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TH11 HEPATOBILIARY SYSTEM Flashcards

1
Q

WHAT ARE THE 2 MAIN TYPES OF LIVER ABSCESS

A
  1. PYOGENIC LIVER ABSCESS
    - bacterial origin
  2. AMEBIC LIVER ABSCESS
    - caused by entamoeba histolytica
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2
Q

WHICH ARE THE 2 GENERAL CATEGORIES OF PYOGENIC LIVER ABSCESS?

A
  1. MACROSCOPIC ABSCESS

2. MICROABSCESS

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3
Q

DEFINE MACROSCOPIC LIVER ABSCESS

A

RESTRICTED TO ONE LOBE OF LIVER
SINGLE OR CONFLUENT
REQUIRES SOME FORM OF PRIMARY DRAINAGE

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4
Q

DEFINE LIVER MICRO ABSCESS?

A

MULTIPLE/ WIDE DISTRIBUTED THROUGHOUT HEPATIC PARENCHYME

REQUIRE PRIMARY MEDICAL THERAPY

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5
Q

WHICH IS THE MOST COMMON PATHOGENIC GROUP IN WHICH INFECTING PATHOGENS ARE INTRODUCED INTO LIVER?

A 
BILIARY TRACT DISEASE
PORTAL VEIN PYLEPHLEBITIS 
HEPATIC ARTERIAL INFECTION 
POST TRAUMATIC INFECTION 
DIRECT EXTENSION OF INFECTION
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6
Q

CLINICAL PRESENTATION OF MACROSCOPIC LIVER ABSCESS?

A 
DEVELOP OVER SEVERAL DAYS (more subacute)
FEVER 
ABDOMINAL PAIN 
NIGHT SWEATS 
ANOREXIA 
WEIGHT LOSS
RUQ TENDERNESS
HEPATOMEGALY SEEN INF 50% PX
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7
Q

CLINICAL PRESENTATION OF LIVER MACRO ABSCESS?

A

ACUTELY SEPTIC CLINICAL PRESENTATION
FEVER
RIGOR
RUQ PAIN > CAN BE SEVERE

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8
Q

INITIAL PROCEDURE OF CHOICE TO ASSESS SUSPECTED LIVER ABSCESS?

A

ABDOMINAL ULTRASONOGRAPHY

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9
Q

TRADITIONAL APPROACH THERAPY OF MACROSCOPIC PYOGENIC LIVER ABSCESS?

A

surgical drainage of abscess

correction of the underlying pathology

course of parenteral antibiotics.

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10
Q

METHOD OF CHOICE IN TX OF MULTIPLE LIVER ABSCESS

A

Antibiotic treatment

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11
Q

2 MAIN HISTOLOGICAL TYPE OF PRIMARY LIVER CANCER?

A

hepatocellular carcinoma

cholangio-carcinoma.

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12
Q

WHICH METHOD OFFERS THE ONLY HOPE TO CURE PRIMARY CANCER OF LIVER?

A

Surgical removal (liver resection or transplantation)

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13
Q

DEFINE KLATSKIN TUMOUR?

A 
extrahepatic cholangiocarcinoma ( adenomacarcinoma of the
extrahepatic bile duct).

CANCER OF BILIARY TREE OCCURING AT JUNCTION OF RIGHT + LEFT HEPATIC BILE DUCT

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14
Q

CLINICAL PRESENTATION OF EXTRAHEPATIC CHOLANGIOCARCINOMA?

A

Progressive jaundice with cholangitis and weight loss

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15
Q

METHOD OFFERING ONLY HOPE TO CURE KLATSKIN TUMOURS?

A

liver resection with

reconstruction to restore bile flow into the intestine.

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16
Q

MOST COMMON PRIMARY CANCER THAT METASTASISE TO LIVER?

A

Cancers of the colon, breast, lung, pancreas and stomach.

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17
Q

DEFINE GALL BLADDER CANCER?

A

an aggressive malignancy, occurs predominantly in elderly people
+ strongly associated with gallstones.

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18
Q

CLINICAL PRESENTATION OF GALL BLADDER CANCER?

A

pain in the right upper quadrant of the

abdomen mimicking acute or chronic cholecystitis.

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19
Q

definition of cholelithiasis

A

synonym of gallstones- which means stones in the biliary system.

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20
Q

term cholecystolithiasis denote

A

Gallstones that are formed and localised in the gallbladder.

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21
Q

What does the term choledocholithiasis denote

A

Gallstones that are localised into common bile duct.

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22
Q

What does the term hepaticolithiasis denote

A

Gallstones that are localised into common hepatic duct.

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23
Q

What does the term hepatolithiasis denote?

A

Gallstones that are localised into intrahepatic biliary tree.

24
Q

3 types of gallstones according to their chemical structures. Which are they?

A

Cholesterol stones, pigment stones and mixed stones.

25
2 clinical forms of cholecystolithiasis. Which are they
Asymptomatic stones and biliary colic (result of temporary obstruction of the gallbladder cystic duct).
26
clinical presentation of biliary colic?
pain often colic, the pain in biliary colic usually constant in epigastrium + RUQ + may radiate to back in region of inferior angle of scapular. Nausea + vomiting common Fever is absent.
27
definition of acute calculus cholecystitis?
Acute inflammation of gallbladder triggered by obstruction of the cystic duct.
28
pathological difference between biliary colic and acute calculus cholecystitis?
In biliary colic >no inflammation of gallbladder In acute calculous cholecystitis = inflammation of gallbladder.
29
Murphy’s sign mean?
Murphy’s sign is established in acute cholecystitis + means an arrest of inspiration with gentle pressure under the right costal margin- result of the inflammatory process of the gallbladder.
30
Which physical findings will help the clinician to distinguish acute cholecystitis from biliary colic?
Tenderness and a positive Murphy’s sign help distinguish acute cholecystitis from biliary colic.
31
Which is the method of choice in diagnosis of acute cholecystitis?
Abdominal ultrasonography. It is a sensitive, inexpensive and reliable tool for diagnosis of acute cholecystitis. In addition to identifying gallstones, ultrasound can demonstrate pericholecystic fluid, gallbladder wall thickening.
32
What are the indications of emergency cholecystectomy in acute cholecystitis?
Localised or generalised peritonitis; simultaneously expression of acute pancreatitis; acute cholecystitis complicated with jaundice.; acute cholecystitis with choledocholithiasis; signs of peritoneal irritation and tenderness, with uncertain cause.
33
What is the definition of acute acalculous cholecystitis?
Acute inflammation of the gallbladder without the obstruction of the cystic duct (in the absence of stones)
34
Which are the most common risk factors for the development of acute acalculous cholecystitis?
Older age critical illness burns and trauma, prolonged use of total parenteral nutrition diabetes, immunosuppression.
35
treatment of acute acalculous cholecystitis?
similar to acute calculous cholecystitis, with cholecystectomy being therapeutic.
36
There are 2 options of the origin of the common bile duct stones. Which are they?
Gallbladder origin- stones originate in the gallbladder and migrate through the cystic duct into the bile duct and primary bile duct stones.
37
complications of choledocholithiasis?
Obstructive jaundice, ascending cholangitis and acute pancreatitis.
38
clinical presentation of ascending cholangitis?
epigastric pain, rigors and jaundice.
39
treatment of ascending cholangitis?
The obstructed bile duct with ascending cholangitis must be drained adequately and quickly by an effective route.
40
What does Mirizzi syndrome mean
Mirizzi syndrome denotes a station of inflammation or a stone in the gallbladder neck that leads to inflammation of the adjoining biliary system with obstruction of the common hepatic duct with jaundice
41
Pyogenic liver abscesses could be result of:
Biliary tract diseases, portal vein pylephlebitis, hepatic arterial infection, post-traumatic liver infection
42
In case of pyogenic liver abscess which of the following is the most common finding during the physical examination?
fever and right upper quadrant tenderness.
43
In present, what is the method of choice for treatment of macroscopic pyogenic liver abscess?
percutaneous drainage under CT or US guidance.
44
Which tumor marker could be useful for diagnosing and follow up of the hepatocellular carcinoma?
alpha fetoprotein
45
Which of the following is also known as klatskin tumor?
hilar cholangiocarcinoma
46
What is the 1st method of choice for treatment of an early stage hepatocellular carcinoma?
liver resection
47
Which of the following diseases is aetiologically connected with hepatocellular carcinoma?
Hepatits B
48
Courvolsler- Terrier sign (painless jaundice and enlarged, non-tender gallbladder or right upper quadrant mass) is observed in:
gall bladder cancer
49
Which of the following is a type of gallstone?
cholesterol stone
50
Condition in which stones are localised in the common bile duct is also known as:
choledochololithiasis
51
imaging method of choice for diagnosing gallstone disease | (cholecystlithiasis)?
ultrasonography
52
Cholecystectomy is indicated in case of:
Acute cholecystitis, choledocholithiasis, gallstone pancreatitis, symptomatic gallstone disease.
53
Murphy’s sign is a typical feature of:
acute cholecystitis
54
In which conditions are there no underlying inflammatory process?
biliary colic
55
Inflammation or a stone in the gallbladders neck that lead to inflammation of the adjoining biliary system, with obstruction of the common hepatic duct and jaundice is known as:
Mirizzi syndrome
56
risk factor for the development of acalculous cholecystitis?
Critical illness, prolonged use of total parenteral nutrition, burns and trauma, immunosuppression.

SURGICAL DISEASES (13 decks)

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