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SB82 Liver
SB82 Liver - loosely taken from Fiser's ABSITE review
| Question | Answer |
|---|---|
| Most common hepatic artery variant | Right hepatic artery off the SMA |
| The variant of left hepatic artery off the left gastric artery is found within what structure? ______________ | The gastrohepatic ligament |
| This structure carries the obliteral umbilical vein to the undersurface of the liver ____________ | Ligamentum teres |
| This line drawn from the middle of the gallbladder fossa to the IVC separates the liver into its right and left lobes ____________ | Cantlie’s line |
| Hepatic segment 1 is also known as the _________ lobe | Caudate |
| What is the term for the peritoneum that covers the liver? ____________ | Glisson’s capsule |
| These ligaments are lateral and medial extensions of the coronary ligament on the posterior surface of the liver ___________ | Triangular ligaments |
| Liver macrophages are also known as _____________ cells | Kupffer |
| The ligament where the bile duct, portal vein and hepatic artery (portal triad) meet | Hepatoduodenal |
| The portal vein is located in this orientation in the portal triad ___________ | Posterior |
| The anterior, posterior, superior and inferior borders of the Foramen of Winslow | Anterior – portal triad, posterior – IVC, superior – liver, inferior – duodenum |
| The Pringle maneuver will not stop this structure from bleeding | Hepatic vein, because it is not within the portal triad |
| The portal vein starts at the joining of these two structures | Splenic vein and SMV |
| The middle hepatic artery is most commonly a branch off of the ____________ hepatic artery | Left |
| Most primary and secondary tumors of the liver are supplied blood by this structure __________ | Hepatic artery |
| The middle hepatic vein joins the ___________ (left / right) hepatic vein in 80% of people before going into the IVC | Left |
| Accessory right hepatic veins drain the medial aspect of the right lobe directly into the ________ | IVC |
| What drains the caudate lobe, and where? | The caudate lobe drains directly into the IVC through separate hepatic veins |
| What is the usual energy source of the liver? ____________ | Ketones |
| Clotting factors NOT made in the liver | vWF and Factor VIII |
| What is the only water-soluble vitamin stored by the liver? | Vitamin B12 |
| Which hepatocytes are most sensitive to ischemia? ________ | Central lobular |
| How much normal liver can be safely resected? | 75% |
| Bilirubin is conjugated into what substance by the liver? __________ | Glucuronic acid |
| Bilirubin is conjugated in the liver by what enzyme? __________ | Glucuronyl transferase |
| The substance produced by the breakdown of bilirubin by bacteria in the terminal ileum __________ | Urobilinogen |
| The final bile composition is determined by what factor? | The active reabsorption of water in the gallbladder |
| Bile acids are conjugated into what substances? | Taurine and glycine |
| The main biliary phospholipid ____________ | Lecithin |
| The purpose of lecithin in bile acid | Solubilizes cholesterol and emulsifies fats in the intestine |
| Jaundice occurs when bilirubin is at what level? | 2.5 |
| Gilbert’s disease – underlying cause, and lab findings | Abnormal uptake; mildly elevated unconjugated bilirubin |
| Crigler-Najjar disease – underlying cause, and lab findings | Inability to conjugate; very elevated unconjugated bilirubin |
| Physiologic jaundice of the newborn– underlying cause, and lab findings | Immature glucuronyl transferase; elevated unconjugated bilirubin |
| Rotor’s syndrome – underlying cause, and lab findings | Deficiency in storage ability; elevated Conjugated bilirubin |
| Dubin-Johnson syndrome – underlying cause, and lab findings | Deficiency in SECRETION; elevated Conjugated bilirubin |
| Anti-HBc-IgM (core) is elevated for the first _______ months | 6 months |
| Findings in a patient who had infection with hepatitis with recovery and subsequent immunity | Elevated anti-HBc and anti-HBs antibodies, and no HBs antigens |
| Causes fulminant hepatitis in pregnancy ___________ | Hepatitis E |
| Most common cause of liver failure __________ | Cirrhosis |
| Best indicator of synthetic function in patients with cirrhosis _______ | Prothrombin time |
| Outcome of acute fulminant hepatic failure is determined by _________ | The course of encephalopathy |
| Liver failure causes hepatic encephalopathy through its inability to metabolize and buildup of what substances? | Ammonia, mercantanes, methane thiols, false neurotransmitters |
| Protein intake in hepatic encephalopathy should be limited to < __________ g/day | 70 |
| How much albumin should be given after paracentesis? | 1 g albumin for each 100 mL ascites removed |
| Postpartum liver failure with ascites is often due to ________________ | Hepatic vein thrombosis |
| How do you diagnose hepatic vein thrombosis? | SMA arteriogram with venous phase contrast |
| To make a diagnosis of SBP, how many neutrophils will be contained in a milliliter of ascitic fluid? | 250 neutrophils per mL |
| What is the most common organism in SBP? | E. coli |
| If there are multiple organisms grown on culture of ascitic fluid in a patient with SBP, what likely caused the contamination? _________ | Bowel perforation |
| Treatment for SBP | Third-generation cephalosporin |
| Initial treatment for bleeding esophageal varix | Sclerotherapy (90% effective) |
| Bleeding varices have a _________ % mortality with the first episode | 33% |
| Another name for hepatic vein occlusive disease | Budd-Chiari syndrome |
| Treatment of Budd-Chiari syndrome | Portocaval shunt (needs to connect to the IVC above the obstruction) |
| Indications for splenorenal shunt | Child’s A cirrhosis with only bleeding on presentation; contraindicated in refractory ascites |
| Most common cause of portal hypertension in children | Extrahepatic thrombosis of the portal vein |
| Amebic abscesses are usually located in the _________ lobe of the liver | Right |
| What are the tests for an echinococcal cyst? | Casoni skin test and indirect hemagglutination |
| Treatment for echinococcal cyst | Pre-operative albendazole followed by intact resection |
| Treatment for schistosomiasis _______________ | Praziquantel |
| Most common organism found in pyogenic liver abscess ____________ | E. coli |
| Most common cause of pyogenic liver abscess ________________ | Bacteremia from intra-abdominal infection |
| Test for hepatic adenoma | No uptake of sulfur colloid (no Kupffer cells in the adenoma – focal nodular hyperplasia will show uptake) |
| This liver lesion has a central stellate scar ____________ | Focal nodular hyperplasia |
| HCC has a ______ % 5-year survival rate with resection | 30% |
| Vascularity of primary liver tumors versus metastatic liver tumors | Primary – hypervascular; metastatic - hypovascular |
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StudyBug82
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