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Essentials of Surgery > Liver > Flashcards

Flashcards in Liver Deck (27):
1

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

2

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

3

Cause of Focal Nodular Hyperlasia of liver

arterial malformation

4

FNH prognosis? treatment?

B9 lesion with central stellate scar, found incidentally. N labs and no potential for malignancy, rupture, or hemorrhage

5

Difference histologically between FNH and liver adenoma

In FNH bile ducts are scattered throughout

6

Hepatic adenoma common etiology

Estrogen

7

Hepatic adenoma do not have __ cells which make Tc Sulfur scan have a filling defect

Kupferr cells

8

Treatment for hepatic adenoma?

If >4cm consider surgical ressection

9

Standard tx for HCC in pt without cirrhosis?

Resection. Up to 70% of total liver can be removed

10

MRCP shows missing segments of the central biliary tree, Dx?

cholangiocarcinoma

11

Jaundice with dilated intrahepatic ducts and small gallbladder, Dx?

Hilar or Central cholangiocarcinoma

12

calcifications of cyst wall are indication of what type?

cystadenocarcinoma

13

TX for cystadenoma or cystadenocarcinoma?

surgical removal

14

TX for simple cyst of liver?

Breakdown of the wall to allow drainage into peritoneal cavity and then resorption by body

15

DX for Ecchinococcus liver cyst?

Serology. Good clues= living in endemic area, calcifications, and eosinophilia

16

Best measure of adequate volume in pt with acute bleeding from varices?

Urine output, put in catheter

17

Pressure above which varices are known to rupture?

12mmHG

18

Pharm tx for variceal bleed?

Somatostatin or vasopressin

19

Procedural tx for variceal bleed?

endoscopy with sclerotherapy or band ligation

20

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

21

complications of ascites

enlargement of hernia, thin/ulcer/rupture of skin overlying, hepatorenal syndrome, spontaneous bacterial peritonitis, acute renal failure (if concominent diuretics)

22

TX of ascites

fluid and Na restriction, diuretics, paracentesis with IV albumin, peritoneal venous shunts to drain

23

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

24

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.

25

Initial tx for autoimmune hepatitis?

Corticosteroids and azathioprine (immunosuppresive)

26

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

27

Wilson's disease and its effects on the liver?

mutation in ATPase transporter on hepatocyte so copper cannot be excreted (usually leaves body with bile) & accum in liver, brain, cornea, kidney, joints. Transplant cures