Monday, February 24, 2020

LIVER

ANATOMY

Right HV: Seg 5-8

Left HV: Seg 2, 3

Middle HV: Seg 4,5,8

Caudate lobe —> IVC

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LPS

- complications of gram- negative sepsis are initiated by endotoxin

(lipopolysaccharide [LPS])

NITRIC OXIDE

- activation of inflammatory cascades includes the upregulation of the inducible or

inflammatory isoform of nitric oxide synthase (iNOS) and subsequent NO production

- in reperfusion injury

ACUTE LIVER FAILURE

- rate and extent of hepatocyte death exceeds the liver’s regenerative capabilities

- fulminant hepatic failure

- hepatic encephalopathy occurring within 26 weeks of severe liver injury in a patient

without a history of previous liver disease or portal hypertension

- 6 days before the onset of encephalopathy and had a median of 2 days between the
onset of jaundice and the development of encephalopathy.

- Hypophosphatemia, a sign of hepatic regeneration

CIRRHOSIS

- fibrous septa throughout the liver

- consequence of sustained wound healing in response to chronic liver injury

- right hepatic lobe atrophy, caudate lobe and left lateral segment hypertrophy,
recanalization of the umbilical vein, a nodular surface contour, dilatation of the portal

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vein, gastroesophageal varices, and
splenomegaly

- Nonalcoholic fatty liver disease is now

the most common chronic liver disease
worldwide

- Chronic hepatitis C infection is the most

common cause of chronic liver disease

- Jaundice usually does not appear until

the bilirubin rises above 2 to 3 mg/dL

- undergo screening for the development of HCC every 6 months

- gastroesophageal varices, which are mainly supplied by the anterior branch of the left
gastric (coronary) vein

LIVER INFECTIONS

- Pyogenic

• right lobe

• hypodense with peripheral enhancement and may contain air-fluid levels

• IV antibiotic therapy should be continued for at least 8 weeks

- Amebic

• superior-anterior aspect of the right lobe of the liver near the diaphragm

• necrotic central portion that contains a thick, reddish brown, pus-like material

• low- density round lesions that have enhancement of the wall, somewhat ragged in
appearance with a peripheral zone of edema.

• Metronidazole 750 mg three times a day for 7 to 10 days

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- Hydatid

• tapeworm Echinococcus granulosus

• albendazole
- Ascariasis

• piperazine citrate, mebendazole, or albendazole

- Schistosomiasis

• praziquantel 40 to 75 mg/kg as a single dose

• hepatic fibrosis followed by presinusoidal portal hypertension —> liver shrinks —>
spleen enlarges

- Viral hepatitis

• pegylated interferon and nucleoside analogs such as tenofovir or entecavir

- Adult polycystic liver disease

• Common agents used for sclerosis include ethanol, minocycline, and tetracycline
- Caroli’s disease

• segmental cystic dilatation of the intrahepatic biliary radicals

- Adenoma

• oral contraceptives

• carry a significant risk of spontaneous rupture with intraperitoneal bleeding

• also have a risk of malignant transformation to a well-differentiated HCC

- >4-5cm should be resected

- Focal nodular hyperplasia

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• central scar

• oral contraceptives

MALIGNANCY

- Cholangiocarcinoma

• external-beam radiation therapy plus a protracted course of intravenous

5-fluorouracil followed by iridium-192 brachytherapy

- GB cancer

• beyond stage T1: reoperation with central liver resection, hilar lymphadenectomy,
and evaluation of cystic duct stump

- Microwave ablation

• produce coagulation necrosis

- Pringle maneuver

• Ischemic preconditioning
- brief interruption of blood flow to an organ, followed by a short reperfusion
period, and then a more prolonged period of ischemia

- preoperative portal vein embolization

• induced ipsilateral lobar atrophy and contralateral lobe hypertrophy

• usually for extended hepatectomies

• done 4 wks prior to surgery