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Surgical Recall > Liver > Flashcards

Liver Flashcards

1
Q

What is the name of the liver capsule?

A

Glisson’s capsule

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2
Q

What is the “bare” area of the liver?

A

Posterior section of the liver against the diaphragm that is “bare” without peritoneal covering

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3
Q

What is Cantle’s line?

A

Line drawn from the gallbladder to a point just to the left of the IVC, which transects the liver into the right and left lobes

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4
Q

Which ligament goes from the anterior abdominal wall to the liver?

A

Falciform ligament

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5
Q

What does the falciform ligament contain?

A

Ligamentum teres (obliterated umbilical vein)

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6
Q

What is the coronary ligament?

A

Peritoneal reflection on top of the liver that “crowns” the liver and attaches it to the diaphragm

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7
Q

What are the triangular ligaments of the liver?

A

Right and left lateral extents of the coronary ligament, which form triangles

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8
Q

What is the origin of the hepatic arterial supply?

A

From the proper hepatic artery off of the celiac trunk

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9
Q

What is the venous supply to the liver?

A

Portal vein, formed from the splenic vein and the SMV

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10
Q

What is the hepatic venous drainage?

A

Via the hepatic veins, which drain into the IVC

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11
Q

What sources supply O2 to the liver?

A

Portal vein: 50%

Hepatic artery: 50%

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12
Q

From what sources does the liver receive blood?

A

Portal vein: 75%

Hepatic artery: 25%

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13
Q

What is the maximum amount of liver that can be resected while retaining adequate liver function?

A

> 80%; if given adequate recovery time, the original mass can be regenerated

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14
Q

What are the signs and symptoms of liver disease?

A

Hepatomegaly, splenomegaly, icterus, pruritus (bile salts in skin), blanching spider telangiectasia, gynecomastia, testicular atrophy, caput medusa, dark urine, clay-colored stools, bradycardia, edema, ascites, fever, fetor hepaticus, hemorrhoids, variceal bleeding, anemia, alopecia, liver tenderness, palmar erythema

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15
Q

Which liver enzymes are made by hepatocytes?

A

AST and ALT

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16
Q

What is the source of alkaline phosphatase?

A

Ductal epithelium

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17
Q

What is Child’s class?

A

Classification system that estimates hepatic reserve in patients with hepatic failure and mortality

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18
Q

What comprises the Child’s classification?

A

A BEAP:
Labs: Albumin, Bilirubin
Clinical: Encephalopathy, Ascites, PT

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19
Q

What does the MELD score stand for?

A

Model for End-stage Liver Disease

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20
Q

What is measured in the MELD score?

A

INR, T.Bili, serum creatinine

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21
Q

What is the most common liver cancer?

A

Metastatic disease 20:1 (usually GI source)

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22
Q

What is the most common primary malignant liver tumor?

A

Hepatocellular carcinoma (hepatoma)

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23
Q

What is the most common primary benign liver tumor?

A

Hemangioma

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24
Q

What lab tests comprise the workup for liver metastasis?

A

LFTs (AST and alkaline phosphatase most useful), CEA for suspected primary colon cancer

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25
Q

What are the associated imaging studies for liver cancer?

A

CT, U/S, A-gram

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26
Q

What is a right hepatic lobectomy?

A

Removal of the right lobe of the liver (all tissue to the right of Cantle’s line)

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27
Q

What is a left hepatic lobectomy?

A

Removal of the left lobe of the liver (all tissue to the left of Cantle’s line)

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28
Q

What is a right trisegmentectomy?

A

Removal of all the liver tissue to the right of the falciform ligament

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29
Q

What are the 3 common types of primary benign liver tumors?

A
  1. Hemangioma
  2. Hepatocellular adenoma
  3. Focal nodular hyperplasia
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30
Q

What are the 4 common types of primary malignant liver tumors?

A
  1. Hepatocellular carcinoma
  2. Cholangiocarcinoma
  3. Angiosarcoma
  4. Hepatoblastoma
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31
Q

What chemical exposures are risk factors for angiosarcoma?

A

Vinyl chloride, arsenic, thorotrast contrast

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32
Q

What is a hepatoma?

A

Hepatocellular carcinoma

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33
Q

What are the other benign liver masses?

A

Benign liver cyst, bile duct hamartoma, bile duct adenoma

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34
Q

What is a liver hamartoma?

A

White hard nodule made up of normal liver cells

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35
Q

What is hepatocellular adenoma?

A

A benign liver tumor

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36
Q

Describe the histology of hepatocellular adenoma.

A

Normal hepatocytes without bile ducts

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37
Q

What are the associated risk factors for hepatocellular adenoma?

A

Women (M:F=1:9), OCPs, anabolic steroids, GSD

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38
Q

What are the signs and symptoms of hepatocellular adenoma?

A

RUQ pain/mass, RUQ fullness, bleeding (rare)

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39
Q

What are the possible complications of hepatocellular adenoma?

A

Rupture with bleeding, necrosis, pain, risk of hepatocellular carcinoma

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40
Q

How is hepatocellular adenoma diagnosed?

A

CT, U/S, +/- biopsy

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41
Q

What is the treatment for a small hepatocellular adenoma (< 5cm)?

A

Stop OCPs; if no regression, surgical resection

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42
Q

What is the treatment for a large hepatocellular adenoma (> 5cm)?

A

Surgical resection

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43
Q

What is focal nodular hyperplasia?

A

Benign liver tumor

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44
Q

Describe the histology of FNH.

A

Normal hepatocytes and bile ducts

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45
Q

What are the associated risk factors for FNH?

A

Women

46
Q

Is FNH associated with OCPs?

A

Yes, but not as clearly as hepatocellular adenoma

47
Q

How is the diagnosis of FNH made?

A

Nuclear technetium-99 study, U/S, CT, A-gram, biopsy

48
Q

What is the classic CT finding in FNH?

A

Liver mass with central scar

49
Q

What are the possible complications of FNH?

A

Pain (no risk of cancer, hemorrhage rare)

50
Q

Is there a cancer risk with FNH?

A

No

51
Q

What is the treatment for FNH?

A

If symptomatic, resection or embolization; Otherwise, stop OCPs and follow

52
Q

Why does embolization work with FNH?

A

FNH tumors are usually fed by only one major artery

53
Q

What is hepatic hemangioma?

A

Benign vascular tumor of the liver

54
Q

What are the signs and symptoms of hepatic hemangioma?

A

RUQ pain/mass, bruits

55
Q

What are the possible complications of hepatic hemangioma?

A

Pain, CHF, coagulopathy, obstructive jaundice, gastric outlet obstruction, Kasabach-Merritt syndrome, hemorrhage (rare)

56
Q

What is Kasabach-Merritt syndrome?

A

Hemangioma, thrombocytopenia and fibrinogenopenia

57
Q

How is the diagnosis of hepatic hemangioma made?

A

CT w/ IV contrast, tagged RBC scan, MRI, U/S

58
Q

Should a biopsy of hepatic hemangioma be performed?

A

No (risk of hemorrhage)

59
Q

What is the treatment for hepatic hemangioma?

A

Observation

60
Q

What are the indications for resection of hepatic hemangioma?

A

Symptoms, hemorrhage, unclear diagnosis

61
Q

What is hepatocellular carcinoma?

A

Most common primary malignancy of the liver

62
Q

What is the incidence of hepatocellular carcinoma?

A

80% of all primary malignant liver tumors

63
Q

What are the geographic high-risk areas for hepatocellular carcinoma?

A

Africa and Asia

64
Q

What are the associated risk factors for hepatocellular carcinoma?

A

Hepatitis B, cirrhosis, aflatoxin, alpha-1-antitrypsin deficiency, hemochromatosis, liver fluke, anabolic steroids, polyvinyl chloride, GSD type I

65
Q

What percentage of patients with cirrhosis will develop hepatocellular carcinoma?

A

5%

66
Q

What are the signs and symptoms of hepatocellular carcinoma?

A

Dull RUQ pain, hepatomegaly, abdominal mass, weight loss, paraneoplastic syndromes, signs of portal hypertension, ascites, jaundice, fever, anemia, splenomegaly

67
Q

What tests should be ordered for workup of hepatocellular carcinoma?

A

U/S, CT, angiography, tumor marker elevation

68
Q

What are the tumor markers for hepatocellular carcinoma?

A

Elevated AFP

69
Q

What is the most common way to get a tissue diagnosis of hepatocellular carcinoma?

A

Needle biopsy with CT, U/S or lapascopic guidance

70
Q

What is the most common site of hepatocellular carcinoma metastasis?

A

Lungs

71
Q

What is the treatment for hepatocellular carcinoma?

A

Surgical resection; liver transplant

72
Q

What are the treatment options for hepatocellular carcinoma if the patient is not a surgical candidate?

A

Percutaneous ethanol tumor injection; cryotherapy; intra-arterial chemotherapy

73
Q

What are the indications for liver transplantation in hepatocellular carcinoma?

A

Cirrhosis, no resection candidacy, no distant or lymph node metastases, no vascular invasion

74
Q

What is the prognosis for unresectable hepatocellular carcinoma?

A

Almost none survive a year

75
Q

What is the prognosis for resectable hepatocellular carcinoma?

A

35% at 5 years

76
Q

Which subtype of hepatocellular carcinoma has the best prognosis?

A

Fibrolamellar hepatoma (young adults)

77
Q

What is a liver abscess?

A

Abscess in the liver parenchyma

78
Q

What are the types of liver abscess?

A

Pyogenic (bacterial), parasitic (amebic), fungal

79
Q

What is the most common location of abscess in the liver?

A

Right > left lobe

80
Q

What are the sources for liver abscesses?

A

Direct spread from biliary tract infection, portal spread from GI infection (e.g. appendicitis, diverticulitis), systemic source (e.g bacteremia), liver trauma (e.g. gun shot), cryptogenic

81
Q

What are the 2 most common types of liver abscesses?

A

Bacterial and amebic

82
Q

What are the 3 most common bacterial organisms affecting the liver?

A

Gram negatives:

  1. E. coli
  2. Klebsiella
  3. Proteus
83
Q

What are the most common sources/causes of bacterial liver abscess?

A

Cholangitis, diverticulitis, liver cancer, liver metastasis

84
Q

What are the signs and symptoms of a bacterial liver abscess?

A

Fever, chills, RUQ pain, leukocytosis, increased LFTs, jaundice, sepsis, weight loss

85
Q

What is the treat for bacterial liver abscesses?

A

IV antibiotics (triple with metronidazole), percutaneous drainage w/ CT or U/S guidance

86
Q

What are the indications for operative drainage of a bacterial liver abscess?

A

Multiple/loculated abscesses or if multiple percutaneous attempts have failed

87
Q

What is the etiology of amebic liver abscesses?

A

Entamoeba histolytica

88
Q

How does an amebic liver abscess spread?

A

Fecal-oral transmission

89
Q

What are the risk factors for amebic liver abscesses?

A

Patients from countries south of the US-Mexico border, institutionalized patients, homosexual men, alcoholics

90
Q

What are the signs and symptoms of amebic liver abscesses?

A

RUQ pain, fever, lymphadenopathy, diarrhea

91
Q

Which lobe is the most common site of amebic liver abscesses?

A

Right lobe

92
Q

What is the classic description of the contents of amebic liver abscesses?

A

“Anchovy paste” pus

93
Q

How is the diagnosis of amebic liver abscess made?

A

Lab tests, U/S, CT

94
Q

What lab tests should be performed in the workup of amebic liver abscess?

A

Indirect hemagglutination titers for Entamoeba antibodies, LFTs

95
Q

What is the treatment of amebic liver abscesses?

A

Metronidazole IV

96
Q

What are the indications for percutaneous surgical drainage of an amebic liver abscess?

A

Refractory to metronidazole, bacterial co-infection, or peritoneal rupture

97
Q

What are the possible complications of large left lobe amebic liver abscesses?

A

Erosion into the pericardial sac

98
Q

What is a hydatid liver cyst?

A

Usually a right lobe cyst filled with Echinoccus granulosus

99
Q

What are the risk factors for hydatid liver cysts?

A

Travel; exposure to dogs, sheep, cattle

100
Q

What are the signs and symptoms of hydatid liver cysts?

A

RUQ abdominal pain, jaundice, RUQ mass

101
Q

How is the diagnosis of hydatid liver cyst made?

A

Indirect hemagglutination antibody test, Casoni skin test, U/S, CT, radiographic imaging

102
Q

What are the findings on AXR with a hydatid liver cyst?

A

Possible calcified outline of cyst

103
Q

What are the majors complications of a hydatid liver cyst?

A

Erosion into the pleural cavity, pericardial sac, biliary tree; rupture in the peritoneal cavity causing fatal anaphylaxis

104
Q

What is the risk of surgical removal of hydatid liver cysts?

A

Rupture or leakage of cyst contents into the abdomen causing a fatal anaphylactic reaction

105
Q

When should percutaneous drainage of a hydatid liver cyst be performed?

A

Never

106
Q

What is the treatment for a hydatid liver cyst?

A

Mebendazole, then surgical resection

107
Q

What is hemobilia?

A

Blood draining via the common bile duct into the duodenum

108
Q

What is the diagnostic triad of hemobilia?

A
  1. RUQ pain
  2. Guaiac positive, upper GI bleeding
  3. Jaundice
109
Q

What are the causes of hemobilia?

A

Trauma with liver laceration, percutaneous transhepatic cholangiography, tumors

110
Q

How is the diagnosis of hemobilia made?

A

EGD, A-gram

111
Q

What is the treatment for hemobilia?

A

A-gram with embolization of the bleeding vessel

Surgical Recall (68 decks)

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