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SURGERY > LIVER, GALLBLADDER AND PANCREAS > Flashcards

LIVER, GALLBLADDER AND PANCREAS Flashcards

(84 cards)

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1
Q

Separates the true left and right lobes of the liver

A

Cantlie’s line

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2
Q

What separates the left lateral and left medial segments of the liver? This also anchors liver to the anterior abdominal wall

A

Falciform ligament

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3
Q

This ligament anatomically divides this liver to small left lobe and small right lobe (not true division)

A

Falciform ligamenet

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4
Q

Mickey mouse sign

A

Porta hepatis

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5
Q

What composes the porta hepatis?

A

Common bile duct
Hepatic artery
Portal vein

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6
Q

Divides the left lobe into left lateral and left medial sector

A

Left portal incisure

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7
Q

This is dorsal to the hepatoduodenal ligament

A

Epiploic foramen of winslow

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8
Q

Segment 1 of Liver

A

Caudate or Spigelian lobe

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9
Q

Segment 2 and 3

A

Left lateral segment

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10
Q

Segment 4

A

Left medial segment

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11
Q

Segment 5 and 8

A

Right anterior segment

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12
Q

Segment 6 and 7

A

Right posterior lobe

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13
Q

Blood supply of the liver

A

Portal vein (75%)
Hepatic artery (25%)

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14
Q

This maneuvers compresses the hepatoduodenal ligament to lessen the blood supply the liver

A

Pringle’s maneuver

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15
Q

What encompasses the hepatoduodenal ligament?

A

Portal vein
Hepatic artery
Common bile duct

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16
Q

ThiS measures liver SYNTHETIC functions

A

Albumin
Clotting factors (except factor 8)
Prothrombin time
INR

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17
Q

When will jaundice be detectable?

A

If serum bilirubin is more that 2.5 to 3 mg/dL

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18
Q

2 requirements for diagnosis of cirrhosis

A

Presence of fibrous tissue
Presence of regenerating nodules

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19
Q

First line of antibiotics for spontaneous bacterial peritonitis

A

Cefotaxime

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20
Q

Normal portal pressure

A

5-10 mmhg

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21
Q

Portal HPN

A

> 5mmhg of IV pressure
15mmhg splenic pressure

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22
Q

How much pressure is necesary for varices to form and bleed?

A

> 12mmhg

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23
Q

Most accurate method of determining portal hpn

A

Hepatic venography

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24
Q

Most significant manifestation of portal hypertension and leading cause of morbidity and mortality

A

Esophageal varices

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25
This is given to reduce index bleed of esophageal varices and reduces moratlity by 50%
Beta blockers eg. Propranolol
26
Current Preferred drug for acute variceal bleeding
Octreotide
27
This procedure is reserved for recurrent variceal bleeding despite endoscopic and medical treatment who are not candidate for TIPS and have vasculature unsuitable for shunt operations
Sugiura-Fukugawa procedure
28
Most definitive form of therapy for complications of portal hypertension
orthotopic liver transplantation
29
Most common route of infection leading to pyogenic liver absces
Ascending route via biliary tree or portal vein
30
More frequent lobe that is affected by pyogenic liver abscess
Right lobe
31
Most common organism causing pyogenic liver abscess
E. Coli
32
Causative agent for amoebic liver abscess
Entamoeba histolytics
33
Most common form of liver abscess worldwide
Amoebic Liver abscess
34
Pathognomonic finding of amoebic liver abscess
Anchovy like paste (reddish brown pus like material) due to necrotic central portion
35
This should be requested to differentiate pyogenic liver abscess vs amoebic liver abscess
Fluorescent antibody test: amoebic liver abscess is positive
36
This is the organism that is responsible for hydatid dse
Echinococcus granulosus
37
MOT of echinococcus granulosus
Ingestion of ova containing feces of dogs
38
UTZ/CT Scan characteristic appearance of hydatid dse
Well defined hypodense lesions Ring like microcalcifications
39
Absolute contraindications for liver biopsy
Significant coagulopathy Biliary dilatation Suspicion for hemangioma or echinococcal cyst
40
Relative contraindications for liver biopsy
Obesity Presence of ascites
41
Most common benign solid mass in liver
Hemangioma
42
Risk factor for adenoma in liver
Current use of estrogens
43
Most common malignant liver tumor
Liver metastasis
44
Liver metastasis usually arises from?
Colonic carcinoma
45
Primary tumor of hepatocyte
Hepatocellular carcinoma
46
Primary tumor of bile ducts
Cholangiocarcinoma
47
Aids in diagnosing Hepatocellular Carcinoma
CT Scan/MRI AFP
48
Tumor marker for HCC
AFP
49
Drug of choice for HCC patient that is non surgical candidate
Sorafenib
50
Characteristic Dual Phase CT sign of Hemangioma
Cetnripetal enhancement followed by decrease in dye over 10 minutes from without to within
51
Histologic feature of gallbladder
No submucosa and muscularis mucusa
52
Blood supply of gall bladder is
Cystic artery from right epigastric artery
53
Borders of triangle of callot
Cystic duct Common hepatic duct Cystic artery
54
Blood supply of bile duct
Gastroduodenal artery Right hepatic artery
55
What is the basal pressure of sphincter of oddi
13 mmhg above duodenal pressure
56
Acute cholecystitis on ultrasound
Gallbladder thickening Pericholecystic fluid Sonographic murphy sign
57
Type of stone that is associated with hemolytic disorder and cirrhosis
Black pigment stone
58
Black pigment stone is due to super saturation of?
Calcium bilirubinate Carbonate Phosphate
59
This gallstones are soft and mushy which may form either from the gallbladder or the bile ducts. Associated with bacterial infections of bile stasis
Brown pigment stones
60
Most common presentation of gallstone disease characterized by recurrent biliary colic due to partial obstruction of the cystic duct
Chronic cholecystitis
61
Most common indication for cholecystectomy
Recurrent episodes of biliary colic
62
Critical view of safety
Triangle of calot must be free of fat w/o exposing the bile duct The base of GB must be dissected off the liver bed CYSTIC DUCT AND CYSTIC ARTERY must be seen circumferentially
63
Diagnostic test of choice for acute cholecystitis
Ultrasound
64
HIDA Scan result if (+) acute cholecystitis
Failure of gallbladder to be filled within 60 minutes after administration of tracer
65
Initial test for choledocholithiasis
Abdominal utz
66
Dilated CBD is
> 8mm
67
Gold standard for dx of choledocholithiasis
ERCP
68
Common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or hartmann's pouch of gallbladder
Mirrizzi syndrome
69
Rigler's triad in gallstone ileus radiographic finding
Pneumobilia Ectopic gallstone Small bowel obstruction
70
Charcot's triad
RUQ pain Fever Jaundice
71
Reynold's pentad
Fever RUQ pain Jaundice Septic shock Mental status change
72
Initial management for grade I acute cholangitis
Medical: antibiotics
73
Pathognomonic sign seen in ERCP of choledochal cysts
Long common channel
74
Triad of choledochal cysts
Abdominal pain Jaundice Mass
75
ERCP/PTC findings in sclerosing cholangitis
(+) multiple dilatation and strictures or beading pattern
76
Most common congenital anomaly of the pancreas
Pancreas divisum
77
Arterial supply of the pancreas
Splenic artery from the celiac trunk Superior pancreaticoduodenal from gastroduodenal artery Inferior pancreaticoduodenal artery from superior mesenteric artery Dorsal, great and caudal pancreatic arteries
78
Diagnostic gold standard for pancreatitis
Abdominal CT Scan
79
Pathognomonic of pancreatic infection in abdominal CT Scan
Abnormal extraluminal gas bubbles
80
Most important causes of pseudocyst of the pancreas
Pancreatitis (75%) Trauma (25%)
81
Most common islet tumor
Insulinoma
82
Whipple's triad
Symptomatic fasting hypoglycemia Serum glucose <50mg/dL relief of symptoms w/ glucose administration
83
Treatment of insulinoma
Simple enucleation EXCEPT if close to main pancreatic duct and >2cm
84
WDHA syndrome of VIPnoma
Watery diarrhea Hypokalemia Achlorydia

SURGERY (6 decks)

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