Chapter 51: Liver- Anatomy

Question 1

Identify the branches of the celiac trunk

Answer 1

1. Celiac trunk
2. Splenic artery
3. Left gastric artery
4. Common hepatic artery
5. Gastroduodenal artery
6. Proper hepatic artery
7. Left hepatic artery
8. Right hepatic artery

Question 2

What is the venous supply?

Answer 2

Portal vein (formed from the splenic vein and the superior mesenteric vein)

Question 3

What is the hepatic venous drainage?

Answer 3

Via the hepatic veins, which drain into the IVC (three veins: left, middle, andright)

Question 4

What sources provide oxygen to the liver?

Answer 4

Portal vein blood—50%

Hepatic artery blood—50%

Question 5

From what sources does the liver receive blood?

Answer 5

Portal system—75%

Hepatic artery system—25%

Question 6

Identify the segments of the liver (French system)

Answer 6

Question 7

What is the overall arrangement of the segments in the liver?

Answer 7

Clockwise, starting at segment 1

Question 8

What is the maximum amount of liver that can be resected while retaining adequate liver function?

Answer 8

>80%

Question 9

What is Child’s class? (Child–Turcotte–Pugh)

Answer 9

Classification system that estimates hepatic reserve in patients with hepatic failure and mortality

Question 10

How can the criteria comprising the modified Child’s classification be remembered?

Answer 10

Use the acronym: “A BEAP”:

Ascites

Bilirubin

Encephalopathy

Albumin

PT (prothrombin time)

Question 11

What is the operative mortality for a portacaval shunt versus overal lintraabdominal operations with cirrhosis in the following Child’s classes:

A

Answer 11

<5% versus overall = 10%

Question 12

What is the operative mortality for a portacaval shunt versus overal lintraabdominal operations with cirrhosis in the following Child’s classes:

B

Answer 12

<15% versus overall = 30%

Question 13

What is the operative mortality for a portacaval shunt versus overal lintraabdominal operations with cirrhosis in the following Child’s classes:

C

Answer 13

≈33% versus overall = 75%

Question 14

What does the MELD score stand for?

Answer 14

Model for End-stage Liver Disease

Question 15

What is measured in the MELD score?

Answer 15

1. INR
2. total bilirubin
3. serum creatinine (SCR)

find good MELD calculators online

Question 16

What is the mortality in cirrhotic patients for nonemergent nontransplant surgery?

Answer 16

Increase in mortality by 1% per 1 point in the MELD score until 20, then 2% foreach MELD point

Question 17

What is the mortality in cirrhotic patients for emergent nontransplant surgery?

Answer 17

14% increase in mortality per 1 point of the MELD score