Liver Flashcards by Clyde Silverio

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

Cantlie’s line

How well did you know this?

Not at all

Perfectly

_____ separates the left lateral and left medial segments

falciform ligament

How well did you know this?

Not at all

Perfectly

the faciform ligaments divide the left lobe to ____

left lateral and left medial segments

small left lobe
large left lobe

How well did you know this?

Not at all

Perfectly

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

Gallbladder
Fissure of ligamentum teres
IVC
Fissure of ligamentum venosum

How well did you know this?

Not at all

Perfectly

The right lobe is composed of what lobes?

Quadrate lobe

2. Caudate lobe

How well did you know this?

Not at all

Perfectly

[Name the coinaud segemen]

caudate

How well did you know this?

Not at all

Perfectly

[Name the coinaud segemen]

left lateral

2 and 3

How well did you know this?

Not at all

Perfectly

[Name the coinaud segemen]

left medial

How well did you know this?

Not at all

Perfectly

[Name the coinaud segemen]

right anterior lobe

5, 8

How well did you know this?

Not at all

Perfectly

[Name the coinaud segemen]

Right posterior lobe

6, 7

How well did you know this?

Not at all

Perfectly

[hepatic vein drainage]

segment 5-8

right hepatic

How well did you know this?

Not at all

Perfectly

[hepatic vein drainage]

segment 4,5,8

middle hepatic

How well did you know this?

Not at all

Perfectly

[hepatic vein drainage]

segment 2,3

left hepatic

How well did you know this?

Not at all

Perfectly

[hepatic vein drainage]

caudate lobe

IVC

How well did you know this?

Not at all

Perfectly

the pringle maneuver compress what structures?

portal vein, hepatic artery, CBD

How well did you know this?

Not at all

Perfectly

[Liver function test]

hepatocellular injury

ALT, AST

How well did you know this?

Not at all

Perfectly

[Liver function test]

Synthetic function

Albumin

Clotting factors EXCEPT factor 8

How well did you know this?

Not at all

Perfectly

[Liver function test]

Cholestasis

TB
B2 transferrin
ALP
GGTP

How well did you know this?

Not at all

Perfectly

[Liver function test]

what is the best measure of liver synthetic function test?

PT and INR

How well did you know this?

Not at all

Perfectly

[Liver function test]

Most specific for liver diseases: AST or ALT?

ALT

How well did you know this?

Not at all

Perfectly

[Liver function test]

increased in extrahepatic

Direct bilirubun

How well did you know this?

Not at all

Perfectly

[Liver function test]

increased in intrahepatic diorders

Indirect unconjucated

How well did you know this?

Not at all

Perfectly

[Liver function test]

indicative of biliary obstruction

alkaline phosphatase

How well did you know this?

Not at all

Perfectly

[Liver function test]

early marker and sensitive test for hepatobiliary disease

GGTP

How well did you know this?

Not at all

Perfectly

[jaundice] detectable when serum bilirubin is?

>2.5 to 3 mg/dL

[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

[cirrhosis] Hepatic nodule formation is due to?

hepatic proliferation limited by enveloping scars

[cirrhosis] vein responsible for caput medusae

umbilical vein

[cirrhosis] ascites is clinically detected if the volume is ____

>1.5L

___ syndrome spigastric vascular murmur

Cruveilhier-Baumgarten Syndrome

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

Cruveilhier-Baumgarten Syndrome

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

Hypoalbuminemia

[cirrhosis] Dupuytren contracture is due to an increase in what compound?

hypoxanthine

[cirrhosis] Asynchronous flapping motions or dorsiflexed hand

asterexis

[spontaneous bacterial peritonitis] what is the first line drug for SBP?

Cefotaxime

[Assessment of hepatic reserve] This predicts surgical risks of intraabdominal operations prepared by patients with cirrhosis

Child-Turcotte-Pugh Score

[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

[Assessment of hepatic reserve] Child-Pugh B is associated with ___ % mortality

30%

[Assessment of hepatic reserve] 80% mortality is associated in what Child-Pugh Score?

Class C

[Portal Hypertension] What is the normal portal pressure?

5-10 mmHg

[Portal Hypertension] Portal hypertension is diagnosed if the direct portal venous pressure is?

>5mmHg

[Portal Hypertension] Portal hypertension is diagnosed if the splenic pressure is?

>15mmHg

[Portal Hypertension] varices form if the portal pressure exceeds? ___

>12mmHg

[Portal Hypertension] what is the most accurate method of determining the portal pressure?

Hepatic Venography

[portosystemic collaterals] Causes Esophageal varices

Left Gastric | Azygous Vein

[portosystemic collaterals] Causes caput medusae

umbilical vein

[portosystemic collaterals] Causes hemorrhoids

middle hemorrhoidal | inferior hemorrhoidal

[Portal hypertension] Due to sinusoidal obstruction

Steatohepatitis | Wilson disease

[Portal hypertension] due to high flow states

AV fistula | Banti syndrome

[diagnosis] Abdominal pain ascites liver enlargement occlusion of the hepatic vein

Budd-Chiari Syndrome

[Pre/Sinu/Postsinusoidal] Alcoholic central hyaline sclerosis

postsinusoidal

[Pre/Sinu/Postsinusoidal] Acute alcoholic hepatitis

sinusoidal

[Pre/Sinu/Postsinusoidal] vitamin A intoxication

Sinusoidal

[Pre/Sinu/Postsinusoidal] Schistosomiasis

Presinusoidal

[Pre/Sinu/Postsinusoidal] Chronic active hepatitis

Pre-sinusoidal

[Pre/Sinu/Postsinusoidal] | vinyl chloride

presinusoidal

[Pre/Sinu/Postsinusoidal] cirrhosis

sinusoidal

[Management of acute variceal bleeding] Drug of choice

Octreotide But vasopressin can be given

[Management of acute variceal bleeding: refractory bleeding] What is the surgical technique if the patient is classified as Child A?

surgical shunt

[Management of acute variceal bleeding: refractory bleeding] What is the surgical management if the patient is classified as Child B and C

TIPS

[Portosystemic Surgical Shunts] Distal splenorenal

Warren

[Portosystemic Surgical Shunts] Left gastric vena caval shunt

Inokuchi

[Portosystemic Surgical Shunts] Small diameter portacaval H graft shunt

Sarfeh

[Portosystemic Surgical: Nonshunts] ligation of venous branches entering the distal esophagus; for recurrent variceal bleeding

Sugiura-Fukugawa

[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

[Portosystemic Surgical: Nonshunts] the most definitive complication of portal hypertension

orthotopic liver transpantation

___ tube is used to initially control esophageal bleed

Sengstaken-Blakemore Tube

Budd-Chiari Syndrome is associated with hyper____

homocysteinemia

[diagnosis] hypoechoic lesion with well-defined borders and variable internal echoes

Pyogenic Liver Abscess

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

pyogenic liver abscess

[diagnosis] RUQ pain, fever elevated WBC, ESR, ALP

pyogenic liver abscess

[pyogenic liver abscess] single or multiple large abscesses can be managed surgically by ____

percutaneous drainage

What is the etiologic agent of hydatid disease?

Echinococcus granulosus

This is the definitive host of echinococcus granulosus

dog

[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

most frequently encountered liver lesion overall

hepatic cysts

most common benign solid mass in the liiver

hemangioma

[diagnose] Dual-phase CT shows asymmetrical peripheral enhancement with progressive centripetal enhancement MRI: hypointense in T1, hyperintense in T2

hemangioma

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

OCP use

[diagnose] On CT: central scar Nuclear scan shows hot nodules

Focal nodular hyperplasia

The most common malignant liver tumor

metastatic

[Management of HCCA] If non-cirrhotic, child A, single lesion, no metastasis

Resection

[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

[Cholangiocarcinoma] Location: when it presents as a hepatic mass

Intrahepatic

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

extrahepatic

Cholangiocarcinoma] Location of a "Klatskin" tumor

at the hepatic duct conffuence

what is the gold standard in treating cholangiocarcinoma?

resection

[Roux-en-Y] The hepatic ducts are attached to this segment

jejunum

[Roux-en-Y] The roux limb refers to the

Jejunum + remaining hepatic duct

[Roux-en-Y] The Y limb refers to the

Duodenum (jejunojejunostomy)

[Roux-en-Y] This part of the small intestine is transected to serve as the Roux and Y limb

Duodenum, Jejunom

Liver Flashcards

(91 cards)