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Flashcards in HBP Deck (18):
1

Ranson criteria on admission

1. Age
2. WBC
3. Blood glucose
4. Serum AST
5. Serum LDH

2

Branches of SMA

1. Inferior pancreaticoduodenal artery (supplies head of the pancreas and to the ascending and inferior parts of the duodenum)
2. Intestinal arteries (branches to ileum, branches to jejunum)
3. Ileocolic artery (supplies last part of ileum, cecum, and appendix)
4. Right colic artery (to ascending colon)
5. Middle colic artery (to the transverse colon)

3

Branches of Celiac trunk

1. Left gastric a.
2. Common hepatic a.
3. Splenic a.

1. Esophageal branch, stomach branch
2. Hepatic a. proper, Gastroduodenal a., Right gastric a.
3. Dorsal pancreatic a., Short gastric a., Left gastro-omental a., Greater pancreatic a.

4

RLQ pain DDx (14)
JC WCS

1. Acute appendicitis
2. Cecal diverticulitis
3. Ureteric colic
4. Ruptured ectopic pregnancy
5. Mesenteric adenitis
6. Torsion of ovarian cyst
7. Ileitis
8. Meckel’s diverticulum
9. Cecal ischemia
10. CA Cecum
11. Inguinal/Femoral hernia
12. Testicular pathology
13. PPU
14. Acute cholecystitis

5

LLQ pain DDx (7)
JC WCS

1. Sigmoid diverticulitis
2. CA Sigmoid
3. Torsion of ovarian cyst
4. Ruptured ectopic pregnancy
5. Ureteric colic
6. Inguinal/Femoral hernia
7. Testicular pathology

6

Central abdominal pain -
Periumbilical pain DDx (7)
JC WCS

1. SB obs
2. GE
3. Early acute appendicitis
4. Bowel ischemia
5. IBS
6. Ruptured AAA
7. Acute pancreatitis

7

Central abdominal pain -
Hypogastrium pain DDx (4)
JC WCS

1. Cystitis
2. PID
3. LB obs
4. AROU

8

Child-Pugh score

ABCDE

Albumin
Bilirubin
PT
Ascites (distension)
Encephalopathy

A - 5-6 (compensated, normal liver function)
B - 7-9 --> can go for transplant
C - 10-15

9

MELD score
(Model for end stage liver disease)

BICE

Bilirubin
INR
Creatinine
Etiology

10

Causes of Portal HT
IT

Pre-hepatic cause (20%)
- Thrombophlebitis of umbilical v.
- Congenital absence of PV
- Malignant invasion of PV (PV thrombosis usu by CA head of pancreas; HCC usu causes ipsilateral PV thrombosis, not usu causing main trunk thrombosis)

Intrahepatic cause (80%)
- Cirrhosis
- Drug
- Chronic hepatitis (8% HBV carrier in HK now)
- Cardiac cirrhosis
- Congenital hepatic fibrosis

Post-hepatic cause
- Budd-Chiari syndrome (affect the main hepatic v.?)
- Constrictive pericarditis

11

Spread of HCC
IT

Local invasion
- PV
- Hepatic v.
- Bile duct

Lymphatic spread (25% of patients)

Transperitoneal spread (Rare)

Hematogenous spread
- Lung, Bone

12

Presentation of HCC
IT

1. Subclinical (50% cases are asymptomatic)
2. Vague epigastric distension
3. Sharp pain due to bleeding
4. Abd mass
5. Abd distension due to ascites
6. Secondaries in Lung, Bone
7. Paraneoplastic syndrome
- Diarrhea, hypo/hyperglycemia, hyperCa, polycythemia (tumor produces EPO)
8. LOW
9. GIB

13

Indication of partial hepatectomy for HCC
IT

1. Uni-lobar involvement
2. No invasion into IVC or PV (actually in QM also do invasion to PV)
3. Acceptable liver fx for major hepatectomy
- Child A
- ICG retention 15 min <14%

14

Indication of liver transplant for HCC
IT

1. HCC <5cm single (or HCC <3cm up to 3 nodules)
2. Child C

15

Indication of TACE for HCC
IT

1. Bi-lobe involvement, no distant spread / complete PV obs / IVC involvement
2. Uni-lobar involvement but liver fx not acceptable for hepatectomy

16

Indication for RFA for HCC
IT

1. HCC <5cm
2. Satisfactory liver fx reserve
3. Laparoscopic or open approach for HCC near to viscera

17

Etiology of HCC
IT

- Hep B (80% of HCC in HK)
- Hep C (in Japan)
- Cirrhosis
- Aflatoxin (in 1960s Africa when food not well preserved)

18

Milan criteria

1 lesion <5 cm
Up to 3 lesions, each <3 cm
No extrahepatic manifestations
No evidence of gross vascular invasion