Liver Flashcards
Entamoeba liver abscess
- male vs. female
- transmission route
- treatment?
- cansoni skin test?
- what confirms the diagnosis?
- right or left lobe?
- male vs. female.
- 7-10 times more common in men than women
- fecal-oral transmission
- treatment: flagyl
- cansoni: echonicoccal cyst
- serology confirms diagnosis
- right lobe preponderance
- Most common cause of liver abscess
- What % of pyogenic liver abscesses are due to biliary spread?
- What % of them have underlying malignancy?
- Biliary spread
- biliary disease: 35-40%.
- Underlying malignancy: ~40% of the biliary diseases
Hepatic adenoma.
- When to resect? Why?
- What’s the probability of malignant transformation?
- Which subtype of hepatic adenoma has the highest risk of malignant transformation?
- Any symptomatic or > 5cm (some say >3-4cm), or pregnant/planning to be pregnant. can rupture. or men (much higher rate of malignancy)
- 5% chance of malig transformation
- b-catenin mutated adenomas
tangent: neurotensin: fibrolamellar HCC. better prognosis
- How much change is made in cardiac output when you do a complete vascular occlusion?
- How much of the cardiac output does the liver get normally?
- What % of blood supply to the liver comes from the portal vein vs. hepatic artery?
- What % of oxygen supply come from them?
- What % of liver do you absolutely need to survive post-hepatectomy.
- 40-60% decrease in cardiac output
- Normally the liver gets ~20% of the cardiac output
- Blood flow: 75% comes from the portal vein. 25% from hepatic artery.
- O2 supply: 50/50
- Need 30%
- Liver resections Which segments are taken in right lobectomy?
- Which segments are taken in right trisegmentectomy (aka right extended hepatectomy)
- Left lobectomy?
- Left trisegmentectomy (aka left extended hepatectomy)
- Left lateral segmentectomy?
- Left medial segmentectomy?
- right lobectomy: 5, 6, 7, 8
- right trisegmentectomy: 5, 6, 7, 8 + 4
- Left lobectomy: 2, 3, 4
- Left trisegmentectomy: 2, 3, 4 + 5, 8
- Left lateral segmentectomy: 2, 3
- Left medial segmentectomy: 4
- Pringle How much clamp on time vs off?
- How much total clamp off time can someone have?
15 min on 5 min off Total 120min ischemia time.
- What is the most common cause of Budd chiari syndrome?
- Thrombolytic Rx can be used within what timeframe?
- Myeloproliferative disorder
- Within 3-4 weeks of onset
HCC
- Resection margin?
- T/F: main portal vein involvement is not a contraindication for resection
- what is the Milan criteria?
- role of adjuvant therapy?
- Margin: 2cm
- generally when portal vein is involved resection IS contraindicated
- Milan criteria: 1 tumor <5cm or 3 tumors each <3cm
- no good adj option
Pyogenic liver abscess
- most common cause
- which organism affects mortality?
- most common cause: biliary
- which organism affects mortality: k. Pneumoniae
Liver CT. Peripheral enhancement
Hemangioma
Hepatic vein pressure gradient. What’s normal? What’s portal hypertension?
HVPG is the difference between WHVP (wedge hepatic venous pressure) and FHVP (free hepatic venous pressure) Normal HVPG: 5 or less. Abnormal: 6 or greater
Liver CT Sulfur colloid uptake
Focal nodular hyperplasia. Sulfur colloid uptake is by kupffer cells. Adenomas don’t have kupffer cells Focal nodular hyperplasia has kupffer cells.
Liver CT Heterogenous mass with early enhancement on the arterial phase
Adenoma
Liver CT Central stellate scar
Focal nodular hyperplsia
What is the most important scan for evaluating colorectal Mets to liver? PET? arterial phase CT? venous phase CT?
Venous phase CT
What is a triple phase CT?
arterial phase Venous phase Delayed phase
- MCC of liver failure in Asia.
- # 1, #2 causes of liver failure in the western world?
Asia- hep B Western: #1: EtOH #2: Hep C
- Mortality of variceal bleed?
- Which hemorrhoidal veins get dilated?
- Maintenance medication for variceal bleed?
- 20% mortality
- Middle and inferior hemorrhoidal veins.
- Propranolol (need a non selective b-blocker. b1 blockade decreases cardiac output. b2 blockade decreases splanchnic blood flow)
What is the most common organism in spontaneous bacterial peritonitis?
- e. Coli NOT klebsiella
- Cystadenoma of the liver. Common in what population?
- Treatment?
Women in 4th and 5th decade Enucleation is curative
Treatment for echinococcal cyst vs. entoemeba? which one may need surgery?
Echino: albendazole. May need surgery Entoemeba: metronidazole. No surgery
Liver MRI. bright on T2 with peripheral enhancement
Hemangioma
Liver lesion. Hyperintense on CT/MRI
Hepatic adenoma. Resect if >5cm or symptomatic with any size
Liver abscess. If you see this type of bacteria you should be concerned about colon cancer
E. Faecalis
What % of all pts with colorectal cancer will have Mets at diagnosis?
1/3
30% will have colonic obstruction at diagnosis
What % of all pts with colorectal cancer will develop metastases?
60% will eventually develop mets
Overall 5 year survival for colorectal cancer in all comers
~50%
Liver imaging. Enhance in arterial phase and wash out in portal venous phase
HCC
What is the Milan criteria
Can do liver transplant if:
- 1 lesion <5cm
- 3 lesions <3cm
- Any child’s class
- no invasion, no mets
What are the available chemo agents for cholangiocarcinoma? Can they do neoadj?
5FU or gemcitabine Yes. Can do neoadj