Hepatobiliary

Question 1

Milan criteria

Answer 1

Single lesion <5cm or up to 3, 3cm or less
No vascular or extra hepatic dz
AFP <1000ng/mL

Question 2

Most sensitive modality for detecting small liver mets

Answer 2

Intraop US

Question 3

Pyogenic liver abscess, tx

Answer 3

Broad spectrum abxs, and perc drainage

Question 4

Required future liver remnant

Answer 4

> 20% healthy, >40% for cirrhotics

Question 5

Gold standard to hypertrophy future liver remnant

Answer 5

Portal vein embolization

Question 6

Contraindications to liver txp

Answer 6

Unstable CAD, pulm htn, O2 dependence, uncontrolled malignancy/infx, noncompliance

Question 7

How to prevent tumor growth between PVE and liver resection

Answer 7

TACE

Question 8

Suspected distal cholangiocarcinoma; next step

Answer 8

ERCP to visualize and bx, possibly stent

Question 9

Common organism in SBP

Answer 9

Gram neg enteric bacteria, E coli, Klebsiella, PsA

Question 10

Isolated gastric varices with hx of chronic pancreatitis; dx and tx

Answer 10

Splenci vein thrombosis, splenectomy

Question 11

Blood supply CBD

Answer 11

Cystic, hepatic, GDA branches 3 and 9 o’clock

Question 12

Significant morbidity and mortality in fulminant liver failure; dx and tx

Answer 12

Intracranial HTN and cerebral edema, invasive ICP monitoring

Question 13

Hydatid disease treatment

Answer 13

Based on WHO classification: Surgery, puncture-aspiration-injection-reaspiration(PAIR), albendazole or observation

Question 14

Most common cause of esophageal varices; tx

Answer 14

Portal HTN from cirrhosis/hepatitis, Endoscopic/beta-blockade -> TIPS

Question 15

Unstable with multiple endoscopic attempts at managing esophageal varix bleed

Answer 15

Sengstaken-Blakemore or Minnesota tube

Question 16

Liver lesion, central scar with intense arterial enhancement

Answer 16

FNH

Question 17

Liver lesion, Hyperechoic with peripheral nodular enhancement and centripetal fill on delay

Answer 17

Hemangioma

Question 18

Liver lesion, cirrhotic with arterial enhancement with wash out

Answer 18

HCC

Question 19

Liver lesion, on OCPs with arterial enhancement and isointense delay

Answer 19

Adenoma

Question 20

Budd-Chiari syndrome; diagnostic test

Answer 20

Duplex US

Question 21

Important to improve outcomes for hernia repair in cirrhotics

Answer 21

Control ascitic fluid (diuretics, paracentesis, TIPS)

Question 22

Major cause of pyogenic liver abscesses

Answer 22

Cholangitis (obstruction due to malignancies/stones)

Question 23

Hemangioma treatment

Answer 23

Observed, if symptomatic resect

Question 24

Hepatic amoebic abscess; tx

Answer 24

Metronidazole

Question 25

Liver abscess, hx of diverticulitis, appendicitis, diarrhea; dx and tx

Answer 25

Pyogenic, IV broad spectrum abxs +/- drain

Question 26

Liver abscess, hx of travel to tropical under-developed areas; dx and tx

Answer 26

Amoebic (Entamoeba histolytica), Metronidazole

Question 27

Liver abscess, hx of distant exposure to sheep grazing area (Mediterranean, Central Asia) may have daughter cysts; dx and tx

Answer 27

Hydatid (Echinococcus), Albendazole +/- PAIR

Question 28

Bleeding esophageal varices; medical tx

Answer 28

Infusion of vasopressin with nitroglycerin, octreotide and PPI

Question 29

Focal nodular hyperplasia; tx

Answer 29

Conservatively, only resect if persistent symptoms, enlarging size, and dx uncertainty

Question 30

TIPS indication

Answer 30

> 2-3 large volume paracenteses/month in spite of optimal sodium restriction and and diuretics

Question 31

Initiating event in the formation of ascites

Answer 31

Sinusoidal hypertension

Question 32

Area of exchange between hepatocyte and blood

Answer 32

Space of Disse

Question 33

Where are most conjugated bile acids absorbed and how

Answer 33

Terminal ileum, active transport