Hepatobiliary System Flashcards
Meaning of clay colored stools + nausea + jaundice =
Obstructive (post-hepatic) jaundice
Treatment of the different hepatic abscesses:
Pyogenic: Percutaneous drainage + IV antibiotics
Amebic: IV metronidazole, unless persistent or superinfected with bacteria, in which case percutaneous drainage and other antibiotics are indicated.
Treatment for hydatid cysts and what to avoid in treatment:
Mebendazole or Albendazole
Do NOT aspirate–could cause major anaphylactic reaction
Lobe most affected by cysts:
The right lobe tends to be the lobe with most of the hydatid AND congenital liver cysts
Patient populations for hepatocellular adenomas:
95% are women in childbearing age also using OCPs
Men using anabolic steroids
People with glycogen storage diseases
Treatments of hepatocellular adenomas:
Surgical Resection
Cessation of exogenous hormones if that is a contributing cause.
How to differentiate between focal nodular hyperplasia and hepatocellular adenoma:
Clinically, perform Tc-99 study which will highlight the FNH but not the adenoma.
Pathologically, the FNH will have ductal cells, hepatocytes, and a central scar whereas the adenoma should only be hepatocytes.
Define aflatoxin and how it plays a role in hepatic disease:
Mycotoxins that are produced by Aspergillus flavus and Aspergillus parasiticus species of fungi.
This is a risk factor for developing hepatitis, cirrhosis, and possibly hepatocellular carcinoma–the most common of all liver cancers.
What are generally the most common malignancies found in the liver?
Overwhelmingly metastasis
Most common primary sources are:
Bronchogenic Carcinoma > other lung cancers, breast, colon
Liver lesions associated with long term OCP use:
Focal Nodular Hyperplasia
Hepatocellular Adenoma
Role of the Child-Pugh Score?
What are the different clinical components contributing to it?
What are the classes and scores associated with them?
Child-Pugh Score is a measure of liver failure.
The Components are:
- Bilirubin
- Albumin
- Ascites
- Neurologic Dysfunction
- PT time
Class A: 5-6 points
Class B: 7-9 points
Class C: 10-15 points
Portosystemic Collaterals and their clinical manifestations in portal hypertension:
- Left gastric vein: esophageal varices
- Umbilical Vein: caput medusae
- Superior hemorrhoidal veins: hemorrhoids
- Veins of Retzius: Retroperitoneal varices
Most common sign of portal HTN:
Splenomegaly
Spleen removal in portal HTN:
Almost never indicated
Complications of shunts for portal HTN:
Encephalopathy (in all shunts except the spleno-renal [Warren] Shunt)
Liver failure from reduced blood flow
