Podcast
Questions and Answers
What is the primary reason for most hepatic resections?
What is the primary reason for most hepatic resections?
What is the estimated normal hepatic blood flow in an average adult?
What is the estimated normal hepatic blood flow in an average adult?
What is the function of bile in the small intestine?
What is the function of bile in the small intestine?
What is the estimated weight of the liver in an average adult?
What is the estimated weight of the liver in an average adult?
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What is the name of the functional unit of the liver composed of hepatocytes, sinusoids, and Kupffer cells?
What is the name of the functional unit of the liver composed of hepatocytes, sinusoids, and Kupffer cells?
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What is the purpose of epidural analgesia in hepatic resection?
What is the purpose of epidural analgesia in hepatic resection?
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What is the process by which glucose is synthesized from amino acids, lactate, and glycerol?
What is the process by which glucose is synthesized from amino acids, lactate, and glycerol?
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What is the purpose of the liver's function in synthesizing plasma proteins such as albumin and alpha-1 antitrypsin?
What is the purpose of the liver's function in synthesizing plasma proteins such as albumin and alpha-1 antitrypsin?
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Which of the following vitamins is NOT stored in the liver?
Which of the following vitamins is NOT stored in the liver?
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What is the function of the ligamentum venosum and ligamentum teres in the liver?
What is the function of the ligamentum venosum and ligamentum teres in the liver?
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What is the primary cause of Hepatocellular carcinoma (HCC)?
What is the primary cause of Hepatocellular carcinoma (HCC)?
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What is the treatment of choice for patients with HCC without evidence of cirrhosis?
What is the treatment of choice for patients with HCC without evidence of cirrhosis?
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What is the term for the breakdown of glycogen to glucose?
What is the term for the breakdown of glycogen to glucose?
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What is the purpose of the liver's function in breaking down hemoglobin from red blood cells?
What is the purpose of the liver's function in breaking down hemoglobin from red blood cells?
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What is the classification system used to divide the liver into eight functionally independent segments?
What is the classification system used to divide the liver into eight functionally independent segments?
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What is the most common symptom of Hepatocellular carcinoma (HCC)?
What is the most common symptom of Hepatocellular carcinoma (HCC)?
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What is the primary objective of a comprehensive preanesthetic evaluation?
What is the primary objective of a comprehensive preanesthetic evaluation?
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What laboratory data is critical to review during the preanesthetic evaluation?
What laboratory data is critical to review during the preanesthetic evaluation?
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What is the primary advantage of using 3D imaging in surgical planning for hepatic resection?
What is the primary advantage of using 3D imaging in surgical planning for hepatic resection?
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What is the primary purpose of administering blood products and antifibrinolytic medication during the preoperative period?
What is the primary purpose of administering blood products and antifibrinolytic medication during the preoperative period?
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What is the primary reason for placing an epidural catheter during the preoperative period?
What is the primary reason for placing an epidural catheter during the preoperative period?
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What is the primary benefit of having a rapid fluid-infusing device immediately available in the room?
What is the primary benefit of having a rapid fluid-infusing device immediately available in the room?
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What is the primary goal of anesthetic interventions during liver resection?
What is the primary goal of anesthetic interventions during liver resection?
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What is the purpose of the Pringle maneuver during liver resection?
What is the purpose of the Pringle maneuver during liver resection?
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What is a common application of hemostatic stapling in liver surgery?
What is a common application of hemostatic stapling in liver surgery?
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What is the typical range of blood loss during liver resection?
What is the typical range of blood loss during liver resection?
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How often can patients tolerate the Pringle maneuver during liver resection?
How often can patients tolerate the Pringle maneuver during liver resection?
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What is the purpose of using dye injection during liver resection?
What is the purpose of using dye injection during liver resection?
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Study Notes
Hepatic Resection Key Points
- Hepatocellular carcinoma and metastasis from colorectal cancer are common cancers that occur within the liver.
- Most hepatic resections are performed to remove cancerous tissue, with bleeding and hemorrhage being major risks associated with the procedure.
- Advances in equipment, perioperative management, and surgical techniques have decreased morbidity and mortality associated with liver resections.
Anatomy and Physiology of the Liver
- The liver is a 1.5 kg organ located in the right upper quadrant of the abdominal cavity, extending from the fifth rib to the lower border of the thoracic cage.
- It is divided into four anatomic lobes (right, left, caudate, and quadrate) and performs many functions that maintain homeostasis.
- The liver lobule is the basic functional unit, comprising hepatocytes, sinusoids, and Kupffer cells in a triangular arrangement around a central vein.
- Liver lobules are connected via an intricate network of arteries, veins, and a unique drainage system.
- Normal hepatic blood flow in the average adult is approximately 1500 mL/min or 25%-30% of cardiac output.
Liver Functions
- The liver produces and excretes bile into the small intestine for fat emulsification.
- It breaks down carbohydrates, fats, and proteins, and is involved in metabolism, synthesis, and storage of various substances.
- The liver synthesizes plasma proteins, such as albumin and alpha-1 antitrypsin, and clotting factors I, II, V, VII, IX, and XI.
- It also stores folate, glycogen, fat-soluble vitamins, and minerals like iron and copper.
Liver Segments and Resection
- The Couinaud classification divides the liver into eight functionally independent segments, each with an independent vascular system.
- The middle hepatic vein divides the liver into right and left lobes, or hemiliver.
- Each segment has a distinct vascular system, making anatomic liver resections possible.
Hepatocellular Carcinoma (HCC)
- HCC is the most common primary malignancy affecting the liver, often caused by chronic hepatitis B or C and cirrhosis due to chronic alcohol abuse.
- Initial symptoms of HCC are variable, including abdominal pain, unexplained weight loss, jaundice, ascites, esophageal varices, or portal hypertension.
- Liver resection is the treatment of choice for HCC, but may be limited in patients with cirrhosis, particularly those with a low platelet count.
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Description
Test your knowledge on hepatic resection, including types of cancer, risks, and surgical advancements. Learn about the importance of perioperative management and modern surgical techniques in liver resections.
