Term
| MC blood supply to liver tumors? |
|
Definition
| Hepatic artery (amenable to embolization) |
|
|
Term
| MC hepatic artery variants = ? |
|
Definition
1. replaced right, from SMA (20%)
-behind neck of panc, posterior to PV, posterolat to CBD
2. replaced left, from left gastric
-in gastrohepatic lig (lesser omentum) |
|
|
Term
| formation of portal vein? |
|
Definition
| IMV + splenic ===> join SMV |
|
|
Term
| segments of liver supp by L vs R portal v/ |
|
Definition
left ==> 2,3,4
right ==> 5-8 |
|
|
Term
| segments of liver and associated hepatic vein? |
|
Definition
Left = 2-4
Mid = 4, 5
Right = 6-8 |
|
|
Term
| MC anatomy of hepatic veins? |
|
Definition
1. middle joins left, then to IVC @ 80%
2. accessory right hepatics drain medial right lobe direct to IVC |
|
|
Term
| caudate blood supply pattern? |
|
Definition
separate portal and arterial blood flow
-direct drainage into IVC via separate hepatic veins |
|
|
Term
|
Definition
within hepatoduodenal ligament
-CBD, PV, Hepatic artery |
|
|
Term
|
Definition
PV= post
CBD = lat
proper hepatic = medial |
|
|
Term
| what does falci separate? |
|
Definition
medial and lateral segments of the left lobe
-lig teres is extension of falci |
|
|
Term
|
Definition
| remnant of umbilical vein |
|
|
Term
|
Definition
line separating right and left lobes
-Thru GB foss to IVC |
|
|
Term
| boundaries @ foramen of Winslow? |
|
Definition
Ant = portal triad
Post = IVC
Inf = duod
Sup = liver |
|
|
Term
|
Definition
| peritoneum that covers liver |
|
|
Term
| where is liver bare area? |
|
Definition
| posterior surface not covered by Glisson's cap |
|
|
Term
|
Definition
lateral and medial extensions of coronary ligament
-posterior liver surface |
|
|
Term
| What liver seg does Portal triad enter |
|
Definition
|
|
Term
|
Definition
1 = caudate
2 = left sup lat
3 = left inf lat
4 = caudate
-----
5 = right inf anteromedial
6 = right inf posterolat
7 = right sup posterolat
8 = right sup anteromedial |
|
|
Term
|
Definition
-Lactic acid from muscle transported to liver
-converted to glucose
-transported back to muscle |
|
|
Term
| what factors are NOT produced by the liver? |
|
Definition
|
|
Term
| what is the only water soluble vitmain stored in the liver? |
|
Definition
B12
-otherwise stores ADEK fat soluble vitamins |
|
|
Term
| where is alk phos located? |
|
Definition
|
|
Term
| usual energy source for liver? |
|
Definition
|
|
Term
| what hepatocytes are most sensitive to iscehmis? |
|
Definition
| central lobular (acinar zone 3) |
|
|
Term
| % of liver that can be safely taken? |
|
Definition
|
|
Term
| enzyme that conjugates bili? |
|
Definition
| glucoronyl transferase (makes glucoronic acid in the liver. Has inc solubility) |
|
|
Term
| cause of dark cola urine? |
|
Definition
| excess urobilinogen (bili breakdown product in T.I.) |
|
|
Term
| pathway for bile acid synthesis? |
|
Definition
1. HMG CoA (+HMG CoA reductase) = cholesterol (rate lim step)
2. Cholesterol (+7-alpha-OHylase) = bile acids |
|
|
Term
| what overactive vs underactive enzyme activity could lead to gallstone formation? |
|
Definition
overactive HMG CoA reductase
or..Underactive 7 alpha OHylase |
|
|
Term
| What are the primary vs secondary bile acids? |
|
Definition
-primary = cholic and chenodeoxycholic (C's)
-secondary = deoxycholic and lithocholic |
|
|
Term
| what are bile acids conjugated to? |
|
Definition
|
|
Term
| where are secondary bile acids made? |
|
Definition
| in the gut via de-hydroxylation of primary acids (cholic and chenodeoxycholic) by bacteria |
|
|
Term
| What is the main biliary phospholipid? |
|
Definition
Lecithin
-solubilizes cholesterol
-emulsifies fats |
|
|
Term
Jaundice syndromes
-name each and the pphys |
|
Definition
Elevated Unconj bili--->(glucoronyl TFase issues)
1. Gilberts = mild deficiency
2. Crigler-Najjar = deficiency of (deadly 2/2 brain dam)
3. Physio J of newborn = immature
Conj bili elevation --->
1. Rotor = deficiency in storage
2. Dubin-J = deficiency in secretion (cMOAT anion t-porter) |
|
|
Term
| jaundice syndrome with poor outcomes? |
|
Definition
crigler-najjar disease
-brain damage due to high unconj bili
-2/2 gluconoryl TFase deficiency |
|
|
Term
| defective cMOAT protein =? |
|
Definition
Dubin- J
-deficiency in secretion = high conj bili |
|
|
Term
| deficiency in bilirubin storage = ? |
|
Definition
Roters syndrome
(good prog)
high conj bili |
|
|
Term
| Acute liver failure definition? |
|
Definition
acute hepatic disease +
coagulopathy +
encephalopathy
*outcome determined by course of encephalopathy* |
|
|
Term
| prognosis of acetaminophen toxicity in acute liver failure? |
|
Definition
| better than non-acetaminophen causes |
|
|
Term
acute liver failure
-stages = ? |
|
Definition
1 = ams
2 = lethargy, confusion
3 = stupor
4 = coma (80% MR) |
|
|
Term
|
Definition
-convert NH3 to NH4+ (ammonium) = prevent uptake
-get rid of ammonia producing bacteria
*titrate to 2-3 stools per day* |
|
|
Term
Acute liver failure
-medical tx options? |
|
Definition
-Lactulose
-limited protein diet (give branched chain aa)
-neomycin |
|
|
Term
| methods to acutely drop ICP? |
|
Definition
-hypervent (pCO2 goal 30-35)
-Mannitol
-raise head of bed
-barb coma |
|
|
Term
| important indications for liver txp @ acute liver failure? |
|
Definition
-Tyl caused and pH < 7.3
-any cause and PT> 50 |
|
|
Term
| Best indicator of synthetic function in pt with cirrhosis? |
|
Definition
|
|
Term
| normal portal vein pressure? |
|
Definition
|
|
Term
| what are the portal to esoph collaterals? |
|
Definition
|
|
Term
| Child-Pugh score components? |
|
Definition
Albumin
Bili
Encephalopathy
Ascites
INR |
|
|
Term
|
Definition
A = 5-6 = 2% MR with shunt
B = 7-9 = 10 %
C = 10+ = 50% |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 40 (anything over 40 gets score of 40) |
|
|
Term
| Basic MELD score breakdown? |
|
Definition
> 15 = would benefit from TXP
< 15 = more likely to die from TXP than disease itself |
|
|
Term
| what test is most prognostic of liver functional reserve? |
|
Definition
| Aminopyrine breath test (not used clinically often) |
|
|
Term
| Contraindications to liver txp? |
|
Definition
Advanced HIV (still true?)
Active sub abuse
Sepsis
Extra-hepatic malig
Severe co-morbidity (esp cardiopulm)
Persistent non-compliance |
|
|
Term
| Liver Txp 1 year vs 5YSR? |
|
Definition
|
|
Term
| MELD > 15.. what are TXP indications? |
|
Definition
-Recurrent/severe encephalopathy
-Refractory ascites
-Recurrent variceal bleed
-Hepatorenal/hepatopulm syndrome
-HCC
-fulminant failure |
|
|
Term
| When to use norfloxacin w/cirrhosis? |
|
Definition
as SBP prophy for cirrhotics w/...
1. hx of SBP
2 pts admitted for UGI bleed |
|
|
Term
| meds for UGI bleed prophy in cirrhotics? |
|
Definition
propranolol-->only if have varices or hx UGI bleed
(can add isosorbide dintrate if needed) |
|
|
Term
Cirrhosis
-basic treatment strategy? |
|
Definition
-limit salt and fluid intake
-Prophy for SBP/Variceal bleed if needed
-diuresis w/lasix +/- spironolactone |
|
|
Term
| what is replacement strategy for ascites removal? |
|
Definition
1 g albumin for every 100 cc removed
-use 25% albumin |
|
|
Term
| pain-control method that is contraindicated in cirrhosis? |
|
Definition
| Spinal or epidural anesthesia |
|
|
Term
| exam finding in stage 1-3 hepatic enceophalopathy vs stage 4? |
|
Definition
asterixis @ 1-3 (development is sign of progression)
Hyper-reflexia, clonus, rigidity @ stage 3+4 |
|
|
Term
| metabolic derangement commonly caused by medical tx for acute liver failure? |
|
Definition
non-anion gap metabolic acidosis
-2/2 lactulose, spironolactone |
|
|
Term
|
Definition
|
|
Term
| What does TIPS improve vs make worse? |
|
Definition
-improves TXP survival creatinine clearance, ascites
-Worsens: Encephalopathy (shunted blood doesnt undergo liver metab) |
|
|
Term
|
Definition
refractory ascites
Child A or B w/minimal encephalopathy (is worsened with TIPS) |
|
|
Term
|
Definition
Peritoneal to R IJ connection
-50% open at one year. rarely used anymore
- |
|
|
Term
| Mgmt of ascites induced pleural effusion? |
|
Definition
NO CHEST TUBES (inc Cx rate)
-tx by controlling the ascites
*thora if in resp distress* |
|
|
Term
| success rat of pt with ascites and umbo? |
|
Definition
25%
-do not wait until rupture...fix electively |
|
|
Term
Pt with CAD and cirrhosis..now with GI bleed...
-what medication combo can be given? |
|
Definition
vasopressin WITH nitroglycerine
-Vasopressin decreases splanchnic flow |
|
|
Term
| Mech of octreotide in variceal bleed? |
|
Definition
| can dec bleeding by decreasing portal pressures/blood flow |
|
|
Term
|
Definition
|
|
Term
| Tx of refractory emergent variceal bleed? |
|
Definition
1. TIPS
2. if not available..porta-caval shunt
*NO spleno-renal shunt..does not fully decompress portal syst) |
|
|
Term
| what does spleno-renal shunt worsen? |
|
Definition
|
|
Term
| common sclerotherapy complication and mgmt? |
|
Definition
late esoph strictures
-mgmt with dilation |
|
|
Term
MR with first variceal bleed?
% that re-bleed? |
|
Definition
33% mortality with first episode
-50% will re-bleed and have 50% MR |
|
|
Term
| Bleeding esoph varices mgmt? |
|
Definition
1. NGT, order blood
2. send and correct coags
3. EGD (sclero or banding = 90% effective)
4. consider octreotide, SBP prophy
5. blakemore if needed
6. TIPS or porta-caval shunt if above fails
7. propranolol after to prevent re-bleed |
|
|
Term
|
Definition
type 1 = rapidly progressive
type 2 = more indolent (survival 6 month average) |
|
|
Term
|
Definition
1. failed fluid challenge
2. r/o other causes (US, paracetesis r/o infxn, UA, CVP, drugs) |
|
|
Term
|
Definition
Txp
-temporizing measures = Midodrine and Octreotide
*possible TIPS as bridge to txp* |
|
|
Term
Hepatopulm syndrome
-pphys
-tx |
|
Definition
-intravascular pulmonary shunting
-txp |
|
|
Term
|
Definition
ascites fluid protein < 1
hx SBP
GI bleed |
|
|
Term
|
Definition
Paracentesis w
1. WBC > 500, PMN > 250
2. +ve cx, gm stain (MC org E. Coli) |
|
|
Term
| usual culture results inn SBP? |
|
Definition
usually one organism (MC E. coli)
-if poly-microbial..worry about bowel perf |
|
|
Term
|
Definition
-3rd gen cephalosporin (if no response in 48 hrs, re-consider dx)
-Albumin 1.5 gm/kg @ time of dx + 1 gm/kg day 3 (inc survival) |
|
|
Term
|
Definition
1.5 gm/kg @ time of dx
1 gm/kg day 3
(inc survival) |
|
|
Term
| type of regeneration after portal vein embolization |
|
Definition
|
|
Term
| PPhys of post partum liver failure w/ascites? |
|
Definition
ovarian v thrombosis (often infected)-->IVC thrombus-->hepatic vein thrombosis
-PPhys = post-partum hypercoag state |
|
|
Term
| postpartum ascites WITHOUT liver fail..pphys? |
|
Definition
portal vein thrombosis
(if also in liver failure..pt has hepatic v thrombosis) |
|
|
Term
|
Definition
1. trans-jugular, intra-hepatic, porto-systemic shunt
-allows antegrade flow from PV to IVC
2. encephalopathy (bypass liver metab)
*PC shunt has worse enceph and mortality* |
|
|
Term
| what needs to be ligated for a splenorenal shunt? |
|
Definition
Left adrenal v
Left gonadal v
IMV
Coronary v
Pancreatic br of splenic v |
|
|
Term
splenorenal shunt
1. indication
2. contraindications |
|
Definition
1. Child A presenting with JUST bleeding
2. refractory ascites (These shunts worsen ascites) |
|
|
Term
| what is decompressed with splenorenal shunt? |
|
Definition
esoph and gastric varices
*no decompression of the portal system* |
|
|
Term
| Type of shunt indicated based on Child score? |
|
Definition
Child B or C --> TIPS
Child A with JUST bleeding (no ascites)-->consider splenorenal
but can also just do TIPS (Splenorenal more durable) |
|
|
Term
| MC cause portal HTN in children? |
|
Definition
| portal vein thrombosis (50%) |
|
|
Term
| Pre, hepatic, post-hepatic causes of portal HTN? |
|
Definition
pre = portal v thrombosis, schistosomiasis, congen hep fibrosis
hepatic = cirrhosis
post = budd chiari (hep vein occlusion), constrictive pericard, CFH, SOS (sinusoidal obstructive syndrome) |
|
|
Term
| MCC massive hematemesis in children? |
|
Definition
|
|
Term
pt with portal vein thrombosis and refractory bleeding..
-tx options? |
|
Definition
No anticoag due to bleed..
consider trans-hepatic direct thrombolysis
-+/- surgical shunt if no other option |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
SOS
1. associated cause?
2. Tx |
|
Definition
sinusoidal obstructive syndrome
1. liver stem cell TXP
2. Supportive, UDCA (urodeoxycholic acid) prophy in pts under going stem cell txp |
|
|
Term
Budd Chiari
-types and %
-MCC? |
|
Definition
-primary = hepatic vein thrombosis = 75%
-secondary = compression = 25%
MCC = idiopathic (50%)...but MC identifiable cause (polycythemia vera) |
|
|
Term
|
Definition
RUQ abd pain
Ascites (MC sx)
Hepatomegaly |
|
|
Term
| best test for dx of budd chiari> |
|
Definition
retrograde hepatic veing angiogram
-can be tx as well
*others= duplex (usual first test), triple phase CT*
*definitive = bx with sinusoidal dilation, and centrilobular congestion* |
|
|
Term
| histopath for Budd chiari? |
|
Definition
| Sinusoidal dilation and centrilobular congestion |
|
|
Term
|
Definition
1. Anticoagulation (possible thrombolysis)
2. TIPS if refractory
3. PC shunt if refractory
4. TXP if refractory |
|
|
Term
| % recurrence of Budd chiari after txp? |
|
Definition
|
|
Term
| isolated gastric varices pphys? |
|
Definition
splenic vein thrombosis
-NO PORTAL HTN, NO ESOPH VARICES |
|
|
Term
| MC isolated splenic v thrombosis? |
|
Definition
|
|
Term
|
Definition
|
|
Term
Primary sclerosing cholangitis
-RF |
|
Definition
Male age 50-60 w/UC
-others = RP fibrosis, Reidel thyroiditis, pancreatitis, DM |
|
|
Term
Primary sclerosing cholangitis
-best test and characteristic findings? |
|
Definition
| ERCP: multiple strictures/dilations (Beaded appearance) |
|
|
Term
Primary sclerosing cholangitis
-Path/marker |
|
Definition
Ai dz (p-ANCA @ 70%)
-extra-hepatic AND intrahepatic duct fibrosis--> portal HTN, hep failure |
|
|
Term
|
Definition
| Bacterial cholangitis UNUSUAL unless hx of biliary tract manipulation |
|
|
Term
Tx Primary sclerosing cholangitis
-definitive. recurrence%?
-palliative |
|
Definition
1. Liver Txp (20% recurrence @ 5 years)
2. palliative w/ PTC tube, dilations. UDCA/cholysteramine vs sx
-doest not resolve after colon rsxn in pts w/UC
*unusual..but can be one side of liver only-->lobectomy*
*unusual...but can be only extrahepatic-->choldochoJ* |
|
|
Term
|
Definition
females
-anti-mitoAb (M2 IgG = most specific) + cholestatic pattern
**dont need bx to Dx (unlike psc, where ERCP bx = dx)** |
|
|
Term
|
Definition
fibrosis of small-sized INTRA-HEPATIC DUCTS
-a/w autoimmune dz (hashimotos) |
|
|
Term
| differences between PSC and PBC? |
|
Definition
PSC: in men, intra-extra hepatic, a/w UC, a/w p-ANCA, dx: ERCP
PBC: females, extra-hepatic, a/w hashimotos, anti-mitoAb, no bx needed for dx, better prog (can survive normal life w.out txp in some) |
|
|
Term
|
Definition
often need liver tx
-20% recurrence rate at 5 years
-immunosupp (MTX, cyclosporine have possible benefit)
-fat soluble vitamins |
|
|
Term
|
Definition
Simple cyst
Echinococcus
Hepatic cystadenoma or cystadenoCa
BIliary cystadenoma or cystadenoCa |
|
|
Term
Echinococcus cyst (hytadid cyst)
-how is it contracted/passed?
-MC location |
|
Definition
-Sheep = carriers --> Dogs-->humans ?
-MC = right lobe liver |
|
|
Term
|
Definition
-ELISA for IgG Abs = best test
-CT: calcified ectocyst w/endocyst (DOUBLE CYST WALL)
+/- daughter cells
-ERCP pre-op to check for biliary communication if pt has Juandice/inc LFTs/cholangitis |
|
|
Term
Echinococcal cyst
-conraindication? |
|
Definition
DO NOT ASPIRATE
-will leak and cause anaphylactic shock |
|
|
Term
Echinococcal cyst (hydatid cyst)
-tx |
|
Definition
DO NOT ASPIRATE
-pre op albendazole x 2 weeks
-Hypertonic saline pack, inject cyst with EtOH (if no bili comm)
-aspirate and avoid rupture
-remove ALL of cyst wall to avoid recurrence
-post op albendazole |
|
|
Term
| Echinococcal cyst-how to find biliary communication? |
|
Definition
Pre-op ERCP
intra-op cholangiogram w/Me-Blue
-->ligate the connection |
|
|
Term
|
Definition
Can aspirate, but lap unroofing is most definitive tx
-perc drain if infected (100% recurrence)
-MC right lobe, women |
|
|
Term
| US findings of hepatic cyst-adenoma, cyst-adenoCa |
|
Definition
Papillary-like fronds within the cyst
-complex cysts, mucin producing.
-adenoma = premalig |
|
|
Term
| tx of cystadenoma vs cystadenoCa? |
|
Definition
if adenoma (pre-malig)-->wedge rsxn
-if Ca..formal resection |
|
|
Term
| US findings of biliary cystadenoma/adenoCa |
|
Definition
VERY thick cyst wall, septated
mucin producing
-usually intrahepatic w/calcifications |
|
|
Term
| types of hepatic abscesses? |
|
Definition
Pyogenic (MC)
Amoebic
Schistosomiasis |
|
|
Term
| MC org pyogenic hepatic abscess? |
|
Definition
|
|
Term
| MCC pyogenic hepatic abscess? |
|
Definition
biliary dz with ascending infxn
-usually multiple abscesses w/biliary source
*other: biliary manip, hematog spread to liver from appy/divertic* |
|
|
Term
| Mortality of pyogenic hepatic abscess? |
|
Definition
|
|
Term
|
Definition
perc drainage, abx (send for cytology to r/o CA)
-surgery if fialed
-ensure open biliary system
**get fu CT to confirm resolution** |
|
|
Term
Ameobic abscess
-transmission
-MC location |
|
Definition
hx travel to SA-->fecal-oral
-primary infxn in colon ==>portal vein==>liver
*usually right lobe, single abscess* |
|
|
Term
|
Definition
Agglutinin + Immuno-electrophoresis Ab (90% of pt are +ve)
**if extra hepatic only..stool cx usually negative**
**Abscess cx often sterile (protozoa only found in rim)** |
|
|
Term
|
Definition
-first line = FLAGYL (not drainage)
**if no improvement-->super-infection**
-perc drain if fails
-surg if fails |
|
|
Term
schistosomiasis abscess
-MC travel / route/ location |
|
Definition
-Middle east, via water through skin
-inc @ right lobe |
|
|
Term
schistosomiasis abscess
-Sx |
|
Definition
maculopapular rash
RUQ pain
can cause Variceal bleeding |
|
|
Term
schistosomiasis abscess
-Dx |
|
Definition
-Agglutinin + immuno-electrophoresis Ab tests
-inc eosinophils
-Stool and urine O and P
-Diffuse rectal petechiae (lives in mesenteric venules) |
|
|
Term
schistosomiasis abscess
-Tx |
|
Definition
1st line = Praziquantel (NOT drainage) + hemorrhage control from variceal bleeding
-perc drain if fail |
|
|
Term
Hepatic adenomas
-% symptomatic
-% bleeding risk
-% malig risk |
|
Definition
|
|
Term
Hepatic adenoma
-MC location |
|
Definition
|
|
Term
|
Definition
-Women on OCPs
-AiDZ, steroids |
|
|
Term
Hepatic adenoma
% that present with rupture |
|
Definition
|
|
Term
|
Definition
-CT/MRI: hypervascular, homogenous
-Sulfur colloid: negative (cold)
-Tagged RBC: negative
-AFP: nrml
**DONT GET FNA 2/2 BLEEDING RISK** |
|
|
Term
Hepatic adenoma
when can you avoid surgery? |
|
Definition
Asympt AND on OCP/steroids AND < 4 cm?
=> DC offending agent and get CT Q4-6 weeks
=> if decrease in size/resolves in 6 months..nothing
-->if not..resect |
|
|
Term
Hepatic adenoma
-when to resect? |
|
Definition
-Size > 4 cm
-Inc size on serial CT, or with new hemorrhagic area
-Worsening or severe sxs
-adenoma and NOT on OCPs or steroids
*can embolize if multiple, unresectable* |
|
|
Term
|
Definition
-CT/MRI: Hypervasc and homogenous (completely fills art phase)
*Central stellate scar*
-Colloid scan: Positive @ 70%
-RBC scan: negative
-AFP normal
-FNA: not sensitive enough (cant ddx vs adenoma) |
|
|
Term
|
Definition
Conservative tx unless...
-enlarging, worsening sx, unsure of dx.
-wedge resection preferred. |
|
|
Term
| tx of FHN if unsure of dx? |
|
Definition
50% are unsure of dx..
-follow hepatic adenoma pathway |
|
|
Term
|
Definition
|
|
Term
| Rupture rate of hemangioma? |
|
Definition
|
|
Term
|
Definition
NO FNA due to bleeding risk
-CT/MRI: peripheral to central enhancement (diagnostic)
-RBC scan: Positive (best test) |
|
|
Term
|
Definition
no resection usually
-if needed consider pre-op embolization
-if in children use steroids
-if unresectable...steroids + XRT |
|
|
Term
|
Definition
|
|
Term
| Raio of mets to primary hepatocellular Ca? |
|
Definition
|
|
Term
|
Definition
-viral hepatitis
-PSC (NOT PBC)
-hemochromatosis, A1AT, (NOT WILSONS)
-hepatic adenoma
-steroids
-alfatoxins |
|
|
Term
HCC
MC associated condition? |
|
Definition
|
|
Term
|
Definition
-CT (triple phase) or MRI: mosiac, non-homogenous, necrotic.
-->vascular in arterial phase, avascular in venous phase
-->nodular or diffuse
-Labs: AFT-L3, DCP |
|
|
Term
HCC path
-subtype and best vs worst prog
-AFP and prog |
|
Definition
-Best = clear cell > lymphocytic > fibrolamellar (young pts)
-worst = diffuse nodular
-AFP correlates with tumor SIZE |
|
|
Term
|
Definition
PVC, thorotrast, arsenic
-rapidly fatal |
|
|
Term
|
Definition
clonorchiasis infection
UC
Hemocrhomatosis
PSC
choledocho cysts
INtra worse than extrahepatic
size and satellite correlate w/outcome |
|
|
Term
|
Definition
1. single tumor, any size, no vascular invasion
2. same as above but with vascular invasion OR multiple tumors < 5 cm
3a = multiple tumors > 5 cm, OR tumor involving major portal/hepatic vein branch
3b = tumor invading other organ (other than gb), OR tumor invading viseral peritoneum
3c = positive regional nodes
4 = mets or distant LN |
|
|
Term
|
Definition
single tumor any size with invasion of BV
OR
multiple tumors < 5 cm |
|
|
Term
|
Definition
3a = multiple tumors > 5 cm OR tumor involving major portal/hepatic v branch
3b = invading other non-gb organ OR invading visceral peritoneum |
|
|
Term
|
Definition
4 = positive regional LN
5 = distant mets or LN |
|
|
Term
| % of HCC that is resectable? |
|
Definition
|
|
Term
| Margins for HCC resection? |
|
Definition
|
|
Term
| 5YSR with resection of HCC? |
|
Definition
30%
recurrence most likely in liver |
|
|
Term
| Meds for unresectable HCC? |
|
Definition
Srafenib = multi-receptor tyrosine kinase inhibitor
-palliatve cryo, RFA, intra-arterial chemo |
|
|
Term
incidental liver nodule found at laparotomy for other reason
-@ colorectal surg: mgmt |
|
Definition
can take it if no other nodules (wedge it)
-if too difficult..bx and restage at 8 weeks w/imaging, labs..then resect if indicated |
|
|
Term
| best test for liver mets ? |
|
Definition
|
|
Term
primary vs metastatic liver tumors
-CT appearance? |
|
Definition
primary = hypervascular
mets = hypo |
|
|
Term
liver tumor with
1. positive colloid scan
2. positive RBC scan |
|
Definition
|
|
Term
| liver tumor with peripheral to central enhancement? |
|
Definition
hemangioma
-MCC benign liver tumor
-also +RBC scan |
|
|
Term
|
Definition
1. one lesion < 5 cm
2. 3 lesions, <3 cm each
3. no extra-hepatic or gross vascular invasion |
|
|
