Flashcards in hepatobiliary GB <3 Deck (34):
Liver blood supply
75% portal vein, 25% hepatic arteries (although 50-50 for oxygen due to different O2 sats). Celiac trunk -> common hepatic -> proper hepatic -> L and R hepatic arteries
Liver venous drainage
R, M, L hepatic veins -> IVC
Connects ab wall to liver, contains ligamentum teres (obliterated umbilical vein)
Peritoneal reflection on cranial aspect of liver that attaches it to diaphragm
peritoneal membrane covering the liver
Contains portal triad (CBD, portal vein, hepatic artery). Forms anterior boundary of epiploic foramen of Winslow, connects the greater and lesser peritoneal cavities.
What are the components of bile?
Cholesterol, lecithin, bile acids, bilirubin
Bile acids released from liver into duodenum -> reabsorbed in terminal ileum -> back to liver via portal vein
Dark urine, clay-colored stools indicates what type of jaundice?
Obstructive (high levels of unconjugated bilirubin, which can enter urine)
Treatment of liver abscess/cyst
Pyogenic: percutaneous drainage + IV abx. Amebic abscess (E. histolytica): IV metronidazole. Parasitic (hydatid cysts): albendazole (never aspirate!) followed by resection.
Most common benign tumor of the liver?
Cavernous hemangioma (results from abnl differentiation of angioblastic tissue during fetal life). Usu just found incidentally; do NOT biopsy, resect only if symptomatic or going to rupture
Seen in child-bearing females, risk factors include OCPs,, anabolic steroids, glycogen storage disease. Even if someone had adenoma that resolved after stopping OCPs, risk of rupture/hemorrhage during pregnancy.
Focal nodular hyperplasia
Benign hepatic tumors with 'central scar' on pathology. Resect only if symptomatic
Hepatocellular carcinoma (aka hepatoma) risk factors
Cirrhosis, Hep B and C, hemochromatosis, A1AT deficiency, liver flukes, anabolic steroid use
What markers are elevated in HCC?
ALP, AST, ALT, GGT, AFP, DCP
Treatment of HCC
Resection (or transplant) only cure
Most common hepatic malignancy?
Metastasis; from colon, breast, lung most often
What is Child-Pugh score based on?
Bilirubin, albumin, ascites, neuro disorder, PT
Most common causes of portal HTN
US: alcoholic cirrhosis. World: schistosomiasis
Left gastric vein -> esophageal veins
Umbilical vein (via falciform ligament) to epigastric veins
Superior rectal vein -> middle and inferior rectal veins
Drawbacks of shunting for portal HTN
Increased incidence of hepatic encephalopathy (more toxins diverted to systemic circulation) and decreased blood to liver = increased death from hepatic failure
What is the EEG like in hepatic encephalopathy?
Use beta-blockers to prevent rupture, but not once actively bleeding / hemodynamically unstable
Rare, severe variant caused by gas-forming bacteria, most often seen in elderly diabetic men. Can result in perforation
10% of all cases of acute cholecystitis. Acute inflammation in absence of gallstones, thought to be 2/2 stasis. Most often seen in ICU pt with multisystem organ failure, trauma (incl major surgery), burns, sepsis, TPN. Tx: urgent CCY
Acute cholangitis: fever, jaundice, RUQ pain
Acute cholangitis: fever, jaundice, RUQ pain plus CNS symptoms and septic shock
SBO caused by gallstone in pt with long standing stones, most commonly a large one that erodes through GB directly into duodenum via fistula. Most common place for obstruction is ileocecal valve.
Carcinoma of the gallbladder is usually what type
Adenocarcinoma. Rare. Peak age 75 yo, F>M
Benign tumors of the bile ducts
Most common type is adenoma, commonly found at ampulla of Vater. Causes intermittent jaundice, RUQ pain. Tx: resection (surgical or endoscopic)
Nearly all are adenocarcinomas. Can arise anywhere along intrahepatic or extrahepatic biliary system, but most common spot is bifurcation into R and L hepatic ducts (Klatskin tumor)