hepatobiliary GB <3 Flashcards Preview

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Flashcards in hepatobiliary GB <3 Deck (34):
1

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

2

Liver venous drainage

R, M, L hepatic veins -> IVC

3

Falciform ligament

Connects ab wall to liver, contains ligamentum teres (obliterated umbilical vein)

4

Coronary ligament

Peritoneal reflection on cranial aspect of liver that attaches it to diaphragm

5

Glisson's capsule

peritoneal membrane covering the liver

6

Hepatodudoenal ligament

Contains portal triad (CBD, portal vein, hepatic artery). Forms anterior boundary of epiploic foramen of Winslow, connects the greater and lesser peritoneal cavities.

7

What are the components of bile?

Cholesterol, lecithin, bile acids, bilirubin

8

Enterohepatic ciculation

Bile acids released from liver into duodenum -> reabsorbed in terminal ileum -> back to liver via portal vein

9

Dark urine, clay-colored stools indicates what type of jaundice?

Obstructive (high levels of unconjugated bilirubin, which can enter urine)

10

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.

11

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

12

Hepatic adenoma

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.

13

Focal nodular hyperplasia

Benign hepatic tumors with 'central scar' on pathology. Resect only if symptomatic

14

Hepatocellular carcinoma (aka hepatoma) risk factors

Cirrhosis, Hep B and C, hemochromatosis, A1AT deficiency, liver flukes, anabolic steroid use

15

What markers are elevated in HCC?

ALP, AST, ALT, GGT, AFP, DCP

16

Treatment of HCC

Resection (or transplant) only cure

17

Most common hepatic malignancy?

Metastasis; from colon, breast, lung most often

18

What is Child-Pugh score based on?

Bilirubin, albumin, ascites, neuro disorder, PT

19

Most common causes of portal HTN

US: alcoholic cirrhosis. World: schistosomiasis

20

Esophageal varices

Left gastric vein -> esophageal veins

21

Caput medusa

Umbilical vein (via falciform ligament) to epigastric veins

22

Hemorrhoids

Superior rectal vein -> middle and inferior rectal veins

23

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

24

What is the EEG like in hepatic encephalopathy?

Normal

25

Esophageal varices

Use beta-blockers to prevent rupture, but not once actively bleeding / hemodynamically unstable

26

Emphysematous cholecystitis

Rare, severe variant caused by gas-forming bacteria, most often seen in elderly diabetic men. Can result in perforation

27

Acalculous cholecystitis

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

28

Charcot's triad

Acute cholangitis: fever, jaundice, RUQ pain

29

Reynold's pentad

Acute cholangitis: fever, jaundice, RUQ pain plus CNS symptoms and septic shock

30

Gallstone ileus

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.

31

Carcinoma of the gallbladder is usually what type

Adenocarcinoma. Rare. Peak age 75 yo, F>M

32

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)

33

Cholangiocarcinoma location

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)

34

Tx of cholangiocarcinoma

Proximal: resect with RenY hepaticojejunostomy. Distal: Whipple procedure. Some are not resectable.