Anatomy
Liver Spots
Sir Hosis
BRB
Surprise
100
The liver receives ___% of its blood supply from the portal venous system
75%
100
50 y M with history of ulcerative cholatitis, elevated bilis, RUQ pain and these CT findings
Intrahepatic cholagniocarcinoma
100
This test of ascitic fluid helps diagnose ascites from portal hypertension and its calculated by:
Serum ascites albumin gradient (SAAG).
Fluid alb - serum alb
Portal HTN > 1.1 g/dL
100
A 45y F with cirrhosis presents to ED after vomiting 1 cup of bright red blood. Hgb is 10, vitals stable. EGD shows varices with bruising, no active bleeding. She is treated with IV fluids and ______ infusion.
Octreotide infusion
100
A 100kg 75y M patient presents for surgical eval of liver mets from right sided colon cancer. The masses are contained to the right side, largest measures 5.5 cm, FLR is estimated to be 18%. The absolute contraindication to hepatic resection is ____.
Functional liver remnant of less than 20%
200
Respectively, aberrant left and right hepatic arteries arise from the ___ and ___ arteries.
Left gastric and superior mesenteric artery
200
45 y F with vague abdominal pain has this finding on CT. Name that lesion
Focal nodular hyperplasia
200
These 5 clinical measurements contribute to a patient's Child Pugh score.
Total Bili, Serum albumin, INR, Ascites, Hepatic encephalopathy
200
A 50 y F with cirrhosis and portal HTN undergoes abdominal surgery. Unexpected retroperitoneal bleeding is encountered. The most likely variceal complex injured is formed by
Mesenteric veins and ovarian veins
200
A 40-year-old woman with history of colon cancer metastatic to the liver is seen in clinic for hepatic resection. What is a poor prognostic factor for metastatic liver tumor resection?
A. CEA of 5 ng/ml
B. Delayed mets 5 years after colon ca diagnosis
C. Bilobar involvement
C. Bilobar involvement
Other bad things:
Extrahepatic mets, Involved lymph nodes with the primary colorectal tumor, CEA > 200, Synchronous presentation, Larger number of tumors, Size of largest hepatic tumor greater than 5 cm, Involved histologic margins
300
The left hepatic vein drains these liver segments.
Segments II and III
Middle hep v: V and VII, primary drainage of IV
Right hep v: Drains all right segments, sole drainage for VI and VII
300
The most common solid liver mass
Hemangioma
300
A 72y Child-Pugh B cirrhotic with hepatic steatosis is diagnosed with a 4-cm HCC. Her liver volume is 1280 mL. The volume of her tumor is 30 mL. What functional liver remnant (FLR) volume would be acceptable for this patient?
~500 mL
FLR goal = 40%
0.4 * ( 1250-30) = 500 ish
300
A 48y M with history of heavy etoh use (now abstaining after severe pancreatitis 2 years ago) patient presents with hematemesis. CT shows occlusion of splenic vein, with patent portal vein. EGD shows slow, isolated gastric variceal bleeding. The best definitive management of this patient is:
Splenectomy
History of pancreatic inflammation + isolated gastric varices = HTN isolated to gastrosplenic veins
300
This multiphase CT finding is indicative of hepatocellular carcinoma
Arterial enhancement followed by venous washout
400
This line from the gallbladder fossa to the inferior cava divides the liver into left and right lobes.
Cantlie line
400
56y healthy F has 2cm distal pancreatic mass, along with 3 small hepatic lesions in segments V, VII, and VIII. The cancer antigen 19-9 is 25 U/mL. EUS FNA is consistent with a low-grade neuroendocrine tumor. The patient should be offered ___, ____, ____ as next step in management.
Distal pancreatectomy, splenectomy, and right hepatectomy.
Low-grade neuroendocrine tumors have good 5-year prognosis and can be surgically resected, if anatomically feasible
400
A febrile cirrhotic with significant ascites undergoes paracentesis with results showing 400 PMNs per mm3. The appropriate antibiotic for this patient is:
Cefotaxime
400
A 40y F with polycystic liver disease presents with acute gastroesophageal variceal bleeding. After initial resuscitation, she undergoes 3 attempts at endoscopic rubber band ligation and medical mgmt with octreotide and vasopressin, but she continues to bleed after attempts at weaning the medications. The most appropriate next step in management is:
Surgical portacaval shunting.
(Most commonly used = distal splenorenal shunts)
TIPS is contraindicated in polycystic liver disease due to anatomic distortion and risk of hemorrhage.
400
A 55y patient with a history of Child-Pugh C cirrhosis is found to have liver masses when undergoing a workup for RUQ pain. A triple-phase contrast-enhanced CT scan of the abdomen demonstrates a 2-cm lesion in segment IV and a 3-cm in segment VI. Both lesions demonstrate arterial enhancement with rapid washout in delayed phases. No extrahepatic disease is identified. The best treatment plan for this patient is _____
Orthotopic liver transplant.
Milan criteria for transplantation: 1 hepatoma less than 5 cm in size, 2 to 3 hepatomas less than 3 cm, no macroscopic vascular invasion, and no extrahepatic disease