Hepatobiliary

Question 1

Primary Hepatoma

Answer 1

aka hepatocellular carcinoma
in pt with cirrhosis
Features: vague RUQ discomfort and weight loss.
Dx: alpha-fetoprotein level, CT
Tx: resection

Question 2

Metastatic Liver Cancer

Answer 2

usually found on CT or with rising CEA in pt with colon cancer.
Tx: resection if slow growing and confined to one lobe; radioablation

Question 3

Hepatic adenoma

Answer 3

complication of birth control pills
tendency to rupture and bleed inside abd
Dx: CT
Tx: surgery

Question 4

Pyogenic Liver Abscesses

Answer 4

complication of biliary tract disease (acute ascending cholangitis)
Features: fever, leukocytosis, tender liver.
Dx: US or CT
Tx: percutaneous drainage

Question 5

Amebic abscess of liver

Answer 5

men with Mexico connection
Features: fever, leukocytosis, tender liver.
Dx: CT, serology
Tx: metronidazole

Question 6

Hemolytic Jaundice

Answer 6

Bilirubin 6-8, all indirect.
No bile in urine.
Find underlying cause of hemolysis and treat it.

Question 7

Hepatocellular Jaundice

Answer 7

elevation of direct and indirect bilirubin
very high transaminases
modest elevation alk phos
work up for hepatitis

Question 8

Obstructive Jaundice

Answer 8

elevated direct and indirect bilirubin
modest elevation transaminases
very high alk phos
Dx: US with dilated biliary ducts
Cause: stones or malignancy
Courvoisier-Terrier sign = large thin-walled distended bladder from malignant obstruction

Question 9

Obstructive Jaundice from stones

Answer 9

obese, fecund woman in 40's
high alk phos
dilated ducts on US
nondilated gallbladder full of stones
Dx: US, MRCP, ERCP
Tx: ERCP, sphincterotomy, stone removal, cholesystectomy