Liver, Biliary System, and Spleen Flashcards
Liver is derived from
Ventral (endodermal) outgrowth of the foregut
Kupffer cells, hepatic stroma, and hepatic vessels arise from
Septum transversum (mesoderm)
Line that divides the liver into 2 lobes
Cantlie’s line
runs from the left side of the gallbladder fossa to the inferior vena cava (IVC).
The functional unit of the liver.
acinar unit
Zone of the liver that is located closest to the portal triad
Zone 1
Zone of the liver that is least susceptible to ischemic insult, but most susceptible to toxic or chemical injury
Zone 1
Zone of the liver that is adjacent to the terminal hepatic vein
Zone 3
Zone of the liver that is most susceptible to ischemic injury
Zone 3
Segments drained by right hepatic duct
V, VI, VII, VIII
left drains I, II, III, IV
Normal gallbladder wall thickness
Accessory bile ducts
Ducts of luschka
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.
Ducts of Luschka
Epithelial lining of the biliary system
Columnar
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).
Rokitansky–Aschoff sinuses
Most liver tumors are supplied primarily by what vessel
Hepatic artery
Vein that drains the II, III, IVa
Left hepatic vein
Vein that drains the V, and IVb segments
Middle hepatic vein
Vein that drains VI, VII, VIII
Right hepatic vein
Segment of the liver that is drained directly into the IVC
Caudate (I)
Makes up 85% of the spleen
Red pulp
White pulp - 15%
3 arteries that supply the spleen
Splenic artery
Left gastroepiploic artery
Short gastric artery
Bile salts are absorbed in what part of the GIT
Terminal ileum
Consumption thrombocytopenia related to hepatic hemangiomata.
Kasabach–Merritt syndrome
Canlead to disseminated intravascular coagulation (DIC).
Lobar predilection of hydatid cyst
Right lobe of the liver
Most common benign liver tumor
Hemangioma
Benign hepatic tumor related to OCP use
Hepatic adenoma
CT shows hypervascular mass with hypodense stellate scar; “Hot” on Tc-macroaggregated albumin scan. Biopsy shows hepatocyte and bile ducts
Focal nodular hyperplasia
CT Scan shows mass that lacks central scarring; “cold” on Tc-macroaggregated albumin scan; biopsy shows hepatocytes
Hepatic adenoma
Management of asymptomatic hemangioma
Observe
Management of symptomatic hepatic hemangioma
Enucleation or lobectomy
Management of asymptomatic focal nodular hyperplasia
Observe with serial CT scan
Management of symptomatic focal nodular hyperplasia
Resection
Includes cholestasis and fibrotic strictures of the intrahepatic and extrahepatic biliary tree that is in association with ulcerative colitis and other autoimmune disease
Primary Sclerosing Cholangitis
Most common cause of liver abscess worldwide
Amebic abscess
The content of this abscess is described as anchovy paste
Amebic abscess
Intermittent jaundice, weight loss, fatigue, pruritus and abdominal pain are symptoms of
Primary sclerosing cholangitis
Endoscopic retrograde cholangiopancreatography (ERCP) demonstrate multiple dilatations and strictures of both the intra- and extra-hepatic biliary tree.
Primary sclerosing cholangitis
Treatment option for patients with PSC and advanced liver disease.
Liver transplantation
Most common cause of cirrhosis worldwide
Hepatitis C
Classification that helps determine the extent of cirrhosis and predict operative mortality
Child-Pugh classification
Operative mortality for Child-Pugh Class A cirrhosis
10%
Operative mortality for Child-Pugh Class B cirrhosis
30%
Operative mortality for Child-Pugh Class C cirrhosis
70%
Diagnostic tests that confirm diagnosis of PSC
ERCP and liver biopsy
AST and ALT > 3 times normal
Chronic liver disease
ALT/AST > 2
Alcoholic cirrhosis
Synthetic function of the liver is best assessed by
PT
5 Parameters used in Child-Pugh classification of cirrhosis
ProBAAN
PROthrombin time Bilirubin Ascites Albumin Neurologic disorder
Most common cause of SBP
E. Coli
Treatment of SBP
Third gen cephalosporin (cefotaxime)
Involves occlusion of the major hepatic veins resulting in postsinusoidal portal HTN.
Budd–Chiari syndrome
Caudate lobe is spared
In women; with hypercoagulable state
Caused by splenic vein thrombosis, typically resultant from pancreatitis. Results in gastroesophageal varices without main PV HTN.
Sinistral portal HTN
Typically patients have preserved liver function, but bleeding may occur. Treatment includes splenectomy.
Used by the transplant community to prioritize patients for liver transplantation.
Model for End-stage Liver Disease (MELD) score
Most common cancer worldwide
Hepatocellular carcinoma
Most common liver mass
Metastatic
Most common cause of hepatocellular carcinoma
HBV
Preferred treatment for hepatocellular carcinoma with Child-Pugh class A and B patients
Partial hepatectomy
5-year survival rate for hepatocellular carcinoma
Cancer of the intra- or extra-hepatic bile ducts.
Cholangiocarcinoma
Most common location of cholangiocarcinoma
Upper 1/3
Unresectable
Procedure for cholangiocarcinoma in the middle 1/3 of the bile duct
Heoaticojejunostomy
Procedure for cholangiocarcinoma in the lower 1/3 of the bile duct
Whipple procedure
Black gallstones
Calcium bilirubinate
Pain caused by transient obstruction of the cystic duct by gallstone
Biliary colic
Charcot’s triad
Fever
RUQ pain
Jaundice
Acute cholangitis
Reynold’s pentad
Fever RUQ pain Jaundice Hypotension Altered mental status
Diffuse deposition of Ca in the gallbladder
Porcelain gallbladder (carcinoma)
5 year survival rate of gallbladder carcinoma
5%
Under which segments of the liver do you expect to find the gallbladder?
Segments IV and V
A 40-year-old man UGI bleed from esophageal varices. What medications may be used?
Vasopressin, octreotide.
The falciform ligament divides
A. Segments I and II
B. Segments III and IV
C. Segments V and VI
D. Segments VII and VIII
B
