Liver Flashcards
2 major risks of hepatic adenoma
life threatening intraperitoneal hemorrhage and malignant transformation
hepatic lesions with peripheral to central enhancement
hepatic hemangioma
41 F with RUQ pain and 6 cm peripheral to central enhancing lesion. Management?
Surgical Enucleation
Angio if actively bleeding
Etiology of Budd Chiari
myeloproliferative disorders, usually Polycythemia Vera
blood supply to the CBD?
Cystic, hepatic, GD arteries – meet to form collaterals that run in the 3 and 9 o clock positions
pathophysiology of hepatorenal syndrome
RAAS and Sympathetics leads to VC of the renal arterial bed
Dx criteria for HRS
Cr >1.5
Abscence of shock, fluid losses
Proteinuris <500 day
Detection of lesions w intraopUS
better than abdominal US – detects small 1-2mm as far as 12 cm from the surface
Administration of ___ ppx to patients with SBP dec the incidence of HRS
Albumin
correct re the occupational exposure to viral hepatitis
Ig and antivirals are indicated after exposure to Hep C virus
CHilds Class C with ruputured umb hernia… most important in periop mgmt?
control of ascitic fluid as hernia repaired with non absorbabale sutures to avoid infectios complications
35 M fever, diarrhea chills, RUQ pain after backpacking Amazon. Leukocytosis without Eos. Alk Phos elevated
CT with R lobe cavity that is enhancing wall and hypoattenuation at the center. Tx?
Metronidazole 10 days
because its a liver amebic abscess
(aspiration only if refractory and surgery only if rupture)
Hepatectomy rules:
- mobilization of liver by division of ligaments
- cholecystectomy and canulation of cystic duct
- isolating vascular sstructures
- ligation of hepatic artery, then PV then lepatic vein
- division of hepatic parenchyma
anatomical landmark of resection plane when performing right and left hepatectomy
Middle hepatic vein
Plane is Cantlies line
TIPS indication
TIPS indicated if > para required every month despite sodium control and max diuretics
Primary BIle salts are conjugated in hepatocytes with
glycine and taurine
25 F on OCP use with abdo pain for 7 mos. CT will well circumscribed heterogeneous mass consistent with hepatic adenoma. HDS. should the mass be resected?
Tes – > 4cm and sx as they pose risk of rupture and canhave malignant transformation
CT findings of hepatic adenoma
peripheral enhancement with centripetal pattern of enhancement
CT hindings of hepatic hemangioma
Peripheral nodular enhancement followed by centripetal late phase (filling in)
CT findings FNH
central scar
CT findings HCC
arterial phase hyperenhancement, enhancing capsule appearance
CT findings intrahepatic cholangiocarcinoma
peripheral rim enhancement thru both arterial and venous phases
62 M with ink PMH with chronic abdo pain unremarkable labs, mild LFT elevation, CT with 3 cm solid liver l=mass with arterial enhancement and pseudocapsul. Dx?
HCC; >1cm eith arterial hyper enhancement,
Initial formation of ascites =?
sinosoidal portal hypertension
true about hepatic hemagiomas
sx hepatic hemangiomas are more common in young women
Hyatid cyst of the liver
Echinococcus granulosus
Liver involvement can lead to venous obstruction, portal HTN, and cholangitis
Active eso variceal bleed in cirrhotic, endoscopy failed. what’s next?
Sengestaken Blakemore tube/balloon tamponade used until TIPS attempted
4 yo boy with UGI bleed, CT w splenomegaly, and EGD with eso varies. h/o long stay in the NICU. what contributed to the delvelopment of this?
Umbilica vein infection leading to PV thrombosis due to umb vein cetherter placemnet while in NICU
most accurate method ofdiagnosisng portal HTN?
hepatic vein pressure gradient
Dx if P >6mmHg
53 M h/o diverticulitis now presenting with RUQ pain, fever, tachy 115, WBC 17, CT with 4.2 liver abscess. whats management?
Admission, antibiotics and IR drainage
DVT started on warfarin, two days gets skin necrosis
DC warfarin start heparin
DVT started on warfarin, two days gets skin necrosis
DC warfarin start heparin
left hepatectomy for HCC. The abdomen entered and gallbladder removed and cystic duct cannulated. Whats the next step?
exposure and ligation left hepatic artery
