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absite liver
| Question | Answer |
|---|---|
| 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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