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absite liver

MC hep a variant R hep A off of SMA going behind pancreas
falciform lig contains what, divides what carries obliterated umbil vein to undersurface of liver; att liver to ant abd wall, sep medial and lateral liver segments
what's name of peritoneum around liver Glisson's capsule
what divides R and L lobes liver portal fissure/Cantlie's line (from middle of GB to IVC)
what is contained in portal triad, aka, position of ea component hepatoduo lig: portal vein (posterior),hepatic artery (medial), c bile duct (lateral)
which segments is where portal triad enters? Where GB is? both seg IV, V
L liver contains which seg, R liver 1-4, 5-8
what are the borders of foramen of winslow anterior portal triad, posterior IVC, inferior duo, superior liver
what's pringle maneuver clamp porta triad/porta hepatis, but won't stop hep v bleeding
what joins to form portal vein SMV+splenic
what is special abt blood flow of caudate receives separate R and L portal and arterial blood flow and drains directly into iVC cia sep hep veins
what are liver macro called kupffer cells
2 membranes in hepatocytes sinusoidal for nutrient uptake, canclicular where alkP is
urea synthesized where in liver!
what energy source does liver use ketones
what is only water sol vitamin stored in liver B12
which hepatocytes most sensitive to isch central lobar (acinar zone III)
steps of bili breakdown heme->bilverdin->bilirubin, conjugated to glucuronic acid w glucuronyl trxs in liver, then secreted into bile
where does urobilinogen come from bac in terminal ileum breakdown bili ->blood ->urine
indirect bili elevation due to Unconjugated; prehepatic (hemolysis) or problems in hep uptake/conjuvation
direct bili elevation due to conjugated bili; secretion problems
2 syndromes unconjugated bili and mechanism Gilberts (abnl uptake), Crigler-Najar (defic glucuronyl trxs)
2 syndromes conjugated Rotos, Dubin-Johnson
what's the cause of physiol jaundice of newborn; which bili is elevated immature glucuronyl trxs, unconjugated
what's serology of person s/p HepB vaccine HepBs Ab, no core or sAg
serology of person w chronic HepB HepBc, HepBsAg but no HepBsAb
serology of person w h/o HepB recovered HepBc and HepBsAb but no sAg
which Hep is DNA (not RNA) Hep B
which lab best indicator liver synthetic fxn PT
liver failure post partum think… hep vein thrombosis (Budd Chiari)
tx hep encephalopathy lactulose, protein <70g, branched aa, neomycin, dopa agonist, dx tap to r/o SBP, guaiac
mech of lactulose, titration eliminates bac in gut and acidifies colon preventing NH3 uptake), titrate to 2-3 stools/d
tx ascites decrs NaCl, spironolactone (counters hyperaldosterone), paracentesis
fluid give s/p paracentesis 1g albumin/100cc
s/s and dx of SBP F, abd pain, PMN>250 in fluid, + Cx
MC bug SBP E Coli
tx SBP 3rd gen cephalo
acute and chronic med tx eso varices sclerotherapy + vasopressin (+NTG if CAD), octreotide; chronic tx=propanolol
how does vasopressin help eso varices splanchnic a constriction
what's nml portal P and how measured <12, estimated by wedged hep venous P
causes of portal HTN divided into 3 grps and causes presinusoidal: schisto, portal v thrombosis; sinusoidal=cirrhosis; post-sinusoidal=hep vein, CHF
how is TIPs performed go from jug vein into hep vein, then put shunt into nearby portal vein branches
risk of TIPs encephalopathy
how does splenic v thrombosis present? MC cause? Tx? isolated gastric varices, 2/2 pancreatitis, tx=splenectomy
4 MC liver abscesses amebic/E histolytica (single abscess), hydatid/Echinococus (mltpl), Schisto (eos), pyogenic
tx Amebic/E histo liver abscess flagyl, don't need aspiration
tx hydatid cyst preop Albendazole, surgery w/o spilling
tx schisto liver praziquantel
MC cause pyogenic abscess, tx usu GNR (MC E Coli) usu contiguous w biliary tract, tx=aspiration and Abx
differentiate hep adenoma and focal nodular hyperplasia adenoma in women w OCP, no sulfur colloid scan uptake; hyperplasia has uptake. Both rapid intake and wash out CT w contrast
MC benign hep tumor hemangioma
tx hemangioma conservative unless sympt, then surgery +/- emboliz…can have consumptive coag and CHF
cancer in liver--1ry v2ry and how tell diff mets most common (20:1), 1ry tumors are hypervascular and mets hypovascular
HCC tumor marker, how does it correlate w progression AFP, correlates w tumor size
HCC survival w resxn 30% 5 yr
how much margin needed? Usu resectable? few are resectable bc of cirrhosis/portohep involvement/mets; 1cm margin
RF for hep sarcoma, px PVC, thorotrast, arsenic, rapidly fatal
RF cholangiosarcoma clonorhiasis infx, UC, hemochromo, 1ry scleros cholangitis, choledochal cyst
which is wrose: intrahep or extrahep cholangiosarc intrahep
should resect CRC mets to liver yes
Created by: ehstephns
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