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ABSITE > Liver & Biliary > Flashcards

Liver & Biliary Flashcards

1
Q

Most common morphology of hilar cholangiocarcinoma

A

Sclerosing/periductal infiltrating

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2
Q

Morphology associated with most favorable prognosis in hilar cholangiocarcinoma

A

Papillary

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3
Q

Which liver resections are favorable for laparoscopic approach

A

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

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4
Q

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

A

Fibrolamellar HCC

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5
Q

Management of incidentally discovered gallbladder cancer invading the lamina propria

A

T1a - cholecystectomy only

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6
Q

Management of incidentally discovered gallbladder cancer invading muscularis layer

A

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

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7
Q

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

A

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

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8
Q

Management of incidentally discovered gallbladder cancer with nodal/distant mets

A

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

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9
Q

Technique of open CBD exploration

A

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

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10
Q

Type 1 choledochal cyst

A

Fusiform dilation of CBD

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11
Q

Management of type 1 choledochal cyst

A

Excision of cyst +/- RNY hepaticojejunostomy

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12
Q

Type II choledochal cyst

A

Extrahepatic diverticulum

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13
Q

Management of type II choledochal cyst

A

Simple cyst excision

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14
Q

Type III choledochal cyst

A

Choledochocele (at ampulla)

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15
Q

Management of type III choledochal cyst

A

Endoscopic drainage or removal

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16
Q

Type IVa choledochal cyst

A

Intrahepatic and extrahepatic cysts

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17
Q

Management of type IVa choledochal cyst

A

Partial hepatectomy and RNY hepaticojejunostomy

18
Q

Type IVb choledochal cyst

A

Multiple extrahepatic cysts

19
Q

Management of type IVb choledochal cyst

A

Excision of cysts +/- RNY hepaticojejunostomy

20
Q

Type V choledochal cysts

A

Caroli disease; multiple intrahepatic cysts

21
Q

Management of type V choledochal cysts

A

Liver transplant

22
Q

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

A

Hemangioma

23
Q

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

A

Hepatic adenoma

24
Q

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

A

Hepatic adenoma

25
Q

Primary common duct stones

A

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

26
Q

Secondary common duct stones

A

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

27
Q

Gallbladder cholesterol polyp: appearance and malignancy potential

A

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

28
Q

Adenomyomatosis of gallbladder

A

Diffuse thickening with mucosal projections. Minimal/low malignant potential

29
Q

Inflammatory polyp of gallbladder

A

Sessile or pedunculated; no malignant potential

30
Q

Right hepatectomy - which segments?

A

5-8

31
Q

Right extended hemihepatectomy - which segments?

A

4-8

32
Q

Left hepatectomy - which segments?

A

2-4

33
Q

Extended left hemihepatectomy - which segments?

A

2-5 and 8

34
Q

Rigler triad

A

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

35
Q

Number of lymph nodes needed in gall bladder cancer for staging

A

At least 6

36
Q

Right and left liver are separated anatomically by?

A

IVC and gallbladder

37
Q

Risk of malignancy with hepatic adenoma

A

5%

38
Q

Most common cause of benign biliary stricture

A

Previous surgery

39
Q

Where are majority of conjugated bile acids absorbed

A

Terminal ileum by active transport

40
Q

Usual location of cystic artery

A

Posterior to hepatic duct

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