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True Learn Studying 2021 > Hepatobiliary Disease Review > Flashcards

Hepatobiliary Disease Review Flashcards

1
Q

Most common benign liver tumor?

A
  • Hemangioma
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2
Q

Clinical features of liver hemangioma?

A
  • more common in women (3:1 ratio)
  • most are asymptomatic
  • stable with low risk of rupture
  • 0 reports of malignant degeneration
  • resection should be considered if mass effect is causing symptoms
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3
Q

What kind of liver tumor should be on your differential if patient is on hormonal therapy? (e.g OCPs, steroids)

A
  • hepatic adenoma
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4
Q

CT scan characteristics of hepatic angioma?

- Arterial phase, portal venous phase, delayed phase

A
  • Arterial: peripheral nodular enhancement (non-homogenous)
  • portal venous: centripetal filling
  • delayed: enhancement of entire mass
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5
Q

CT scan characteristics of hepatic adenoma?

- Arterial phase, portal venous phase, delayed phase

A
  • Arterial: peripheral then leading to centripetal enhancement (homogenous)
  • portal venous: isodense or hypodense (compared to surrounding parenchyma)
  • delayed: isodense or hypodense
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6
Q

CT scan characteristics of Focal Nodular Hyperplasia?

- Arterial phase, portal venous phase, delayed phase

A
  • arterial: intense enhancement, central fibrous scar with radiating septa
  • venous phase: partial filling
  • delayed: enhancement of central scar
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7
Q

First step of a right hepatectomy

A
  • cholecystectomy
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8
Q

most common sign of recurrence for gall bladder cancer?

A
  • ascites

- jaundice

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9
Q

What is the underlying physiology behind hepatorenal syndrome?

A
  • liver failure leads to severe vasodilation and arterial hypovolemia -> kidneys see decreased BP and therefore retain sodium/water
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10
Q

Pharmacological therapy for HRS?

A
  • Albumin + vasoconstrictive agent (most common is terlipressin)
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11
Q

Patient is post op from a VARD, has small volume hematemesis…next step?

A
  • CTA of the abdomen and possible angio-embolization

- this is potentially a herald bleed from a pseudoaneurysm

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12
Q

what are primary bile salts conjugated with in hepatocytes?

A
  • taurine and glycine
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13
Q

where is the bulk of conjugated bile acids absorbed in the GI tract?

A
  • 80% of all secreted conjugated bile salts are absorbed in the terminal ileum
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14
Q

what vitamins do bile acids help absorb?

A
  • fat soluble ones

- A D E K

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15
Q

indication to resect a hepatic adenoma

A
  • male gender
  • size > 5cm
  • symptomatic
  • suspicion of malignancy on imaging
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16
Q

jaundice, right upper quadrant pain, hematemesis…what do you call this triad (not an eponym)

A

hemobilia

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17
Q

Male who recently traveled to the tropics has a fever and right upper quadrant pain. CT scan shows a large cystic mass with a thick hyperenhancing wall…what does he have?

A

Entamoeba histolytica infection

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18
Q

Male who recently traveled to the tropics has a fever and right upper quadrant pain. CT scan shows a large cystic mass with a thick hyperenhancing wall…how do you treat it?

A

10 days of metronidazole

E. Histolytica infection

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19
Q

when do you consider a TIPS procedure for ascites?

A

when 2-3 large volume paracentesis are required per month despite salt restriction and maximized diuretic use

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20
Q

In children, what is the most common cause of portal vein thrombosis

A

previously infected umbilical vein

  • be on the look out for ICU babies
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21
Q

mass in liver that is hypointense on T1 but hyperintense on T2 MRI imaging?

A

likely a hepatic hemangioma

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22
Q

Liver mass that is hyper intense T1 and hypo intense T2?

A

could be either HCC or hepatic adenoma

23
Q

how deep is a T1a gallbladder carcinoma tumor?

A

invades only the lamina propria

24
Q

how deep is a T1b gall bladder carcinoma?

A

extends to the muscular propria

  • partial hepatectomy with portal lymphadenectomy
25
how high of an amylase indicates a pancreatic fistula?
3 times above serum is indicative of a pancreatic fistula
26
``` Give the following for Pseudocyst: Location: Communication with ducts: Mucin Stain: Amylase: CEA: ```
- anywhere - yes - negative - high - low
27
``` Serous Cystic Neoplasm: Location: Communication with ducts: Mucin Stain: Amylase: CEA: ```
- anywhere - no - negative - low - low
28
``` Mucinous Cystic Neoplasm: Location: Communication with ducts: Mucin Stain: Amylase: CEA: ```
- body tail > head - very rarely - positive - low - high
29
``` Give the following for Intraductal papillary mucinous Neoplasm: Location: Communication with ducts: Mucin Stain: Amylase: CEA: ```
- head > tail - yes - positive - high - high
30
Reasons to resect a hepatic adenoma?
- > 5cm in size regardless of OCP use - symptomatic - cannot diagnose based on imaging - rupture
31
gallstone dissolving medication
Urodeoxycholic acid - can only be used with small cholesterol stones where surgery is contraindicated/unwanted
32
Most common etiology of Budd Chiari Syndrome
Myloproliferative disorders
33
Future liver remnant that can be left after resection and is considered sufficient for patient without parenchymal disease?
20-30%
34
future liver remnant needed after resection for patient with parenchymal disease?
40%
35
you calculate that the future liver remnant is insufficient...what can you do to try and tip the odds in the patient's favor?
Portal vein embolisation can cause hypertrophy in the projected FLR
36
buzz word to perform right hepatecotmy with lymphadenectomy for gall bladder cancer found on final path of cholecystectomy?
invades the muscle layer
37
peripheral nodular enhancement on early phase liver CT followed by centripetal filling in during the late phase
hepatic hemangioma
38
nonrim hyperenhancing lesion on early phase CT of the liver with washout there after
hepatocellular carcinoma
39
vinyl chloride exposure increases risk for what?
hepatic angiosarcoma
40
anatomical marker between left and right hepatic lobes?
Cantlie's line - imaginary line between gall bladder fossa and IVC...in 70% of patients this is where the middle hepatic vein is
41
in which patient should you be worried about gall bladder cancer
older patients (age > 60), with cholelithiasis and single polyp > 10 mm
42
preferred treatment for symptomatic hepatic hemangioma
enucleation
43
exposure to vinyl chloride increases your risk for what?
hepatic angiosarcoma
44
peripheral enhancement, smooth, with centripetal pattern of enhancement on liver CT scan
hepatic adenoma
45
peripheral rim enhancement during both early and late phase of liver CT scan
intrahepatic cholangiocarcinoma
46
most common polyps found within gall bladders?
cholesterolosis - represents more than 50% of all gall bladder polyps
47
Screening for patients with primary sclerosing cholangitis
- Right upper quadrant US every 6-12 months - MRI/MRCP every 6-12 months - colonoscopy every 1-2 years
48
how do you treat a type III choledochal cyst?
ERCP and sphincterotomy, no need to resect because of limited malignant potential
49
location of splenic artery in relation to pancreas?
runs superiorly to pancreas
50
location of splenic vein in relation to pancreas?
runs posteriorly
51
Management of Cholecystostomy tube for acalculous cholecystitis
- US to assess for stones or sludge | - if present then cholecystectomy, if absent can remove drain once output is minimal
52
How do you localize a gastrinoma
Somatostatin Scintigraphy
53
female with epigastric pain, found to have pancreatic mass, EGD with biopsy gets a bloody aspirate
solid pseudo papillary neoplasm of the pancreas
54
most common cause of liver pyogenic abscess
- E. choli | - Klebsiella

True Learn Studying 2021 (27 decks)

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