Liver 3 Flashcards
This liver lesion enhances on arterial phase and washes out on portal-venous phase;
HCC
Both hepatic adenomas and HCC enhance on arterial phase, how do we distinguish the two?
adenomas do not demonstrate delayed washout on portal-venous phase
HCC has delayed washout on portal-venous phase
Appropriate steps to therapy for acute suppurative cholangitis include what?
resuscitate
biliary decompression
systemic antibiotics
This mass appears as a heterogenous, poorly circumscribed mass with bright arterial enhancement and quick washout;
HCC
Peripheral to central enhancement on a CT, we think of what liver lesion?
hemangioma
Enhancement of a central scar is typical of what liver lesion?
FNH
When would you not do a laparoscopic trans-cystic common bile duct exploration?
if you have stones in common hepatic duct
if cystic duct friable or small (<3 mm)
gallstones greater than 6-8 mm
>8 CBD stones
When doing a cholecystectomy, and you get spillage of bile and stones, how do we classify the wound?
contaminated wound–> high risk for post-op intra-abdominal abscess
dirty wound–> gangrenous cholecystitis
clean-contaminated–> elective chole with little or no bile spillage
How do we position pts for percutaneous liver biopsies?
supine
hand over head
lidocaine injection over upper border of rib to avoid subcostal vessels
inject needle
have pt hold breath while removing biopsy specimen
What is future liver remnant?
amount of liver remaining after a surgical resection needed to maintain normal liver function
20-25% FLR is adequate in healthy pts
in pts w/underlying liver dx, or prior chemo, higher % needed to prevent post-hepatectomy liver failure
Bile leak occurs in what % of pts after hepatectomy?
10%
How do we confirm a bile leak after hepatectomy?
when bilirubin concentration in drainage fluid is >3x greater than that of serum bilirubin usually on day 3
Procedure of choice for suspected bile leak after hepatectomy?
percutaneous drainage
Performing a laparoscopic cholecystectomy and intraop cholangiogram shows CBD stone, what do you do next?
attempt to flush CBD w/NS
give 1-2 mg of glucagon IV (relaxes Sphincter of Oddi)
perform a laparoscopic exploration next
How do we treat proximal biliary tree injuries such as transection of the proximal hepatic duct slightly distal to hepatic bifurcation?
distal bile duct should be oversewn
proximal duct should be resected back to healthy tissues
and anastomosed to jejunum in a s-s fashion
Incidence of cholangiocarcinoma seen in what age groups?
50-70 yrs old
exception are pts with PSC, and those w/choledochal cysts
In terms of cholangiocarcinoma, peri-hilar tumors involving the bifurcation of the hepatic ducts are commonly referred to as?
Klatskin tumors
What classification system do we use to classify choledochal cysts?
Todani classification
What are the Todani classifications of choledochal cysts?
I–> fusiform dilation of CBD without intra-hepatic involvement
II–> a diverticulum off of the CBD
IV A–> single fusiform dilation of the extrahepatic bile duct as well as dilation of intrahepatic bile ducts
IV B–> multiple extra-hepatic bile duct dilations
V (Caroli’s dx)–> an intrahepatic bile duct cyst only
Adenomyomatosis of GB commonly found where in the GB and is it cancerous?
commonly in fundus
not considered a premalignant lesion
seen in 1-9% of GB specimens
Cholecystitis can precipitate symptoms and crises in which pts?
sickle cell pts
(these pts need tube decompression for cholecystitis, 3-8 weeks later once tract has formed, they need an interval cholecystectomy, risk of recurrence is 20-30%)
What test do we use to test for sphincter of oddi dysfunction that could benefit from transduodenal sphincteroplasty?
morphine-neostigmine test
morphine–> causes sphincter contraction
neostigmine–> causes biliary contraction
On US if we see a defined compressible mass with hyperechoic features we think of?
hemangioma
If we see late arterial homogenous enhancement with a hypodense central scar that enhances on delayed contrast imaging we think of what liver lesion?
FNH