Liver Flashcards
What is the name of the liver capsule?
Glisson’s capsule
What is the “bare” area of the liver?
Posterior section of the liver against the diaphragm that is “bare” without peritoneal covering
What is Cantle’s line?
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
Which ligament goes from the anterior abdominal wall to the liver?
Falciform ligament
What does the falciform ligament contain?
Ligamentum teres (obliterated umbilical vein)
What is the coronary ligament?
Peritoneal reflection on top of the liver that “crowns” the liver and attaches it to the diaphragm
What are the triangular ligaments of the liver?
Right and left lateral extents of the coronary ligament, which form triangles
What is the origin of the hepatic arterial supply?
From the proper hepatic artery off of the celiac trunk
What is the venous supply to the liver?
Portal vein, formed from the splenic vein and the SMV
What is the hepatic venous drainage?
Via the hepatic veins, which drain into the IVC
What sources supply O2 to the liver?
Portal vein: 50%
Hepatic artery: 50%
From what sources does the liver receive blood?
Portal vein: 75%
Hepatic artery: 25%
What is the maximum amount of liver that can be resected while retaining adequate liver function?
> 80%; if given adequate recovery time, the original mass can be regenerated
What are the signs and symptoms of liver disease?
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
Which liver enzymes are made by hepatocytes?
AST and ALT
What is the source of alkaline phosphatase?
Ductal epithelium
What is Child’s class?
Classification system that estimates hepatic reserve in patients with hepatic failure and mortality
What comprises the Child’s classification?
A BEAP:
Labs: Albumin, Bilirubin
Clinical: Encephalopathy, Ascites, PT
What does the MELD score stand for?
Model for End-stage Liver Disease
What is measured in the MELD score?
INR, T.Bili, serum creatinine
What is the most common liver cancer?
Metastatic disease 20:1 (usually GI source)
What is the most common primary malignant liver tumor?
Hepatocellular carcinoma (hepatoma)
What is the most common primary benign liver tumor?
Hemangioma
What lab tests comprise the workup for liver metastasis?
LFTs (AST and alkaline phosphatase most useful), CEA for suspected primary colon cancer
What are the associated imaging studies for liver cancer?
CT, U/S, A-gram
What is a right hepatic lobectomy?
Removal of the right lobe of the liver (all tissue to the right of Cantle’s line)
What is a left hepatic lobectomy?
Removal of the left lobe of the liver (all tissue to the left of Cantle’s line)
What is a right trisegmentectomy?
Removal of all the liver tissue to the right of the falciform ligament
What are the 3 common types of primary benign liver tumors?
- Hemangioma
- Hepatocellular adenoma
- Focal nodular hyperplasia
What are the 4 common types of primary malignant liver tumors?
- Hepatocellular carcinoma
- Cholangiocarcinoma
- Angiosarcoma
- Hepatoblastoma
What chemical exposures are risk factors for angiosarcoma?
Vinyl chloride, arsenic, thorotrast contrast
What is a hepatoma?
Hepatocellular carcinoma
What are the other benign liver masses?
Benign liver cyst, bile duct hamartoma, bile duct adenoma
What is a liver hamartoma?
White hard nodule made up of normal liver cells
What is hepatocellular adenoma?
A benign liver tumor
Describe the histology of hepatocellular adenoma.
Normal hepatocytes without bile ducts
What are the associated risk factors for hepatocellular adenoma?
Women (M:F=1:9), OCPs, anabolic steroids, GSD
What are the signs and symptoms of hepatocellular adenoma?
RUQ pain/mass, RUQ fullness, bleeding (rare)
What are the possible complications of hepatocellular adenoma?
Rupture with bleeding, necrosis, pain, risk of hepatocellular carcinoma
How is hepatocellular adenoma diagnosed?
CT, U/S, +/- biopsy
What is the treatment for a small hepatocellular adenoma (< 5cm)?
Stop OCPs; if no regression, surgical resection
What is the treatment for a large hepatocellular adenoma (> 5cm)?
Surgical resection
What is focal nodular hyperplasia?
Benign liver tumor
Describe the histology of FNH.
Normal hepatocytes and bile ducts