Hepatobiliary

Question 1

Right hepatic artery off of ___ in ___%.

Answer 1

SMA in 17% (Every year)

Question 2

Left hepatic artery off of ___ in ___%

Answer 2

Left gastric artery in 10%

Question 3

Kupffer cells….

Answer 3

clear portal blood immunosurveillance

Question 4

Portal triad…

Answer 4

portal vein posterior to CBD (on R) and hepatic artery (on L)

Question 5

Hepatorenal syndrome…. what lab value?

Answer 5

See low urinary Na

Question 6

Cholangitis…….symptoms?

Answer 6

jaundice, RUQ tenderness, fever, hypotension, change in mental status

Question 7

Cholangitis…… what to do?

Answer 7

Needs immediate IV abx, fluid resuscitation and emergent drainage of CBD (Every year)— we said ERCP too….

Question 8

Retained CBD stone identified on T-Tube cholangiogram 6 weeks postop best managed by _______.

Answer 8

radiology stone retrieval

Question 9

Benign biliary stricture…………….. cause?

Answer 9

1 cause is iatrogenic (lap chole)

Question 10

Gallbladder adenocarcinoma:
__% have stones. Cholecystectomy adequate if ____.
If grossly visible tumor, do ___, ____, ____.

Answer 10

90% have stones; chole ok if confined to mucosa; if grossly visible— do regional lymphadenectomy, wedge segment V, skeletonize portal triad

Question 11

Porcelain gallbladder: ___% risk of cancer.

____ indicated.

Answer 11

30-65%;

cholecystectomy

Question 12

Hematobilia triad: ___, ____, ____.

Workup and Rx is ________.

Answer 12

GI bleed, jaundice, RUQ pain.

Workup and Rx with arteriogram.

Question 13

Gallbladder concentrates bile by ________

Answer 13

by active absorption of Na, Cl (H20 then follows)

Question 14

Hepatic adenoma: ___% rupture/bleed.
Benign or malignant potential? _____.
Hot or cold on liver scan? ____.
Indication for resection? _____.

Answer 14

10% rupture; malignant potential; cold on liver scan; hepatic adenoma IS an indication for resection. (Every year)

Question 15

Hepatic hemangioma Rx?????

Answer 15

Do nothing unless giant or symptomatic/consumptive.

Question 16

Kasaback Merritt syndrome…

Answer 16

consuptive coagulopathy or CHF due to hemangioma

Question 17

Amebic Abscess (anchovy paste) Rx????

Answer 17

Metronidazole, not surgical

Question 18

Hydatid= ________ cyst….
Positive tests? ___________ and ________.
Rx? ____________________________

Answer 18

Echinococcal cyst; +Casoni skin test; +indirect hemagglutination; Rx RESECT (pericystectomy)

Question 19

____________ is #1 cancer worldwide

Answer 19

Hepatocellular CA

Question 20

HCC may have high __________ (lab)

Answer 20

alpha-FP

Question 21

#1 cause of HCC \_\_\_\_\_\_\_\_\_.
also associated with...........

Answer 21

Chronic Hep B and C; also assoc w/ any cirrhosis (EtOH, hemochromatosis, primary biliary cirrhosis, alpha-1 antitrypsin deficiency), clonorchis sinesis (flukes), aflatoxin, fibrolamellar variant has better prognosis