HPB Flashcards
What proportion of PNETs are functioning?
10%
How quickly does the liver regenerate following resection of sections 2/3
4-6months
Which patients should have surveillance for pancreatic cancer?
- Hereditary pancreatitis and a PRSS1 mutation
- BRCA1/2, PALB2/CDKN2a mutations with 1+ FDR
- Peutz Jaegers syndrome
- Consider with 2 FDR or Lynch syndrome
Screen with MRI/MRCP/EUS
In hereditary pancreatitis offer pancreatic CT
What are some characteristic findings of PSC?
Reveresed portal venous flow and early portal hypertension
What tests should be sent at EUS FNA for PCN?
CEA + Cytology/KRAS/GNAS and Lipase levels
Cannot differentiate between MCN/IPMN
What is a contraindication to TACE for HCC?
Portal vein thrombosis.
Sorafenib is useful in cases of irresectable disease.
When is a Kasai procedure used?
Congenital biliary atresia
What is the incidence of CBD stones with normal duct size and LFTs and age <55
5%
In which pancreatic cystic neoplasm is Ca19-9 useful?
IPMN where there is suspicion of malignant transformation
What is the most common site of metastasis with HCC?
Lung (direct to IVC) > LN
What are the risk factors for post ERCP Pancreatitis?
Normal bilirubin Young age Pancreatic duct injection Precut sphincterotomy Balloon dilatation of spinchter SOD
What proportion of cases of PSC are associated with IBD?
70%
What is the incidence of cancer in a porcelain gallbladder?
6-10%
How should <1cm GB polyps be followed up?
If ‘high risk’ (Age >50, PSC, Indian, Sessile)
<6mm - US at 6months then annually
6-9mm - Cholecystectomy
Otherwise
<6mm US at 1,3,5 years
6-9mm - US 6 months then annually
If increases by 2mm or more –> cholecystectomy
EAES guidelines
What factors make IPMN at high risk of progression to malignancy?
- Jaundice
- Enhancing mural nodule ≥5mm
- MPD ≥10mm
High risk
MPD5-9.9, Cyst ≥40mm or enlarging ≥5mm per year increased risk
What adjunctive treaments should be given to patients undergoing surgery for CRLM?
Combination chemotherapy –> higher DFS and prob OS
What defines a locally advanced/irresectable pancreatic tumour?
Arterial
1) Head - SMA/CA >180
2) Body - SMA/CA >180 or aortic involvement
Venous
Unreconstructable SMV/PV
What nutritional support is required for patients with pancreatic cancer?
Pancreatin (creon)
How does a Hydatid cyst classically present?
Triad of jaundice, pain and urticarial rash
What is the optimal treatment of T2-3 GB cancer?
Formal resection of sections IVb and V
For T1 - open cholecystectomy and regional LN sampling
Which type of gallstone is most frequently found in the CBD?
a Brown pigment stone
In which patients with CRLM should ablative therapies be offered?
Only in those not suitable for liver resection.
-Selective internal radiation therapy (SIRT) is not recommended at present outside of research programmes
What is the Strasberg classification for BDI?
A - cystic duct/liver bed leak
B - partial ligation of biliary tree (mostly aberrant right hepatic)
C - partial transection of biliary tree not communicating with CBD
D - lateral injury of biliary system without loss of continuity
E - Ligation/division of biliary tree
What factors are most prognostic of severe pancreatitis at presentation?
APACHE II>8
Obesity