Liver

Question 1

Ligaments that suspend liver

Answer 1

Falciform (between anterior abdominal wall and anterior liver)
Anterior and posterior coronary ligaments
Right and left triangular ligaments

And the 3 hepatic veins draining into the IVC

Question 2

Boundaries of caudate lobe
Portions of caudate lobe

Answer 2

Posterior: retrohepatic IVC
Anterior: left portal vein; ligamentum venosum coursing from LPV to junction LHV and IVC; base of segment IV
Superior: LHV and MHV origins

1-r: fuses with segments VI and VII
1-l (Spigelian lobe): sits on left of IVC, separated from left lateral section by lesser omentum
paracaval: anterior to IVC, posterior to PV

Question 3

Child-Pugh model: what does it do? What do the results mean? What are its limitations (2)?

Answer 3

Initially designed to predict mortality in patients with cirrhosis undergoing porto-caval shunt
Now validated to predict mortality after other abdominal operations

Uses bilirubin, albumin, presence of ascites, prothrombin time, encephalopathy
5-6: A, surgical mortality 10%, 1y survival 100%
7-9: B, surgical mortality 30%, 1y survival 80%
10-15: C, surgical mortality 82%, 1y survival 45%

Limitations
- ascites and encephalopathy are subjective
- does not predict renal function
- variables are not continuous so same points may be generated for significantly different liver function

Question 4

MELD model

Answer 4

Model for end-stage liver disease
Initially used to predict 3-month mortality following TIPS
Now used to prioritise patients for deceased-donor transplant, and to predict post-operative mortality of cirrhotics following other surgical operation (cardiac, orthopaedic, abdominal)
Uses bilirubin, creatinine and INR, age and ASA

Question 5

Caroli’s disease

Answer 5

Rare congenital disorder characterised by cystic dilatation of intrahepatic bile ducts
A cause of brown pigment (CBD) stones

Question 6

The portal vein

Answer 6

Arises from the post-duodenal vitelline vein plexus
Carries 50% oxygen to liver and 80% blood flow
A trunk 5-9cm long, 0.9cm wide, formed behind neck of pancreas at L2 from confluence of SMV and splenic vein
IMV enters here too in 1/3 pts
Enters the hepatoduodenal ligament behind hepatic a. and CBD
Left PV longer and thinner, right PV short and wide
Receives pancreaticoduodenal and left and right gastric veins as it runs behind the pancreas

Question 7

What does TACE stand for

Answer 7

Transarterial chemo-embolisation
Can be used for treatment of HCC and small bowel NET metastasis

Question 8

Child-Pugh model: what does it do? What do the results mean? What are its limitations (2)?

Answer 8

Initially designed to predict mortality in patients with cirrhosis undergoing porto-caval shunt
Now validated to predict mortality after other abdominal operations

Uses bilirubin, albumin, presence of ascites, prothrombin time, encephalopathy
5-6: A, surgical mortality 10%, 1y survival 100%
7-9: B, surgical mortality 30%, 1y survival 80%
10-15: C, surgical mortality 82%, 1y survival 45%

Limitations
- ascites and encephalopathy are subjective
- does not predict renal function
- variables are not continuous so same points may be generated for significantly different liver function