LIVER

Question 1

ECHINOCOCCOSIS surgery

Answer 1

HEPATIC CYST ( ECHINOCOCCOSIS )

pre-op therapy with albendazole for at least 3 months

POSITION:

• . supine for anterior cysts
• . lateral flank approach for cysts in seg. VI and VII

Open cyst evacuation:
- . for cysts on periphery , safest approach
- . field lined with hypertonic saline(20%) soaked gauze
- . cyst cavity opened and content aspirated with large suction device
- . once contents aspirated, cyst can be opened completely
• . any remaining debris meticulously cleared
- . cyst irrigated with a scolecoidal agent
• . hypertonic saline, cetrimide,
- . cyst filled with omentum

Pericystectomy:

• . best for cysts along the periphery of liver
• . need proper pre-op evaluation of location of bile ducts and vessels ( CT or US )
• . complete resection of cyst wall without entering cyst cavity
• . along a plane outside pericyst or along cyst wall
• . advantages: decrease risk of content spillage ( anaphylaxis and recurrence )
• . disadvantage: increased risk of bleeding and damage to bile ducts

Question 2

What organism do you cover for with spontaneous bacterial peritonitis

Answer 2

gm - anaerob

WBC cut off is

Question 3

MELT score cut off needed to safely resect deliver

Answer 3

8

Question 4

Percent liver remanent that can be left when resecting liver

Normal functioning liver

Answer 4

20%!

Question 5

Percent liver remanent that can be left when resecting liver

Prior chemotherapy

Answer 5

Need 30%

Question 6

Percent liver remanent that can be left when resecting liver

Hepatic cirhossi

Answer 6

40%

Question 7

Percent liver remanent that can be left when resecting liver

Hepatic cirhossi and prior chemotherapy

Answer 7

50%

Question 8

What can be done to hypertrophy the liver prior to resection

And how long does it take

Answer 8

Embolization of the PORTAL vein

Only 1 month!

Question 9

HEPATECTOMIES

Answer 9

SPECIFIC CONSENT ISSUES

Mortality