Other Diseases of Liver

Question 1

features of pyogenic liver abscesses

Answer 1

solitary, polymicrobial, often found in right lobe of liver

Question 2

what test is diagnostic for most pyogenic liver abscesses

Answer 2

ultrasound

Question 3

what type of cells are seen on microscopic analysis of focal nodular hyperplasia

Answer 3

Kupffer cells

Question 4

major/main cause of pyogenic liver abscess

Answer 4

cholangitis: either from hepatobiliary malignancy or biliary instrumentation
most common organisms are E. coli and Klebsiella

Question 5

in what patient population are fungal liver abscesses most commonly seen

Answer 5

those with hematologic malignancies and neutropenia

Question 6

most common cause of Budd Chiari syndrome

Answer 6

myeloproliferative diseases (specifically polycythemia vera)

Question 7

what anatomic landmark establishes the boundary between segment 4 and segment 5 & 8 of the liver

Answer 7

the middle hepatic vein

Question 8

amebic liver abscess cause

Answer 8

Entamoeba histolytica

Question 9

findings on aspiration of amebic liver abscess

Answer 9

“anchovy paste”

Question 10

treatment of amebic liver abscess

Answer 10

flagyl

Question 11

most common cause of portal vein thrombosis in children

Answer 11

umbilical vein infection

Question 12

features of echinococcal cysts on imaging

Answer 12

aka hydatid cyst; calcified cysts with internal septations and daughter cysts

Question 13

testing for echinococcal cyst?

Answer 13

Casoni skin test

Question 14

echinococcal cyst treatment

Answer 14

initially give albendazole; then surgically excise or perform PAIR (puncture, aspiration, injection, and reaspiration) therapy after

Question 15

what vessel passes through the triangle of calot

Answer 15

the right hepatic artery

Question 16

what segments make up the right liver?

Answer 16

5-8

Question 17

most common presenting sign of Budd Chiari syndrome?

Answer 17

ascites

Question 18

absolute contraindications to percutaneous liver biopsy:

Answer 18

patient unable to cooperate with procedure; unable to locate/identify adequate biopsy site

Question 19

lab abnormalities associated with severe obstructive jaundice besides LFTs:

Answer 19

prolonged PT because of vitamin K deficiency

Question 20

What is the anatomical landmark between the left and right lobes of the liver?

Answer 20

middle hepatic vein

Question 21

3 types of liver abscesses

Answer 21

pyogenic (bacterial), amebic (Entamoeba), and echinoccocal

Question 22

treatment of pyogenic liver abscess

Answer 22

broad spectrum antibiotics and source control (perc drainage)

Question 23

treatment of amebic liver abscess

Answer 23

metronidazole for 10 days (95% effective)

aspiration or perc drainage only if no clinical response to abx after 5-7 or very large abscesses

Question 24

treatment of echinococcal cysts

Answer 24

open surgical drainage with care not to spill intracystic contents (risk of anaphylaxis) or aspiration of cystic contents with instillation of scolicidal agents (PAIR procedure)

Question 25

Clinical features of echinococcal/hydatid cysts

Answer 25

seen in pts in their 40s

single cyst on CT with rim containing calcifications

Question 26

appearance of hepatic adenoma on imaging

Answer 26

well-circumscribed heterogenous massess with early enhancement on arterial phase

Question 27

True or false. Hepatic adenomas are usually symptomatic

Answer 27

true

Question 28

appearance of hepatic hemangioma on imaging

Answer 28

hypervascular lesions with peripheral to central enhancement