Term
| Amount of hepatic blood flow supplied by the portal vein |
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Definition
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Term
| Normal portal venous pressure |
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Definition
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Term
| MC location of the portal vein in the hepato-duodenal ligament |
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Definition
| Posterior to the Hepatic artery and CBD |
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Term
| Typical location in the liver of a focal nodular hyperplasia |
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Definition
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Term
| Proposed cause of focal nodular hyperplasia |
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Definition
| early embryologicdisturbance in liver blood flow |
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Term
| Treatment of focal nodular hyperplasia |
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Definition
| Nothing, unless diagnosis cannot be made or symptomatic -> resection |
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Term
| Best way to screen for hepatocellular carcinoma in high risk pts with viral hepatitis |
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Definition
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Term
| Caudate lobe hypertrophy and inhomogenous contrast enhancment on CT in a pt with RUQ pain, jaundice, hepatomegaly |
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Definition
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Term
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Definition
| Thrombosis of the hepatic IVC or hepatic veins -> hepatic venous outflow obstruction -> post-sinusoidal liver failur and cirrhosis |
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Term
| Treatment of Budd-Chiari syndrome |
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Definition
Acute setting: anticoagulation
subsequent treatment is either selective shunt or TIPS (if indication is for portal HTN) or transplantation (for liver failure) |
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Term
| Central scar on CT: FNH vs. hepatic adenoma |
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Definition
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Term
| Increased fat signal on MRI: FNH vs. hepatic adenoma |
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Definition
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Term
| Best imaging modality to distinguish b/w hepatic adenoma and FNH other than CT or MRI and appearance of each in that modality |
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Definition
| Sulfur colloid scan: adenomas will appear "cold" and FNHs will appear "hot" because of the Kupffer cells |
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Term
| Treatment of a hepatic adenoma and why |
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Definition
| Surgical resection because of risk of malignant degeneration (5%), hemorrhage or rupture. |
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Term
| Cause of hydatid cysts of the liver and how to dx |
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Definition
| Echinococcus granulosius ELISA + CT or US |
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Term
| Types of echinococcal cysts |
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Definition
Type I- simple (Gharai)
Type II- cysts with free-floating hyperechogenic material called hydatid sand
Type III- cyst with rosette appearance suggestive of a daughter cyst
Type IV- cyst with diffuse hyperechoic solid pattern |
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Term
| Treatment of echinococcal cysts |
|
Definition
Type I or II- Anti-helmintic agent (mebendazole or albendazole) PAIR (percutaneous aspiration and injection of solicidal agent and reasperation)
Type II or IV or those refractory to PAIR, lap or open cystectomy with instillatin of scolicidal agent
Last ditch effort is formal liver resection |
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|
Term
|
Definition
1st line: Low sodium diet and lasix/spironolactone
2nd line: large volume (4-6 L) paracentesis followed by 25% SPA |
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Term
| Most common source of pyogenic liver abscess |
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Definition
Biliary tree
Other etiologies: seeding of the PV from appendicitis, diverticulitis, IBD and systemic infxs like endocarditis |
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|
Term
| Treatment of pyogenic liver abscess |
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Definition
| Abx and percutaneous drainage (+/- catheter drainage) |
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|
Term
| Clinical signs/sx of pyogenic liver abscess |
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Definition
| Fever, RUQ pain, jaundice |
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Term
| Cell principally responsible for fibrosis leading to cirrhosis |
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Definition
| Ito cells (AKA liver stellate cells) |
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Term
| UGI bleeding and splenomegaly in an o/w healthy child and risk factors |
|
Definition
Portal vein thrombosis
Risk factors:
- Neonatal umbilical vein catheterization (causign PV injury)
- neonatal omphalitis (umbilical sepsis)
- neonatal intra-abdominal sepsis (leading to infectious seeding of the portal vein)
- congenital webs in PV
- inherited hypercoagulable states |
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Term
| Treatment for children with portal vein thrombosis and refractory bleeding |
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Definition
| Rex Shunt- SMV to LPV bypass at the Rex recessus |
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|
Term
| Treatment for UGI bleeding in a patient with isolated splenic vein thrombosis |
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Definition
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Term
| Single fluid collxn in the R lobe of liver with rim of peripheral edema on CT scan in a Hispanic alcoholic with fevers, RUQ pain and leukocytosis, causitive agent and way to confirm the dx |
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Definition
| Amebic liver abscess, entomeba hystolitica, serologic tests using immunoassays |
|
|
Term
| Tx algorhythm for amebic liver abscess |
|
Definition
medical management (oral Flagyl) for 7-10d;
percutaneous US-guided aspiration if no improvement in 48-72 hours |
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|
Term
| Complications of giant hemangiomas in children |
|
Definition
| AV shunting, CHF and thrombocytopenia |
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Term
| MC benign tumor of the liver |
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Definition
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|
Term
| Treatment options for polycystic liver dz |
|
Definition
| PAIR (instilling alcohol) for sinle cysts or dominant cysts -> open or laproscopic fenestration or resection --> formal lobectomy --> transplant |
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|
Term
| Factors a/w liver cyst growth |
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Definition
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|
Term
| Best way to control esophageal bleeding not controlled by medical management in a pt who is a candidate for liver transplant |
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Definition
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|
Term
| Difference between a selective and non-selective portal-systemic vein shunt |
|
Definition
non-selective diverts all portal blood flood away from the liver, completely decompressing PHT but increasing risk of encephalopathy;
Selective shunts decompress only part of the portal venous system theoretically leading to less encephalopathy |
|
|
Term
| 2 selective portal-systtem shunts |
|
Definition
1. Distal splenorenal shunt
2. Small diameter, portocaval H graft shunt |
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|
Term
| Diff b/w HCC and Fibrolamelar Carcinoma |
|
Definition
| FLC tends to be in younger pts, not a/w HBV, cirrhosis of elevated AFP levels; also has better prognosis |
|
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Term
| Feature linking FLC and FNH and distinguishing characteristics |
|
Definition
| Histopathologically, they both have central fibrotic area; however, the central scar of FNH is an actually vascular entitiy and thus lights up on CT with contrast |
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|
Term
|
Definition
|
|
Term
| Infectious risk factors for HCC |
|
Definition
Hep B
Hep C
Aflatoxin produced by some Aspergillus species |
|
|
Term
| Lifestyle risk factors for HCC |
|
Definition
|
|
Term
| Metabolic liver diseases that are risk factors for HCC |
|
Definition
Alpha-1 antitrypsin defociency
Wilson's disease
Hereditary hemochromatosis |
|
|
Term
| Facotrs making up the MELD score |
|
Definition
Bilirubin
Creatinine
INR
Sodium |
|
|
Term
| Significance of MELD score |
|
Definition
estimates 3-month mortality of patients with end stage liver disease
Ranges from 6 - 40. Mortality is 1.9% for score < 9; 71.3 for score of 40 |
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|
Term
| Segments drained by the Right hepatic vein |
|
Definition
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|
Term
| Segments drained by the Middle hepatic vein |
|
Definition
|
|
Term
| Segments drained by the Left hepatic vein |
|
Definition
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|
Term
| Structure whose location is marked by the round ligament |
|
Definition
| The intrahepatic location of the left portal vein |
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|
Term
| Pattern of entry into the IVC of the hepatic veins |
|
Definition
Right hepatic vein enters through it's own orefice
the Left and Middle hepatic veins enter jointly through one orefice |
|
|
Term
| Source of a replaced right hepatic artery and position within the portal triad |
|
Definition
SMA
Posterior to the portal vein |
|
|
Term
# MC primary hepatic malignancy in children
# presentation
# Tx |
|
Definition
# Hepatoblastoma
# Asymptomatic abdominal mass, anemia, thrombocytosis, and elevated AFP levels
# Chemotx first then resection |
|
|
Term
| Components of Child-Pugh scorring system |
|
Definition
# Ascites (none-mild, tense)
# encephalopathy (none, stage I-II, Stage III-IV)
# INR (< 1.7, 1.7-2.3, >2.3)
# bilirubin (<2, 2-3, >3)
# albumin (>3.5, 2.8-3.5, <2.8) |
|
|
Term
| Outcome predicted Child-Pugh score and levels |
|
Definition
# mortality at 1 year
# A: 5-6, no mortality at 1 yr
# B: 7-9, 20% mortality at 1 yr
# C: 10-15, 55% mortality at 1 yr |
|
|
Term
| Most widely used test for assessment of hepatic reserve before major hepatic resection |
|
Definition
| Indocyanine green clearance |
|
|
Term
| Pathogenesis of Budd-Chiari syndrome |
|
Definition
| Thrombosis of the hepatic veins or intrahepatic vena cava ususally due to an underlying hypercoagulable state |
|
|
Term
| Diagnosis of and management of Budd-Chiari syndrove |
|
Definition
| CT scan and duplex ultrasound scan or the hepatic veins; initial management is with heparinization, but eventually will need a surgical non-selective portosystemic shunt and/or transplant |
|
|
Term
| Complications of fulminant liver failure most likely to lead to death |
|
Definition
|
|
Term
| A/w symptoms: FNA vs hepatic adenoma |
|
Definition
|
|
Term
| Risk of ruprture: FNA vs hepatic adenoma |
|
Definition
|
|
Term
| Risk of malignant degeneration: FNA vs hepatic adenoma |
|
Definition
|
|
Term
|
Definition
| Embryologic vascular injury |
|
|
Term
| Pre-operative portal vein embolization indicated |
|
Definition
| When the remnant liver volume is expected to be less than 40% if the pt has normal liver function; If the patient has abnormal liver function, pre-operative portal vein embolization is indicated if the remnant liver volume is expected to be less than 50% |
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|
Term
| Clotting factor with the shortest half-life |
|
Definition
|
|
Term
| Area of the liver most likely affected by pyogenic liver abscesses? Amebic? |
|
Definition
| 75% of liver abscess involve right lobe |
|
|
Term
| B/w pyogenic and amebic liver abscesses, one much more common in men than in women |
|
Definition
|
|
Term
| B/w pyogenic and amebic liver abscesses, one more likely to be multiple |
|
Definition
|
|
Term
| B/w pyogenic and amebic liver abscesses, one more likely to be managed with antibiotics alone (without drainage/cather) |
|
Definition
|
|
Term
| B/w pyogenic and amebic liver abscesses, one more deadly |
|
Definition
| Higher mortality rate with pyogenic abscesses |
|
|
Term
| Management of FNH in a patient taking OCPs |
|
Definition
| Observation (no link between FNH and OCPs) |
|
|
Term
| Best procedure if surgery is necessary for hemangioma |
|
Definition
|
|
Term
| Kasabach-Merritt syndrome |
|
Definition
| In a giant hemangioma, intravascular coagulation, platelet trapping and consumption of clotting factos |
|
|
Term
| MRI findings indicative of hemangioma |
|
Definition
| peripheral nodulat enhancement, brightness on T2-weighted imaging, low signal intensity on T1-weighted imaging |
|
|
Term
| Best method to distinguish between hemangioma and FNH |
|
Definition
| MRI more specific than CT; but when inconclusive, radiolabeled red blood cell scan |
|
|
Term
| Types of portal HTN and MCCs of each |
|
Definition
# pre-sinusoidal: intrahepatic (schistosomiasis, congenital hepatic fibrosis)
# sinusoidal: Alcohol, hemachromatosis and Wilson disease (causes of cirrhosis)
# post-sinusoidal: Budd-Chiari syndrome and congenital webs |
|
|
Term
| Tips: selective or non-selective shunt |
|
Definition
|
|
Term
| Good indications for TIPS |
|
Definition
# when pt's do not respond to medical management of variceal bleeding
# Refractory ascities
# bridge to transplantation in pts with hepatorenal syndrome |
|
|
Term
| 1 year patency rate of TIPS |
|
Definition
|
|
Term
| Absolute contraindications to TIPS |
|
Definition
| Right heart failure and polycystic liver disease |
|
|
Term
| Definition of and examples of primary bile acids |
|
Definition
| Bile acids made in the liver ; cholic acid and chenodeoxycholic acid |
|
|
Term
| Definition of and examples of secondary bile acids |
|
Definition
| Bile acids formed by bacterial modification of primary bile acids; deoxycholic and lithocholic acids |
|
|
Term
| Location and mechanism of reabsorption of bile acids |
|
Definition
| Passively in the jejunum and actively in the ileum |
|
|
Term
| Affect of ingestion of food on the bile acid concentration in the liver |
|
Definition
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