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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
Name the structure inferiorly related to the spleen
The splenic flexure of the colon
26
Name the structure medially related to the spleen
Left kidney
27
Name the most likely organism to be responsible for ascending cholangitis
E.Coli
28
What is the most common predisposing factor to the development of ascending cholangitis?
Gallstones
29
Recall the components of Charcot's triad
1. RUQ pain 2. Fever 3. Jaundice
30
What additional 2 factors (alongside Charcot's triad) make up Reynold's pentad?
1. Hypotension | 2. Confusion
31
What is the treatment of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?
Biliary stenting
32
What is another name for Whipple's procedure?
Pancreaticoduodenectomy
33
Describe the typical LFT patterns seen in a patient with pre-hepatic jaundice
Bilirubin - Normal/ high ALT/AST - Normal Alk Phos - Normal
34
Describe the typical LFT patterns seen in a patient with hepatic jaundice
Bilirubin - High ALT/ AST - Elevated (often very high) Alk Phos - Modest elevation
35
Describe the typical LFT patterns seen in a patient with post-hepatic jaundice
Bilirubin - High/very high ALT/ AST - Moderate elevation Alk Phos - High/ very high
36
What type of jaundice is associated with pale stools?
Post hepatic jaundice
37
Define Mirizzi Syndrome
Common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infindibulum of the gallbladder
38
What is Courvoisier's law?
States that in cases of a non-tender palpable gallbladder accompanied by painless jaundice, the cause is unlikely to be gallstones
39
Name a drug which may cause cholestasis
Ciprofloxacin
40
What is the most common cause of chronic pancreatitis?
Chronic alcohol abuse
41
Give 2 genetic causes of chronic pancreatitis
1. Cystic Fibrosis | 2. Haemochromotosis
42
Recall the Glasgow scale for pancreatitis severity (PANCREAS)
``` 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
Purtscher (Ischaemic) retinopathy is a rare complication associated with which condition?
Pancreatitis
44
Name a recognised systemic complication of acute pancreatitis
Acute respiratory distress syndrome - ARDS
45
Suggest 5 potential local complications associated with acute pancreatitis
1. Peripancreatic fluid collection 2. Pseudocysts 3. Pancreatic necrosis 4. Pancreatic abscess 5. Haemorrhage
46
Name the preferred diagnostic test for chronic pancreatitis
CT pancreas with IV contrast - looking for pancreatic calcification
47
What does PTC stand for?
Percutaneous transhepatic cholangiography
48
Outline some of the potential indications for a Whipple's procedure (7)
1. Pancreatic cancer 2. Pancreatic cyst 3. Ampullary cancer 4. Cholangiocarcinoma 5. Pancreatitis 6. Neuro-endocrine tumour 7. Small bowel tumour
49
What diagnoses makes up ~ 90% of primary pancreatic malignancies?
Ductal carcinoma of the pancreas
50
Suggest 3 risk factors associated with pancreatic cancer
1. Smoking 2. Diabetes 3. Positive family history
51
Which structures are removed during a Whipple's procedure?
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
Name the 3 principle clinical features associated with a tumour of the head of the pancreas
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
Define thrombophlebitis migrans
A recurrent migratory superficial thrombophlebitis caused by a paraneoplastic hypercoagulable state
54
Give 3 complications associated with a Whipple's procedure
1. Pancreatic fistula 2. Delayed gastric emptying 3. Pancreatic insufficiency
55
Outline the components of the FOLFIRINOX regime used in the treatment of metastatic disease
1. Folinic acid 2. 5-fluorouracil 3. Irinotecan 4. Oxaliplatin
56
What are the typical 3 components of MEN-1 - Wermer's syndrome?
1. Hyperparathyroidism 2. Endocrine pancreatic tumours 3. Pituitary tumours - most commonly prolactinomas
57
Recall the 4 components to the current definition of acute respiratory distress syndrome
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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