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ABSITE > Biliary > Flashcards

Biliary Flashcards

1
Q

Most common cause benign biliary stricture

A

Previous surgery

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2
Q

Cholangitis s/p liver txp, dx and tx

A

Anastomotic biliary stricture, ERCP stent

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3
Q

Meperidine metabolism and toxic metabolite

A

Renal, normeperidine

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4
Q

Asymptomatic GB polyp <1cm, tx

A

Surveillance US yearly

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5
Q

Asymptomatic GB polyp >1cm, tx

A

Lap chole

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6
Q

Asymptomatic GB polyp >2cm, tx

A

Cancer workup prior to sx

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7
Q

GB ca limited to laminate propria, tx

A

T1a, Simple cholecystectomy

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8
Q

GB ca invading muscle or perimuscular connective tissue, tx

A

T1b/T2, chole with en bloc IVb/V resection and portal/hepatoduodenal lig lymphadenectomy

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9
Q

GB ca invading visceral peritoneum/adjacent liver or 2+ adjacent organs, tx

A

T3 and T4, consider extended right hepatectomy

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10
Q

Risk factors cholangiocarcinoma

A

PSC, choledochal cysts, UC, bil tract infxns

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11
Q

Absolute contraindications to lap chole

A

Uncorrected coagulopathy, inability to tolerate pneumo

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12
Q

Recent trauma, tachy with blood from ampulla of Vater, dx and tx

A

Hemobilia, angioembolization

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13
Q

Black gallstones, dx

A

Sickle cell or hereditary spherocytosis

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14
Q

Several small gallbladder polyps with cholesterol laden macrophages, dx

A

Cholesterolosis

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15
Q

Fever, jaundice, abd pain, dx and tx

A

Acute cholangitis, fluids, IV abx and ERCP for decompression

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16
Q

Aberrant duct during lap chole, next step

A

IOC

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17
Q

Future liver remnant volume

A

20% healthy, 30% liver dysfunction, 40% cirrhosis

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18
Q

Gold standard test to determine Future Liver Remnant

A

CT Volumetry

19
Q

Gold standard tx for inadequate future liver remanant

A

Portal vein embolization

20
Q

Absolute contraindication portal vein embolization

A

Portal hypertension

21
Q

Painless jaundice, elevated C19-9, CBD stricture; dx

A

Lower duct cholangiocarcinoma

22
Q

IOC without contrast in duo; next step

A

1.0mg glucagon

23
Q

Gallbladder Ca first metastasis

A

Cystic duct lymph nodes

24
Q

Nonop management of gallstones

A

Ursodeoxycholic acid

25
Q

Types choledochal cysts

A

I: fusiform extrahepatic
II: saccular CBD
III: distal CBD
IV: intra & extra hepatic
V: intrahepatic only

26
Q

Type I choledochal cyst; tx

A

Resection, cholecystectomy, RYHJ

27
Q

Type II choledochal cyst; tx

A

Cyst excision

28
Q

Type III choledochal cyst; tx

A

Endoscopic sphincterotomy and cyst unroofing

29
Q

Type IV choledochal cyst; tx

A

Excision extrahepatic cyst, chole, RYHJ, liver resection

30
Q

Type V choledochal cyst; tx

A

Hepatic resection w/w/o RYHJ

31
Q

Bouveret syndrome

A

Gastric outlet obstruction by impacted stone in pylorus or prox duo

32
Q

Gallbladder Ca tx

A

T1a - simple chole
T1b - radical chole (segment IVB and V with portal lymphadenectomy)

33
Q

Indication for radical chole

A

T1b GB Ca (invades muscle layer)

34
Q

SAS in ICU with GB distention, elevated TB, no stones

A

Acalculous cholecystitis

35
Q

S/p lap chole, n/v, abd pain, tachy; dx and next step

A

Biloma and RUQUS

36
Q

Obstructive jaundice and periampullary mass; dx and tx

A

Likely adenoma and needs resection for risk of malignancy

37
Q

Portal triad structures and their orientation

A

CBD lateral
Portal vein posterior
Hepatic artery medially

38
Q

Gallstone pancreatitis, tx

A

ERCP with stone extraction, lap chole same admission

39
Q

How is bile concentrated

A

Active secretion of NaCl

40
Q

Most potent stimulator of bile secretion

A

Secretin

41
Q

Abdominal pain and elevated LFTs/bili s/p cholecystectomy; next step

A

ERCP (missed bile duct injury)

42
Q

Hx UC with nausea, itching and multiple biliary strictures resulting in sepsis requiring stents; dx and tx

A

PSC, liver txp

43
Q

Resectable lower duct extrahepatic cholangiocarcinoma; tx

A

Pancreaticoduodenectomy

44
Q

Bismuth-Strasberg Bile Duct Injury

A

A - cystic or luschka leak
B - aberrant right hepatic
C - leak from aberrant right hepatic
D - lateral CBD injury
E1 - 2+ cm
E2 - <2cm
E3 - bifurcation
E4 - above bifurcation
E5 - aberrant right and stricture main duct

ABSITE (34 decks)

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