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Liver Flashcards

1
Q

Couinad liver segmentation divides the liver into how many segments?

A

8 segments

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2
Q

How much blood does the portal vein supply to the liver?

A

Almost 75% of hepatic inflow
But provides 50-70% of liver’s oxygen requirement
Lacks valves; can provide high flows at low pressures

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3
Q

What makes up the portal vein?

A

SV + SMV meet behind the neck of the pancreas
IMV joins SV as well

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4
Q

Connections between the portal and systemic venous systems during times of high portal venous pressures are commonly seen where?

A
  1. Submucosal veins of proximal stomach and distal esophagus receive portal flow from the short gastric veins and left gastric veins
  2. Umbilical and abdominal wall veins recanalize from increased portal venous pressure from the umbilical vein in the ligamentum teres—> caput meduasae
  3. Superior hemorrhoidal plexus receives portal flow from the IMV tributaries
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5
Q

What % of liver inflow is from the hepatic artery?

A

25-30%

Provides 30-50% of liver oxygenation

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6
Q

Common hepatic artery anatomy:

A
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7
Q

A replaced or accessory right hepatic artery comes off of what vessel?

A

SMA

Occurs 10-20% of the time

Usually runs behind the head of the pancreas

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8
Q

A replaced or accessory left hepatic artery comes off of what vessel?

A

Left gastric artery
5-10% of the time

Courses in the lesser omentum

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9
Q

Location of the CBD in the hepatoduodenal ligament:

A

To the right of the hepatic artery
Anterior to the portal vein

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10
Q

What factors make up the Childs-Pugh score?

A

Bilirubin
Albumin
PT
Encephalopathy
Ascites

5-6 A, 7-9B, 10-15 C

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11
Q

How do we define portal HTN?

A

Portal pressure >5 mmHg
Pressures 8-10 mmHg are needed to stimulate collateralization

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12
Q

What’s a TIPS procedure?

A

Porto-systemic shunt between hepatic vein and portal vein to decompress portal pressure

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13
Q

Some limitations of TIPS therapy?

A

Shunt thrombosis/stenosis (up to 50% at 1 year)
Encephalopathy

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14
Q

Who gets pyogenic liver abscesses?

A

People in their 50-60s

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15
Q

Entamoeba histolytica is associated with what?

A

Amebic liver abscess

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16
Q

Features of amebic vs pyogenic liver abscesses;

A
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17
Q

Pathogenesis of liver amebiasis?

A

Fecal-oral route of protozoan E. Histolytica

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18
Q

A diagnostic aspiration of an amebic liver abscess would reveal what?

A

Anchovy paste consistency

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19
Q

Treatment for amebiasis?

A

Metronidazole; 750/TID for 10 days

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20
Q

Cause of hydatid disease of the liver?

A

Echinococcus granularis

Endemic to sheep grazing areas

Dog is definitive host

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21
Q

Radiographic images of hydatid dx of the liver shows what?

A

Double walled cysts, daughter cysts

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22
Q

Tx for hydatid dx of the liver?

A

Surgery

PAIR technique?

Mebendazole/Albendazole

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23
Q

This benign liver lesions found in women 20-40, associated with OCP use;

A

Adenoma

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24
Q

Histologically what do liver adenomas look like?

A

Hepatocytes containing glycogen and fat

They don’t contain the bile ductules normally seen in liver architecture

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25
Q

Liver adenomas associated with high risk of malignant transformation contain what mutation?

A

B-catenin activation

26
Q

Two major risks associated with adenomas?

A

Rupture

Malignant transformation

27
Q

Characteristic features of adenomas on CT/MRI?

A

CT—> peripheral enhancement with centripetal progression

MRI—> well demarcated heterogenous mass containing hemorrhage or fat

28
Q

Second most common benign liver tumor after hemangiomas?

A

FNH

29
Q

This benign liver lesions is described as a central fibrous scar with radiating septa;

A

FNH

30
Q

Microscopically, this benign liver lesion is described as cords of benign appearing hepatocytes divided by multiple fibrous septa originating from a central scar;

A

FNH

31
Q

Characteristic of FNH on CT/MRI;

A

Strong hypervascularity in the arterial phase, with central non-enhancing scar

32
Q

Kasabach-Merrit syndrome?

A

Syndrome of hemangioma + consumptive coagulopathy + thrombocytopenia

33
Q

Peripheral nodular enhancement pattern seen with this benign liver lesion:

A

Hemangiomas

34
Q

Indications for hemangioma resection?

A

Increase in size
Rupture
Kasbach-Merritt syndrome

35
Q

Complication associated with liver hemangiomas in children?

A

CHF 2/2 arterial-venous shunting

36
Q

How does HCC present on CT imaging?

A

Arterial enhancing mass with washout of delayed phase

37
Q

Contrast enhancement during arterial phase with prominent central scar defines what liver lesion?

A

FNH

38
Q

Second most common benign liver lesion behind hemangiomas?

A

FNH

39
Q

Talk to me about primary bile acids:

A

Primary bile acids (cholate and chenodeoxycholate) are conjugated in the liver with glycine and taurine to form bile salts

These conjugated bile acids are then secreted into bile and into the gut to aid in fat digestion

80% of conjugated bile acids are actively reabsorbed back at the terminal ileum

5% escape absorption and leave via urine/feces

40
Q

RUQ, hepatomegaly and ascites; think of?

A

Budd chairi syndrome; portal HTN 2/2 occlusion of portal venous system

41
Q

Primary v secondary Budd chiari syndrome:

A

1; caused by spontaneous thrombosis of hepatic veins 2/2 myeloproliferative d/o

2; caused by external compression of venous outflow tract from tumor or abscess

42
Q

Barcelona guidelines for liver tx?

A

Solitary tumor <5 cm or <3 tumors, <3 cm

43
Q

Major hepatectomy removes how many segments?

A

3 or more

44
Q

Firbolamellar hepatocarcinoma?

A

Has a central scar similar to FNH

Typically seen in younger pts (25 vs 50-60 in HCC)

Usually no hx of cirrhosis, hepatitis

See elevated levels of neurotensin

Tends to be resectable

45
Q

Histologically fibrolamellar hepatocarcinoma looks like what?

A

Large polygonal cells with sheets of collagen

46
Q

What is the encephalopathy rate assc with TIPS?

A

30%

47
Q

Major limitations of TIPS asides from encephalopathy rate?

A

High shun stenosis (up to 50%) after 1 year

48
Q

Risk of malignant transformation with hepatic adenomas?

A

5%

B-catenin mutated adenomas have the highest risk of malignant degeneration

49
Q

Surveillance for HCC; what imaging modality preferred?

A

US

50
Q

Parameters of child Pugh score?

A

Ascites
Encephalopathy
Albumin
INR
Bilirubin

A- 5-10% mortality
B- 10-40%
C- 20-100%

51
Q

Used to prioritize pts for liver transplant and used for perioperative mortality:

A

MELD

52
Q

P2Y12 inhibitor?

A

Ticagrelor

53
Q

Wilsons dx?

A

Recessive

Mutation in ATP7B; copper builds up in tissues; can lead to end stage liver dx, cirrhosis

54
Q

When do we resect hepatic adenomas?

A

Symptomatic/pain
>5 cm lesion
If there is concern for malignancy

55
Q

MCC cirrhosis in western world v east?

A

West; hep c, followed by alcohol

East; Hep b

56
Q

Gold standard for intrahepatic cholangiocarcinoma?

A

If no mets; surgical resection for R0 resection has 50% 5 year survival

CCA is 2nd most common primary liver tumor after HCC

57
Q

Milan criteria for hepatic transplant:

A

1 lesions <5 cm
3 lesions < 3 cm
No vascular invasion, no nodal involvement, no extrahepatic involvement

58
Q

Hydatid dx:

A

Dogs are definitive host

Humans are intermediate hosts

59
Q

CT vs duplex US for dx of Budd chiari syndrome?

A

Duplex US

60
Q

Diagnosing entameoba histolytica;

A

Identifying specific antibodies in serum via serological testing;
ELISA, indirect hemagluttination, indirect immunoflourescence, latex agglutination technique

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