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Most common hepatic artery variant
Right hepatic off of SMA
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Second most common hepatic artery variant
Left hepatic off left gastric (found in gastrohepatic artery)
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Structure separating the medial and lateral segments of the left lobe of liver
Falciform
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Structure that carries the remnant of the umbilical vein
Falciform
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Structure that carries the obliterated umbilical vein to undersurface of liver; extending from falciform
Ligamentum teres
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Line drawn from middle of GB fossa to IVC
Cantlie's line
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Segment I of liver
Caudate
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Segments II-IV of liver
Left lobe
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Segments V-Viii of liver
Right lobe
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Peritoneum that covers the liver
Glisson's capsule
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Area on posterior-superior surface of liver not covered by Glisson's capsule
Bare area
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Structures near segments IV and V
Portal triad, gallbladder
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Liver macrophages
Kupffer cells
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Structure containing the bile duct, portal vein, and hepatic artery
Hepatoduodenal ligament
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Portal triad (structure + location)
Portal vein (posterior), CBD (lateral), hepatic artery (medial)
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SMV + splenic vein
Portal vein
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Segments of liver drained by left portal vein
II, III, IV
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Segments of liver drained by right portal vein
V, VI, VII, VIII
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Number of hepatic veins
3 (left, middle, right)
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structure draining phrenic veins
IVC
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Enzyme located in canalicular membrane
Alkaline phosphatase
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Usual energy source of liver
Ketones
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Only water-soluble vitamin stored in liver
B12
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Hepatocytes most sensitive to ischemia
Central lobular
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Breakdown product of hemoglobin
Bilirubin
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Enzyme causing breakdown of bilirubin by bacteria in terminal ileum
Urobilinogen
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Enzyme causing dark urine
Urobilinogen
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Amino acids conjugated to bile acids to increase water solubility (2)
Taurine, glycine
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Main biliary phospholipid; solubilizes cholesterol
Lecithin
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First location where jaundice is evident
Under tongue
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Causes of unconjugated bilirubinemia
hemolysis, deficiency of uptake or conjugation
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Causes of conjugated bilirubinemia
Secretion defects, excretion defects (stones, strictures, tumor)
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Abnormal bilirubin uptake with mildly high unconjugated bili
Gilbert's syndrome
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Inability to conjugate bilirubin, causing unconjugated bilirubinemia
Criglar-Najjar disease
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Immature glucoronyl transferase causing high unconjugated bilirubinemia
Physiologic jaundice of the newborn
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Deficiency in storage of bilirubin; causes elevated conjugated bilirubin
Rotor's syndrome
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Deficiency of bilirubin secretion; causes high conjugated bilirubin
Dubin-Johnson syndrome
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RNA hepatitis with few serious long-term consequences
Hep A
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DNA hepatitis capable of causing long-term infection; vaccination available
Hep B
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RNA hepatitis with a long incubation period and capability of causing long-term infection; most common hepatitis leading to transplant
Hep C
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RNA hepatitis cofactor for Hep B
Hep D
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RNA hepatitis that can cause fulminant hepatic failure in pregnancy
Hep E
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Anti-HBs antibodies only in:
s/p Hep B vaccination
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Anti-HBs and anti-HBc with NO HBs antigens in:
Previous Hep B infection; now recovered
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Most common cause of liver failure
Cirrhosis
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Best indicator of synthetic function of liver
PT
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Cause of hepatic encephalopathy
Buildup of ammonia, mercatanes, methane thiols
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Causes other than liver failure encephalopathy (4)
GI bleed, infection, electrolyte imbalances, drugs
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Cathartic that gets rid of bacteria in gut and acidifies colon
Lactulose
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Source of ascites
Hepatic/splanchnic lymph
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Method of shunting ascites into venous system (2)
Peritoneovenous shunts (Denver, LeVeen)
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Cause of postpartum liver failure with ascites
Hepatic vein thrombosis
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Most common organism causing spontaneous bacterial peritonitis
E coli
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Risk factors for SBP (5)
Prior SBP, variceal hemorrhage, low-protein ascites, nephrotic syndrome, SLE in children
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Treatment of SBP
3rd generation cephalosporins
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drugs to treat bleeding esophageal varices (2)
octreotide, vasopressin
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tube used to control esophageal and/or gastric varices
Sengstaken-Blakemore tube
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Initial therapy for bleeding esophageal varices
Endoscopy and sclerotherapy
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Backup therapy for bleeding esophageal varices (after failed endoscopy)
TIPS
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Venous collaterals that develop with portal hypertension (5)
Paraumbilical vein of Sappey, retroperitoneal veins of Retzius, inferior rectal veins, esophageal varices, splenophrenic veins
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Presinusoidal causes of portal hypertension (3)
Schistosomiasis, congenital hepatic fibrosis, portal vein thrombosis
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Sinusoidal causes of portal hypertension (1)
Cirrhosis
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Postsinusoidal causes of portal hypertension (3)
Budd-Chiari (hepatic vein occlusion), constrictive pericarditis, CHF
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Normal portal vein pressure
<12mmHg
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collaterals between portal vein and systemic venous system of lower esophagus
coronary veins
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risk of TIPS
encephalopathy
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shunt with lowest risk of encephalopathy
splenorenal shunt
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shunt that can worsen ascites
splenorenal shunt
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shunt used in Child's B and C
TIPS
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Shunt used in Child's A with just bleeding
Splenorenal
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Categories to determine Child's class (5)
Albumin, bilirubin, encephalopathy, ascites, nutrition
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Most common cause of portal HTN in children
Extrahepatic thrombosis of portal vein
-
Occlusion of hepatic veins and IVC
Budd-Chiari syndrome
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Treatment of Budd Chiari
Portacaval shunt
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Cause of isolated gastric varices without elevation of pressure in rest of portal system
Splenic vein thrombosis
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Most common cause of splenic vein thrombosis
Pancreatitis
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Treatment of splenic vein thrombosis
Splenectomy
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Common lobe of liver for amebic abscess
Right
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Anchovy paste
Amebic abscesses
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Treatment of amebic abscess
Flagyl
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Most common cause of amebic abscess
Entamoeba histolytica
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Hydatid cyst organism
Echinococcus
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Most common lobe for echinococcal cyst
Right
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Treatment of echinococcal cyst
Albendazole, surgical removal
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Complications of echinococcal cyst aspiration
Leakage and anaphylactic shock
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Liver abscess that can also cause a maculopapular rash and eosinophilia
Schistosomiasis
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Organism causing liver abscess and variceal bleeding
Schistosomiasis
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Treatment of schistosomiasis
Praziquantel
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Most common organism in pyogenic liver abscess
E. coli
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Infections that can cause liver abscess as a secondary infection
Appendicitis, diverticulitis, cholecystitis/cholangitis
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Benign liver tumors occurring commonly in women, steroid users, OCP users
Hepatic adenoma
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Benign hepatic tumor with no uptake on sulfur colloid scan (because no Kupffer cells present)
Hepatic adenoma
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Treatment of hepatic adenoma
Stop OCP's (if asymptomatic), tumor resection or embolization (if symptomatic)
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Benign liver condition with central stellate scar
Focal nodular hyperplasia
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Most common benign hepatic tumor
Hemangioma
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Lesion appearing as hypervascular lesion on CT/MRI
Hemangioma
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Rare complication of hemangioma
Consumptive coagulopathy and CHF
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Most common malignant liver tumor
Metastasis
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Most common liver cancer worldwide
Hepatocellular carcinoma
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Risk factors for HCC (9)
HBC, HCV, ETOH, hemachromatosis, alpha 1 antitrypsin, PSC, alfatoxin, hdepatic adenoma, steroids
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Liver conditions that do not increase risk for HCC
PBC, Wilson's disease
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Serum marker for hepatocellular carcinoma
AFP
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5-year survival of HCC after resection
30%
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margin required for HCC
1cm
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risk factor for hepatic sarcoma (3)
PVC, thorotrast, arsenic
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Risk factors for cholangiosarcoma (5)
Clonorchiasis infection, UC, hemachromatosis, PSC, choledochal cysts
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5-year survival of resected colon ca mets
20%
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primary blood supply of liver tumors
hepatic artery
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primary liver tumors: hypovascular or hypervascular?
Hypervascular
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Metastatic liver tumors: hypovascular or hypervascular?
Hypovascular
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