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RRC Cards > HPB > Flashcards

HPB Flashcards

1
Q

mother pancreatic lesion

A

mucinous cystic neoplasm (middle aged F)

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2
Q

elevated marker in mucinous cystic neoplasm

A

CEA (ovarian stroma)

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3
Q

most common location mucinous cystic neoplasm

A

tail

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4
Q

grandmother pancreatic lesion

A

serous cystadenoma

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5
Q

NCCN resectability of panc adenoca

A
  • no arterial contact

- SMV/PV <180 without vein deformity

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6
Q

NCCN borderline resectability of panc adenoca

A
  • SMA <180
  • HA <180 or variant anatomy
  • tail tumor <180 contact with celiac axis + intact GDA
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7
Q

NCCN unresectable panc adenoca

A
  • SMA >180
  • celiac axis >180
  • unreconstructable SMV/PV
  • distant mets
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8
Q

most common pancreatic adenoca mets

A

liver

peritoneum

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9
Q

5 yr risk cancer in main duct IPMN

A

50-70%

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10
Q

1 primary hepatic malignancy

A

HCC

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11
Q

2 most common benign hepatic tumor

A

FNH

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12
Q

1 most common benign hepatic tumor

A

cavernous hemangioma

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13
Q

subtypes of hepatocellular adenomas

A
  1. hepatocyte nuclear factor 1a inactivated (30-40%)
  2. inflammatory (40-50%)
  3. beta-catenin activated (10-15%)
  4. unclassified (10-25%)
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14
Q

subtype hepatic adenoma with highest malignant transformation

A

beta catenin activated

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15
Q

difference between FNH & adenoma on hepatobiliary phase

A

FNH iso or hyper

adenoma hypo

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16
Q

genetic association with hepatic angiomyolipoma

A

tuberous sclerosis

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17
Q

most common functioning pNET

A

insulinoma (whipples triad)

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18
Q

Todani classification of bile duct cysts

A

I: fusiform dilation of EHD
II: true diverticulum of supraduodenal EHD
III: choledochocele (focally dilated intraduodenal segment of EHD within duodenal wall)
IV: intra and extrahepatic cystic dilations
V: Caroli dz, intrahepatic cystic dilation 2/2 AR in-utero malformation of ductal plate, central dot sign

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19
Q

Mirizzi syndrome

A

CHD and IHD dilation 2/2 extrinsic compression from stone in GB neck or cystic duct
predisposed by:
- long cystic duct running parallel to CHD
- low insertion of cystic duct into CBD

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20
Q

Bouveret syndrome

A

gastric outlet obstruction 2/2 to impaction of a gallstone in the pylorus or proximal duodenum

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21
Q

biliary-enteric fistulas causes & results in

A

causes:

  • chronic cholecystitis
  • duodenal ulcer
  • tumor
  • trauma

results in: Bouveret syndrome, gallstone ileus

22
Q

Rigler triad

A
  • pneumobilia
  • SBO
  • ectopic calcified gallstone (usu in the right iliac fossa)

seen in gallstone ileus

23
Q

adenomyomatosis pathology

A
  • idiopathic, nonneoplastic, noninflammatory GB wall thickening
  • epithelial hyperplasia with mucosal invagination into smooth muscle layer
  • bile or cholesterol crystals deposit in Rokitansky-Aschoff sinuses
  • thickening = focal, segmental, diffuse
24
Q

adenomyomatosis imaging

A

thickening = focal, segmental, diffuse
- segmental form: annular thickening -> strictures (“hourglass” appearance in GB mid body)
US: echogenic foci with comet tail (reverberation of US pulse within cholesterol crystals)
MRI: cystic spaces (=R-A sinuses) with curvilinear arrangement; string of beads

25
Q

GB polyps - types

A
  • cholesterol (>50%)
  • adenoma (30%): premalignant
  • inflammatory (10%)
  • malignant (5%): adenoca (90%), other (mets, SCC, angiosarcoma)
26
Q

GB polyps - management

A

≤6 mm: no f/u
7-9 mm: yearly f/u w US to ensure no growth
≥10 mm: surgical consultation for cholecystectomy (greater chance of premalignant adenoma)
- if no cholecystectomy, annual f/u

ACR 2013

27
Q

primary sclerosing cholangitis - imaging

A

multifocal regions of segmental intra- & extrahepatic biliary ductal dilation and stricturing

  • active inflammation: abN thickening, hyperenhancement of bile duct walls
  • clue on MRCP: greater than expected number of peripheral ducts
  • string of beads, withered tree
28
Q

primary sclerosing cholangitis - complications

A

cholangiocarcinoma (NOT HCC)
biliary cirrhosis: “central regenerative hypertrophy”
colorectal carcinoma (if assoc w IBD)

29
Q

recurrent pyogenic cholangitis

A

formation of pigment stones throughout biliary tree

  • resultant biliary strictures, repeated bouts of cholangitis
  • 2/2 Clonorchiasis (liver fluke), Ascaris infxn

dilated IHD/EHD full of T1 bright pigmented stones
localized IHD dilation MC affects left hepatic lobe

30
Q

Von Meyenberg complexes

A

benign biliary hamartomas
failure of involution of embryonic bile ducts
1-5mm cystic masses, no communic w biliary tree
US: echogenic +/- comet tail artifact

likely dx if innumerable small, slightly complex “cysts” in healthy pt

31
Q

HIV cholangiopathy

A

biliary inflam’n caused by AIDS-related opportunistic infxns
- CMV, cryptosporidium

presumptive diagnosis in advanced AIDS (CD4 <100)

32
Q

HIV cholangiopathy - imaging

A

multiple intrahepatic strictures (identical to PSC)
papillary stenosis
GB wall thickening

33
Q

biliary ischemia

A

complication of hepatic artery stenosis/thrombosis

  • sole vascular supply to biliary system
  • assoc w biliary necrosis & abscess formation

high mortality rates if retransplantation or thrombectomy/thrombolysis not immediately performed
critical to recognize

34
Q

peribiliary cyst

A

thin walled cysts of serous glands adj to IHD
- no communication with biliary tree

benign; do not mistaken for dilated bile ducts
assoc w chronic liver dz, cirrhosis, ADPCKD

35
Q

hepatic mucinous cystic neoplasm

A

formerly biliary cystadenoma/carcinoma
- now non-invasive or invasive hepatic MCN

well-defined uni or multiloculated cystic mass in liver with septations, papillary projections, mural calcifications
no communication with biliary tree

36
Q

cholangiocarcinoma - risk factors

A

primary sclerosing cholangitis
recurrent pyogenic cholangitis
Clonorchiasis (liver fluke)
choledochal cyst

37
Q

cholangiocarcinoma - locations

A

hilar (Klatskin) - confluence of hepatic ducts

intrahepatic/peripheral (least common)
- capsular retraction

distal (extrahepatic; distal CBD)

  • “sclerosing”: stricture, ill-defined, desmoplastic
  • “papillary”: intraductal, polypoid mass
38
Q

emphysematous cholecystitis - demographics

A

50-70 yo diabetics

39
Q

emphysematous cholecystitis - bugs

A

Clostridium welchii / perfringens
E. coli
Bacteroides fragilis

40
Q

Milan criteria liver transplant HCC

A

One HCC <5 cm or 3 HCC all <3 cm without tumor in vein or evidence of mets elsewhere

41
Q

criteria to use LiRADS

A
  • prior bx proven HCC
  • cirrhosis
  • chronic hep B
42
Q

which cystic pancreatic lesions need surgical mgmt

A
  • mucinous cystic neoplasm

- main duct IPMN

43
Q

hemochromatosis patterns

A

Primary: liver, Pancreas, Myocardium, thyroid
Secondary: liver, Spleen, bone marrow

44
Q

cholangiocarcinoma risk in choledochal cyst/caroli disease

A

< 10%

45
Q

types of castleman’s disease

A
  1. unicentric (hyaline vascular –> plasmacytic)
  2. HHV8 associated (hypervascular –> plasmacytic)
  3. HHV8 -ve/idiopathic (“ “)
46
Q

medication given during ERCP to see pancreatic ducts

A

secretin

47
Q

syndromes associated w/ PNET

A

MEN1
VHL
TS
NFI

48
Q

enhancement pattern peliosis hepatis

A

central to peripheral

49
Q

infectious causes of peliosis

A

bartonella

50
Q

most common cause graft failure post liver transplant

A

rejection

51
Q

most common vascular complication liver transplant

A

hepatic artery stenosis or thrombosis

RRC Cards (17 decks)

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