Abdomen Flashcards
Whats the algorithm for hepatocellular carcinoma treatment?
If no portal HTN and Plt>100k may be resectable.
Noncirrhotic: if liver remnant>25% resect
Child A: if liver remnant >40% resect
Child B/C: transplant if milan criteria met
If liver remnant low, portal vein embo and recheck 4 weeks later
If unresectable, TACE or ablation
Whats milan criteria?
1 tumor <5 cm or 3 tumors <3 cm each, No vascular or extrahepatic involvement
What’s workup for liver mass? What is used to calculate meld and child pugh scores
CBC, CMP, INR, 4 phase CT (noncon, arterial, portal, venous), AFP. Pet ct if hcc.
Meld: Bili, INR, Cr, Na, dialysis status
Child: Bili, INR, albumin, ascites, enceph
Whats critical view of safety for lap ing hernia
Pubic symphysis, Myopectinal orifice, conjoint tendon, iliopubic tract, inferior epigastric artery
How do you calculate peritoneal carcinomatosis index?
13 sectors (1-9 for the sections of abdomen, 4 for proximal/distal jejunum/ileum). Each quadrant given 0-3 based on size of largest tumor
ITP workup/treatment?
easy bruising/bleeding, joint swelling, hepato/splenomegaly
Goal Hgb>7, Plt>10k to prevent spontaneous ICH
Heme consult to rule out malignancy
Treatment:
Steroids work but not long lasting
Splenectomy
If persistent thrombocytopenia, get tagged RBC scan to look for accessory spleen
Pancreatic cyst algorithm
Get CT panc protocol
MRCP/EUS w fluid sampling
High amylase + high CEA + Mucin = IPMN
If Main duct IPMN: OR
If branch duct IPMN:
- High risk if >3 cm, mural nodules, symptomatic -> OR
If body: Distal panc/splenectomy
If head: Whipple
Chronic pancreatitis surgical options
Dilated duct (>6mm) without head enlargement: Puestow
Enlarged head without dilated duct: Beger procedure
Dilated duct and enlarged head: Frey procedure
Pancreatic Pseudocyst
Intervene if >6 weeks and > 6cm.
If within 2 cm of posterior gastric wall, endoscopic cystgastrostomy
Otherwise surgical cystojejunostomy
