ANATOMY

What is the name of the liver capsule?

What is the “bare” area?

Glisson’s capsule

Posterior section of the liver against the diaphragm that is “bare” without peritoneal covering

What is Cantle’s line?

Which ligament goes from the anterior abdominal wall to the liver?

What does the falciform ligament contain?

What is the coronary ligament?

What are the triangular ligaments of the liver?

Line drawn from the gallbladder to a point just to the left of the inferior vena cava, which transects the liver into the right and left lobes

Falciform ligament

Ligamentum teres (obliterated umbilical vein)

Peritoneal reflection on top of the liver that crowns (hence “coronary”) the liver and attaches it to the diaphragm

Right and left lateral extents of the coronary ligament, which form triangles

What is the venous supply?

What is the hepatic venous drainage?

Portal vein (formed from the splenic vein and the superior mesenteric vein)

Via the hepatic veins, which drain into the IVC (three veins: left, middle, and right)

What sources provide oxygen to the liver?

From what sources does the liver receive blood?

Identify the segments of the liver (French system).

What is the overall arrangement of the segments in the liver?

What is the maximum amount of liver that can be resected while retaining adequate liver function?

What are the signs/symptoms of liver disease?

Chapter 52 / Liver 347

Portal vein blood—50%

Hepatic artery blood—50%

Portal system—75%

Hepatic artery system—25%

Clockwise, starting at segment 1

80%; if given adequate recovery time, the original mass can be regenerated (Remember Prometheus!)

Hepatomegaly, splenomegaly, icterus, pruritus (from bile salts in skin), blanching spider telangiectasia, gynecomastia, testicular atrophy, caput medusae, dark urine, clay-colored stools, bradycardia, edema, ascites, fever, fetor hepaticus (sweet musty smell), hemorrhoids, variceal bleeding, anemia, body hair loss, liver tenderness, palmar erythema

348 Section II / General Surgery

Which liver enzymes are made by hepatocytes?

What is the source of alkaline phosphatase?

What is Child’s class? (Child-Turcotte-Pugh)

What comprises the Child’s classification?

How can the criteria comprising the modified Child’s classification be remembered?

Define Child’s classification: A

B

C

What is the operative mortality for a portocaval shunt vs. overall intraabdominal operations with cirrhosis in the following Child’s classes:

A?

B?

C?

What does the MELD score stand for?

What is measured in the MELD score?

AST and ALT (aspartate aminotransferase and alanine aminotransferase)

Ductal epithelium (thus, elevated with ductal obstruction)

Classification system that estimates hepatic reserve in patients with hepatic failure and mortality

Laboratory: bilirubin, albumin Clinical: encephalopathy, ascites,

prothrombin time (PT)

Use the acronym: “A BEAP”:

Ascites

Bilirubin

Encephalopathy

Albumin

PT (prothrombin time)

(Think: As in a letter grading system, A is better than B, B is better than C)

5% vs. overall 10%15% vs. overall 30%33% vs. overall 75%

Model for End-stage Liver Disease

INR, T.Bili, serum creatinine (SCR); find good MELD calculators online