Liver, Pancreas, Gallbladder Flashcards
Follicular neoplasm or suspicious for a follicular neoplasm of FNAB
Lobectomy
Vaccination of patients undergoing splenectomy against OPSI
2 weeks prior to surgery ( elective splenectomy)
Or
2 weeks after surgery ( emergent splenectomy)
Against: S. Pneumoniae , H. Influenzae type B, N. Meningitidis , Annual influenza vaccine.
Routine part of treatment for hepatic metastasis.
Resection
Law which states that a palpable gallbladder and painless jaundice , the cause is less likely gallstones
Courvoisier law
Most common congenital anomaly involving the pancreas (10% of children)
Pancreas divisum
Triad of right upper quadrant pain, upper gastrointestinal hemorrhage, jaundice.
Hemobilia
Procedure of choice for acute cholecystitis
Laparoscopic cholecystectomy
Most frequently encountered liver lesion over all?
Hepatic cysts
Most common benign solid tumor of the liver
Hemangioma
Most common type of hepatic abscess in the Philippines?
Amoebic in origin
Component of the Child-Pugh score
Encephalopathy
Ascites
Bilirubin
Albumin
Prothrombin
Most common vascular structure injured during the dissection of Calot’s triangle in laparoscopic cholecystectomy
Right hepatic artery
Cystic dilatations of the extrahepatic and or intrahepatic biliary tree?
Choledochal cyst
Cancer associated with choledochal cyst such that excision is recommended whenever possible when high risk cysts are diagnosed.
Cholangiocarcinoma
Diagnostic for Zollinger - Ellison Syndrome
Serum gastrin level.
In equivocal cases, when the gastrin level is not markedly elevated: Secreting stimulation test
Functional pancreatic tumor associated with symptomatic fasting hypoglycemia , a documented serum glucose <50 mg/dL , and relief of symptoms with the administration of glucose.
Insulinoma
Standard practice for the surgical management of hernia in children?
High ligation of the hernia sac
Clinical features of hepatocellular carcinoma?
- Older age
- Chronic alcoholic
- Cirrhosis symptoms
- Mass in the right lobe of the liver on imaging
- Elevated alpha fetoprotein level laboratory
Clinical features of hepatocellular carcinoma
- Older age
- Chronic alcoholic
- Cirrhosis symptoms
- Mass in the right lobe of the liver on imaging
- Elevated alpha fetoprotein level laboratory
Signs of abdominal wall hemorrhage associated with acute pancreatitis?
- Cullens sign ( periumbilical ecchymosis)
- Grey turner sign ( flank ecchymosis)
Should be monitored in patients with cholestatic jaundice?
- Electrocardiogram
Jaundice could be a presentation of cardiac disease due to liver congestion
Indication of surgical incurability for pancreatic cancer
- Palpable mass
- Signs of metastasis in advance stages
Symptom of carcinoma of body and tail of pancreas?
- Migratory thrombophlebitis
- Trousseau’s syndrome
Trosseau’s syndrome: spontaneous recurrent or migratory thromboses (superficial or deep) in people with occult or recently diagnosed visceral disease.
Definitive management for cholangitis?
Endoscopic biliary decompression
Goals of management of late stage pancreatic cancer?
Relieving gastric outlet obstruction and biliary obstruction
Primary histologic type of cholangiocarcinoma
Adenocarcinoma ( >95%)
Inguinal hernia repair procedure with the least recurrence rate.
Shouldice repair (2.2%)
The standard treatment for a patient with biliary colic and cholecystholithiasis by ultrasound is _________________.
Cholecystectomy
In patients with obstructive jaundice, what non-invasive procedure would help you in localizing the cause?
Magnetic resonance pancreatography
The most likely diagnosis in a 70yo male presenting with significant weight loss accompanied by progressive jaundice, anorexia, pruritus, and tea colored urine with positive Courvoisiers sign is?
Pancreatic head cancer
Courvoisier’s sign: palpable gallbladder + painless jaundice
A 75 yo hypertensive but otherwise asymptomatic female during her annual executive check-up was found to have a 5mm stone in her thin walled gallbladder. What treatment option is best for her?
Close monitoring / Observation
The most common solid benign mass in the liver is ?
Hemangioma
Choledochal cyst that are not completely excised during surgery may develop into ________?
Cholangiocarcinoma
A 15 yo/ M comes in because of fever and jaundice. On PE , a palpable mass is felt at the RUQ. Initial ultrasound shows a fusiform dilatation of the CBD ; the intrahepatic ducts are normal. The gallbladder is normal. The most likely diagnosis is ____________.
Choledochal cyst
Ligament that separates the left lateral and left medial segments of the liver?
Falciform ligament
Grossly, it separates the liver into a large right lobe and a small left lobe.
Contents of the porta hepatis?
- Common hepatic duct
- Proper hepatic artery
- Portal vein
Laboratory markers of the liver synthetic function?
- Serum albumin
- Prothrombin time
- Clotting factors except factor VIII
Laboratory tests that indicate the integrity of hepatocellular membranes?
AST & ALT
Most definitive form of therapy for complications of portal hypertension
Orthotopic liver transplantation
Etiologic agent of the most common form of liver abscess worldwide?
Entamoeba histolytica
Absolute contraindication to a liver biopsy
- Significant coagulopathy
- Biliary dilatation
- Suspicion of hemangioma or echinococcal cyst
Benign solid neoplasm of the liver that has risk for spontaneous intraperitoneal rupture and malignant degeneration
Hepatic adenoma
Classification of a cholangiocarcinoma located at the hepatic duct confluence + the left hepatic duct
IIIB
BISMUTH -CORLETTE CLASSIFICATION OF CHOLANGIOCARCINOMA
I- distal to hepatic confluence
II- extend to hepatic confluence
IIIA- Confluence to + right hepatic duct (rAyt)
III B- confluence + left hepatic duct
IV- confluence + bilateral bilateral hepatic ducts
Bismuth-Corlette classification for cholangiocarcinoma extending to and and involving the hepatic duct confluence!
Type II
Borders of the original triangle described by Calot
- Cystic duct
- Common hepatic duct
- Cystic artery
In schwartz: triangle of Calot is the Hepatocystic triangle
Borders of the hepatocystic triangle of Budde.
- Cystic duct
- Common hepatic duct
- Inferior margin of the right lobe of the liver
Gallstones associated with bacterial infections and bile stasis
Brown pigment stones
Most common presentation of gallstone disease characterized by recurrent biliary colic.
Chronic cholecystitis
Abrupt cessation of deep inspiration while the examiner hooks their fingers under the patient’s right subcostal margin?
Positive Murphy’s Sign
Sign of acute cholecystitis
Type of cholidocholilithiasis where stones are formed in the gallbladder and migrate to the common bile duct
Secondary choledocholithiasis
Primary choledocholithiasis are formed in the common bile duct
Common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct
Mirizzi Syndrome
Gallstone ileus of the duodenum
Bouveret Syndrome
Choledochal cyst type presenting as a saccular diverticulum
Type 2
CHOLEDOCHAL CYST TYPES
I- Fusiform
2- Saccular
3- Choledochoceles
4a- Extrahepatic and Intrahepatic duct involvement
4b- Extrahepatic ducts only
5- zintrahepatic ducts only (Caroli disease)
Peri umbilical ecchymosis seen in acute pancreatitis due to blood dissecting the falciform ligament.
Cullen sign
Diagnosis of acute pancreatitis?
Two or more of the following:
1. Severe characteristic abdominal pain
2. Serum amylase / lipase >3x upper limit
3. Contrast - enhanced CT findings of acute pancreatitis
Most common etiology of chronic pancreatitis?
TIGAR-O Classification
T: toxic / metabolic
I: Idiopathic
G: Genetic
A: Autoimmune
R: Recurrent and Severe Acute Pancreatitis
O: Obstructive
Most important causes of pancreatic pseudocyst
Pancreatitis (75%)
Trauma (25%)
Only definitive and potentially curative treatment of periampullary pancreatic carcinoma
Whipple surgery ( Pancreatico-duodenectomy)
Dermatitis associated with glucagonoma
Necrolytic migratory erythema
Most common indication of splenectomy overall
Trauma
Most common complication after splenectomy?
Infection
Most feared complication after splenectomy?
Overwhelming Post splenectomy Infection (OPSI)
Vaccination timing in emergent splenectomy?
2 weeks after surgery
Elective splenectomy 2 weeks before
Most common surgical disorder of the small intestines
Mechanical small bowel obstruction
Most common cause of obstruction in small intestines ?
Adhesions
Charcot’s Triad
Jaundice, RUQ pain, Fever
Raynaud’s Pentad
Charcot triad + Shock
- Jaundice
- RUQ Pain
- Fever
- Hypotension
- Tachycardia
Tx: IV Antibiotics + Fluid resuscitation, if not effective Emergency Biliary Decompression
Boundaries of Passaro’s Triangle?
- Cystic duct
- Common bile duct
- Second & Third parts of the doudenum
- Neck & Body of pancreas
