Liver & Biliary Flashcards
Most common morphology of hilar cholangiocarcinoma
Sclerosing/periductal infiltrating
Morphology associated with most favorable prognosis in hilar cholangiocarcinoma
Papillary
Which liver resections are favorable for laparoscopic approach
Tumors <5cm, segments 2, 3, 4, 5, or 6
Well circumscribed hepatic mass with a central scar and elevated neurotensin level
Fibrolamellar HCC
Management of incidentally discovered gallbladder cancer invading the lamina propria
T1a - cholecystectomy only
Management of incidentally discovered gallbladder cancer invading muscularis layer
T1b - extended cholecystectomy (non-anatomic partial hepatectomy of liver parenchyma surrounding gallbladder fossa)
Management of incidentally discovered gallbladder cancer spread to the serosa/connective tissue but no lymph nodes
T2/T3 - central hepatectomy with resection of segments IVB and V
Management of incidentally discovered gallbladder cancer with nodal/distant mets
T3/T4 - neoadjuvant chemoradiation -> central hepatectomy if response
Technique of open CBD exploration
Anterior longitudinal choledochotomy on the CBD, stone removal, then T-tube placed to prevent stricture
Type 1 choledochal cyst
Fusiform dilation of CBD
Management of type 1 choledochal cyst
Excision of cyst +/- RNY hepaticojejunostomy
Type II choledochal cyst
Extrahepatic diverticulum
Management of type II choledochal cyst
Simple cyst excision
Type III choledochal cyst
Choledochocele (at ampulla)
Management of type III choledochal cyst
Endoscopic drainage or removal
Type IVa choledochal cyst
Intrahepatic and extrahepatic cysts
Management of type IVa choledochal cyst
Partial hepatectomy and RNY hepaticojejunostomy
Type IVb choledochal cyst
Multiple extrahepatic cysts
Management of type IVb choledochal cyst
Excision of cysts +/- RNY hepaticojejunostomy
Type V choledochal cysts
Caroli disease; multiple intrahepatic cysts
Management of type V choledochal cysts
Liver transplant
Liver lesion on CT: peripheral nodular enhancement, centripetal filling in portal-venous phase
Hemangioma
Liver lesion on CT: well-circumscribed heterogenous mass with transient homogenous enhancement in arterial phase, returns to isodense in portal venous phase and delayed phase
Hepatic adenoma
Liver lesion on MRI: hyperdense on T1-weighted images, early enhancement with gadolinium injection; lesion appears ‘cold’ on nuclear imaging
Hepatic adenoma
Primary common duct stones
Originate in CBD, made up of calcium bilirubinate and cholesterol; associated with infection
Secondary common duct stones
Originate in gallbladder, made up of cholesterol/calcium (cholesterol stones), or calcium bilirubinate (black stones); associated with hemolytic disorders
Gallbladder cholesterol polyp: appearance and malignancy potential
Multiple, homogenous, pedunculated, typically <1cm. No malignant potential
Adenomyomatosis of gallbladder
Diffuse thickening with mucosal projections. Minimal/low malignant potential
Inflammatory polyp of gallbladder
Sessile or pedunculated; no malignant potential
Right hepatectomy - which segments?
5-8
Right extended hemihepatectomy - which segments?
4-8
Left hepatectomy - which segments?
2-4
Extended left hemihepatectomy - which segments?
2-5 and 8
Rigler triad
Pneumobiliar, SBO, and ectopic gallstone - seen in gallstone ileus
Number of lymph nodes needed in gall bladder cancer for staging
At least 6
Right and left liver are separated anatomically by?
IVC and gallbladder
Risk of malignancy with hepatic adenoma
5%
Most common cause of benign biliary stricture
Previous surgery
Where are majority of conjugated bile acids absorbed
Terminal ileum by active transport
Usual location of cystic artery
Posterior to hepatic duct
