Liver & Biliary

Question 1

Most common morphology of hilar cholangiocarcinoma

Answer 1

Sclerosing/periductal infiltrating

Question 2

Morphology associated with most favorable prognosis in hilar cholangiocarcinoma

Answer 2

Papillary

Question 3

Which liver resections are favorable for laparoscopic approach

Answer 3

Tumors <5cm, segments 2, 3, 4, 5, or 6

Question 4

Well circumscribed hepatic mass with a central scar and elevated neurotensin level

Answer 4

Fibrolamellar HCC

Question 5

Management of incidentally discovered gallbladder cancer invading the lamina propria

Answer 5

T1a - cholecystectomy only

Question 6

Management of incidentally discovered gallbladder cancer invading muscularis layer

Answer 6

T1b - extended cholecystectomy (non-anatomic partial hepatectomy of liver parenchyma surrounding gallbladder fossa)

Question 7

Management of incidentally discovered gallbladder cancer spread to the serosa/connective tissue but no lymph nodes

Answer 7

T2/T3 - central hepatectomy with resection of segments IVB and V

Question 8

Management of incidentally discovered gallbladder cancer with nodal/distant mets

Answer 8

T3/T4 - neoadjuvant chemoradiation -> central hepatectomy if response

Question 9

Technique of open CBD exploration

Answer 9

Anterior longitudinal choledochotomy on the CBD, stone removal, then T-tube placed to prevent stricture

Question 10

Type 1 choledochal cyst

Answer 10

Fusiform dilation of CBD

Question 11

Management of type 1 choledochal cyst

Answer 11

Excision of cyst +/- RNY hepaticojejunostomy

Question 12

Type II choledochal cyst

Answer 12

Extrahepatic diverticulum

Question 13

Management of type II choledochal cyst

Answer 13

Simple cyst excision

Question 14

Type III choledochal cyst

Answer 14

Choledochocele (at ampulla)

Question 15

Management of type III choledochal cyst

Answer 15

Endoscopic drainage or removal

Question 16

Type IVa choledochal cyst

Answer 16

Intrahepatic and extrahepatic cysts

Question 17

Management of type IVa choledochal cyst

Answer 17

Partial hepatectomy and RNY hepaticojejunostomy

Question 18

Type IVb choledochal cyst

Answer 18

Multiple extrahepatic cysts

Question 19

Management of type IVb choledochal cyst

Answer 19

Excision of cysts +/- RNY hepaticojejunostomy

Question 20

Type V choledochal cysts

Answer 20

Caroli disease; multiple intrahepatic cysts

Question 21

Management of type V choledochal cysts

Answer 21

Liver transplant

Question 22

Liver lesion on CT: peripheral nodular enhancement, centripetal filling in portal-venous phase

Answer 22

Hemangioma

Question 23

Liver lesion on CT: well-circumscribed heterogenous mass with transient homogenous enhancement in arterial phase, returns to isodense in portal venous phase and delayed phase

Answer 23

Hepatic adenoma

Question 24

Liver lesion on MRI: hyperdense on T1-weighted images, early enhancement with gadolinium injection; lesion appears ‘cold’ on nuclear imaging

Answer 24

Hepatic adenoma

Question 25

Primary common duct stones

Answer 25

Originate in CBD, made up of calcium bilirubinate and cholesterol; associated with infection

Question 26

Secondary common duct stones

Answer 26

Originate in gallbladder, made up of cholesterol/calcium (cholesterol stones), or calcium bilirubinate (black stones); associated with hemolytic disorders

Question 27

Gallbladder cholesterol polyp: appearance and malignancy potential

Answer 27

Multiple, homogenous, pedunculated, typically <1cm. No malignant potential

Question 28

Adenomyomatosis of gallbladder

Answer 28

Diffuse thickening with mucosal projections. Minimal/low malignant potential

Question 29

Inflammatory polyp of gallbladder

Answer 29

Sessile or pedunculated; no malignant potential

Question 30

Right hepatectomy - which segments?

Answer 30

5-8

Question 31

Right extended hemihepatectomy - which segments?

Answer 31

4-8

Question 32

Left hepatectomy - which segments?

Answer 32

2-4

Question 33

Extended left hemihepatectomy - which segments?

Answer 33

2-5 and 8

Question 34

Rigler triad

Answer 34

Pneumobiliar, SBO, and ectopic gallstone - seen in gallstone ileus

Question 35

Number of lymph nodes needed in gall bladder cancer for staging

Answer 35

At least 6

Question 36

Right and left liver are separated anatomically by?

Answer 36

IVC and gallbladder

Question 37

Risk of malignancy with hepatic adenoma

Answer 37

5%

Question 38

Most common cause of benign biliary stricture

Answer 38

Previous surgery

Question 39

Where are majority of conjugated bile acids absorbed

Answer 39

Terminal ileum by active transport

Question 40

Usual location of cystic artery

Answer 40

Posterior to hepatic duct