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Clinical Medicine > HPB Surgery > Flashcards

HPB Surgery Flashcards

1
Q

Name 5 structures that are in contact with the poster-inferior surface of the liver

A
  1. Abdominal oesophagus
  2. Stomach
  3. Duodenum
  4. Hepatic flexure of the colon
  5. Right kidney
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2
Q

What structure separates the left and right lobes of the liver superiorly?

A

Falciform ligament

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3
Q

What is the embryological origin of the ligamentum teres?

A

Obliterated remains of the left umbilical vein

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4
Q

What is the embryological origin of the ligamentum venosum?

A

Fibrous remnant of the foetal ductus venosus - shunted oxygenated blood from the left umbilical vein to the IVC

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5
Q

Outline the contents of the porta hepatis as well as their relations to each other

A
  1. Common hepatic duct - anteriorly
  2. Hepatic artery - in the middle
  3. Portal vein posteriorly
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6
Q

Recall the source of the 2 components of autonomic fibres that run alongside the portal triad in the porta hepatis

A
  1. Sympathetic - Coeliac axis

2. Parasympathetic - Vagus

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7
Q

Which 2 structures come together to form the common bile duct?

A
  1. Common hepatic duct

2. Cystic duct

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8
Q

What is another name for the duct of Wirsung?

A

The main pancreatic duct

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9
Q

The opening of the ampulla of Vater into the duodenum is mediated by which structure?

A

The sphincter of Oddi

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10
Q

Name the space that separates the portal vein and the inferior vena cava

A

Foramen of Winslow

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11
Q

Give 2 structures that an inflamed gallbladder is at risk of ulcerating into

A
  1. Duodenum

2. Transverse Colon

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12
Q

Outline the borders of Calot’s triangle

A
  1. Liver
  2. Cystic duct
  3. Common hepatic duct
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13
Q

The cystic artery (supplying the gallbladder is usually a branch of which artery

A

Right hepatic artery

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14
Q

Define Pringle’s manoeuvre

A

Compression of the hepatic artery in the anterior wall of the foramen of Winslow in order to control surgical haemorrhage e.g. during a cholecystectomy

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15
Q

Why is gangrene of the gallbladder rare?

A

Even if the cystic artery becomes thromboses (e.g. in acute cholecystitis) it has a rich secondary blood supply from the liver bed.

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16
Q

Briefly outline the general position of the pancreas

A

Lies retroperitoneally in approximately the transpyloric plane

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17
Q

Which structure runs along the upper border of the pancreas?

A

Splenic artery

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18
Q

Outline the blood supply to the pancreas

A
  1. Splenic artery

2. Pancreaticoduodenal arteries

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19
Q

What is the name given to the accessory pancreatic duct

A

Duct of Santorini

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20
Q

What is a clinical complication is a patient with an annular pancreas at risk of?

A

Duodenal obstruction

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21
Q

Suggest 2 possible complications of compression from a neoplasm at the head of the pancreas

A
  1. Obstructive jaundice - due to compression of the common bile duct
  2. Obstruction of the IVC and/or portal vein
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22
Q

Suggest 2 possible causes of a pseudocyst of the pancreas

A
  1. Perforation of a posterior gastric ulcer

2. Acute pancreatitis

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23
Q

Define a pseudocyst of the pancreas

A

Closure of the lesser sac around the pancreas which subsequently becomes filled with fluid

24
Q

Which structures are carried within the gastrosplenic ligament?

A

Short gastric and left gastro-epiploic vessels

25
Q

Name the structure inferiorly related to the spleen

A

The splenic flexure of the colon

26
Q

Name the structure medially related to the spleen

A

Left kidney

27
Q

Name the most likely organism to be responsible for ascending cholangitis

A

E.Coli

28
Q

What is the most common predisposing factor to the development of ascending cholangitis?

A

Gallstones

29
Q

Recall the components of Charcot’s triad

A
  1. RUQ pain
  2. Fever
  3. Jaundice
30
Q

What additional 2 factors (alongside Charcot’s triad) make up Reynold’s pentad?

A
  1. Hypotension

2. Confusion

31
Q

What is the treatment of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?

A

Biliary stenting

32
Q

What is another name for Whipple’s procedure?

A

Pancreaticoduodenectomy

33
Q

Describe the typical LFT patterns seen in a patient with pre-hepatic jaundice

A

Bilirubin - Normal/ high
ALT/AST - Normal
Alk Phos - Normal

34
Q

Describe the typical LFT patterns seen in a patient with hepatic jaundice

A

Bilirubin - High
ALT/ AST - Elevated (often very high)
Alk Phos - Modest elevation

35
Q

Describe the typical LFT patterns seen in a patient with post-hepatic jaundice

A

Bilirubin - High/very high
ALT/ AST - Moderate elevation
Alk Phos - High/ very high

36
Q

What type of jaundice is associated with pale stools?

A

Post hepatic jaundice

37
Q

Define Mirizzi Syndrome

A

Common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infindibulum of the gallbladder

38
Q

What is Courvoisier’s law?

A

States that in cases of a non-tender palpable gallbladder accompanied by painless jaundice, the cause is unlikely to be gallstones

39
Q

Name a drug which may cause cholestasis

A

Ciprofloxacin

40
Q

What is the most common cause of chronic pancreatitis?

A

Chronic alcohol abuse

41
Q

Give 2 genetic causes of chronic pancreatitis

A
  1. Cystic Fibrosis

2. Haemochromotosis

42
Q

Recall the Glasgow scale for pancreatitis severity (PANCREAS)

A 
P - PaO2 <7.9kPa
A - Age >55 years 
N - Neutrophils (WBC >15)
C - Calcium < 2mmol/L
R - Renal function (Urea >16mmol/L)
E - Enzymes (LDH >600)
A - Albumin <32 g/L (serum)
S - Sugar, blood glucose >10mmol/L
43
Q

Purtscher (Ischaemic) retinopathy is a rare complication associated with which condition?

A

Pancreatitis

44
Q

Name a recognised systemic complication of acute pancreatitis

A

Acute respiratory distress syndrome - ARDS

45
Q

Suggest 5 potential local complications associated with acute pancreatitis

A
  1. Peripancreatic fluid collection
  2. Pseudocysts
  3. Pancreatic necrosis
  4. Pancreatic abscess
  5. Haemorrhage
46
Q

Name the preferred diagnostic test for chronic pancreatitis

A

CT pancreas with IV contrast - looking for pancreatic calcification

47
Q

What does PTC stand for?

A

Percutaneous transhepatic cholangiography

48
Q

Outline some of the potential indications for a Whipple’s procedure (7)

A
  1. Pancreatic cancer
  2. Pancreatic cyst
  3. Ampullary cancer
  4. Cholangiocarcinoma
  5. Pancreatitis
  6. Neuro-endocrine tumour
  7. Small bowel tumour
49
Q

What diagnoses makes up ~ 90% of primary pancreatic malignancies?

A

Ductal carcinoma of the pancreas

50
Q

Suggest 3 risk factors associated with pancreatic cancer

A
  1. Smoking
  2. Diabetes
  3. Positive family history
51
Q

Which structures are removed during a Whipple’s procedure?

A
  1. Head of the pancreas
  2. Antrum of the stomach
  3. 1st and 2nd parts of the duodenum
  4. Common bile duct
  5. Gallbladder
52
Q

Name the 3 principle clinical features associated with a tumour of the head of the pancreas

A
  1. Obstructive jaundice - due to compression of the common bile duct
  2. Abdominal pain radiating to the back - due to invasion of the coeliac plexus or secondary to pancreatitis
  3. Weight loss
53
Q

Define thrombophlebitis migrans

A

A recurrent migratory superficial thrombophlebitis caused by a paraneoplastic hypercoagulable state

54
Q

Give 3 complications associated with a Whipple’s procedure

A
  1. Pancreatic fistula
  2. Delayed gastric emptying
  3. Pancreatic insufficiency
55
Q

Outline the components of the FOLFIRINOX regime used in the treatment of metastatic disease

A
  1. Folinic acid
  2. 5-fluorouracil
  3. Irinotecan
  4. Oxaliplatin
56
Q

What are the typical 3 components of MEN-1 - Wermer’s syndrome?

A
  1. Hyperparathyroidism
  2. Endocrine pancreatic tumours
  3. Pituitary tumours - most commonly prolactinomas
57
Q

Recall the 4 components to the current definition of acute respiratory distress syndrome

A
  1. Acute onset within 7 days
  2. PaO2:FiO2 ratio <300
  3. Bilateral infiltrates on CXR
  4. Alveolar oedema not explained by fluid overload or cariogenic causes

Clinical Medicine (8 decks)

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