Drl Fiser Absite Liver

Front 1

What is the #1 hepatic artery variant?

Back 1

right hepatic artery off SMA, courses behind pancreas, posterolateral to the common bile duct

Front 2

What variant of the left hepatic artery is found in about 20% of the population?

Back 2

left hepatic artery off left gastric artery

Front 3

What is the most common variant of the common hepatic artery?

Back 3

off SMA

Front 4

What lobes of the liver does the falciform ligament separate?

Back 4

medial and lateral segments of the left lobe

Front 5

What does the falciform ligament carry?

Back 5

remnant of the umbilical vein

Front 6

What carries the obliterated umbilical vein to the undersurface of the liver?

Back 6

ligamentum teres

Front 7

What separates the right and left lobes of the liver?

Back 7

cantlie's line aka portal fissure

(drawn from the gallbladder fossa to the IVC)

Front 8

What is the peritoneum that covers the liver called?

Back 8

Glisson's capsule

Front 9

The portal triad enters and the gallbladder lies under what two segments of liver?

Back 9

IV and V

Front 10

What are liver macrophages called?

Back 10

Kupffer cells

Front 11

What is the orientation of the contents of the hepatoduodenal ligament?

Back 11

CBD lateral, hepatic artery medial and portal vein posterior

Front 12

What is clamped in the Pringle maneuver?

Back 12

portal hepatis

Front 13

What are the four borders of the foramen of Winslow?

Back 13

anterior - portal triad, posterior - IVC, inferior - duodenum, superior - liver

Front 14

What 3 vessels form the portal vein and what is their configuration?

Back 14

IMV enters the splenic vein, SMV joins the splenic vein

Front 15

How many portal veins in the liver? and what % of the blood supply do they provide?

Back 15

2 portal veins in the liver, 2/3 of the blood supply

Front 16

What are the hepatic arteries? and veins?

Back 16

right, left and middle, same as the veins

Front 17

In 80% of the population what is the configuration of the hepatic veins entering the IVC?

Back 17

Middle hepatic vein joins left hepatic vein before going into the IVC. In the other 20%, all 3 go directly into the IVC.

Front 18

What is unique about the blood supply and drainage of the caudate lobe?

Back 18

Caudate lobe – receives separate right and left portal and arterial blood flow; drains directly into IVC via separate hepatic veins

Front 19

What membrane of the liver does nutrient uptake occur?

Back 19

sinusoidal membrane

Front 20

What is the usual energy source for the liver?

Back 20

ketones

Front 21

What is the only water soluble vitamin stored in the liver?

Back 21

B12

Front 22

What are the 2 most common problems with hepatic resection?

Back 22

bleeding and bile leak

Front 23

Which hepatocytes are most sensitive to ischemia?

Back 23

central lobular (acinar zone III)

Front 24

What % of the liver can be safely resected?

Back 24

75%

Front 25

Bilirubin is conjugated to what in the liver which improves water solubility?

Back 25

glucuronic acid

Front 26

What comprises 85% of bile? what is the main phospholipid in bile?

Back 26

bile salts, lecithin

Front 27

In bile, what is used to make bile acids?

Back 27

cholesterol

Front 28

What two molecules are bile acids conjugated to in order to make them more water soluble?

Back 28

taurine or glycine

Front 29

What are the two primary bile acids? the two secondary (dehydroxylated primary acids by bacteria in gut)?

Back 29

primary - cholic and chenodeoxycholic
secondary - deoxycholic and lithocholic

Front 30

What level of bilirubin is necessary for jaundice?

Back 30

>2.5

Front 31

What is the maximum bilirubin possible (unless pt has underlying renal disease, hemolysis or bile duct-hepatic vein fistula)?

Back 31

30

Front 32

What disease is the abnormal uptake of bilirubin resulting in mildly high unconjugated bilirubin?

Back 32

Gilbert's disease

Front 33

What disease is the inability to conjugate bilirubin; deficiency of glucuronyl transferase; high unconjugated bilirubin -> life threatening disease.

Back 33

Crigler-Najjar disease

Front 34

Physiologic jaundice of newborn has high unconjugated bilirubin and is the result of which immature enzyme?

Back 34

glcuronyl transferase

Front 35

There are two syndromes that have a high conjugated bilirubin. Which one is a deficiency in storage ability and which one is a deficiency in secretion ability?

Back 35

Rotor's syndrome is a deficiency in storage ability. Dubin-Johnson syndrome is a deficiency in secretion ability.

Front 36

In hep B which Ig dominates in the first 6 months? which one then takes over?

Back 36

IgM then IgG

Front 37

In Hep B which Anti-HB rises 10-12 weeks after infection? and 12-14? and 14-16?

Back 37

10-12 weeks Anti HBc
12-14 weeks Anti-HBe
14-16 weeks Anti-HBs

Front 38

What Ab is elevated in a pt who is vaccinated against Hep B

Back 38

Anti-HBs

Front 39

If a pt has elevated anti-HBc and elevated anti-HBs antibodies and no HBs antigens, what does that mean?

Back 39

pt had infection with recovery and subsequent immunity

Front 40

What is the most common viral hepatitis leading to liver TXP?

Back 40

Hep C (long incubation period)

Front 41

Hepatitis D is a cofactor for which other Hepatitis?

Back 41

Hep B

Front 42

What does Hepatitis E cause?

Back 42

fulminant hepatic failure in pregnancy, most often in 3rd trimester

Front 43

What is the most common cause of liver failure?

Back 43

cirrhosis

Front 44

What is the best indicator of synthetic function in pts with cirrhosis?

Back 44

prothrombin time (PT)

Front 45

What is the mortality of acute fulminant hepatic failure? The course of what sx determines the outcome?

Back 45

80% mortality, encephalopathy

Front 46

What is the main medical tx for hepatic encephalopathy and how does it work?

Back 46

lactulose is a cathartic that gets rid of bacteria in the gut and acidifies the colon preventing NH3 uptake by converting it to ammonium (titrate to 2-3 stools per day)

Front 47

What should you limit the protein intake to in hepatic encephalopathy?

Back 47

<70 g/day

Front 48

Other than the mainstay, lactulose, name three other medical treatments for hepatic encephalopathy.

Back 48

Neomycin, L-dopa, bromocriptine

Front 49

When you do a paracentesis for ascites what do you need to replace and what is the dose?

Back 49

albumin, 1g for every 100cc removed

Front 50

What is increased aldosterone caused by in ascites?

Back 50

impaired hepatic metabolism and impaired GFR

Front 51

Hepatorenal syndrome has the same appearance as prerenal azotemia what is the tx (2)?

Back 51

stop diuretics, give volume

Front 52

What is the cause of postpartium liver failure with ascities and how do you dx?

Back 52

hepatic vein thrombosis

Dx: SMA arteriogram with venous phase contrast

Front 53

Sx of SBP include fever, abdominal pain, positive cultures and PMNs greater than what level in the fluid?

Back 53

250

Front 54

SBP is most commonly mono-organism; if it is not then you need to worry about what?

Back 54

bowel perforation

Front 55

What is the most common organism in SBP?

Back 55

E. coli

Front 56

What is a risk factor for SBP in children?

Back 56

SLE

Front 57

What is the tx for SBP?

Back 57

3rd -generation cephalosporin; pts usually respond within 48 hrs

Front 58

What is 90% effective at treating esophageal varices?

Back 58

sclerotherapy

Front 59

Name 2 medical treatments for esophageal varices and how they work.

Back 59

vasopressin (splanchnic artery constriction)
octreatide (decreased portal pressure by decreased blood flow)

Front 60

In pts with esophageal varices who are on vasopressin and have CAD should get what additional medical tx?

Back 60

NTG

Front 61

What is the name of the tube for esophageal varices that has a risk of esophageal rupture and is hardly used anymore?

Back 61

Sengstaken-Blakemore

Front 62

What is the role for propanolol in esophageal varices?

Back 62

may help prevent rebleeding; no good role acutely

Front 63

Pts who develop strictures after sclerotherapy for esophageal varices are easily managed with what tx? what if they develop refractory variceal bleeding, what tx?

Back 63

dilatation, TIPS for refractory bleeding

Front 64

What does TIPS stand for?

Back 64

transjugular intrahepatic portosystemic shunt

Front 65

What is the mortality of bleeding varices with 1st episode? What % will rebleed and what is the mortality with each subsequent bleeding episode?

Back 65

33%, 50%, 50%

Front 66

50% of portal hypertension in children is caused by what?

Back 66

portal vein thrombosis

Front 67

What is the normal port vein pressure?

Back 67

<12 mmHg

Front 68

What procedure would you do for a Child's A cirrhotic that just has bleeding as a symptom?

What if the pt is Child's B or C with indication for shunt (bleeding, progression of coagulopathy, visceral hypoperfusion, refractory ascites)?

Back 68

splenorenal shunt (more durable) for A

TIPS for B or C

Front 69

Pts with TIPS are at risk for developing what?

Back 69

encephalopathy

Front 70

What is the most common cause of massive hematemesis in children?

Back 70

portal HTN due to extrahepatic thrombosis of the portal vein

Front 71

What is the tx for Budd-Chiari syndrome?

Back 71

portacaval shunt (needs to connect to the IVC above the obstruction)

Front 72

Isolated gastric varices without elevation of pressure in the rest of the portal system can be caused by what?

Back 72

Splenic vein thrombosis

Front 73

What is most often the cause of splenic vein thrombosis?

Back 73

pancreatitis

Front 74

What is the treatment for splenic vein thrombosis?

Back 74

splenectomy

Front 75

What is the organism in amebic liver abscesses?

Back 75

Entamoeba Histalytica

Front 76

Risk factors for Entamoeba histalytica include ETOH and travel to Mexico. How do you dx?

Back 76

CT characteristics, elevated LFTs, white count, serology (cultures are often sterile since the protozoa exists only in peripheral rim)

Front 77

What is the tx for amebic liver abscesses?

Back 77

Flagyl; aspiration if refractory of contaminated; surgery only for free rupture

Front 78

What is the organism in hydatid liver cysts?

Back 78

Echinococcus

Front 79

How do you dx echinococcus infections (2 tests)?

Back 79

Positive Casoni skin test, positive indirect hemagglutination

Front 80

Abdominal CT shows liver lesion with ectocyst (calcified) and endocyt. What is that characteristic of?

Back 80

hydatid cyst

Front 81

What is the tx for hydatid cyst?

Back 81

preop albendazole, surgical removal (may wan to inject cyst with alcohol at time of removal to kill organsims) need to get all of cyst wall

Front 82

Why don't you aspirate hydatid cysts?

Back 82

can leak out and cause anaphylactic shock

Front 83

Pt with hydatid cyst has jaundice, elevated LFTs or cholangitis. What do you need to do preop?

Back 83

ERCP to check for communication with the biliary system

Front 84

Maculopapular rash, increased eosinophils. Sigmoid colon has fine granulation tissue, petechiae, ulcers and can cause variceal bleeding. What is the dx and what is the tx?

Back 84

Schistosomiasis

Tx: praziquantel and control variceal bleeding

Front 85

80% of liver abscess are what type? what is the number one organism?

Back 85

pyogenic, E. coli

Front 86

Treatment for hepatic adenoma

Back 86

Asx: stop OCP; if regression no further therapy

Sx: tumor resection for bleeding & malignancy risk

Front 87

Do Hepatic adenomas have kupffer cells

Back 87

no - so no uptake on sulfur colloid scan

Front 88

What % hepatic adenomas rupures

Back 88

20% (with 80% symptomatic)

Front 89

What has central stellate scar

Back 89

focal nodular hyperplasia

Front 90

Does FNH require surgery

Back 90

no no malignancy risk

Front 91

What is the most common benign hepatic tumor

Back 91

hemangioma

Front 92

Do hemangiomas rupture? symptomatic?

Back 92

rare; most asymptomatic

Front 93

should you bx a hemangioma

Back 93

no risk hemorrhage

Front 94

Tx of hemangioma

Back 94

conservative unless symptomatic

Front 95

What is kasabach merritt syndrome? associated with?

Back 95

consumptive coagulapathy; hemagioma

Front 96

What is the #1 risk fx for HCC (others)

Back 96

hep B (hepc; etoh, hemochromatosis, aklpah1 antitrypsin def, psc, aflatoxins, hepatic adenoma, steroids, pesticide

Front 97

are primary bilary cirrhosis or wilson dx risk fx for hcc

Back 97

no

Front 98

What are risk factors for hepatic sarcoma

Back 98

pvc, thorotrast, arsenic

Front 99

Which are hyper/hypovascular primary/met liver tumor

Back 99

primary - hyper

metastatic -hypo