HPB Flashcards

1
Q

mother pancreatic lesion

A

mucinous cystic neoplasm (middle aged F)

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2
Q

elevated marker in mucinous cystic neoplasm

A

CEA (ovarian stroma)

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3
Q

most common location mucinous cystic neoplasm

A

tail

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4
Q

grandmother pancreatic lesion

A

serous cystadenoma

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5
Q

NCCN resectability of panc adenoca

A
  • no arterial contact

- SMV/PV <180 without vein deformity

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6
Q

NCCN borderline resectability of panc adenoca

A
  • SMA <180
  • HA <180 or variant anatomy
  • tail tumor <180 contact with celiac axis + intact GDA
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7
Q

NCCN unresectable panc adenoca

A
  • SMA >180
  • celiac axis >180
  • unreconstructable SMV/PV
  • distant mets
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8
Q

most common pancreatic adenoca mets

A

liver

peritoneum

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9
Q

5 yr risk cancer in main duct IPMN

A

50-70%

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10
Q

1 primary hepatic malignancy

A

HCC

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11
Q

2 most common benign hepatic tumor

A

FNH

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12
Q

1 most common benign hepatic tumor

A

cavernous hemangioma

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13
Q

subtypes of hepatocellular adenomas

A
  1. hepatocyte nuclear factor 1a inactivated (30-40%)
  2. inflammatory (40-50%)
  3. beta-catenin activated (10-15%)
  4. unclassified (10-25%)
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14
Q

subtype hepatic adenoma with highest malignant transformation

A

beta catenin activated

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15
Q

difference between FNH & adenoma on hepatobiliary phase

A

FNH iso or hyper

adenoma hypo

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16
Q

genetic association with hepatic angiomyolipoma

A

tuberous sclerosis

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17
Q

most common functioning pNET

A

insulinoma (whipples triad)

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18
Q

Todani classification of bile duct cysts

A

I: fusiform dilation of EHD
II: true diverticulum of supraduodenal EHD
III: choledochocele (focally dilated intraduodenal segment of EHD within duodenal wall)
IV: intra and extrahepatic cystic dilations
V: Caroli dz, intrahepatic cystic dilation 2/2 AR in-utero malformation of ductal plate, central dot sign

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19
Q

Mirizzi syndrome

A

CHD and IHD dilation 2/2 extrinsic compression from stone in GB neck or cystic duct
predisposed by:
- long cystic duct running parallel to CHD
- low insertion of cystic duct into CBD

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20
Q

Bouveret syndrome

A

gastric outlet obstruction 2/2 to impaction of a gallstone in the pylorus or proximal duodenum

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21
Q

biliary-enteric fistulas causes & results in

A

causes:

  • chronic cholecystitis
  • duodenal ulcer
  • tumor
  • trauma

results in: Bouveret syndrome, gallstone ileus

22
Q

Rigler triad

A
  • pneumobilia
  • SBO
  • ectopic calcified gallstone (usu in the right iliac fossa)

seen in gallstone ileus

23
Q

adenomyomatosis pathology

A
  • idiopathic, nonneoplastic, noninflammatory GB wall thickening
  • epithelial hyperplasia with mucosal invagination into smooth muscle layer
  • bile or cholesterol crystals deposit in Rokitansky-Aschoff sinuses
  • thickening = focal, segmental, diffuse
24
Q

adenomyomatosis imaging

A

thickening = focal, segmental, diffuse
- segmental form: annular thickening -> strictures (“hourglass” appearance in GB mid body)
US: echogenic foci with comet tail (reverberation of US pulse within cholesterol crystals)
MRI: cystic spaces (=R-A sinuses) with curvilinear arrangement; string of beads

25
GB polyps - types
- cholesterol (>50%) - adenoma (30%): premalignant - inflammatory (10%) - malignant (5%): adenoca (90%), other (mets, SCC, angiosarcoma)
26
GB polyps - management
≤6 mm: no f/u 7-9 mm: yearly f/u w US to ensure no growth ≥10 mm: surgical consultation for cholecystectomy (greater chance of premalignant adenoma) - if no cholecystectomy, annual f/u ACR 2013
27
primary sclerosing cholangitis - imaging
multifocal regions of segmental intra- & extrahepatic biliary ductal dilation and stricturing - active inflammation: abN thickening, hyperenhancement of bile duct walls - clue on MRCP: greater than expected number of peripheral ducts - string of beads, withered tree
28
primary sclerosing cholangitis - complications
cholangiocarcinoma (NOT HCC) biliary cirrhosis: “central regenerative hypertrophy” colorectal carcinoma (if assoc w IBD)
29
recurrent pyogenic cholangitis
formation of pigment stones throughout biliary tree - resultant biliary strictures, repeated bouts of cholangitis - 2/2 Clonorchiasis (liver fluke), Ascaris infxn dilated IHD/EHD full of T1 bright pigmented stones localized IHD dilation MC affects left hepatic lobe
30
Von Meyenberg complexes
benign biliary hamartomas failure of involution of embryonic bile ducts 1-5mm cystic masses, no communic w biliary tree US: echogenic +/- comet tail artifact likely dx if innumerable small, slightly complex "cysts" in healthy pt
31
HIV cholangiopathy
biliary inflam'n caused by AIDS-related opportunistic infxns - CMV, cryptosporidium presumptive diagnosis in advanced AIDS (CD4 <100)
32
HIV cholangiopathy - imaging
multiple intrahepatic strictures (identical to PSC) papillary stenosis GB wall thickening
33
biliary ischemia
complication of hepatic artery stenosis/thrombosis - sole vascular supply to biliary system - assoc w biliary necrosis & abscess formation high mortality rates if retransplantation or thrombectomy/thrombolysis not immediately performed critical to recognize
34
peribiliary cyst
thin walled cysts of serous glands adj to IHD - no communication with biliary tree benign; do not mistaken for dilated bile ducts assoc w chronic liver dz, cirrhosis, ADPCKD
35
hepatic mucinous cystic neoplasm
formerly biliary cystadenoma/carcinoma - now non-invasive or invasive hepatic MCN well-defined uni or multiloculated cystic mass in liver with septations, papillary projections, mural calcifications no communication with biliary tree
36
cholangiocarcinoma - risk factors
primary sclerosing cholangitis recurrent pyogenic cholangitis Clonorchiasis (liver fluke) choledochal cyst
37
cholangiocarcinoma - locations
hilar (Klatskin) - confluence of hepatic ducts intrahepatic/peripheral (least common) - capsular retraction distal (extrahepatic; distal CBD) - “sclerosing”: stricture, ill-defined, desmoplastic - “papillary”: intraductal, polypoid mass
38
emphysematous cholecystitis - demographics
50-70 yo diabetics
39
emphysematous cholecystitis - bugs
Clostridium welchii / perfringens E. coli Bacteroides fragilis
40
Milan criteria liver transplant HCC
One HCC <5 cm or 3 HCC all <3 cm without tumor in vein or evidence of mets elsewhere
41
criteria to use LiRADS
- prior bx proven HCC - cirrhosis - chronic hep B
42
which cystic pancreatic lesions need surgical mgmt
- mucinous cystic neoplasm | - main duct IPMN
43
hemochromatosis patterns
Primary: liver, Pancreas, Myocardium, thyroid Secondary: liver, Spleen, bone marrow
44
cholangiocarcinoma risk in choledochal cyst/caroli disease
< 10%
45
types of castleman's disease
1. unicentric (hyaline vascular --> plasmacytic) 2. HHV8 associated (hypervascular --> plasmacytic) 2. HHV8 -ve/idiopathic (" ")
46
medication given during ERCP to see pancreatic ducts
secretin
47
syndromes associated w/ PNET
MEN1 VHL TS NFI
48
enhancement pattern peliosis hepatis
central to peripheral
49
infectious causes of peliosis
bartonella
50
most common cause graft failure post liver transplant
rejection
51
most common vascular complication liver transplant
hepatic artery stenosis or thrombosis