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liver Flashcards

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1
Q

what is cantles line

A

line drawn from gallbladder to point just to left of IVC, which transects liver into right and left lobes

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2
Q

which ligament goes from ant abd wall to liver

A

falciform ligament

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3
Q

what ligament attaches liver to diaphragm

A

coronary ligament

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4
Q

venous supply of liver

A

portal vein

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5
Q

max amt liver can be resected while retaining adequate liver function

A

> 80%; if given adequate recovery tie, original mass can be regenerated

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6
Q

what is child’s class (child-turcotte pugh)

A

classification system that estimates hepatic reserve in pts w hepatic failure and mortality

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7
Q

what comprises the child’s classification

A

” a beap”

ascites, bilirubin,encephalopathy, albumin, pt

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8
Q

Meld score

A

“model for end stage liver disease”

measures: INR, t bili, serum creatinine

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9
Q

mc liver cancer

A

metastic ds out numbers primary tumors (usually from GI tract)

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10
Q

mc primary malignant liver tumor

A

hepatocellular carcinoma (hepatoma)

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11
Q

mc primary benign liver tumor

A

hemangioma

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12
Q

imaging/lab studies for liver cancer

A

ct scan, us, a gram

lfts, cea

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13
Q

right trisegmentectomy

A

removal of all the liver tissue to right of falciform ligament

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14
Q

3 common types of primary benign liver tumors

A
  1. hemangioma
  2. hepatocellular adenoma
  3. focal nodular hyperplasia
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15
Q

4 common types of primary malignant liver tumors

A
  1. hepatocellur carcinoma (hepatoma)
  2. cholangiocarcinoma (when intrahepatic)
  3. angiosarcoma (assoc w chemical exposure)
  4. hepatoblastoma (mc in infants/kids)
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16
Q

what chemical exposures are risk factors for angiosarcoma

A

vinyl chloride*, arsenic, thorotrast contrast

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17
Q

liver hamartoma

A

white hard nodule made up of normal liver cells

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18
Q

risk factors for hepatocellular adenoma

A

women, birth control pills, anabolic steroids, glycogen storage ds

age 30-35

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19
Q

s/sx hepatocellular adenoma

A

ruq pain/mass, ruq fullness, bleeding (rare)

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20
Q

complications hepatocellular adenoma

A

rupture w bleeding, necrosis, pain, risk of hepatocellular carcinoma

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21
Q

dx hepatocellular adenoma

A

ct scan, us, +/- bx

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22
Q

tx small hepatocellular adenoma

A

stop birth control pills, it may regress; if not surgical resection

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23
Q

tx large (>5cm), bleeding, painful or ruptured hepatocellular adenoma

A

surgical resection

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24
Q

what is focal nodular hyperplasia (FNH)

A

benign liver tumor; normal hepatocytes and bile ducts (adenoma has no bile ducts) occurring around 40y in females

can be assoc with birth control pills

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25
dx fnh
nuclear technetium 99 study, us, ct , a gram, bx
26
classic ct scan finding of fnh
liver mass w central scar
27
complications of fnh
pain; no cancer risk
28
tx fnh
resection or embolization if pt is symptomatic; otheriwse follow if dx is confirmed; stop birth control
29
s/sx hepatic hemangioma
ruq pain/mass, bruits
30
complications of hepatic hemangioma
pain, CHF, coag, obstructive jaundice, gastric outlet obstruction, Kasabach-Merritt syndrome, hemorrhage
31
kasabach-merritt syndrome
hemangioma and thrombocytopenia and fibrinogenopenia
32
dx hepatic hemangioma
ct scan w iv contrast, tagged red blood scan, mri, us
33
tx hepatic hemangioma
observation
34
high risk areas for hepatocellular carcinoma
africa and asia
35
risk factors hepatocellular carcinoma (hepatoma)
hep B*, cirrhosis*, aflatoxin (fungi toxin of aspergillus flavus)*
36
s/sx of hepatoma
dull ruq, hepatomegaly, abd mass, wl, paraneoplastic syndromes, portal htn, ascites, jaundice, fever, anemia, splenomegaly
37
pt w dull ruq pain, hepatomegaly, wl, jaundice and fever
hepatoma
38
workup for hepatoma
us, ct, angiography, tumor marker elev (alpha fetoprotein)
39
mc site metastasis of hepatoma
lungs
40
tx hepatoma
surgical resection, if possible lobectomy; liver transplant
41
nonsurgical tx hepatoma
percutaneous ethanol tumor injection, cryotherapy, intra arterial chemo
42
indications for liver transplant
cirrhosis and NO resection candidacy as well as no distant or lymph node metastases and no vascular invasion; the tumor must be single
43
which subtype of hepatoma has best prognosis
fibrolamellar hepatoma (young adults)
44
types of liver abscess
pyogenic (bacterial)*, parasitic (amebic)*, fungal
45
mc location of liver abscess
right lobe
46
3 mc bacterial organisms affecting the liver
gram neg: e coli, klebsiella, proteus
47
mc sources/causes of bacterial liver abscesses
cholangitis, diverticulitis, liver cancer, liver metastasis
48
s/sx bacterial liver abscess
fever,* chills*, ruq pain*, leukocytosis, inc lfts, jaundice, sepsis, wl
49
tx bacterial liver abscess
iv abx (triple abx w metro), percutaneous drainage w ct or us guidance
50
cause of amebic (parasitic) liver abscess
entamoeba histolytica
51
how does amebic liver abscess occur
fecal-oral transmission
52
s/sx amebic liver abscess
ruq pain, fever, hepatomegaly, diarrhea | chills less common than w pyogenic abscess
53
pt w ruq pain, fever, hepatomegaly, diarrhea
amebic liver abscess
54
which love mc involved amebic liver abscess
right lobe
55
classic description of amebic liver abscess
anchovy paste pus
56
dx amebic liver abscess
lab tests, us, ct indirect hemagglutination titers for Entamoeba antibodies elev in >95% of cases, elev lfts
57
tx amebic liver abscess
metro IV surgery drainage- refractory to metro, bacterial co infx, or peritoneal rupture
58
possible complications of large left lobe liver amebic abscess
erosion into pericardial sac
59
hydatid liver cyst
usually a right lobe cyst filled w Echinococcus granulosus
60
rf for hydatid liver cyst
travel, exposure to dogs, sheep, and cattle
61
s/sx hydatid liver cyst
ruq pain, jaundice, ruq mass
62
dx hydatid liver cyst
indirect hemagglutination antibody test (serologic testing), Casoni skin test, us, ct, radiographic imaging
63
axr finding hydatid liver cyst
possible calcified outline of cyst
64
risk of surgical removal of echinococcal (hydatid) cysts
rupture or leakage of cyst contents into abd may cause fatal anayphylactic rxn (never drain because risk of anaphylaxis)
65
tx hydatid liver cyst
mebendazole followed by surgical resection toxic irrigations- hypertonic saline, ethanol,cetrimide
66
what is a hemobilia
blood draining via the common bile duct into the duodenum
67
triad s/sx of hemobilia
ruq pain, guaiac pos/upper gi bleeding, jaundice
68
causes of hemobilia
trauma w liver laceration, percut transhepatic cholangiography (PTC), tumors
69
dx hemobilia
EGD (blood out of ampulla of Vater), a gram
70
tx hemobilia
a gram w embolization of the bleeding vessel
71
bellhemia
seen after trauma, connection of bile ducts and venous system, resulting in rapid and very elevated serum bilirubin
72
portal hypertension
elev portal pressure resulting from resistance to portal flow
73
3 etiologies of portal hypertension
1. prehepatic- thrombosis of portal vein/atresia of portal vein 2. hepatic-cirrhosis (distortion of normal parenchyma by regenerating hepatic nodules), hepatocellular carcinoma, fibrosis 3. posthepatic- budd chiari syndrome: thrombosis of hepatic veins
74
mc cause portal htn in us
cirrhosis
75
name of liver capsule
glisson's capsule
76
mc pe finding in pts w portal htn
splenomegaly
77
4 assoc clinical finding in portal htn
1. esophageal varices 2. splenomegaly 3. caput medusae (engorgement of periumbilical veins) 4. hemorrhoids
78
pe findings of cirrhosis and portal htn
spider angiooma, palmar erythema, ascites, truncal obesity and peripheral wasting, encephalopathy, asterixis (liver flap), gynecomastia, jaundice
79
name of periumbilical bruit heard w caput medusae
cruveilhier-baumgarten bruit
80
assoc between esophageal varices and portal htn
coronary vein backing up into the azygous system
81
assoc between caput medusae and portal htn
umbilical vein draining into epigastric vein
82
assoc w retroperitoneal varices and portal htn
small mesenteric veins draining retroperitoneally into lumbar veins
83
assoc w hemorrhoids and portal htn
superior hemorrhoidal vein backing up into the middle and inferior hemorrhoidal veins
84
mc cause portal htn in US and outside of US
US- cirrhosis outside-schistosomiasis
85
budd chiari syndrome
thrombosis of hepatic veins
86
most feared complication of portal htn
bleeding from esophageal varices
87
esophageal varices
engorgement of the esophageal venous plexuses secondary to inc collateral blood flow from portal system as a result of portal htn
88
rule of 2/3 portal htn
2/3 pt w cirrhosis dev it 2/3 pt w it will dev esophageal varices 2/3 pt w varices will bleed from them
89
s/sx pt w cirrhosis and known varices w upper GI bleeding
hematemesis, melena, hematochezia
90
initial tx of bleeding esophageal varices
large bore ivx2, iv fluid, foley, t/c, labs, correct coag (vit K, ffp), +/- intubation to protect from aspiration
91
dx upper gi bleeding
EGD (upper GI endoscopy) to look for varices, ulcers, gastritis, etc
92
EGD tx for bleeding varices
1. emergent endoscopic sclerotherapy | 2. endoscopic band ligation
93
med tx for bleeding varices
somatostatin (octreotide) or iv vasopressin to achieve vasoconstriction of mesenteric vessels; if bleeding continues, consider balloon (sengstaken-blakemore tube) tamponade of varices, beta blocker
94
selective shunt for bleeding varices
shunt that selectively decompresses the varices without decompressing the portal vein
95
TIPS if cant stop variceal bleeding
transjugular intrahepatic portosystemic shunt- angriographic radiologist places small tube stent intrahepatically between the hepatic vein and branch of portal vein via percut jugular vein route
96
warren shunt
distal splenorenal shunt w ligation of coronary vein
97
mc perioperative cause of death following shunt procedure
hepatic failure secondary to dec blood flow
98
what is used to counteract the coronary artery vasoconstriction of iv vasopressin
nitro iv drip
99
meds to tx hepatic encephalopathy
lactulose po with or without neomycin po

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