Liver Flashcards
____ is a plane from gallbladder fossa to IVC separating the true left and right lobes of the liver
Cantlie’s line
_____ separates the left lateral and left medial segments
falciform ligament
the faciform ligaments divide the left lobe to ____
left lateral and left medial segments
small left lobe
large left lobe
the right lobe of the liver is divided by the following structures
- Gallbladder
- Fissure of ligamentum teres
- IVC
- Fissure of ligamentum venosum
The right lobe is composed of what lobes?
- Quadrate lobe
2. Caudate lobe
[Name the coinaud segemen]
caudate
1
[Name the coinaud segemen]
left lateral
2 and 3
[Name the coinaud segemen]
left medial
4
[Name the coinaud segemen]
right anterior lobe
5, 8
[Name the coinaud segemen]
Right posterior lobe
6, 7
[hepatic vein drainage]
segment 5-8
right hepatic
[hepatic vein drainage]
segment 4,5,8
middle hepatic
[hepatic vein drainage]
segment 2,3
left hepatic
[hepatic vein drainage]
caudate lobe
IVC
the pringle maneuver compress what structures?
portal vein, hepatic artery, CBD
[Liver function test]
hepatocellular injury
ALT, AST
[Liver function test]
Synthetic function
Albumin
Clotting factors EXCEPT factor 8
[Liver function test]
Cholestasis
TB
B2 transferrin
ALP
GGTP
[Liver function test]
what is the best measure of liver synthetic function test?
PT and INR
[Liver function test]
Most specific for liver diseases: AST or ALT?
ALT
[Liver function test]
increased in extrahepatic
Direct bilirubun
[Liver function test]
increased in intrahepatic diorders
Indirect unconjucated
[Liver function test]
indicative of biliary obstruction
alkaline phosphatase
[Liver function test]
early marker and sensitive test for hepatobiliary disease
GGTP
[jaundice]
detectable when serum bilirubin is?
> 2.5 to 3 mg/dL
[Cirrhosis]
causes if impaired hepatic regeneration
- Destruction of reticulin framework
- Disturbances in blood supply
- Necrosis too extensive
- Malnutrition
- Inhibition of hepatocyte proliferation
[cirrhosis]
Hepatic nodule formation is due to?
hepatic proliferation limited by enveloping scars
[cirrhosis]
vein responsible for caput medusae
umbilical vein
[cirrhosis]
ascites is clinically detected if the volume is ____
> 1.5L
___ syndrome
spigastric vascular murmur
Cruveilhier-Baumgarten Syndrome
This syndrome shunts blood from the portal vein to the umbilical vein. It can be present without caput medusae.
Cruveilhier-Baumgarten Syndrome
[cirrhosis]
Horizontal white bands and/or proximal white nail plate is due to?
Hypoalbuminemia
[cirrhosis]
Dupuytren contracture is due to an increase in what compound?
hypoxanthine
[cirrhosis]
Asynchronous flapping motions or dorsiflexed hand
asterexis
[spontaneous bacterial peritonitis]
what is the first line drug for SBP?
Cefotaxime
[Assessment of hepatic reserve]
This predicts surgical risks of intraabdominal operations prepared by patients with cirrhosis
Child-Turcotte-Pugh Score
[Assessment of hepatic reserve]
what are the components of the Child Pugh Score?
Jaundice: bilirubin 2-3 Ascites: minimal, controlled Prothrombin time: 40-70% Albumin: 2.8 to 3.5 Nutritional status: Good
Child Pugh B is described above
[Assessment of hepatic reserve]
Child-Pugh B is associated with ___ % mortality
30%
[Assessment of hepatic reserve]
80% mortality is associated in what Child-Pugh Score?
Class C
[Portal Hypertension]
What is the normal portal pressure?
5-10 mmHg
[Portal Hypertension]
Portal hypertension is diagnosed if the direct portal venous pressure is?
> 5mmHg
[Portal Hypertension]
Portal hypertension is diagnosed if the splenic pressure is?
> 15mmHg
[Portal Hypertension]
varices form if the portal pressure exceeds? ___
> 12mmHg
[Portal Hypertension]
what is the most accurate method of determining the portal pressure?
Hepatic Venography
[portosystemic collaterals]
Causes Esophageal varices
Left Gastric
Azygous Vein
[portosystemic collaterals]
Causes caput medusae
umbilical vein
[portosystemic collaterals]
Causes hemorrhoids
middle hemorrhoidal
inferior hemorrhoidal
[Portal hypertension]
Due to sinusoidal obstruction
Steatohepatitis
Wilson disease
[Portal hypertension]
due to high flow states
AV fistula
Banti syndrome
[diagnosis]
Abdominal pain
ascites
liver enlargement
occlusion of the hepatic vein
Budd-Chiari Syndrome
[Pre/Sinu/Postsinusoidal]
Alcoholic central hyaline sclerosis
postsinusoidal
[Pre/Sinu/Postsinusoidal]
Acute alcoholic hepatitis
sinusoidal
[Pre/Sinu/Postsinusoidal]
vitamin A intoxication
Sinusoidal
[Pre/Sinu/Postsinusoidal]
Schistosomiasis
Presinusoidal
[Pre/Sinu/Postsinusoidal]
Chronic active hepatitis
Pre-sinusoidal
[Pre/Sinu/Postsinusoidal]
vinyl chloride
presinusoidal
[Pre/Sinu/Postsinusoidal]
cirrhosis
sinusoidal
[Management of acute variceal bleeding]
Drug of choice
Octreotide
But vasopressin can be given
[Management of acute variceal bleeding: refractory bleeding]
What is the surgical technique if the patient is classified as Child A?
surgical shunt
[Management of acute variceal bleeding: refractory bleeding]
What is the surgical management if the patient is classified as Child B and C
TIPS
[Portosystemic Surgical Shunts]
Distal splenorenal
Warren
[Portosystemic Surgical Shunts]
Left gastric vena caval shunt
Inokuchi
[Portosystemic Surgical Shunts]
Small diameter portacaval H graft shunt
Sarfeh
[Portosystemic Surgical: Nonshunts]
ligation of venous branches entering the distal esophagus; for recurrent variceal bleeding
Sugiura-Fukugawa
[Portosystemic Surgical: Nonshunts]
Splenectomy+ Perihiatal devascularization of the lower esophagus +Ligation of the left gastric vessels + devascularization of the proximal hald of the stomach + separation of stomach from its bed through the abdominal approach
Hassab procedure
[Portosystemic Surgical: Nonshunts]
the most definitive complication of portal hypertension
orthotopic liver transpantation
___ tube is used to initially control esophageal bleed
Sengstaken-Blakemore Tube
Budd-Chiari Syndrome is associated with hyper____
homocysteinemia
[diagnosis]
hypoechoic lesion with well-defined borders and variable internal echoes
Pyogenic Liver Abscess
[diagnosis]
hypodense lesions with or without air-fluid levels and peripheral enhancement
pyogenic liver abscess
[diagnosis]
RUQ pain, fever
elevated WBC, ESR, ALP
pyogenic liver abscess
[pyogenic liver abscess]
single or multiple large abscesses can be managed surgically by ____
percutaneous drainage
What is the etiologic agent of hydatid disease?
Echinococcus granulosus
This is the definitive host of echinococcus granulosus
dog
[diagnosis]
anteroinferior or posteroinferior portions of the right lobe, dull RUQ pain or abdominal distention, allergic or anaphylactic reaction with cycst rupture
Hydatid disease
Tx: albendazole
most frequently encountered liver lesion overall
hepatic cysts
most common benign solid mass in the liiver
hemangioma
[diagnose]
Dual-phase CT shows asymmetrical peripheral enhancement with progressive centripetal enhancement
MRI: hypointense in T1, hyperintense in T2
hemangioma
The greatest risk factor of this benign solid neoplasm of the liver is
OCP use
[diagnose]
On CT: central scar
Nuclear scan shows hot nodules
Focal nodular hyperplasia
The most common malignant liver tumor
metastatic
[Management of HCCA]
If non-cirrhotic, child A, single lesion, no metastasis
Resection
[Management of HCCA]
What are the indications of liver transplant?
- Nodule < 5cm
- 2 or 3 nodules <3cm
- No vascular invasion
- No extrahepatic spread
- Child A, B, C
[Cholangiocarcinoma]
Location: when it presents as a hepatic mass
Intrahepatic
Cholangiocarcinoma]
Location: when it presents at the proximal (hilar) area
extrahepatic
Cholangiocarcinoma]
Location of a “Klatskin” tumor
at the hepatic duct conffuence
what is the gold standard in treating cholangiocarcinoma?
resection
[Roux-en-Y]
The hepatic ducts are attached to this segment
jejunum
[Roux-en-Y]
The roux limb refers to the
Jejunum + remaining hepatic duct
[Roux-en-Y]
The Y limb refers to the
Duodenum (jejunojejunostomy)
[Roux-en-Y]
This part of the small intestine is transected to serve as the Roux and Y limb
Duodenum, Jejunom