

A

FNH

ABS (23 decks)

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