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Flashcards in Liver Deck (105)
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1

what is the largest single gland of the body?

liver

2

what are the three hepatic veins

right middle and left

3

where does the caudate lobe drain?

directly into the IVC

4

what is 75% of the blood supply of the liver?

portal vein

5

Origin of the portal vein formed by confluence of the

SMV and splenic vein

6

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

7

why would you resect a benign liver lesion?

Hemorrhage or risk of hemorrhage
Risk of malignant transformation
Inability to exclude malignancy

8

what is the most common benign hepatic tumor?

cavernous hemangioma

9

who typically gets cavernosu hemangiomas

women 30-50 years old

10

when are cavernous hemangiomas usually found?

incidental on x-ray

11

if symptomatic present with RUQ pain or fullness. (pain uncommon <8-10 cm)

hemangioma

12

PE findings w/ hemangioma

rare but may see hepatomegaly or arterial bruit in the RUQ

13

very rare presentations of hemangioma

CHF
Jaundice
Spontaneous or traumatic rupture – hemorrhagic shock
Early satiety, nausea and vomiting
Thrombocytopenia may be present from sequestration and destruction of platelets in large lesions

14

dx of hemangioma

CT/MRI
FNA (risk of hemorrhage)
U/S

15

what will a hemangioma look like on US

well-circumscribed
uniformly hyperechoic lesions

16

what type CT do you want for a hemangioma

contrast enhanced, triple phase w/ delayed imaging

17

in arterial phase filled in periphery then there is more central filling with delayed phase.

hemangioma

18

how will a hemangioma look like on MRI

T1- low signal intensity
T2- high signal intensity

19

what will a hemangioma look like on RBC scan (useful if MRI is non-diagnostic)

delayed centripetal filling

20

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

21

indications for resection of hemangioma

Severe symptoms
Inability to obtain a firm diagnosis
Rapid growth
Rupture

22

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

23

how is embolization done

catheter in femoral artery
go to hepatic artery and inject things into artery to get it to stop bleeding

24

what can be used for embolization

Coils, ethanol, sodium tetradecyl sulfate cyanoacrylate, polyvinyl alcohol (PVA), microspheres, gelatin sponge (Gelfoam)

25

2nd most common benign liver lesion
Usually well circumscribed lesion with central scar

focal nodular hyperplasia

26

who do focal nodular hyperlasia often occur in?

females of reproductive age
associated w/ OCP (possibly)

27

are focal nodular hyperplasias symptomatic

no, and usually have normal LFTS

28

is there risk w/ focal nodular hyperplasia?

Nope- Rarely ruptures and no risk of malignant transformation (unlike adenoma)

29

ways to diagnose a FNH

dynamic CT w/ delayed imaging (look for central scar)
US- characteristics spoke-whell vascular

30

what will FNH look like on a technetium scan?

Technetium sulphur colloid scan helpful b/c FNH contains Kupffer cells – increased uptake