6. Anatomy Segmental liver anatomy. Depicted is segmental liver anatomy as originally described by Couinaud. The right lobe consists of segments 5 through 8, the left lobe of segments 2 through 4, and theleft lateral segment of segments 2 and 3
37. Grade 1 hepatic injury Grade 1 hepatic injury in a 21-year-old man with a stabbing injury to the right upper quadrant of the abdomen. Axial, contrast-enhanced computed tomography (CT) scan demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1 cm thick
38. Grade 2 Liver Injury A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury after minor blunt abdominal trauma. Nonenhanced axial CT scan at the level of the hepatic veins shows a subcapsular hematoma 3 cm thick
39. Grade 3 Liver Injury Grade 3 liver injury in a 22-year-old woman after blunt abdominal trauma. Contrast-enhanced axial CT scan through the upper abdomen shows a 4-cm-thick subcapsular hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of the right lobe of the liver. Free fluid is seen around the spleen and left lobe of the liver consistent with hemoperitoneum
70. Amoebic Abscess Con’t. A well demarcated swelling is seen in the epigastrium in a case of a left lobe amoebic liver abscess
71.
72. Amebic Liver Abscess Chest radiograph demonstrating elevation of the right hemidiaphragm Abdominal CT scan demonstrating a large abscess in the right hepatic lobe
73.
74. Amoebic Abscess Con’t. Rupture of a left lobe amoebic Liver Abscess into pericardium Huge pericardial effusion in a patient with a superior amoebic liver abscess
136. Alcoholic Hepatitis Mallory’s bodies A – low power view demonstrating the cardinal features of steatosis, fibrosis , inflammation and hepa- tocellular injury B – (Black arrow) Mallory Bodies C – (Open arrow) pericellular fibrosis “ chicken wire fibrosis” D – the unit lesion (satellitosis)
175. The Child’s Classification for Determining the Operative Risk of a Shunting Procedure in a Patient with Portal Hypertension Child Group C A B Serum Bilirubin (mg/dL) < 2 2 - 3 > 3 Serum Albumin (g/dL) > 3.5 3 – 3.5 < 3 Presence of Ascites Absent Early controlled Severe Presence of Encephalopathy Absent minimal Severe Presence of malnutrition Absent Mild Severe Operative Mortality Rate 2 % 10 % 50 %
223. Normally a balance of bile salts, lecithin and cholesterol keep gallstones from forming. If there are abnormally high levels of bile salts or, more commonly, cholesterol, stones can form. Symptoms usually occur when the stones block one of the biliary ducts, otherwise benign gallstones may be discovered on x-ray or abdominal CT.
224. Gallstones HMG COA Mevalonate Choleterol Bile Acids HMG COA reductase Several intermediate steps 7-alpha hydroxylase (rate limiting step)
261. Hydrops of the Gallbladder Gallbladder mucocele/hydrops Note the gross wall thickening; this is usually measured on the anterior wall of the gallbladder
262. Hydrops of the Gallbladder perioperative photograph of a gallbladder shows the inflamed mucosa in a gallbladder; note the stones perioperative photograph of a gallbladder in a patient with acute cholecystitis shows an inflamed, edematous gallbladder with areas of erythema and congestion.
351. The Child’s Classification for Determining the Operative Risk of a Shunting Procedure in a Patient with Portal Hypertension Child Group C A B Serum Bilirubin (mg/dL) < 2 2 - 3 > 3 Serum Albumin (g/dL) > 3.5 3 – 3.5 < 3 Presence of Ascites Absent Early controlled Severe Presence of Encephalopathy Absent minimal Severe Presence of malnutrition Absent Mild Severe Operative Mortality Rate 2 % 10 % 50 %
