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Surgery > Liver, Pancreas, Gallbladder > Flashcards

Liver, Pancreas, Gallbladder Flashcards

1
Q

Follicular neoplasm or suspicious for a follicular neoplasm of FNAB

A

Lobectomy

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2
Q

Vaccination of patients undergoing splenectomy against OPSI

A

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.

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3
Q

Routine part of treatment for hepatic metastasis.

A

Resection

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4
Q

Law which states that a palpable gallbladder and painless jaundice , the cause is less likely gallstones

A

Courvoisier law

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5
Q

Most common congenital anomaly involving the pancreas (10% of children)

A

Pancreas divisum

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6
Q

Triad of right upper quadrant pain, upper gastrointestinal hemorrhage, jaundice.

A

Hemobilia

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7
Q

Procedure of choice for acute cholecystitis

A

Laparoscopic cholecystectomy

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8
Q

Most frequently encountered liver lesion over all?

A

Hepatic cysts

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9
Q

Most common benign solid tumor of the liver

A

Hemangioma

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10
Q

Most common type of hepatic abscess in the Philippines?

A

Amoebic in origin

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11
Q

Component of the Child-Pugh score

A

Encephalopathy
Ascites
Bilirubin
Albumin
Prothrombin

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12
Q

Most common vascular structure injured during the dissection of Calot’s triangle in laparoscopic cholecystectomy

A

Right hepatic artery

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13
Q

Cystic dilatations of the extrahepatic and or intrahepatic biliary tree?

A

Choledochal cyst

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14
Q

Cancer associated with choledochal cyst such that excision is recommended whenever possible when high risk cysts are diagnosed.

A

Cholangiocarcinoma

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15
Q

Diagnostic for Zollinger - Ellison Syndrome

A

Serum gastrin level.

In equivocal cases, when the gastrin level is not markedly elevated: Secreting stimulation test

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16
Q

Functional pancreatic tumor associated with symptomatic fasting hypoglycemia , a documented serum glucose <50 mg/dL , and relief of symptoms with the administration of glucose.

A

Insulinoma

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17
Q

Standard practice for the surgical management of hernia in children?

A

High ligation of the hernia sac

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18
Q

Clinical features of hepatocellular carcinoma?

A
  1. Older age
  2. Chronic alcoholic
  3. Cirrhosis symptoms
  4. Mass in the right lobe of the liver on imaging
  5. Elevated alpha fetoprotein level laboratory
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19
Q

Clinical features of hepatocellular carcinoma

A
  1. Older age
  2. Chronic alcoholic
  3. Cirrhosis symptoms
  4. Mass in the right lobe of the liver on imaging
  5. Elevated alpha fetoprotein level laboratory
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20
Q

Signs of abdominal wall hemorrhage associated with acute pancreatitis?

A
  1. Cullens sign ( periumbilical ecchymosis)
  2. Grey turner sign ( flank ecchymosis)
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21
Q

Should be monitored in patients with cholestatic jaundice?

A
  1. Electrocardiogram

Jaundice could be a presentation of cardiac disease due to liver congestion

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22
Q

Indication of surgical incurability for pancreatic cancer

A
  1. Palpable mass
  2. Signs of metastasis in advance stages
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23
Q

Symptom of carcinoma of body and tail of pancreas?

A
  1. Migratory thrombophlebitis
  2. Trousseau’s syndrome

Trosseau’s syndrome: spontaneous recurrent or migratory thromboses (superficial or deep) in people with occult or recently diagnosed visceral disease.

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24
Q

Definitive management for cholangitis?

A

Endoscopic biliary decompression

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25
Q

Goals of management of late stage pancreatic cancer?

A

Relieving gastric outlet obstruction and biliary obstruction

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26
Q

Primary histologic type of cholangiocarcinoma

A

Adenocarcinoma ( >95%)

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27
Q

Inguinal hernia repair procedure with the least recurrence rate.

A

Shouldice repair (2.2%)

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28
Q

The standard treatment for a patient with biliary colic and cholecystholithiasis by ultrasound is _________________.

A

Cholecystectomy

29
Q

In patients with obstructive jaundice, what non-invasive procedure would help you in localizing the cause?

A

Magnetic resonance pancreatography

30
Q

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?

A

Pancreatic head cancer

Courvoisier’s sign: palpable gallbladder + painless jaundice

31
Q

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?

A

Close monitoring / Observation

32
Q

The most common solid benign mass in the liver is ?

A

Hemangioma

33
Q

Choledochal cyst that are not completely excised during surgery may develop into ________?

A

Cholangiocarcinoma

34
Q

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 ____________.

A

Choledochal cyst

35
Q

Ligament that separates the left lateral and left medial segments of the liver?

A

Falciform ligament

Grossly, it separates the liver into a large right lobe and a small left lobe.

36
Q

Contents of the porta hepatis?

A
  1. Common hepatic duct
  2. Proper hepatic artery
  3. Portal vein
37
Q

Laboratory markers of the liver synthetic function?

A
  1. Serum albumin
  2. Prothrombin time
  3. Clotting factors except factor VIII
38
Q

Laboratory tests that indicate the integrity of hepatocellular membranes?

A

AST & ALT

39
Q

Most definitive form of therapy for complications of portal hypertension

A

Orthotopic liver transplantation

40
Q

Etiologic agent of the most common form of liver abscess worldwide?

A

Entamoeba histolytica

41
Q

Absolute contraindication to a liver biopsy

A
  1. Significant coagulopathy
  2. Biliary dilatation
  3. Suspicion of hemangioma or echinococcal cyst
42
Q

Benign solid neoplasm of the liver that has risk for spontaneous intraperitoneal rupture and malignant degeneration

A

Hepatic adenoma

43
Q

Classification of a cholangiocarcinoma located at the hepatic duct confluence + the left hepatic duct

A

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

44
Q

Bismuth-Corlette classification for cholangiocarcinoma extending to and and involving the hepatic duct confluence!

A

Type II

45
Q

Borders of the original triangle described by Calot

A
  1. Cystic duct
  2. Common hepatic duct
  3. Cystic artery

In schwartz: triangle of Calot is the Hepatocystic triangle

46
Q

Borders of the hepatocystic triangle of Budde.

A
  1. Cystic duct
  2. Common hepatic duct
  3. Inferior margin of the right lobe of the liver
47
Q

Gallstones associated with bacterial infections and bile stasis

A

Brown pigment stones

48
Q

Most common presentation of gallstone disease characterized by recurrent biliary colic.

A

Chronic cholecystitis

49
Q

Abrupt cessation of deep inspiration while the examiner hooks their fingers under the patient’s right subcostal margin?

A

Positive Murphy’s Sign

Sign of acute cholecystitis

50
Q

Type of cholidocholilithiasis where stones are formed in the gallbladder and migrate to the common bile duct

A

Secondary choledocholithiasis

Primary choledocholithiasis are formed in the common bile duct

51
Q

Common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct

A

Mirizzi Syndrome

52
Q

Gallstone ileus of the duodenum

A

Bouveret Syndrome

53
Q

Choledochal cyst type presenting as a saccular diverticulum

A

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)

54
Q

Peri umbilical ecchymosis seen in acute pancreatitis due to blood dissecting the falciform ligament.

A

Cullen sign

55
Q

Diagnosis of acute pancreatitis?

A

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

56
Q

Most common etiology of chronic pancreatitis?

A

TIGAR-O Classification
T: toxic / metabolic
I: Idiopathic
G: Genetic
A: Autoimmune
R: Recurrent and Severe Acute Pancreatitis
O: Obstructive

57
Q

Most important causes of pancreatic pseudocyst

A

Pancreatitis (75%)
Trauma (25%)

58
Q

Only definitive and potentially curative treatment of periampullary pancreatic carcinoma

A

Whipple surgery ( Pancreatico-duodenectomy)

59
Q

Dermatitis associated with glucagonoma

A

Necrolytic migratory erythema

60
Q

Most common indication of splenectomy overall

A

Trauma

61
Q

Most common complication after splenectomy?

A

Infection

62
Q

Most feared complication after splenectomy?

A

Overwhelming Post splenectomy Infection (OPSI)

63
Q

Vaccination timing in emergent splenectomy?

A

2 weeks after surgery

Elective splenectomy 2 weeks before

64
Q

Most common surgical disorder of the small intestines

A

Mechanical small bowel obstruction

65
Q

Most common cause of obstruction in small intestines ?

A

Adhesions

66
Q

Charcot’s Triad

A

Jaundice, RUQ pain, Fever

67
Q

Raynaud’s Pentad

A

Charcot triad + Shock
- Jaundice
- RUQ Pain
- Fever
- Hypotension
- Tachycardia

Tx: IV Antibiotics + Fluid resuscitation, if not effective Emergency Biliary Decompression

68
Q

Boundaries of Passaro’s Triangle?

A
  1. Cystic duct
  2. Common bile duct
  3. Second & Third parts of the doudenum
  4. Neck & Body of pancreas

Surgery (14 decks)

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