LIVER Flashcards
(33 cards)
Basic medical treatments for cirrhosis / portal HTN:
- Sodium restriction
- Diuresis
- Paracentesis
- Nutritional optimization
Treatment of bleeding esophageal varices - INTIAL BLEED:
- Endoscopic band ligation
- PPI
- Antibiotics
Treatment of bleeding esophageal varices - FIRST RE-BLEED:
Second endoscopy
Treatment of bleeding esophageal varices - SECOND RE-BLEED:
TIPS
Last resort for treatment of bleeding esophageal varices?
Esophageal devascularization - fire stapler across GE junction without transection (leave a jejunostomy for feeding)
PROCEDURE: Balloon tamponade of bleeding esophageal varices
- Place tube into stomach and inflate large round gastric balloon
- Retract balloon until compressing GE junction - confirm by KUB
- Inflate long esophageal balloon to tamponade
- Distal port placed to suction to empty luminal contents
- For Minnesota tubes - proximal port to drain salivary secretions
Management of chronic esophageal varices
- Small
- Medium / large
- Small: Beta blockers (naolol or propanolol)
- Medium / large: Endoscopic ligation
Diagnosis for SBP?
Paracentesis (PMN > 250)
Primary treatment of SBP?
- Paracentesis (“tap until dry”)
- Cefotaxime (or cetriaxone or fluoroquinolone)
- If renal dysfunction: albumin decreases mortality
- If PD catheter present: Intraperitoneal abx x2 weeks
Treatment of Budd Chiara syndrome?
- Heparin
- Angioplasty / stent if amenable
- Consider thrombolytics if well-defined acute clot
- For failure of above: TIPS or OLT
Liver mass:
“Periphery of liver wiwth peripheral edema, no rim enhancement”
Amebic abscess
Liver mass:
“Multilocular, calcified rim”
Hydatid cyst
Liver mass:
“Central stellate scar, enhances on arterial phase”
FNH
Liver mass:
“Peirpheral to central enhancement, hyperintense arterial phase that fades”
Hemangioma
Liver mass:
“Early enhancement on arterial phase, no delayed washout”
AdenomaLi
Liver mass:
“Early enhancement on arterial phase, delayed washout on portal venous phase”
HCC
Treatment for pyogenic abscess?
Antibiotics and perc drainage (failure may require surgical drainage)
How is the diagnosis of amebic abscess made?
Serology and US
Treatment options for amebic abscess?
- < 10 cm?
- > 10 cm?
- Ruptured?
- < 10 cm: Flagyl
- > 10 cm: Perc drainage
- Surgical excision
How is the diagnosis of hydatid cyst made?
Serology and US
Treatment options for hydatid cyst?
- Unilocular and < 5 cm?
- Multilocular / > 10 cm / high rupture risk?
- Unilocular and < 5 cm: Albendazole
- Multilocular / > 10 cm / high rupture risk: Albendazole and surgical excision (need entire wall)
Primary treatment for FNH?
Conservative
Treatment for persistent FNH?
Resection
Treatment of hepatic hemangioma:
- Asymptomatic?
- Symptomatic?
- Bleeding or giant (< 10 cm)?
- Asymptomatic: Conservative and repeat US in 6-12 months
- Symptomatic: Enucleation or liver resection
- Bleeding or giant (> 10 cm): Preop TACE
