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Surgery – Questions > Lange - Liver/gall Bladder/pancreas > Flashcards

Lange - Liver/gall Bladder/pancreas Flashcards

0
Q

Annular pancreas associated with?

A

Down syndrome

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1
Q

Choledochal cyst associated with?

A

Cholangiocarcinoma

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2
Q

Patient with SBO and air in biliary tree suggests?

A

Gallstone ileus

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3
Q

Patient with history of liver trauma who develops G.I. bleeding weeks later – suspected diagnosis? Confirm and treat with?

A

Hemobilia

Angiography and embolization

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4
Q

Point of HIDA scan?

A

Patency of cystic duct

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5
Q

Needle biopsy of liver mass is contraindicated if mass is believed to be?

A

Hepatic adenoma

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6
Q

Classes of the splenic injury? Management?

A

Class I – non-expanding subcapsular hematoma (Non-operative management)

Class II – laceration 1-3 cm deep (Non-operative management)

Class III – major parenchymal injury (operate)

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7
Q

VIPoma presents with? Management?

A

WDHA – watery diarrhea, hypokalemia, achlorhydra (And metabolic acidosis)

Octreotide (decreases diarrhea) and excision of tumor

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8
Q

Felty’s syndrome? Possible tx?

A

Rheumatoid arthritis, neutropenia, splenomegaly

Splenectomy

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9
Q

Anechoic area (on US) of liver suggestive of?

A

Benign, non-parasitic cyst

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10
Q

Treatment of pseudocyst? If fails?

A

Usually self resolves

If enlarges, Percutaneous drainage

If unsuccessful, internal drainage into stomach

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11
Q

Why could serum amylase be normal in pancreatitis?

A
  1. Hyperlipidemia (Interferes with chemical detection of Amylase)
  2. Increased urinary excretion
  3. Destruction of pancreatic parenchyma (chronic pancreatitis)
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12
Q

Causes for serum amylase to be elevated in absence of pancreatitis?

A
  1. Perforated peptic ulcer
  2. Gangrenous cholecystitis
  3. Small bowel strangulation
  4. Chronic renal failure
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13
Q

Most common site of trauma to the pancreas?

A

Neck

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14
Q

When to perform:

  1. Pancreaticojejunostomy (Puestow)
  2. Whipple procedure
  3. Distal pancreatectomy
A
  1. Pancreatitis with dilated pancreatic ducts and persistent symptoms after ERCP
  2. Disease confined to head pancreas
  3. Disease involves body and tail of pancreas
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15
Q

Patients with pancreatitis may also have dyspnea because?

A

Factor released from pancreas alters pulmonary surfactant causing atelectasis

16
Q

Treatment for insulinoma?

A

Enucleation

17
Q

Whipple’s triad?

A

indicates insulinoma

  1. Hypoglycemic symptoms
  2. Blood glucose under 50 during episode
  3. Relief of symptoms by IV glucose
18
Q

Scan to locate gastrinoma?

A

SRS – nuclear scan using radiolabeled somatostatin (binds to somatostatin receptors on gastrin producing cells)

20
Q

Patient from China with multiple strictures in biliary tree and dilated intrahepatic ducts?

A

Cholangiohepatitis from C. Sinesis

21
Q

Point of HIDA scan?

A

Determine patency of biliary tree

22
Q

Organisms most commonly associated in ascending Cholangitis?

A

E. coli and Klebsiella

23
Q

During cholecystectomy, also should do? If positive?

A

Intraoperative cholangiogram to rule out CBD stones

Choledochoduodenostomy OR ERCP/sphincterotomy

24
Q

Structure that courses through triangle of Calot?

A

Cystic artery

25
Q

Biliary disease that affects men more than women? Common location? Management?

A

Cholangiocarcinoma

Proximal - excision of hepatic duct bifurcation and reconstruction with Roux-en-Y limb of jejunum

Distal - Whipple

Inoperable - palliative endoscopic stent

26
Q

Treatment of gallbladder CA? Never use?

A

Stage I - confined to mucosa/submucosa - nothing

Stage II - penetrates muscular layer
(Resection of liver lobes and ports hepatis lymph nodes)

Stage III - lymph node involvement (Resection of liver lobes and ports hepatis lymph nodes

Stage IV - no resection indicated

Chemo or radiation

27
Q

Pt presents with acute cholecystitis - when to do cholecystectomy?

A

2-3 days of hospital admission

28
Q

Acalculus cholecystitis most commonly encountered when?

A

Trauma or after operations

29
Q

Management of stable pt with acute acalculus cholecystitis?

Unstable pt?

A

Cholecystectomy

Percutaneous drainage

30
Q

Hepatic adenoma associated with?

A

OCP
diabetes drugs
Pregnancy

31
Q

Focal nodular hyperplasia - symptoms? Histology? Link to cancer? Unobservable with?

A

Asymptomatic

Central stellar scar

None.

CT/US

32
Q

Most common hepatic lesion? Sign?

A

Hemangioma. Waxing and waning effect with contrast CT

33
Q

Normal portal Venus pressure?

A

5-10 mm

34
Q

Scan to look for accessory spleen?

A

Radioactive technetium

35
Q

MELD score based on

A

Bilirubin
INR
Creatinine?

54
Q

Courvouisier’s sign?

If due to gallstones?

A

Enlarged gallbladder from obstructive jaundice due to malignancy

Shrunken bladder in obstructive jaundice due to gallstones

Surgery – Questions (8 decks)

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