Liver Flashcards
1
Q
____ is a plane from gallbladder fossa to IVC separating the true left and right lobes of the liver
A
Cantlie’s line
2
Q
_____ separates the left lateral and left medial segments
A
falciform ligament
3
Q
the faciform ligaments divide the left lobe to ____
A
left lateral and left medial segments
small left lobe
large left lobe
4
Q
the right lobe of the liver is divided by the following structures
A
- Gallbladder
- Fissure of ligamentum teres
- IVC
- Fissure of ligamentum venosum
5
Q
The right lobe is composed of what lobes?
A
- Quadrate lobe
2. Caudate lobe
6
Q
[Name the coinaud segemen]
caudate
A
1
7
Q
[Name the coinaud segemen]
left lateral
A
2 and 3
8
Q
[Name the coinaud segemen]
left medial
A
4
9
Q
[Name the coinaud segemen]
right anterior lobe
A
5, 8
10
Q
[Name the coinaud segemen]
Right posterior lobe
A
6, 7
11
Q
[hepatic vein drainage]
segment 5-8
A
right hepatic
12
Q
[hepatic vein drainage]
segment 4,5,8
A
middle hepatic
13
Q
[hepatic vein drainage]
segment 2,3
A
left hepatic
14
Q
[hepatic vein drainage]
caudate lobe
A
IVC
15
Q
the pringle maneuver compress what structures?
A
portal vein, hepatic artery, CBD
16
Q
[Liver function test]
hepatocellular injury
A
ALT, AST
17
Q
[Liver function test]
Synthetic function
A
Albumin
Clotting factors EXCEPT factor 8
18
Q
[Liver function test]
Cholestasis
A
TB
B2 transferrin
ALP
GGTP
19
Q
[Liver function test]
what is the best measure of liver synthetic function test?
A
PT and INR
20
Q
[Liver function test]
Most specific for liver diseases: AST or ALT?
A
ALT
21
Q
[Liver function test]
increased in extrahepatic
A
Direct bilirubun
22
Q
[Liver function test]
increased in intrahepatic diorders
A
Indirect unconjucated
23
Q
[Liver function test]
indicative of biliary obstruction
A
alkaline phosphatase
24
Q
[Liver function test]
early marker and sensitive test for hepatobiliary disease
A
GGTP
25
[jaundice]
detectable when serum bilirubin is?
>2.5 to 3 mg/dL
26
[Cirrhosis]
causes if impaired hepatic regeneration
1. Destruction of reticulin framework
2. Disturbances in blood supply
3. Necrosis too extensive
4. Malnutrition
5. Inhibition of hepatocyte proliferation
27
[cirrhosis]
Hepatic nodule formation is due to?
hepatic proliferation limited by enveloping scars
28
[cirrhosis]
vein responsible for caput medusae
umbilical vein
29
[cirrhosis]
ascites is clinically detected if the volume is ____
>1.5L
30
___ syndrome
spigastric vascular murmur
Cruveilhier-Baumgarten Syndrome
31
This syndrome shunts blood from the portal vein to the umbilical vein. It can be present without caput medusae.
Cruveilhier-Baumgarten Syndrome
32
[cirrhosis]
Horizontal white bands and/or proximal white nail plate is due to?
Hypoalbuminemia
33
[cirrhosis]
Dupuytren contracture is due to an increase in what compound?
hypoxanthine
34
[cirrhosis]
Asynchronous flapping motions or dorsiflexed hand
asterexis
35
[spontaneous bacterial peritonitis]
what is the first line drug for SBP?
Cefotaxime
36
[Assessment of hepatic reserve]
This predicts surgical risks of intraabdominal operations prepared by patients with cirrhosis
Child-Turcotte-Pugh Score
37
[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
38
[Assessment of hepatic reserve]
Child-Pugh B is associated with ___ % mortality
30%
39
[Assessment of hepatic reserve]
80% mortality is associated in what Child-Pugh Score?
Class C
40
[Portal Hypertension]
What is the normal portal pressure?
5-10 mmHg
41
[Portal Hypertension]
Portal hypertension is diagnosed if the direct portal venous pressure is?
>5mmHg
42
[Portal Hypertension]
Portal hypertension is diagnosed if the splenic pressure is?
>15mmHg
43
[Portal Hypertension]
varices form if the portal pressure exceeds? ___
>12mmHg
44
[Portal Hypertension]
what is the most accurate method of determining the portal pressure?
Hepatic Venography
45
[portosystemic collaterals]
Causes Esophageal varices
Left Gastric
| Azygous Vein
46
[portosystemic collaterals]
Causes caput medusae
umbilical vein
47
[portosystemic collaterals]
Causes hemorrhoids
middle hemorrhoidal
| inferior hemorrhoidal
48
[Portal hypertension]
Due to sinusoidal obstruction
Steatohepatitis
| Wilson disease
49
[Portal hypertension]
due to high flow states
AV fistula
| Banti syndrome
50
[diagnosis]
Abdominal pain
ascites
liver enlargement
occlusion of the hepatic vein
Budd-Chiari Syndrome
51
[Pre/Sinu/Postsinusoidal]
Alcoholic central hyaline sclerosis
postsinusoidal
52
[Pre/Sinu/Postsinusoidal]
Acute alcoholic hepatitis
sinusoidal
53
[Pre/Sinu/Postsinusoidal]
vitamin A intoxication
Sinusoidal
54
[Pre/Sinu/Postsinusoidal]
Schistosomiasis
Presinusoidal
55
[Pre/Sinu/Postsinusoidal]
Chronic active hepatitis
Pre-sinusoidal
56
[Pre/Sinu/Postsinusoidal]
| vinyl chloride
presinusoidal
57
[Pre/Sinu/Postsinusoidal]
cirrhosis
sinusoidal
58
[Management of acute variceal bleeding]
Drug of choice
Octreotide
But vasopressin can be given
59
[Management of acute variceal bleeding: refractory bleeding]
What is the surgical technique if the patient is classified as Child A?
surgical shunt
60
[Management of acute variceal bleeding: refractory bleeding]
What is the surgical management if the patient is classified as Child B and C
TIPS
61
[Portosystemic Surgical Shunts]
Distal splenorenal
Warren
62
[Portosystemic Surgical Shunts]
Left gastric vena caval shunt
Inokuchi
63
[Portosystemic Surgical Shunts]
Small diameter portacaval H graft shunt
Sarfeh
64
[Portosystemic Surgical: Nonshunts]
ligation of venous branches entering the distal esophagus; for recurrent variceal bleeding
Sugiura-Fukugawa
65
[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
66
[Portosystemic Surgical: Nonshunts]
the most definitive complication of portal hypertension
orthotopic liver transpantation
67
___ tube is used to initially control esophageal bleed
Sengstaken-Blakemore Tube
68
Budd-Chiari Syndrome is associated with hyper____
homocysteinemia
69
[diagnosis]
hypoechoic lesion with well-defined borders and variable internal echoes
Pyogenic Liver Abscess
70
[diagnosis]
hypodense lesions with or without air-fluid levels and peripheral enhancement
pyogenic liver abscess
71
[diagnosis]
RUQ pain, fever
elevated WBC, ESR, ALP
pyogenic liver abscess
72
[pyogenic liver abscess]
single or multiple large abscesses can be managed surgically by ____
percutaneous drainage
73
What is the etiologic agent of hydatid disease?
Echinococcus granulosus
74
This is the definitive host of echinococcus granulosus
dog
75
[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
76
most frequently encountered liver lesion overall
hepatic cysts
77
most common benign solid mass in the liiver
hemangioma
78
[diagnose]
Dual-phase CT shows asymmetrical peripheral enhancement with progressive centripetal enhancement
MRI: hypointense in T1, hyperintense in T2
hemangioma
79
The greatest risk factor of this benign solid neoplasm of the liver is
OCP use
80
[diagnose]
On CT: central scar
Nuclear scan shows hot nodules
Focal nodular hyperplasia
81
The most common malignant liver tumor
metastatic
82
[Management of HCCA]
If non-cirrhotic, child A, single lesion, no metastasis
Resection
83
[Management of HCCA]
What are the indications of liver transplant?
1. Nodule < 5cm
2. 2 or 3 nodules <3cm
3. No vascular invasion
4. No extrahepatic spread
5. Child A, B, C
84
[Cholangiocarcinoma]
Location: when it presents as a hepatic mass
Intrahepatic
85
Cholangiocarcinoma]
Location: when it presents at the proximal (hilar) area
extrahepatic
86
Cholangiocarcinoma]
Location of a "Klatskin" tumor
at the hepatic duct conffuence
87
what is the gold standard in treating cholangiocarcinoma?
resection
88
[Roux-en-Y]
The hepatic ducts are attached to this segment
jejunum
89
[Roux-en-Y]
The roux limb refers to the
Jejunum + remaining hepatic duct
90
[Roux-en-Y]
The Y limb refers to the
Duodenum (jejunojejunostomy)
91
[Roux-en-Y]
This part of the small intestine is transected to serve as the Roux and Y limb
Duodenum, Jejunom
