Questions and Answers
What is the primary reason for most hepatic resections?
Removal of cancerous tissue
What is the estimated normal hepatic blood flow in an average adult?
1500 mL/min
What is the function of bile in the small intestine?
Emulsification of fats
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?
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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?
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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?
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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)?
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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?
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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?
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What is the most common symptom of Hepatocellular carcinoma (HCC)?
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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?
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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?
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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?
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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?
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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?
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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?
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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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