HBP Flashcards
1
Q
Ranson criteria on admission
A
- Age
- WBC
- Blood glucose
- Serum AST
- Serum LDH
2
Q
Branches of SMA
A
- Inferior pancreaticoduodenal artery (supplies head of the pancreas and to the ascending and inferior parts of the duodenum)
- Intestinal arteries (branches to ileum, branches to jejunum)
- Ileocolic artery (supplies last part of ileum, cecum, and appendix)
- Right colic artery (to ascending colon)
- Middle colic artery (to the transverse colon)
3
Q
Branches of Celiac trunk
A
- Left gastric a.
- Common hepatic a.
- Splenic a.
- Esophageal branch, stomach branch
- Hepatic a. proper, Gastroduodenal a., Right gastric a.
- Dorsal pancreatic a., Short gastric a., Left gastro-omental a., Greater pancreatic a.
4
Q
RLQ pain DDx (14)
JC WCS
A
- Acute appendicitis
- Cecal diverticulitis
- Ureteric colic
- Ruptured ectopic pregnancy
- Mesenteric adenitis
- Torsion of ovarian cyst
- Ileitis
- Meckel’s diverticulum
- Cecal ischemia
- CA Cecum
- Inguinal/Femoral hernia
- Testicular pathology
- PPU
- Acute cholecystitis
5
Q
LLQ pain DDx (7)
JC WCS
A
- Sigmoid diverticulitis
- CA Sigmoid
- Torsion of ovarian cyst
- Ruptured ectopic pregnancy
- Ureteric colic
- Inguinal/Femoral hernia
- Testicular pathology
6
Q
Central abdominal pain -
Periumbilical pain DDx (7)
JC WCS
A
- SB obs
- GE
- Early acute appendicitis
- Bowel ischemia
- IBS
- Ruptured AAA
- Acute pancreatitis
7
Q
Central abdominal pain -
Hypogastrium pain DDx (4)
JC WCS
A
- Cystitis
- PID
- LB obs
- AROU
8
Q
Child-Pugh score
A
ABCDE
Albumin Bilirubin PT Ascites (distension) Encephalopathy
A - 5-6 (compensated, normal liver function)
B - 7-9 –> can go for transplant
C - 10-15
9
Q
MELD score (Model for end stage liver disease)
A
BICE
Bilirubin
INR
Creatinine
Etiology
10
Q
Causes of Portal HT
IT
A
Pre-hepatic cause (20%)
- Thrombophlebitis of umbilical v.
- Congenital absence of PV
- Malignant invasion of PV (PV thrombosis usu by CA head of pancreas; HCC usu causes ipsilateral PV thrombosis, not usu causing main trunk thrombosis)
Intrahepatic cause (80%)
- Cirrhosis
- Drug
- Chronic hepatitis (8% HBV carrier in HK now)
- Cardiac cirrhosis
- Congenital hepatic fibrosis
Post-hepatic cause
- Budd-Chiari syndrome (affect the main hepatic v.?)
- Constrictive pericarditis
11
Q
Spread of HCC
IT
A
Local invasion
- PV
- Hepatic v.
- Bile duct
Lymphatic spread (25% of patients)
Transperitoneal spread (Rare)
Hematogenous spread
- Lung, Bone
12
Q
Presentation of HCC
IT
A
- Subclinical (50% cases are asymptomatic)
- Vague epigastric distension
- Sharp pain due to bleeding
- Abd mass
- Abd distension due to ascites
- Secondaries in Lung, Bone
- Paraneoplastic syndrome
- Diarrhea, hypo/hyperglycemia, hyperCa, polycythemia (tumor produces EPO) - LOW
- GIB
13
Q
Indication of partial hepatectomy for HCC
IT
A
- Uni-lobar involvement
- No invasion into IVC or PV (actually in QM also do invasion to PV)
- Acceptable liver fx for major hepatectomy
- Child A
- ICG retention 15 min <14%
14
Q
Indication of liver transplant for HCC
IT
A
- HCC <5cm single (or HCC <3cm up to 3 nodules)
2. Child C
15
Q
Indication of TACE for HCC
IT
A
- Bi-lobe involvement, no distant spread / complete PV obs / IVC involvement
- Uni-lobar involvement but liver fx not acceptable for hepatectomy
