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Oral Boards > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

Etiology of pre-hepatic jaundice

A

Hemolysis
Hematoma resporption
Inherited disorders of unconjugated hyperbilirubinemia

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2
Q

Etiology of intra-hepatic jaundice

A

Hepatitis (viral or inflammatory)

Intrinsic liver dysfunction (cirrhosis)

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3
Q

Etiology of post-hepatic jaundice

A

Choledocholithiasis
Chronic pancreatitis
Peri-ampullary tumor (duodenal, ampullary, pancreatic, bile duct)

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4
Q

Labs in pre-hepatic jaundice

A

Unconjucated hyperbilirubinemia

Normal ALP/AST/ALT

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5
Q

Labs in intra-hepatic jaundice

A

Conjugated, unconjugated

AST/ALT > ALP

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6
Q

Labs in post-hepatic jaundice

A

Conjugated hyperbilirubinemia

ALP > AST/ALP

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7
Q

2 most common causes of post-hepatic biliary obstruction

A

Intra-luminal obstruction: Choledocholithiasis (fever, RUQ pain, jaundice)
Extra-luminal compression: Chronic panc vs. peri-ampullary malignancy

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8
Q

Symptoms of peri-ampullary malignancy

A

Weight loss, steatorrhea, diabetes

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9
Q

Classic radiologic features of chronic pancreatitis

A

Smooth tapered narrowing of CBD; absence of discrete HOP mass; pancreatic calcifications

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10
Q

Most common peri-ampullary malignancy

A

Pancreatic cancer

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11
Q

Initial work-up of peri-ampullary mass (prior to imaging)

A
  • H&P
  • Endocrine/exocrine insufficiency (DM, WLOSS, steatorrhea)
  • PE: distant mets (SMJ/Virchow’s)
  • Labs: CBC, CMP, Coags, CA 19-9
  • Nutritional status, performance status
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12
Q

T/F CA 19-9 can be falsely elevated in the setting of jaundice

A

True

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13
Q

Imaging for suspected peri-ampullary malignancy

A 
Dual phase (late arterial/porto-venous phase) CT A+P with 1 mm slices
- CXR or CT chest to complete staging
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14
Q

Rare or Common: A patient presenting with pancreatic cancer and cholangitis.

A

RARE

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15
Q

Most common post-Whipple complications

A

Pancreatic fistula
DGE
Post-pancreatectomy hemorrhage

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16
Q

Definition of pancreatic fistula

A

Drain output on or after POD3 with amylase content greater than 3x upper normal serum value (can be associated with pain/fever/WBC)

17
Q

T/F Pancreatic fistula can be associated with other post-Whipple complications, i.e. abscess, DGE, hemorrhage

A

True

18
Q

T/F A low output pancreatic fistula in the absence of WBC elevation or other post-op complications can be managed with Octreotide

A

True

19
Q

T/F In the setting of fevers, WBC, ileus, DGE a CT is required to rule out an intra-abdominal fluid collection

A

True

20
Q

T/F GJ or HJ leaks are uncommon

A

True

21
Q

T/F It is important to have source control if there is any evidence of an intra-abdominal abscess related to a pancreatic fistula as proximity of amylase-rich fluid to adjacent vascular structures can lead to PSA formation

A

True

22
Q

Definition of DGE

A
  • Occurs in 15% cases

- Failure to remove NGT by POD4 or re-insertion after POD3

23
Q

Most common cause of post-pancreatectomy hemorrhage

A

Bleeding arterial pseudoaneurysm

24
Q

Ideal management of frankly sanguineous drain output

A

Prompt CTA or selective visceral angiogram due to concern for portntial PSA of the GDA or IPDA; best managed with endovascular techniques (i.e. HA embolization)

25
Q

If neoadjuvant therapy is used for PDAC, should you use a metal or silastic stent?

A

Metal

26
Q

CT imaging should ideally be performed within what interval of time prior to a Whipple?

A

30 days

27
Q

4 Clinical Stages of PDAC

A

Resectable (no abutment of arterial, minor/no venous involvement)
Borderline resectable
Locally advanced
Metastatic (peritoneal or distant mets)

28
Q

Vascular abutment vs. encasement

A

Abutment: up to 180 degrees contact
Encasement: exceeds 180 degree circumference

29
Q

Borderline resectable vs. locally advanced PDAC

A

Borderline (any of the following)

  1. Abutment of SMA or Celiac
  2. Short segment CHA encasement amenable to resection/recon
  3. Involvment of SMV/PV amenable to resection/recon

Locally advanced

  1. Encasement of SMA or celiac
  2. Occlusion of the SMV/PV without recon options
30
Q

T/F Following radiographic imaging of PDAC, histologic confirmation is recommended

A

True; though when a mass cannot be visualized on imaging or by EUS, empiric OR is okay

31
Q

EUS/FNA vs. percutaneous biopsy for PDAC

A

EUS/FNA

32
Q

If NA therapy is planned, BMS or silastic stent?

A

BMS; silastic stent needs to be changed every 6-8 weeks to maintain patency; stent goes below cystic duct

33
Q

Vasculature to think about when staging PDAC

A

SMA/Celiac
CHA
SMV-PV

34
Q

Median overall survival for surgery-first PDAC

A

24 months; most experience recurrence with a 7-month median disease-free survival without adjuvant CTX

35
Q

T/F Adjuvant therapy is recommended for all PDAC patients post Whipple

A

True

36
Q

NA chemo for which patients for PDAC

A

Borderline resectable

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