LIVER

Question 1

focal nodular hyperplasia
CT findings
MRI findings

Answer 1

“arterial outside
venous inside”
“like cancer outgrowing its blood supply” blah blah blah cannot double top glass characteristics in clinical transformation this is Lynsey

Stellate

MRI:
peripheral nodular enhancement arterial face

Centripetal enhancement Venus phase

Question 2

Test for focal nodular hyperplasia

Answer 2

Sulfur colloid

Question 3

Where in the liver metastases found

Answer 3

Periphery of the liver

Question 4

What size cystadenoma should be resected

Answer 4

Greater than equal to 3 cm

After trial of discontinuation of birth control

Question 5

CT findings of adenoma

Answer 5

Heterogeneous

Question 6

CT findings of hemangioma

Answer 6

Peripheral AND central enhancement

Question 7

MILAN criteria

Answer 7

Eligible for transplantation for hepatocellular carcinoma

Based on an initial size of tumor (not downsizing)

Less than or equal to three tumors
Less than 3 cm

Or one tumor less than 5 cm

Question 8

fibrolamellar hepatocellular carcinoma

Answer 8

Young patient
No cirrhosis
Not associated with hepatitis B
Can be AFP negative

Question 9

Most likely cause of alter sound showing intrahepatic structure that is cystic and an elevated White blood cell count

Answer 9

Amoebic abscess

Pyogenic

Question 10

Test for a amoebic abscess

Answer 10

Hemagglutinin

Question 11

What does calcification suggest in infected liver picture

Answer 11

Hydatid cyst

Question 12

Organisms identified in pyogenic abscess

Answer 12

E. coli number one
Strep faecalis
Kleb
Proteus
anaerobic colon
B frag

Question 13

What is the usual source of pyogenic abscess

Answer 13

GI

also can be from bili

Question 14

Econ a cockle cyst CT findings

Answer 14

thick wall
Calcifications in debris
Septations– daughter cysts

Question 15

Diagnoses of echinococal cyst

Answer 15

ELISA

Hemagglutinin

Question 16

Medication for pretreating echinococal cyst

Answer 16

Albendazole

Question 17

Cystadenoma CT findings

Answer 17

Complex cyst

mural nodules

Question 18

What does TIPS stand for

Answer 18

Transjugular
intrahepatic
portosystemic
Shunt

Question 19

What kind of shunt is TIPS

Answer 19

Nonselective
Good for stopping bleeding
Bad for encephalopathy(Because no longer clearing toxins through deliver)
Pretty good for ascites

NO for right heart failure

Question 20

Mesocaval shunt

Answer 20

Best for urgent treatment of bleeding varices

really buggers up transplant options though

Question 21

Distal spinal shunt

Answer 21

Time-consuming

Selective shunt

Good for encephalopathy

Question 22

Child’s class

Answer 22

Child class a / b / c

Billy Ruben 2/ 2-3 / >3
Albumin >3.5 / 2.8-3.5 / 2.2
Encephalopathy 0 / controlled / uncontrolled
Ascites 0 / controlled / uncontrolled

Question 23

Surgical mortality associated with child score

Answer 23

Child a: 5-6 10%
Charles B: 7-9 30%
Child C: 10-15 75 – 80%!

Question 24

What is the MELD score needed to get on the transplant list

Answer 24

15

Question 25

TIPS is best with MELD less than

Answer 25

24 or greater is contraindication

uptodate

Question 26

MELD for major liver surgery

Answer 26

8?

Question 27

Anatomy of portal triad

Answer 27

ant right CBD
left HA
portal vein

Question 28

replaced right hapatic artery

Answer 28

SMA to
posterior portal vein
posterior to pancrease
posterior to cystic artery

Question 29

test to r/u hemangioma if CT scan and MRI are equivocal

Answer 29

Tagged red blood cell scan

Question 30

labs to get for ruling out liver malig

Answer 30

AFP

LFTs / bili / coags

hepatitis panel

Question 31

Basic steps to gain access for a Pringle

Answer 31

Pars flaccid (gastrohepatic ligament) is opened any fingers passed through the foramen of Winslow

Porta hepatis can then be encircled with umbilical tape

Question 32

Treatment of encephalopathy

Answer 32

Decrease aromatic
(can use branch chain amino acids)

Lactulose

neomycin decreased bacteria that makes ammonium