Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oral Boards > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

When concerned about a bile duct injury, when to go straight to PTC instead of ERCP

A

if transection is definitely suspected. Otherwise, if concerned about cystic duct stump, hepatic bed, or incomplete transection, ERCP first is reasonable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bismuth Strasberg A

A

Cystic duct stump leak or duct of luska leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bismuth Stransburg B

A

LIgaiton and division of anomylous right sided segmental hepatic duct

(present as late pain, not reliably diagnosed with ERCP since both right and left main ducts opacity. Presents with persistent pain, diagnosed with MRCP.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bismuth Strasburg C

A

Same as B, but proximal duct leaks freely into abdomen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Bismuth Strasburg D

A

lateral injury to extrahepatic bile duct, cautery injury or otherwise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bismuth Strasburg E

A

Disruption of biliary-enteric continuity. Will require PTC

  1. Greater than 2 cm from confluence
  2. Less than 2 cm from confluence
  3. Injury at confluence
  4. Separation of right and left hepatic ducts
  5. Ligation below confluence with associated ligation of right posterior duct.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bismuth strasburg classification

A

Repair is HJ for all but type A (maybe Type D if no stricture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Contraindications to immediate reapir of bile duct injury

A
  1. Inexperience
  2. Extensive thermal injury
  3. Massive blood loss
  4. HD instability
  5. Major vascular injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Latest time to consider early repair for bile duct injury in patient doing well

A

72 hours. (otherwise external and internal drainage followed by elective repair 6-8 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Preoperative considerations before biliary enteric reconstruction after bile duct injury

A

Bile re-feeding

nurtiion

Fat soluble vitamin replacement, especially vitamin K (likely parenteral needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Position of right hepatic artery in relation to hepatic duct

A

directly posterior (principle of anterior only dissection on biliary reconstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Differential for liver mass

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Annual incidence of HCC in cirrhosis

A

3-4% per year.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for cholangiocarcinoma

A
  1. Primary sclerosing cholangitis
  2. Hepatic parasitic infection (schistosomiasis)
  3. Hx of choledochal cysts
  4. Hx of choledochal stones
  5. cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common liver mets

A
  1. far away CRC
  2. Second far away NET
  3. rare ones include breast, adrenal, sarcoma, renal, melanoma, reproductive tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

work up for liver mass

A
  1. CBC, BMP, INR, LIver profile
  2. Hepatitis panel
  3. CEA, AFP, CA19-9
  4. U/S and Triphasic CT
  5. Dodatate scan if hx of NET
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Imaging for liver mass with biomarkers should be sufficient, but if a biopsy is necessary - markers to help differentiate

A
  1. Lung - TTF-1
  2. Breat - ER/PR
  3. Colon - CK-20
  4. Pancreaticobiliary - CK-7
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

LIver lesion imaging characteristics

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

cholangiocarcinoma (characteristics)

A

delayed venous enhancement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Milan criteria

A
  1. 1 lesion less than 5 cm
  2. 3 less than 3 cm
  3. No vascular invasion or extrahepatic involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Screening for HCC (population and frequency)

A

Cirrhotics of any kind

LIver U/S and AFP every 6-12 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

HCC imaging characteristics

A

arterial enhancement with venous washout

23
Q

Childs pugh score

A

Childs A could undergo resection (except those with portal hypertension) (poor mans test - platelet count < 100k)

Childs B - only limited resection

Childs C - not suitable for resection

24
Q

Future liver remnant requirements

A
  1. 20% normal patient
  2. 30% s/p chemotherapy
  3. 40% cirrhosis
25
Q

Survival after resection for HCC

A

approximately 70% (both resection or transplant) 5 year survival

26
Q

Other modes of treatment for HCC

A
  1. Radiofrequency or microwave ablation
  2. Chemoembolization
  3. Sorafenib
27
Q

Key steps for liver resection for HCC

A
  1. Need central and arterial access, low CVP strategy
  2. Intraoperative U/S to define vascular anatomy and surveil for other lesions
  3. Look for distant mets
  4. Encircle porta for possible Pringle maneuver
  5. Parenchymal transection with control of bile and vascular structures.
  6. Post resection U/S
28
Q

CRC mets appearance

A

hypointense lesions in portal venous phase

29
Q

Causes of hyperbilirubinemia

A
30
Q

Prior to cholecystectomy for gallstone ileus, need this imaging work up

A

Evaluation of CBD in case of Mirrizzi syndrome element - MRCP or ERCP

Usually can close the duodenum with transverse closure.

31
Q

Surgical procedure for gallbladder cancer

A
  1. cholecystectomy
  2. Segment 4B and 5 resection
  3. portal lymphadenectomy
  4. bile duct resection to achieve negative margins.
32
Q

Indications for prophylactic cholecystectomy

A

Porcelein gallbladder

Gall bladder polyps > 1 cm

33
Q

Distant nodes in gallbladder cancer that make it metastatic disease

A

celiac or aortocaval nodes

34
Q

Simple cholecystectomy appropriate for this T stage gallbladder CA

A

T1a

35
Q

Work up for gallbladder CA

A
  1. LFTs
  2. multiphasic CT C/A/P
  3. CEA, CA19-9
  4. Consider staging laparoscopy
  5. If jaundices, MRCP
36
Q

T staging for gallbladder CA

A
  1. T1a invades lamina propria
  2. T1b invades the muscular layer
  3. T2 Perimuscular connective tissue (no serosa or liver)
  4. T3 Invades serosa or liver or other organ)
  5. T4 portal vein or hepatic artery or 2 other structures
37
Q

Work up for extrahepatic cholangiocarcinoma

A
  1. Multiphase CT c/a/p
  2. LFTs
  3. CEA, CA19-9
  4. MRCP
  5. IGg4
    6.
38
Q

Bismuth-corlette classification of hilar cholangiocarcinoma

A
  1. Common hepatic duct below level of bifurcation
  2. Klatskin (Altemeier) tumors at bifurcation of right and left
  3. A. confluence and right hepatic duct, B confluence and left hepatic duct
  4. Confluence and both right and left hepatic ducts
  5. Stricture at common and cystic duct.
39
Q

prinicples of resection for hilar cholangiocarcinoma

A
  1. Must have artrial inflow
  2. Must have portal inflow
  3. Must have venous outflow
  4. Must have biliary drainage.
  5. Must have enough liver (FLR)
40
Q

Is portal vein or hepatic artery invovlement a contraindication to resection for extrahepatic cholagnio

A

NO

41
Q

Candidate for transplant for extrahepatic cholangio

A

tumor < 3 cm

No nodal disease

No intrahepatic or extrahepatic metastatic diasease.

42
Q

5 types of choledochal cysts and their treatments

A
  1. fusiform dilation of CBD; resection, chole, HJ
  2. saccular cyst off of CBD; resection and closure
  3. distal CBD; sphincterotomy and endoscopic unroofing (low risk of cancer, so resection not always performed)
  4. Intra and extrahepatic dilations; resection which may involve hepatectomy, chole, and HJ
43
Q

Thickness of gallbladder wall associated with cholecystitis

A

> 4mm

44
Q

Diameter of dilated CBD

A

> 6 mm

45
Q

Young pateint without cirrhosis with HCC - type? and marker?

A

Fibrolemmelar variant

Neurotensin

46
Q

Most common cause of pyogenic liver abscesses

A

cholangitis

47
Q

Most effective imaging modality to detect small liver mets

A

Intraoperative U/S (MRI and CT are equivalent)

48
Q

Most common implicated etiology of Budd Chiari

A

myeloproliferatrive disorders

49
Q

Most common cause of acute liver failure in the USA

A

Acetaminophen toxicity (followed by inderminate)

50
Q

Order of operations for partial hepatectomy

A

cholecystectomy, ligation of artery, portal vein, the hepatic vein

51
Q

Examples of 2 liver flukes

A

Clonorchis, Opisthorchis

52
Q

Hepatic pressure gradients and their clinical correlates

Normal

Portal HTN

Varices

Variceal bleeding and ascites

A

6-9 mm Hg

9-12 mm Hg

> 12 mm Hg

53
Q

Contraindication to percutaneous drainage of liver abscess

A

massive ascites

Oral Boards (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions