Karteikarten
Liver - Absite
Karten in diesem Stapel (181)
- 1MC Right Hepatic Artery VariantSuperior Mesenteric Artery
(20%)
behind pancreas, posterolateral to CBD - 2MC Left Hepatic Artery VarientLeft Gastric Artery
(20%)
found in gastrohepatic ligament medially - 3Falciform LigamentSeparates medial and lateral segments of the LEFT liver lobe, attaches liver to anterior abdominal wall
- 4Embryologic Remnant Assoc with Falciform LigamentUmbilical Vein
- 5Ligamentum terescarries the obliterated umbilical vein to the undersurface of the liver, extends from falciform ligament
- 6What separates the right and left liver lobes?Cantlie's Line, portal fissure
from middle of GB fossa to IVC - 7Liver Segment ICaudate Lobe
- 8Liver Segment IIsuperior left lateral segment
- 9Liver Segment IIIinferior left lateral segment
- 10Liver Segment IVleft medial segment (quadrate lobe)
- 11Liver Segment VInferior Right Anteromedial Segment
- 12Liver Segment VIInferior Right Posterolateral Segment
- 13Liver Segment VIISuperior Right Posterolateral Segment
- 14Liver Segment VIIISuperior Right Anteromedial Segment
- 15Peritoneum that covers the liverGlisson's Capsule
- 16Where is the bare area of the liver?posterior-superior surface of liver not covered by Glisson's Capsule
- 17What are the Triangular Ligaments?Lateral and medial extensions of the coronary ligament on the posterior surface of the liver
- 18Where does the portal triad enter the liver?segments IV and V
- 19Where does the GB lie on the liver?Segments IV and V
- 20What are the liver Macrophages called?Kupffer Cells
- 21What makes the Portal Triad?CBD (lateral)
Portal Vein (Posterior)
Proper Hepatic Artery (Medial) - 22Ligament in which the portal triad lies within?Hepatoduodenal Ligament
- 23What is the Pringle Maneuver?Clamping the Porta Hepatis, hepatoduodenal ligament
- 24What does the Pringle Maneuver not prevent bleeding?Still have Hepatic Vein Bleeding
- 25What makes the Foramen of WinslowAnterior: portal Triad
Posterior: IVC
Inferior: Duodenum
Superior Caudate Lobe - 26What makes the Portal Vein?Forms from superior mesenteric vein joining with splenic vein
- 27Where does the Inferior Mesenteric Drain into?enters splenic vein
- 28Left Portal Vein supplies which liver segments?II, III, IV
- 29Right Portal Vein Supplies which Liver SegmentsV, VI, VII, and VIII
- 30What is the arterial blood supply to the liver?Right, left and middle hepatic arteries
- 31Middle Hepatic Artery MC branches from where?Left Hepatic Artery
- 32Most Primary and Secondary Liver Tumors are supplied by which vessel?Hepatic Artery
- 33Left Hepatic Vein drains which liver segments?II, III, superior IV
- 34Middle Hepatic Vein drains which Liver segments?V and inferior IV
- 35Right Hepatic Vein drains which Liver Segments?VI, VII, VIII
- 36Where does the middle hepatic vein drain?80% into Left Hepatic Vein
20% into IVC - 37Accessory Right Hepatic Veins drain into what?drain medial aspect of right lobe directly to IVC
- 38Where does Caudate lobe get its blood supply from?right and left portal vein and arteries
- 39Where does the Caudate Lobe drain into?IVC via separate hepatic veins
- 40Where is Alkaline Phosphatase From?Canalicular Membrane
- 41Where does nutrient uptake in liver occur at?sinusoidal membrane
- 42What is the energy source of the liver?ketones
- 43What factors are not made in the liver?vWF and Factor VIII
- 44Which water soluble vitamin is stored in the liver?B12
- 45What are the two MC problems associated with hepatic resection?bleeding and bile leak
- 46Which hepatocytes are most sensitive to ischemia?central lobular, acinar zone III
- 47How much of normal liver can be safely resected?75%
- 48What's the pathway of Hgb breakdown to Bilirubin?Hgb -> heme -> biliverdin -> bilirubin
- 49Contents of bile?85% bile salts
protein, phospholipids (lecithin), cholesterol, bilirubin - 50What transporter is associated with more concentrated bile in GB?Na/K ATPase facilitating
resorption of water in GB - 51What two amino acids conjugate with bile salts?taurine and glycine
- 52What are primary bile acids?cholic and chenodeoxycholic
- 53What are secondary bile acids?deoxycholic and lithocholic
(dehydroxylated primary bile acids by bacteria in gut) - 54What is the main biliary phospholipid?Lecithin
- 55What is the purpose of biliary phospholipids?emulsifies fat, solubilizes cholesterol
- 56Purpose of Bilesolubilize cholesterol and emulsify fats in the intesting forming micelles that enter enterocytes
- 57Total bilirubin level associated with jaundice>2.5; first evident under tongue
- 58What is maximum bilirubin level?30
- 59What diseases are associated with total bilirubin levels higher than maximum?underlying renal disease, hemolysis, or bile duct-hepatic vein fistula
- 60Causes of elevated unconjugated biliruinprehepatic causes like hemolysis
or hepatic deficiencies of uptake or conjugation - 61Causes of elevated conjugated bilirubinsecretion defects into bile ducts, excretion defects into GI tract like stones, structures or tumor.
- 62Gilbert's Diseaseabnormal conjugation; mild defect in glucuronyl transferase
- 63Crigler-Najjar Diseaseinability to conjugate; severe deficiency of glucuronyl transferase; high unconjugated bilirubin
- 64Physiologic jaundice of a newbornimmature glucuronyl transferase, high unconjugated bilirubin
- 65Rotor's Syndromedeficiency in storage ability
high conjugated bilirubin
Autosomal Recessive - 66Dubin-Johnson Syndromedeficiency in secretion ability
high conjugated bilirubin
AUtosomal Recessive
Black Liver - 67MC hepatitis viruses associated with Fulminant Hepatic FailureHepatitis B, D, E
- 68MC hepatitis in the worldHepB
- 69Which Hepatitis Viruses are RNA?A, C, D, E
- 70Which Hepatitis Viruses are DNA?HepB
- 71MC Hepatitis WorldwideHepB
- 72MC hepatitis leading to liver transplantHepC
- 73This viral hepatitis causes fulminant hepatic failure in pregnancyHepE
- 74Anti-HBc-IgM is elevated when?First 6 months, then IgG takes over
- 75Tx of HepCSovaldi
- 76MCC of liver failureCirrhosis
- 77Best indicator of synthetic function in patient with cirrhosisProthrombin Time (PT)
- 78How is outcome of acute liver failure determined?course of encephalopathy
- 79King's College Criteria of Poor Prognostic Indicators: Acetaminophen-induced Acute Liver Failurearterial pH <7.3
OR all
INR >6.5, Cr >3.4mg/dL,grade III/IV encephalopathy - 80King's College Criteria of Poor Prognostic Indicators: Non-Acetaminophen-induced Acute Liver FailureINR > 6.5
OR any 3 of following:
Age <10/>40, drug toxicity/undetermined
jaundice >7d before encephalopathy, INR>3.5, bili >17mg/dL - 81What can cause encephalopathy?liver failure, GI bleed, infxn (SBP), electrolyte imbalances, drugs
- 82Treatment of Hepatic EncephalopathyLactulose, limit protein intake (<70g/d), Branched Chain amino acids, Neomycin
- 83How does lactulose work?cathartic that gets rid of bacteria in gut and acidifies colon preventing NH3 uptake by converting it to ammonium, titrate to 2-3stools/day
- 84Mechanism of CirrhosisHepatocyte Destruction, fibrosis and scarring of liver, increased hepatic pressure, portal venous congestion, lymphatic overload, leakage of splanchnic and hepatic lymph into peritoneum, ascites
- 85When doing a paracentesis for ascites, how much albumin do you replace?1g albumin for every 100cc removed
- 86Treatment of Ascites due to hepatic/splanchnic lymphwater restriction (1-1.5L/d),
decrease NaCl (1-2g/d),
diuretic (spironolactone),
paracentesis, TIPS if refractory
ppx abx for SBP - 87Hepatorenal Syndromeprogressive renal failure, labs like prerenal azotemia, kidneys normal but not well profused, usually sign of end stage liver disease
- 88Treatment of hepatorenal syndromestop diuretics, give volume, midodrine and octreotide, no good therapy other than liver TXP
- 89What neurological sign is indicative of progressing liver failure?asterixis
- 90What is postpartum liver failure with ascites?hepatic vein thrombosis from ovarian vein source, infectious component (pelvic thrombophlebitis
- 91How to diagnose postpartum liver failure with ascites?SMA arteriogram with venous phase contrast
- 92How to treat postpartum liver failure with ascites?heparin and antibiotics
- 93What is spontaneous bacterial peritonitis?fever, abdominal pain, PMNs >250 in fluid, positive cultures
- 94Top Bugs associated with SBPE. coli (#1), pneumococci, streptococci
MC mono-organism unless bowel perforated - 95Risk Factors to developing SBPprior SBP, UGI Bleed (variceal hemorrhage), low-protein ascites
- 96Treatment of SBP3rd generation cephalosporins, patients usually respond within 48hrs
- 97Treatments for Esophageal VaricesBanding/Sclerotherapy
Vasopressin, Octreotide
Sengstaken-Blakemore Esophageal Tube
Propranolol, TIPS - 98What does vasopressin do?splanchnic artery constriction
- 99what does octreotide do?decreases portal pressure by decreasing blood flow
- 100What to give patients with esophageal varices and CAD when giving vasopressin?NTG
- 101Why is Sengstaken-Blakemore Esophageal Tube not used often in Esophageal Varicesrisk of esophageal rupture
- 102When to use TIPS in patients with esophageal varicesrefractory variceal bleeding
- 103Causes of pre-sinusoidal obstructionschistosomiasis, portal vein thrombosis (50% of portal HTN cases in children)
- 104Cause of sinusoidal obstructioncirrhosis
- 105Causes of post-sinusoidal obstructionBudd-Chiari Syndrome (hepatic vein occlusive disease), constrictive pericarditis, CHF
- 106Measurement of Portal Vein Pressurehepatic venous wedge pressure
- 107portal HTN portal vein pressure>10-12mmHg
- 108What acts as collaterals between the portal vein and systemic venous system of lower esophagus (azygous)Coronary Veins
- 109What can portal HTN cause?esophageal varices, ascites, splenomegaly, hepatic encephalopathy
- 110What does TIPS stand for?Transjugular Intrahepatic Portosystemic Shunt
- 111When to use TIPSprotracted bleeding, progression to coagulopathy, visceral hypoperfusion, or refractory ascites
- 112What does TIPS do?allows antegrade flow from portal vein to the IVC
- 113Complication of TIPSdevelopment of encephalopathy
- 114How is a TIPS procedure performed?catheter into hepatic vein via jugular v
needle passed thru hepatic v thru liver into major portal vein and dilated with metal stent - 115Splenorenal Shuntlow rate of encephalopathy, need to ligate left adrenal vein, left gonadal vein, inferior mesenteric vein and pancreatic branches of splenic vein
- 116Splenorenal shunts are contraindicated in which patients?patients with refractory ascites
- 117Child's B or C with indication for shuntTIPS
- 118Child's A that just has bleeding as a symptomsplenorenal shunt; otherwise do TIPS
- 119What are the components of Child's Pugh Score?Albumin
Bilirubin
Encephalopathy
Ascites
INR - 120What does the Child's Pugh Score correlate with?mortality after open shunt placement
- 121% mortality associated with Child's A2%
- 122% mortality associated with Child's B10%
- 123% mortality associated with Child's C50%
- 124What does MELD stand for?Model for End Stage Liver Disease
- 125What are the components associated with MELD Score?INR, Creatinine, and total bilirubin
- 126What is the most common cause of massive hematemesis in children?portal HTN, usually from extra-hepatic portal vein thrombosis
- 127Budd-Chiari Syndromeocclusion of hepatic veins or IVC
- 128Risk Factor for Budd-Chiari SyndromePolycythemia Vera
- 129Diagnostic Test for Budd-Chiari Syndromeangiogram with venous phase
CT Angiogram
Liver Bx - sinusoidal dilatation, congestion, centrilobular congestion - 130Treatment of Budd Chiari Syndromeporta-caval shunt (connect w/ IVC above obstruction)
if acute, catheter directed tPA - 131Sinistral HTNIsolated gastric varices without elevation of pressure in the rest of the portal system, from splenic vein thrombosis
- 132Splenic Vein Thrombosis is most often caused by:pancreatitis
- 133Treatment of Splenic Vein ThrombosisSplenectomy if symptomatic
- 134Risk Factor for portal vein thrombosishypercoagulable states
- 135Treatment of Portal Vein ThrombosisHepatic indicated if acute thrombosis, may eventually need a shunt
- 136MC liver lobe to find amebic abscessesright lobe
- 137Primary Infections Causing Liver AbscessesAmebic Colitis
- 138Risk Factors for Amebic Liver AbscessesTravel to Mexico, ETOH, fecal-oral transmission
- 139Symptoms associated with amebic liver abscessfever, chills, RUQ pain, increased WBCs, jaundice, hepatomegaly
- 140Tx of amebic liver abscessFlagyl, aspiration only if refractory, surgery only if free rupture
- 141Type of cyst associated with Enchinococcushydatid cyst
- 142Skin test associated with echinococcusCasoni Skin Test
- 143Animals associated with EchinococcusSheep - Carriers
Dogs - Human Exposure - 144Liver Lobe associated with EchinococcusRight Liver Lobe
- 145Why can't you aspirate Echinococcus Cystsmay cause anaphylactic shock
- 146Abdominal CT findings associated with EchinococcusEctocyst - calcified
Endocyst - double-walled cyst - 147When to do preop-ERCP for Echinococcusjaundice, elevated LFTs, or cholangitis
- 148Treatment for Echinococcuspre-op albendazole (2weeks)
surgical removal (inject with EtOH 1st) - 149Schistosomiasis S&Smaculopapular rash, increased eosinophils
can cause variceal bleeding - 150How is Schistosomiasis contracted?through skin; acquired in water
- 151Treatment of SchistosomiasisPraziquantel and control variceal bleeding
- 152Symptoms associated with pyogenic liver abscessfever, chills, weight loss, RUQ pain, elevated LFTs + WBCs, sepsis
- 153Mortality associated with liver pyogenic abscesses with sepsis15%
- 154MC organism associated with pyogenic liver abscessGNR like E. coli
- 155MCC of pyogenic liver abscessMC 2/2 to continguous infection from biliary tract
(other causes - diverticulitis, appendicitis) - 156How to diagnose pyogenic liver abscesses?aspiration
- 157Treatment of pyogenic liver abscessesCT-guided drainage and antibiotics
surgical drainage - 158Causes of hepatic adenomaswomen, steroid use, OCPs
- 159MC lobe associated with hepatic adenomasRight Lobe
- 160% of hepatic adenomas are symptomatic, risk of rupture80% - symptomatic
50% - bleed - 161How to diagnose Hepatic Adenomasno Kupffer Cells, thus no uptake on sulfur colloid scan
- 162Treatment of hepatic adenomasAsx & <4cm: stop OCPs, if no regression,resect
Sx or >4cm: resect if bleeding, embolize if multiple or unresectable - 163Focal Nodular Hyperplasiacentral stellate scar
no malignancy risk, unlikely to rupture - 164Diagnostic Test for Focal Nodular HyperplasiaAbdominal CT
has Kupffer Cells so will take up sulfur colloid on liver scan - 165Treatment of Focal Nodular HyperplasiaConservative therapy, no resection
- 166MC benign hepatic tumorhemangiomas
- 167Diagnostic Testing of HemangiomasMRI and CT showing peripheral to central enhancement
Tagged RBC is best test - 168Treatment of hemangiomasconservative unless symptomatic, then surgery with pre-op embolization
steroids (possible XRT) for unresectable dx - 169Rare complications of hemangiomasKasabach-Merritt Syndrome
consumptive coagulopathy
and CHF - 170Solitary Liver Cystscongenital, women, right lobe, walls have characteristic blue hue
most can be left alone - 171Metastases : Primary Ratio Malignant Liver Tumor20:1
- 172MC Cancer worldwidehepatocellular cancer
- 173Risk Factors for Hepatocellular CAHepB (#1), HepC, ETOH, hemochromatosis, alpha-1-antitrypsin deficiency, PSC, aflatoxins, hepatic adenoma, steroids, pesticides
- 174Fibrolamellar hepatocellular carcinoma (FHCC)hepatocellular carcinoma that typically affects young adults
Best Prognosis
laminated fibrous layers interspersed between the tumor cells - 175Hepatocellular CA with worse prognosisdiffuse nodular type
- 176AFP level associated with HCCcorrelates with tumor size
- 1775-year survival rate with resection of HCC30%
- 178Margins required for HCC resection1-cm
- 179Risk Factors for Hepatic SarcomaPVC, Thorotrast, Arsenic
- 180difference between primary liver vs metastatic liver tumorsprimary liver tumor - hypervasular
metastatic liver tumor - hypovascular - 181isolated colon CA mets to livercan resect if you leave enough liver for survival
35% 5-year survival after resection
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- Surgery - Absite Review Karteikarten am Liver - Absite, erstellt von Jennifer Huber am 03/08/2018.
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- Jennifer Huber
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