LIVER

Question 1

Divides the liver into small LEFT lobe and large RIGHT lobe

Answer 1

Falciform ligament

Question 2

Segmental Anatomy of the Liver

Answer 2

Segment 1 - Caudate IVC

Segment 2 and 3- L lateral segment L hepatic vein

Segment 4 - L medial segment middle hepatic vein

Segment 5 and 8 - R anterior lobe R hepatic vein, middle hepatic vein

Segment 6 and 7 - R posterior lobe

Question 3

The most common variant of normal hepatic artery anatomy is

Answer 3

Replaced R hepatic artery from the SMA

Question 4

Liver Function Tests

Answer 4

Hepatocellular Injury - AST and ALT

Abnormal Synthetic Function - albumin, clotting factors EXCEPT factor VIII

Cholestasis - total bilirubin, B2, alk phosphatase, GGTP

Question 5

Measures liver synthetic function

Answer 5

serum albumin
prothrombin time
clotting factors (EXCEPT factor VIII)

PT and INR - best tests among the 3

prolonged PT - vitamin K deficiency or warfarin therapy

Question 6

Indicators of integrity of hepatocellular membranes; increased levels reflect hepatocellular injury w/ leakage

Answer 6

AST and ALT

AST - liver, cardiac,muscle, skeletal muscle,kidney, brain, pancreas,lungs and RBC
ALT - more specific for liver disease

MODERATE increases - viral hepatitis
GREAT increases - ischemia, toxin ingestion (acetaminophen), fulminant hepatitis

Question 7

Indicative of BILIARY OBSTRUCTION

Answer 7

alkaline phosphatase
liver and bones
half life -7 days

Question 8

Early marker and sensitive test for hepatobiliary disease

Answer 8

GGTP

Question 9

Jaundice becomes detectable when serum bilirubin level is

Answer 9

> 2.5 - 3 mg/dL

Question 10

Final sequelae of chronic liver injury characterized by fibrous septa that leads to hepatic nodules

Answer 10

Cirrhosis

Question 11

The gold standard or identi ying liver lesions by imaging is

Answer 11

Intraoperative Ultrasound

Question 12

Physiologic changes noted in patients with cirrhosis

Answer 12

elevated resting energy expenditure

increased cardiac output and heart rate

decreased systemic vascular resistance and blood pressure

Question 13

Presinusoidal Causes of Portal HPN

Answer 13

EXTRAHEPATIC
portal vein thrombosis
splenic vein thrombosis

INTRAHEPATIC
	congenital hepatic fibrosis
	primary biliary cirrhosis
	sarcoidosis
	schistosomiasis

Question 14

Sinusoidal Causes of Portal HPN

Answer 14

steatohepatitis

Wilson disease

Question 15

Postsinusoidal Causes of Portal HPN

Answer 15

EXTRAHEPATIC
Budd Chiari syndrome
Right hepatic failure

INTRAHEPATIC
	hemochromatosis
	laennec (alcoholic) cirrhosis
	secondary biliay cirrhosis
	posthepatitic cirrhosis

Question 16

The most accurate method for measuring portal HPN

Answer 16

hepatic venography

HVPG = WHVP - FHVP

> 10 - portal HPN

Question 17

Most significant manifestation of portal HPN

Answer 17

esophageal varices

Question 18

Management of Acute Variceal Bleeding

Answer 18

MEDICAL
Vasopressin
Octreotide - preferred

SURGICAL
early endoscopy and variceal ligation or sclerotherapy

refractory bleeding
	surgical shunt - Child A
	transjugular intrahepatic portosystemic shunt (TIPS) - Child B and C

Question 19

Congestive hepatopathy characterized by obstruction to hepatic venous outflow

Answer 19

Budd Chiari Syndrome

young women w/ myelofibrosis
factor V Leiden mutation
anti cardiolipin antibodies
OCP

Management:
systemic anticoagulation

Question 20

Predicts the risk of portocaval shunt procedure

Answer 20

Child Turcotte Pugh (CTP)

	bilirubin
	albumin
	INR
	(+) encephalopathy
	(+) ascites

Question 21

Predicts mortality after TIPS

Answer 21

Model for End Stage Liver Disease (MELD)

serum creatinine
total bilirubin
INR

Question 22

Percutaneous procedure used for treatment of patients who have gastroesophageal varices in the setting of portal hypertension

Answer 22

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

creates an intrahepatic shunt b/w portal and systemic circulation — decreased portal pressure and blood flow through varices

Question 23

MC complication of TIPS

Answer 23

Encephalopathy

Question 24

Pyogenic Liver Abscess

Answer 24

R lobe
E.coli

correction of underlying cause
broad spectrum antibiotics at least 8 weeks
percutaneous aspiration
failure of medical management — surgical drainage/resection

Question 25

Most frequently encountered liver lesion overall

Answer 25

Hepatic Cysts

Question 26

MC benign solid masses in the liver

Answer 26

Hemangioma women PAIN dual phase CT: asymmetrical peripheral enhancement w/ progressive centripetal enhancement MRI: hypointense on T1 and hyperintense on T2 enucleation or resection

Question 27

Benign solid neoplasm that occurs in young women, typically solitary

Answer 27

Adenoma prior or current use of OCP COMPLICATIONS - spontaneous rupture and hemorrhage, malignant degeneration resection

Question 28

Occurs in young women and usually do not rupture spontaneously or degenerate into malignancy

Answer 28

Focal Nodular Hyperplasia abdominal pain - usual indication for surgery CT/MRI - central scar Nuclear scan - hot

Question 29

Primary Malignant Liver Tumors

Answer 29

Hepatocytes - Hepatocellular carcinoma (HCC) | Bile ducts - Cholangiocarcinoma

Question 30

MC malignant liver tumor

Answer 30

Metastatic from COLONIC carcinoma

Question 31

2nd MC benign tumor of the liver

Answer 31

Focal Nodular Hyperplasia

Question 32

Risk factors for Hepatocellular Carcinoma

Answer 32

``` Cirrhosis Hep B or C Alcoholic Hemochromatosis Non alcoholic steatohepatitis ```

Question 33

Patient’s eligible or the Mayo Clinical protocol to treat hilar cholangiocarcinoma

Answer 33

hilar cholangiocarcinoma with PSC or patients with unresectable hilar cholangiocarcinoma who have not received prior radiotherapy

Question 34

Considered a primary determinant of suitability or resection when evaluating a patient with hepatic colorectal metastases

Answer 34

Predicted volume of hepatic remnant

Question 35

The only FDA-approved systemic chemotherapeutic agent or HCC

Answer 35

Sorafenib

Question 36

The primary indication for hepatic resection in cirrhotic patients

Answer 36

HCC