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Surgery > Liver Theory > Flashcards

Liver Theory Flashcards

1
Q

Amoebic liver abscess commonly affects

A

Right lobe

Posterosuperior aspect

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2
Q

Anchovy pus sauce

A 
Amoebic liver abscess
Liquefaction necrosis thrombosis of blood vessels broken rbcs
No wbc unless secondarily infected
Choc brown color
Odourless
Usually sterile
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3
Q

Life cycle of entameoba histolytica

A

Mature cyst in faeces-food n water-stomach pass undamaged-in alkaline medium cyst wall lysis by trypsin-excystation-quadrinucleate amoebae-metacyst trophozoites-crypts of caecum-

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4
Q

Acute liver abscess presentation

A

Toxicity
Rt sided abdominal pain tenderness
Fever loss of weight chills rigor non productive cough shoulder pain
Intercostal tenderness rt sided pleural effu
Mild jaundice rigidity skin edema
Features-systemic abdominal thoracic

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5
Q

Complications of amoebic liver abscess

A

Rupture(lung pleura abdomen pericardium intestine biliary system skin)
Infection septicemia liver failure
Hepatic encephalopathy.
Buddchiari

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6
Q

Most dangerous complication of ala

A

Cardiac tamponade

Mostly in left lobe abscess

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7
Q

Ddx for acute ala

A

Acute cholecystitis
Hcc
Subphrenic abscess
Pyogenic liver abscess

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8
Q

Ddx for chronic amebic liver abscess

A

Hepatoma

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9
Q

Inv ala

A 
Tc hb esr crp
Lft pt 
Us abdomen
Cxr?
Ct
Sigmoidoscopy colonoscopy
Technetium 99 scanning
Iha -most sensitive
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10
Q

Medical Treatment ala

A

Metro 800mg tds or inj 500mg iv tds 10-40days
Tinidazole 600mg bd 5days
Luminal : duodohydroxyquin diloxanide furoate paromomycin
Tissue : emetine dehydroemetine
Mixed: nitroimidazole derivatives
Others-chloroquine tetracycline

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11
Q

Indications for aspiration in ala

A 
>10cm
Sec infection
Drug therapy failure
Large left lobe abscess
Seronegative abscess
Pregnancy
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12
Q

Amoebicidal drug c/i in pregnancy

A

Metronidazole c/i in frst trimester

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13
Q

Widened prothrombin time rx

A

Inj vit k 10mg im or iv 5days

Still wide-ffp

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14
Q

Aspiration ala position

A

Rt 6th ics midaxillary line

Us guided now

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15
Q

Percutaneous drainage

A

Pigtail catheter
7-20days
Mainstay of treatment?

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16
Q

Indications for surgery in ala

A 
Recurrence
Thick pus
Multiloculated abscess
Left lobe abscess
Ruptured abscess
Caudate lobe abscess
Multiple abcess
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17
Q

Ala surgery

A

Malecots catheter
Transperitoneal approach
Avoid alcohol chloroquine 250mg bd 10days nd diloxanide furoate 500mg tds 10-14 days

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18
Q

Apple core sign

A

Barium enema

Hepatocellular carcinoma

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19
Q

Def host echinococcus granulosus

A

Dog

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20
Q

Most commonly involved segment hydatid disease

A

7

Right lobe

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21
Q

Layers of hydatid. Cysts

A

Adventitia host derived
Laminated membrane or ectocyst
Germinal epithelium (only living part)

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22
Q

Features of hydtid fluid

A

Clear
High specific gravity
Shows hooklets and scolices

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23
Q

Sites for hydatid cyst

A

Liver lungs muscles bones

Rarely kidney brain spleen

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24
Q

Water lily sign

A

Hydatid cyst
Separated laminTed membrane
More often seen in lung hydatid

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25
Q

Possible courses of hydatid disease

A 
Calcified
Enlarged nd palpable
Jaundice due to pressure over biliary tree
Rupture into peritoneal cavity anaphylactic reaction
Rupture into biliary channels(commonest)
Rupture into bowel pleura
Sec inf
Sec cysts
Hepatic dysfn
Disseminated abdominal hydatidosis
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26
Q

Cf hydatid disease

A

Hydatid thrill
Jaundice n pain
Anaphylaxis
Discomfort in rt upper quadrant
Dyspepsia hydatid cachexia wt loss fatigue vomiting
Splenomegaly cholangitis pleural eff allergic asthma fever
Camellotte sign

27
Q

Camellote sign

A

Hydatid
Same as water lily sign?
Following intrabiliary rupture gas enters into the cyst causing partial collapse of cyst wall

28
Q

Ddx for hydatid

A

Hepatoma
Ala
Cystic disease of liver

29
Q

Complications of hydatid

A

Anaphylaxis rupture
Obst jaundice
Infection calci liver failure

30
Q

Inv hydatid

A 
Us (diagnostic)
Xray
Ct
Serology elisa iha lat etc
Sec laboratory tests(arc 5 immuno electrophoresis?
Lft
casonis
Mri
Pair
31
Q

Hassen gharbis ultrasound based classification

A

Liver hydatid

5 types?

32
Q

Casoni’s test

A

Intradermal test
Hydatid
Not used nowadays

33
Q

Who classification of liver hydatid

A 
Cl
Ce1
Ce2
Ce3-water lily
Ce4
Ce5-calcified
34
Q

Contraindications for drug therapy in hydatid

A 
Large cysts
Honeycomb (withsepta)
Infected cyst 
Calcified cyst
Pregnancy
35
Q

Drugs hydatid cyst

A

Albendazole 4 week cycle with 2wk drug free interval
3 such cycles400mgbd or 10mg/day/kg
Praziquantel 60mg/kg
Mebendazole

36
Q

Side effects of albendazole

A

Altered lft
Fever
Alopecia
Leucopenia

37
Q

PAIR

A

Liver hydatid
Puncture aspiration injection reaspiration
Under us or ct
Procedure

38
Q

Contraindications for pair

A 
Inaccessible cysts hyperechogenic cyst
Honeycomb cyst
Cystobiliary communication
Calcified cyst
Lung cysts
39
Q

Complications of PAIR

A

Fever anaphylaxis infection recurrence

40
Q

Gold standard therPy for hydatid disease

A

Surgery

41
Q

Scoliocidal agents

A 
Cetrimide
Alcohol 80%
Hypertonic saline 15%
Sod hypochlorite
Hydrogen peroxide
42
Q

Which scolicidal agent is. Used in. Case of cystobiliary communication

A

Hypertonic saline(15%-20%)

43
Q

Types of surgeries used for hydatid disease

A 
Conservative-
Lap-asp-eva-scoli-
Partial pericystectomy
Laporoscopic approach using perforator grinder aspi
Radical-
Pericystectomy lobectomy hepatectomy
Communication
44
Q

Cystpbiliary communicationcorrection

A

Suturing t tube drainage
Pericystectomy marsupialization
Capitonnage introflexion omentoplasty
Etc

45
Q

Malignant hydatid

A 
Echinococcus multilocularis(alveolaris)
Liver failure
46
Q

Risk factors for hepatoma

A 
Aflatoxin
Hep b and c chronic carriers
Alcoholic cirrhosis
Clonarchis sinensis
Smoking
Hemochromatosis @1antitrypsin deficiency
Hepatic adenoma
Env Chemicals
Tannins griseofulvin etc
Anabolic steroids pvc
Nafld obesity diabetes
Pbc wilsons disease
47
Q

Types of hcc

A

Hanging type of tumour
Pushingtype
Infiltrative

48
Q

Okuda classification of hcc

A

Multifocal
Indeterminate
Spreading
Expanding

49
Q

Variants of hcc

A 
Fibrolamellar
Mixed hepatocellu,ar cholangiocellular
Clear cell variant
Giant cell variant
Sarcomatoid
50
Q

Fibrolamellar variant hcc

A 
Younger
Equal inc in m nd f
No elevated afp
Elevated vit b12 binding protein n neurotensin level
Unrelated to viral hep or cirrhosis
Left lobe common 
Fibrous stroma with thin hyaline bands
51
Q

Child pugh scoring

A

….

52
Q

Cf hepatoma

A 
Painless mass in rt hypochondriac with loss of apetiten weight
Jaundice
Ascitis
Splenomegaly
Hep thrill bruit
Fever
Hemoperitoneun
features of chronic liver disease
Liver failure gi bleed
Paraneoplastic
53
Q

Types of presentation of hcc

A 
Asymptomatic 
Symptomatic
Symptoms due to complications
Symptoms due to metastasis 
Paraneoplastic syndrome
54
Q

Ddx hcc

A 
Secondaries
Cholangiocarcinoma
Liver abscess
Polycystic liver disease hydatid cyst
Benign tumours hepatosteatosis
55
Q

Investigations hcc

A 
US-hyperechoic mosaic with thin halo
Ct scan abdomen
Tumour markers
Celiac or ct angiography 
Lft
Li rads ceus
Contrast mri or ct
Ascitic tap
Lapascopic evaluation
Hrct
Fdg pet
Surveillance scanning
56
Q

Tumour markers for hcc

A

Afp>100iu (usually more than 400iu even upto 1000iu)
Pivka ii
Dcp
Glypican 3

57
Q

Definitive treatment for hcc

A

If limited to 1 lobe hemihepatectomy

Total hepatectomy with orthotopic liver transplantation

58
Q

Indications for transplantation

A

Resection c/i as in cirrhotics portal htn varices ascitis

59
Q

C/i to liver resection in hcc

A

Extrahepatic tissues or node inv
Portal vein thrombus
Distant spread
Cirrhotics portal htn???

60
Q

Palliative treatment for hcc

A

Rfa
Percutaneous ethanol or acetic acid injection
Tac adriomycin/cisplatin/mitomycin thru gastroduodenal artery
Tae tace
Microwave or cryoablations
Hepatic artery ligation
Targeted iodine 131 with lipiodol injection

61
Q

Hcc ideL for rfa

A

<3cm
Deep in parenchyma
Away drom hilum

62
Q

A lesion >1cm in US with afp>20ng/ml is almost diagnostic of

A

Hcc

63
Q

Chemotherapy for hcc

A 
Sorafenib
Levatinib
Regorafenib carbozantinib
Iiv adriamycin(doxorubicin) cisplatin carboplatin mitomycin c 5 fu 
Octreotide
Neoadjuvant chemotherapy

Surgery (6 decks)

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