Flashcards in Liver Deck (27):
When to do a liver needle bx?
Not on an asymptomatic patient! Use this only when nature of tumor cannot be determined with other imaging/tests. High risk for seeding
Cavernous Hemangioma: what is it? malignant? management?
endothelial vascular spaces with septa. B9. Do not bx for risk of hemorrhage. Usually asymptomatic, only do surgery if large and painful. They can also spontaneously thrombose
Cause of Focal Nodular Hyperlasia of liver
FNH prognosis? treatment?
B9 lesion with central stellate scar, found incidentally. N labs and no potential for malignancy, rupture, or hemorrhage
Difference histologically between FNH and liver adenoma
In FNH bile ducts are scattered throughout
Hepatic adenoma common etiology
Hepatic adenoma do not have __ cells which make Tc Sulfur scan have a filling defect
Treatment for hepatic adenoma?
If >4cm consider surgical ressection
Standard tx for HCC in pt without cirrhosis?
Resection. Up to 70% of total liver can be removed
MRCP shows missing segments of the central biliary tree, Dx?
Jaundice with dilated intrahepatic ducts and small gallbladder, Dx?
Hilar or Central cholangiocarcinoma
calcifications of cyst wall are indication of what type?
TX for cystadenoma or cystadenocarcinoma?
TX for simple cyst of liver?
Breakdown of the wall to allow drainage into peritoneal cavity and then resorption by body
DX for Ecchinococcus liver cyst?
Serology. Good clues= living in endemic area, calcifications, and eosinophilia
Best measure of adequate volume in pt with acute bleeding from varices?
Urine output, put in catheter
Pressure above which varices are known to rupture?
Pharm tx for variceal bleed?
Somatostatin or vasopressin
Procedural tx for variceal bleed?
endoscopy with sclerotherapy or band ligation
Benefit of selective liver shunt compared to full shunt?
Only diverting some blood away from liver reduces risk of encephalopathy while still reducing the pressure/demand of the liver
complications of ascites
enlargement of hernia, thin/ulcer/rupture of skin overlying, hepatorenal syndrome, spontaneous bacterial peritonitis, acute renal failure (if concominent diuretics)
TX of ascites
fluid and Na restriction, diuretics, paracentesis with IV albumin, peritoneal venous shunts to drain
3 Indications for liver transplant
1. chronic progressive advanced liver disease
2. Fulminant hepatic failure (massive hepatocyte necrosis within 8-12w of symptom onset)
3. unresectable malignancy
3 criteria of MELD score? What is this used to predict? What score is req to be considered for transplant?
Bilirubin, Cr, INR. Severity of liver disease and mortality risk of pt. Not considered until MELD reaches 15.
Initial tx for autoimmune hepatitis?
Corticosteroids and azathioprine (immunosuppresive)
Hemochromatosis and its effects on the liver?
AR mutation in HFE gene causes abnormal iron sensing and inc absorption of iron from GIT. Fe deposits in tissues especially liver/pancreas/heart. HUGE inc in HCC risk! Transplant is not a cure