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HEPATOLOGY > SURGERY: LIVER ANATOMY > Flashcards

SURGERY: LIVER ANATOMY Flashcards

1
Q

Functional Segments of Liver are known as

A

Couinaud segment

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2
Q

Cantlie’s line

A

Cholecysto-Caval line
Imaginary line joining the IVC and GALL BLADDER

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3
Q

Which vein lies below Cantlie’s line

A

Middle Hepatic Vein

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4
Q

Couinaud segments
🧠⚡Start from A(1) in clockwise direction ⚡

🧠⚡All Longitudinal divisions are formed by HEPATIC VEINS ⚡
🧠⚡Remember H not with H ⚡

🧠⚡All Horizontal divisions are formed by PORTAL VEINS⚡

A

Left hemi liver: 4A, 2, 3, 4B
Right Hemi Liver: 5 6 7 8

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5
Q

Left Hemiliver is divided into

⭐ Divided by

A

⭐ Divided by : Left Hepatic Vein
Left Medial
Left Lateral

⭐ Divided by : Left Portal Vein
Left Superior
Left Inferior

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6
Q

Vein that lies below Falciform ligament

A

Left Hepatic Vein

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7
Q

Right Hemiliver division

⭐ Divided by :

A

⭐ Divided by : Right Hepatic Vein
Right Anterior
Right Posterior

⭐ Divided by : Right Portal Vein
Right Superior
Right Inferior

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8
Q

Right Hemiliver division

⭐ Divided by :

A

⭐ Divided by : Left Hepatic Vein
Left Medial
Left Lateral

⭐ Divided by : Left Portal Vein
Left Superior
Left Inferior

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9
Q

SINGLE BEST ANSWER for STRUCTURE DIVIDING LIVER INTO FUNCTIONAL SEGMENTS

A

Portal Veins

Other: Hepatic vein

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10
Q

Major FISSURES of LIVER are

A

⭐ site of 3 Major Hepatic Veins
Right
Middle
Left

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11
Q

Minor Fissures in Liver

A

Formed by PORTAL VEINS
1. Right Portal vein
2. Left Portal vein
3. Fissure of Ganz

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12
Q

Sectors of Liver

A
  1. Right Posterior
  2. Right Anterior
  3. Left Lateral
  4. Left Medial
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13
Q

Which sectors form the GALL BLADDER FOSSA

A

4B and 5

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14
Q

Which segments are removed in RADICAL CHOLECYSTECTOMY

A

Segment 4B and 5

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15
Q

Bare area of Liver corresponds to which Segment

A

Segment 7

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16
Q

⚡⚡ MOST COMMON segment of Lover affected by Amoebic Liver Abscess

A

Segment 7

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17
Q

Caudate Lobe: Segment

Quadrate Lobe: Segment

A

Caudate Lobe: Segment 1

Quadrate Lobe: Segment 4

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18
Q

Caudate Lobe
Special Features

A

⭐ Recieves Blood from Both sides
⭐ Drains BILE into Both sides
⭐ Directly drains to IVC

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19
Q

Majority of Caudate Lobe lies

A

Toward Left side of IVC

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20
Q

CAVAL LIGAMENT

Formed by?
Function?

A

⭐ 50% of Caudate Lobe encircles the IVC ➡️ known as CAVAL Ligament

⭐ Mobilising the LIVER during Liver Resection

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21
Q

Segment 1 is divided into

A
  1. Segment 9
  2. Spigelian lobe
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22
Q

Which segment is INVOLVED EARLY in CHOLANGIOCARCINOMA

A

Segment 1

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23
Q

Which segment undergoes HYPERTROPHY in BUDD CHIARI Syndrome

A

Segment 1
(Direct connection with IVC)

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24
Q

Mickey Mouse SIGN on Duplex Scan
Seen in

A
  1. Liver Pedicle
  2. Varicose veins at Sapheno-femoral junction
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25
Q

Mickey Mouse in Medicine

  1. Mickey Mouse Pelvis
  2. Mickey Mouse Sign
  3. Mickey Mouse Cast
  4. Mickey Mouse Sign on Duplex Scan
  5. Mickey Fenn
A
  1. Mickey Mouse Pelvis
    ⭐ Down Syndrome (Outward flaring of Iliac Wings)
  2. Mickey Mouse Sign
    ⭐ Paget’s disease (⬆️ Radiotracer uptake in Bone scan of pedicles and spinous process of Vertebra)
    ⭐ Anencephaly
    ⭐ Progressive Supra nuclear Palsy
    ⭐ Hutch Diverticulum: IVU/CT
  3. Mickey Mouse Cast
    ⭐ Dysmorphic RBC Cast in Glomerular Hematuria
  4. Mickey Mouse Sign on Duplex Scan
    ✨ Liver Pedicle
    ✨ Varicose veins at Sapheno-femoral junction
  5. Mickey Fenn
    ⭐ Chloral hydrate ➕ Alcohol
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26
Q

Liver Pedicle
🧠⚡Ant ➡️ Post: DAVE ⚡

A

⭐ Ducts ( Rt and Left Hepatic Duct)
⭐ Artery ( Rt and Left Hepatic Artery)
⭐ Vein
⭐ Epiploic Foramen of Winslow

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27
Q

Rouvier’s Sulcus
🧠⚡ROG ⚡

A

Fissure of Ganz

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28
Q

Pringle’s maneuver

A

Compressing the Liver Pedicle at the FREE EDGE of Lesser Omentum (OR) FORAMEN of Winslow
⬇️
Helps to control Bleeding in Liver
Helps to Detect Source of Bleeding

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29
Q

Blood Supply of Liver

A

80%: Portal Vein
20%: Hepatic Artery

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30
Q

Which Hepatic Artery is Larger?

A

Right HEPATIC ARTERY

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31
Q

Segments removed
⭐ Left Trisectorectomy

⭐ Right Trisectorectomy

A

⭐ Left Trisectorectomy (Extended Left Hepatectomy)
4A, 4B, 2, 3, 5, 8

⭐ Right Trisectorectomy (Extended Right Hepatectomy)
5,6,7,8, 4A,4B

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32
Q

Posterior Relations of Liver

A
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33
Q

Space of Disse
Contains?

A

Area between Hepatocyte and Sinusoid

Contains:
1. Ito cells
2. Microvilli of adjacent hepatocytes
3. Fine collagen Fibers (type 3)

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34
Q

Cells that store Vitamin A in LIVER

A

Ito cells
(OR)
Hepatic STELLATE Cells

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35
Q

Origin of Ito cells

A

Mesenchymal cells

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36
Q

The 2 states of Ito cells

A
  1. Dormant state: Store Vitamin A
  2. Active state: Get activated by LIVER INJURY and replace damaged Hepatocytes with collagenous scar tissue ➡️ Fibrosis
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37
Q

Cells responsible for FIBROSIS in Cirrhosis

A

Ito cells

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38
Q

Lymph produced in the liver is drained by

A
  1. Peri sinusoidal Space of DISSE
  2. Peri Portal cleft of Mall
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39
Q

Porta Hepatis

⭐ STRUCTURES Entering at PORTA HEPATIS

⭐ STRUCTURES Exiting at PORTA HEPATIS

A

Deep Transverse Fissure that is situated on the INFERIOR SURFACE of RIGHT LOBE of LIVER

STRUCTURES Entering at PORTA HEPATIS
1. HEPATIC ARTERY
2. PORTAL VEIN
3. HEPATIC NERVOUS PLEXUS

STRUCTURES Exiting at PORTA HEPATIS
1. Bile Duct Lt and Right
2. Lymphatics

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40
Q

Fibrous sheath that surrounds Duct, Hepatic artery, Portal Vein in each Liver Segment is known as

A

Valoean sheath

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41
Q

Valoean sheath is a continuation of

A

Glisson’s capsule

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42
Q

Glisson in medicine

A
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43
Q

Use of VALOEAN SHEATH

A

Facilitate surgical control of Right and Left Vasculo-biliary pedicles of Liver

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44
Q

Painful HEPATOMEGALY seen in
🧠⚡We HAVe Cardiac⚡

A
  1. Weil’s disease
  2. Hepatoma & HCC
  3. Actinomycosis
  4. Abscess: Pyogenic
  5. Amoebiasis
  6. Viral Hepatitis
  7. Cardiac Failure
45
Q

💊💉 MANAGEMENT of HCC

46
Q

Functional Liver Reserve is found by

47
Q

Milan’s CRITERIA used for

A

Possibility of LIVER TRANSPLANT ro a patient with < 25% FLR

48
Q

ALPP’S PROCEDURE
Used for

A

Associated Liver Partition & Portal vein ligation for Staged Hepatectomy

49
Q

💊💉 Palliative MANAGEMENT for HCC
🧠⚡MR HIT⁴ ⚡

A
  1. Microwave Ablation
  2. Radiofrequency ablation
  3. HIFU (High Frequency Ultrasonic therapy)
  4. Intralesional ETHANOL (Percutaneous)
  5. Tyrosine Kinase ⛔
    ✨ Sunitinib
    ✨ Sorafenib
    ✨ Regorafenib
  6. TACE (Trans arterial Chemo embolization)
  7. TARE (Trans arterial Radio embolization with Ytterium spheres)
  8. Thermal ablation
    ✨ Cryo
    ✨ Radiofrequency
    ✨ Microwave
    ✨ Nd:Yag
50
Q

Tyrosine Kinase ⛔
🧠⚡RSS ⚡

A

✨ Sunitinib
✨ Sorafenib
✨ Regorafenib

51
Q

Radiofrequency ablation can be done for tumours upto

52
Q

⚡⚡ MOST IMPORTANT PROGNOSTIC FACTOR IN HCC

A

Stage of Disease

53
Q

⚡⚡ MOST COMMON SITE OF DISTANT METASTASIS IN HCC

54
Q

PROGNOSTIC SCORES IN HCC
🧠⚡OBC ⚡

A
  1. Okuda
  2. BCLC (Barcelona Clinic Score)
  3. CLIP (Cancer of Liver Italian Program)
  4. CUPI (Chinese University Prognostic Index)
55
Q

OKUDA Score
🧠⚡BATA⚡

A

Bilirubin
Ascites
Tumor size
Albumin

56
Q

BCLC Score
🧠⚡ PCT⚡

A
  1. Performance status score
  2. Child Pugh score
  3. Tumour size
57
Q

CLIP Score
🧠⚡PCT-A⚡

A
  1. Portal Vein Thrombosis
  2. Child Pugh Score
  3. Tumor size
  4. AFP
58
Q

Performance Status Scores

A
  1. Karnofsky score
  2. ECOG score
59
Q

🌸 TYPES of HCC

A
  1. Pushing: Push against Parenchyma
    BEST PROGNOSIS
  2. Hanging
  3. Infiltrating
60
Q

Non Cirrhotic Liver
➕
Singe Large HARD (Scirrhous) Liver Tumour
➕
Well Demarcated & Encapsulated
➕
Central Fibrotic Area
➕
Good Resectability

A

Fibrolamellar Varient

61
Q

Fibrolamellar Varient Serum MARKERS

A

✨ Neurotensin B ⬆️ ⬆️
✨ ⬆️ S. unsaturated Vitamin B12 binding Capacity
AFP NORMAL

62
Q

Prognosis of Fibrolamellar Varient HCC

A

Good Prognosis
➕
Recurrance VERY HIGH

63
Q

Large Polygonal Cells embedded in FIBROUS STROMA forming Lamellar structures

A

Fibrolamellar Varient

64
Q

⚡⚡ MOST COMMON Age of Presentation of HEPATOBLASTOMA

A

< 18 months

65
Q

ASSOCIATIONS OF HEPATOBLASTOMA
🧠⚡FB⚡

A
  1. FAP: Familial Adenomatous Polyposis
  2. Beckwith Wiedmann Syndrome
  3. Prematurity & Low Birth Weight
66
Q

🧑🏻‍⚕️ Clinical Features of HEPATOBLASTOMA

A
  1. Mass in Abdomen
  2. Anemia
  3. Thrombocytopenia
67
Q

⭐ ANEMIA is seen in which Liver Cancer?

⭐ POLYCYTHEMIA is seen in which Liver Cancer?

A

⭐ ANEMIA is seen in which Liver Cancer?
🎯 HEPATOBLASTOMA

⭐ POLYCYTHEMIA is seen in which Liver Cancer?
🎯 HCC

68
Q

Tumour marker of HEPATOBLASTOMA

A

AFP ⬆️ ⬆️

69
Q

Liver Malignancy with NORMAL AFP?

A

Fibrolamellar Varient of HCC

70
Q

💊💉 MANAGEMENT of
✨ Localized HEPATOBLASTOMA
✨ Metastasized HEPATOBLASTOMA

A

✨ Localized HEPATOBLASTOMA
🎯 Surgery ➕ Chemoradiation

✨ Metastasized HEPATOBLASTOMA
🎯 Resection of Hepatic Tumour
➕
Resection (OR) Chemo of Pulmonary Metastasis

71
Q

⚡⚡ MOST COMMON MALIGNANT MESENCHYMAL TUMOUR OF LIVER

A

Angiosarcoma

72
Q

Angiosarcoma is ASSOCIATED with which syndromes

A
  1. Hemochromatosis
  2. NF1
73
Q

Hepatic BRUIT ➕
➕
CENTRAL HYPOVASCULARITY & PERIPHERAL CONTRAST STAINING
➕
VASCULAR LAKES
➕
ON Biopsy: Presence of DILATED SINUSOIDS

A

Angiosarcoma

74
Q

Factor 8 Staining Liver Tumor

A

Epitheloid Hemangioendothelioma

75
Q

Epitheloid Hemangioendothelioma

A

✨ B/L Multiple Lesions
✨ High Output Cardiac Failure
✨ Fulminant Liver Failure
✨ Hypervascular Tumour
✨ Malignant conversion to Angiosarcoma

76
Q

💊💉 MANAGEMENT of Epitheloid Hemangioendothelioma

A

Total Hepatectomy ➕ Liver transplant

77
Q

🩺 IOC for Epitheloid Hemangioendothelioma

A

CECT
⬇️
HYPERVASCULAR TUMOUT

78
Q

Liver Tumour ASSOCIATED with HIGH OUTPUT CARDIAC FAILURE

A
  1. Liver HEMANGIOMA
  2. Epitheloid Hemangioendothelioma
79
Q

ASSOCIATIONS of Epitheloid Hemangioendothelioma

A
  1. OCP
  2. Vinyl Chloride
80
Q

Use of CK7 & CK20

A

To detect the original location of Metastasis in LIVER
⭐ Tumour of Unknown Origin

81
Q

CK7➕ & CK20⛔
🧠⚡ 7 tumours of the ♀️ ⚡

A
  1. Endometrial Carcinoma
  2. Cervical Cancer
  3. Ovary cancer (except Mucinous)
  4. Breast Cancer
  5. Thyroid Cancer
  6. Salivary Gland Cancer
  7. Lung Adenocarcinoma
  8. Mesothelioma
82
Q

CK7⛔ & CK20➕
🧠⚡ 2.0 ➡️ MC⚡

A
  1. Merkel Cell Cancer
  2. Colorectal Cancer
83
Q

CK7⛔ & CK20⛔
🧠⚡Steroid producing cells⚡

A
  1. Adrenal Cortex Cancer
  2. RCC: Clear Cell
  3. HEPATOCELLULAR Cancer HCC
  4. PROSTATE CANCER
  5. Squamous cell Cancer
84
Q

CK7➕ & CK20➕
🧠⚡ Please USE Ovary⚡

A
  1. Pancreatic Ca
  2. Urothelial Ca
  3. Stomach Ca
  4. Extrahepatic Bile Duct Ca
  5. Ovarian Mucinous Cancer
85
Q

⚡⚡ MOST COMMON SITE OF COLORECTAL CANCER METASTASIS

86
Q

Colorectal Cancer METASTASIS
Cytokertin Profile

A

CK7 ⛔
CK20 ➕

87
Q

Predictors of POOR OUTCOME of Colorectal Cancer with Liver METASTASIS

A
  1. LN ➕ 1° Tumour
  2. Disease free interval < 12 months
  3. > 1 tumour
  4. Tumour size > 5cm
  5. CEA level > 200ng/ml
  6. Synchronous lesion
88
Q

Metachronous Ca
vs
synchronous Ca

89
Q

⚡⚡ MOST COMMON INDICATION OF LIVER TRANSPLANT IN CHILDREN

⚡⚡ MOST COMMON INDICATION OF LIVER TRANSPLANT IN ADULTS

A

⚡⚡ MOST COMMON INDICATION OF LIVER TRANSPLANT IN CHILDREN
🎯 EHBA

⚡⚡ MOST COMMON INDICATION OF LIVER TRANSPLANT IN ADULTS
🎯 NON-CHOLESTATIC
✨ Hepatitis B & C
✨ Alcoholic Liver Disease
✨ Cryptogenic

90
Q

INDICATION OF LIVER TRANSPLANT IN ADULTS

A

🎯 NON-CHOLESTATIC
✨ Hepatitis B & C
✨ Alcoholic Liver Disease
✨ Cryptogenic

🎯 CHOLESTATIC
✨ 1° BILIARY CIRRHOSIS
✨ 1° SCLEROSING CHOLANGITIS

🎯 AUTOIMMUNE
🎯 MALIGNANCY
🎯 MISCELLANEOUS

91
Q

INDICATION OF LIVER TRANSPLANT IN CHILDREN

A

🎯 EHBA
🎯 IEM
🎯 CHOLESTATIC
✨ PSC
✨ ALAGILLE Syndrome
🎯 AUTOIMMUNE
🎯 VIRAL HEPATITIS
🎯 MISCELLANEOUS

92
Q

KING COLLEGE CRITERIA USED FOR

A

Possibility of TRANSPLANT in ACUTE LIVER FAILURE

93
Q

KING COLLEGE CRITERIA in ALF DUE TO: Acetaminophen Poisoning
🧠⚡PCM⚡

A

A. pH < 7.3 (OR) Lactate > 3.5
(OR)
B. 3 out of 3:
🎯 PT > 100s
🎯 Creatinine > 300 micromol/L (3.4 mg/dl)
🎯 Mental Status ➡️ Hepatic Encephalopathy Grade 3 (OR) 4

94
Q

KING COLLEGE CRITERIA in ALF DUE TO: NON-Acetaminophen Poisoning
🧠⚡ABCDE ⚡

A

A. PT > 100s
(OR)
B. 3 out of 5:
🎯 Age < 10 or > 40
🎯 Bilirubin > 17.5 mg/dl
🎯 Coagulopathy with INR > 3.5 (OR) PT > 50s
🎯 Duration BETWEEN Jaundice & Encephalopathy > 7 days (Not Hyperacute)
🎯 Etiology:
✨ Wilson
✨ Hepatitis C & E
✨ Idiosyncratic Drug reaction

95
Q

Types of LIVER TRANSPLANT

A
  1. Orthotopic
  2. Heterotopic
    3.Auxiliary Transplant
96
Q

Difference between TOTAL ORTHOTOPIC LIVER TRANSPLANTATION (OLTX ) & Auxiliary ORTHOTOPIC LIVER transplantation (A-OLTX)

97
Q

TOTAL ORTHOTOPIC LIVER TRANSPLANTATION (OLTX ) INDICATIONS

🧠⚡FBC⚡

A
  1. Fulminant Hepatic Failure
  2. 1° Biliary Cirrhosis
  3. Cirrhosis
98
Q

Lifelong IMMUNOSUPPRESSION is needed in which type of Liver Transplant

A

TOTAL ORTHOTOPIC LIVER TRANSPLANTATION (OLTX)

99
Q

Auxiliary ORTHOTOPIC LIVER transplantation (A-OLTX) INDICATION
🧠⚡CNG Too High Price⚡

A
  1. Crigler Najjar Syndrome Type 1
  2. Neimann Pick Disease
  3. Galactosemia
  4. Tyrosinemia
  5. Hereditary Familial Hypercholestrolemia

Others in age < 40yrs
1. Reversible Fulminant Hepatic Failure
2. Non-cirrhotic Metabolic Liver Disease
3. Hyperacute Liver Failure with Acetaminophen Overdose
4. No Hemodynamic Instability

100
Q

Enhancing Lesions in LIVER
🧠⚡Medical Hospitals Hate All Families⚡

A
  1. METASTASIS ( hypervascular)
  2. HCC
  3. HEMANGIOMA
  4. ADENOMA
  5. FOCAL NODULAR HYPERPLASIA
101
Q

Technitium Scan in Hepatic Diseases

102
Q

⚡⚡ MOST COMMON Anomaly of HEPATIC ARTERY

A

Right Hepatic Artery arising from Superior Mesenteric Artery

103
Q

Fissure for Ligamentum Venosum

A

Venous Fissure

104
Q

Preferential Flow of Portal Vein is towards

A

Right Side

105
Q

SNAKE SKIN APPEARANCE OF GASTRIC MUCOSA

A

Portal Hypertension Gastropathy
⬇️
Diffuse dilatation of Mucosal & Submucosal Venous Plexus of stomach ASSOCIATED with overlying Gastritis

106
Q

NORMAL Portal Blood Flow

A

1-1.5 L/min

107
Q

🎯 NORMAL Portal venous Pressure
🎯 NORMAL HVPG: Hepatic Venous Pressure Gradient

A

🎯 NORMAL Portal venous Pressure
⭐ 5-10 mmHg

🎯 NORMAL HVPG: Hepatic Venous Pressure Gradient
⭐ 1-5 mmHg

108
Q

Portal HYPERTENSION is considered when
⭐ Portal Venous Pressure
⭐ HVPG

A

⭐ Portal Venous Pressure
🎯 > 10 mmHg

⭐ HVPG
🎯 ≥ 6 mmHg

HEPATOLOGY (16 decks)

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