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INTRODUCTION

Test Taking Tip

  • Familiarity with the distinction between benign liver tumors is critical. Know the diagnostic modalities necessary to identify hepatic adenomas, focal nodular hyperplasia (FNH), and hemangiomas, as well as infectious etiologies such as pyogenic, amebic, or hydatid cysts; management of colorectal cancer metastasis to the liver; and familiarity with classifications of cholangiocarcinomas

ANATOMY

List the ligaments of the liver:

  • The falciform ligament, coronary ligaments, and the right and left triangular ligaments

What structures are contained within the hepatoduodenal ligament?

  • Porta hepatis: proper hepatic artery, portal vein, common bile duct (CBD)

What line divides the liver into left and right lobes?

  • Cantlie line (runs from the middle of the gallbladder fossa anteriorly to the inferior vena cava posteriorly)

How many Couinaud segments are in the liver?

  • 8

Which segments are removed in a right hepatectomy?

  • Segments 5 to 8

Which segments are removed in a right trisegmentectomy?

  • Segments 4 to 8

Which segments removed are in a left hepatectomy?

  • Segments 2 to 4

Which segments are removed in a left lateral trisegmentectomy?

  • Segments 2 and 3

Which segments are removed in a left trisegmentectomy?

  • Segments 2, 3, 4, 5, and 8

How much percentage of blood flow does the portal vein supply to the liver?

  • 70%

What percentage of cardiac output accounts for hepatic blood flow?

  • 25%

FIGURE 15-1

Couinaud liver segments (1 through 8) numbered in a clockwise manner. The left lobe includes segments 2 to 4, the right lobe includes segments 5 to 8, and the caudate lobe is segment 1. (Reproduced with permission from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery, 11th ed. New York, NY: McGraw Hill; 2019.)

FIGURE 15-2

Hepatic resection nomenclature and anatomy. Hepatic segments removed in the formal major hepatic resections are indicated. The International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane 2000 terminology also is presented. IVC, inferior vena cava; LHV, left hepatic vein; MHV, middle hepatic vein; RHV, right hepatic vein. (Reproduced with permission from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery, 11th ed. New York, NY: McGraw Hill; 2019.)

How much of the liver’s oxygen supply is provided by the hepatic artery?

  • 50%

How many hepatic veins are there?

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