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Flashcards in Liver Deck (91)
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1

____ is a plane from gallbladder fossa to IVC separating the true left and right lobes of the liver

Cantlie's line

2

_____ separates the left lateral and left medial segments

falciform ligament

3

the faciform ligaments divide the left lobe to ____

left lateral and left medial segments

small left lobe
large left lobe

4

the right lobe of the liver is divided by the following structures

1. Gallbladder
2. Fissure of ligamentum teres
3. IVC
4. Fissure of ligamentum venosum

5

The right lobe is composed of what lobes?

1. Quadrate lobe
2. Caudate lobe

6

[Name the coinaud segemen]

caudate

1

7

[Name the coinaud segemen]

left lateral

2 and 3

8

[Name the coinaud segemen]

left medial

4

9

[Name the coinaud segemen]

right anterior lobe

5, 8

10

[Name the coinaud segemen]

Right posterior lobe

6, 7

11

[hepatic vein drainage]

segment 5-8

right hepatic

12

[hepatic vein drainage]

segment 4,5,8

middle hepatic

13

[hepatic vein drainage]

segment 2,3

left hepatic

14

[hepatic vein drainage]

caudate lobe

IVC

15

the pringle maneuver compress what structures?

portal vein, hepatic artery, CBD

16

[Liver function test]

hepatocellular injury

ALT, AST

17

[Liver function test]

Synthetic function

Albumin
Clotting factors EXCEPT factor 8

18

[Liver function test]

Cholestasis

TB
B2 transferrin
ALP
GGTP

19

[Liver function test]

what is the best measure of liver synthetic function test?

PT and INR

20

[Liver function test]

Most specific for liver diseases: AST or ALT?

ALT

21

[Liver function test]

increased in extrahepatic

Direct bilirubun

22

[Liver function test]

increased in intrahepatic diorders

Indirect unconjucated

23

[Liver function test]

indicative of biliary obstruction

alkaline phosphatase

24

[Liver function test]

early marker and sensitive test for hepatobiliary disease

GGTP

25

[jaundice]

detectable when serum bilirubin is?

>2.5 to 3 mg/dL

26

[Cirrhosis]

causes if impaired hepatic regeneration

1. Destruction of reticulin framework
2. Disturbances in blood supply
3. Necrosis too extensive
4. Malnutrition
5. Inhibition of hepatocyte proliferation

27

[cirrhosis]

Hepatic nodule formation is due to?

hepatic proliferation limited by enveloping scars

28

[cirrhosis]

vein responsible for caput medusae

umbilical vein

29

[cirrhosis]

ascites is clinically detected if the volume is ____

>1.5L

30

___ syndrome

spigastric vascular murmur

Cruveilhier-Baumgarten Syndrome

31

This syndrome shunts blood from the portal vein to the umbilical vein. It can be present without caput medusae.

Cruveilhier-Baumgarten Syndrome

32

[cirrhosis]

Horizontal white bands and/or proximal white nail plate is due to?

Hypoalbuminemia

33

[cirrhosis]

Dupuytren contracture is due to an increase in what compound?

hypoxanthine

34

[cirrhosis]

Asynchronous flapping motions or dorsiflexed hand

asterexis

35

[spontaneous bacterial peritonitis]

what is the first line drug for SBP?

Cefotaxime

36

[Assessment of hepatic reserve]

This predicts surgical risks of intraabdominal operations prepared by patients with cirrhosis

Child-Turcotte-Pugh Score

37

[Assessment of hepatic reserve]

what are the components of the Child Pugh Score?

Jaundice: bilirubin 2-3
Ascites: minimal, controlled
Prothrombin time: 40-70%
Albumin: 2.8 to 3.5
Nutritional status: Good

Child Pugh B is described above

38

[Assessment of hepatic reserve]

Child-Pugh B is associated with ___ % mortality

30%

39

[Assessment of hepatic reserve]

80% mortality is associated in what Child-Pugh Score?

Class C

40

[Portal Hypertension]

What is the normal portal pressure?

5-10 mmHg

41

[Portal Hypertension]

Portal hypertension is diagnosed if the direct portal venous pressure is?

>5mmHg

42

[Portal Hypertension]

Portal hypertension is diagnosed if the splenic pressure is?

>15mmHg

43

[Portal Hypertension]

varices form if the portal pressure exceeds? ___

>12mmHg

44

[Portal Hypertension]

what is the most accurate method of determining the portal pressure?

Hepatic Venography

45

[portosystemic collaterals]

Causes Esophageal varices

Left Gastric
Azygous Vein

46

[portosystemic collaterals]

Causes caput medusae

umbilical vein

47

[portosystemic collaterals]

Causes hemorrhoids

middle hemorrhoidal
inferior hemorrhoidal

48

[Portal hypertension]

Due to sinusoidal obstruction

Steatohepatitis
Wilson disease

49

[Portal hypertension]

due to high flow states

AV fistula
Banti syndrome

50

[diagnosis]

Abdominal pain
ascites
liver enlargement
occlusion of the hepatic vein

Budd-Chiari Syndrome

51

[Pre/Sinu/Postsinusoidal]

Alcoholic central hyaline sclerosis

postsinusoidal

52

[Pre/Sinu/Postsinusoidal]

Acute alcoholic hepatitis

sinusoidal

53

[Pre/Sinu/Postsinusoidal]

vitamin A intoxication

Sinusoidal

54

[Pre/Sinu/Postsinusoidal]

Schistosomiasis

Presinusoidal

55

[Pre/Sinu/Postsinusoidal]

Chronic active hepatitis

Pre-sinusoidal

56

[Pre/Sinu/Postsinusoidal]
vinyl chloride

presinusoidal

57

[Pre/Sinu/Postsinusoidal]

cirrhosis

sinusoidal

58

[Management of acute variceal bleeding]

Drug of choice

Octreotide

But vasopressin can be given

59

[Management of acute variceal bleeding: refractory bleeding]

What is the surgical technique if the patient is classified as Child A?

surgical shunt

60

[Management of acute variceal bleeding: refractory bleeding]


What is the surgical management if the patient is classified as Child B and C

TIPS

61

[Portosystemic Surgical Shunts]

Distal splenorenal

Warren

62

[Portosystemic Surgical Shunts]

Left gastric vena caval shunt

Inokuchi

63

[Portosystemic Surgical Shunts]

Small diameter portacaval H graft shunt

Sarfeh

64

[Portosystemic Surgical: Nonshunts]

ligation of venous branches entering the distal esophagus; for recurrent variceal bleeding

Sugiura-Fukugawa

65

[Portosystemic Surgical: Nonshunts]


Splenectomy+ Perihiatal devascularization of the lower esophagus +Ligation of the left gastric vessels + devascularization of the proximal hald of the stomach + separation of stomach from its bed through the abdominal approach

Hassab procedure

66

[Portosystemic Surgical: Nonshunts]


the most definitive complication of portal hypertension

orthotopic liver transpantation

67

___ tube is used to initially control esophageal bleed

Sengstaken-Blakemore Tube

68

Budd-Chiari Syndrome is associated with hyper____

homocysteinemia

69

[diagnosis]

hypoechoic lesion with well-defined borders and variable internal echoes

Pyogenic Liver Abscess

70

[diagnosis]

hypodense lesions with or without air-fluid levels and peripheral enhancement

pyogenic liver abscess

71

[diagnosis]

RUQ pain, fever
elevated WBC, ESR, ALP

pyogenic liver abscess

72

[pyogenic liver abscess]

single or multiple large abscesses can be managed surgically by ____

percutaneous drainage

73

What is the etiologic agent of hydatid disease?

Echinococcus granulosus

74

This is the definitive host of echinococcus granulosus

dog

75

[diagnosis]

anteroinferior or posteroinferior portions of the right lobe, dull RUQ pain or abdominal distention, allergic or anaphylactic reaction with cycst rupture

Hydatid disease

Tx: albendazole

76

most frequently encountered liver lesion overall

hepatic cysts

77

most common benign solid mass in the liiver

hemangioma

78

[diagnose]

Dual-phase CT shows asymmetrical peripheral enhancement with progressive centripetal enhancement

MRI: hypointense in T1, hyperintense in T2

hemangioma

79

The greatest risk factor of this benign solid neoplasm of the liver is

OCP use

80

[diagnose]

On CT: central scar
Nuclear scan shows hot nodules

Focal nodular hyperplasia

81

The most common malignant liver tumor

metastatic

82

[Management of HCCA]

If non-cirrhotic, child A, single lesion, no metastasis

Resection

83

[Management of HCCA]

What are the indications of liver transplant?

1. Nodule < 5cm
2. 2 or 3 nodules <3cm
3. No vascular invasion
4. No extrahepatic spread
5. Child A, B, C

84

[Cholangiocarcinoma]

Location: when it presents as a hepatic mass

Intrahepatic

85

Cholangiocarcinoma]

Location: when it presents at the proximal (hilar) area

extrahepatic

86

Cholangiocarcinoma]

Location of a "Klatskin" tumor

at the hepatic duct conffuence

87

what is the gold standard in treating cholangiocarcinoma?

resection

88

[Roux-en-Y]

The hepatic ducts are attached to this segment

jejunum

89

[Roux-en-Y]

The roux limb refers to the

Jejunum + remaining hepatic duct

90

[Roux-en-Y]

The Y limb refers to the

Duodenum (jejunojejunostomy)

91

[Roux-en-Y]

This part of the small intestine is transected to serve as the Roux and Y limb

Duodenum, Jejunom