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ABSITE Flashcards > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

R hepatic artery off of what artery in 17%?

A

SMA

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2
Q

L hepatic off of what artery in 10%?

A

L gastric artery

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3
Q

Kupffer cells

A

Clear portal blood

Immunosurveillance

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4
Q

Portal triad

A

Portal vein posterior to CBD (on right) and hepatic artery (on left)

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5
Q

Urine finding in hepatorenal syndrome?

A

Low urine Na

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6
Q

Cholangitis

A 
Jaundice
RUQ tenderness
Fever
Hypotension
AMS

Tx: emergent ERCP, IV abx

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7
Q

Retained CBD stone identified on T-tube cholangiogram, tx?

A

Radiology stone retrieval

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8
Q

Porcelain gallbladder

A

30-65% risk of cancer

Cholecystectomy indicated

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9
Q

Hematobilia triad

A

GI bleed
Jaundice
RUQ pain

Tx: arteriogram

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10
Q

How is bile concentrated by gall bladder?

A

Active absorption of Na, Cl (H2O follows)

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11
Q

Hepatic adenoma tx?

A

10% rupture/bleed
Have malignant potential
Indication for resection

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12
Q

Hepatic hemangioma

A

Resect only if giant or symptomatic

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13
Q

Kasaback-Merritt syndrome?

A

Consumptive coagulopathy or CHF due to hemangioma

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14
Q

Amebic abscess tx

A

Tx: metronidazole

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15
Q

Hydatid cyst

A

Tx: resect

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16
Q

Cantilie line

A

imaginary line that divides right and left lobe of the liver, runs from IVC to middle of the GB (not the falciform ligament)

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17
Q

Segments within each lobe of liver

A

Caudate lobe-segment 1, left lobe-segment 2,3,4a,4b. right lobe-segment 5-8

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18
Q

Symptomatic cholelithiasis in pregnant patient

A

try to do elective chole in 2nd trimester

19
Q

+IOC tx?

A

try to flush the stone through with glucagon (up to 2x)

  • Large duct, small stone -> trancystic exploration
  • Large stone, small duct -> lap CBD, post-op ERCP
20
Q

No filling of hepatic ducts with IOC

A

high suspicion of hepatic duct injury, convert to open procedure

21
Q

Gallstone ileus

A

SBO caused by gallstone lodged in ileocecal valve
- Fistula connecting GB to duodenum usually
- Riggler’s triad: pneumobilia, SBO, visible gallstone in small bowel
- Tx: enterotomy proximal to obstruction and milk out stone to relieve obstruction
o Wait to take down fistula and cholecystectomy later

22
Q

Gallbladder polyp tx

A
  • Asymptomatic -> nothing to do
  • > 10 mm -> cholecystectomy (increased risk of cancer)
  • > 18 mm treat as cancer until proven otherwise
  • > 6 mm -> requires surveillance
23
Q

Hepatic vein pressure gradient in portal HTN

A

> 6 mm Hg

o Gradient between wedged hepatic vein pressure and the free hepatic vein pressure
o Hepatic vein pressure >12 -> a/w variceal rupture

24
Q

Pyogenic abscess

A

o MC abscess
o 2/2 to biliary tract or GI infxn -> E coli (MC)
o Tx: perc drain, abx

25
Q

Amebic abscess

A

o South America, Mexico
o Dx: imaging, serology
o Tx: flagyl, rarely need drainage

26
Q

Echinococcal abscess

A

o Hydatid cyst, double walled cystic appearance on CT
o Check serology
o Tx: albendazole, surgical excision, do not aspirate or spill (causes anaphylaxis)

27
Q

Components of Child-Pugh

A

bili, albumin, PT, encephalopathy, ascites

28
Q

Components of MELD

A

bili, INR, Cr

29
Q

Todani classification of choledochal cysts

A

o Type 1: fusiform dilation of extrahepatic biliary tree
“ Tx: resection, hepaticojejunostomy
o Type 2: saccular diverticulum of CBD
“ Tx: excise, possibly need to do roux-en-y
o Type 3: choledococele, dilation of intramural duct
“ Tx: transduodenal excision or sphincteroplasty
o Type 4A: multiple dilation of intra and extrahepatic ducts
“ Tx: Hepatic resection of affected areas, hepatico-j
o Type 4B: multiple dilation of extrahepatic ducts alone
“ Tx: excision, hepatico-j
o Type 5: dilation of intrahepatic ducts
“ Tx: transplant

30
Q

Hepatic cyst

A
  • Symptomatic:
    o Cyst fenestration
    o R/o other pathology
31
Q

Hemangioma

A
  • Peripheral and central enhancement on arterial phase of CT
  • Symptomatic
    o Only reason to resect
32
Q

FNH

A
  • Benign

- Well demarcated, rapid arterial enhancement, central stellate scar

33
Q

Adenoma

A
  • 10% malignant potential
  • Arterial enhancement with washout in porto-venous phase, smooth surface
  • Tx
    o Stop OCP, see if regresses
    o >4 cm or no regression: resect
    o Ruptured: IR embolization and then resect in elective setting
34
Q

Hepatocellular carcinoma

A
  • Hypervascular, hyperdense in arterial phase
  • Can be diagnosed on imaging alone, with elevated AFP
  • No PET scan
  • MC site of metastasis: lung
35
Q

Resection criteria in HCC

A

o Future liver remnant: can resect up to 75% in healthy liver
- 30-40% FLN required in Child-Pugh A

36
Q

Milan criteria for transplant

A

” 1 lesion <5 cm
“ 3 or fewer lesions <3 cm
“ No gross vascular or extra-hepatic spread

37
Q

GB cancer tx

A
  • T1a: invades only lamina propria
    o Tx: cholecystectomy
  • T1b and beyond: muscle layer and beyond
    o Tx: cholecystectomy and limited hepatic resection (segment 4b and 5), portal LN resection
38
Q

Highest negative predictive value for choledocholithiasis

A

GGT

39
Q

Assessing biliary tree after roux-en-y

A

trans-gastric ERCP or double balloon endoscopy

40
Q

Fibrolamellar variant of HCC

A

young patient without cirrhosis, better prognosis, neurotensin tumor marker

41
Q

Hemobilia dx.tx

A

-> tx angioembolization, EGD first

42
Q

Left lateral segmentectomy

A

segment 2 & 3

43
Q

Extended right hepatectomy

A

5, 6, 7, 8 ,4

ABSITE Flashcards (19 decks)

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