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MTM > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

Acute cholecystitis needs what

A

Acute cholecystectomy
Within 72hrs, if delayed then after giving antibiotics

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2
Q

Normal bile duct calibre

A

4cm

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3
Q

Bile draining post cholesystectomy

A

Do ERCP and stenting or sphincterotomy if needed

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4
Q

What to do if bile duct got injured

A

Reconstruction by hepatobiliary surgeon

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5
Q

Pancreatic cancer with liver metastasis

A

Palliative chemo

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6
Q

Post ERCP still jaundice and new generalized abdominal pain

A

Do CT
To exclude ampulla trauma
Duodenal perforation
Pancreatitis

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7
Q

Why ERCP is technically challenging

A

Side view endoscope

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8
Q

Confirm pancreatic necrosis

A

FNAC for culture but it has risk of seeding infection so careful
Do before necrosectomy

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9
Q

Diagnostic and planning work up for gall stone

A

USG
Diameter of CBD
Liver function test

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10
Q

Difficult to dissect Calot’s triangle due to dense adhesion for exceeding timeline of 72hrs period of acute cholecystitis

A

Do operative cholecystoSTOMY
and leave it until situation settles
Then definitive surgery

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11
Q

When to do pancreatic necrosectomy

A

Infected necrosis on FNAC
AND hemodynamically unstable

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12
Q

Unable to cannulate ampulla for jaundice from carcinoma of pancreatic head

A

Percutaneous transhepatic cholangiogram and drain under USG

BUT before that undertake staging of the disease whether it is resectable or not cause PTC drain has high risk of dislodging

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13
Q

What is called when gall stone becomes impacted in Hartmann’s pouch

A

Mirizzi syndrome
Which makes Calot’s triangle difficult to delineate

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14
Q

Importance of mirizzi syndrome

A

High risk of CBD injury

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15
Q

Site of bile salts absorbtion

A

Ileum

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16
Q

Complication of mirizzi syndrome

A

Empyema

17
Q

How to manage intra operative finding of mirizzi syndrome with empyema

A

Operative cholecystoSTOMY

18
Q

Septic shock with RUQ tenderness without gall stone, without jaundice and normal calibre bile duct

A

Acute acalculous cholecystitis

19
Q

Which disease is mostly associated with acalculous cholecystitis

A

Type 2 DM

20
Q

How to scan liver lesion of HCC prior to excision

A

MRI

21
Q

Time to appear pseudocyst after acute pancreatitis

A

After 4 weeks

22
Q

Elevated marker of pancreatic pseudocyst

A

Amylase

23
Q

Glasgow criteria mnemonic for both alcohol and stone related pancreatitis

A

PANCREAS [severe if 3 or more present]
PaO2<8kPa
Age>55yrs
Neutrophilia WCC>15k
Calcium<2mmol/L
Renal function urea>16mmol/L
Enzymes LDH>600iU/L:AST>200iU/L
Albumin<3.2g/L
Sugar>10mmol/L

24
Q

Definitive Treatment of gall stone pancreatitis

A

Cholecystectomy once acute attack has settled

25
Q

How to prevent infection in pancreatic necrosis

A

Imipenem

26
Q

USG feature of hemangioma

A

Hyperechoic

27
Q

Treatment of bile leak from CBD after lapcol

A

ERCP sphincteroTOMY and CBD stenting

This is called cystic stump leak

28
Q

Which blood function do we need before ERCP

A

Coagulation profile

29
Q

Investigation to exclude both pancreatitis and perforated viscus

A

Contrast CT of abdomen and pelvis

30
Q

Percentage of CBD stone presenting with gall stone

A

10%

31
Q

How to prepare coagulation profile before pancreatic cancer surgery

A

Vit K
LMWH
Relieve biliary obstruction with plastic stenting (metallic ones may become embedded)

32
Q

How to reduce endotoxemia before pancreatic cancer surgery

A

Lactulose
IV mannitol
Bile salt substitution

33
Q

What is endotoxemia

A

https://images.app.goo.gl/k8xaTqnTvtHD37Sf6

Endotoxemia is defined as the elevation of plasma levels of lipopolysaccharides (LPS) that may be due to increased gut permeability, high levels of intestinal LPS-containing bacteria, or both.

https://images.app.goo.gl/4dYMCoXma2o1ifKH9

34
Q

Treatment of hepatocellular adenoma

A

Resection
In males it has high risk of malignant transformation

35
Q

What to do if CBD stone can’t be removed even after ERCP

A

Choledocho duodeno stomy

36
Q

Risk of Choledocho duodeno stomy

A

Long term risk of ascending cholangitis but are of less concern in older patients

37
Q

Relation of liver function test with cholecystectomy

A

We can proceed with surgery if liver function is normal

38
Q

Triad of cholangitis

A

Charcot’s triad

Pain (RUQ)
Fever (usually with rigors)
Jaundice

Rigor: a sudden feeling of cold with shivering accompanied by a rise in temperature, often with copious sweating, especially at the onset or height of a fever.

39
Q

Treatment of cholangitis with CBD <4cm

A

ERCP & stenting

MTM (12 decks)

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