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SURGERY > LIVER > Flashcards

LIVER Flashcards

1
Q

Divides the liver into small LEFT lobe and large RIGHT lobe

A

Falciform ligament

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2
Q

Segmental Anatomy of the Liver

A

Segment 1 - Caudate IVC

Segment 2 and 3- L lateral segment L hepatic vein

Segment 4 - L medial segment middle hepatic vein

Segment 5 and 8 - R anterior lobe R hepatic vein, middle hepatic vein

Segment 6 and 7 - R posterior lobe

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3
Q

The most common variant of normal hepatic artery anatomy is

A

Replaced R hepatic artery from the SMA

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4
Q

Liver Function Tests

A

Hepatocellular Injury - AST and ALT

Abnormal Synthetic Function - albumin, clotting factors EXCEPT factor VIII

Cholestasis - total bilirubin, B2, alk phosphatase, GGTP

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5
Q

Measures liver synthetic function

A

serum albumin
prothrombin time
clotting factors (EXCEPT factor VIII)

PT and INR - best tests among the 3

prolonged PT - vitamin K deficiency or warfarin therapy

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6
Q

Indicators of integrity of hepatocellular membranes; increased levels reflect hepatocellular injury w/ leakage

A

AST and ALT

AST - liver, cardiac,muscle, skeletal muscle,kidney, brain, pancreas,lungs and RBC
ALT - more specific for liver disease

MODERATE increases - viral hepatitis
GREAT increases - ischemia, toxin ingestion (acetaminophen), fulminant hepatitis

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7
Q

Indicative of BILIARY OBSTRUCTION

A

alkaline phosphatase
liver and bones
half life -7 days

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8
Q

Early marker and sensitive test for hepatobiliary disease

A

GGTP

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9
Q

Jaundice becomes detectable when serum bilirubin level is

A

> 2.5 - 3 mg/dL

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10
Q

Final sequelae of chronic liver injury characterized by fibrous septa that leads to hepatic nodules

A

Cirrhosis

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11
Q

The gold standard or identi ying liver lesions by imaging is

A

Intraoperative Ultrasound

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12
Q

Physiologic changes noted in patients with cirrhosis

A

elevated resting energy expenditure

increased cardiac output and heart rate

decreased systemic vascular resistance and blood pressure

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13
Q

Presinusoidal Causes of Portal HPN

A

EXTRAHEPATIC
portal vein thrombosis
splenic vein thrombosis

INTRAHEPATIC
	congenital hepatic fibrosis
	primary biliary cirrhosis
	sarcoidosis
	schistosomiasis
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14
Q

Sinusoidal Causes of Portal HPN

A

steatohepatitis

Wilson disease

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15
Q

Postsinusoidal Causes of Portal HPN

A

EXTRAHEPATIC
Budd Chiari syndrome
Right hepatic failure

INTRAHEPATIC
	hemochromatosis
	laennec (alcoholic) cirrhosis
	secondary biliay cirrhosis
	posthepatitic cirrhosis
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16
Q

The most accurate method for measuring portal HPN

A

hepatic venography

HVPG = WHVP - FHVP

> 10 - portal HPN

17
Q

Most significant manifestation of portal HPN

A

esophageal varices

18
Q

Management of Acute Variceal Bleeding

A

MEDICAL
Vasopressin
Octreotide - preferred

SURGICAL
early endoscopy and variceal ligation or sclerotherapy

refractory bleeding
	surgical shunt - Child A
	transjugular intrahepatic portosystemic shunt (TIPS) - Child B and C
19
Q

Congestive hepatopathy characterized by obstruction to hepatic venous outflow

A

Budd Chiari Syndrome

young women w/ myelofibrosis
factor V Leiden mutation
anti cardiolipin antibodies
OCP

Management:
systemic anticoagulation

20
Q

Predicts the risk of portocaval shunt procedure

A

Child Turcotte Pugh (CTP)

	bilirubin
	albumin
	INR
	(+) encephalopathy
	(+) ascites
21
Q

Predicts mortality after TIPS

A

Model for End Stage Liver Disease (MELD)

serum creatinine
total bilirubin
INR
22
Q

Percutaneous procedure used for treatment of patients who have gastroesophageal varices in the setting of portal hypertension

A

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

creates an intrahepatic shunt b/w portal and systemic circulation — decreased portal pressure and blood flow through varices
23
Q

MC complication of TIPS

A

Encephalopathy

24
Q

Pyogenic Liver Abscess

A

R lobe
E.coli

correction of underlying cause
broad spectrum antibiotics at least 8 weeks
percutaneous aspiration
failure of medical management — surgical drainage/resection

25
Q

Most frequently encountered liver lesion overall

A

Hepatic Cysts

26
Q

MC benign solid masses in the liver

A

Hemangioma

women
PAIN

dual phase CT: asymmetrical peripheral enhancement w/ progressive centripetal enhancement
MRI: hypointense on T1 and hyperintense on T2

enucleation or resection
27
Q

Benign solid neoplasm that occurs in young women, typically solitary

A

Adenoma

prior or current use of OCP

COMPLICATIONS - spontaneous rupture and hemorrhage, malignant degeneration

resection
28
Q

Occurs in young women and usually do not rupture spontaneously or degenerate into malignancy

A

Focal Nodular Hyperplasia

abdominal pain - usual indication for surgery

CT/MRI - central scar
Nuclear scan - hot
29
Q

Primary Malignant Liver Tumors

A

Hepatocytes - Hepatocellular carcinoma (HCC)

Bile ducts - Cholangiocarcinoma

30
Q

MC malignant liver tumor

A

Metastatic

from COLONIC carcinoma
31
Q

2nd MC benign tumor of the liver

A

Focal Nodular Hyperplasia

32
Q

Risk factors for Hepatocellular Carcinoma

A 
Cirrhosis
Hep B or C
Alcoholic
Hemochromatosis
Non alcoholic steatohepatitis
33
Q

Patient’s eligible or the Mayo Clinical protocol to treat hilar cholangiocarcinoma

A

hilar cholangiocarcinoma with PSC or patients with unresectable
hilar cholangiocarcinoma who have not received prior radiotherapy

34
Q

Considered a primary determinant of suitability or resection when evaluating a patient with hepatic colorectal metastases

A

Predicted volume of hepatic remnant

35
Q

The only FDA-approved systemic chemotherapeutic agent or HCC

A

Sorafenib

36
Q

The primary indication for hepatic resection in cirrhotic patients

A

HCC

SURGERY (27 decks)

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