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