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35 Cards in this Set
- Front
- Back
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How much of the total liver volume does the right lobe make up?
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Two-thirds
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How much of the total liver volume does the caudate lobe make up?
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1%
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Define lobes, sections and relationship to hepatic veins.
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Right lobe - Segments 5, 6, 7, 8
Right anterior section - 5, 8 Right posterior section - 6, 7 Left lobe - Segments 2, 3, 4 Left lateral section - 2, 3 Left medial section - 4 Right hepatic vein divides right anterior and posterior sections. Middle hepatic vein divides right anterior and left medial sections. This is the plane in which right hepatectomy or left hepatectomy takes place. Left hepatic vein divides left medial and left lateral sections. |
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What is the venous drainage of the caudate lobe?
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The caudate arises as a separate anatomical unit from the rest of the liver and has its own venous drainage in the form of short veins draining directly into the IVC.
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What is the future liver remnant (FLR)? What is the FLR that can be tolerated by patients with normal liver function vs those with portal hypertension?
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FLR is the liver remnant that will remain after resection. In patients with normal liver function, at least 20% FLR is needed. In patients with underlying liver disease, at least 40% FLR is needed.
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What formula is used to estimate total liver volume (TLV)?
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TLV = (1267)(BSA) - 794
where TLV is in cm3 and BSA = body surface area in m2 |
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What formula is used to determine the standardized FLR (sFLR)?
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sFLR = measured FLR / TLV
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What is the best way to treat pain from bulky liver metastases from pancreatic NET? |
TACE |
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What is the treatment for advanced or metastatic biliary cancers? What is the median survival? |
Gemcitabine and cisplatin (ABC trial) is associated with median survival of 12 months (compared to 8 with gem alone) |
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PAS-positive globules on pancreatic cyst fluid aspirate is associated with what lesion? |
Solid pseudopapillary neoplasm |
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Describe features of pancreatic acinar cell carcinoma. |
- Associated with lipase hypersecretion syndrome: high serum lipase, polyarthralgia, eosinophilia, subcutaneous fat necrosis - Can produce other digestive enzymes, i.e. trypsin, chymotrypsin, amylase - Highly cellular, no prominent stromal component, uniform cells with large, centrally located nucleoli and eosinophilic, granular cytoplasm - Generally have better prognosis that pancreatic adenocarcinoma |
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Should all patients with suspected insulinoma get an octreotide scan? |
No. Octreotide scans are less reliable for insulinomas than other neuroendocrine tumors. Only order for patients with metastatic disease seen on axial imaging and being considered for octreotide therapy. |
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Name two agents that are first line systemic therapy for metastatic neuroendocrine tumor. |
Everolimus Sunitinib |
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What lesion does this likely represent? |
Serous cystadenoma - central calcification or scar within cyst containing multiple septations Can be safely observed! |
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Describe features of Von Hippel Lindau syndrome. |
- Autosomal dominant, requires second hit - Clear cell renal cell carcinoma - Cerebellar hemangioblastoma - Retinal angioma - Pheochromocytoma - Spinal tumors - Pancreatic serous cystadenomas and endocrine tumors |
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What is the treatment for necrolytic migratory erythema associated with glucogonoma? |
Amino acid infusion |
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What is the trademark appearance of pancreatic neuroendocrine tumors? |
- Early arterial phase enhancement - Washout on subsequent contrast phases |
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A pancreatic tail cyst in a young woman should be assumed to be which lesion until proven otherwise? |
Mucinous cystic neoplasm (MCN) |
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What characteristics of side branch IPMN indicate higher chance of malignancy? |
- Size > 3 cm - Mural nodules or solid component - Pancreatic ductal dilatation - Main duct involvement (mixed) - Symptomatic |
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What are the radiographic, pathologic, and laboratory features of autoimmune pancreatitis? |
- Diffuse pancreatic enlargement - No obvious mass - Plasmacytic infiltration indicating lymphoplasmacytic sclerosing pancreatitis - High serum IgG4 (not sensitive) |
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For patients with locally advanced, unresectable pancreatic head cancers who present with back pain, what is the initial treatment that is most likely to help with back pain? |
Systemic therapy (Start before jumping to celiac plexus block) |
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What two hereditary conditions are most strongly associated with the development of pancreatic cancer? |
1) Peutz Jehger syndrome (STK11 mutation --> 100 fold increase in risk) 2) Hereditary pancreatitis (50-80 fold increase in risk) |
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Is colorectal cancer metastatic to an aortocaval node a contraindication to liver resection? |
Yes |
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Name risk factors for post op bile leak after liver resection. |
- Repeat hepatectomy - Extended hepatectomy - Intraoperative bile leaks - Biliary resections and reconstructions **Tumor size not a clear risk factor |
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Name some strategies to manage liver failure following liver resection. |
- Lactulose - Limit protein to 50g/day - Avoid large amounts of saline |
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When should you assess response to PVE in preparation for resection? |
4-8 weeks after PVE |
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What are indications for hepatic adenoma resection? |
- Size > 5 cm in women - Any adenomas in men - Symptomatic |
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What maneuver can increase the efficacy of RFA of lesions near portal vein branches? |
Pringle to reduce heat sink effect |
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What factors make a liver metastasis amenable to RFA? |
- Size < 3 cm - Away from the liver surface - Away from major inflow or outflow vessels |
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Should resection of metastases from solid pseudopapillary tumors be considered? |
Yes, these are indolent tumors with better prognosis and good cure rates |
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What are the layers of the gallbladder wall from inside to out? |
Mucosa Lamina propria Muscularis Perimuscular soft tissue Serosa |
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Describe T staging for gallbladder cancer. |
T1a Invades lamina propria but not muscularis T1b Invades muscle layer T2 Invade perimuscular soft tissue T3 Invades serosa or liver or one other organ but not major vessels T4 Invades main portal vein or hepatic artery; or invades 2 or more extrahepatic organs |
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Describe N staging for gallbladder cancer. |
N0 none N1 Regional nodes along cystic duct, CBD, portal vein, hepatic artery N2 Periaortic, pericaval, SMA, celiac nodes |
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Describe TNM staging for gallbladder cancer. |
Stage I - T1 N0 M0 Stage II - T2 N0 M0 Stage IIIA - T3 N0 M0 Stage IIIB - T1-T3 N1 M0 Stage IVA - T4 N0-1 M0 Stage IVB - Any T N2 M0 or Any T Any N M1 **Note that T4 or N2 disease makes you STAGE IV - you don't need distant mets to make you stage IV |
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What pathologic features define pancreatic neuroendocrine carcinoma? |
Rule of 20's - > 20 mitoses/10 HPF OR - > 20% Ki-67 **Treat with platinum/etopside regimen **Resection of mets generally not standard of care |
