the liver

Question 1

give some details about the liver

Answer 1

liver is largest organ in the body and its 1.5

surrounded whole by fibrous tissue and partially by the peritoneum

Question 2

what the function of the liver ?

Answer 2

1- production of the bilirubin
2- metabolism of the body like fat ,CHO,protein , drugs and hormone

3- maintaining the core temperature of the body that are the hormones could act and maintaining the body temperature

4-filteration of the blood from the bacteria and the foreign body

Question 3

whatre the lobs of the liver ?

Answer 3

Rt and Lt lobe

caudate and cuadrare

Question 4

what’re the ligaments of the liver ?

Answer 4

These include the coronary, triangular, falciform, round, hepatogastric and hepatoduodenal ligaments, together with ligamentum venosum. and ligmentum teres

Question 5

what’re the content of the porta hepatis

Answer 5

porta hepatis is a deep fissure in the inferior surface of the liver through which all the neurovascular structures (except hepatic veins) and hepatic ducts enter or leave the liver 1. It runs in the hepatoduodenal ligament and contains: right and left hepatic ducts. right and left branches of hepatic artery.

Question 6

whats the blood of the liver ?

Answer 6

hepatic artery and the portal vein

Question 7

the lymphatic drainage of the liver ?

Answer 7

The liver produces a large amount of lymph, which is estimated to be 25 to 50 % of lymph flowing through the thoracic duct. … It is suggested that 80 % or more of hepatic lymph drains into portal lymphatic vessels, while the remainder drains through sublobular and capsular lymphatic vessels.

Question 8

the venous drainage of the liver ?

Answer 8

hepatic veins are the veins that drain de-oxygenated blood from the liver into the inferior vena cava.

Question 9

what’re the segment of the liver ?

Answer 9

Lt to the line between the gall bladder 
---------------------------------------------------------
3L & M 
1- left hepatic artery 
2-left hepatic vein 
3-left portl vein 
4- meddle hepatic vein 

3R & M

1- right hepatic artery
2-right hepatic ve

Question 10

why we divid the liver into segments ?

Answer 10

1- because each segment have it own separate venous drainage

2-we divide it into many section because the lesion or tumer may attack only one segment

Question 11

what the benefit of the ultrasound in the liver ?

Answer 11

1- detect the liver tumer and liver cyst and a good guide to take liver biopsy

2- duct dictation and gall stones

Question 12

what’re the benefit of the CT scan ?

Answer 12

the CT need contact but the MRI use the bile as contrast

if the I give him oral contrast to see the stomach and the duodenum in the relation to the hilum

if give him IV contact

early arterial phase —– small liver tumer
venous phase —— inflammatory lesion
late venous phase ———heamangioma
measurement the density of the liver lesion (cystic)

Question 13

whats the MRCP ?

Answer 13

Magnetic resonance cholangiopancreatography

its non-invasive hight quality imaging of the bile duct but ERCP is better picture

Question 14

whats the MRA ?

Answer 14

magnetic resonance angiogram

its angiogram for the hepatic vein and portal vein alternative of the hepatic angiography

Question 15

whats the ERCP?

Answer 15

Endoscopic retrograde cholangio-pancreatography

Diagnostic for the obstructive jaundice and bile tract abnormality

therapeutic for the sone and duct stricture
insert stent and take tumer biopsy for cytology

Question 16

what the difference between the ERCP and MRCP ?

Answer 16

MRCP is that it is not a therapeutic procedure, while in contrast ERCP is used for both diagnosis and treatment.

ERCP is an invasive procedure where incision is required on the body whereas MRCP is non-invasive

RCP involves the use of a contrast dye to be inserted while images are being taken whereas a dye is not used in MRCP as it is a completely non-invasive procedure

ERCP is more expensive than MRCP

ERCP cannot be done in persons who have undergone previous allergic reaction
MRCP cannot be opted for in persons who have undergone previous stent surgery or have a pacemaker implanted as the magnetic resonance will interfere in the working of the pace maker.

Question 17

whats the PTC ? and whats the indication ?

Answer 17

Percutaneous transhepatic cholangiography

• when the failure of the ERCP
• or there is tumer in the hilum of the duct that make visualization through the ERSP is impossible to see the intrahepatic duct

Question 18

what’re the indications of the angiography in the liver disease ?

Answer 18

a-Dignostic

• to visualize the hepatic artery and the portal vein
• give information about liver nodule

b-Therpeutic

• treat any occlusion in the artery and the vein
• treat the emboli in the liver
• chemoembolization

Question 19

laparoscopy and laparoscopic U/S indication ?

Answer 19

these are used for the staging

• HBP cancer
• peritoneal meatstis
• superficial liver tumer

Question 20

what’re the material that used in the nuclear medicine scanning ?

Answer 20

• ## technishium 99mif there is any bile leakage or obstruction

its only obtained by the kuppfer cell not the hepatocyte
its differnate the adenoma from the hemangioma which don’t take the sulfur because its hepatocyte from focal nodular hyperplasia which take the sulfur because its the kuppfer cells

Question 21

T or F

CT is better than MRCP in the detection of the billiard tree pathology

Answer 21

false , CT for liver parenchyma

while the MRCP in the billiard duct

Question 22

T OR F

MRCP is invasive and therapeutic tech. while ERCP noninainvasive and only diagnostic

Answer 22

false

Question 23

T OR F

ct can’t diagnosis the liver cyst

Answer 23

false

Question 24

T OR F

PTC is an IV injection of dye when it fail then ERCP is second choice

Answer 24

false

Question 25

T OR F

pancritits and cholngitis , bleeeding and perforation are the main complication of MRCP .

Answer 25

false

Question 26

how to suspect or diagnosis pt with liver trauma ?

Answer 26

1- in penetrating trauma as stabbing in the Lower chest and upper abdomen and pt with low PB and high pulse rate (heamodynic unstable )

2- in blunt trauma and stable hemodynamically and have tenderness and gardening (spasm of muscle on palpation )

Question 27

what’re the complication of penetrating and blunt trauma of the liver

Answer 27

اما نزيف الدم
او الدم يطلع بالكابسول
او يصير ابسس

او يصير للدكت فستيولا
او ستركشر للدكت
-------------------------
او يصير للشريان توسع 
او فستيولا 
-------------------
او بالاخير 
liver failure

Question 28

pyogenic liver abscess ?

Answer 28

aute or chronic

multiple and smal , single and large

Question 29

whats the manifestation of the liver abcesss?

Answer 29

pain, redness, swelling, fever

and loss of function as lethargy malaise anorexia

Question 30

whose pt are risk for the liver access ?

Answer 30

1-immuncompromise 
2- malnourished 
3- elderly 
4- DM
5-post trauma and post operation 
6-sicker

Question 31

whats the most common cause of the liver abcesss ?

Answer 31

E.choli and streptococcus milleri

Question 32

whats the source of the liver access ?

Answer 32

1- common is from the duct
2- from the blood hematogenous hepatic artery
3-potal vein
4 from the liver it self (per hepatic infective focus )

Question 33

Dx for the liver abccess ?

Answer 33

ct to see ht eparanchymai

and x ray for the air and the fluid LEVEL