Beruflich Dokumente
Kultur Dokumente
ODESSA BACUD-TIANGCO, MD
ANATOMY
ANATOMY
HEPATIC VEIN
Small
short
hepatic
veins
HEPATIC ARTERY
Replaced
hepatic
artery
Accessory
hepatic
artery
PORTAL VEIN
PORTAL VEIN
75%
Posterior to the
bile duct & hepatic
artery
valveless
3-5 mm Hg
BILIARY SYSTEM
C3 & C4
LIVER LOBE
PHYSIOLOGY:
SYNTHETIC FUNCTIONS
Coagulation
factors
Plasma proteinseg. albumin
Glucose
Lipoproteins
Triglyceride
Cholesterol
Bile salt
BILIRUBIN METABOLISM
uncojugated
BILIRUBIN METABOLISM
uncojugated
BILIRUBIN METABOLISM
conjugated
BILE
Bile
85% water
1% fats
BILE ACIDS
Primary : cholic &
chenodeoxycholic
Secondary : deoxycholic
& lithocholic
500-1000ML/24H
ULTRASOUND
Economical
Intrahepatic biliary
ductal dilation
ULTRASOUND
Microbubble
contrast
Doppler UTZ
laparoscopic
Highly sensitive
Dual- & triplephase IV contrast
3-D
PRE-OPERATIVE
EVALUATIONinflow & outflow
of hepatic blood
vessel
-Liver volume
Primary vs.
metastatic
MRC
PET Scan
F-flurodeoxyglycose
Angiography
Percutaneous biopsy
Diagnostic laparoscopy
LIVER FAILURE
ACUTE
CHRONIC
Etiology
Acetaminophen overdose
Viral hepatitis
HEPATIC ENCEPHALOPATHY
Treatment
ACETAMINOPHEN TOXICITY
CIRRHOSIS
CIRRHOSIS
Hepatic fibrosis
Nodular regeneration
Etiology
Pathogenesis
Clinical manifestations
CIRRHOSIS
ULTRASOUND
ULTRASOUND
Coarsened
echotexture
CHILD-TURCOTTE-PUGH CLASSIFICATION
CHILD-TURCOTTE-PUGH
CLASSIFICATION
PORTAL HYPERTENSION
PORTAL HYPERTENSION
Etiology
Pathophysiology
Clinical manifestations
Clinical manifestations
Cruveilhier-Baumgarten murmur
SURGICAL CONCERNS
Encephalopathy
Ascites
Variceal bleeding
VARICEAL BLEEDING
Prevention of bleeding
VARICEAL BLEEDING
Management of bleeding
TRANSJUGULAR INTRAHEPATIC
PORTOSYSTEMIC SHUNT
PORTOCAVAL SHUNT
Eck fistula
high incidence of
hepatic
encephalopathy
decreased liver
function
makes subsequent
hepatic transplantation
much more technically
difficult
MESOCAVAL SHUNT
technically easier
does not adversely
affect subsequent
hepatic
transplantation.
higher incidence of
shunt thrombosis and
rebleeding
SUGIURA PROCEDURE
In patients with
extrahepatic portal
vein thrombosis
and refractory
variceal bleeding
Congenital cysts
Biliary cystadenoma
Caroli's disease
LIVER INFECTIONS
Hydatid Disease
Ascariasis
Schistosomiasis
Viral hepatitis
A single abscess is the most common presentation; spread to the liver via
the vascular route is associated with multiple abscesses
The right hepatic lobe is affected more than twice as frequently as the
left, due to vascular anatomy
Aspiration of abscess fluid and subsequent culture guide antibiotic
choice
Failure to culture pathogenic organism(s) may be due to prior antibiotic
treatment or inadequate anaerobic culture
Treatment includes antibiotics and often either percutaneous or surgical
drainage/debridement, depending on the size, number, and complexity of
the abscess(es)
Resection if :
Childs A & B
No portal hypertension