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ABSITE > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

What 3 structures make up the portal triad?

A

CBD, portal vein, common hepatic artery - in the hepatoduodenal ligament

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2
Q

Cantle’s Line

A

Separates the R and L lobe of the liver

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3
Q

Segments of the liver

A
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4
Q

What is the venous drainage of the liver?

A

3 hepatic veins drain into the IVC

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5
Q

Most common replaced right hepatic artery comes off of?

A

The SMA

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6
Q

Most common replaced left hepatic artery comes off of?

A

Left gastric (gastrohepatic ligament)

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7
Q

In what trimester should cholecystectomy be done in pregnancy?

A

2nd trimester

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8
Q

Stones identified during IOC?

A

Glucagon, flush

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9
Q

Benign hyperplastic gallbladder polyps. What size to remove?

A

1.0cm

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10
Q

Gallbladder polyps of ___ need serial imaging with yearly US

A

0.6-0.9cm

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11
Q

Gallbladder polys >18mm treat as _____

A

Cancer

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12
Q

Portal Hypertension is defined as a hepatic vein pressure gradient > than ______

A

6mmHg - difference between wedged hepatic vein pressure and free hepatic vein pressure

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13
Q

Polyps between ____ and ____ size have an increased risk of malignancy and should undergo cholecystectomy

A

1.0 and 1.9cm

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14
Q

Polyps of this size need repeat imaging in 1 year, and if stable, no further follow up required

A

<0.5cm

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15
Q

Gallbladder cancer will first metastasize to which nodes?

A

Cystic duct nodes

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16
Q

`What to do if CBD stones are identified on IOC?

A

Flush, glucagon x2

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17
Q

In patients with severe pancreatitis, how long to wait for cholecystectomy?

A

At 6-8 weeks, ERCP + sphincterotomy

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18
Q

Rigler’s Triad

A

Bowel obstruction, gallstone in intestine, pneumobilia

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19
Q

What type of portal hypertension is schistosomiasis ?

A

Pre-sinusoidal

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20
Q

What type of portal hypertension is alcoholic cirrhosis and viral hepatitis?

A

Sinusoidal

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21
Q

What type of portal hypertension is Budd Chiari syndrome?

A

Post-sinudoisal

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22
Q

TIPS (transjugular intrahepatic portosystemic shunt)

A

Stent between hepatic vein and portal vein. Used for acute variceal bleeding, Budd chiari or hepatic hydrothorax

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23
Q

The use of ________ is associated with increased rates of primary fascial closure in patients with open abdomen

A

3% hypertonic saline (removes intestinal edema)

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24
Q

Mattox Maneuver

A

Exposure of the left retroperitoneum
1. Mobilize the inferior portion of the descending colon
2. Divide the white line of toldt bluntly
3. Rotate kidney, pancreas and spleen medially

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25
Q

Cattell-Braasch Maneuver

A

Right medial visceral rotation
-Mobilize the right colon superiorly

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26
Q

Selective portosystemic shunt

A

Decompresses only part of the portal venous system- good for variceal bleeding, does not help with ascites

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27
Q

Non-selective portosystemic shunt

A

Decompresses the entire portal venous system, side to side portocaval shunt. Higher rate of encephalopathy

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28
Q

What type of shunt to use with variceal bleeding?

A

Selective shunt

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29
Q

What type of shunt to use with ascites?

A

Non-selective shunt

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30
Q

Treatment of pyogenic abscess

A

Percutaneous drainage + ABX

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31
Q

How to treat aeombic abscess?

A

Flagyl

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32
Q

Double walled cyst on CT

A

Echinococcal cyst - Albendazole + Surgical excisin

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33
Q

Hepatic vein pressure gradient required for variceal rupture?

A

12mmHg

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34
Q

Child-Pugh Score

A

Pooh BEAAr- Prothrombin time, Bilirubin, encephalophy, ascites, albumin

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35
Q

Components of MELD Score

A

Bilirubin, INR, Creatinine

36
Q

At which MELD score do patients have a survival benefit for transplant?

A

15

37
Q

What is the most common cause of a benign biliary stricture?

A

Previous cholecystectomy

38
Q

Most common risk factors for cholangiocarcinoma?

A

UC and PSC

39
Q

Bismuth A injury

A

Injury to cystic duct or ducts of Luschka

40
Q

Bismuth B injury

A

Injury to aberrant R hepatic duct

41
Q

Bismuth C injury

A

Leak from aberrant R hepatic duct

42
Q

Bismuth D injury

A

Lateral CBD injury

43
Q

Bismuth E1 injury

A

Hepatic duct injury >2cm from R and L hepatic duct confluence

44
Q

Bismuth E2 injury

A

Hepatic duct injury <2cm from R and L hepatic duct confluence

45
Q

Bismuth E3 injury

A

CBD injury at confluence or R and L hepatic duct

46
Q

Bismuth E4 injury

A

CBD injury above the confluence or R and L hepatic duct

47
Q

Bismuth E5 injury

A

Main hepatic duct and accessory R hepatic duct injury

48
Q

Ductal injures <3cm treatment?

A

Simple ligation and drain placement

49
Q

Ductal injuries >4mm treatment?

A

Repair or reconstruction

50
Q

Type I choledocal cyst

A

Extrahepatic ductal dilation - Tx = Resection with hepaticojejnostomy

51
Q

Type II choledocal cyst

A

Diverticulum of CBD - Tx = Roux en Y

52
Q

Type III choledocal cyst

A

Choledococele or dilation of ampulla of vader - Tx = ERCP - transduodenal excision or spinchterplasty

53
Q

Type IVa choledocal cyst

A

Dilation of intra AND extrahepatic ducts- Tx = Excision with biliary reconstruction.

54
Q

Type V choledocal cyst

A

Caroli’s disease- dilation of intrahepatic ducts ONLY - Tx = Transplant

55
Q

Soap Bubble or Paintbrush sign on IOC

A

Villous small bowel adenoma

56
Q

Which is preferred CBD exploration transcystic or transductal?

A

Transcystic

57
Q

Most potent stimulator of bile secretion

A

Secretin

58
Q

Future Liver Remnant in patients without underlying liver disease?

A

20-30%

59
Q

Future Liver Remnant in patients with underlying liver disease?

A

40%

60
Q

Type of shunt used for variceal bleeding?

A

Selective shunt

61
Q

Type of shunt used for ascites?

A

Non-selective shunt

62
Q

Type IVb choledocal cyst

A

Extrahepatic ductal dilation ONLY

63
Q

Most common liver tumor?

A

Hemangima

64
Q

Kasabach-Meritt Syndrome

A

Consumptive coagulopathy associated with hemangioma

65
Q

Name that tumor:
On CT Hypodense on pre-contrast
Peripheral to central enhancement in arterial phase
Persistent contrast on delayed series

A

Hemangioma

66
Q

Hemangioma MRI findings

A

Hypointense on T1, hyperintense on T2

67
Q

2nd most common liver tumor?

A

FNH

68
Q

Name that tumor:
On CT well demarcated
Rapid enhancement in arterial phase with central stellate scar

A

FNH

69
Q

FNH MRI findings

A

Hypointense with central scar on T1, isointense with hyperintense scar on T2

70
Q

Name that tumor:
On CT: arterial enhancement with washout on portal phase
Smooth surface with tumor capsule
Associated with OCP’s and seroids

A

Adenoma

71
Q

Adenoma MRI findings

A

Hyperintense on T1 and T2

72
Q

FNH is (negative/positive) for suulfer colloid uptake)

A

Positive

73
Q

Adenoma is (negatiive/positive) for sulfer colloids uptake

A

Negative

74
Q

Name that tumor:
On CT: hyperintense on arterial phase, hypodense during delayed phase

A

Hepatocellular carcinoma

75
Q

Milan criteria for transplant in early to severe cirrhosis in patients with HCC?

A

One less than 5 or 3 less than 3, no gross vascular or extrahepatic spread

76
Q

Afferent limb syndrome is caused by?

A

Too long afferent limb, should be less than 12-15cm

77
Q

Epigastric pain, postprandial fullness, and sudden explosive vomiting of bilious contents

A

Roux syndrome

78
Q

Early vs Late dumping syndrome

A

Early- 30-60 minutes after eating- tachycardia, diaphoresis, caused by fluid shifts
Late 2-3 hrs after eating- weakness, hunger, autonomic symptoms due to hyperinsulinemic response

79
Q

Surgical management T1a gallbladder cancer

A

Lamina propria- Cholecystectomy alone

80
Q

Surgical management T1b gallbladder cancer and greater

A

Invades muscle layer - cholecystectomy with segment IVb V hepatic resection and portal lymphadenectomy

81
Q

Highest negative predictive value for choledocolithiasis?

A

GGT - Normal GGT has 97% NPV

82
Q

Tumor marker for fibrolamellar variant of HCC?

A

Neurotensin

83
Q

Whats the first treatment for hemobilia coming from trauma?

A

Angioembolization

84
Q

Right liver resection

A

Segments 5-8

85
Q

Left liver resection

A

2-4 +/- caudate

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