HPB

Question 1

What is the treatment for amoebic liver abscess?

Answer 1

Metronidazole
Role for aspiration controversial

Question 2

What are the typical pathogens in cholangitis

Answer 2

Enteric bacteria from the duodenum
E. coli
Klebsiella spp
Enterobacter spp
Enterococcus spp

Question 3

Indication for transplant in HCC

Answer 3

Milan criteria
- single nodule <5cm or not more then 3 nodule <3cm
- no macrovadcular invasion
- no extra hepatic spread

Question 4

Definition of threshold growth in LI-RADS

Answer 4

Increase in diameter of a mass by greater or equal to 50% in less than or equal to 6 months on CT or MRI, excluding USS studies

Question 5

Describe with pathophysiology of Budd-Chiari syndrome

Answer 5

Obstruction of hepatic outflow tract due to thrombosis or primary disease of the venous wall
- 75% have identifiable prothrombotic disorder

Liver congestion

Hepatic ischaemia, necrosis and sinusoidal thrombosis

Hepatic fibrosis

Increase sinusoidal pressure causes ascites and portal HTN

decrease perfusion leds to parenchymal atrophy

Formation of intra-hepatic collaterals

Imbalance of arterial and venous flow leds to regenerative and neoplastic nodules

Question 6

Pancreatic cystic lesions

Answer 6

Non-neoplastic
- pancreatic pseudocyst
- simple cysts

Neoplastic
- Serous cystadenomas (typically woman >60, negligible malignant potential)
- mucinous cystadenoma (typically woman, 40-60, malignant potential)
- IPMN
- Solid papillary epithelial neoplasms (SPEN) (females <40, malignant potential)
- pNET with cystic degradation

Question 7

MRI characteristics of HCC

Answer 7

Arterial enhancement
Rapid Washout in PV phase
Restriction diffusion
T2 hyper-intense
Don’t take up primovist

Question 8

MRI characteristics metastases

Answer 8

Most are hypovascular
(Exceptions TERMS - thyroid, endocrine, renal call carcinoma, melanoma, sarcoma)

Question 9

FNH - MRI imaging

Answer 9

Isodense on T2
Enhance with contrast, hypointense central scar
Always iso or hyperintense on delayed primovist sequence

Question 10

What is the physiological roles of bile?

Answer 10

Excretion (eg cholesterol)
Provides enteric bile salts which aid in the digestion of fats

Question 11

Symptoms of glucagonoma

Answer 11

6 D’s

Declining weight
Dermatitis (necrotic migratory erythema)
Depression
DVT
Diabetes mellitus
Diarrhoea

Question 12

Clinical signs of liver disease

Answer 12

Hands: leucoychia, clubbing, palmar erythema, bruising, hepatic flap
Skin: jaundice, scratch marks, spider naevi, bruising, oedema
Abdominal: hepatosplenomegaly, ascites, caput Medusa
Hepatic encephalopathy