SESAP ABDOMIN

Question 1

Calot’s original description of the triangle

Answer 1

cystic duct, the common hepatic duct, and the cystic artery

Question 2

Risk of bile duct injury with laparoscopic cholecystectomy is

Answer 2

0.3–0.8%.

Question 3

Critical wiindow of safety steps

Answer 3

(1) dissecting the triangle of Calot to allow one-third of the gallbladder to be dissected free from liver bed,
(2) clearing the triangle of Calot to allow visualization segment V of liver visible through the window
(3) ensuring that the cystic artery and cystic duct are the only structures between the gallbladder and hepatoduodenal ligament.

Question 4

Groove pancreatitis

Answer 4

is a form of chronic segmental pancreatitis

appears as scarring in the groove between the pancreatic head, duodenal wall, and common bile duct.

Frequently, this may appear as a poorly enhancing mass in the region of the head of the pancreas with adjacent inflammatory changes to the duodenal wall on CT imaging.

Characteristics that distinguish this entity from pancreatic cancer include smooth biliary duct narrowing and normal enhancement of the pancreatic head.

Question 5

Interval appendectomy,

Answer 5

no

once considered routine, is no longer justified; recurrent appendicitis rates are reported between 5% and 7% and interval appendectomy complication rates are between 2% and 23%.

Question 6

ERCP  CBD stone
successful
overall complication rate 
hirty-day mortality rates range 
Pancreatitis rates
necrotizing pancreatitis  rates

Answer 6

ERCP in this setting is more than 90% successful at clearing the common bile duct. If the first ERCP attempt is unsuccessful, a repeat attempt is worthwhile. The overall complication rate after ERCP in this setting is 5–7%. Thirty-day mortality rates range from 0.1 to 0.5% in large series. Pancreatitis occurs in 5–10% of patients after ERCP with stone extraction, and necrotizing pancreatitis occurs in 0.7%.

Question 7

Indications for right hemicolectomy Neuroendocrine tumors (NET; also called carcinoids) of the appendix

Answer 7

> 2 cm

regardless of tumor size, include lymphovascular invasion, presence of goblet cells, invasion of the appendiceal mesentery, and tumor location at the base of the appendix.

Question 8

common indications to perform DCS include

Answer 8

arterial pH less than 7.2, partial thromboplastin time greater than 50% of normal, temperature less than 35°C, lactate greater than 5 mmol/L, and a base deficit greater than 15 mmol/L (or >6 mmol/L in patients >55 years).

Platelet count is not typically used as a variable in the decision process.