LIVER Flashcards
MELD score needed to safely perform liver surgery
MELD less than or equal to 8
MELD score needed to get on the transplant list
MELD GREATER than 8
9 or greater
Extra MELD score points given for transplant
20 extra MELD score points are given for transplant
What part of the liver is a hemangioma found
On the edge
Most common benign liver tumor
Do not biopsy
Do not operate– Unless, damage control bleeding over so vessel
Management of bleeding ruptured adenoma
Do not operate– Unless, damage control bleeding over so vessel
Primary sclerosing cholangitis
Management
If no malignancy found on work up:
If isolated collection:
Resect
if diffuse disease
Stent
If present for years:
Transplant
Laboratory test for ecchinocucus AND amoeba
ELISA!
Treatment of ecchinocucus
Albendazole Failure in medical therapy rule out biliary tree communication with ERCP? Surgery Aspirate Hypertonic sailing Sclerosis 20 minutes Pack omentum
Treatment of amoeba
first Metronidazole only!
If not better in three days:
chloroquin
If not better in seven days:
Aspirate and without superinfection
If failed aspiration: percutaneous drain
If feel percutaneous drain surgery
Treatment of abscess
Most common RIGHT
Need to check if there is an intra-abdominal source!
CT guided drainage
Antibiotics - zosyn
If not resolved in three weeks of drainage then open drainage through 12 rib
Always biopsy abscess to rule out cancer
May need colonoscopy afterwards
If multiple abscesses drain one entry with antibiotics see if it resolves
Treatment of fungus abscess
amphotericin B
Treatment of tuberculosis abscess
Isoniazid
Rifampin
Test of ameba
Complement fixation
ELISA (same as ecchino)
Test for echinococcal
“electrifying case if spilage”
Electrophoresis
Indirect hemagglutinin / ELISA
ELISA / complement fixation; and test for echino electrophoresis/ ELISA all neg - what lab test is next
Mycobacterium for ruling out tuberculosis
Hepatitis
stool O and P
