focal nodular hyperplasia
CT findings
MRI findings
“arterial outside
venous inside”
“like cancer outgrowing its blood supply” blah blah blah cannot double top glass characteristics in clinical transformation this is Lynsey
Stellate
MRI:
peripheral nodular enhancement arterial face
Centripetal enhancement Venus phase
Test for focal nodular hyperplasia
Sulfur colloid
Where in the liver metastases found
Periphery of the liver
What size cystadenoma should be resected
Greater than equal to 3 cm
After trial of discontinuation of birth control
CT findings of adenoma
Heterogeneous
CT findings of hemangioma
Peripheral AND central enhancement
MILAN criteria
Eligible for transplantation for hepatocellular carcinoma
Based on an initial size of tumor (not downsizing)
Less than or equal to three tumors
Less than 3 cm
Or one tumor less than 5 cm
fibrolamellar hepatocellular carcinoma
Young patient
No cirrhosis
Not associated with hepatitis B
Can be AFP negative
Most likely cause of alter sound showing intrahepatic structure that is cystic and an elevated White blood cell count
Amoebic abscess
Pyogenic
Test for a amoebic abscess
Hemagglutinin
What does calcification suggest in infected liver picture
Hydatid cyst
Organisms identified in pyogenic abscess
E. coli number one Strep faecalis Kleb Proteus anaerobic colon B frag
What is the usual source of pyogenic abscess
GI
also can be from bili
Econ a cockle cyst CT findings
thick wall
Calcifications in debris
Septations– daughter cysts
Diagnoses of echinococal cyst
ELISA
Hemagglutinin
Medication for pretreating echinococal cyst
Albendazole
Cystadenoma CT findings
Complex cyst
mural nodules
What does TIPS stand for
Transjugular
intrahepatic
portosystemic
Shunt
What kind of shunt is TIPS
Nonselective
Good for stopping bleeding
Bad for encephalopathy(Because no longer clearing toxins through deliver)
Pretty good for ascites
NO for right heart failure
Mesocaval shunt
Best for urgent treatment of bleeding varices
really buggers up transplant options though
Distal spinal shunt
Time-consuming
Selective shunt
Good for encephalopathy
Child’s class
Child class a / b / c
Billy Ruben 2/ 2-3 / >3
Albumin >3.5 / 2.8-3.5 / 2.2
Encephalopathy 0 / controlled / uncontrolled
Ascites 0 / controlled / uncontrolled
Surgical mortality associated with child score
Child a: 5-6 10%
Charles B: 7-9 30%
Child C: 10-15 75 – 80%!
What is the MELD score needed to get on the transplant list
15
TIPS is best with MELD less than
24 or greater is contraindication
uptodate
MELD for major liver surgery
8?
Anatomy of portal triad
ant right CBD
left HA
portal vein
replaced right hapatic artery
SMA to
posterior portal vein
posterior to pancrease
posterior to cystic artery
test to r/u hemangioma if CT scan and MRI are equivocal
Tagged red blood cell scan
labs to get for ruling out liver malig
AFP
LFTs / bili / coags
hepatitis panel
Basic steps to gain access for a Pringle
Pars flaccid (gastrohepatic ligament) is opened any fingers passed through the foramen of Winslow
Porta hepatis can then be encircled with umbilical tape
Treatment of encephalopathy
Decrease aromatic
(can use branch chain amino acids)
Lactulose
neomycin decreased bacteria that makes ammonium