Surgery > Liver > Flashcards

Liver Flashcards

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1
Q

—— divided liver into functional segments

A

Couinaud

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2
Q

structure and line that divides liver into hemilivers

A

middle hepatic vein
cantlies line

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3
Q

Left lobe is divided lateral and medial by

A

Left hepatic vein (lies beneath falciform lig)

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4
Q

Left lobe is divided into superior and inf by

A

left portal vein

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5
Q

RHV divides right lobe into

A

post and anterior segment

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6
Q

Functional classification of liver is based on

A

hepatic «_space;portal veins

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7
Q

Number of sectors in liver

A

4

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8
Q

Number of major fissures in liver

A

3
RHV LHV MHV

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9
Q

Number of minor fissures in liver

A

3
LPV
RPV
fissure of Ganz

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10
Q

Gallbladder fossa is formed by

A

segments 4 B and 5

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11
Q

segment 1 is present where

A

Towards left of IVC

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12
Q

Importance of segment 1

A

in BCS when there is hepatic venous out flow obstruction, segment one undergoes hypertrophy due to direct venous drainage into IVC

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13
Q

segment one is further divided into

A

Segment 9
Spigelian lobe

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14
Q

bare area of liver is which segment?

A

7 - right posterosuperior

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15
Q

classification for liver resection

A

Brisbane

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16
Q

Mickey Mouse sign in liver

A

structures in liver pedicle
Portal vein posterior
Common bile duct, right side
Hepatic artery left

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17
Q

categories in child pugh score

A

encephalopathy
ascites
BR
Albumin
PTINR

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18
Q

root of spread of pyogenic liver absence

A

ascending cholangitis

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19
Q

most common segment involved in amoebic, liver abscess

A

segment 7

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20
Q

most common cause of pyogenic liver abscess overall

A

poly microbial

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21
Q

most common organism of pyogenic liver abscess overall

A

E. coli

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22
Q

most common cause of pyogenic liver abscess in asia

A

Klebsiella

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23
Q

most common cause of pyogenic liver abscess in children w chronic granulomatous disease

A

S aureus

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24
Q

more common elevated investigation in Amebic liver abscess

A

PT/INR

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25
more common elevated investigation in pyogenic liver abscess
ALP
26
Rx Amoebic liver abscess
double strength metronidazole started If responding – – – > continue for 2 to 3 weeks
27
What is given after the metronidazole course?
10 days of Diloxanide furoate
28
Indications of aspiration or insertion of pigtail catheter
1. no response to medication. 2.Abscess cavity > 5 cm in size. 3.Pregnant patient. 4.Impending rupture. 5. Left lobe liver abscess:
29
Why is left lobe liver absence drained immediately?
slim chance of rupture into the pericardium.
30
complications of amoebic liver abscess
rupture 2° infection
31
most common sight of rupture of amoeba, liver abscess
sub diaphragmatic space
32
management of pyogenic liver abscess
IV antibiotics low threshold for drainage
33
causative agent of hydatid disease of liver
Echinococcus granulosis/ multilocularis
34
definitive and intermediate host for echinococcus
Definitive dog Intermediate sheep
35
IOC hydatid disease of liver
CECT
36
inactive stages of Hcysts in liver
CE4, CE5
37
Honeycomb cyst is which CE
CE 2
38
Water lily sign is seen in which CE
CE3a
39
solid cyst with a calcified wall seen in which CE
CE 5
40
management of H cyst of liver
albendazole x 7-10 days f/b PAIR
41
most common scolicidal agent used in PAIR
Hypertonic saline
42
scolicidal agents
ethanol Hypertonic saline Absolute alcohol cetrimide Solution Mebendazole sol
43
Contraindications for PAIR
1.Debt and calcified cyst 2. Deep seated cyst 3. Impending rupture. 4. Multi septate. 5. Extrahepatic cyst. 6. cystobiliary communication.
44
surgical procedures for H cyst
cystopericystectomy Liver resection capitonage
45
IOC liver tumors
Triple phase CT
46
most common benign tumour of the liver:
Hemangiona.
47
Second most common benign tumour of the liver:
Focal nodular hyperplasia.
48
most common malignant liver tumour:
metastasis.
49
most common primary malignant liver tumour :
Hepatocellular carcinoma
50
most common primary malignant liver tumour in children:
Hepatoblastoma
51
v large hemangiomas can lead to
Kasabach Merrit syndrome - consumption coagulopathy
52
etiology of FNH
vascular insult to liver
53
findings on triple phase CT in liver hemangioma
Appears hypodense in non contrast phase. Peripheral nodular enhancement: in arterial phase. Homogenous enhancement: In venous/washout phase.
54
findings on triple phase CT in FNH
central stellate scar
55
ddx central stellate scar
FNH oncocytoma
56
special cells on FNH showing hot spot on —— scan
Kupffer cells - hot spot on sulfur colloid scan
57
benign liver tumor w strongest assoc with OCPs
Hepatic adenoma
58
adenoma pts present w
hepatomegaly
59
MC non traumatic cause of hemoperitoneum
hepatic adenoma
60
hepatic adenoma appearance on triple phase CT
heterogeneous
61
mx of hepatic adenoma
<2 cm : observe >5 cm : resection
62
classification of liver cell adenoma
Bordeaux
63
thorotrast exposure inc risk of
HCC RCC cholangioCA
64
MC c/f of HCC
hepatomegaly
65
paraneoplastic syndromes in HCC
hypoglycemia hyper cholesterolemia gynecomastia Cushing
66
MC paraneoplastic syndrome in HCC
hypoglycemia
67
MC biochemical paraneoplastic syndrome in HCC
hypercholesteremia
68
tumor markers HCC
AFP PIVKA2 Glycipan. HepPar-1 Neurotensin B:
69
MILAN criteria
single tumor < 5 cm or 1-3 tumours <3 cm with no distant mets / vascular invasion
70
Mx Child Pugh A tumour:
Adequate functional liver reserve (>25%), resectable tumour → Liver resection.
71
mx Child Pugh B and C tumour : Functional liver reserve < 25%
Transplantation if patients meet the miLAN criteria
72
Mx patients do not meet the mILAN criteria
NIMURA technique /ALPPS procedure: Portal vein embolization
73
mx advanced / mets HCC
palliative
74
if multiple tymours in one lobe in HCC, technique that can be used
TACE / TARE (Yttrium is used )
75
prognostic indicators for HCC
1.OKUDA 2.CLIP 3.BCLC
76
okuda score components
BATA bilirubin ascites tumor size albumin
77
most imp prognostic factor in HCC
stage
78
mc site of mets in HCC
lung
Surgery
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