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Flashcards in liver Deck (99):
1

what is cantles line

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

2

which ligament goes from ant abd wall to liver

falciform ligament

3

what ligament attaches liver to diaphragm

coronary ligament

4

venous supply of liver

portal vein

5

max amt liver can be resected while retaining adequate liver function

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

6

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

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

7

what comprises the child's classification

" a beap"

ascites, bilirubin,encephalopathy, albumin, pt

8

Meld score

"model for end stage liver disease"

measures: INR, t bili, serum creatinine

9

mc liver cancer

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

10

mc primary malignant liver tumor

hepatocellular carcinoma (hepatoma)

11

mc primary benign liver tumor

hemangioma

12

imaging/lab studies for liver cancer

ct scan, us, a gram

lfts, cea

13

right trisegmentectomy

removal of all the liver tissue to right of falciform ligament

14

3 common types of primary benign liver tumors

1. hemangioma
2. hepatocellular adenoma
3. focal nodular hyperplasia

15

4 common types of primary malignant liver tumors

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

16

what chemical exposures are risk factors for angiosarcoma

vinyl chloride*, arsenic, thorotrast contrast

17

liver hamartoma

white hard nodule made up of normal liver cells

18

risk factors for hepatocellular adenoma

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


age 30-35

19

s/sx hepatocellular adenoma

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

20

complications hepatocellular adenoma

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

21

dx hepatocellular adenoma

ct scan, us, +/- bx

22

tx small hepatocellular adenoma

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

23

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

surgical resection

24

what is focal nodular hyperplasia (FNH)

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

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