Flashcards in Liver Deck (105)
what is the largest single gland of the body?
what are the three hepatic veins
right middle and left
where does the caudate lobe drain?
directly into the IVC
what is 75% of the blood supply of the liver?
Origin of the portal vein formed by confluence of the
SMV and splenic vein
what is the order of biliary drainage
Bile canaliculi → segmental bile ducts (drain the segments) → right and left hepatic ducts → common hepatic duct → common bile duct at point of insertion of the cystic duct
why would you resect a benign liver lesion?
Hemorrhage or risk of hemorrhage
Risk of malignant transformation
Inability to exclude malignancy
what is the most common benign hepatic tumor?
who typically gets cavernosu hemangiomas
women 30-50 years old
when are cavernous hemangiomas usually found?
incidental on x-ray
if symptomatic present with RUQ pain or fullness. (pain uncommon <8-10 cm)
PE findings w/ hemangioma
rare but may see hepatomegaly or arterial bruit in the RUQ
very rare presentations of hemangioma
Spontaneous or traumatic rupture – hemorrhagic shock
Early satiety, nausea and vomiting
Thrombocytopenia may be present from sequestration and destruction of platelets in large lesions
dx of hemangioma
FNA (risk of hemorrhage)
what will a hemangioma look like on US
uniformly hyperechoic lesions
what type CT do you want for a hemangioma
contrast enhanced, triple phase w/ delayed imaging
in arterial phase filled in periphery then there is more central filling with delayed phase.
how will a hemangioma look like on MRI
T1- low signal intensity
T2- high signal intensity
what will a hemangioma look like on RBC scan (useful if MRI is non-diagnostic)
delayed centripetal filling
Follow-up for hemangioma
US at 6 months and at 12 months after initial diagnosis
if no change in size- probs don't need long term follow up
indications for resection of hemangioma
Inability to obtain a firm diagnosis
what can you do to decrease risk of bleeding w/ hemangioma
May embolize if hemorrhage or pre-resection to shrink tumor to decrease risk of bleeding
how is embolization done
catheter in femoral artery
go to hepatic artery and inject things into artery to get it to stop bleeding
what can be used for embolization
Coils, ethanol, sodium tetradecyl sulfate cyanoacrylate, polyvinyl alcohol (PVA), microspheres, gelatin sponge (Gelfoam)
2nd most common benign liver lesion
Usually well circumscribed lesion with central scar
focal nodular hyperplasia
who do focal nodular hyperlasia often occur in?
females of reproductive age
associated w/ OCP (possibly)
are focal nodular hyperplasias symptomatic
no, and usually have normal LFTS
is there risk w/ focal nodular hyperplasia?
Nope- Rarely ruptures and no risk of malignant transformation (unlike adenoma)
ways to diagnose a FNH
dynamic CT w/ delayed imaging (look for central scar)
US- characteristics spoke-whell vascular