liver and gall bladder Flashcards
It is a plane fro the gallbladder fossa to the IVC that separates the livers right and left lobe grossly
cantlies line
How is the portal vein formed
- splenic vein
2. superior mesenteric vein
This measures the liver’s synthetic function
- PT
- Clotting factors (except factor 8)
- Serum albumin
This measures the integrity of hepatocellular membranes
- AST
2. ALT
What is the half life of alkaline phosphatase
7 days
It is the diagnostic and therapeutic procedure of choice for stones in the CBD associated with obstructive jaundice, cholangitis, and gallstone pancreatitis
ERCP
Parameters of Child Pugh Score
- Albumin
- Bilirubin
- clotting factors (INR)
- encephalopathy
- Ascites
Scoring of Child Pugh Score
5 - 6 - 10 %
7 - 9 30%
10 - 15 - 75 - 80%
What is the normal venous pressure
5 - 10 mmHg
What is the pressure in diagnosing portal hypertension
- > 5 mmHg than the IVC pressure
- splenic pressure > 15 mmHg
- portal venous pressure at surgery is > 20 mmHg
What is the portal pressure needed to form varices
> 12 mmHg
Most common cause of portal hyptertension?
Liver cirrhosis
Most accurate method in determining portal hypertension
hepatic venography
treatment of portal hypertension
- CTP A - surgical shunt
2. CTP B and C - TIPS
It is a distal splenorenal shunt
Warren shunt
An uncommon congestive hepatopathy characterized by the obstruction of hepatic venous outflow due to endoluminal venous thrombosis or compressive lesion external to the veins
Budd Chiari Syndrome
What is the common site of pyogenic liver abscess
right lobe of liver
Treatment of pygenic liver abscess
- correction of underlying cause
- percutaneous needle aspiratio
- IV antibiotic therapy for 8 weeks
Most common location of amebic abscess
superior anterior aspect of the right lobe
Treatment of amebic abscess
- metronidazole 750 mg TID for 7 to 10 days
What is the most common location of hydatid disease
anterior inferior or posterior inferior segment of the right lobe of the liver
Treatment of hydatid cyst
Surgery and instillation of scolicidal agent
Milan critera for liver transplantation
- single < 5 cm
- 2 or 3 nodulers < 3 cm
- no vascular invasion or extrahepatic spread
Treatment option for liver cancer
- hepatic resection
2. liver transplantation
Most common site of metastasis of liver cancer
lungs
Types of Cholangiocarcinoma
- intrahepatic
2. extrahepatic (klatskin tumor)
What is the manifestation of klatskin tumor
Obstructive and painless jaundice
Most important risk factor for gallbladder carcinoma
cholelithiasis
Most USEFUL radiologic test for diagnosing acute cholecystitis
UTZ
- thickening of GB
- pericholecystic fluid
- sonographic murphy’s sign
most ACCURATE radiologic test for diagnosis acute cholecystitis
HIDA scan
Gold standard for diagnosing choledocholithiases
endoscopic cholangiography
What is charcot’s triad
- fever
- RUQ pain
- Jaundice
What is reynaud’s pentad
- fever
- RUQ pain
- Jaundice
- Septic shock
- mental status changes
Most common type of choledochal cyst
Type I - cystic dilatation of the extrahepatic bile duct
Types of choledochal cyst
Type I - extrahepatic duct Type II - common bile duct Type III - distal duct into the duodenum Type IV - intrahepatic and extrahepatic duct Type V - intrahepatic duct
Treatment of choledochal cyst
complete cyst excision with roux en Y hepaticojejunostomy
