Hepatobiliary

Question 0

Most common cancer in the liver? Blood marker? Surgery when? Otherwise?

Answer 0

Metastatic cancer; CEA

Slow growing primary tumor or metastases confined to one lobe

Radioablation

Question 1

Primary hepatoma – a.k.a.? In US, seem in patients with? Blood marker? Imaging? Surgery when?

Answer 1

Hepatocellular carcinoma; cirrhosis

Alpha-fetoprotein; CT scan

Surgical resection if technically possible

Question 2

Hepatic adenoma associated with? Complication? Imaging? Surgery when?

Answer 2

Birth control pills; can rupture and massively bleed

CT scan

Emergency surgery

Question 3

Pyogenic liver abscess – complication? Presentation? Diagnosed with? Management?

Answer 3

Billy tract disease, specifically acute sending cholangitis

Fever, leukocytosis, tender liver

Ultrasound or CT scan

Percutaneous drainage

Question 4

Mexican immigrant with abscess of the liver – suspected diagnosis? Sampling of the pus will show? Management?

Answer 4

Amoebic abscess;

nothing – diagnosis made by serology (this takes too long, treatment is started based on clinical findings);

metronidazole

Question 5

Hemolytic jaundice – expected bilirubin level? Bile in urine?

Answer 5

6-8

No bile in urine

Question 6

Elevated unconjugated bilirubin, normal conjugated bilirubin – Diagnosis?

Answer 6

Hemolytic jaundice

Question 7

Elevation of conjugated and unconjugated bilirubin, high transaminases, slightly elevated alkaline phosphatase – diagnosis?

Answer 7

Hepatitis

Question 8

Elevation of conjugated and unconjugated bilirubin, slight elevation in transaminases, high alkaline phosphatase levels – diagnosis? Diagnosis with?

Answer 8

Obstructive jaundice; ultrasound

Question 9

Obstructive jaundice caused by stones – confirm diagnosis with? Management?

Answer 9

ERCP

ERCP for sphincterotomy and stone removal. Cholecystectomy to follow

Question 10

Types of cancer can cause jaundice?

Answer 10

#Adenocarcinoma of the head of the pancreas
#Adenocarcinoma of the ampulla of vater
#Cholangiocarcinoma
#Pancreatic cancer

Question 11

obstructive jaundice caused by tumor - diagnosis with? Management?

Answer 11

1. CT scan
#If positive, percutaneous biopsy
#If negative ERCP (Endoscopy will show ampullary cancers, cholangiogram will show intrinsic tumors of the duct or small pancreatic cancers)

Question 12

Apple core lesions on ERCP suggest?

Answer 12

Intrinsic tumor arising from the duct

Question 13

Patient with malignant obstructive jaundice and guaiac positive stools – suspected diagnosis? First test?

Answer 13

Ampullary cancer; endoscopy