Liver Flashcards
(25 cards)
What is the celiac trunk?
The celiac trunk is a major artery that branches off the abdominal aorta.
What are the branches of the celiac trunk?
The branches of the celiac trunk include the splenic artery and the left gastric artery.
What is the splenic artery?
The splenic artery supplies blood to the spleen.
What is the left gastric artery?
The left gastric artery supplies blood to the stomach.
What are the main arteries supplying the liver?
Common hepatic artery, Gastroduodenal artery, Proper hepatic artery, Left hepatic artery, Right hepatic artery
What is the venous supply to the liver?
Portal vein (formed from the splenic vein and the superior mesenteric vein)
What is the hepatic venous drainage?
Via the hepatic veins, which drain into the IVC (three veins: left, middle, and right)
What sources provide oxygen to the liver?
Portal vein blood - 50%, Hepatic artery blood - 50%
From what sources does the liver receive blood?
Portal system - 75%, Hepatic artery system - 25%
How many segments are identified in the liver (French system)?
7
What is the overall arrangement of the segments in the liver?
Clockwise, starting at segment 1
What is the maximum amount of liver that can be resected while retaining adequate liver function?
> 80%
Remember Prometheus!
What is Child’s class? (Child-Turcotte-Pugh)
Classification system that estimates hepatic reserve in patients with hepatic failure and mortality
How can the criteria comprising the modified Child’s classification be remembered?
Use the acronym: “A BEAP”: Ascites, Bilirubin, Encephalopathy, Albumin, PT (prothrombin time)
What are the criteria for Child-Pugh Class A liver disease?
• Ascites: none
• Bilirubin: <2 mg/dL
• Encephalopathy: none
• Albumin: >3.5 g/dL
• PT INR: <1.7
What are the criteria for Child-Pugh Class B liver disease?
• Ascites: controlled
• Bilirubin: 2–3 mg/dL
• Encephalopathy: minimal
• Albumin: 2.8–3.5 g/dL
• PT INR: 1.7–2.2
What are the criteria for Child-Pugh Class C liver disease?
• Ascites: uncontrolled
• Bilirubin: >3 mg/dL
• Encephalopathy: severe
• Albumin: <2.8 g/dL
• PT INR: >2.2
What is the operative mortality for a portacaval shunt in Child-Pugh Class A, B, and C cirrhosis?
Class A: <5%
Class B: <15%
Class C: ≈33%
What is the operative mortality for overall intraabdominal operations in Child-Pugh Class A, B, and C cirrhosis?
Class A: 10%
Class B: 30%
Class C: 75%
What does MELD score stand for and what is measured in it?
Stands for: Model for End-stage Liver Disease
Measured: INR, total bilirubin, serum creatinine
How does MELD score affect mortality in cirrhotic patients undergoing nonemergent surgery?
Mortality increases by 1% per MELD point until MELD 20
After MELD 20: 2% increase per point
How does MELD score affect mortality in emergent nontransplant surgery?
14% increase in mortality per 1 point of the MELD score
What is the most common liver cancer overall?
Metastatic disease (20:1 compared to primary tumors); primary site is usually the gastrointestinal (GI) tract.
What is the most common primary malignant liver tumor?
Hepatocellular carcinoma (also called hepatoma).
