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SB82 Liver

SB82 Liver - loosely taken from Fiser's ABSITE review

QuestionAnswer
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
Created by: StudyBug82