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