15-Hepatobiliary Flashcards Preview

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Flashcards in 15-Hepatobiliary Deck (51):
1

Ligaments of the liver

falciform, coronary, right and left triangular ligaments

A image thumb
2

Structures contained within the hepatoduodenal ligament and orientation

porta hepatis: proper hepatic a, portal v, CBD

portal vein- posterior

CBD- lateral

hepatic artery- medial

A image thumb
3

Line dividing liver into R and L lobes

Cantlie line (runs from middle of GB fossa anteriorly to IVC posteriorly)

4

Number of Couinaud segments in the liver

8

5

Segments removed in R hepatectomy

5-8

6

Segments removed in R trisegmentectomy

4-8

7

Segments removed in L hepatectomy

2-4

8

Segments removed in L lateral segmentectomy

2-3

9

Segments removed in L trisegmentectomy

2-5, 8

10

Percentage of blood flow to liver from portal vein

70%

(see card 13, in any case sabiston has 75%)

11

Percentage of cardiac output accounting for hepatic blood flow

25%

12

Percentage of oxygen supply provided by hepatic artery

50%

(sabiston p.1431 has 30-50%)

13

Fraction that portal vein contributes to total hepatic blood flow

2/3 (sabiston has 75%)

14

Number of hepatic veins

3 (R, M, L)

15

Approximate length of CBD

7cm

16

Normal CBD diameter

0.5-1.5cm

17

Arterial supply of bile ducts

primarily R hepatic artery

18

Origin of sympathetic innervation of GB

celiac axis

19

Parasympathetic innervation of GB

Vagus nerve

20

Ducts of Luschka

accessory ducts directly from liver bed into GB

21

amount of bilirubin produced daily in normal adult

250-350mg

22

amount of bilirubin from turnover of senescent RBCs

~85%

23

most common cause of hyperbilirubinemia in adults

cholelithiasis

24

major metabolite of heme

bilirubin

25

name of sinusiodal macrophages

Kupffer cells

26

half-life of albumin

20 days

27

half-life of transferrin

6 days

28

major protein produced by the liver

albumin

29

bile acids conjugated with these to form bile salts

glycine and taurine

30

major site of bile acid reabsorption

distal ileum

31

AR disorder increasing conjugated bilirubin with normal LFTs

Dubin-Johnson

32

percentage of population with gallstones

~10%

33

group of Indians in southern AZ at high risk for gallstones

Pima Indians

34

Lowest risk population for gallstones

Sub-saharan Africans

35

Gallstone classification

cholesterol, black pigment, or brown-pigment

36

main composition of black pigmented stones

calcium bilirubinate

37

main composition of brown pigmented stones

calcium salts of unconjugated bilirubin

38

what causes gallstone formation

cholesterol supersaturation, acclerated crystal nucleation, GB hypomotility

39

2 primary bile acids

cholate, chenodeoxycholate

40

most common inherited cause of hyperbilirubinemia

gilbert syndrome (decreased activity of glucuronyl transferase enzyme)

41

enzyme found in cells of bile duct that rises with obstruction

alkaline phosphatase

42

liver synthesizes all coag factors except

von willebrand factor

43

what is type I crigler-naijar syndrome

severe unconjugated hyperbilirubinemia, kernicterus, bilirubin deposits in the brain causing severe motor dysfxn and retardation

44

what is type ii crigler-najjar syndrome

less severe than type I, enzyme activity 10% of normal

45

which substance metabolized by gut bacteria to lactate that converts ammonia to ammonium salt?

lactulose

46

secondary bile salts

lithocholate, deoxycholate, ursodeoxycholate

47

hormone that is potent stimulator of GB contraction

CCK

48

is prophylactic cholecystectomy recommended in diabetics?

no

49

incidence of ERCP-induced pancreatitis

~5%

50

rapid, noninvasive imaging study that provides detailed biliary tree and pancreatic duct images equal to those of ercp?

mrcp

51

percentage of pigmented stones and cholesterol stones seen on plain abd films?