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ABSITE Flash Cards > Hepatobilliary > Flashcards

Hepatobilliary Flashcards

1
Q

rate of patient’s that develop type 1 diabetes after distal pancreatectomy

A

10%

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2
Q

location of beta islet cells in pancreas

A

predominately in the tail of the pancreas

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3
Q

function of beta islet cells in pancreas

A

produce insulin

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4
Q

in what cells is insulin produced in the pancreas

A

beta islet cells

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5
Q

when would you perform a Puestow procedure

A
  • pancreatic duct dilation 1-2 cm away from the head of the pancreas
  • ductal dilation > 6 mm
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6
Q

another name for the puestow procedure

A

lateral pancreaticojejunostomy

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7
Q

when would you perform the Frey procedure

A

for pancreatic obstruction at the head with distal duct dilation

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8
Q

Describe the Frey procedure

A

pancreatic head resection with a 1 cm remnant at the duodenal margin, with lateral pancreaticojejunostomy to decompress the distal pancreas

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9
Q

Indication for Berger procedure

A
  • pancreatic head inflammatory mass that is NOT cancer
  • without distal main duct obstruction/dilation
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10
Q

dissecting out distal portion of pancreas for distal pancreatectomy, you notice blood oozing after you liberate inferior portion of pancreas. What did you injure?

A

splenic vein

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11
Q

Grey-Turner sign

A
  • discoloration at the flanks secondary to inflammatory extravasation from pancreatitis
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12
Q

Cullen Sign

A
  • periumbilical discoloration secondary to extravasation of inflammatory fluid from pancreatitis
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13
Q

25 year old male recently traveled to Africa, returns with 2 weeks of RUQ pain fever, malaise, and weight loss. US of liver shows fluid collection

A

Amebic infection

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14
Q

first line treatment for amebic liver abscess

A

metronidazole

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15
Q

what is one great thing about pancreatic neuroendocrine tumors, if low grade

A
  • great prognosis if all lesions are resected, no need for neoadjuvant chemotherapy
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16
Q

what test do you perform to assess a functional liver remnant prior to hepatic resection

A

CT with 3D reconstruction

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17
Q

patient with chronic pancreatitis, plan is for palliative surgery to address pain and biopsy shows rare atypical cells…what should you worry about

A

pancreatic cancer, and therefore this patient requires oncologic resection

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18
Q

most common liver lesion in an otherwise healthy female

A

hemangioma

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19
Q

liver lesion with peripheral nodular enhancement in the arterial phase with central filling in the delayed phase

A

hemangioma

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20
Q

liver lesion with arterial enhancement and washout on delayed imaging

A

hepatocellular carcinoma

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21
Q

liver lesion with rim enhancement on CT scan with contrast

A

hepatic abscess

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22
Q

indications to operate on a pancreatic pseudocyst

A
  • persistant abdominal pain
  • feeding intolerance
  • inability to exclude cystic neoplasm
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23
Q

T1a gall bladder cancer

A

cancer limited to the mucosa

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24
Q

T1b gall bladder cancer

A

cancer invading the muscularis

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25
Q

gall bladder cancer invading the muscularis is given what T stage

A

T1b

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26
Q

at what T stage in gall bladder cancer should you pursue hepatic resection of segments IVb and V

A

T1b and greater

OR

T1a with positive margins on pathology

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27
Q

Branch Duct Intraductal papillary mucinous neoplasm features that would necessitate resection

A
  • obstructive jaundice
  • enhancing solid component
  • main duct dilation greater than 1 cm
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28
Q

BD-IPMN worrisome features that would necessitate endoscopic imaging and possible resection

A
  • IPMN greater than 3 cm
  • non-enhancing mural nodules
  • thickened enhancing cyst walls
  • main duct 5-9 mm in siz / abrupt caliber change
  • lymphadenopathy / pancreatitis
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29
Q

type 1 choledochal cyst

A

fusiform dilation of the CBD w/o intrahepatic involvement

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30
Q

type 2 choledochal cyst

A

diverticulum off of the CBD

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31
Q

type 4a choledochal cyst

A
  • single fusiform dilation of the extra hepatic bile ducts
  • plus dilation of the intrahepatic ducts
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32
Q

-type 4b choledochal cyst

A

multiple extra hepatic ductal dilations

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33
Q

type 5 choledochal cyst
- bonus points for eponym

A

intrahepatic bile duct cysts only
- Caroli disease

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34
Q

what is associated with choledochal cysts and thought to contribute to their development

A

anomalous pancreatobiliary junction

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35
Q

what metabolic derangements would you expect in a patient with a VIPoma?

A
  • achlorhydria
  • hypokalemia
  • hypercalcemia
  • hyperglycemia
  • acidosis
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36
Q

what is achlorhydria, and why is it relevant

A
  • inability of the stomach to secrete HCl
  • in VIPomas you see this phenomenon, contributes to acidosis seen in VIPomas
37
Q

Epynomen for VIPoma

A

Verner-Morrison Syndrome

38
Q

What is Verner-Morrisone Syndrome

A
  • Patient with a VIPoma
39
Q

how long should your lateral pancreatojejunostomy be in a Puestow Procedure?

A

studies show improved outcomes with an at least 6 cm anastomosis

40
Q

fluid characteristics of a pancreatic serous cyst

A
  • CEA: low
  • Fluid quality: clear
  • Amylase: low
  • Mucin staining: negative
41
Q

fluid characteristics of a pancreatic mucinous cyst neoplasm

A
  • CEA: High
  • fluid quality: thick
  • Amylase: low
  • Mucin Staining: Positive
42
Q

fluid characteristics of a pancreatic IPMN

A
  • CEA: high
  • fluid quality: clear and thick
  • Amylase: High
  • Mucin Staining: positive
43
Q

fluid characteristics of pancreatic pseudocyst

A
  • CEA: low
  • fluid quality: clear
  • Amylase: High
  • Mucin Staining: negative
44
Q

which pancreatic lesions have ovarian-type stroma on histopathology?

A

Mucinous cystic neoplasms

45
Q

how do you adequately examine an abdomen to determine resectability of a pancreatic cancer

A

evaluate the following
- liver
- bowel
- abdominal wall
- enter lesser sac via gastrocolic ligament to look at pancreas and LNs

46
Q

What is sump syndrome

A

complication of a side-to-side choledochoduodenostomy in which food, stones, or other debris accumulate in the CBD and thereby obstruct normal biliary drainage

47
Q

what must you include in an oncologic distal pancreatectomy

A

the spleen

48
Q

what should one do with all choledochal cysts?

A

excise them all because of the risk of malignancy

49
Q

when is it acceptable to enucleate a pancreatic insulinoma

A
  • < 2cm
  • at least 2mm from duct
50
Q

most common functional pancreatic neuroendocrine tumor in MEN1

A

gastrinoma (54%)

51
Q

How would you manage a pancreatic leak that has gone on for 7 days

A
  • NPO
  • TPN
  • Somatostatin
  • beyond that can consider ERCP and stent if it persists
52
Q

how many grades of pancreatic fistulas exist

A

Three

A, B, C

53
Q

Grade A pancreatic fistula

A

biochemical leak of no clinical significance, not actually a fistula

54
Q

Grade B pancreatic fistula

A

fistula that requires a change in post-operative management (e.g. drain placement)

55
Q

Grade C pancreatic fistula

A

fistula that leads to reoperation, organ failure and/or death

56
Q

what scan would you use to diagnose pancreatic divisum

A

secretin-enhanced MRCP

57
Q

Liver lesion with lack of sulfur colloid uptake

A

hepatic adenoma

58
Q

recommended FLR for healthy person getting hepatic resection

A

20%

59
Q

recommended FLR for person with some liver dysfunction getting hepatic resection

A

30%

60
Q

recommended FLR for person with cirrhosis getting hepatic resection

A

40%

61
Q

how do you induce growth in FLR prior to liver resection

A

portal vein embolization of segments planned for resection

62
Q

hepatic abscess < 5 cm in size, how should you drain

A

percutaneous aspiration, if accessible

63
Q

hepatic abscess > 5 cm in size, how should you drain

A

percutaneous drain placement, if accessible

64
Q

which vein in the liver joins the middle vein to form a common trunk prior to dumping into the vena cava

A
  • left hepatic vein joins the middle hepatic vein
65
Q

Depression
Diabetes
Dermatitis
DVTs

what should you think about

A

Glucagonoma

66
Q

chemotherapy used for gall bladder carcinoma

A

Gemcitabine and cisplatin

67
Q

62M with CT CAP showing a lobulated multicystic mass in the body of the pancreas with a sunburst appearance, what is most likely to be

A

serous cystic neoplasm

68
Q

At what size would you excise a serous cystic neoplasm of the pancreas

A

consider it when it is greater than 4cm

clinical course is harder to predict at that size or greater (sampling bias if biopsied)

69
Q

How much do you dilate the cystic duct before a Choledochoscopy

A

5-8 mm

70
Q

How do you close the cystic duct after choledochoscopy?

A

with an endo-loop

71
Q

How do you treat a type 1 choledochal cyst

A

excision with hypaticojejunostomy

72
Q

How do you treat a type 2 choledochal cyst

A

diverticulectomy and primary repair

73
Q

how do you treat a type 3 choledochal cyst

A

endoscopic sphincterotomy vs transduodenal excision and sphincterplasty

74
Q

How do you treat a type 4 choledochal cyst

A

hepaticojejunostomy with partial hepatectomy if disease involves one lobe

75
Q

how do you treat a type 5 choledochal cyst

A

liver transplant

76
Q

How do you know you’re done with a Kocher Maneuver?

A

Anterior surface of the aorta and left renal vein

77
Q

treatment for type 1 choledochal cyst

A

excision and hepaticojejunostomy

78
Q

treatment for type 2 choledochal cyst

A

diverticulectomy and primary repair

79
Q

treatment for type 3 choledochal cyst

A

endoscopic sphincterotomy vs transdoudenal excision and sphincterplasty

80
Q

treatment for type 4 choledochal cyst

A

hepaticojejunostomy with partial hepatectomy if disease involves one lobe

81
Q

treatment for type 5 choledochal cyst

A

liver transplant

82
Q

What kind of process causes hydatid cyst within the liver

A

Echinococcal infection

83
Q

Patient hydatid cysts, what is first line treatment?

A

Albendazole

84
Q

how do you distinguish portal vein from hepatic veins when using intra-operative ultrasound?

A

portal vein has hyperechoic layer secondary to Glisson’s capsule

85
Q

How is CA 19-9 used in pancreatic cancer

A

used to monitor response to therapy, not useful for diagnosis

86
Q

What can cause a falsely elevated CA 19-9

A

biliary obstruction, as CA 19-9 is held within cells lining biliary tree

87
Q

patient with 2 cm “honeycomb” lesion at head of pancreas…EUS with low amylase and low CEA

A

Serous Cystadenoma

88
Q

how do you diagnose Primary Sclerosing Cholangitis

A

MRCP

89
Q

Most common type of biliary injury that occurs during a lap chole

A

Complete biliary transection at or below hepatic bifurcation

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