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SURGICAL DISEASES > TH11 HEPATOBILIARY SYSTEM > Flashcards

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
Q

2 clinical forms of cholecystolithiasis. Which are they

A

Asymptomatic stones and biliary colic (result of temporary obstruction of the gallbladder
cystic duct).

26
Q

clinical presentation of biliary colic?

A

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
Q

definition of acute calculus cholecystitis?

A

Acute inflammation of gallbladder triggered by obstruction of the cystic duct.

28
Q

pathological difference between biliary colic and acute calculus
cholecystitis?

A

In biliary colic >no inflammation of gallbladder

In acute calculous cholecystitis
= inflammation of gallbladder.

29
Q

Murphy’s sign mean?

A

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
Q

Which physical findings will help the clinician to distinguish acute cholecystitis from biliary
colic?

A

Tenderness and a positive Murphy’s sign help distinguish acute cholecystitis from biliary
colic.

31
Q

Which is the method of choice in diagnosis of acute cholecystitis?

A

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
Q

What are the indications of emergency cholecystectomy in acute cholecystitis?

A

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
Q

What is the definition of acute acalculous cholecystitis?

A

Acute inflammation of the gallbladder without the obstruction of the cystic duct (in the absence of stones)

34
Q

Which are the most common risk factors for the development of acute acalculous
cholecystitis?

A

Older age
critical illness
burns and trauma, prolonged use of total parenteral nutrition
diabetes, immunosuppression.

35
Q

treatment of acute acalculous cholecystitis?

A

similar to acute calculous cholecystitis, with cholecystectomy being therapeutic.

36
Q

There are 2 options of the origin of the common bile duct stones. Which are they?

A

Gallbladder origin- stones originate in the gallbladder and migrate through the cystic duct into the bile duct and primary bile duct stones.

37
Q

complications of choledocholithiasis?

A

Obstructive jaundice, ascending cholangitis and acute pancreatitis.

38
Q

clinical presentation of ascending cholangitis?

A

epigastric pain, rigors and jaundice.

39
Q

treatment of ascending cholangitis?

A

The obstructed bile duct with ascending cholangitis must be drained adequately and quickly
by an effective route.

40
Q

What does Mirizzi syndrome mean

A

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
Q

Pyogenic liver abscesses could be result of:

A

Biliary tract diseases, portal vein pylephlebitis, hepatic arterial infection,
post-traumatic liver infection

42
Q

In case of pyogenic liver abscess which of the following is the most common finding during
the physical examination?

A

fever and right upper quadrant tenderness.

43
Q

In present, what is the method of choice for treatment of macroscopic pyogenic liver
abscess?

A

percutaneous drainage under CT or US guidance.

44
Q

Which tumor marker could be useful for diagnosing and follow up of the hepatocellular
carcinoma?

A

alpha fetoprotein

45
Q

Which of the following is also known as klatskin tumor?

A

hilar cholangiocarcinoma

46
Q

What is the 1st method of choice for treatment of an early stage hepatocellular carcinoma?

A

liver resection

47
Q

Which of the following diseases is aetiologically connected with hepatocellular carcinoma?

A

Hepatits B

48
Q

Courvolsler- Terrier sign (painless jaundice and enlarged, non-tender gallbladder or right
upper quadrant mass) is observed in:

A

gall bladder cancer

49
Q

Which of the following is a type of gallstone?

A

cholesterol stone

50
Q

Condition in which stones are localised in the common bile duct is also known as:

A

choledochololithiasis

51
Q

imaging method of choice for diagnosing gallstone disease

(cholecystlithiasis)?

A

ultrasonography

52
Q

Cholecystectomy is indicated in case of:

A

Acute cholecystitis, choledocholithiasis, gallstone pancreatitis,
symptomatic gallstone disease.

53
Q

Murphy’s sign is a typical feature of:

A

acute cholecystitis

54
Q

In which conditions are there no underlying inflammatory process?

A

biliary colic

55
Q

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:

A

Mirizzi syndrome

56
Q

risk factor for the development of acalculous cholecystitis?

A

Critical illness, prolonged use of total parenteral nutrition, burns and
trauma, immunosuppression.

SURGICAL DISEASES (13 decks)

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