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SURGERY > LIVER, GALLBLADDER AND PANCREAS > Flashcards

LIVER, GALLBLADDER AND PANCREAS Flashcards

1
Q

Separates the true left and right lobes of the liver

A

Cantlie’s line

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2
Q

What separates the left lateral and left medial segments of the liver? This also anchors liver to the anterior abdominal wall

A

Falciform ligament

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3
Q

This ligament anatomically divides this liver to small left lobe and small right lobe (not true division)

A

Falciform ligamenet

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4
Q

Mickey mouse sign

A

Porta hepatis

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5
Q

What composes the porta hepatis?

A

Common bile duct
Hepatic artery
Portal vein

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6
Q

Divides the left lobe into left lateral and left medial sector

A

Left portal incisure

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7
Q

This is dorsal to the hepatoduodenal ligament

A

Epiploic foramen of winslow

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8
Q

Segment 1 of Liver

A

Caudate or Spigelian lobe

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9
Q

Segment 2 and 3

A

Left lateral segment

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10
Q

Segment 4

A

Left medial segment

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11
Q

Segment 5 and 8

A

Right anterior segment

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12
Q

Segment 6 and 7

A

Right posterior lobe

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13
Q

Blood supply of the liver

A

Portal vein (75%)
Hepatic artery (25%)

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14
Q

This maneuvers compresses the hepatoduodenal ligament to lessen the blood supply the liver

A

Pringle’s maneuver

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15
Q

What encompasses the hepatoduodenal ligament?

A

Portal vein
Hepatic artery
Common bile duct

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16
Q

ThiS measures liver SYNTHETIC functions

A

Albumin
Clotting factors (except factor 8)
Prothrombin time
INR

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17
Q

When will jaundice be detectable?

A

If serum bilirubin is more that 2.5 to 3 mg/dL

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18
Q

2 requirements for diagnosis of cirrhosis

A

Presence of fibrous tissue
Presence of regenerating nodules

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19
Q

First line of antibiotics for spontaneous bacterial peritonitis

A

Cefotaxime

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20
Q

Normal portal pressure

A

5-10 mmhg

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21
Q

Portal HPN

A

> 5mmhg of IV pressure
15mmhg splenic pressure

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22
Q

How much pressure is necesary for varices to form and bleed?

A

> 12mmhg

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23
Q

Most accurate method of determining portal hpn

A

Hepatic venography

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24
Q

Most significant manifestation of portal hypertension and leading cause of morbidity and mortality

A

Esophageal varices

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25
Q

This is given to reduce index bleed of esophageal varices and reduces moratlity by 50%

A

Beta blockers eg. Propranolol

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26
Q

Current Preferred drug for acute variceal bleeding

A

Octreotide

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27
Q

This procedure is reserved for recurrent variceal bleeding despite endoscopic and medical treatment who are not candidate for TIPS and have vasculature unsuitable for shunt operations

A

Sugiura-Fukugawa procedure

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28
Q

Most definitive form of therapy for complications of portal hypertension

A

orthotopic liver transplantation

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29
Q

Most common route of infection leading to pyogenic liver absces

A

Ascending route via biliary tree or portal vein

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30
Q

More frequent lobe that is affected by pyogenic liver abscess

A

Right lobe

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31
Q

Most common organism causing pyogenic liver abscess

A

E. Coli

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32
Q

Causative agent for amoebic liver abscess

A

Entamoeba histolytics

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33
Q

Most common form of liver abscess worldwide

A

Amoebic Liver abscess

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34
Q

Pathognomonic finding of amoebic liver abscess

A

Anchovy like paste (reddish brown pus like material) due to necrotic central portion

35
Q

This should be requested to differentiate pyogenic liver abscess vs amoebic liver abscess

A

Fluorescent antibody test: amoebic liver abscess is positive

36
Q

This is the organism that is responsible for hydatid dse

A

Echinococcus granulosus

37
Q

MOT of echinococcus granulosus

A

Ingestion of ova containing feces of dogs

38
Q

UTZ/CT Scan characteristic appearance of hydatid dse

A

Well defined hypodense lesions
Ring like microcalcifications

39
Q

Absolute contraindications for liver biopsy

A

Significant coagulopathy
Biliary dilatation
Suspicion for hemangioma or echinococcal cyst

40
Q

Relative contraindications for liver biopsy

A

Obesity
Presence of ascites

41
Q

Most common benign solid mass in liver

A

Hemangioma

42
Q

Risk factor for adenoma in liver

A

Current use of estrogens

43
Q

Most common malignant liver tumor

A

Liver metastasis

44
Q

Liver metastasis usually arises from?

A

Colonic carcinoma

45
Q

Primary tumor of hepatocyte

A

Hepatocellular carcinoma

46
Q

Primary tumor of bile ducts

A

Cholangiocarcinoma

47
Q

Aids in diagnosing Hepatocellular Carcinoma

A

CT Scan/MRI
AFP

48
Q

Tumor marker for HCC

A

AFP

49
Q

Drug of choice for HCC patient that is non surgical candidate

A

Sorafenib

50
Q

Characteristic Dual Phase CT sign of Hemangioma

A

Cetnripetal enhancement followed by decrease in dye over 10 minutes from without to within

51
Q

Histologic feature of gallbladder

A

No submucosa and muscularis mucusa

52
Q

Blood supply of gall bladder is

A

Cystic artery from right epigastric artery

53
Q

Borders of triangle of callot

A

Cystic duct
Common hepatic duct
Cystic artery

54
Q

Blood supply of bile duct

A

Gastroduodenal artery
Right hepatic artery

55
Q

What is the basal pressure of sphincter of oddi

A

13 mmhg above duodenal pressure

56
Q

Acute cholecystitis on ultrasound

A

Gallbladder thickening
Pericholecystic fluid
Sonographic murphy sign

57
Q

Type of stone that is associated with hemolytic disorder and cirrhosis

A

Black pigment stone

58
Q

Black pigment stone is due to super saturation of?

A

Calcium bilirubinate
Carbonate
Phosphate

59
Q

This gallstones are soft and mushy which may form either from the gallbladder or the bile ducts. Associated with bacterial infections of bile stasis

A

Brown pigment stones

60
Q

Most common presentation of gallstone disease characterized by recurrent biliary colic due to partial obstruction of the cystic duct

A

Chronic cholecystitis

61
Q

Most common indication for cholecystectomy

A

Recurrent episodes of biliary colic

62
Q

Critical view of safety

A

Triangle of calot must be free of fat w/o exposing the bile duct
The base of GB must be dissected off the liver bed
CYSTIC DUCT AND CYSTIC ARTERY must be seen circumferentially

63
Q

Diagnostic test of choice for acute cholecystitis

A

Ultrasound

64
Q

HIDA Scan result if (+) acute cholecystitis

A

Failure of gallbladder to be filled within 60 minutes after administration of tracer

65
Q

Initial test for choledocholithiasis

A

Abdominal utz

66
Q

Dilated CBD is

A

> 8mm

67
Q

Gold standard for dx of choledocholithiasis

A

ERCP

68
Q

Common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or hartmann’s pouch of gallbladder

A

Mirrizzi syndrome

69
Q

Rigler’s triad in gallstone ileus radiographic finding

A

Pneumobilia
Ectopic gallstone
Small bowel obstruction

70
Q

Charcot’s triad

A

RUQ pain
Fever
Jaundice

71
Q

Reynold’s pentad

A

Fever
RUQ pain
Jaundice
Septic shock
Mental status change

72
Q

Initial management for grade I acute cholangitis

A

Medical: antibiotics

73
Q

Pathognomonic sign seen in ERCP of choledochal cysts

A

Long common channel

74
Q

Triad of choledochal cysts

A

Abdominal pain
Jaundice
Mass

75
Q

ERCP/PTC findings in sclerosing cholangitis

A

(+) multiple dilatation and strictures or beading pattern

76
Q

Most common congenital anomaly of the pancreas

A

Pancreas divisum

77
Q

Arterial supply of the pancreas

A

Splenic artery from the celiac trunk
Superior pancreaticoduodenal from gastroduodenal artery
Inferior pancreaticoduodenal artery from superior mesenteric artery
Dorsal, great and caudal pancreatic arteries

78
Q

Diagnostic gold standard for pancreatitis

A

Abdominal CT Scan

79
Q

Pathognomonic of pancreatic infection in abdominal CT Scan

A

Abnormal extraluminal gas bubbles

80
Q

Most important causes of pseudocyst of the pancreas

A

Pancreatitis (75%)
Trauma (25%)

81
Q

Most common islet tumor

A

Insulinoma

82
Q

Whipple’s triad

A

Symptomatic fasting hypoglycemia
Serum glucose <50mg/dL
relief of symptoms w/ glucose administration

83
Q

Treatment of insulinoma

A

Simple enucleation EXCEPT if close to main pancreatic duct and >2cm

84
Q

WDHA syndrome of VIPnoma

A

Watery diarrhea
Hypokalemia
Achlorydia

SURGERY (6 decks)

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