Surgical Aspects Liver/Pancreas

Question 1

Whipple Procedure

• Removal
• Mortality

Answer 1

Remove

• Curve of duodenum
• head of pancreas
• Gall Bladder
• 10 % Mortality

Question 2

Puestow Operation

Answer 2

• Tx chronic Pancreatitis

- Lateral pancreatico-Jejunostomy

Question 3

Pancreatic Pseudocyst

• Morph
• Tx

Answer 3

• Cyst encapsulated by fluid or smooth muscle; lacks epithelium
• Percutaneous drainage; internal drainage via endoscopy; via Laparotomy

Question 4

Pancreatic Cancer

• Prognosis
• Treatment

Answer 4

• Prog: 7% 5 year survival; 3.5 month median survival untreated
• Whipple (Head); Distal Pancreatectomy (Body/head) + Splenectomy

Question 5

Liver Transplant Indications

Answer 5

• End stage Liver Disease
• Absence of systemic disease
• Full comprehension of procedure and risks

Question 6

Acute Liver Failure Definition

Answer 6

• Hepatic Encephalopathy
• Coagulopathy (INR > 1.5)

Both within 26 weeks of initial onset acute hepatitis in patient without pre-existing liver disease

Question 7

Liver Transplant Disease A/S

Answer 7

• HCV
• Alcoholic Liver Disease
• Primary Biliary Cirrhosis
• Other: Fulminate failure, HCC

Question 8

Liver Transplant Contra

Answer 8

• Extrahepatic infx
• malignancy
• active substance abuse
• advanced CV/Pulm Dx
• Systemic Organ failure

Question 9

MELD

Answer 9

• Liver transplant selection score

- Based on Creatinine, INR, + Bilirubin

Question 10

Liver Abscess Tx

Answer 10

• Blood Culture (+ means pyogenic. not amoebic)
• Parental Abx
• Precutaneous CT drainage

Question 11

Ameobic Liver Abcess

• Morph
• Tx

Answer 11

• Single Abcess in Right Lobe
• “Anchovy Paste”
• Tx Metronidazole; sometimes drainage

Question 12

Echinococcal Liver Cysts

• morph
• LabDx
• Tx

Answer 12

• Morph: Solitary RL calcifoed Cyst
• LabDx: Cason Skin Test
• Tx: Excision of cyst w/ rupture