Liver

Question 1

2 major risks of hepatic adenoma

Answer 1

life threatening intraperitoneal hemorrhage and malignant transformation

Question 2

hepatic lesions with peripheral to central enhancement

Answer 2

hepatic hemangioma

Question 3

41 F with RUQ pain and 6 cm peripheral to central enhancing lesion. Management?

Answer 3

Surgical Enucleation

Angio if actively bleeding

Question 4

Etiology of Budd Chiari

Answer 4

myeloproliferative disorders, usually Polycythemia Vera

Question 5

blood supply to the CBD?

Answer 5

Cystic, hepatic, GD arteries – meet to form collaterals that run in the 3 and 9 o clock positions

Question 6

pathophysiology of hepatorenal syndrome

Answer 6

RAAS and Sympathetics leads to VC of the renal arterial bed

Question 7

Dx criteria for HRS

Answer 7

Cr >1.5
Abscence of shock, fluid losses
Proteinuris <500 day

Question 8

Detection of lesions w intraopUS

Answer 8

better than abdominal US – detects small 1-2mm as far as 12 cm from the surface

Question 9

Administration of ___ ppx to patients with SBP dec the incidence of HRS

Answer 9

Albumin

Question 10

correct re the occupational exposure to viral hepatitis

Answer 10

Ig and antivirals are indicated after exposure to Hep C virus

Question 11

CHilds Class C with ruputured umb hernia… most important in periop mgmt?

Answer 11

control of ascitic fluid as hernia repaired with non absorbabale sutures to avoid infectios complications

Question 12

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?

Answer 12

Metronidazole 10 days
because its a liver amebic abscess

(aspiration only if refractory and surgery only if rupture)

Question 13

Hepatectomy rules:

Answer 13

1. mobilization of liver by division of ligaments
2. cholecystectomy and canulation of cystic duct
3. isolating vascular sstructures
4. ligation of hepatic artery, then PV then lepatic vein
5. division of hepatic parenchyma

Question 14

anatomical landmark of resection plane when performing right and left hepatectomy

Answer 14

Middle hepatic vein

Plane is Cantlies line

Question 15

TIPS indication

Answer 15

TIPS indicated if > para required every month despite sodium control and max diuretics

Question 16

Primary BIle salts are conjugated in hepatocytes with

Answer 16

glycine and taurine

Question 17

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?

Answer 17

Tes – > 4cm and sx as they pose risk of rupture and canhave malignant transformation

Question 18

CT findings of hepatic adenoma

Answer 18

peripheral enhancement with centripetal pattern of enhancement

Question 19

CT hindings of hepatic hemangioma

Answer 19

Peripheral nodular enhancement followed by centripetal late phase (filling in)

Question 20

CT findings FNH

Answer 20

central scar

Question 21

CT findings HCC

Answer 21

arterial phase hyperenhancement, enhancing capsule appearance

Question 22

CT findings intrahepatic cholangiocarcinoma

Answer 22

peripheral rim enhancement thru both arterial and venous phases

Question 23

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?

Answer 23

HCC; >1cm eith arterial hyper enhancement,

Question 24

Initial formation of ascites =?

Answer 24

sinosoidal portal hypertension

Question 25

true about hepatic hemagiomas

Answer 25

sx hepatic hemangiomas are more common in young women

Question 26

Hyatid cyst of the liver

Answer 26

Echinococcus granulosus

Liver involvement can lead to venous obstruction, portal HTN, and cholangitis

Question 27

Active eso variceal bleed in cirrhotic, endoscopy failed. what’s next?

Answer 27

Sengestaken Blakemore tube/balloon tamponade used until TIPS attempted

Question 28

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?

Answer 28

Umbilica vein infection leading to PV thrombosis due to umb vein cetherter placemnet while in NICU

Question 29

most accurate method ofdiagnosisng portal HTN?

Answer 29

hepatic vein pressure gradient

Dx if P >6mmHg

Question 30

53 M h/o diverticulitis now presenting with RUQ pain, fever, tachy 115, WBC 17, CT with 4.2 liver abscess. whats management?

Answer 30

Admission, antibiotics and IR drainage

Question 31

DVT started on warfarin, two days gets skin necrosis

Answer 31

DC warfarin start heparin

Question 32

DVT started on warfarin, two days gets skin necrosis

Answer 32

DC warfarin start heparin

Question 33

left hepatectomy for HCC. The abdomen entered and gallbladder removed and cystic duct cannulated. Whats the next step?

Answer 33

exposure and ligation left hepatic artery