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Hepatology > Liver masterclass > Flashcards

Liver masterclass Flashcards

1
Q

what are the 2 major lobes of the liver

A

right and left

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2
Q

What are the accessory lobes

A

quadrate and caudate

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3
Q

what is the Glisson capsule

A

covers the liver and is a continuation of peritoneum

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4
Q

Which ligament is anterior

A

falciform ligament

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5
Q

what is found around the portal vein

A

posterior plexus

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5
Q

what are the posterior ligaments called

A

triangular ligaments

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6
Q

where is the anterior plexus found

A

around the hepatic artery

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7
Q

what % of CO goes to the liver

A

25% (hepatic artery)

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8
Q

what supplies 75% of the blood to the liver

A

portal vein

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9
Q

what flows into the portal vein

A

SMV, IMV, splenic vein and the left gastric vein

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10
Q

what is the normal pressure range in the portal vein

A

5-8mmHg

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11
Q

How does blood enter and exit the liver

A

hepatic artery and portal vein enters the liver via the hilum/porta hepatis and then the vessels are distributed into segments and passes into the segments via portal tracts. blood leaves the sinusoids via central veins which coalesce to form the 3 main branches of hepatic vein (right, middle and left) before entering IVC

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12
Q

How many segments are found in the liver

A

8

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13
Q

what segments are found in the left liver

A

2,3,4

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14
Q

what segments are found in the right liver

A

5,6,7,8

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15
Q

what segments are found in caudate lobe

A

1

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16
Q

what segment is autonomous and has independent blood supply

A

1 (in caudate lobe)

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17
Q

what is the structural unit of liver

A

hepatic lobule which is a polyhedron surrounded by 4-6 portal tracts and portal venous branches

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18
Q

what is the functional unit of liver lobule

A

acinus (parenchyma supplied by the smallest portal tracts containing PV radicles, hepatic arterioles and bile ductules)

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19
Q

True or false: Blood flows from the periphery of acinus to the centre?

A

False: blood flows from the centre to the terminal branches

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20
Q

which zone is well oxygenated and found around the portal tracts

A

1

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21
Q

which zone is around the central vein and is the least oxygenated

A

3

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22
Q

True or false: zone 1 is most susceptible to anoxic injury

A

false: zone 3 is because of it being least oxygenated

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23
Q

name 5 functions of the liver

A

formation and secretion of bile
nutrient and vitamin metabolism
inactivation of various substances
drug and alcohol metabolism
synthesis of plasma proteins

24
Q

what metabolic processes are found in peiportal zone 1:

A

gluconeogenisis, B-oxidation, amino acid metabolism, ureagenesis

25
Q

what processes are found at zone 3

A

glycolysis, lipogenesis, ammonia clearance, detox

26
Q

which zone helps with hepatocyte regeneration

A

2

27
Q

Into what is ammonia converted to be excreted in urine

A

urea

28
Q

How is jaundice described in Gilbert’s syndrome

A

Jaundice associated with fasting/intercurrent illness.

Pathogenesis may involve complex defects in the liver’s uptake of bilirubin. Glucuronyl transferase activity is low, though not as low as in Crigler-Najjar syndrome type II. In many patients, red blood cell destruction is also slightly accelerated, but this acceleration does not cause anemia or hyperbilirubinemia. Liver histology is normal.

29
Q

What are the fat soluble vitamins

A

D,K,A

30
Q

what does deficiency in vit K cause

A

easy bruising

31
Q

what does vitamin D deficiency cause

A

bone pain

32
Q

what does vit A deficiency cause

A

night blindness

33
Q

Name 3 causes of RUQ discomfort

A

acute viral hepatitis
alcoholic hepatitis
NAFLD

34
Q

How is RUQ pain in galls stones described

A

increases over hours and then decreases

35
Q

what causes colic pain

A

small and large bowel obstruction

36
Q

Name 2 symptoms of acute budd chiari syndrome

A

sudden onset of severe RUQ pain and ascites

37
Q

risk factors of viral hepatitis

A

travel history
sexual history
contacts with jaundice
IV drug use
body piercing/tattoos

38
Q

True or false: Drug history is not important in liver problems

A

false

39
Q

what autoimmune conditions is associated with liver disease

A

thyroid disease, RA, DM

40
Q

what metabolic causes of liver disease are there

A

haemochromatosis. Wilson’s disease., alpha 1-antitrypsin defciency

41
Q

what signs will be seen in a patient with metabolic syndrome

A

acanthosis nigricans, skin tags

42
Q

what can cause pigmentation of the abdomen

A

haemochromatosis
porhyria cutanea tarda
primary biliary cirrhosis

43
Q

what signs will be seen in Fe deficiency

A

koilonychia
angular stomatitis
atrophic glossitis

44
Q

what will be seen in folate/B12 def

A

tongue raw, beefy appearance
angular stomatitis

45
Q

what are the features of chronic liver disease

A

leukonychia
palmar erythema
spider naevi
gynaecomastia

46
Q

How will autoimmune liver disease present

A

thyromegaly, synovitis, skin rashes

47
Q

What will cause arthropathy

A

hemochromatosis

48
Q

What will you find in hep B patients

A

Pyoderma gangrenosum + erythema nodosum

49
Q

where will you find kayser fleischer rings

A

wilsons disease

50
Q

what will causes palpable left lobe in epigastrium

A

ethanolic liver disease and NAFLD

51
Q

What will cause increased encephalopathy, increased asictes, abdominal discomfort with no gaurding and no rebound tenderness

A

spontaneous bacterial peritonitis

52
Q

what will cause a palpable caudate lobe in epigastrium

A

budd-chiari syndrome

53
Q

How many cm below costal margin must the liver be palpable to be hepatomegaly

A

> 5cm/ total span >15cm

54
Q

what will causes a palpable gallbladder

A

cystic duct obstruction
obstruction of common bile duct

55
Q

what will cause palpable gallbladder and jaundice?

A

pancreatic cancer
distal cholangiocarcinoma

55
Q

true or false: the lower pole of the kidneys can be palpable in thin individuals

A

true

56
Q

Name 5 causes of ascites

A

constrictive pericarditis
nephrotic syndrome
protein losing enteropathy
malignant ascites
chylous ascites

57
Q

what is absence of bowel sounds for 2 minutes called

A

paralytic ileus

Hepatology (5 decks)

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