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Surgery > liver > Flashcards

liver Flashcards

1
Q

what is cantles line

A

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

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2
Q

which ligament goes from ant abd wall to liver

A

falciform ligament

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3
Q

what ligament attaches liver to diaphragm

A

coronary ligament

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4
Q

venous supply of liver

A

portal vein

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5
Q

max amt liver can be resected while retaining adequate liver function

A

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

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6
Q

what is child’s class (child-turcotte pugh)

A

classification system that estimates hepatic reserve in pts w hepatic failure and mortality

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7
Q

what comprises the child’s classification

A

” a beap”

ascites, bilirubin,encephalopathy, albumin, pt

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8
Q

Meld score

A

“model for end stage liver disease”

measures: INR, t bili, serum creatinine

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9
Q

mc liver cancer

A

metastic ds out numbers primary tumors (usually from GI tract)

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10
Q

mc primary malignant liver tumor

A

hepatocellular carcinoma (hepatoma)

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11
Q

mc primary benign liver tumor

A

hemangioma

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12
Q

imaging/lab studies for liver cancer

A

ct scan, us, a gram

lfts, cea

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13
Q

right trisegmentectomy

A

removal of all the liver tissue to right of falciform ligament

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14
Q

3 common types of primary benign liver tumors

A
  1. hemangioma
  2. hepatocellular adenoma
  3. focal nodular hyperplasia
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15
Q

4 common types of primary malignant liver tumors

A
  1. hepatocellur carcinoma (hepatoma)
  2. cholangiocarcinoma (when intrahepatic)
  3. angiosarcoma (assoc w chemical exposure)
  4. hepatoblastoma (mc in infants/kids)
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16
Q

what chemical exposures are risk factors for angiosarcoma

A

vinyl chloride*, arsenic, thorotrast contrast

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17
Q

liver hamartoma

A

white hard nodule made up of normal liver cells

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18
Q

risk factors for hepatocellular adenoma

A

women, birth control pills, anabolic steroids, glycogen storage ds

age 30-35

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19
Q

s/sx hepatocellular adenoma

A

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

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20
Q

complications hepatocellular adenoma

A

rupture w bleeding, necrosis, pain, risk of hepatocellular carcinoma

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21
Q

dx hepatocellular adenoma

A

ct scan, us, +/- bx

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22
Q

tx small hepatocellular adenoma

A

stop birth control pills, it may regress; if not surgical resection

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23
Q

tx large (>5cm), bleeding, painful or ruptured hepatocellular adenoma

A

surgical resection

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24
Q

what is focal nodular hyperplasia (FNH)

A

benign liver tumor; normal hepatocytes and bile ducts (adenoma has no bile ducts) occurring around 40y in females

can be assoc with birth control pills

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25
Q

dx fnh

A

nuclear technetium 99 study, us, ct , a gram, bx

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26
Q

classic ct scan finding of fnh

A

liver mass w central scar

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27
Q

complications of fnh

A

pain; no cancer risk

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28
Q

tx fnh

A

resection or embolization if pt is symptomatic; otheriwse follow if dx is confirmed; stop birth control

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29
Q

s/sx hepatic hemangioma

A

ruq pain/mass, bruits

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30
Q

complications of hepatic hemangioma

A

pain, CHF, coag, obstructive jaundice, gastric outlet obstruction, Kasabach-Merritt syndrome, hemorrhage

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31
Q

kasabach-merritt syndrome

A

hemangioma and thrombocytopenia and fibrinogenopenia

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32
Q

dx hepatic hemangioma

A

ct scan w iv contrast, tagged red blood scan, mri, us

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33
Q

tx hepatic hemangioma

A

observation

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34
Q

high risk areas for hepatocellular carcinoma

A

africa and asia

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35
Q

risk factors hepatocellular carcinoma (hepatoma)

A

hep B, cirrhosis, aflatoxin (fungi toxin of aspergillus flavus)*

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36
Q

s/sx of hepatoma

A

dull ruq, hepatomegaly, abd mass, wl, paraneoplastic syndromes, portal htn, ascites, jaundice, fever, anemia, splenomegaly

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37
Q

pt w dull ruq pain, hepatomegaly, wl, jaundice and fever

A

hepatoma

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38
Q

workup for hepatoma

A

us, ct, angiography, tumor marker elev (alpha fetoprotein)

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39
Q

mc site metastasis of hepatoma

A

lungs

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40
Q

tx hepatoma

A

surgical resection, if possible lobectomy; liver transplant

41
Q

nonsurgical tx hepatoma

A

percutaneous ethanol tumor injection, cryotherapy, intra arterial chemo

42
Q

indications for liver transplant

A

cirrhosis and NO resection candidacy as well as no distant or lymph node metastases and no vascular invasion; the tumor must be single

43
Q

which subtype of hepatoma has best prognosis

A

fibrolamellar hepatoma (young adults)

44
Q

types of liver abscess

A

pyogenic (bacterial), parasitic (amebic), fungal

45
Q

mc location of liver abscess

A

right lobe

46
Q

3 mc bacterial organisms affecting the liver

A

gram neg: e coli, klebsiella, proteus

47
Q

mc sources/causes of bacterial liver abscesses

A

cholangitis, diverticulitis, liver cancer, liver metastasis

48
Q

s/sx bacterial liver abscess

A

fever,* chills, ruq pain, leukocytosis, inc lfts, jaundice, sepsis, wl

49
Q

tx bacterial liver abscess

A

iv abx (triple abx w metro), percutaneous drainage w ct or us guidance

50
Q

cause of amebic (parasitic) liver abscess

A

entamoeba histolytica

51
Q

how does amebic liver abscess occur

A

fecal-oral transmission

52
Q

s/sx amebic liver abscess

A

ruq pain, fever, hepatomegaly, diarrhea

chills less common than w pyogenic abscess

53
Q

pt w ruq pain, fever, hepatomegaly, diarrhea

A

amebic liver abscess

54
Q

which love mc involved amebic liver abscess

A

right lobe

55
Q

classic description of amebic liver abscess

A

anchovy paste pus

56
Q

dx amebic liver abscess

A

lab tests, us, ct

indirect hemagglutination titers for Entamoeba antibodies elev in >95% of cases, elev lfts

57
Q

tx amebic liver abscess

A

metro IV

surgery drainage- refractory to metro, bacterial co infx, or peritoneal rupture

58
Q

possible complications of large left lobe liver amebic abscess

A

erosion into pericardial sac

59
Q

hydatid liver cyst

A

usually a right lobe cyst filled w Echinococcus granulosus

60
Q

rf for hydatid liver cyst

A

travel, exposure to dogs, sheep, and cattle

61
Q

s/sx hydatid liver cyst

A

ruq pain, jaundice, ruq mass

62
Q

dx hydatid liver cyst

A

indirect hemagglutination antibody test (serologic testing), Casoni skin test, us, ct, radiographic imaging

63
Q

axr finding hydatid liver cyst

A

possible calcified outline of cyst

64
Q

risk of surgical removal of echinococcal (hydatid) cysts

A

rupture or leakage of cyst contents into abd may cause fatal anayphylactic rxn

(never drain because risk of anaphylaxis)

65
Q

tx hydatid liver cyst

A

mebendazole followed by surgical resection

toxic irrigations- hypertonic saline, ethanol,cetrimide

66
Q

what is a hemobilia

A

blood draining via the common bile duct into the duodenum

67
Q

triad s/sx of hemobilia

A

ruq pain, guaiac pos/upper gi bleeding, jaundice

68
Q

causes of hemobilia

A

trauma w liver laceration, percut transhepatic cholangiography (PTC), tumors

69
Q

dx hemobilia

A

EGD (blood out of ampulla of Vater), a gram

70
Q

tx hemobilia

A

a gram w embolization of the bleeding vessel

71
Q

bellhemia

A

seen after trauma, connection of bile ducts and venous system, resulting in rapid and very elevated serum bilirubin

72
Q

portal hypertension

A

elev portal pressure resulting from resistance to portal flow

73
Q

3 etiologies of portal hypertension

A
  1. prehepatic- thrombosis of portal vein/atresia of portal vein
  2. hepatic-cirrhosis (distortion of normal parenchyma by regenerating hepatic nodules), hepatocellular carcinoma, fibrosis
  3. posthepatic- budd chiari syndrome: thrombosis of hepatic veins
74
Q

mc cause portal htn in us

A

cirrhosis

75
Q

name of liver capsule

A

glisson’s capsule

76
Q

mc pe finding in pts w portal htn

A

splenomegaly

77
Q

4 assoc clinical finding in portal htn

A
  1. esophageal varices
  2. splenomegaly
  3. caput medusae (engorgement of periumbilical veins)
  4. hemorrhoids
78
Q

pe findings of cirrhosis and portal htn

A

spider angiooma, palmar erythema, ascites, truncal obesity and peripheral wasting, encephalopathy, asterixis (liver flap), gynecomastia, jaundice

79
Q

name of periumbilical bruit heard w caput medusae

A

cruveilhier-baumgarten bruit

80
Q

assoc between esophageal varices and portal htn

A

coronary vein backing up into the azygous system

81
Q

assoc between caput medusae and portal htn

A

umbilical vein draining into epigastric vein

82
Q

assoc w retroperitoneal varices and portal htn

A

small mesenteric veins draining retroperitoneally into lumbar veins

83
Q

assoc w hemorrhoids and portal htn

A

superior hemorrhoidal vein backing up into the middle and inferior hemorrhoidal veins

84
Q

mc cause portal htn in US and outside of US

A

US- cirrhosis

outside-schistosomiasis

85
Q

budd chiari syndrome

A

thrombosis of hepatic veins

86
Q

most feared complication of portal htn

A

bleeding from esophageal varices

87
Q

esophageal varices

A

engorgement of the esophageal venous plexuses secondary to inc collateral blood flow from portal system as a result of portal htn

88
Q

rule of 2/3 portal htn

A

2/3 pt w cirrhosis dev it
2/3 pt w it will dev esophageal varices
2/3 pt w varices will bleed from them

89
Q

s/sx pt w cirrhosis and known varices w upper GI bleeding

A

hematemesis, melena, hematochezia

90
Q

initial tx of bleeding esophageal varices

A

large bore ivx2, iv fluid, foley, t/c, labs, correct coag (vit K, ffp), +/- intubation to protect from aspiration

91
Q

dx upper gi bleeding

A

EGD (upper GI endoscopy) to look for varices, ulcers, gastritis, etc

92
Q

EGD tx for bleeding varices

A
  1. emergent endoscopic sclerotherapy

2. endoscopic band ligation

93
Q

med tx for bleeding varices

A

somatostatin (octreotide) or iv vasopressin to achieve vasoconstriction of mesenteric vessels; if bleeding continues, consider balloon (sengstaken-blakemore tube) tamponade of varices, beta blocker

94
Q

selective shunt for bleeding varices

A

shunt that selectively decompresses the varices without decompressing the portal vein

95
Q

TIPS if cant stop variceal bleeding

A

transjugular intrahepatic portosystemic shunt- angriographic radiologist places small tube stent intrahepatically between the hepatic vein and branch of portal vein via percut jugular vein route

96
Q

warren shunt

A

distal splenorenal shunt w ligation of coronary vein

97
Q

mc perioperative cause of death following shunt procedure

A

hepatic failure secondary to dec blood flow

98
Q

what is used to counteract the coronary artery vasoconstriction of iv vasopressin

A

nitro iv drip

99
Q

meds to tx hepatic encephalopathy

A

lactulose po with or without neomycin po

Surgery (21 decks)

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