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Surgery > Liver, Biliary System, and Spleen > Flashcards

Liver, Biliary System, and Spleen Flashcards

1
Q

Liver is derived from

A

Ventral (endodermal) outgrowth of the foregut

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2
Q

Kupffer cells, hepatic stroma, and hepatic vessels arise from

A

Septum transversum (mesoderm)

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3
Q

Line that divides the liver into 2 lobes

A

Cantlie’s line

runs from the left side of the gallbladder fossa to the inferior vena cava (IVC).

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4
Q

The functional unit of the liver.

A

acinar unit

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5
Q

Zone of the liver that is located closest to the portal triad

A

Zone 1

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6
Q

Zone of the liver that is least susceptible to ischemic insult, but most susceptible to toxic or chemical injury

A

Zone 1

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7
Q

Zone of the liver that is adjacent to the terminal hepatic vein

A

Zone 3

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8
Q

Zone of the liver that is most susceptible to ischemic injury

A

Zone 3

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9
Q

Segments drained by right hepatic duct

A

V, VI, VII, VIII

left drains I, II, III, IV

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10
Q

Normal gallbladder wall thickness

A
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11
Q

Accessory bile ducts

A

Ducts of luschka

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12
Q

Implicated as a common source of postcholecystectomy biliary leaks that are not caused by injury to the major ducts or by failure to close the cystic duct stump.

A

Ducts of Luschka

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13
Q

Epithelial lining of the biliary system

A

Columnar

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14
Q

Form from the invagination of the epithelium through the fibromuscular layer as a result of inflammation and ↑ intraluminal pressure in the gallbladder (eg, cholangitis, acute cholecystitis).

A

Rokitansky–Aschoff sinuses

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15
Q

Most liver tumors are supplied primarily by what vessel

A

Hepatic artery

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16
Q

Vein that drains the II, III, IVa

A

Left hepatic vein

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17
Q

Vein that drains the V, and IVb segments

A

Middle hepatic vein

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18
Q

Vein that drains VI, VII, VIII

A

Right hepatic vein

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19
Q

Segment of the liver that is drained directly into the IVC

A

Caudate (I)

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20
Q

Makes up 85% of the spleen

A

Red pulp

White pulp - 15%

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21
Q

3 arteries that supply the spleen

A

Splenic artery
Left gastroepiploic artery
Short gastric artery

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22
Q

Bile salts are absorbed in what part of the GIT

A

Terminal ileum

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23
Q

Consumption thrombocytopenia related to hepatic hemangiomata.

A

Kasabach–Merritt syndrome

Canlead to disseminated intravascular coagulation (DIC).

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24
Q

Lobar predilection of hydatid cyst

A

Right lobe of the liver

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25
Q

Most common benign liver tumor

A

Hemangioma

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26
Q

Benign hepatic tumor related to OCP use

A

Hepatic adenoma

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27
Q

CT shows hypervascular mass with hypodense stellate scar; “Hot” on Tc-macroaggregated albumin scan. Biopsy shows hepatocyte and bile ducts

A

Focal nodular hyperplasia

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28
Q

CT Scan shows mass that lacks central scarring; “cold” on Tc-macroaggregated albumin scan; biopsy shows hepatocytes

A

Hepatic adenoma

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29
Q

Management of asymptomatic hemangioma

A

Observe

30
Q

Management of symptomatic hepatic hemangioma

A

Enucleation or lobectomy

31
Q

Management of asymptomatic focal nodular hyperplasia

A

Observe with serial CT scan

32
Q

Management of symptomatic focal nodular hyperplasia

A

Resection

33
Q

Includes cholestasis and fibrotic strictures of the intrahepatic and extrahepatic biliary tree that is in association with ulcerative colitis and other autoimmune disease

A

Primary Sclerosing Cholangitis

34
Q

Most common cause of liver abscess worldwide

A

Amebic abscess

35
Q

The content of this abscess is described as anchovy paste

A

Amebic abscess

36
Q

Intermittent jaundice, weight loss, fatigue, pruritus and abdominal pain are symptoms of

A

Primary sclerosing cholangitis

37
Q

Endoscopic retrograde cholangiopancreatography (ERCP) demonstrate multiple dilatations and strictures of both the intra- and extra-hepatic biliary tree.

A

Primary sclerosing cholangitis

38
Q

Treatment option for patients with PSC and advanced liver disease.

A

Liver transplantation

39
Q

Most common cause of cirrhosis worldwide

A

Hepatitis C

40
Q

Classification that helps determine the extent of cirrhosis and predict operative mortality

A

Child-Pugh classification

41
Q

Operative mortality for Child-Pugh Class A cirrhosis

A

10%

42
Q

Operative mortality for Child-Pugh Class B cirrhosis

A

30%

43
Q

Operative mortality for Child-Pugh Class C cirrhosis

A

70%

44
Q

Diagnostic tests that confirm diagnosis of PSC

A

ERCP and liver biopsy

45
Q

AST and ALT > 3 times normal

A

Chronic liver disease

46
Q

ALT/AST > 2

A

Alcoholic cirrhosis

47
Q

Synthetic function of the liver is best assessed by

A

PT

48
Q

5 Parameters used in Child-Pugh classification of cirrhosis

A

ProBAAN

PROthrombin time
Bilirubin
Ascites
Albumin
Neurologic disorder
49
Q

Most common cause of SBP

A

E. Coli

50
Q

Treatment of SBP

A

Third gen cephalosporin (cefotaxime)

51
Q

Involves occlusion of the major hepatic veins resulting in postsinusoidal portal HTN.

A

Budd–Chiari syndrome

Caudate lobe is spared
In women; with hypercoagulable state

52
Q

Caused by splenic vein thrombosis, typically resultant from pancreatitis. Results in gastroesophageal varices without main PV HTN.

A

Sinistral portal HTN

Typically patients have preserved liver function, but bleeding may occur. Treatment includes splenectomy.

53
Q

Used by the transplant community to prioritize patients for liver transplantation.

A

Model for End-stage Liver Disease (MELD) score

54
Q

Most common cancer worldwide

A

Hepatocellular carcinoma

55
Q

Most common liver mass

A

Metastatic

56
Q

Most common cause of hepatocellular carcinoma

A

HBV

57
Q

Preferred treatment for hepatocellular carcinoma with Child-Pugh class A and B patients

A

Partial hepatectomy

58
Q

5-year survival rate for hepatocellular carcinoma

A
59
Q

Cancer of the intra- or extra-hepatic bile ducts.

A

Cholangiocarcinoma

60
Q

Most common location of cholangiocarcinoma

A

Upper 1/3

Unresectable

61
Q

Procedure for cholangiocarcinoma in the middle 1/3 of the bile duct

A

Heoaticojejunostomy

62
Q

Procedure for cholangiocarcinoma in the lower 1/3 of the bile duct

A

Whipple procedure

63
Q

Black gallstones

A

Calcium bilirubinate

64
Q

Pain caused by transient obstruction of the cystic duct by gallstone

A

Biliary colic

65
Q

Charcot’s triad

A

Fever
RUQ pain
Jaundice

Acute cholangitis

66
Q

Reynold’s pentad

A 
Fever
RUQ pain
Jaundice
Hypotension
Altered mental status
67
Q

Diffuse deposition of Ca in the gallbladder

A

Porcelain gallbladder (carcinoma)

68
Q

5 year survival rate of gallbladder carcinoma

A

5%

69
Q

Under which segments of the liver do you expect to find the gallbladder?

A

Segments IV and V

70
Q

A 40-year-old man UGI bleed from esophageal varices. What medications may be used?

A

Vasopressin, octreotide.

71
Q

The falciform ligament divides

A. Segments I and II
B. Segments III and IV
C. Segments V and VI
D. Segments VII and VIII

A

B

Surgery (10 decks)

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